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Rush B, Ziegler J, Dyck S, Dhaliwal S, Mooney O, Lother S, Celi LA, Mendelson AA. Disparities in access to and timing of interventional therapies for pulmonary embolism across the United States. J Thromb Haemost 2024:S1538-7836(24)00171-5. [PMID: 38554934 DOI: 10.1016/j.jtha.2024.03.013] [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: 10/17/2023] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Interventional therapies (ITs) are an emerging treatment modality for pulmonary embolism (PE); however, the degree of racial, sex-based, and sociodemographic disparities in access and timing is unknown. OBJECTIVES To investigate barriers to access and timing of ITs for PE across the United States. METHODS A retrospective cohort study utilizing the Nationwide Inpatient Sample from 2016-2020 included adult patients with PE. The use of ITs (mechanical thrombectomy and catheter-directed thrombolysis) was identified via International Classification of Diseases 10th revision codes. Early IT was defined as procedure performed within the first 2 days after admission. RESULTS A total of 27 805 273 records from the 2016-2020 Nationwide Inpatient Sample database were examined. There were 387 514 (1.4%) patients with PE, with 14 249 (3.6%) of them having undergone IT procedures (11 115 catheter-directed thrombolysis, 2314 thrombectomy, and 780 both procedures). After multivariate adjustment, factors associated with less use of IT included Black race (odds ratio [OR], 0.90; 95% CI, 0.86-0.94; P < .01), Hispanic race (OR, 0.73; 95% CI, 0.68-0.79; P < .01), female sex (OR, 0.88; 95% CI, 0.85-0.91; P < .01), treatment in a rural hospital (OR, 0.49; 95% CI, 0.44-0.54; P < .01), and lack of private insurance (Medicare OR, 0.77; 95% CI, 0.73-0.80; P < .01; Medicaid OR, 0.65; 95% CI, 0.61-0.69; P < .01; no coverage OR, 0.87; 95% CI, 0.82-0.93; P < .01). Among the patients who received IT, 11 315 (79%) procedures were conducted within 2 days of admission and 2934 (21%) were delayed. Factors associated with delayed procedures included Black race (OR, 1.12; 95% CI, 1.01-1.26; P = .04), Hispanic race (OR, 1.52; 95% CI, 1.28-1.80; P < .01), weekend admission (OR, 1.37; 95% CI, 1.25-1.51; P < .01), Medicare coverage (OR, 1.24; 95% CI, 1.10-1.40; P < .01), and Medicaid coverage (OR, 1.29; 95% CI, 1.12-1.49; P < .01). CONCLUSION Significant racial, sex-based, and geographic barriers exist in overall access to IT for PE in the United States.
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Affiliation(s)
- Barret Rush
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Jennifer Ziegler
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephanie Dyck
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Surinder Dhaliwal
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Owen Mooney
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sylvain Lother
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leo Anthony Celi
- Harvard Medical School, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Asher A Mendelson
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Rush B, Zeigler J, Cheng MP, Hrymak C, Lother S. Outcomes with severe pulmonary coccidioidomycosis and respiratory failure in the United States. Journal of the Association of Medical Microbiology and Infectious Disease Canada 2023; 8:40-48. [PMID: 37008578 PMCID: PMC10052912 DOI: 10.3138/jammi-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/15/2022] [Accepted: 10/21/2022] [Indexed: 01/12/2023]
Abstract
Background: Coccidioidomycosis is a fungal infection with presentations ranging from asymptomatic illness to severe pneumonia and respiratory failure. The outcomes of patients with severe pulmonary coccidioidomycosis requiring mechanical ventilation (MV) are not well understood. Methods: We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample (NIS) from 2006 to 2017. Patients >18 years of age with a diagnosis of pulmonary coccidioidomycosis were included in the cohort. Results: A total of 11,045 patients were hospitalized with a diagnosis of pulmonary coccidioidomycosis during the study period. Of these, 826 (7.5%) patients required MV during their hospitalization with a mortality rate of 33.5% compared to 1.3% ( p < 0.01) for patients not requiring MV. Results of the multivariable logistic regression model show that risk factors for MV included the history of neurological disorders and paralysis (OR 3.38, 95% CI 2.70 to 4.20, p < 0.01; OR 3.13, 95% CI 1.91 to 5.15, p < 0.01, respectively) and HIV (OR 1.63, 95% 1.10 to 2.43, p < 0.01). Risk factors for mortality among patients requiring MV included older age (OR 1.24 per 10-year increase, 95% CI 1.08 to 1.42, p < 0.01), coagulopathy (OR 1.61, 95% CI 1.09 to 2.38, p = 0.01) and HIV (OR 2.83; 95% CI 1.32 to 6.10; p < 0.01). Conclusions: Approximately 7.5% of patients admitted with coccidioidomycosis in the United States require MV, and MV is associated with high mortality (33.5%).
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Affiliation(s)
- Barret Rush
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer Zeigler
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew P Cheng
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sylvain Lother
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Gottlieb ER, Ziegler J, Rush B. Ensuring Progress Toward Racial Equity in Pulse Oximetry-Reply. JAMA Intern Med 2022; 182:1329-1330. [PMID: 36342690 DOI: 10.1001/jamainternmed.2022.4857] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eric Raphael Gottlieb
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge
| | - Jennifer Ziegler
- Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Barret Rush
- Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Cheng MP, Paquette K, Lawandi A, Stabler SN, Akhter M, Davidson AC, Gavric M, Jinah R, Saeed Z, Demir K, Sangsari S, Huang K, Mahpour A, Shamatutu C, Caya C, Troquet JM, Clark G, Rush B, Wong T, Stenstrom R, Sweet D, Yansouni CP. qSOFA does not predict bacteremia in patients with severe manifestations of sepsis. J Assoc Med Microbiol Infect Dis Can 2022; 7:364-368. [PMID: 37397823 PMCID: PMC10312224 DOI: 10.3138/jammi-2022-0006] [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] [Received: 07/04/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 07/04/2023]
Abstract
BACKGROUND Bloodstream infections in septic patients may be missed due to preceding antibiotic therapy prior to obtaining blood cultures. We leveraged the FABLED cohort study to determine if the quick Sequential Organ Failure Assessment (qSOFA) score could reliably identify patients at higher risk of bacteremia in patients who may have false negative blood cultures due to previously administered antibiotic therapy. METHODS We conducted a multi-centre diagnostic study among adult patients with severe manifestations of sepsis. Patients were enrolled in one of seven participating centres between November 2013 and September 2018. All patients from the FABLED cohort had two sets of blood cultures drawn prior to the administration of antimicrobial therapy, as well as additional blood cultures within 4 hours of treatment initiation. Participants were categorized according to qSOFA score, with a score ≥2 being considered positive. RESULTS Among 325 patients with severe manifestations of sepsis, a positive qSOFA score (defined as a score ≥2) on admission was 58% sensitive (95% CI 48% to 67%) and 41% specific (95% CI 34% to 48%) for predicting bacteremia. Among patients with negative post-antimicrobial blood cultures, a positive qSOFA score was 57% sensitive (95% CI 42% to 70%) and 42% specific (95% CI 35% to 49%) to detect patients who were originally bacteremic prior to the initiation of therapy. CONCLUSIONS Our results suggest that the qSOFA score cannot be used to identify patients at risk for occult bacteremia due to the administration of antibiotics pre-blood culture.
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Affiliation(s)
- Matthew P Cheng
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- McGill Interdisciplinary Initiative in Infection and Immunity, McGill University Health Centre, Montreal, Quebec, Canada
| | - Katryn Paquette
- Division of Neonatology, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada
| | - Alexander Lawandi
- Critical Care Department, National Institutes of Health Clinical Center, Bethesda, Maryland, United States
| | - Sarah N Stabler
- Department of Pharmacy Services, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - Murtaza Akhter
- Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, Arizona, United States
| | - Adam C Davidson
- Department of Emergency Medicine, Lion’s Gate Hospital, North Vancouver, British Columbia, Canada
| | - Marko Gavric
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rehman Jinah
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zahid Saeed
- Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, Arizona, United States
| | - Koray Demir
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Sassan Sangsari
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Huang
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amirali Mahpour
- Division of Respirology, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Chris Shamatutu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chelsea Caya
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jean-Marc Troquet
- Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Greg Clark
- Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Barret Rush
- Division of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Titus Wong
- Department of Medical Microbiology, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Robert Stenstrom
- Department of Emergency Medicine, St-Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Sweet
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cedric P Yansouni
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- McGill Interdisciplinary Initiative in Infection and Immunity, McGill University Health Centre, Montreal, Quebec, Canada
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Gottlieb ER, Ziegler J, Morley K, Rush B, Celi LA. Assessment of Racial and Ethnic Differences in Oxygen Supplementation Among Patients in the Intensive Care Unit. JAMA Intern Med 2022; 182:849-858. [PMID: 35816344 PMCID: PMC9274443 DOI: 10.1001/jamainternmed.2022.2587] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [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: 01/11/2023]
Abstract
IMPORTANCE Pulse oximetry (SpO2) is routinely used for transcutaneous monitoring of blood oxygenation, but it can overestimate actual oxygenation. This is more common in patients of racial and ethnic minority groups. The extent to which these discrepancies are associated with variations in treatment is not known. OBJECTIVE To determine if there are racial and ethnic disparities in supplemental oxygen administration associated with inconsistent pulse oximeter performance. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was based on the Medical Information Mart for Intensive Care (MIMIC)-IV critical care data set. Included patients were documented with a race and ethnicity as Asian, Black, Hispanic, or White and were admitted to the intensive care unit (ICU) for at least 12 hours before needing advanced respiratory support, if any. Oxygenation levels and nasal cannula flow rates for up to 5 days from ICU admission or until the time of intubation, noninvasive positive pressure ventilation, high-flow nasal cannula, or tracheostomy were analyzed. MAIN OUTCOMES AND MEASURES The primary outcome was time-weighted average supplemental oxygen rate. Covariates included race and ethnicity, sex, SpO2-hemoglobin oxygen saturation discrepancy, data duration, number and timing of blood gas tests on ICU days 1 to 3, partial pressure of carbon dioxide, hemoglobin level, average respiratory rate, Elixhauser comorbidity scores, and need for vasopressors or inotropes. RESULTS This cohort included 3069 patients (mean [SD] age, 66.9 [13.5] years; 83 were Asian, 207 were Black, 112 were Hispanic, 2667 were White). In a multivariable linear regression, Asian (coefficient, 0.602; 95% CI, 0.263 to 0.941; P = .001), Black (coefficient, 0.919; 95% CI, 0.698 to 1.140; P < .001), and Hispanic (coefficient, 0.622; 95% CI, 0.329 to 0.915; P < .001) race and ethnicity were all associated with a higher SpO2 for a given hemoglobin oxygen saturation. Asian (coefficient, -0.291; 95% CI, -0.546 to -0.035; P = .03), Black (coefficient, -0.294; 95% CI, -0.460 to -0.128; P = .001), and Hispanic (coefficient, -0.242; 95% CI, -0.463 to -0.020; P = .03) race and ethnicity were associated with lower average oxygen delivery rates. When controlling for the discrepancy between average SpO2 and average hemoglobin oxygen saturation, race and ethnicity were not associated with oxygen delivery rate. This discrepancy mediated the effect of race and ethnicity (-0.157; 95% CI, -0.250 to -0.057; P = .002). CONCLUSIONS AND RELEVANCE In this cohort study, Asian, Black, and Hispanic patients received less supplemental oxygen than White patients, and this was associated with differences in pulse oximeter performance, which may contribute to known race and ethnicity-based disparities in care.
