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Alternative Imaging Modalities in Ischemic Heart Failure (AIMI-HF) IMAGE HF Project I-A: study protocol for a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature108622
Source
Trials. 2013;14:218
Publication Type
Article
Date
2013
Author
Eileen O'Meara
Lisa M Mielniczuk
George A Wells
Robert A deKemp
Ran Klein
Doug Coyle
Brian Mc Ardle
Ian Paterson
James A White
Malcolm Arnold
Matthias G Friedrich
Eric Larose
Alexander Dick
Benjamin Chow
Carole Dennie
Haissam Haddad
Terrence Ruddy
Heikki Ukkonen
Gerald Wisenberg
Bernard Cantin
Philippe Pibarot
Michael Freeman
Eric Turcotte
Kim Connelly
James Clarke
Kathryn Williams
Normand Racine
Linda Garrard
Jean-Claude Tardif
Jean DaSilva
Juhani Knuuti
Rob Beanlands
Author Affiliation
Montreal Heart Institute, Montréal, QC, Canada.
Source
Trials. 2013;14:218
Date
2013
Language
English
Publication Type
Article
Keywords
Algorithms
Canada
Clinical Protocols
Diagnostic Imaging - methods
Heart Arrest - etiology
Heart Failure - diagnosis - etiology - mortality - therapy
Humans
Magnetic Resonance Imaging
Myocardial Infarction - etiology
Myocardial Ischemia - complications - diagnosis - mortality - therapy
Patient Readmission
Patient Selection
Positron-Emission Tomography
Predictive value of tests
Prognosis
Registries
Research Design
Time Factors
Tomography, Emission-Computed, Single-Photon
Abstract
Ischemic heart disease (IHD) is the most common cause of heart failure (HF); however, the role of revascularization in these patients is still unclear. Consensus on proper use of cardiac imaging to help determine which candidates should be considered for revascularization has been hindered by the absence of clinical studies that objectively and prospectively compare the prognostic information of each test obtained using both standard and advanced imaging.
This paper describes the design and methods to be used in the Alternative Imaging Modalities in Ischemic Heart Failure (AIMI-HF) multi-center trial. The primary objective is to compare the effect of HF imaging strategies on the composite clinical endpoint of cardiac death, myocardial infarction (MI), cardiac arrest and re-hospitalization for cardiac causes.In AIMI-HF, patients with HF of ischemic etiology (n = 1,261) will follow HF imaging strategy algorithms according to the question(s) asked by the physicians (for example, Is there ischemia and/or viability?), in agreement with local practices. Patients will be randomized to either standard (SPECT, Single photon emission computed tomography) imaging modalities for ischemia and/or viability or advanced imaging modalities: cardiac magnetic resonance imaging (CMR) or positron emission tomography (PET). In addition, eligible and consenting patients who could not be randomized, but were allocated to standard or advanced imaging based on clinical decisions, will be included in a registry.
AIMI-HF will be the largest randomized trial evaluating the role of standard and advanced imaging modalities in the management of ischemic cardiomyopathy and heart failure. This trial will complement the results of the Surgical Treatment for Ischemic Heart Failure (STICH) viability substudy and the PET and Recovery Following Revascularization (PARR-2) trial. The results will provide policy makers with data to support (or not) further investment in and wider dissemination of alternative 'advanced' imaging technologies.
NCT01288560.
Notes
Cites: Am J Cardiol. 2004 May 15;93(10):1275-915135703
Cites: N Engl J Med. 1971 Dec 23;285(26):1441-65122894
Cites: Am J Cardiol. 1974 Oct 3;34(5):520-54278154
Cites: Am J Cardiol. 1983 Mar 1;51(5):831-66681931
Cites: Circulation. 1983 Oct;68(4):785-956352078
Cites: J Thorac Cardiovasc Surg. 1983 Oct;86(4):519-276604845
Cites: N Engl J Med. 1985 Jun 27;312(26):1665-713873614
Cites: N Engl J Med. 1986 Apr 3;314(14):884-83485252
Cites: Ann Surg. 1989 Sep;210(3):348-52; discussion 352-42673084
Cites: Circulation. 1990 Nov;82(5):1629-462225367
Cites: Circulation. 1991 Nov;84(5 Suppl):III290-51934422
Cites: J Am Coll Cardiol. 1993 Oct;22(4):984-978409073
Cites: Am J Cardiol. 1994 Mar 15;73(8):527-338147295
Cites: Circulation. 1994 Dec;90(6):2687-947994809
Cites: Circulation. 1998 Nov 10;98(19 Suppl):II51-69852880
Cites: J Thorac Cardiovasc Surg. 2005 Feb;129(2):246-915678031
Cites: Eur J Heart Fail. 2006 Jan;8(1):63-716084759
Cites: Can J Cardiol. 2006 Jan;22(1):23-4516450016
Cites: Can J Cardiol. 2007 Feb;23(2):107-1917311116
Cites: Curr Probl Cardiol. 2007 Jul;32(7):375-41017560992
Cites: J Nucl Med. 2007 Jul;48(7):1135-4617574986
Cites: J Am Coll Cardiol. 2007 Nov 13;50(20):2002-1217996568
Cites: JACC Cardiovasc Imaging. 2009 Jan;2(1):34-4419356530
Cites: JACC Cardiovasc Imaging. 2009 Sep;2(9):1060-819761983
Cites: J Nucl Med. 2010 Apr;51(4):567-7420237039
Cites: Am J Cardiol. 2010 Jul 15;106(2):187-9220599001
