Skip header and navigation

Refine By

96 records – page 1 of 10.

Absence of bias against smokers in access to coronary revascularization after cardiac catheterization.

https://arctichealth.org/en/permalink/ahliterature176495
Source
Int J Qual Health Care. 2005 Feb;17(1):37-42
Publication Type
Article
Date
Feb-2005
Author
Jacques Cornuz
Peter D Faris
P Diane Galbraith
Merril L Knudtson
William A Ghali
Author Affiliation
Department of Medicine, University of Lausanne, Lausanne, Switzerland.
Source
Int J Qual Health Care. 2005 Feb;17(1):37-42
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Alberta - epidemiology
Angioplasty, Balloon, Coronary - utilization
Attitude of Health Personnel
Cardiac Catheterization - utilization
Cohort Studies
Coronary Artery Bypass - utilization
Coronary Disease - diagnosis - therapy
Female
Humans
Male
Middle Aged
Myocardial Revascularization - utilization
Prejudice
Prospective Studies
Smoking - epidemiology
Abstract
Many consider smoking to be a personal choice for which individuals should be held accountable. We assessed whether there is any evidence of bias against smokers in cardiac care decision-making by determining whether smokers were as likely as non-smokers to undergo revascularization procedures after cardiac catheterization.
Prospective cohort study. Subjects and setting. All patients undergoing cardiac catheterization in Alberta, Canada.
Patients were categorized as current smokers, former smokers, or never smokers, and then compared for their risk-adjusted likelihood of undergoing revascularization procedures (percutaneous coronary intervention or coronary artery bypass grafting) after cardiac catheterization.
Among 20406 patients undergoing catheterization, 25.4% were current smokers at the time of catheterization, 36.6% were former smokers, and 38.0% had never smoked. When compared with never smokers (reference group), the hazard ratio for undergoing any revascularization procedure after catheterization was 0.98 (95% CI 0.93-1.03) for current smokers and 0.98 (0.94-1.03) for former smokers. The hazard ratio for undergoing coronary artery bypass grafting was 1.09 (1.00-1.19) for current smokers and 1.00 (0.93-1.08) for former smokers. For percutaneous coronary intervention, the hazard ratios were 0.93 (0.87-0.99) for current smokers and 1.00 (0.94-1.06) for former smokers.
Despite potential for discrimination on the basis of smoking status, current and former smokers undergoing cardiac catheterization in Alberta, Canada were as likely to undergo revascularization procedures as catheterization patients who had never smoked.
PubMed ID
15668309 View in PubMed
Less detail

Absence of sex differences in pharmacotherapy for acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature179138
Source
Can J Cardiol. 2004 Jul;20(9):899-905
Publication Type
Article
Date
Jul-2004
Author
Susan E Jelinski
William A Ghali
Gerry A Parsons
Colleen J Maxwell
Author Affiliation
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Source
Can J Cardiol. 2004 Jul;20(9):899-905
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Anticoagulants - therapeutic use
Aspirin - therapeutic use
Calcium Channel Blockers - therapeutic use
Canada - epidemiology
Cohort Studies
Drug Evaluation
Drug Therapy
Female
Fibrinolytic Agents - therapeutic use
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - drug therapy
Patient Admission
Platelet Aggregation Inhibitors - therapeutic use
Sex Factors
Urban health
Abstract
Previous studies have indicated that sex differences may exist in the pharmacological management of acute myocardial infarction (AMI), with female patients being treated less aggressively.
To determine if previously reported sex differences in AMI medication use were also evident among all AMI patients treated at hospitals in an urban Canadian city.
All patients who had a primary discharge diagnosis of AMI from all three adult care hospitals in Calgary, Alberta, in the 1998/1999 fiscal year were identified from hospital administrative records (n=914). A standardized, detailed chart review was conducted. Information collected from the medical charts included sociodemographic and clinical characteristics, comorbid conditions, and cardiovascular medication use during hospitalization and at discharge.
Similar proportions of female and male patients were treated with thrombolytics, beta-blockers, angiotensin-converting enzyme inhibitors, nitrate, heparin, diuretics and digoxin. Among patients aged 75 years and over, a smaller proportion of female patients received acetylsalicylic acid in hospital than did male patients (87% versus 95%; P=0.026). Multivariable logistic regression analysis revealed that, after correction for age, use of other anticoagulants/antiplatelets and death within 24 h of admission, sex was no longer an independent predictor for receipt of acetylsalicylic acid in hospital. Medications prescribed at discharge were similar between male and female patients.
The results from this Canadian chart review study, derived from detailed clinical data, indicate that the pattern of pharmacological treatment of female and male AMI patients during hospitalization and at discharge was very similar. No sex differences were evident in the treatment of AMI among patients treated in an urban Canadian centre.
PubMed ID
15266360 View in PubMed
Less detail