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Affiliation(s)
- Eric Raphael Gottlieb
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge
| | - Jennifer Ziegler
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Katharine Morley
- Harvard Medical School, Boston, Massachusetts.,Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Barret Rush
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leo Anthony Celi
- Harvard Medical School, Boston, Massachusetts.,Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Sohani ZN, Butler-Laporte G, Aw A, Belga S, Benedetti A, Carignan A, Cheng MP, Coburn B, Costiniuk CT, Ezer N, Gregson D, Johnson A, Khwaja K, Lawandi A, Leung V, Lother S, MacFadden D, McGuinty M, Parkes L, Qureshi S, Roy V, Rush B, Schwartz I, So M, Somayaji R, Tan D, Trinh E, Lee TC, McDonald EG. Low-dose trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia (LOW-TMP): protocol for a phase III randomised, placebo-controlled, dose-comparison trial. BMJ Open 2022; 12:e053039. [PMID: 35863836 PMCID: PMC9310160 DOI: 10.1136/bmjopen-2021-053039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection of immunocompromised hosts with significant morbidity and mortality. The current standard of care, trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 15-20 mg/kg/day, is associated with serious adverse drug events (ADE) in 20%-60% of patients. ADEs include hypersensitivity reactions, drug-induced liver injury, cytopenias and renal failure, all of which can be treatment limiting. In a recent meta-analysis of observational studies, reduced dose TMP-SMX for the treatment of PJP was associated with fewer ADEs, without increased mortality. METHODS AND ANALYSIS A phase III randomised, placebo-controlled, trial to directly compare the efficacy and safety of low-dose TMP-SMX (10 mg/kg/day of TMP) with the standard of care (15 mg/kg/day of TMP) among patients with PJP, for a composite primary outcome of change of treatment, new mechanical ventilation, or death. The trial will be undertaken at 16 Canadian hospitals. Data will be analysed as intention to treat. Primary and secondary outcomes will be compared using logistic regression adjusting for stratification and presented with 95% CI. ETHICS AND DISSEMINATION This study has been conditionally approved by the McGill University Health Centre; Ethics approval will be obtained from all participating centres. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04851015.
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Affiliation(s)
- Zahra N Sohani
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Guillaume Butler-Laporte
- Department of Epidemiology, Occupational Health, and Biostatistics, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew Aw
- Division of Hematology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sara Belga
- Division of Infectious Diseases, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Benedetti
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Occupational Health, and Biostatistics, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Alex Carignan
- Division of Microbiology and Infectious Diseases, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Matthew P Cheng
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bryan Coburn
- Division of Infectious Diseases, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Cecilia T Costiniuk
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Nicole Ezer
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Respirology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan Gregson
- Departments of Pathology and Laboratory Medicine and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Johnson
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kosar Khwaja
- Department of Epidemiology, Occupational Health, and Biostatistics, McGill University, Montreal, Quebec, Canada
- Department of Critical Care Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alexander Lawandi
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Victor Leung
- Department of Laboratory Medicine & Pathology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sylvain Lother
- Department of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Derek MacFadden
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michaeline McGuinty
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Leighanne Parkes
- Division of Medical Microbiology and Infectious Diseases, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Salman Qureshi
- Department of Epidemiology, Occupational Health, and Biostatistics, McGill University, Montreal, Quebec, Canada
- Division of Respirology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Critical Care Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Valerie Roy
- Division of Microbiology and Infectious Diseases, Centre Hospitalier Universitaire de Sherbrooke Hôtel-Dieu, Sherbrooke, Quebec, Canada
| | - Barret Rush
- Department of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ilan Schwartz
- Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Miranda So
- Sinai Health System-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto, Ontario, Canada
| | - Ranjani Somayaji
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Darrell Tan
- Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada
| | - Emilie Trinh
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Clinical Practice Assessment Unit, Montreal, Quebec, Canada
| | - Emily G McDonald
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Clinical Practice Assessment Unit, Montreal, Quebec, Canada
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Brahmania M, Alotaibi A, Mooney O, Rush B. Treatment in disproportionately minority hospitals is associated with an increased mortality in end-stage liver disease. Eur J Gastroenterol Hepatol 2021; 33:1408-1413. [PMID: 32796359 DOI: 10.1097/meg.0000000000001860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/10/2022]
Abstract
BACKGROUND Racial and ethnic disparities are a barrier in delivery of healthcare across the USA. Care for minority patients tends to be clustered into a small number of providers at minority hospitals, which has been associated with worse clinical outcomes in several conditions. However, the outcomes of treatment in patients with end-stage liver disease (ESLD) at predominately minority hospitals are unknown. We investigated the burden of the problem. METHODS We utilized the nationwide in-patient sample (NIS) to conduct a retrospective nationwide cohort analysis. All patients >18 years of age admitted with ESLD were included in the analysis. A multivariate logistic regression model was used to study the mortality rate among patients with ESLD treated at minority hospitals compared to nonminority hospitals. RESULTS A total of 53 281 467 hospitalizations from the 2008 to 2014 NIS were analyzed. There were 163 470 patients with ESLD that met inclusion criteria. In-hospital mortality rates for all races were 8.0 and 8.1% in black and Hispanic minority hospitals, respectively, compared to 7.3% in nonminority hospitals (P < 0.01). On multivariate analysis, treatment of ESLD in black and Hispanic minority hospitals was associated with 11% [odds ratio (OR), 1.11; 95% confidence interval (CI), 1.03-1.20; P < 0.01] and 22% (OR, 1.22; 95% CI, 1.09-1.37; P < 0.01) increased odds of death, respectively, compared to treatment in nonminority hospitals regardless of patient's race. CONCLUSION Patients with ESLD treated at minority hospitals are faced with an increased mortality rate regardless of patient's race. This study highlights another quality gap that needs improvement to affect overall survival among patients with ESLD.
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Affiliation(s)
- Mayur Brahmania
- Department of Medicine, Division of Gastroenterology, Western University, London Health Sciences Center, London, Ontario, Canada
| | - Ammar Alotaibi
- Department of Medicine, Division of Gastroenterology, Western University, London Health Sciences Center, London, Ontario, Canada
- Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Owen Mooney
- Department of Medicine, Division of Critical Care, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Barret Rush
- Department of Medicine, Division of Critical Care, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
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Wong R, Lother S, Patel P, Rush B. MP29-11 NEPHROSTOMY TUBE VS. URETERAL STENT FOR OBSTRUCTING SEPTIC CALCULI: A NATIONWIDE PROPENSITY SCORE MATCHED ANALYSIS. J Urol 2021. [DOI: 10.1097/ju.0000000000002026.11] [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: 11/25/2022]
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Rush B, Lother S, Paunovic B, Mooney O, Kumar A. Outcomes With Severe Blastomycosis and Respiratory Failure in the United States. Clin Infect Dis 2021; 72:1603-1607. [PMID: 32227089 DOI: 10.1093/cid/ciaa294] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/20/2020] [Accepted: 03/18/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) are not well understood in the modern era. Limited historical case series reported 50-90% mortality in patients with acute respiratory distress syndrome caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis. METHODS We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample from 2006-2014. Patients aged >18 years with a diagnosis of blastomycosis who received MV were included. RESULTS There were 1848 patients with a diagnosis of blastomycosis included in the study. Of these, 219 (11.9%) underwent MV with a mortality rate of 39.7% compared with 2.5% in patients not requiring ventilatory support (P < .01). The median (IQR) time to death for patients requiring MV was 12 (8-16) days. The median length of hospital stay for survivors of MV was 22 (14-37) days. The rate of MV was higher for patients treated in teaching hospitals (63.4% vs 57.2%, P = .05) and lower for those receiving care at a rural hospital (12.3% vs 17.2%, P = .04). In a multivariate model, female gender was associated with increased risk of mortality (OR, 1.84; 95% CI, 1.06-3.20; P = .03) as was increasing patient age (10-year age increase OR, 1.64; 95% CI, 1.33-2.02; P < .01). CONCLUSIONS In the largest published cohort of patients with blastomycosis, mortality for patients on MV is high at ~40%, 16-fold higher than those without MV.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sylvain Lother
- Division of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bojan Paunovic
- Division of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Owen Mooney
- Division of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anand Kumar
- Division of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Brahmania M, Wiskar K, Walley KR, Celi LA, Rush B. Lower household income is associated with an increased risk of hospital readmission in patients with decompensated cirrhosis. J Gastroenterol Hepatol 2021; 36:1088-1094. [PMID: 32562577 PMCID: PMC8063220 DOI: 10.1111/jgh.15153] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM The impact of household income, a surrogate of socioeconomic status, on hospital readmission rates for patients with decompensated cirrhosis has not been well characterized. METHODS The Nationwide Readmission Database from 2012 to 2014 was used to study the association of lower median household income on 30-, 90-, and 180-day hospital readmission rates for patients with decompensated cirrhosis. RESULTS From the 42 679 001 hospital admissions contained in the sample, there were 82 598 patients with decompensated cirrhosis who survived a hospital admission in the first 6 months of the year. During a uniform 6-month follow-up period, 25 914 (31.4%), 39 928 (48.3%), and 47 496 (57.5%) patients were readmitted at 30, 90, and 180 days, respectively. After controlling for demographic and clinical confounders, patients residing in the three lowest income quartiles were significantly more likely to be readmitted at 30 days than those in the fourth quartile (first quartile, odds ratio [OR] 1.32 [95% confidence interval, CI, 1.17-1.47, P < 0.01]; second quartile, OR 1.25 [95% CI 1.13-1.38, P < 0.01]; and third quartile, OR 1.08 [95% CI 0.97-1.20, P = 0.07]). The association between lower socioeconomic status and the higher risk of readmissions persisted at 90 days (first quartile, OR 1.21 [95% CI 1.14-1.30, P < 0.01]) and 180 days (first quartile, OR 1.32 [95% CI 1.20-1.44, P < 0.01]). CONCLUSION Patients with decompensated cirrhosis residing in the lowest income quartile had a 32% higher odds of hospital readmissions at 30, 90, and 180 days compared with those in the highest income quartile.