Cites: N Engl J Med. 2011 Apr 28;364(17):1607-1621463150
Cites: N Engl J Med. 2011 Apr 28;364(17):1671-321463151
Cites: N Engl J Med. 2011 Apr 28;364(17):1617-2521463153
Cites: Circ Cardiovasc Imaging. 2012 Mar;5(2):262-70; discussion 27022438424
Cites: J Am Coll Cardiol. 2001 Mar 15;37(4):992-711263626
Cites: Thorac Cardiovasc Surg. 2000 Feb;48(1):9-1410757150
Cites: Ann Intern Med. 2012 Jun 5;156(11):785-95, W-270, W-271, W-272, W-273, W-274, W-275, W-276, W-277, W-27822312131
Cites: J Am Coll Cardiol. 2001 Apr;37(5):1210-311300424
Cites: Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-26611904577
Cites: J Am Coll Cardiol. 2002 Apr 3;39(7):1151-811923039
Cites: Ann Intern Med. 2003 Jul 15;139(2):137-4712859163
PubMed ID
23866673 View in PubMed
Less detail

Barriers and facilitators to CPR training and performing CPR in an older population most likely to witness cardiac arrest: a national survey.

https://arctichealth.org/en/permalink/ahliterature107629
Source
Resuscitation. 2013 Dec;84(12):1747-52
Publication Type
Article
Date
Dec-2013
Author
Christian Vaillancourt
Ann Kasaboski
Manya Charette
Rafat Islam
Martin Osmond
George A Wells
Ian G Stiell
Jamie C Brehaut
Jeremy M Grimshaw
Author Affiliation
Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, ON, Canada. Electronic address: cvaillancourt@ohri.ca.
Source
Resuscitation. 2013 Dec;84(12):1747-52
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude to Health
Canada
Cardiopulmonary Resuscitation - education
Female
Health Surveys
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest - therapy
Telephone
Abstract
Bystander CPR rates are lowest at home, where 85% of out-of-hospital cardiac arrests occur. We sought to identify barriers and facilitators to CPR training and performing CPR among older individuals most likely to witness cardiac arrest.
We selected independent-living Canadians aged =55 using random-digit-dial telephone calls. Respondents were randomly assigned to answer 1 of 2 surveys eliciting barriers and facilitators potentially influencing either CPR training or performance. We developed survey instruments using the Theory of Planned Behavior, measuring salient attitudes, social influences, and control beliefs.
Demographics for the 412 respondents (76.4% national response rate): Mean age 66, 58.7% female, 54.9% married, 58.0% CPR trained (half >10 years ago). Mean intentions to take CPR training in the next 6 months or to perform CPR on a victim were relatively high (3.6 and 4.1 out of 5). Attitudinal beliefs were most predictive of respondents' intentions to receive training or perform CPR (Adjusted OR; 95%CI were 1.81; 1.41-2.32 and 1.63; 1.26-2.04 respectively). Respondents who believed CPR could save a life, were employed, and had seen CPR advertised had the highest intention to receive CPR training. Those who believed CPR should be initiated before EMS arrival, were proactive in a group, and felt confident in their CPR skills had the highest intention to perform CPR.
Attitudinal beliefs were most predictive of respondents' intention to complete CPR training or perform CPR on a real victim. Behavioral change techniques targeting these specific beliefs are most likely to make an impact.
PubMed ID
23989115 View in PubMed
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BIPHASIC Trial: a randomized comparison of fixed lower versus escalating higher energy levels for defibrillation in out-of-hospital cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature164714
Source
Circulation. 2007 Mar 27;115(12):1511-7
Publication Type
Article
Date
Mar-27-2007
Author
Ian G Stiell
Robert G Walker
Lisa P Nesbitt
Fred W Chapman
Donna Cousineau
James Christenson
Paul Bradford
Sunil Sookram
Ross Berringer
Paula Lank
George A Wells
Author Affiliation
Department of Emergency Medicine, Ottawa Health Research Institute, University of Ottawa, Ontario, Canada, K1Y 4E9. istiell@ohri.ca
Source
Circulation. 2007 Mar 27;115(12):1511-7
Date
Mar-27-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Allied Health Personnel
Canada
Cardiac Output, Low - diagnosis - etiology
Cardiopulmonary Resuscitation
Combined Modality Therapy
Defibrillators - statistics & numerical data
Double-Blind Method
Electric Countershock - methods - statistics & numerical data
Electrocardiography
Emergency Medical Services - statistics & numerical data
Female
First Aid - methods - statistics & numerical data
Heart Arrest - etiology - prevention & control
Humans
Male
Middle Aged
Myocardial Infarction - diagnosis - etiology
Myocardial Ischemia - diagnosis - etiology
Myocardium - pathology
Treatment Outcome
Ventricular Fibrillation - complications - therapy
Abstract
There is little clear evidence as to the optimal energy levels for initial and subsequent shocks in biphasic waveform defibrillation. The present study compared fixed lower- and escalating higher-energy regimens for out-of-hospital cardiac arrest.