Access to health care among status Aboriginal people with chronic kidney disease.

https://arctichealth.org/en/permalink/ahliterature154422
Source
CMAJ. 2008 Nov 4;179(10):1007-12
Publication Type
Article
Date
Nov-4-2008
Author
Song Gao
Braden J Manns
Bruce F Culleton
Marcello Tonelli
Hude Quan
Lynden Crowshoe
William A Ghali
Lawrence W Svenson
Sofia Ahmed
Brenda R Hemmelgarn
Author Affiliation
Department of Medicine, Division of Nephrology, University of Calgary, Calgary, AB.
Source
CMAJ. 2008 Nov 4;179(10):1007-12
Date
Nov-4-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alberta - epidemiology
Chronic Disease
Creatinine - blood
Delphi Technique
Female
Glomerular Filtration Rate
Health Services Accessibility
Healthcare Disparities
Humans
Indians, North American - statistics & numerical data
Kidney Diseases - epidemiology
Male
Middle Aged
Nephrology
Office visits - statistics & numerical data
Patient Admission - statistics & numerical data
Registries
Severity of Illness Index
Abstract
Ethnic disparities in access to health care and health outcomes are well documented. It is unclear whether similar differences exist between Aboriginal and non-Aboriginal people with chronic kidney disease in Canada. We determined whether access to care differed between status Aboriginal people (Aboriginal people registered under the federal Indian Act) and non-Aboriginal people with chronic kidney disease.
We identified 106 511 non-Aboriginal and 1182 Aboriginal patients with chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m(2)). We compared outcomes, including hospital admissions, that may have been preventable with appropriate outpatient care (ambulatory-care-sensitive conditions) as well as use of specialist services, including visits to nephrologists and general internists.
Aboriginal people were almost twice as likely as non-Aboriginal people to be admitted to hospital for an ambulatory-care-sensitive condition (rate ratio 1.77, 95% confidence interval [CI] 1.46-2.13). Aboriginal people with severe chronic kidney disease (estimated glomerular filtration rate
Notes
Cites: Arch Intern Med. 2000 Jun 26;160(12):1862-610871982
Cites: J Am Soc Nephrol. 2000 Dec;11(12):2351-711095658
Cites: N Engl J Med. 2001 May 10;344(19):1443-911346810
Cites: Can J Public Health. 2001 Mar-Apr;92(2):155-911338156
Cites: Med Care. 2001 Jun;39(6):551-6111404640
Cites: N Engl J Med. 2001 Sep 20;345(12):861-911565518
Cites: Clin Invest Med. 2001 Aug;24(4):164-7011558850
Cites: Lancet. 2001 Oct 6;358(9288):1147-5311597669
Cites: Diabetes Care. 2002 Mar;25(3):512-611874939
Cites: JAMA. 2002 Mar 13;287(10):1288-9411886320
Cites: Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-26611904577
Cites: Med J Aust. 2002 Aug 5;177(3):135-812149081
Cites: Ann Intern Med. 2002 Aug 20;137(4):298-912186531
Cites: Ann Intern Med. 2002 Sep 17;137(6):479-8612230348
Cites: Arch Intern Med. 2002 Sep 23;162(17):2002-612230424
Cites: Am J Public Health. 2003 May;93(5):798-80212721147
Cites: BMJ. 2003 Aug 23;327(7412):419-2212933728
Cites: Nephrol Dial Transplant. 2004 Jul;19(7):1808-1415199194
Cites: CMAJ. 2004 Sep 14;171(6):577-8215367459
Cites: Health Rep. 1993;5(2):179-888292757
Cites: Am J Public Health. 1996 Apr;86(4):520-48604782
Cites: CMAJ. 1996 Dec 1;155(11):1569-788956834
Cites: Health Econ. 1997 Mar-Apr;6(2):197-2079158971
Cites: Health Rep. 1998 Spring;9(4):49-58(Eng); 51-61(Fre)9836880
Cites: Ann Intern Med. 1999 Mar 16;130(6):461-7010075613
Cites: Am J Kidney Dis. 1999 Apr;33(4):728-3310196016
Cites: J Am Soc Nephrol. 2005 Feb;16(2):459-6615615823
Cites: Can J Public Health. 2005 Jan-Feb;96 Suppl 1:S39-4415686152
Cites: J Am Soc Nephrol. 2007 Nov;18(11):2953-917942955
Comment In: CMAJ. 2008 Nov 4;179(10):985-618981431
PubMed ID
18981441 View in PubMed
Less detail

