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Canadian survey of clinical status at dialysis initiation 1998-1999: a multicenter prospective survey.

https://arctichealth.org/en/permalink/ahliterature188002
Source
Clin Nephrol. 2002 Oct;58(4):282-8
Publication Type
Article
Date
Oct-2002
Author
B M Curtis
B J Barret
K. Jindal
O. Djurdjev
A. Levin
P. Barre
K. Bernstein
P. Blake
E. Carlisle
P. Cartier
C. Clase
B. Culleton
C. Deziel
S. Donnelly
J. Ethier
A. Fine
G. Ganz
M. Goldstein
J. Kappel
G. Karr
S. Langlois
D. Mendelssohn
N. Muirhead
B. Murphy
G. Pylpchuk
E. Toffelmire
Author Affiliation
Division of Nephrology, Memorial University of Newfoundland, Canada.
Source
Clin Nephrol. 2002 Oct;58(4):282-8
Date
Oct-2002
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Canada
Creatinine - urine
Cross-Sectional Studies
Diabetes Mellitus - metabolism - physiopathology - therapy
Female
Food Habits
Glomerular Filtration Rate - physiology
Health Surveys
Humans
Kidney Failure, Chronic - metabolism - physiopathology - therapy
Male
Middle Aged
Prospective Studies
Renal Dialysis
Serum Albumin - metabolism
Treatment Outcome
Urban health
Abstract
The current growth in end-stage kidney disease populations has led to increased efforts to understand the impact of status at dialysis initiation on long-term outcomes. Our main objective was to improve the understanding of current Canadian nephrology practice between October 1998 and December 1999.
Fifteen nephrology centers in 7 provinces participated in a prospective data collection survey. The main outcome of interest was the clinical status at dialysis initiation determined by: residual kidney function, preparedness for chronic dialysis as measured by presence or absence of permanent peritoneal or hemodialysis access, hemoglobin and serum albumin. Uremic symptoms at dialysis initiation were also recorded, however, in some cases these symptom data were obtained retrospectively.
Data on 251 patients during 1-month periods were collected. Patients commenced dialysis at mean calculated creatinine clearance levels of approximately 10 ml/min, with an average of 3 symptoms. 35% of patients starting dialysis had been known to nephrologists for less than 3 months. These patients are more likely to commence without permanent access and with lower hemoglobin and albumin levels. Even of those known to nephrologists, only 66% had permanent access in place.
Patients commencing dialysis in Canada appear to be doing so in relative concordance with published guidelines with respect to timing of initiation. Despite an increased awareness of kidney disease, a substantial number of patients continues to commence dialysis without previous care by a nephrologist. Of those who are seen by nephrologists, clinical and laboratory parameters are suboptimal according to current guidelines. This survey serves as an important baseline for future comparisons after the implementation of educational strategies for referring physicians and nephrologists.
PubMed ID
12400843 View in PubMed
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How reliable is emergency department triage?

https://arctichealth.org/en/permalink/ahliterature201325
Source
Ann Emerg Med. 1999 Aug;34(2):141-7
Publication Type
Article
Date
Aug-1999
Author
C M Fernandes
R. Wuerz
S. Clark
O. Djurdjev
Author Affiliation
University of British Columbia, Vancouver, Canada, Harvard Medical School, Boston, MA, USA. Multicentre Operations Research Group. cfernand@unixg.ubc.ca
Source
Ann Emerg Med. 1999 Aug;34(2):141-7
Date
Aug-1999
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Clinical Competence
Emergency Service, Hospital - standards
Female
Humans
Infant
Male
Middle Aged
Observer Variation
Patient Simulation
Reproducibility of Results
Triage - classification - standards - statistics & numerical data
Abstract
To measure interrater and intrarater agreement for an emergency department triage system.
A 2-phase experimental study was conducted using previously described in-person scripted encounters with emergency nurses who perform patient triage and attending emergency physicians at a tertiary referral center. Standardized patient scenarios were presented twice over 6 weeks. Participants rated severity for each patient using a 5-tier triage system (nurses only) and estimated the probability of hospital admission, the most appropriate time frame to physician evaluation (5 choices, from "Immediate" to "More than 24 hours"), the need for a monitored ED bed, and the need for diagnostic services. Interrater agreement was measured by a coefficient of agreement for multiple raters and multiple categories.
Of the 37 participants (fewer than 90% of those eligible), 19 (51%) completed both phases (12 nurses, 7 physicians). Four (33%) of the nurses assigned the same severity ratings for the 5 cases in phase 2 as they did in phase 1. Intrarater agreement among the 12 nurses rating triage severity was.757. Interrater agreement of nurses and physicians was substantial regarding need for ED monitoring, and moderate to substantial for other triage assessments.
There was general agreement in interrater assessment of triage classification. Continued work is necessary to more fully delineate areas of variation.
PubMed ID
10424913 View in PubMed
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Obstacles to residents' conducting research and predictors of publication.