The Randomized Controlled Trial to Compare Fixed Versus Escalating Energy Regimens for Biphasic Waveform Defibrillation (BIPHASIC Trial) was a multicenter, randomized controlled trial of 221 out-of-hospital cardiac arrest patients who received > or = 1 shock given by biphasic automated external defibrillator devices that were randomly programmed to provide, blindly, fixed lower-energy (150-150-150 J) or escalating higher-energy (200-300-360 J) regimens. Patient mean age was 66.0 years; 79.6% were male. The cardiac arrest was witnessed in 63.8%; a bystander performed cardiopulmonary resuscitation in 23.5%; and initial rhythm was ventricular fibrillation/ventricular tachycardia in 92.3%. The fixed lower- and escalating higher-energy regimen cases were similar for the 106 multishock patients and for all 221 patients. In the primary analysis in multishock patients, conversion rates differed significantly (fixed lower, 24.7%, versus escalating higher, 36.6%; P=0.035; absolute difference, 11.9%; 95% CI, 1.2 to 24.4). Ventricular fibrillation termination rates also were significantly different between groups (71.2% versus 82.5%; P=0.027; absolute difference, 11.3%; 95% CI, 1.6 to 20.9). For the secondary analysis of first shock success, conversion rates were similar between the fixed lower and escalating higher study groups (38.4% versus 36.7%; P=0.92), as were ventricular fibrillation termination rates (86.8% versus 88.8%; P=0.81). There were no distinguishable differences between regimens for survival outcomes or adverse effects.
This is the first randomized trial to compare fixed lower and escalating higher biphasic energy regimens in out-of-hospital cardiac arrest, and it demonstrated higher rates of ventricular fibrillation conversion and termination with an escalating higher-energy regimen for patients requiring multiple shocks. These results suggest that patients in ventricular fibrillation benefit from higher biphasic energy levels if multiple defibrillation shocks are required.
Notes
Comment In: Evid Based Med. 2007 Oct;12(5):14217909233
Comment In: Circulation. 2007 Nov 6;116(19):e522; author reply e52317984386
Comment In: ACP J Club. 2007 Sep-Oct;147(2):3317764124
PubMed ID
17353443 View in PubMed
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The Canadian C-spine rule performs better than unstructured physician judgment.

https://arctichealth.org/en/permalink/ahliterature183855
Source
Ann Emerg Med. 2003 Sep;42(3):395-402
Publication Type
Article
Date
Sep-2003
Author
Glen Bandiera
Ian G Stiell
George A Wells
Catherine Clement
Valerie De Maio
Katherine L Vandemheen
Gary H Greenberg
Howard Lesiuk
Robert Brison
Daniel Cass
Jonathan Dreyer
Mary A Eisenhauer
Iain Macphail
R Douglas McKnight
Laurie Morrison
Mark Reardon
Michael Schull
James Worthington
Author Affiliation
Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada.
Source
Ann Emerg Med. 2003 Sep;42(3):395-402
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Cervical Vertebrae - injuries - radiography
Clinical Competence
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Predictive value of tests
Prospective Studies
ROC Curve
Sensitivity and specificity
Spinal Injuries - diagnosis - radiography
Abstract
We compare the predictive accuracy of emergency physicians' unstructured clinical judgment to the Canadian C-Spine rule.
This prospective multicenter cohort study was conducted at 10 Canadian urban academic emergency departments. Included in the study were alert, stable, adult patients with a Glasgow Coma Scale score of 15 and trauma to the head or neck. This was a substudy of the Canadian C-Spine and CT Head Study. Eligible patients were prospectively evaluated before radiography. Physicians estimated the probability of unstable cervical spine injury from 0% to 100% according to clinical judgment alone and filled out a data form. Interobserver assessments were done when feasible. Patients underwent cervical spine radiography or follow-up to determine clinically important cervical spine injuries. Analyses included comparison of areas under the receiver operating characteristic (ROC) curve with 95% confidence intervals (CIs) and the kappa coefficient.
