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Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field.

https://arctichealth.org/en/permalink/ahliterature165764
Source
CJEM. 2006 Nov;8(6):401-7
Publication Type
Article
Date
Nov-2006
Author
Michel R Le May
Richard Dionne
Justin Maloney
John Trickett
Irene Watpool
Michel Ruest
Ian Stiell
Sheila Ryan
Richard F Davies
Author Affiliation
University of Ottawa Heart Institute, Ottawa, ON.
Source
CJEM. 2006 Nov;8(6):401-7
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Ambulances - manpower
Canada
Electrocardiography - utilization
Emergency Medical Technicians - education
Female
Humans
Male
Myocardial Ischemia - drug therapy - pathology
Predictive value of tests
Questionnaires
Thrombolytic Therapy
Time Factors
Abstract
Most studies of pre-hospital management of ST-elevation myocardial infarction (STEMI) have involved physicians accompanying the ambulance crew, or electrocardiogram (ECG) transmission to a physician at the base hospital. We sought to determine if Advanced Care Paramedics (ACPs) could accurately identify STEMI on the pre-hospital ECG and contribute to strategies that shorten time to reperfusion.
A STEMI tool was developed to: 1) measure the accuracy of the ACPs at diagnosing STEMI; and 2) determine the potential time saved if ACPs were to independently administer thrombolytic therapy. Using registry data, we subsequently estimated the time saved by initiating thrombolytic therapy in the field compared with in-hospital administration by a physician.
Between August 2003 and July 2004, a correct diagnosis of STEMI on the pre-hospital ECG was confirmed in 63 patients. The performance of the ACPs in identifying STEMI on the ECG resulted in a sensitivity of 95% (95% confidence interval [CI] 86%-99%), a specificity of 96% (95% CI 94%-98%), a positive predictive value (PPV) of 82% (95% CI 71%-90%), and a negative predictive value (NPV) of 99% (95% CI 97%-100%). ACP performance for appropriately using thrombolytic therapy resulted in a sensitivity of 92% (95% CI 78%-98%), a specificity of 97% (95% CI 94%-98%), a PPV of 73% (95% CI 59%-85%) and an NPV of 99% (95% CI 97%-100%). We estimated that the median time saved by ACP administration of thrombolytic therapy would have been 44 minutes.
ACPs can be trained to accurately interpret the pre-hospital ECG for the diagnosis of STEMI. These results are important for the design of regional integrated programs aimed at reducing delays to reperfusion.
PubMed ID
17209489 View in PubMed
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Hospitalization costs of primary stenting versus thrombolysis in acute myocardial infarction: cost analysis of the Canadian STAT Study.

https://arctichealth.org/en/permalink/ahliterature183003
Source
Circulation. 2003 Nov 25;108(21):2624-30
Publication Type
Article
Date
Nov-25-2003
Author
Michel R Le May
Richard F Davies
Marino Labinaz
Heather Sherrard
Jean-François Marquis
Louise A Laramée
Edward R O'Brien
William L Williams
Rob S Beanlands
Graham Nichol
Lyall A Higginson
Author Affiliation
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada. mlemay@ottawaheart.ca
Source
Circulation. 2003 Nov 25;108(21):2624-30
Date
Nov-25-2003
Language
English
Publication Type
Article
Keywords
Canada
Cardiac Catheterization - statistics & numerical data
Cost-Benefit Analysis
Follow-Up Studies
Hospital Costs - statistics & numerical data
Hospitalization - economics - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Middle Aged
Multivariate Analysis
Myocardial Infarction - economics - therapy
Outcome Assessment (Health Care)
Patient Readmission - statistics & numerical data
Stents - economics - statistics & numerical data
Thrombolytic Therapy - economics - statistics & numerical data
Tissue Plasminogen Activator - economics - therapeutic use
Abstract
We previously showed that primary stenting was more effective than accelerated tPA in reducing the 6-month composite of death, reinfarction, stroke, or repeat revascularization for ischemia. This study looks at the hospitalization costs of primary stenting compared with accelerated tPA.
Initial and 6-month hospitalization costs were computed for all patients randomly assigned to primary stenting (n=62) or accelerated tPA (n=61) in the Stenting versus Thrombolysis in Acute myocardial infarction Trial (STAT). Costs and resource usage were collected in detail for each patient. Physician fees were obtained directly from billings to the Ontario Health Insurance Plan. The length of initial hospitalization was 6.7+/-11.3 days in the stent group and 8.7+/-6.7 days in the tPA group (P
PubMed ID
14597591 View in PubMed
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Perceived usefulness of syndromic surveillance in Ontario during the H1N1 pandemic.