https://arctichealth.org/en/permalink/ahliterature194716
Source
Acad Med. 2001 May;76(5):477
Publication Type
Article
Date
May-2001
Author
S. Gill
A. Levin
O. Djurdjev
E M Yoshida
Author Affiliation
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Source
Acad Med. 2001 May;76(5):477
Date
May-2001
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
British Columbia
Chi-Square Distribution
Education, Medical, Graduate - organization & administration
Female
Humans
Internal Medicine - education
Internship and Residency - organization & administration
Male
Medical Staff, Hospital - education - psychology
Mentors
Multivariate Analysis
Organizational Culture
Predictive value of tests
Proportional Hazards Models
Publishing - organization & administration
Questionnaires
Research - organization & administration
Schools, Medical - organization & administration
Time Factors
Workload
Abstract
Internal medicine residents at one school identified barriers to and predictors of publishing their research. Insufficient time was the key obstacle to completing research. Residents with previous research experience, senior residents, and men were more likely to publish.
PubMed ID
11346527 View in PubMed
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Validation of the modified multisystem organ failure score as a predictor of mortality in patients with AIDS-related Pneumocystis carinii pneumonia and respiratory failure.

https://arctichealth.org/en/permalink/ahliterature205067
Source
Chest. 1998 Jul;114(1):199-206
Publication Type
Article
Date
Jul-1998
Author
D M Forrest
O. Djurdjev
C. Zala
J. Singer
L. Lawson
J A Russell
J S Montaner
Author Affiliation
British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
Source
Chest. 1998 Jul;114(1):199-206
Date
Jul-1998
Language
English
Publication Type
Article
Keywords
AIDS-Related Opportunistic Infections - mortality
APACHE
Acute Disease
Adult
Area Under Curve
British Columbia - epidemiology
Female
Forecasting
Humans
Intensive Care
L-Lactate Dehydrogenase - analysis
Male
Middle Aged
Multiple Organ Failure - diagnosis
Patient Admission
Patient Discharge
Pneumonia, Pneumocystis - mortality
Prognosis
ROC Curve
Reproducibility of Results
Respiratory Distress Syndrome, Adult - diagnosis
Respiratory Insufficiency - mortality
Retrospective Studies
Severity of Illness Index
Survival Rate
Abstract
To validate a previously developed multisystem organ failure (MSOF) score with and without the addition of the lactate dehydrogenase (LDH) level as a predictor of survival to hospital discharge in patients with AIDS-related Pneumocystis carinii pneumonia (PCP) and acute respiratory failure (ARF).
Retrospective chart review between April 1, 1991, and September 30, 1996.
University-affiliated tertiary care center in downtown Vancouver, British Columbia, Canada.
All patients with PCP-related ARF admitted to the ICU of St. Paul's Hospital during the study period.
As putative prognostic instruments, data were extracted regarding the APACHE II (acute physiology and chronic health evaluation II), acute lung injury (ALI), AIDS, and modified MSOF scores, as well as LDH levels, at entry to the ICU. Patients were stratified based on an LDH level of or = 2,000 U/L and this threshold was assessed in its predictability of outcome when added to each of the above scores. For APACHE II, the score was categorized in six groups and evaluated with and without inclusion of the LDH. Receiver operating characteristic curves were constructed for LDH and for each score with and without the LDH level to assess accuracy of prediction. The area under each curve was calculated and compared to estimate the statistical significance of observed differences.
There were 40 admissions to the ICU of 38 patients with 52.5% mortality. The ALI and AIDS scores were not predictive of outcome. The modified MSOF and APACHE II scores were significant predictors of survival and the performance of both was enhanced by the addition of LDH.
Both the APACHE II and the modified MSOF scores were significant predictors of outcome in the patient population studied. These results validate the modified MSOF score as an effective predictor of survival to hospital discharge among patients with AIDS-related PCP who develop ARF and the performance of the score is enhanced by the addition of the LDH level.
PubMed ID
9674470 View in PubMed
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