During 18 months, 6265 patients were enrolled. The mean age was 36.6 years (range 16 to 97 years), and 50.1% were men. Sixty-four (1%) patients had a clinically important injury. The physicians' kappa for a 0% predicted probability of injury was 0.46 (95% CI 0.28 to 0.65). The respective areas under the ROC curve for predicting cervical spine injury were 0.85 (95% CI 0.80 to 0.89) for physician judgment and 0.91 (95% CI 0.89 to 0.92) for the Canadian C-Spine rule (P
Notes
Comment In: Ann Emerg Med. 2004 Jun;43(6):789-90; author reply 790-115259167
Comment In: Ann Emerg Med. 2003 Sep;42(3):403-412944894
Comment In: Ann Emerg Med. 2004 Jun;43(6):78815259165
Comment In: Ann Emerg Med. 2004 Jun;43(6):788-915259166
PubMed ID
12944893 View in PubMed
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The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma.

https://arctichealth.org/en/permalink/ahliterature182232
Source
N Engl J Med. 2003 Dec 25;349(26):2510-8
Publication Type
Article
Date
Dec-25-2003
Author
Ian G Stiell
Catherine M Clement
R Douglas McKnight
Robert Brison
Michael J Schull
Brian H Rowe
James R Worthington
Mary A Eisenhauer
Daniel Cass
Gary Greenberg
Iain MacPhail
Jonathan Dreyer
Jacques S Lee
Glen Bandiera
Mark Reardon
Brian Holroyd
Howard Lesiuk
George A Wells
Author Affiliation
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont, Canada.
Source
N Engl J Med. 2003 Dec 25;349(26):2510-8
Date
Dec-25-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Algorithms
Canada
Cervical Vertebrae - injuries - radiography
Decision Support Techniques
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Neck Injuries - radiography
Prospective Studies
Risk factors
Sensitivity and specificity
Spinal Fractures - radiography
Traumatology - standards
Wounds, Nonpenetrating - radiography
Abstract
The Canadian C-Spine (cervical-spine) Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are decision rules to guide the use of cervical-spine radiography in patients with trauma. It is unclear how the two decision rules compare in terms of clinical performance.
We conducted a prospective cohort study in nine Canadian emergency departments comparing the CCR and NLC as applied to alert patients with trauma who were in stable condition. The CCR and NLC were interpreted by 394 physicians for patients before radiography.
Among the 8283 patients, 169 (2.0 percent) had clinically important cervical-spine injuries. In 845 (10.2 percent) of the patients, physicians did not evaluate range of motion as required by the CCR algorithm. In analyses that excluded these indeterminate cases, the CCR was more sensitive than the NLC (99.4 percent vs. 90.7 percent, P
Notes
Comment In: ACP J Club. 2004 Jul-Aug;141(1):2415230572
Comment In: N Engl J Med. 2004 Apr 1;350(14):1467-9; author reply 1467-915074005
Comment In: N Engl J Med. 2003 Dec 25;349(26):2553-514695417
Comment In: N Engl J Med. 2004 Apr 1;350(14):1467-9; author reply 1467-915070802
PubMed ID
14695411 View in PubMed
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Cardiac resynchronization therapy in patients with permanent atrial fibrillation: results from the Resynchronization for Ambulatory Heart Failure Trial (RAFT).

https://arctichealth.org/en/permalink/ahliterature121574
Source
Circ Heart Fail. 2012 Sep 1;5(5):566-70
Publication Type
Article
Date
Sep-1-2012
Author
Jeff S Healey
Stefan H Hohnloser
Derek V Exner
David H Birnie
Ratika Parkash
Stuart J Connolly
Andrew D Krahn
Chris S Simpson
Bernard Thibault
Magdy Basta
Francois Philippon
Paul Dorian
Girish M Nair
Soori Sivakumaran
Elizabeth Yetisir
George A Wells
Anthony S L Tang
Author Affiliation
Population Health Research Institute, Hamilton, Ontario, Canada.
Source
Circ Heart Fail. 2012 Sep 1;5(5):566-70
Date
Sep-1-2012
Language
English
Publication Type
Article
Keywords
Action Potentials
Aged
Atrial Fibrillation - complications - diagnosis - mortality - physiopathology
Canada
Cardiac Resynchronization Therapy - adverse effects - mortality
Cardiac Resynchronization Therapy Devices
Defibrillators, Implantable
Electric Countershock - adverse effects - instrumentation - mortality
Exercise Test
Female
Heart Failure - complications - diagnosis - mortality - physiopathology - therapy
Hospitalization
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Questionnaires
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Abstract
Cardiac resynchronization (CRT) prolongs survival in patients with systolic heart failure and QRS prolongation. However, most trials excluded patients with permanent atrial fibrillation.