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Affiliation(s)
- Mayur Brahmania
- Department of Medicine, Division of Gastroenterology, London Health Sciences Center, Western University, London, Ontario
| | - Katie Wiskar
- Department of Medicine, Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia
| | - Keith R Walley
- Department of Medicine, Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia,,Center for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia
| | - Leo A Celi
- Department of Medicine, Division of Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA
| | - Barret Rush
- Department of Internal Medicine, Division of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Levitt EE, Syan SK, Sousa S, Costello MJ, Rush B, Samokhvalov AV, McCabe RE, Kelly J, MacKillop J. Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation. Addict Behav 2021; 112:106649. [PMID: 32979691 DOI: 10.1016/j.addbeh.2020.106649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/28/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Substance use disorders (SUD) are frequently comorbid with other psychiatric conditions, but a comprehensive diagnostic assessment is often not feasible clinically. Efficient psychometrically-validated screening tools exist for commonly comorbid conditions, but cutoff accuracies have typically not been evaluated in addiction treatment settings. This study examined the performance of several widely-used screening measures in relation to diagnostic status from a clinical interview to identify and validate cutoff scores in an inpatient SUD treatment setting. METHOD Participants were 99 patients in a large residential SUD treatment program in Ontario, Canada. Participants completed a screening battery, including the Patient Health Questionnaire - 9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7), and Post-Traumatic Stress Disorder Checklist-5 (PCL-5), and underwent a semi-structured diagnostic clinical interview. Receiver operating characteristic curves were used to determine optimal cutoff scores on the screening tool against the interview-based diagnosis. RESULTS Area under the curve (AUC) was statistically significant for all screens and were as follows: PHQ-9 = 0.70 (95% CI = 0.59-0.80), GAD-7 = 0.74 (95% CI = 0.63-0.84), and PCL-5 = 0.79 (95% CI = 0.66-0.91). The optimal accuracy cutoff scores based on sensitivity and specificity were: PHQ-9 ≥ 16, GAD-7 ≥ 9, the PCL-5 ≥ 42. CONCLUSIONS In general, the candidate screeners performed acceptably in this population. However, the optimal cutoff scores were notably higher than existing guidelines for depression and PTSD, potentially due to the general elevations in negative affectivity among individuals initiating SUD treatment. Further validation of these cutoff values is warranted. PUBLIC HEALTH SIGNIFICANCE This study provides modified screening cutoff scores for major depression, anxiety disorders, and post-traumatic stress disorder in addiction treatment settings.
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Affiliation(s)
- E E Levitt
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, Canada; Homewood Research Institute, Guelph, Canada
| | - S K Syan
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, Canada; Homewood Research Institute, Guelph, Canada
| | - S Sousa
- Homewood Research Institute, Guelph, Canada
| | | | - B Rush
- Homewood Research Institute, Guelph, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - A V Samokhvalov
- Homewood Research Institute, Guelph, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - R E McCabe
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, Canada
| | - J Kelly
- Recovery Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - J MacKillop
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, Canada; Homewood Research Institute, Guelph, Canada.
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Kumar A, Kasloff SB, Leung A, Cutts T, Strong JE, Hills K, Gu FX, Chen P, Vazquez-Grande G, Rush B, Lother S, Malo K, Zarychanski R, Krishnan J. Decontamination of N95 masks for re-use employing 7 widely available sterilization methods. PLoS One 2020; 15:e0243965. [PMID: 33326504 PMCID: PMC7744046 DOI: 10.1371/journal.pone.0243965] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
The response to the COVID-19 epidemic is generating severe shortages of personal protective equipment around the world. In particular, the supply of N95 respirator masks has become severely depleted, with supplies having to be rationed and health care workers having to use masks for prolonged periods in many countries. We sought to test the ability of 7 different decontamination methods: autoclave treatment, ethylene oxide gassing (ETO), low temperature hydrogen peroxide gas plasma (LT-HPGP) treatment, vaporous hydrogen peroxide (VHP) exposure, peracetic acid dry fogging (PAF), ultraviolet C irradiation (UVCI) and moist heat (MH) treatment to decontaminate a variety of different N95 masks following experimental contamination with SARS-CoV-2 or vesicular stomatitis virus as a surrogate. In addition, we sought to determine whether masks would tolerate repeated cycles of decontamination while maintaining structural and functional integrity. All methods except for UVCI were effective in total elimination of viable virus from treated masks. We found that all respirator masks tolerated at least one cycle of all treatment modalities without structural or functional deterioration as assessed by fit testing; filtration efficiency testing results were mostly similar except that a single cycle of LT-HPGP was associated with failures in 3 of 6 masks assessed. VHP, PAF, UVCI, and MH were associated with preserved mask integrity to a minimum of 10 cycles by both fit and filtration testing. A similar result was shown with ethylene oxide gassing to the maximum 3 cycles tested. Pleated, layered non-woven fabric N95 masks retained integrity in fit testing for at least 10 cycles of autoclaving but the molded N95 masks failed after 1 cycle; filtration testing however was intact to 5 cycles for all masks. The successful application of autoclaving for layered, pleated masks may be of particular use to institutions globally due to the virtually universal accessibility of autoclaves in health care settings. Given the ability to modify widely available heating cabinets on hospital wards in well-resourced settings, the application of moist heat may allow local processing of N95 masks.
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Affiliation(s)
- Anand Kumar
- Sections of Critical Care Medicine and Infectious Diseases, Departments of Medicine, Medical Microbiology and Pharmacology, University of Manitoba, Winnipeg, Canada
| | - Samantha B. Kasloff
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Anders Leung
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Todd Cutts
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - James E. Strong
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Kevin Hills
- National Centre for Foreign Animal Diseases, Canadian Food Inspection Agency, Winnipeg, Canada
| | | | - Paul Chen
- University of Toronto, Toronto, Canada
| | - Gloria Vazquez-Grande
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Barret Rush
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Sylvain Lother
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Kimberly Malo
- Occupational & Environmental Safety and Health, Winnipeg Regional Health Authority, Winnipeg, Canada
| | - Ryan Zarychanski
- Sections of Critical Care and Hematology, Departments of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jay Krishnan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
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13
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Rush B, Danziger J, Walley KR, Kumar A, Celi LA. Treatment in Disproportionately Minority Hospitals Is Associated With Increased Risk of Mortality in Sepsis: A National Analysis. Crit Care Med 2020; 48:962-967. [PMID: 32345833 PMCID: PMC8085686 DOI: 10.1097/ccm.0000000000004375] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Treatment in a disproportionately minority-serving hospital has been associated with worse outcomes in a variety of illnesses. We examined the association of treatment in disproportionately minority hospitals on outcomes in patients with sepsis across the United States. DESIGN Retrospective cohort analysis. Disproportionately minority hospitals were defined as hospitals having twice the relative minority patient population than the surrounding geographical mean. Minority hospitals for Black and Hispanic patient populations were identified based on U.S. Census demographic information. A multivariate model employing a validated algorithm for mortality in sepsis using administrative data was used. SETTING The National Inpatient Sample from 2008 to 2014. PATIENTS Patients over 18 years of age with sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 4,221,221 patients with sepsis were identified. Of these, 612,217 patients (14.5%) were treated at hospitals disproportionately serving the black community (Black hospitals), whereas 181,141 (4.3%) were treated at hospitals disproportionately serving the Hispanic community (Hispanic hospitals). After multivariate analysis, treatment in a Black hospital was associated with a 4% higher risk of mortality compared to treatment in a nonminority hospital (odds ratio, 1.04; 95% CI, 1.03-1.05; p < 0.01). Treatment in a Hispanic hospital was associated with a 9% higher risk of mortality (odds ratio, 1.09; 95% CI, 1.07-1.11; p < 0.01). Median hospital length of stay was almost 1 day longer at each of the disproportionately minority hospitals (nonminority hospitals: 5.9 d; interquartile range, 3.1-11.0 d vs Hispanic: 6.9 d; interquartile range, 3.6-12.9 d and Black: 6.7 d, interquartile range, 3.4-13.2 d; both p < 0.01). CONCLUSIONS Patients with sepsis regardless of race who were treated in disproportionately high minority hospitals suffered significantly higher rates of in-hospital mortality.
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Affiliation(s)
- Barret Rush
- Department of Internal Medicine, Division of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - John Danziger
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Keith R Walley
- Center for Heart Lung Innovation (HLI), University of British Columbia, Vancouver BC
| | - Anand Kumar
- Department of Internal Medicine, Division of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
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Gausden EB, Popper JE, Sculco PK, Rush B. Computerized navigation for total hip arthroplasty is associated with lower complications and ninety-day readmissions: a nationwide linked analysis. Int Orthop 2020; 44:471-476. [PMID: 31919568 DOI: 10.1007/s00264-019-04475-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/12/2019] [Accepted: 12/23/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The objective was to evaluate if the use of CA-THA was associated with lower complications in the first 90 days following THA compared with conventional THA. METHODS The Nationwide Readmission Database (NRD) was queried to identify patients who underwent THA between 2012 and 2014. The primary outcome was arthroplasty-related complications within the first 90 days following THA. Multivariate models predicting the risk of complications, readmission, and revision-related readmission within 90 days of discharge were created. RESULTS A total of 309,252 patients with a minimum 90-day follow-up following elective primary THA were identified. After controlling for age, sex, comorbidities, indication, income, and type of insurance, the use of CA during THA resulted in a 12% reduced odds of 90-day complications (OR 0.88, 95% CI 0.77-0.99, p = 0.04). DISCUSSION The use of CA-THA resulted in lower 90-day complication rates and readmission rates compared with traditional THA after controlling for confounding variables. There was no significant difference in the rates of revision surgery between the groups within the first 90 days.
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Affiliation(s)
- Elizabeth B Gausden
- Department of Orthopedics, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA.
| | | | - Peter K Sculco
- Department of Orthopedics, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA
| | - Barret Rush
- Division of Critical Care Medicine, University of Manitoba, Winnipeg, Canada
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15
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Alotaibi AS, Brahmania M, Mooney O, Rush B. A3 TREATMENT IN DISPROPORTIONATELY MINORITY HOSPITALS IS ASSOCIATED WITH AN INCREASED MORTALITY IN END STAGE LIVER DISEASE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Racial and ethnic disparities continue to remain a barrier in delivery of health care across the United States. Care for minority patients tends to be clustered into a small number of providers at minority hospitals, which has been associated with worse clinical outcomes in several conditions. However, the outcomes of treatment in end stage liver disease (ESLD) patients at predominately minority hospitals is unknown.