Adapting the Charlson Comorbidity Index for use in patients with ESRD.

https://arctichealth.org/en/permalink/ahliterature184742
Source
Am J Kidney Dis. 2003 Jul;42(1):125-32
Publication Type
Article
Date
Jul-2003
Author
Brenda R Hemmelgarn
Braden J Manns
Hude Quan
William A Ghali
Author Affiliation
Department of Medicine, University of Calgary, Calgary, Alberta, Canada. bhemmelg@ucalgary.ca
Source
Am J Kidney Dis. 2003 Jul;42(1):125-32
Date
Jul-2003
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
Comorbidity
Diagnosis-Related Groups
Female
Humans
Kidney Failure, Chronic - epidemiology - therapy
Life tables
Likelihood Functions
Male
Middle Aged
Multivariate Analysis
Peritoneal dialysis
Proportional Hazards Models
Renal Dialysis
Risk Adjustment
Severity of Illness Index
Survival Analysis
Abstract
Accurate prediction of survival for patients with end-stage renal disease (ESRD) and multiple comorbid conditions is difficult. In nondialysis patients, the Charlson Comorbidity Index has been used to adjust for comorbidity. The purpose of this study is to assess the validity of the Charlson index in incident dialysis patients and modify the index for use specifically in this patient population.
Subjects included all incident hemodialysis and peritoneal dialysis patients starting dialysis therapy between July 1, 1999, and November 30, 2000. These 237 patients formed a cohort from which new integer weights for Charlson comorbidities were derived using Cox proportional hazards modeling. Performance of the original Charlson index and the new ESRD comorbidity index were compared using Kaplan-Meier survival curves, change in likelihood ratio, and the c statistic.
After multivariate analysis and conversion of hazard ratios to index weights, only 6 of the original 18 Charlson variables were assigned the same weight and 6 variables were assigned a weight higher than in the original Charlson index. Using Kaplan-Meier survival curves, we found that both the original Charlson index and the new ESRD comorbidity index were associated with and able to describe a wide range of survival. However, the new study-specific index had better validated performance, indicated by a greater change in the likelihood ratio test and higher c statistic.
This study indicates that the original Charlson index is a valid tool to assess comorbidity and predict survival in patients with ESRD. However, our modified ESRD comorbidity index had slightly better performance characteristics in this population.
PubMed ID
12830464 View in PubMed
Less detail

An administrative data merging solution for dealing with missing data in a clinical registry: adaptation from ICD-9 to ICD-10.