The Resynchronization for Ambulatory Heart Failure Trial (RAFT) randomized patients to an implantable cardioverter defibrillator (ICD) or ICD+CRT, stratified by the presence of permanent atrial fibrillation. Patients with permanent atrial fibrillation were randomized to CRT-ICD (n=114) or ICD (n=115). Patients receiving a CRT-ICD were similar to those receiving an ICD: age (71.6±7.3 versus 70.4±7.7 years), left ventricular ejection fraction (22.9±5.3% versus 22.3±5.1%), and QRS duration (151.0±23.6 versus 153.4±24.7 ms). There was no difference in the primary outcome of death or heart failure hospitalization between those assigned to CRT-ICD versus ICD (hazard ratio, 0.96; 95% CI, 0.65-1.41; P=0.82). Cardiovascular death was similar between treatment arms (hazard ratio, 0.97; 95% CI, 0.55-1.71; P=0.91); however, there was a trend for fewer heart failure hospitalizations with CRT-ICD (hazard ratio, 0.58; 95% CI, 0.38-1.01; P=0.052). The change in 6-minute hall walk duration between baseline and 12 months was not different between treatment arms (CRT-ICD: 19±84 m versus ICD: 16±76 m; P=0.88). Patients treated with CRT-ICD showed a trend for a greater improvement in Minnesota Living with Heart Failure score between baseline and 6 months (CRT-ICD: 41±21 to 31±21; ICD: 33±20 to 28±20; P=0.057).
Patients with permanent atrial fibrillation who are otherwise CRT candidates appear to gain minimal benefit from CRT-ICD compared with a standard ICD.
Notes
Comment In: Circ Heart Fail. 2013 Mar;6(2):e2223513051
Comment In: Circ Heart Fail. 2012 Sep 1;5(5):547-922991403
PubMed ID
22896584 View in PubMed
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Clinical characteristics associated with adverse events in patients with exacerbation of chronic obstructive pulmonary disease: a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature104951
Source
CMAJ. 2014 Apr 1;186(6):E193-204
Publication Type
Article
Date
Apr-1-2014
Author
Ian G Stiell
Catherine M Clement
Shawn D Aaron
Brian H Rowe
Jeffrey J Perry
Robert J Brison
Lisa A Calder
Eddy Lang
Bjug Borgundvaag
Alan J Forster
George A Wells
Source
CMAJ. 2014 Apr 1;186(6):E193-204
Date
Apr-1-2014
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Analysis of Variance
Canada
Cause of Death
Cohort Studies
Decision Making
Disease Progression
Emergency Service, Hospital - utilization
Emergency Treatment - adverse effects - methods
Female
Follow-Up Studies
Hospital Mortality
Hospitalization - statistics & numerical data
Hospitals, Teaching
Humans
Intubation, Intratracheal - statistics & numerical data
Logistic Models
Male
Middle Aged
Multivariate Analysis
Patient Discharge - statistics & numerical data
Patient Readmission - statistics & numerical data
Prospective Studies
Pulmonary Disease, Chronic Obstructive - mortality - physiopathology - therapy
Risk assessment
Sex Distribution
Survival Analysis
Abstract
To assist physicians with difficult decisions about hospital admission for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) presenting in the emergency department, we sought to identify clinical characteristics associated with serious adverse events.
We conducted this prospective cohort study in 6 large Canadian academic emergency departments. Patients were assessed for standardized clinical variables and then followed for serious adverse events, defined as death, intubation, admission to a monitored unit or new visit to the emergency department requiring admission.
We enrolled 945 patients, of whom 354 (37.5%) were admitted to hospital. Of 74 (7.8%) patients with a subsequent serious adverse event, 36 (49%) had not been admitted after the initial emergency visit. Multivariable modelling identified 5 variables that were independently associated with adverse events: prior intubation, initial heart rate = 110/minute, being too ill to do a walk test, hemoglobin
Notes
Cites: Chest. 1991 Mar;99(3):595-91995214
Cites: BMJ. 1995 Sep 2;311(7005):594-77663253
Cites: Am J Respir Crit Care Med. 1998 May;157(5 Pt 1):1418-229603117
Cites: Ann Intern Med. 2006 Feb 7;144(3):165-7116461960
Cites: Acad Emerg Med. 2007 Jan;14(1):6-1417119187
Cites: Am J Epidemiol. 2007 Mar 15;165(6):710-817182981
Cites: Can Respir J. 2007 Sep;14 Suppl B:5B-32B17885691
Cites: Respir Care. 2003 Aug;48(8):783-512890299
Cites: Eur Respir J. 2008 Oct;32(4):953-6118508819
Cites: Indian J Chest Dis Allied Sci. 2008 Oct-Dec;50(4):335-4219035052
Cites: Emerg Med J. 2009 Apr;26(4):278-8219307390
Cites: Acad Emerg Med. 2009 Apr;16(4):316-2419298621
Cites: BMJ. 2009;339:b414619875425
Cites: Am J Respir Crit Care Med. 2009 Dec 15;180(12):1189-9519797160
Cites: Arch Intern Med. 2010 Oct 11;170(18):1664-7020937926
Cites: Respirology. 2011 Jan;16(1):146-5120920140
Cites: Lung. 2011 Jun;189(3):225-3221556787
Cites: Respiration. 2012;84(1):17-2622327370
Cites: Prim Care Respir J. 2012 Sep;21(3):295-30122786813
Cites: Thorax. 2012 Nov;67(11):970-622895999
Cites: Acad Emerg Med. 2013 Jan;20(1):17-2623570474
Cites: Med Care. 2013 Jul;51(7):597-60523604015
Cites: J Am Coll Cardiol. 2000 Sep;36(3):959-6910987628
Cites: Eur Respir J. 2001 Mar;17(3):343-911405509
Cites: J Clin Epidemiol. 2001 Aug;54(8):774-8111470385
Cites: Am J Respir Crit Care Med. 2003 Jun 1;167(11):1522-712615634
Cites: N Engl J Med. 2003 Jun 26;348(26):2618-2512826636
Cites: Ann Emerg Med. 1989 May;18(5):523-72497664
Cites: Intensive Care Med. 2004 Sep;30(9):1747-5415258727
Cites: Arch Phys Med Rehabil. 2004 Sep;85(9):1525-3015375829
Cites: Respir Med. 2004 Apr;98(4):318-2915072172
Cites: Chest. 2004 Feb;125(2):473-8114769727
Cites: N Engl J Med. 2003 Dec 25;349(26):2510-814695411
Cites: J Am Geriatr Soc. 2008 May;56(5):909-1318384582
PubMed ID
24549125 View in PubMed
Less detail

Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions.