Aims
To evaluate in-hospital mortality rate among ESLD patients treated in minority hospitals compared to non-minority hospitals.
Methods
We utilized the Nationwide Inpatient Sample (NIS) to conduct a retrospective nationwide cohort analysis. All patients >18 years of age admitted with ESLD were included in the analysis. A multivariate logistic regression model was used to study the mortality rate among ESLD patients treated at minority hospitals compared to ESLD patients treated at non-minority hospitals.
Results
A total of 53,281,467 hospitalizations from the 2008–2014 NIS sample were analyzed. There were 163,470 patients with ESLD that met inclusion criteria. There were 10,178 (6.2%) and 31,226 (19.1%) ESLD patients treated at Black and Hispanic minority hospitals, respectively. In hospital mortality rate for all races were 8.0% and 8.1% in Black and Hispanic minority hospitals, respectively, compared to 7.3% in non-minority hospitals (p<0.01). On multivariate analysis, treatment of ESLD in Black and Hispanic minority hospitals were associated with a 11% (OR: 1.11; 95% CI: 1.03–1.20; p<0.01) and 22% (OR: 1.22; 95% CI: 1.09–1.37; p<0.01) increased odds of death, respectively, compared to treatment in a non-minority hospital regardless of patient race.
Conclusions
ESLD patient treated at minority hospital are faced with an increased mortality rate regardless of a patients race. The current study highlights a quality gap that needs improvement to effect overall survival among ESLD patients.
Funding Agencies
None
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Affiliation(s)
| | | | - O Mooney
- University of Manitoba, Winnipeg, MB, Canada
| | - B Rush
- University of Manitoba, Winnipeg, MB, Canada
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16
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Kumar A, Kasloff SB, Leung A, Cutts T, Strong JE, Hills K, Gu FX, Chen P, Vazquez-Grande G, Rush B, Lother S, Malo K, Zarychanski R, Krishnan J. Decontamination of N95 masks for re-use employing 7 widely available sterilization methods. PLoS One 2020. [PMID: 33326504 DOI: 10.1101/2020.04.05.20049346] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 05/14/2023] Open
Abstract
The response to the COVID-19 epidemic is generating severe shortages of personal protective equipment around the world. In particular, the supply of N95 respirator masks has become severely depleted, with supplies having to be rationed and health care workers having to use masks for prolonged periods in many countries. We sought to test the ability of 7 different decontamination methods: autoclave treatment, ethylene oxide gassing (ETO), low temperature hydrogen peroxide gas plasma (LT-HPGP) treatment, vaporous hydrogen peroxide (VHP) exposure, peracetic acid dry fogging (PAF), ultraviolet C irradiation (UVCI) and moist heat (MH) treatment to decontaminate a variety of different N95 masks following experimental contamination with SARS-CoV-2 or vesicular stomatitis virus as a surrogate. In addition, we sought to determine whether masks would tolerate repeated cycles of decontamination while maintaining structural and functional integrity. All methods except for UVCI were effective in total elimination of viable virus from treated masks. We found that all respirator masks tolerated at least one cycle of all treatment modalities without structural or functional deterioration as assessed by fit testing; filtration efficiency testing results were mostly similar except that a single cycle of LT-HPGP was associated with failures in 3 of 6 masks assessed. VHP, PAF, UVCI, and MH were associated with preserved mask integrity to a minimum of 10 cycles by both fit and filtration testing. A similar result was shown with ethylene oxide gassing to the maximum 3 cycles tested. Pleated, layered non-woven fabric N95 masks retained integrity in fit testing for at least 10 cycles of autoclaving but the molded N95 masks failed after 1 cycle; filtration testing however was intact to 5 cycles for all masks. The successful application of autoclaving for layered, pleated masks may be of particular use to institutions globally due to the virtually universal accessibility of autoclaves in health care settings. Given the ability to modify widely available heating cabinets on hospital wards in well-resourced settings, the application of moist heat may allow local processing of N95 masks.
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Affiliation(s)
- Anand Kumar
- Sections of Critical Care Medicine and Infectious Diseases, Departments of Medicine, Medical Microbiology and Pharmacology, University of Manitoba, Winnipeg, Canada
| | - Samantha B Kasloff
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Anders Leung
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Todd Cutts
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - James E Strong
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Kevin Hills
- National Centre for Foreign Animal Diseases, Canadian Food Inspection Agency, Winnipeg, Canada
| | | | - Paul Chen
- University of Toronto, Toronto, Canada
| | - Gloria Vazquez-Grande
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Barret Rush
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Sylvain Lother
- Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Kimberly Malo
- Occupational & Environmental Safety and Health, Winnipeg Regional Health Authority, Winnipeg, Canada
| | - Ryan Zarychanski
- Sections of Critical Care and Hematology, Departments of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jay Krishnan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
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Ufere NN, Brahmania M, Sey M, Teriaky A, El-Jawahri A, Walley KR, Celi LA, Chung RT, Rush B. Outcomes of in-hospital cardiopulmonary resuscitation for patients with end-stage liver disease. Liver Int 2019; 39:1256-1262. [PMID: 30809903 DOI: 10.1111/liv.14079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 09/12/2018] [Revised: 12/29/2018] [Accepted: 02/21/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS There have been improving survival trends after in-hospital cardiac arrest for the general population, but there is limited information on the outcomes of hospitalized patients with end-stage liver disease (ESLD) who undergo cardiopulmonary resuscitation (CPR). We aimed to examine survival to hospital discharge after receipt of in-hospital CPR in patients with ESLD using a nationally representative sample. METHODS We used the Nationwide Inpatient Sample database from 2006 to 2014 to identify adult patients who underwent in-hospital CPR. Using multivariate modelling, we compared survival to hospital discharge for patients with ESLD to those without ESLD. We also compared outcomes of patients with ESLD to patients with metastatic cancer. RESULTS A total of 177 533 patients underwent in-hospital CPR, of which 1474 (0.8%) had ESLD. Patients with ESLD had lower rates of survival to hospital discharge compared to patients without ESLD (10.7% vs 28.6%, P < 0.01). In multivariate modelling, ESLD was significantly associated with lower odds of survival to hospital discharge after in-hospital CPR (OR 0.35, 95% CI 0.28-0.44, P < 0.01). Among survivors of in-hospital CPR, ESLD patients had a significantly lower chance of discharge to home compared to patients without ESLD (3.2% vs 8.0%, P < 0.05). Patients with ESLD also had lower rates of survival to hospital discharge compared to those with metastatic cancer (10.7% vs 15.5%, P < 0.01). CONCLUSIONS Outcomes are poor after in-hospital CPR in patients with ESLD and are worse than for patients with metastatic cancer. The current analysis can be used to inform goals of care discussions for patients with ESLD.
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Affiliation(s)
- Nneka N Ufere
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Mayur Brahmania
- Division of Gastroenterology, Department of Medicine, London Health Sciences Center, University of Western Ontario, London, ON, Canada
| | - Michael Sey
- Division of Gastroenterology, Department of Medicine, London Health Sciences Center, University of Western Ontario, London, ON, Canada
| | - Anouar Teriaky
- Division of Gastroenterology, Department of Medicine, London Health Sciences Center, University of Western Ontario, London, ON, Canada
| | - Areej El-Jawahri
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Keith R Walley
- Division of Critical Care Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Leo A Celi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Raymond T Chung
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Barret Rush
- Division of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
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18
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Parhar HS, Durham JS, Anderson DW, Rush B, Prisman E. The association between the Nutrition-Related index and morbidity following head and neck microsurgery. Laryngoscope 2019; 130:375-380. [PMID: 30840321 DOI: 10.1002/lary.27912] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/15/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES/HYPOTHESIS Despite consensus that preoperative nutritional assessment is of importance in the head and neck surgical oncology population, it remains unclear how exactly malnutrition is associated with perioperative morbidity especially among those undergoing microvascular surgery. We aimed to study this association to help inform preoperative risk stratification, guide the use of nutritional interventions, and ultimately help prevent malnutrition related morbidity. STUDY DESIGN Database analysis. METHODS Retrospective, linked analysis of the 2011 to 2016 National Surgical Quality Improvement Program. After identifying eligible patients and stratifying according to the Nutrition-Related Index, a univariate screen of preoperative demographic and clinical covariates was performed. Subsequently, propensity score matching was utilized to control for differences in baseline covariates. Perioperative complications and mortality were then analyzed using the propensity score-matched cohorts. RESULTS Among 977 identified patients, 276 (28.2%) were malnourished. Malnourished patients had higher rates of comorbidity, were more likely to actively smoke, and were more likely to have primaries in the oropharynx or hypopharynx/larynx. After propensity score matching to control for confounders, malnourished patients had higher rates of pulmonary complications (21.5% vs. 11.6%, P < .01), higher rates of bleeding or need for transfusion (56.6% vs. 43.0%, P < .01), higher rates of venous thromboembolism (3.7% vs. 0.8%, P = .03), and a higher 30-day mortality rates (3.7% vs. 0.0%, P < .01). CONCLUSIONS This nationwide analysis finds that 28.2% of patients undergoing surgery for head and neck cancers with free flap reconstruction are malnourished. Malnourishment was found to be independently associated with postoperative pulmonary complications, bleeding or need for transfusion, and 30-day mortality. LEVEL OF EVIDENCE NA Laryngoscope, 130:375-380, 2020.
