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Accuracy of healthcare worker recall and medical record review for identifying infectious exposures to hospitalized patients.

https://arctichealth.org/en/permalink/ahliterature168575
Source
Infect Control Hosp Epidemiol. 2006 Jul;27(7):722-8
Publication Type
Article
Date
Jul-2006
Author
M. Aquino
J M Raboud
A. McGeer
K. Green
R. Chow
P. Dimoulas
M. Loeb
D. Scales
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 2006 Jul;27(7):722-8
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Disease Transmission, Infectious
Environmental Exposure
Hospitalization
Humans
Inpatients
Medical Audit
Mental Recall
Ontario
Personnel, Hospital
Abstract
To determine the validity of using healthcare worker (HCW) recall of patient interactions and medical record review for contact tracing in a critical care setting.
Trained observers recorded the interactions of nurses, respiratory therapists, and service assistants with study patients in a medical-surgical intensive care unit. These observers' records were used as the reference standard to test the criterion validity of using HCW recall data or medical record review data to identify exposure characteristics. We assessed the effects of previous quarantine of the HCW (because of possible exposure) and the availability of patients' medical records for use as memory aids on the accuracy of HCW recall.
A 10-bed medical-surgical intensive care unit at Mount Sinai Hospital in Toronto, Ontario.
Thirty-six HCWs observed caring for 16 patients, for a total of 55 healthcare worker shifts.
Recall accuracy was better among HCWs who were provided with patient medical records as memory aids (P
PubMed ID
16807848 View in PubMed
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Assay of HIV gp41 amino acid sequence to identify baseline variation and mutation development in patients with virologic failure on enfuvirtide.

https://arctichealth.org/en/permalink/ahliterature165857
Source
Antiviral Res. 2007 Jul;75(1):58-63
Publication Type
Article
Date
Jul-2007
Author
M R Loutfy
J M Raboud
J S G Montaner
T. Antoniou
B. Wynhoven
F. Smaill
D. Rouleau
J. Gill
W. Schlech
Z L Brumme
T. Mo
K. Gough
A. Rachlis
P R Harrigan
S L Walmsley
Author Affiliation
University of Toronto, Toronto, Ont., Canada. mloutfy@nygh.on.ca
Source
Antiviral Res. 2007 Jul;75(1):58-63
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adult
Amino Acid Sequence
Amino Acid Substitution
Base Pairing
Base Sequence
Canada - epidemiology
Codon
Drug Resistance, Viral - genetics
Female
Genetic Variation
HIV Envelope Protein gp41 - blood - therapeutic use
HIV Fusion Inhibitors - blood - therapeutic use
HIV Infections - blood - epidemiology - virology
HIV-1 - drug effects - genetics
Humans
Male
Middle Aged
Molecular Sequence Data
Mutagenesis, Insertional
Mutation
Peptide Fragments - blood - therapeutic use
Polymorphism, Genetic
Prevalence
RNA, Viral - blood - genetics
Reproducibility of Results
Retrospective Studies
Reverse Transcriptase Polymerase Chain Reaction
Sequence Analysis, DNA
Sequence Homology, Amino Acid
Abstract
In this study, we retrospectively assessed a gp41 genotypic assay in 404 enfuvirtide-na?ve individuals (340 clade B, 64 non-B clade) to determine the prevalence of baseline polymorphisms and in 41 patients virologically failing enfuvirtide to determine correlates of resistance to this agent. Conserved and polymorphic regions of gp41 were identified in clade B isolates, with 127 of 328 codons (38.7%) being highly conserved (
PubMed ID
17196268 View in PubMed
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A computer model to simulate family history of breast/ovarian cancer in BRCA1 mutation carriers.