https://arctichealth.org/en/permalink/ahliterature185825
Source
JAMA. 2003 Apr 16;289(15):1941-9
Publication Type
Article
Date
Apr-16-2003
Author
Paul C Hébert
Dean Fergusson
Morris A Blajchman
George A Wells
Andrew Kmetic
Doug Coyle
Nancy Heddle
Marc Germain
Mindy Goldman
Baldwin Toye
Irwin Schweitzer
Carl vanWalraven
Dana Devine
Graham D Sher
Author Affiliation
University of Ottawa Centre for Transfusion Research, and Clinical Epidemiology Program of the Ottawa Health Research Institute, Ottawa, Ontario, Canada. phebert@ohri.ca
Source
JAMA. 2003 Apr 16;289(15):1941-9
Date
Apr-16-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood Banks - methods - standards
Canada
Cell Separation
Cross Infection - epidemiology
Erythrocyte Transfusion - methods - standards
Female
Filtration
Hospital Mortality
Humans
Intensive Care Units
Leukocytes
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Postoperative Hemorrhage - therapy
Retrospective Studies
Abstract
A number of countries have implemented a policy of universal leukoreduction of their blood supply, but the potential role of leukoreduction in decreasing postoperative mortality and infection is unclear.
To evaluate clinical outcomes following adoption of a national universal prestorage leukoreduction program for blood transfusions.
Retrospective before-and-after cohort study conducted from August 1998 to August 2000 in 23 academic and community hospitals throughout Canada, enrolling 14 786 patients who received red blood cell transfusions following cardiac surgery or repair of hip fracture, or who required intensive care following a surgical intervention or multiple trauma.
Universal prestorage leukoreduction program introduced by 2 Canadian blood agencies. A total of 6982 patients were enrolled during the control period and 7804 patients were enrolled following prestorage leukoreduction.
All-cause in-hospital mortality and serious nosocomial infections (pneumonia, bacteremia, septic shock, all surgical site infections) occurring after first transfusion and at least 2 days after index procedure or intensive care unit admission. Secondary outcomes included rates of posttransfusion fever and antibiotic use.
Unadjusted in-hospital mortality rates were significantly lower following the introduction of leukoreduction compared with the control period (6.19% vs 7.03%, respectively; P =.04). Compared with the control period, the adjusted odds of death following leukoreduction were reduced (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.75-0.99), but serious nosocomial infections did not decrease (adjusted OR, 0.97; 95% CI, 0.87-1.09). The frequency of posttransfusion fevers decreased significantly following leukoreduction (adjusted OR, 0.86; 95% CI, 0.79-0.94), as did antibiotic use (adjusted OR, 0.90; 95% CI, 0.82-0.99).
A national universal leukoreduction program is potentially associated with decreased mortality as well as decreased fever episodes and antibiotic use after red blood cell transfusion in high-risk patients.
Notes
Comment In: JAMA. 2003 Sep 24;290(12):1580; author reply 158014506115
Comment In: JAMA. 2003 Apr 16;289(15):1993-512697804
PubMed ID
12697796 View in PubMed
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Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury.