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Affiliation(s)
- Harman S Parhar
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, U.S.A
| | - J Scott Durham
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald W Anderson
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barret Rush
- T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, U.S.A.,Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Rush B, Fruhstofer C, Walley KR, Celi LA, Brahmania M. Palliative medicine and hospital readmissions in end-stage liver disease. BMJ Support Palliat Care 2019:bmjspcare-2018-001635. [PMID: 30760459 DOI: 10.1136/bmjspcare-2018-001635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with end-stage liver disease (ESLD) have a reduced life expectancy and a significant symptom burden. Our aim is to determine if inpatient palliative care (PC) referral for patients with ESLD is associated with decreased hospital readmission rates. METHODS The 2013 US Nationwide Readmission Database (NRD) was used for the current analysis. The NRD allows for longitudinal analysis of all patient hospital admissions across 22 states. Patients ≥18 years of age with a diagnosis of ESLD with at least two decompensating events were included in the analysis. PC referral at the index hospitalisation divided the cohort into two groups, which were tracked for 9 months. RESULTS A total of 14 325 172 hospital admissions from the 2013 NRD were examined. In the first 3 months of 2013, a total of 3647 patients with ESLD were admitted with 206 (5.6%) receiving PC referral during the index admission. After the index hospitalisation, patients referred to PC were more likely to be discharged to skilled nursing facilities (45.5% vs 14.7%; p<0.01) or hospice/home care (32.9% vs 15.3%; p<0.01). After propensity score matching, those patients referred to PC demonstrated a significantly lower rate of 1-year hospital readmission (11.0% vs 32.1%; p<0.01). CONCLUSION Inpatient PC referral for patients with ESLD was associated with lower rates of hospital readmission. Early concurrent PC referral likely has added beneficial effects beyond quality of life issues and symptom management.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Clark Fruhstofer
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Keith R Walley
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, University of British Columbia, Vancouver, Canada
| | - Leo Anthony Celi
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mayur Brahmania
- Division of Gastroenterology, Department of Medicine, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
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Rush B, Walley KR, Celi LA, Rajoriya N, Brahmania M. Reply. Hepatology 2019; 69:920-921. [PMID: 28922468 DOI: 10.1002/hep.29534] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Barret Rush
- Department of Medicine, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Keith R Walley
- Department of Medicine, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | | | - Neil Rajoriya
- Department of Medicine, The Liver Unit, Queen Elizabeth Hospital University of Birmingham, Birmingham, UK
| | - Mayur Brahmania
- Department of Medicine, Division of Gastroenterology, University Hospital, University of Western Ontario, London, ON, Canada
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Rush B, Hertz P, Bond A, McDermid RC, Celi LA. Response. Chest 2019; 151:1184. [PMID: 28483115 DOI: 10.1016/j.chest.2017.02.029] [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] [Received: 02/14/2017] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Barret Rush
- Department of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Paul Hertz
- Department of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alexandra Bond
- Department of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Robert C McDermid
- Department of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Rush B, Celi LA, Stone DJ. Applying machine learning to continuously monitored physiological data. J Clin Monit Comput 2018; 33:887-893. [PMID: 30417258 DOI: 10.1007/s10877-018-0219-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 03/12/2018] [Accepted: 11/08/2018] [Indexed: 01/09/2023]
Abstract
The use of machine learning (ML) in healthcare has enormous potential for improving disease detection, clinical decision support, and workflow efficiencies. In this commentary, we review published and potential applications for the use of ML for monitoring within the hospital environment. We present use cases as well as several questions regarding the application of ML to the analysis of the vast amount of complex data that clinicians must interpret in the realm of continuous physiological monitoring. ML, especially employed in bidirectional conjunction with electronic health record data, has the potential to extract much more useful information out of this currently under-analyzed data source from a population level. As a data driven entity, ML is dependent on copious, high quality input data so that error can be introduced by low quality data sources. At present, while ML is being studied in hybrid formulations along with static expert systems for monitoring applications, it is not yet actively incorporated in the formal artificial learning sense of an algorithm constantly learning and updating its rules without external intervention. Finally, innovations in monitoring, including those supported by ML, will pose regulatory and medico-legal challenges, as well as questions regarding precisely how to incorporate these features into clinical care and medical education. Rigorous evaluation of ML techniques compared to traditional methods or other AI methods will be required to validate the algorithms developed with consideration of database limitations and potential learning errors. Demonstration of value on processes and outcomes will be necessary to support the use of ML as a feature in monitoring system development: Future research is needed to evaluate all AI based programs before clinical implementation in non-research settings.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Sreet, Vancouver, BC, V6Z 1Y6, Canada.
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, MIT Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,Division of Pulmonary Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - David J Stone
- Departments of Anesthesiology and Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, 22904, USA
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Rush B, Wiskar K, Fruhstorfer C, Celi LA, Walley KR. The Impact of Chronic Ozone and Particulate Air Pollution on Mortality in Patients With Sepsis Across the United States. J Intensive Care Med 2018; 35:1002-1007. [PMID: 30295138 DOI: 10.1177/0885066618804497] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The impact of chronic exposure to air pollution on mortality in patients with sepsis is unknown. We attempted to quantify the relationship between air pollution, notably excess ozone, and particulate matter (PM), with in-hospital mortality in patients with sepsis nationwide. METHODS The 2011 Nationwide Inpatient Sample (NIS) was linked with ambient air pollution data from the Environmental Protection Agency for both 8-hour ozone exposure and annual mean 2.5-micron PM (PM2.5) pollution levels. A validated severity of illness model for sepsis using administrative data was used to control for sepsis severity. RESULTS The records of 8 023 590 hospital admissions from the 2011 NIS sample were analyzed. Of these, there were 444 928 patients who met the Angus definition of sepsis, treated in hospitals for which air pollution data were available. The cohort had an overall mortality of 11.2%. After adjustment for severity of sepsis, increasing exposure to ozone pollution was associated with increased risk of mortality (odds ratio [OR]: 1.04 for each 0.01 ppm increase, 95% confidence interval [CI]: 1.03-1.05; P < .01). Particulate matter was not associated with mortality (OR: 0.99 for each 5 µg/m3 increase, 95% CI: 0.97-1.01; P = .28). When stratified by sepsis source, ozone pollution had a higher impact on patients with pneumonia (OR: 1.06, 95% CI: 1.04-1.08; P < .01) compared to those patients without pneumonia (OR: 1.02, 95% CI: 1.01-1.03; P < .01). CONCLUSION Exposure to increased levels of ozone but not particulate air pollution was associated with higher risk of mortality in patients with sepsis. This association was strongest in patients with pneumonia but persisted in all sources of sepsis. Further work is needed to understand the relationship between ambient ozone air pollution and sepsis outcomes.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Center for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Katie Wiskar
- Division of General Internal Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clark Fruhstorfer
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leo Anthony Celi
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Keith R Walley
- Division of Critical Care Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Center for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
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Rush B, Wiskar K, Celi LA, Walley KR, Russell JA, McDermid RC, Boyd JH. Association of Household Income Level and In-Hospital Mortality in Patients With Sepsis: A Nationwide Retrospective Cohort Analysis. J Intensive Care Med 2018; 33:551-556. [PMID: 28385107 PMCID: PMC5680141 DOI: 10.1177/0885066617703338] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Associations between low socioeconomic status (SES) and poor health outcomes have been demonstrated in a variety of conditions. However, the relationship in patients with sepsis is not well described. We investigated the association of lower household income with in-hospital mortality in patients with sepsis across the United States. METHODS Retrospective nationwide cohort analysis utilizing the Nationwide Inpatient Sample (NIS) from 2011. Patients aged 18 years or older with sepsis were included. Socioeconomic status was approximated by the median household income of the zip code in which the patient resided. Multivariate logistic modeling incorporating a validated illness severity score for sepsis in administrative data was performed. RESULTS A total of 8 023 590 admissions from the 2011 NIS were examined. A total of 671 858 patients with sepsis were included in the analysis. The lowest income residents compared to the highest were younger (66.9 years, standard deviation [SD] = 16.5 vs 71.4 years, SD = 16.1, P < .01), more likely to be female (53.5% vs 51.9%, P < .01), less likely to be white (54.6% vs 76.6%, P < .01), as well as less likely to have health insurance coverage (92.8% vs 95.9%, P < .01). After controlling for severity of sepsis, residing in the lowest income quartile compared to the highest quartile was associated with a higher risk of mortality (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.03-1.08, P < .01). There was no association seen between the second (OR: 1.02, 95% CI: 0.99-1.05, P = .14) and third (OR: 0.99, 95% CI: 0.97-1.01, P = .40) quartiles compared to the highest. CONCLUSION After adjustment for severity of illness, patients with sepsis who live in the lowest median income quartile had a higher risk of mortality compared to residents of the highest income quartile. The association between SES and mortality in sepsis warrants further investigation with more comprehensive measures of SES.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katie Wiskar
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Keith R. Walley
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - James A. Russell
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert C. McDermid
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - John H. Boyd
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Parhar HS, Gausden E, Patel J, Prisman E, Anderson DW, Durham JS, Rush B. Analysis of readmissions after transoral robotic surgery for oropharyngeal squamous cell carcinoma. Head Neck 2018; 40:2416-2423. [PMID: 30102813 DOI: 10.1002/hed.25362] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 10/29/2017] [Revised: 03/03/2018] [Accepted: 05/16/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND As transoral robotic surgery (TORS) is being increasingly used to treat patients with oropharyngeal squamous cell carcinoma (OPSCC), there is an interest in determining contributors to readmission. METHODS We conducted this retrospective multivariate analysis modeling 30-day readmission using the Nationwide Readmissions Database (2012-2014). RESULTS Of 950 patients, 117 (12.3%) were readmitted. Hemorrhage and diet/aspiration accounted for 32.5% and 19.7% of readmissions, respectively. Of those readmitted, 23.1% required operative bleeding control, 11.1% required transfusion, 1.7% required tracheostomy, and 18.8% required gastrostomies. Those readmitted were older (mean 63.2 years, SD 9.5 vs 60.9 mean years, SD 10.3) and had longer hospitalizations (mean 5.7 days, SD 6.8 vs mean 4.3 days, SD 4.1) and higher rates of aspiration/pneumonia (9.4% vs 2.4%, P < .01) on index admission. Multivariate analysis demonstrated that aspiration/pneumonia on index admission was independently associated with readmission (OR 3.128, 95% CI 1.178-8.302). CONCLUSIONS Of the patients 12.3% were readmitted within 30 days with hemorrhage and diet complications as significant contributors.
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Affiliation(s)
- Harman S Parhar
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, Canada.,T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Elizabeth Gausden
- T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Jayendrakumar Patel
- T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Eitan Prisman
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Donald W Anderson
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - J Scott Durham
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Barret Rush
- T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Division of Critical Care Medicine, University of British Columbia, Vancouver, Canada
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Rush B, Walley KR. The Emerging Role of Palliative Care in the Management of Canadians With Heart Failure. Can J Cardiol 2018; 34:1114-1115. [PMID: 30093302 DOI: 10.1016/j.cjca.2018.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Barret Rush
- Department of Medicine, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Center for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
| | - Keith R Walley
- Department of Medicine, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Center for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Fundamental features of septic shock are vasodilation, increased permeability, hypovolemia, and ventricular dysfunction. Vasodilation owing to increased nitric oxide and prostaglandins is treated with vasopressors (norepinephrine first). Increased permeability relates to several pathways (Slit/Robo4, vascular endothelial growth factor, angiopoietin 1 and 2/Tie2 pathway, sphingosine-1-phosphate, and heparin-binding protein), some of which are targets for therapies. Hypovolemia is common and crystalloid is recommended for fluid resuscitation. Cardiomyocyte-inflammatory interactions decrease contractility and dobutamine is recommended to increase cardiac output. There is benefit in decreasing heart rate in selected patients with esmolol. Ivabradine is a novel agent for heart rate reduction without decreasing contractility.