https://arctichealth.org/en/permalink/ahliterature194900
Source
Math Biosci. 2001 May;171(1):99-111
Publication Type
Article
Date
May-2001
Author
C D Bajdik
J M Raboud
M T Schechter
B C McGillivray
R P Gallagher
Author Affiliation
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada. cbajdik@bccancer.bc.ca
Source
Math Biosci. 2001 May;171(1):99-111
Date
May-2001
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - epidemiology - genetics
British Columbia - epidemiology
Computer simulation
Family Health
Female
Genes, BRCA1 - genetics
Genetic Predisposition to Disease - genetics
Germ-Line Mutation - genetics
Humans
Middle Aged
Models, Genetic
Ovarian Neoplasms - epidemiology - genetics
Pedigree
Abstract
The BRCA1 gene and its relationship to family history of breast/ovarian cancer are difficult to study in a population because of practical and ethical issues. The paucity of information on BRCA1 in the general population was a major theme in a recent review of genetic testing in Canada. We develop a simulation model to mimic genetic inheritance and cancer incidence in the family of someone with a germline BRCA1 mutation. Given someone's age and family structure, our model simulates his or her family history in three steps: (1) determine which family members have the mutation, (2) determine the ages of family members and (3) determine which family members have breast/ovarian cancer. Each step involves random variation. Some parameters in our model are estimated using local (British Columbia, Canada) population data. The breast/ovarian cancer risk associated with BRCA1 mutations is estimated using values published in the literature. An example is provided to illustrate the model's application. The model incorporates results from genetics, demography and epidemiology, but requires several additional assumptions. Research to address these assumptions is recommended.
PubMed ID
11325386 View in PubMed
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Estimating the effect of treatment on quality of life in the presence of missing data due to drop-out and death.

https://arctichealth.org/en/permalink/ahliterature204588
Source
Qual Life Res. 1998 Aug;7(6):487-94
Publication Type
Article
Date
Aug-1998
Author
J M Raboud
J. Singer
A. Thorne
M T Schechter
S D Shafran
Author Affiliation
Department of Health Care and Epidemiology, University of British Columbia, Canada. jraboud@hivnet.ubc.ca
Source
Qual Life Res. 1998 Aug;7(6):487-94
Date
Aug-1998
Language
English
Publication Type
Article
Keywords
AIDS-Related Opportunistic Infections - drug therapy - microbiology
Bacteremia - drug therapy - microbiology
Canada
Clinical Trials as Topic - methods
Humans
Logistic Models
Mycobacterium avium Complex
Patient Dropouts - statistics & numerical data
Quality of Life
Statistics, nonparametric
Abstract
Quality of life was measured in a study of two multidrug regimens for mycobacterium avium complex MAC bactaeremia using the MOS-HIV questionnaire. The effect of treatment on quality of life was estimated at each follow-up time in three ways: (1) using only the observed data, (2) after assigning the worst possible quality of life scores for individuals who died, and (3) after imputing missing scores for patients who either died or dropped out of the study. The overall quality of life scores were also compared between treatment groups with categorical generalized estimating equation models and three-dimensional graphs. Of the 179 patients included in these analyses, 84 (47%) either died or dropped out during the 16 week study period. When the quality of life scores were compared between the treatment groups with the Wilcoxon rank sum test using only the observed data, there was no significant difference between the groups at 16 weeks of follow-up. When the worst possible quality of life scores were assumed for patients who had died, both the magnitude and the statistical significance of the difference in the quality of life scores between the groups increased. Imputing missing data for patients who either dropped out or died resulted in even larger differences in quality of life between the treatment groups. We conclude that ignoring missing data due to drop-outs and death can result in an underestimation of the treatment effect and overly optimistic statements about the outcome of the participants on both treatment arms due to the selective drop-out of participants with poorer quality of life. To obtain a valid assessment of the effect of treatment on quality of life, the experience of the patients who died or dropped out of the study must be considered.
PubMed ID
9737138 View in PubMed
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Factors associated with critical-care healthcare workers' adherence to recommended barrier precautions during the Toronto severe acute respiratory syndrome outbreak.