https://arctichealth.org/en/permalink/ahliterature159191
Source
BMC Med Res Methodol. 2008;8:1
Publication Type
Article
Date
2008
Author
Danielle A Southern
Colleen M Norris
Hude Quan
Fiona M Shrive
P Diane Galbraith
Karin Humphries
Min Gao
Merril L Knudtson
William A Ghali
Author Affiliation
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. dasouthe@ucalgary.ca
Source
BMC Med Res Methodol. 2008;8:1
Date
2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Alberta - epidemiology
Algorithms
Cardiac Catheterization - mortality - utilization
Comorbidity
Data Collection
Humans
International Classification of Diseases
Medical Records - classification
Middle Aged
Models, Statistical
Myocardial Ischemia - classification - mortality - therapy
Registries - standards - statistics & numerical data
Risk assessment
Risk factors
Abstract
We have previously described a method for dealing with missing data in a prospective cardiac registry initiative. The method involves merging registry data to corresponding ICD-9-CM administrative data to fill in missing data 'holes'. Here, we describe the process of translating our data merging solution to ICD-10, and then validating its performance.
A multi-step translation process was undertaken to produce an ICD-10 algorithm, and merging was then implemented to produce complete datasets for 1995-2001 based on the ICD-9-CM coding algorithm, and for 2002-2005 based on the ICD-10 algorithm. We used cardiac registry data for patients undergoing cardiac catheterization in fiscal years 1995-2005. The corresponding administrative data records were coded in ICD-9-CM for 1995-2001 and in ICD-10 for 2002-2005. The resulting datasets were then evaluated for their ability to predict death at one year.
The prevalence of the individual clinical risk factors increased gradually across years. There was, however, no evidence of either an abrupt drop or rise in prevalence of any of the risk factors. The performance of the new data merging model was comparable to that of our previously reported methodology: c-statistic = 0.788 (95% CI 0.775, 0.802) for the ICD-10 model versus c-statistic = 0.784 (95% CI 0.780, 0.790) for the ICD-9-CM model. The two models also exhibited similar goodness-of-fit.
The ICD-10 implementation of our data merging method performs as well as the previously-validated ICD-9-CM method. Such methodological research is an essential prerequisite for research with administrative data now that most health systems are transitioning to ICD-10.
Notes
Cites: J Clin Epidemiol. 2000 Apr;53(4):377-8310785568
Cites: Can J Cardiol. 2000 Oct;16(10):1225-3011064296
Cites: Natl Vital Stat Rep. 2001 May 18;49(2):1-3211381674
Cites: J Clin Epidemiol. 2002 Feb;55(2):184-9111809357
Cites: Med Care. 2002 Aug;40(8):675-8512187181
Cites: Med Care. 2005 Nov;43(11):1130-916224307
Cites: Can J Cardiol. 2004 Dec;20(14):1417-2315614334
Cites: Am J Cardiol. 2005 Sep 1;96(5):639-4216125485
Cites: Am Heart J. 2005 Oct;150(4):800-616209985
Cites: Med Care. 2005 Nov;43(11):1116-2216224305
Cites: J Clin Epidemiol. 1992 Jun;45(6):613-91607900
PubMed ID
18215293 View in PubMed
Less detail

Appropriateness of the use of intravenous immune globulin before and after the introduction of a utilization control program.

https://arctichealth.org/en/permalink/ahliterature124586
Source
Open Med. 2012;6(1):e28-34
Publication Type
Article
Date
2012
Author
Thomas E Feasby
Hude Quan
Michelle Tubman
David Pi
Alan Tinmouth
Lawrence So
William A Ghali
Author Affiliation
Faculty of Medicine, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta. feasby@ucalgary.ca
Source
Open Med. 2012;6(1):e28-34
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Alberta
Algorithms
British Columbia
Chi-Square Distribution
Child
Child, Preschool
Decision Making
Efficiency, Organizational
Female
Health Services - utilization
Humans
Immunoglobulins, Intravenous - administration & dosage - therapeutic use
Inappropriate Prescribing - statistics & numerical data
Logistic Models
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Program Development - methods - statistics & numerical data
Program Evaluation
Risk
Time Factors
Young Adult
Abstract
Intravenous immune globulin (IVIG) is an expensive and sometimes scarce blood product that carries some risk. It may often be used inappropriately. We evaluated the appropriateness of IVIG use before and after the introduction of an utilization control program to reduce inappropriate use.
We used the RAND/UCLA Appropriateness Method to measure the appropriateness of IVIG use in the province of British Columbia (BC) in 2001 and 2003, before and after the introduction of a utilization control program designed to reduce inappropriate use. For comparison, we measured the appropriateness of use during the same periods in the province of Alberta, which had no control program.
Of 2256 instances of IVIG use, 54.1% were deemed to be appropriate, 17.4% were of uncertain benefit, and 28.5% were deemed inappropriate. The frequency of inappropriate use in BC after the introduction of the utilization control program did not differ significantly from the frequency before the program or the frequency in Alberta.
Almost half of IVIG use in BC and Alberta was judged to be inappropriate or of uncertain benefit, and the frequency of inappropriate use did not decrease after implementation of a utilization control program in BC. More effective utilization controls are necessary to prevent wasted resources and unnecessary risk to patients.
Notes
Cites: Mayo Clin Proc. 2000 Jan;75(1):83-510630762
Cites: JAMA. 2011 Apr 20;305(15):1589-9021505138
Cites: J Allergy Clin Immunol. 2001 Oct;108(4 Suppl):S139-4611586282
Cites: Br J Dermatol. 2002 Sep;147(3):518-2212207594
Cites: J Pediatr Hematol Oncol. 2002 Oct;24(7):540-412368690
Cites: Can J Clin Pharmacol. 2003 Spring;10(1):11-612687032
Cites: Health Technol Assess. 2004 Feb;8(6):iii-iv, 1-7214960256
Cites: CMAJ. 2004 Aug 31;171(5):455-915337725
Cites: Biometrics. 1977 Mar;33(1):159-74843571
Cites: Int J Technol Assess Health Care. 1986;2(1):53-6310300718
Cites: J Am Board Fam Pract. 1991 Nov-Dec;4(6):411-81767693
Cites: JAMA. 1993 Aug 25;270(8):961-68123097
Cites: Lancet. 1994 Apr 30;343(8905):1059-637909099
Cites: Clin Lab Haematol. 1995 Mar;17(1):75-807621634
Cites: Brain. 1996 Aug;119 ( Pt 4):1067-778813271
Cites: Lancet. 1997 Jan 25;349(9047):225-309014908
Cites: JAMA. 2005 Nov 9;294(18):2305-1416278358
Cites: N Z Med J. 2006;119(1246):U234017151714
Cites: Intern Med J. 2007 May;37(5):308-1417504278
Cites: Transfusion. 2007 Nov;47(11):2072-8017958537
Cites: Neurology. 2010 Aug 24;75(8):678-920733142
Cites: Neurology. 2000 Nov 14;55(9):1256-6211087764
PubMed ID
22567080 View in PubMed
Less detail