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Affiliation(s)
- James A Russell
- Department of Medicine, Centre for Heart Lung Innovation, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
| | - Barret Rush
- Division of Critical Care Medicine, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - John Boyd
- Department of Medicine, Centre for Heart Lung Innovation, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
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Abstract
SummaryTwo patients with congenital factor-V deficiency and a third with a combined deficiency of factor V and factor VIII are described. Under cover of fresh frozen plasma, tooth extractions were performed on two of these patients and spontaneous bleeding arrested.It is concluded that the achievement of a blood level of factor V of 20 per cent once daily is sufficient to assure adequate haemostasis. A low recovery of factor V activity in the plasma following infusion was found. However, in spite of this, adequate blood levels were easily attained due to the excellent preservation of factor V activity in the stored fresh frozen plasma.
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Rush B, Fruhstorfer C. Residual Confounding Prohibits Interpretation of Results After Propensity Score Matching. Am J Cardiol 2018; 121:670. [PMID: 29290369 DOI: 10.1016/j.amjcard.2017.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/15/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Barret Rush
- Department of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clark Fruhstorfer
- Department of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Deol N, Brahmania M, Rush B. A186 LOWER HOSPITAL READMISSION RATES IN PATIENTS RECEIVING TIPS FOR ESOPHAGEAL VARICEAL BLEEDING: A NATIONWIDE LINKED ANALYSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.186] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Deol
- Gastroenterology, Western University, London, ON, Canada
| | | | - B Rush
- University of British Columbia, Vancouver, BC, Canada
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Abstract
OBJECTIVES Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred. DESIGN Retrospective cohort study. SETTING Nationwide Inpatient Sample, 2006-2012. PATIENTS Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25). CONCLUSIONS In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.
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Affiliation(s)
- Patrick D Tyler
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David J Stone
- Departments of Anesthesiology and Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin P Geisler
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Stuart McLennan
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Leo Anthony Celi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Barret Rush
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Rush B, Tyler PD, Stone DJ, Geisler BP, Walley KR, Celi LA. Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis. Crit Care Med 2018; 46:e81-e86. [PMID: 29068858 PMCID: PMC5734994 DOI: 10.1097/ccm.0000000000002777] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The outcomes of critically ill patients who undergo interhospital transfer are not well understood. Physicians assume that patients who undergo interhospital transfer will receive more advanced care that may translate into decreased morbidity or mortality relative to a similar patient who is not transferred. However, there is little empirical evidence to support this assumption. We examined country-level U.S. data from the Nationwide Readmissions Database to examine whether, in mechanically ventilated patients with sepsis, interhospital transfer is associated with a mortality benefit. DESIGN Retrospective data analysis using complex survey design regression methods with propensity score matching. SETTING The Nationwide Readmissions Database contains information about hospital admissions from 22 States, accounting for roughly half of U.S. hospitalizations; the database contains linkage numbers so that admissions and transfers for the same patient can be linked across 1 year of follow-up. PATIENTS From the 2013 Nationwide Readmission Database Sample, 14,325,172 hospital admissions were analyzed. There were 61,493 patients with sepsis and on mechanical ventilation. Of these, 1,630 patients (2.7%) were transferred during their hospitalization. A propensity-matched cohort of 1,630 patients who did not undergo interhospital transfer was identified. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The exposure of interest was interhospital transfer to an acute care facility. The primary outcome was hospital mortality; the secondary outcome was hospital length of stay. The propensity score included age, gender, insurance coverage, do not resuscitate status, use of renal replacement therapy, presence of shock, and Elixhauser comorbidities index. After propensity matching, interhospital transfer was not associated with a difference in in-hospital mortality (12.3% interhospital transfer vs 12.7% non-interhospital transfer; p = 0.74). However, interhospital transfer was associated with a longer total hospital length of stay (12.8 d interquartile range, 7.7-21.6 for interhospital transfer vs 9.1 d interquartile range, 5.1-17.0 for non-interhospital transfer; p < 0.01). CONCLUSIONS Patients with sepsis requiring mechanical ventilation who underwent interhospital transfer did not have improved outcomes compared with a cohort with matched characteristics who were not transferred. The study raises questions about the risk-benefit profile of interhospital transfer as an intervention.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada
| | - Patrick D Tyler
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David J Stone
- Departments of Anesthesiology and Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Benjamin P Geisler
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114
| | - Keith R Walley
- Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada
| | - Leo Anthony Celi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
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Rush B, Walley KR, Celi LA, Rajoriya N, Brahmania M. Palliative care access for hospitalized patients with end-stage liver disease across the United States. Hepatology 2017; 66:1585-1591. [PMID: 28660622 DOI: 10.1002/hep.29297] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [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] [Received: 11/14/2016] [Revised: 02/28/2017] [Accepted: 05/20/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED Patients with end-stage liver disease (ESLD) often have a high symptom burden. Historically, palliative care (PC) services have been underused in this population. We investigated the use of PC services in patients with ESLD hospitalized across the United States. We used the Nationwide Inpatient Sample to conduct a retrospective nationwide cohort analysis. All patients >18 years of age admitted with ESLD, defined as those with at least two liver decompensation events, were included in the analysis. A multivariate logistic regression model predicting referral to PC was created. We analyzed 55,208,382 hospitalizations from the 2006-2012 Nationwide Inpatient Sample, with 39,349 (0.07%) patients meeting study inclusion. PC consultation was performed in 1,789 (4.5%) ESLD patients. The rate of PC referral in ESLD increased from 0.97% in 2006 to 7.1% in 2012 (P < 0.01). In multivariate analysis, factors associated with lower referral to PC were Hispanic race (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.66-0.89; P < 0.01) and insurance coverage (OR, 0.74; 95% CI, 0.65-0.84; P < 0.01). Factors associated with increased referral to PC were age (per 5-year increase, OR, 1.05; 95% CI, 1.03-1.08; P < 0.01), do-not-resuscitate status (OR, 16.24; 95% CI, 14.20-18.56; P < 0.01), treatment in a teaching hospital (OR, 1.25; 95% CI, 1.12-1.39; P < 0.01), presence of hepatocellular carcinoma (OR, 2.00; 95% CI, 1.71-2.33; P < 0.01), and presence of metastatic cancer (OR, 2.39; 95% CI, 1.80-3.18; P < 0.01). PC referral was most common in west coast hospitals (OR, 1.81; 95% CI, 1.53-2.14; P < 0.01) as well as large-sized hospitals (OR, 1.49; 95% CI, 1.22-1.82; P < 0.01). CONCLUSION From 2006 to 2012 the use of PC in ESLD patients increased substantially; socioeconomic, geographical, and ethnic barriers to accessing PC were observed. (Hepatology 2017;66:1585-1591).
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Affiliation(s)
- Barret Rush
- Department of Medicine, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Keith R Walley
- Department of Medicine, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Leo A Celi
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Neil Rajoriya
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Mayur Brahmania
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.,Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Wiskar K, Celi LA, Walley KR, Fruhstorfer C, Rush B. Inpatient palliative care referral and 9-month hospital readmission in patients with congestive heart failure: a linked nationwide analysis. J Intern Med 2017; 282:445-451. [PMID: 28741859 DOI: 10.1111/joim.12657] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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] [Indexed: 01/19/2023]
Abstract
OBJECTIVE End-stage heart failure (HF) is characterized by high symptom burden and frequent hospitalization. Palliative care (PC) is recommended for advanced HF, and there is some evidence in other diseases that this may reduce readmission rates. We attempted examine the association of an inpatient PC visit on hospital readmission for patients admitted with HF. METHODS Retrospective linked nationwide analysis from 2013 with 9-month follow-up for all hospital readmissions for patients admitted with HF exacerbations using the Nationwide Readmission Database (NRD). The NRD gathers all hospital admissions for patients from 22 states and tracks patients throughout the year, allowing for examination of readmission statistics. A propensity score model for PC visit was made, and patients were matched in a 1 : 1 fashion. RESULTS There were 102 746 patients who survived an admission for HF in the first 3 months of 2013. Of these, 2287 (2.2%) patients had a PC visit as inpatients. After matching based on propensity for a PC visit during the index hospitalization, 2282 patients who received a PC visit were matched to 2282 patients who did not. Those receiving a PC visit were less likely to be readmitted for HF (9.3% vs. 22.4%, P < 0.01) or for any cause (29.0% vs. 63.2%, P < 0.01) during the 9-month follow-up period. The average hospital charges during the follow-up period for the non-PC cohort were $77 643 per patient. The average charges for PC patients were $23 200 (P < 0.01). CONCLUSIONS Patients with HF who received an inpatient PC visit had significantly lower rates of all-cause and HF-specific readmission in the subsequent 9 months. Total 9-month hospital charges were also significantly lower for patients who received an inpatient PC visit.
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Affiliation(s)
- K Wiskar
- Department of Medicine, Division of General Internal Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - L A Celi
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - K R Walley
- Department of Medicine, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, BC, Canada
| | - C Fruhstorfer
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - B Rush
- Department of Medicine, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, BC, Canada.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Rush B, Brahmania M. Concerns for the Methodology and Results Described in "Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life". Clin Gastroenterol Hepatol 2017; 15:1641-1642. [PMID: 28395949 DOI: 10.1016/j.cgh.2017.04.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Barret Rush
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Division of Critical Care Medicine, Department of Medicine, St. Paul's Hospital, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Mayur Brahmania
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
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Wiskar KJ, Celi LA, McDermid RC, Walley KR, Russell JA, Boyd JH, Rush B. Patterns of Palliative Care Referral in Patients Admitted With Heart Failure Requiring Mechanical Ventilation. Am J Hosp Palliat Care 2017; 35:620-626. [DOI: 10.1177/1049909117727455] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Katie J. Wiskar
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Robert C. McDermid
- Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - Keith R. Walley
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - James A. Russell
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John H. Boyd
- Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, British Columbia, Canada
- Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barret Rush
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada
- Division of Critical Care Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Rush B, Rousseau J, Sekhon M, Griesdale DE. In Reply to "Erroneous Methodology in 'Craniotomy Versus Craniectomy for Acute Traumatic Subdural Hematoma in the United States: A National Retrospective Cohort Analysis'". World Neurosurg 2017; 91:652. [PMID: 27432644 DOI: 10.1016/j.wneu.2016.03.077] [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] [Received: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
| | - Justin Rousseau
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA; Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mypinder Sekhon
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald E Griesdale
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Anesthesia, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Rush B, Berger L, Anthony Celi L. Access to Palliative Care for Patients Undergoing Mechanical Ventilation With Idiopathic Pulmonary Fibrosis in the United States. Am J Hosp Palliat Care 2017; 35:492-496. [PMID: 28602096 DOI: 10.1177/1049909117713990] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/16/2022] Open
Abstract
OBJECTIVE The utilization of palliative care (PC) in patients with end-stage idiopathic pulmonary fibrosis (IPF) is not well understood. METHODS The Nationwide Inpatient Sample (NIS) was utilized to examine the use of PC in mechanically ventilated (MV) patients with IPF. The NIS captures 20% of all US inpatient hospitalizations and is weighted to estimate 95% of all inpatient care. RESULTS A total of 55 208 382 hospital admissions from the 2006 to 2012 NIS samples were examined. There were 21 808 patients identified with pulmonary fibrosis, of which 3166 underwent mechanical ventilation and were included in the analysis. Of the 3166 patients in the main cohort, 408 (12.9%) had an encounter with PC, whereas 2758 (87.1%) did not. After multivariate logistic regression modeling, variables associated with increased access to PC referral were age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.03, P < .01), treatment in an urban teaching hospital (OR: 1.49, 95% CI: 1.27-3.58, P < .01), and do-not-resuscitate status (OR: 9.86, 95% CI: 7.48-13.00, P < .01). Factors associated with less access to PC were Hispanic race (OR: 0.64, 95% CI: 0.41-0.99, P = .04) and missing race (OR: 0.52, 95% CI: 0.34-0.79, P < .01), with white race serving as the reference. The use of PC has increased almost 10-fold from 2.3% in 2006 to 21.6% in 2012 ( P < .01). CONCLUSION The utilization of PC in patients with IPF who undergo MV has increased dramatically between 2006 and 2012.