https://arctichealth.org/en/permalink/ahliterature160928
Source
Infect Control Hosp Epidemiol. 2007 Nov;28(11):1275-83
Publication Type
Article
Date
Nov-2007
Author
A. Shigayeva
K. Green
J M Raboud
B. Henry
A E Simor
M. Vearncombe
D. Zoutman
M. Loeb
A. McGeer
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.
Source
Infect Control Hosp Epidemiol. 2007 Nov;28(11):1275-83
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Adult
Allied Health Personnel
Critical Care
Disease Outbreaks
Female
Guideline Adherence
Humans
Infection Control - methods
Male
Middle Aged
Ontario
Protective Clothing - utilization
Retrospective Studies
Severe Acute Respiratory Syndrome - prevention & control - therapy
Abstract
To assess factors associated with adherence to recommended barrier precautions among healthcare workers (HCWs) providing care to critically ill patients with severe acute respiratory syndrome (SARS).
Fifteen acute care hospitals in Ontario, Canada.
Retrospective cohort study.
All patients with SARS who required intubation during the Toronto SARS outbreak in 2003.
HCWs who provided care to or entered the room of a SARS patient during the period from 24 hours before intubation until 4 hours after intubation.
Standardized interviews were conducted with eligible HCWs to assess their interactions with the SARS patient, their use of barrier precautions, their practices for removing personal protective equipment, and the infection control training they received.
Of 879 eligible HCWs, 795 (90%) participated. In multivariate analysis, the following predictors of consistent adherence to recommended barrier precautions were identified: recognition of the patient as a SARS case (odds ratio [OR], 2.5 [95% confidence interval {CI}, 1.5-4.5); recent infection control training (OR for interactive training, 2.7 [95% CI, 1.7-4.4]; OR for passive training, 1.7 [95% CI, 1.0-3.0]), and working in a SARS unit (OR, 4.0 [95% CI, 1.8-8.9]) or intensive care unit (OR, 4.3 [95% CI, 2.0-9.0]). Two factors were associated with significantly lower rates of consistent adherence: the provision of care for patients with higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (OR for score APACHE II of 20 or greater, 0.4 [95% CI, 0.28-0.68]) and work on shifts that required more frequent room entry (OR for 6 or more entries per shift, 0.5 [95% CI, 0.32-0.86]).
There were significant deficits in knowledge about self-protection that were partially corrected by education programs during the SARS outbreak. HCWs' adherence to self-protection guidelines was most closely associated with whether they provided care to patients who had received a definite diagnosis of SARS.
PubMed ID
17926279 View in PubMed
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The impact of needle-exchange programs on the spread of HIV among injection drug users: a simulation study.

https://arctichealth.org/en/permalink/ahliterature185047
Source
J Urban Health. 2003 Jun;80(2):302-20
Publication Type
Article
Date
Jun-2003
Author
J M Raboud
M C Boily
J. Rajeswaran
M V O'Shaughnessy
M T Schechter
Author Affiliation
Division of Infectious Disease, University Health Network, University of Toronto, Ontario, Canada. rabound@mshri.on.ca
Source
J Urban Health. 2003 Jun;80(2):302-20
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
British Columbia - epidemiology
HIV Infections - complications - epidemiology - prevention & control - transmission
Humans
Monte Carlo Method
Needle Sharing - adverse effects
Needle-Exchange Programs
Program Evaluation
Substance Abuse, Intravenous - complications - virology
Abstract
To determine the impact of the implementation of a needle-exchange program (NEP) on the spread of human immunodeficiency virus (HIV) in an injection drug user (IDU) community. We conducted a Monte Carlo simulation study of a theoretical population of 10000 IDUs. The population was followed monthly from 1984 to 2000. HIV was assumed to be transmitted only by needle sharing. The NEP was introduced in 1989 and evaluated over a period of 11 years. The impacts of the proportion of the population attending the NEP, the risk level of IDUs attending the NEP, the reduction in needle-sharing frequency, and the number of new needle-sharing partners acquired at the NEP on prevalence and incidence of HIV were determined. Increasing the proportion of the population who always attend the NEP and eliminating needle-sharing incidents among IDUs who always attended the NEP were the most effective ways of reducing the spread of HIV. Attracting high-risk users instead of lower risk users to the NEP also reduced the spread of HIV, but to a lesser extent. NEPs are effective at reducing the spread of HIV; even under the worst case scenario of low risk users more likely to attend the NEP, one additional partner per month as a result of attending the NEP, and poor NEP attendance, the estimated prevalence was still less than that from the scenario without an NEP. Under our model, NEPs were shown to reduce the spread of HIV significantly. Efforts should be focused on getting as many IDUs as possible to become regular NEP attenders and stop sharing needles rather than partially reducing the frequency of sharing by a larger number of IDUs.
Notes
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PubMed ID
12791806 View in PubMed
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Suppression of plasma virus load below the detection limit of a human immunodeficiency virus kit is associated with longer virologic response than suppression below the limit of quantitation.