Assessing accuracy of diagnosis-type indicators for flagging complications in administrative data.

https://arctichealth.org/en/permalink/ahliterature180182
Source
J Clin Epidemiol. 2004 Apr;57(4):366-72
Publication Type
Article
Date
Apr-2004
Author
Hude Quan
Gerry A Parsons
William A Ghali
Author Affiliation
Quality Improvement and Health Information, Calgary Health Region, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9. hquan@ucalgary.ca
Source
J Clin Epidemiol. 2004 Apr;57(4):366-72
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Diagnosis-Related Groups
Forms and Records Control - standards
Humans
Medical Records - standards
Outcome Assessment (Health Care) - methods - standards
Patient Discharge - standards
Postoperative Complications - diagnosis
Abstract
Canadian administrative hospital discharge data contain a diagnosis-type indicator for each coded diagnosis that allows researchers to distinguish complications from pre-existing diagnoses. Given that the validity of diagnosis-type indicators is unknown, we conducted a detailed chart review to evaluate the accuracy of diagnosis-type indicators for flagging complications.
We obtained administrative hospital discharge data for 1,200 randomly selected adult inpatient separations in Calgary, Alberta, occurring between April 1, 1996 and March 31, 1997. Each discharge record contains up to 16 diagnoses and 16 corresponding diagnosis-type indicators (value of "2"=complication). The corresponding medical charts were reviewed for evidence of diagnoses and complications. A complication was defined as a new diagnosis arising after the start of hospitalization. We determined the extent to which the diagnosis-type indicator in the administrative data agreed with the chart reviewer's assessment (criterion standard) of whether a diagnosis was a complication or not.
The agreement for complications between the two databases varied greatly across 12 conditions studied (kappa range: 0-0.72) and was often low (kappa
PubMed ID
15135837 View in PubMed
Less detail

Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database.