https://arctichealth.org/en/permalink/ahliterature172691
Source
JAMA. 2005 Sep 28;294(12):1511-8
Publication Type
Article
Date
Sep-28-2005
Author
Ian G Stiell
Catherine M Clement
Brian H Rowe
Michael J Schull
Robert Brison
Daniel Cass
Mary A Eisenhauer
R Douglas McKnight
Glen Bandiera
Brian Holroyd
Jacques S Lee
Jonathan Dreyer
James R Worthington
Mark Reardon
Gary Greenberg
Howard Lesiuk
Iain MacPhail
George A Wells
Author Affiliation
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Source
JAMA. 2005 Sep 28;294(12):1511-8
Date
Sep-28-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Brain Injuries - radiography
Canada
Cohort Studies
Craniocerebral Trauma - radiography
Decision Support Systems, Clinical
Female
Glasgow Coma Scale
Humans
Male
Middle Aged
Prospective Studies
Sensitivity and specificity
Tomography, X-Ray Computed - standards
United States
Abstract
Current use of cranial computed tomography (CT) for minor head injury is increasing rapidly, highly variable, and inefficient. The Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) are previously developed clinical decision rules to guide CT use for patients with minor head injury and with Glasgow Coma Scale (GCS) scores of 13 to 15 for the CCHR and a score of 15 for the NOC. However, uncertainty about the clinical performance of these rules exists.
To compare the clinical performance of these 2 decision rules for detecting the need for neurosurgical intervention and clinically important brain injury.
In a prospective cohort study (June 2000-December 2002) that included 9 emergency departments in large Canadian community and university hospitals, the CCHR was evaluated in a convenience sample of 2707 adults who presented to the emergency department with blunt head trauma resulting in witnessed loss of consciousness, disorientation, or definite amnesia and a GCS score of 13 to 15. The CCHR and NOC were compared in a subgroup of 1822 adults with minor head injury and GCS score of 15.
Neurosurgical intervention and clinically important brain injury evaluated by CT and a structured follow-up telephone interview.
Among 1822 patients with GCS score of 15, 8 (0.4%) required neurosurgical intervention and 97 (5.3%) had clinically important brain injury. The NOC and the CCHR both had 100% sensitivity but the CCHR was more specific (76.3% vs 12.1%, P
Notes
Comment In: ACP J Club. 2006 Mar-Apr;144(2):5316539368
Comment In: JAMA. 2005 Sep 28;294(12):1551-316189370
PubMed ID
16189364 View in PubMed
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Evaluation of the safety of C-spine clearance by paramedics: design and methodology.

https://arctichealth.org/en/permalink/ahliterature137412
Source
BMC Emerg Med. 2011;11:1
Publication Type
Article
Date
2011
Author
Christian Vaillancourt
Manya Charette
Ann Kasaboski
Justin Maloney
George A Wells
Ian G Stiell
Author Affiliation
Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital - Civic Campus, 1053 Carling Avenue, Room F-658, Ottawa, ON, K1Y 4E9, Canada. cvaillancourt@ohri.ca
Source
BMC Emerg Med. 2011;11:1
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Allied Health Personnel - education
Canada
Cohort Studies
Decision Support Techniques
Humans
Immobilization
Prospective Studies
Research Design
Safety
Transportation of Patients - methods - standards
Abstract
Canadian Emergency Medical Services annually transport 1.3 million patients with potential neck injuries to local emergency departments. Less than 1% of those patients have a c-spine fracture and even less (0.5%) have a spinal cord injury. Most injuries occur before the arrival of paramedics, not during transport to the hospital, yet most patients are transported in ambulances immobilized. They stay fully immobilized until a bed is available, or until physician assessment and/or X-rays are complete. The prolonged immobilization is often unnecessary and adds to the burden of already overtaxed emergency medical services systems and crowded emergency departments.
The goal of this study is to evaluate the safety and potential impact of an active strategy that allows paramedics to assess very low-risk trauma patients using a validated clinical decision rule, the Canadian C-Spine Rule, in order to determine the need for immobilization during transport to the emergency department.This cohort study will be conducted in Ottawa, Canada with one emergency medical service. Paramedics with this service participated in an earlier validation study of the Canadian C-Spine Rule. Three thousand consecutive, alert, stable adult trauma patients with a potential c-spine injury will be enrolled in the study and evaluated using the Canadian C-Spine Rule to determine the need for immobilization. The outcomes that will be assessed include measures of safety (numbers of missed fractures and serious adverse outcomes), measures of clinical impact (proportion of patients transported without immobilization, key time intervals) and performance of the Rule.
Approximately 40% of all very low-risk trauma patients could be transported safely, without c-spine immobilization, if paramedics were empowered to make clinical decisions using the Canadian C-Spine Rule. This safety study is an essential step before allowing all paramedics across Canada to selectively immobilize trauma victims before transport. Once safety and potential impact are established, we intend to implement a multi-centre study to study actual impact.