https://arctichealth.org/en/permalink/ahliterature200922
Source
J Infect Dis. 1999 Oct;180(4):1347-50
Publication Type
Article
Date
Oct-1999
Author
J M Raboud
S. Rae
R S Hogg
B. Yip
C H Sherlock
P R Harrigan
M V O'Shaughnessy
J S Montaner
Author Affiliation
Data and Methodology Program, Canadian HIV Trials Network, Vancouver, Canada.
Source
J Infect Dis. 1999 Oct;180(4):1347-50
Date
Oct-1999
Language
English
Publication Type
Article
Keywords
Acquired Immunodeficiency Syndrome - blood - drug therapy - virology
Adult
Anti-HIV Agents - therapeutic use
British Columbia
Confidence Intervals
Double-Blind Method
Drug Therapy, Combination
Female
HIV Infections - blood - drug therapy - virology
HIV Protease Inhibitors - therapeutic use
HIV-1 - isolation & purification
Humans
Male
RNA, Viral - blood
Reagent kits, diagnostic
Reverse Transcriptase Inhibitors - therapeutic use
Sensitivity and specificity
Time Factors
Viral Load - instrumentation - methods
Abstract
Suppression of human immunodeficiency virus type 1 plasma virus load (PVL) to 500 copies/mL, the relative risks of PVL rising above 1000 copies/mL for participants in the INCAS trial and the British Columbia Drug Treatment Program with a PVL nadir below the limit of detection (LOD) were 0.04 (95% confidence interval [CI], 0.02-0.09) and 0.06 (95% CI, 0.03-0.12), respectively. The corresponding relative risks for persons with a detectable but not quantifiable PVL nadir were 0.25 (95% CI, 0.13-0.50) and 0.54 (95% CI, 0.25-1.19). The relative risks of virologic failure associated with a PVL nadir detectable but not quantifiable and a PVL nadir below the LOD were statistically different (P
PubMed ID
10479170 View in PubMed
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Symptomatic and health status outcomes in the Canadian randomized MAC treatment trial (CTN010). Canadian HIV Trials Network Protocol 010 Study Group.

https://arctichealth.org/en/permalink/ahliterature198840
Source
Int J STD AIDS. 2000 Apr;11(4):212-9
Publication Type
Article
Date
Apr-2000
Author
J. Singer
A. Thorne
S. Khorasheh
J M Raboud
A W Wu
I. Salit
C M Tsoukas
C. Lemieux
S D Shafran
Author Affiliation
Canadian HIV Trials Network, St Paul's Hospital, Vancouver, BC. joel@hivnet.ubc.ca
Source
Int J STD AIDS. 2000 Apr;11(4):212-9
Date
Apr-2000
Language
English
Publication Type
Article
Keywords
AIDS-Related Opportunistic Infections - drug therapy - physiopathology
Adolescent
Adult
Antitubercular Agents - therapeutic use
Bacteremia - drug therapy - physiopathology
Canada
Ciprofloxacin - therapeutic use
Clarithromycin - therapeutic use
Clofazimine - therapeutic use
Drug Therapy, Combination
Ethambutol - therapeutic use
Health status
Humans
Mycobacterium avium-intracellulare Infection - drug therapy - physiopathology
Outcome and Process Assessment (Health Care)
Rifabutin - therapeutic use
Rifampin - therapeutic use
Treatment Outcome
Abstract
Our objective was to compare the effect of 2 regimens for treatment of Mycobacterium avium complex (MAC) bacteraemia in an HIV-positive population on symptoms and health status outcomes using a substudy of an open-label randomized controlled trial. The study was conducted in 24 hospital-based human immunodeficiency virus (HIV) clinics in 16 Canadian cities. Patients had HIV infection and MAC bacteraemia and were given either rifampin 600 mg, ethambutol 15 mg/kg daily, clofazimine 100 mg daily and ciprofloxacin 750 mg twice daily (4-drug arm) or rifabutin 600 mg daily (amended to 300 mg daily in mid-trial), ethambutol 15 mg/kg daily and clarithromycin 1000 mg twice daily (3-drug arm). The primary health status outcome was the change on the 8-item symptom subscale of the Medical Outcome Study (MOS)-HIV Health Survey adapted for MAC. Changes on other MOS-HIV subscales and on the Karnofsky score were also evaluated. Patients on the 3-drug arm had better outcomes on the MOS-HIV symptom subscale at 16 weeks (P=0.06), with statistically significant differences restricted to night sweats and fever and chills (P
PubMed ID
10772083 View in PubMed
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Variability in leukocyte subset measurements among five laboratories in Vancouver.