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Affiliation(s)
- Barret Rush
- 1 Division of Critical Care Medicine, St Pauls Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,2 Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Landon Berger
- 1 Division of Critical Care Medicine, St Pauls Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,3 Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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Rush B, McDermid RC, Celi LA, Walley KR, Russell JA, Boyd JH. Association between chronic exposure to air pollution and mortality in the acute respiratory distress syndrome. Environ Pollut 2017; 224:352-356. [PMID: 28202265 PMCID: PMC5683074 DOI: 10.1016/j.envpol.2017.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/03/2017] [Accepted: 02/04/2017] [Indexed: 05/03/2023]
Abstract
The impact of chronic exposure to air pollution and outcomes in the acute respiratory distress syndrome (ARDS) is unknown. The Nationwide Inpatient Sample (NIS) from 2011 was utilized for this analysis. The NIS is a national database that captures 20% of all US in-patient hospitalizations from 47 states. Patients with ARDS who underwent mechanical ventilation from the highest 15 ozone pollution cities were compared with the rest of the country. Secondary analyses assessed outcomes of ARDS patients for ozone pollution and particulate matter pollution on a continuous scale by county of residence. A total of 8,023,590 hospital admissions from the 2011 NIS sample were analyzed. There were 93,950 patients who underwent mechanical ventilation for ARDS included in the study. Patients treated in high ozone regions had significantly higher unadjusted hospital mortality (34.9% versus 30.8%, p < 0.01) than patients in cities with control levels of ozone. After controlling for all variables in the model, treatment in a hospital located in a high ozone pollution area was associated with an increased odds of in-hospital mortality (OR 1.11, 95% CI 1.08-1.15, p < 0.01). After adjustment for all variables in the model, for each increase in ozone exposure by 0.01 ppm the OR for death was 1.07 (95% CI 1.06-1.08, p < 0.01). Similarly, for each increase in particulate matter exposure by 10 μg/m3, the OR for death was 1.08 (95% CI 1.02-1.16, p < 0.01). Chronic exposure to both ozone and particulate matter pollution is associated with higher rates of mortality in ARDS. These preliminary findings need to be confirmed by further detailed studies.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115, USA; Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada.
| | - Robert C McDermid
- Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, BC, Canada.
| | | | - Keith R Walley
- Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada.
| | - James A Russell
- Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada.
| | - John H Boyd
- Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada.
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Wormsbecker A, Sekhon MS, Griesdale DE, Wiskar K, Rush B. The association between anemia and neurological outcome in hypoxic ischemic brain injury after cardiac arrest. Resuscitation 2017; 112:11-16. [DOI: 10.1016/j.resuscitation.2016.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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Rush B, Ashkanani M, Romano K, Hertz P. Utilization of electroencephalogram post cardiac arrest in the United States: A nationwide retrospective cohort analysis. Resuscitation 2016; 110:141-145. [PMID: 27886947 DOI: 10.1016/j.resuscitation.2016.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 03/30/2016] [Revised: 08/14/2016] [Accepted: 11/07/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The use of electroencephalogram (EEG) has been demonstrated to have diagnostic and prognostic value in cardiac arrest patients. The use of this modality across the United States in this population is unknown. METHODS The Nationwide Inpatient Sample (NIS) is a federal database capturing 20% of all US hospital admissions. A cohort of patients who suffered both in and out of hospital cardiac arrests from the 2006 to 2012 NIS datasets was created. RESULTS The records of 55,208,382 hospitalizations were analyzed, of which 207,703 patients suffered a cardiac arrest. There were 2952 (1.42%) patients who also had an EEG. Patients who had an EEG compared to those who did not were: younger (62.2 years SD 16.6 vs 66.9 years SD 16.2, p<0.01), were less likely to have insurance coverage (89.9% vs 91.6%, p=0.03) and had significantly longer length of stay (8.6days IQR 3.7-17.1 vs 4.1days IQR 1.0-10.5, p<0.01). Patients treated at urban teaching hospitals were more likely to receive an EEG than patients treated at urban non-teaching and rural hospitals (p<0.01). The rate of EEG in survivors of cardiac arrest increased from 1.03% in 2006 to 2.16% in 2012, a relative increase of 110% (p<0.02). The median time to performance of an EEG was 1.6days IQR 0.33-4.53 days. CONCLUSION EEG is performed on approximately 2% of patients who suffer cardiac arrest in the United States. The treatment hospital and patient characteristics of those who received an EEG different from those who did not.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada; Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave., Boston, MA 02115, USA.
| | - Mohammad Ashkanani
- Division of Epilepsy, Department of Neurology, University of British Columbia, Vancouver, BC, Canada.
| | - Kali Romano
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada; Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
| | - Paul Hertz
- Division of General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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Rush B, Romano K, Ashkanani M, McDermid RC, Celi LA. Impact of hospital case-volume on subarachnoid hemorrhage outcomes: A nationwide analysis adjusting for hemorrhage severity. J Crit Care 2016; 37:240-243. [PMID: 27663296 DOI: 10.1016/j.jcrc.2016.09.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 04/20/2016] [Revised: 07/19/2016] [Accepted: 09/09/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There have been suggestions that patients with subarachnoid hemorrhage (SAH) have a better outcome when treated in high-volume centers. Much of the published literature on the subject is limited by an inability to control for severity of SAH. METHODS This is a nationwide retrospective cohort analysis using the Nationwide Inpatient Sample (NIS). The NIS Subarachnoid Severity Scale was used to adjust for severity of SAH in multivariate logistic regression modeling. RESULTS The records of 47 911 414 hospital admissions from the 2006-2011 NIS samples were examined. There were 11 607 patients who met inclusion criteria for the study. Of these, 7787 (67.0%) were treated at a high-volume center compared with 3820 (32.9%) treated at a low-volume center. Patients treated at high-volume centers compared with low-volume centers were more likely to receive endovascular aneurysm control (58.5% vs 51.2%, P=.04), be transferred from another hospital (35.4% vs 19.7%, P<.01), be treated in a teaching facility (97.3% vs 72.9%, P<.01), and have a longer length of stay (14.9 days [interquartile range 10.3-21.7] vs 13.9 days [interquartile range, 8.9-20.1], P<.01). After adjustment for all baseline covariates, including severity of SAH, treatment in a high-volume center was associated with an odds ratio for death of 0.82 (95% confidence interval, 0.72-0.95; P<.01) and a higher odds of a good functional outcome (odds ratio, 1.16; 95% confidence interval, 1.04-1.28; P<.01). CONCLUSION After adjustment for severity of SAH, treatment in a high-volume center was associated with a lower risk of in-hospital mortality and a higher odds of a good functional outcome.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 W 12th Ave, Vancouver, British Columbia, Canada V5Z 1M9; Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115.
| | - Kali Romano
- Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Mohammad Ashkanani
- Division of Epilepsy, Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Robert C McDermid
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 W 12th Ave, Vancouver, British Columbia, Canada V5Z 1M9; Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, BC, Canada.
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Rush B, Wiskar K, Fruhstorfer C, Hertz P. Association between seizures and mortality in patients with aneurysmal subarachnoid hemorrhage: A nationwide retrospective cohort analysis. Seizure 2016; 41:66-9. [PMID: 27491069 DOI: 10.1016/j.seizure.2016.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 04/10/2016] [Revised: 07/07/2016] [Accepted: 07/16/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The impact of seizures on outcomes in patients with subarachnoid hemorrhage (SAH) is not well understood, with conflicting results published in the literature. METHOD For this retrospective cohort analysis, data from the Nationwide Inpatient Samples (NIS) for 2006-2011 were utilized. All patients aged ≥18 years with a primary admitting diagnosis of subarachnoid hemorrhage were included. Patients with a diagnosis of seizure were segregated from the initial cohort. Multivariable logistic regression modeled the risk of death while adjusting for severity of SAH as well as co-morbidities. The primary outcome of this analysis was in-hospital mortality. RESULTS 12,647 patients met inclusion criteria for the study, of which 1336 had a diagnosis of seizures. The unadjusted in-hospital mortality was higher for patients with seizures compared to those without (16.2% vs 11.6%, p<0.01). Compared to patients without seizures, patients with seizures were younger (52.4 years SD 13.9 vs 54.8 years, SD 13.6; p<0.01), more likely to be male (35.6% vs 31.0%, p<0.01) and had longer hospital stays (18.3 days, IQR 12.0-27.5 vs 14.8 days, IQR 10.0-21.9; p<0.01). After adjusting for the severity of SAH, seizures were found to be associated with increased mortality (OR 1.57, 95% CI 1.32-1.87, p<0.01). CONCLUSION In this large nationwide analysis, the presence of seizures in patients with SAH was associated with higher in-hospital mortality. This finding has potentially important implications for goals of care decision-making and prognostication, but further study in the area is needed.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada; Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Katie Wiskar
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada.