Notes
Cites: JAMA. 2001 Oct 17;286(15):1841-811597285
Cites: Ann Emerg Med. 2001 Dec;38(6):703-411719755
Cites: Prehosp Emerg Care. 2002 Oct-Dec;6(4):421-412385610
Cites: Acad Emerg Med. 2003 Feb;10(2):146-5012574012
Cites: N Engl J Med. 2003 Dec 25;349(26):2510-814695411
Cites: Adv Data. 2004 Mar 18;(340):1-3415068333
Cites: Lancet. 1974 Jul 13;2(7872):81-44136544
Cites: N Engl J Med. 1979 May 24;300(21):1213-6431650
Cites: N Engl J Med. 1981 Oct 1;305(14):783-97266631
Cites: N Engl J Med. 1984 Mar 1;310(9):573-76694708
Cites: N Engl J Med. 1984 Mar 1;310(9):577-806694709
Cites: Ann Emerg Med. 1984 Oct;13(10):905-76476515
Cites: N Engl J Med. 1985 Sep 26;313(13):793-93897864
Cites: Ann Emerg Med. 1986 Jan;15(1):44-93942356
Cites: Arch Intern Med. 1986 Jan;146(1):81-33510600
Cites: Ann Intern Med. 1986 Oct;105(4):586-913530079
Cites: Am J Surg. 1986 Dec;152(6):643-83789288
Cites: Am J Surg. 1987 May;153(5):473-83578669
Cites: Ann Emerg Med. 1987 Jul;16(7):738-423592327
Cites: J Trauma. 1987 Sep;27(9):980-63656481
Cites: Arch Intern Med. 1987 Dec;147(12):2155-613689067
Cites: J Trauma. 1989 Oct;29(10):1438-92509727
Cites: J Trauma. 1990 May;30(5):623-62188001
Cites: J Emerg Med. 1990 Mar-Apr;8(2):177-822362120
Cites: AJR Am J Roentgenol. 1990 Sep;155(3):465-722117342
Cites: J Gen Intern Med. 1990 Nov-Dec;5(6):528-92266437
Cites: Am Surg. 1991 Jun;57(6):366-92048847
Cites: Emerg Med Clin North Am. 1991 Nov;9(4):733-421915045
Cites: Orthopedics. 1992 Feb;15(2):179-831738720
Cites: Ann Emerg Med. 1992 Jun;21(6):719-221590614
Cites: J Emerg Med. 1992 Sep-Oct;10(5):539-441401852
Cites: J Trauma. 2002 Oct;53(4):744-5012394877
Cites: J Trauma. 1988 Jun;28(6):784-83385821
Cites: Ann Emerg Med. 1988 Aug;17(8):792-63394981
Cites: Ann Emerg Med. 1988 Sep;17(9):906-113046446
Cites: Ann Emerg Med. 1988 Sep;17(9):915-83415063
Cites: J Emerg Med. 1988 May-Jun;6(3):203-73049775
Cites: Radiology. 1989 Mar;170(3 Pt 1):831-42492671
Cites: Am J Emerg Med. 1989 Mar;7(2):139-422920074
Cites: Ann Emerg Med. 1992 Dec;21(12):1454-601443841
Cites: J Trauma. 1993 Jan;34(1):32-98437193
Cites: Postgrad Med. 1993 Mar;93(4):205-9, 2128446536
Cites: J Trauma. 1993 Mar;34(3):342-68483172
Cites: J Trauma. 1993 Apr;34(4):549-53; discussion 553-48487340
Cites: Lancet. 1993 Nov 27;342(8883):1317-227901634
Cites: South Med J. 1993 Nov;86(11):1253-58235777
Cites: Ann Emerg Med. 1994 Jan;23(1):48-518273958
Cites: J Emerg Med. 1993 Sep-Oct;11(5):619-208308242
Cites: Ann Emerg Med. 1994 Apr;23(4):797-8018161049
Cites: Arch Surg. 1994 Jun;129(6):643-58204040
Cites: Int J Oral Maxillofac Surg. 1995 Feb;24(1 Pt 1):26-97782637
Cites: Ann Emerg Med. 1995 Jul;26(1):31-67793717
Cites: East Afr Med J. 1995 Mar;72(3):186-87796772
Cites: JAMA. 1997 Feb 12;277(6):488-949020274
Cites: CMAJ. 1997 Jun 1;156(11):1537-449176419
Cites: Acad Emerg Med. 1998 Mar;5(3):214-99523928
Cites: Ann Emerg Med. 1998 Oct;32(4):461-99774931
Cites: Prehosp Emerg Care. 1999 Jan-Mar;3(1):1-69921731
Cites: Ann Emerg Med. 1999 Apr;33(4):437-4710092723
Cites: Ann Emerg Med. 2005 Aug;46(2):123-3116046941
Cites: Ann Emerg Med. 2009 Nov;54(5):663-671.e119394111
Cites: BMJ. 2009;339:b414619875425
Cites: CMAJ. 2010 Aug 10;182(11):1173-920457772
Cites: JAMA. 1999 Oct 20;282(15):1458-6510535437
Cites: N Engl J Med. 2000 Jul 13;343(2):94-910891516
Cites: Acad Emerg Med. 2001 Feb;8(2):112-611157285
Cites: Ann Emerg Med. 2001 Jun;37(6):609-1511385329
PubMed ID
21284880 View in PubMed
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