https://arctichealth.org/en/permalink/ahliterature214222
Source
Clin Invest Med. 1995 Oct;18(5):349-56
Publication Type
Article
Date
Oct-1995
Author
K. Mandigo
J M Raboud
L. Haley
J S Montaner
Author Affiliation
Canadian HIV Trials Network, Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver.
Source
Clin Invest Med. 1995 Oct;18(5):349-56
Date
Oct-1995
Language
English
Publication Type
Article
Keywords
British Columbia
CD4 Lymphocyte Count
HIV Infections - blood
Humans
Laboratories - standards
Lymphocyte Count
Lymphocyte Subsets
Prospective Studies
Abstract
Cell counts and percentages of CD4 are widely used in the prognostic and clinical management of HIV-infected patients, and as surrogate outcomes in clinical trials involving HIV-infected individuals. Considerable variability in CD4 counts has been documented due to physiologic and methodologic factors. While studies of variability of CD4 counts among American and French laboratories have been reported in the literature, no published data are available for Canadian laboratories. This paper describes the results of a study to determine the variability of leukocyte subsets among 5 laboratories in Vancouver, British Columbia. Samples were collected in a prospective fashion from 52 HIV-negative patients from July 1991 to November 1993. Coefficients of variation (CV) were calculated for leukocyte subset percentages and absolute cell counts among laboratories. Our results demonstrate that the variability in leukocyte subsets among 5 Vancouver laboratories was lower than or comparable with published findings. The variability remained stable over the time period of the study, although 4 of the 5 laboratories participated in quality assurance programs. This suggests a plateau in the impact of this program. Since the variability among laboratories is less than the variability attributable to physiologic factors, further research efforts to reduce this variability should focus on physiologic sources.
PubMed ID
8529317 View in PubMed
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Violence in the emergency department: a survey of health care workers.

https://arctichealth.org/en/permalink/ahliterature200077
Source
CMAJ. 1999 Nov 16;161(10):1245-8
Publication Type
Article
Date
Nov-16-1999
Author
C M Fernandes
F. Bouthillette
J M Raboud
L. Bullock
C F Moore
J M Christenson
E. Grafstein
S. Rae
L. Ouellet
C. Gillrie
M. Way
Author Affiliation
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC. cfernand@unixg.ubc.ca
Source
CMAJ. 1999 Nov 16;161(10):1245-8
Date
Nov-16-1999
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Aggression
Attitude of Health Personnel
Attitude to Health
British Columbia - epidemiology
Efficiency
Emergency Service, Hospital
Exercise
Female
Hospitals, Urban
Humans
Incidence
Interpersonal Relations
Job Satisfaction
Male
Occupational Health
Personnel Turnover
Personnel, Hospital
Professional-Patient Relations
Retrospective Studies
Security Measures
Sleep
Stress, Physiological - epidemiology
Stress, Psychological - epidemiology
Violence - prevention & control - statistics & numerical data
Workplace
Abstract
Violence in the workplace is an ill-defined and underreported concern for health care workers. The objectives of this study were to examine perceived levels of violence in the emergency department, to obtain health care workers' definitions of violence, to determine the effect of violence on health care workers and to determine coping mechanisms and potential preventive strategies.
A retrospective written survey of all 163 emergency department employees working in 1996 at an urban inner-city tertiary care centre in Vancouver. The survey elicited demographic information, personal definition of violence, severity of violence, degree of stress as a result of violence and estimate of the number of encounters with violence in the workplace in 1996. The authors examined the effects of violence on job performance and job satisfaction, and reviewed coping and potential preventive strategies.
Of the 163 staff, 106 (65%) completed the survey. A total of 68% (70/103) reported an increased frequency of violence over time, and 60% (64/106) reported an increased severity. Most of the respondents felt that violence included witnessing verbal abuse (76%) and witnessing physical threats or assaults (86%). Sixty respondents (57%) were physically assaulted in 1996. Overall, 51 respondents (48%) reported impaired job performance for the rest of the shift or the rest of the week after an incident of violence. Seventy-seven respondents (73%) were afraid of patients as a result of violence, almost half (49%) hid their identities from patients, and 78 (74%) had reduced job satisfaction. Over one-fourth of the respondents (27/101) took days off because of violence. Of the 18 respondents no longer working in the emergency department, 12 (67%) reported that they had left the job at least partly owing to violence. Twenty-four-hour security and a workshop on violence prevention strategies were felt to be the most useful potential interventions. Physical exercise, sleep and the company of family and friends were the most frequent coping strategies.
Violence in the emergency department is frequent and has a substantial effect on staff well-being and job satisfaction.
Notes
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Comment In: CMAJ. 2000 Feb 22;162(4):490, 49210701376
Comment In: CMAJ. 1999 Nov 16;161(10):1262-310584087
PubMed ID
10584084 View in PubMed
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12 records – page 1 of 2.