| | - Clark Fruhstorfer
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Paul Hertz
- Division of General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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Rush B, Hertz P, Bond A, McDermid RC, Celi LA. Use of Palliative Care in Patients With End-Stage COPD and Receiving Home Oxygen: National Trends and Barriers to Care in the United States. Chest 2016; 151:41-46. [PMID: 27387892 DOI: 10.1016/j.chest.2016.06.023] [Citation(s) in RCA: 66] [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: 03/06/2016] [Revised: 06/07/2016] [Accepted: 06/27/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND To investigate the use of palliative care (PC) in patients with end-stage COPD receiving home oxygen hospitalized for an exacerbation. METHODS A retrospective nationwide cohort analysis was performed, using the Nationwide Inpatient Sample. All patients ≥ 18 years of age with a diagnosis of COPD, receiving home oxygen, and admitted for an exacerbation were included. RESULTS A total of 55,208,382 hospitalizations from the 2006-2012 Nationwide Inpatient Sample were examined. There were 181,689 patients with COPD, receiving home oxygen, and admitted for an exacerbation; 3,145 patients (1.7%) also had a PC contact. There was a 4.5-fold relative increase in PC referral from 2006 (0.45%) to 2012 (2.56%) (P < .01). Patients receiving PC consultations compared with those who did not were older (75.0 years [SD 10.9] vs 70.6 years [SD 9.7]; P < .01), had longer hospitalizations (4.9 days [interquartile range, 2.6-8.2] vs 3.5 days [interquartile range, 2.1-5.6]), and more likely to die in hospital (32.1% vs 1.5%; P < .01). Race was significantly associated with referral to palliative care, with white patients referred more often than minorities (P < .01). Factors associated with PC referral included age (OR, 1.03; 95% CI, 1.02-1.04; P < .01), metastatic cancer (OR, 2.40; 95% CI, 2.02-2.87; P < .01), nonmetastatic cancer (OR, 2.75; 95% CI, 2.43-3.11; P < .01), invasive mechanical ventilation (OR, 4.89; 95% CI, 4.31-5.55; P < .01), noninvasive mechanical ventilation (OR, 2.84; 95% CI, 2.58-3.12; P < .01), and Do Not Resuscitate status (OR, 7.95; 95% CI, 7.29-8.67; P < .01). CONCLUSIONS The use of PC increased dramatically during the study period; however, PC contact occurs only in a minority of patients with end-stage COPD admitted with an exacerbation.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA.
| | - Paul Hertz
- Division of General Internal Medicine, University Health Network, Toronto, ON, Canada
| | - Alexandra Bond
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert C McDermid
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, BC, Canada
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Rush B, Biagioni BJ, Berger L, McDermid R. Mechanical Ventilation Outcomes in Patients With Pulmonary Hypertension in the United States: A National Retrospective Cohort Analysis. J Intensive Care Med 2016; 32:588-592. [PMID: 27279084 DOI: 10.1177/0885066616653926] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The outcome of patients with pulmonary arterial hypertension (PAH) who undergo mechanical ventilation is not well known. METHODS The Nationwide Inpatient Sample for 2006 to 2012 was used to isolate patients with a diagnosis of PAH who also underwent invasive (MV) and noninvasive (NIMV) mechanical ventilation. The primary outcome was in-hospital mortality. RESULTS The hospital records of 55 208 382 patients were studied, and there were 21 070 patients with PAH, of whom 1646 (7.8%) received MV and 834 (4.0%) received NIMV. Those receiving MV had higher mortality (39.1% vs 12.6%, P < .001) and longer hospital stays (11.9 days, interquartile range [IQR] 6.1-22.2 vs 6.7 days, IQR 3.4-11.9, P < .001) than those undergoing NIMV. Of the patients treated with MV, 4.4% also used home oxygen therapy and had similar overall mortality to those who did not use home oxygen (35.3% vs 39.1%, P = .46). Similarly, there was no relationship between home oxygen use and mortality in patients treated with NIMV (10.6% vs 12.6%, P = .48). Notably, more patients treated with NIMV used home oxygen than those treated with MV (14.4% vs 4.4%, P < .001). CONCLUSION Patients with PAH who undergo invasive mechanical ventilation have an in-hospital mortality of 39.1%. Future work may help identify the types of patients who benefit most from advanced respiratory support in a critical care setting.
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Affiliation(s)
- Barret Rush
- 1 Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,2 Harvard T.H. Chan School of Public Health, Harvard University, MA, USA
| | - Bradly J Biagioni
- 3 Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Landon Berger
- 1 Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,4 Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert McDermid
- 1 Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,5 Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada
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Rush B, Wiskar K, Berger L, Griesdale D. Trends in Extracorporeal Membrane Oxygenation for the Treatment of Acute Respiratory Distress Syndrome in the United States. J Intensive Care Med 2016; 32:535-539. [DOI: 10.1177/0885066616631956] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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
Objectives: Our aim was to describe patient characteristics and trends in the use of extracorporeal membrane oxygenation (ECMO) for the treatment of acute respiratory distress syndrome (ARDS) in the United States from 2006 to 2011. Methods: We used the Nationwide Inpatient Sample to isolate all patients aged 18 years who had a discharge International Classification of Diseases, Ninth Revision diagnosis of ARDS, with and without procedure codes for ECMO, between 2006 and 2011. Results: We examined a total of 47 911 414 hospital discharges, representing 235 911 271 hospitalizations using national weights. Of the 1 479 022 patients meeting the definition of ARDS (representing 7 281 206 discharges), 775 underwent ECMO. There was a 409% relative increase in the use of ECMO for ARDS in the United States between 2006 and 2011, from 0.0178% to 0.090% ( P = .0041). Patients treated with ECMO had higher in-hospital mortality (58.6% vs 25.1%, P < .0001) and longer hospital stays (15.8 days vs 6.9 days, P < .0001). They were also younger (47.9 vs 66.4 years, P < .0001) and more likely to be male (62.2% vs 49.6%, P < .0001). The median time to initiate ECMO from the time of admission was 0.5 days (interquartile range [IQR] 4.9 days). Conclusion: There has been a dramatic increase in ECMO use for the treatment of ARDS in the United States.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Katie Wiskar
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Landon Berger
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald Griesdale
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Rush B, Wormsbecker A, Stenstrom R, Kassen B. Moxifloxacin Use and Its Association on the Diagnosis of Pulmonary Tuberculosis in An Inner City Emergency Department. J Emerg Med 2015; 50:371-5. [PMID: 26416134 DOI: 10.1016/j.jemermed.2015.07.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/22/2015] [Revised: 07/21/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Moxifloxacin can be used in the treatment of tuberculosis, its effect on the diagnosis and treatment of pulmonary tuberculosis is not well characterized. OBJECTIVE To identify patients from the St. Paul's Hospital emergency department (ED) treated with moxifloxacin who also had sputum sent for investigation of possible tuberculosis and the impact on sensitivity of acid-fast bacilli (AFB) smears and time to initiation of tuberculosis treatment. METHODS We conducted a retrospective single-center cohort study on patients that were prescribed moxifloxacin in the ED during a 5-year period and had samples collected for pulmonary tuberculosis. All AFB samples obtained throughout the hospital in patients not exposed to moxifloxacin during the same time period were also examined. RESULTS Two-thousand six hundred and seventy-three patients who were admitted to St. Paul's Hospital through the ED received moxifloxacin during the study period. 273 (10.2%) of these patients were subsequently investigated for tuberculosis, with 9 positive cases of Mycobacterium tuberculosis (3.3%). One-thousand three hundred and sixty-nine patients not exposed to moxifloxacin were screened for tuberculosis with 33 active cases (2.4%). The false-negative rate for AFB smears in the exposed group was 85.2% vs. 53.8% in the unexposed group (relative risk of false-negative AFB = 1.55; 95% CI 1.24-2.03). Time to initiation of anti-tuberculosis therapy was significantly delayed in the exposed group, with median time to initiation of 14 days vs. 2 days (p = 0.013). CONCLUSIONS Exposure to moxifloxacin is associated with significantly increased rates of false-negative AFB smears and was associated with a significant delay in the initiation of anti-tuberculosis therapy.
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Affiliation(s)
- Barret Rush
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Wormsbecker
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rob Stenstrom
- Department of Emergency Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Barry Kassen
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
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Burnside RD, Spudich L, Rush B, Kubendran S, Schaefer GB. Secondary complex chromosome rearrangement identified by chromosome analysis and FISH subsequent to detection of an unbalanced derivative chromosome 12 by SNP array analysis. Cytogenet Genome Res 2013; 142:129-33. [PMID: 24335332 DOI: 10.1159/000356558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 11/19/2022] Open
Abstract
Microarray analysis is used to detect small copy number changes (deletions and duplications) that may be associated with genetic syndromes and phenotypic abnormalities. However, there are limitations to what microarrays are able to detect. We present a patient referred for microarray in whom chromosome analysis identified a more complex structural rearrangement than was indicated by the microarray. Our studies included Affymetrix Cytoscan HD array, chromosome analysis and fluorescence in situ hybridization (FISH) using a subtelomere probe targeting chromosome 3. Array analysis revealed a 6.45-Mb terminal duplication of 3q28q29 and a 1.02-Mb terminal deletion of 12p13.33. This suggested an unbalanced translocation derivative. In order to investigate visibility of the rearrangement, chromosome analysis was performed, revealing an additional balanced complex chromosome rearrangement involving chromosomes 3 and 11, including a translocation with breakpoints at 3p13 and 11p11.2, as well as a paracentric inversion of segment 3p25p13 translocated onto chromosome 11. Subtelomere FISH confirmed that the duplicated chromosome 3q material observed in the array analysis was localized to distal 12p. This case clearly illustrates the combined utilization of classic cytogenetics, FISH and array technologies to better characterize chromosomal abnormalities.
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Affiliation(s)
- R D Burnside
- Laboratory Corporation of America, Center for Molecular Biology and Pathology, Department of Cytogenetics, Research Triangle Park, N.C., USA
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Boylan K, DeJesus-Hernandez M, Rush B, Desaro P, Johnston A, Kryston T, Rutherford N, Baker M, Wszolek Z, Dickson D, Rademakers R. Phenotype of Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Dementia with ALS (FTD/ALS) Associated with the GGGGCC Repeat Expansion in C9ORF72 (c9FTD/ALS) (IN9-1.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in9-1.004] [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: 11/15/2022] Open
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Boeve B, Graff-Radford N, Boylan K, DeJesus-Hernandez M, Knopman D, Josephs K, Pedraza O, Vemuri P, Rush B, Fields J, Ferman T, Baker M, Rutherford N, Jones D, Lowe V, Wszolek Z, Adeli A, Savica R, Boot B, Gavrilova R, Kuntz K, Whitwell J, Kantarci K, Jack C, Dickson D, Parisi J, Lucas J, Petersen R, Rademakers R. Characterization of Frontotemporal Dementia +/- Amyotrophic Lateral Sclerosis Associated with the GGGGCC Repeat Expansion in C9ORF72 (S54.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s54.005] [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: 11/15/2022] Open
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