https://arctichealth.org/en/permalink/ahliterature128521
Source
J Public Health (Oxf). 2012 Jun;34(2):195-202
Publication Type
Article
Date
Jun-2012
Author
Rachel Savage
Anna Chu
Laura C Rosella
Natasha S Crowcroft
Monali Varia
Michelle E Policarpio
Norman G Vinson
Anne-Luise Winter
Karen Hay
Richard F Davies
Ian Gemmill
Don Willison
Ian Johnson
Author Affiliation
Surveillance and Epidemiology, Public Health Ontario, Toronto, ON, Canada.
Source
J Public Health (Oxf). 2012 Jun;34(2):195-202
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Data Collection
Health Personnel
Humans
Influenza A Virus, H1N1 Subtype
Influenza, Human - epidemiology
Ontario - epidemiology
Pandemics
Population Surveillance - methods
Abstract
Despite the growing popularity of syndromic surveillance, little is known about if or how these systems are accepted, utilized and valued by end users. This study seeks to describe the use of syndromic surveillance systems in Ontario and users' perceptions of the value of these systems within the context of other surveillance systems.
Ontario's 36 public health units, the provincial ministry of health and federal public health agency completed a web survey to identify traditional and syndromic surveillance systems used routinely and during the pandemic and to describe system attributes and utility in monitoring pandemic activity and informing decision-making.
Syndromic surveillance systems are used by 20/38 (53%) organizations. For routine surveillance, laboratory, integrated Public Health Information System and school absenteeism data are the most frequently used sources. Laboratory data received the highest ratings for reliability, timeliness and accuracy ('very acceptable' by 92, 51 and 89%). Hospital/clinic screening data were rated as the most reliable and timely syndromic data source (50 and 43%) and ED visit data the most accurate (48%). During the pandemic, laboratory data were considered the most useful for monitoring the epidemiology and informing decision-making while ED screening and visit data were considered the most useful syndromic sources.
End user perceptions are valuable for identifying opportunities for improvement and guiding further investments in public health surveillance.
PubMed ID
22194318 View in PubMed
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Prognostic use of cardiac troponin T and troponin I in patients with heart failure.

https://arctichealth.org/en/permalink/ahliterature185756
Source
Can J Cardiol. 2003 Mar 31;19(4):383-6
Publication Type
Article
Date
Mar-31-2003
Author
Jeffrey S Healey
Richard F Davies
Stuart J Smith
Ross A Davies
Daylily S Ooi
Author Affiliation
Division of Cardiology, Ottawa Heart Institute and Department of Medicine, University of Ottawa, Ontario, Canada.
Source
Can J Cardiol. 2003 Mar 31;19(4):383-6
Date
Mar-31-2003
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers
Disease-Free Survival
Female
Heart Failure - blood - diagnosis - mortality - pathology - therapy
Humans
Male
Middle Aged
Ontario - epidemiology
Patient Admission
Predictive value of tests
Prognosis
Prospective Studies
Severity of Illness Index
Troponin I - blood
Troponin T - blood
Abstract
Troponin T (cTnT) and troponin I (cTnI) are present in the sera of some heart failure (HF) patients and have potential importance as prognostic markers.
To prospectively evaluate the prognostic value of cTnT and cTnI in well-characterized HF patients and clarify their relationship to other clinical markers of HF severity.
cTnT and cTnI were measured in 78 HF patients (45 inpatients, 33 outpatients) who were followed up prospectively for 12 months.
Plasma cTnT (> or =0.02 ng/mL) and cTnI (> or =0.3 ng/mL) were detected in 51% and 46% of patients, respectively. These patients were more likely to be inpatients (70% versus 45% for cTnT, 75% versus 43% for cTnI, P
PubMed ID
12704483 View in PubMed
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The use of syndromic surveillance for decision-making during the H1N1 pandemic: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature119353
Source
BMC Public Health. 2012;12:929
Publication Type
Article
Date
2012
Author
Anna Chu
Rachel Savage
Don Willison
Natasha S Crowcroft
Laura C Rosella
Doug Sider
Jason Garay
Ian Gemmill
Anne-Luise Winter
Richard F Davies
Ian Johnson
Author Affiliation
Public Health Ontario, Toronto, ON, Canada.
Source
BMC Public Health. 2012;12:929
Date
2012
Language
English
Publication Type
Article
Keywords
Administrative Personnel - psychology
Computer Systems
Data Collection
Decision Making
Humans
Influenza A Virus, H1N1 Subtype - isolation & purification
Influenza, Human - epidemiology
Interviews as Topic
Ontario - epidemiology
Pandemics
Public Health - standards
Qualitative Research
Risk assessment
Sentinel Surveillance
Abstract
Although an increasing number of studies are documenting uses of syndromic surveillance by front line public health, few detail the value added from linking syndromic data to public health decision-making. This study seeks to understand how syndromic data informed specific public health actions during the 2009 H1N1 pandemic.
Semi-structured telephone interviews were conducted with participants from Ontario's public health departments, the provincial ministry of health and federal public health agency to gather information about syndromic surveillance systems used and the role of syndromic data in informing specific public health actions taken during the pandemic. Responses were compared with how the same decisions were made by non-syndromic surveillance users.
Findings from 56 interviews (82% response) show that syndromic data were most used for monitoring virus activity, measuring impact on the health care system and informing the opening of influenza assessment centres in several jurisdictions, and supporting communications and messaging, rather than its intended purpose of early outbreak detection. Syndromic data had limited impact on decisions that involved the operation of immunization clinics, school closures, sending information letters home with school children or providing recommendations to health care providers. Both syndromic surveillance users and non-users reported that guidance from the provincial ministry of health, communications with stakeholders and vaccine availability were driving factors in these public health decisions.
Syndromic surveillance had limited use in decision-making during the 2009 H1N1 pandemic in Ontario. This study provides insights into the reasons why this occurred. Despite this, syndromic data were valued for providing situational awareness and confidence to support public communications and recommendations. Developing an understanding of how syndromic data are utilized during public health events provides valuable evidence to support future investments in public health surveillance.
Notes
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Cites: MMWR Morb Mortal Wkly Rep. 2005 Aug 26;54 Suppl:117-2216177702
PubMed ID
23110473 View in PubMed
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