https://arctichealth.org/en/permalink/ahliterature155447
Source
Health Serv Res. 2008 Aug;43(4):1424-41
Publication Type
Article
Date
Aug-2008
Author
Hude Quan
Bing Li
L Duncan Saunders
Gerry A Parsons
Carolyn I Nilsson
Arif Alibhai
William A Ghali
Author Affiliation
Department of Community Health Sciences and Centre for Health and Policy Studies, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N4N1, Canada.
Source
Health Serv Res. 2008 Aug;43(4):1424-41
Date
Aug-2008
Language
English
Publication Type
Article
Keywords
Alberta - epidemiology
Current Procedural Terminology
Databases, Factual
Diagnostic Tests, Routine - classification - statistics & numerical data
Forms and Records Control - statistics & numerical data
Humans
International Classification of Diseases - classification - statistics & numerical data
Medical Records - classification - statistics & numerical data
Medical Records Department, Hospital - classification - statistics & numerical data
Patient Discharge - statistics & numerical data
Quality Indicators, Health Care
Reproducibility of Results
Retrospective Studies
Sensitivity and specificity
Abstract
The goal of this study was to assess the validity of the International Classification of Disease, 10th Version (ICD-10) administrative hospital discharge data and to determine whether there were improvements in the validity of coding for clinical conditions compared with ICD-9 Clinical Modification (ICD-9-CM) data.
We reviewed 4,008 randomly selected charts for patients admitted from January 1 to June 30, 2003 at four teaching hospitals in Alberta, Canada to determine the presence or absence of 32 clinical conditions and to assess the agreement between ICD-10 data and chart data. We then re-coded the same charts using ICD-9-CM and determined the agreement between the ICD-9-CM data and chart data for recording those same conditions. The accuracy of ICD-10 data relative to chart data was compared with the accuracy of ICD-9-CM data relative to chart data.
Sensitivity values ranged from 9.3 to 83.1 percent for ICD-9-CM and from 12.7 to 80.8 percent for ICD-10 data. Positive predictive values ranged from 23.1 to 100 percent for ICD-9-CM and from 32.0 to 100 percent for ICD-10 data. Specificity and negative predictive values were consistently high for both ICD-9-CM and ICD-10 databases. Of the 32 conditions assessed, ICD-10 data had significantly higher sensitivity for one condition and lower sensitivity for seven conditions relative to ICD-9-CM data. The two databases had similar sensitivity values for the remaining 24 conditions.
The validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions was generally similar though validity differed between coding versions for some conditions. The implementation of ICD-10 coding has not significantly improved the quality of administrative data relative to ICD-9-CM. Future assessments like this one are needed because the validity of ICD-10 data may get better as coders gain experience with the new coding system.
Notes
Cites: Med Care. 2006 Nov;44(11):1011-917063133
Cites: Ann Intern Med. 1993 Oct 15;119(8):844-508018127
Cites: Med Care. 1994 Jan;32(1):81-908277803
Cites: Med Care. 1997 Jun;35(6):589-6029191704
Cites: J Chronic Dis. 1987;40(5):373-833558716
Cites: Biometrics. 1977 Mar;33(1):159-74843571
Cites: Med Care. 2004 Apr;42(4):355-6015076812
Cites: Stat Med. 2003 May 15;22(9):1551-7012704615
Cites: Med Care. 2002 Oct;40(10):856-6712395020
Cites: Med Care. 2002 Aug;40(8):675-8512187181
Cites: Ann Intern Med. 1988 Nov 1;109(9):745-513142326
Cites: JAMA. 1990 Sep 19;264(11):1426-312391739
Cites: Med Care. 2000 Aug;38(8):796-80610929992
Cites: J Am Coll Surg. 2002 Mar;194(3):257-6611893128
Cites: JAMA. 1992 Aug 19;268(7):896-91640619
Cites: Am J Obstet Gynecol. 2006 Apr;194(4):992-100116580288
Cites: Med Care. 2005 Nov;43(11):1130-916224307
Cites: Health Serv Res. 2005 Oct;40(5 Pt 2):1620-3916178999
Cites: Stroke. 2005 Aug;36(8):1776-8116020772
Cites: J Crit Care. 2005 Mar;20(1):12-916015512
Cites: Med Care. 2005 Feb;43(2):182-815655432
Cites: Bull World Health Organ. 2004 Dec;82(12):904-1315654404
Cites: J Clin Epidemiol. 2004 Dec;57(12):1288-9415617955
Cites: Med Care. 1998 Jan;36(1):8-279431328
Cites: J Clin Epidemiol. 1997 Jun;50(6):711-89250269
PubMed ID
18756617 View in PubMed
Less detail

Assessment and reporting of perioperative cardiac risk by Canadian general internists: art or science?

https://arctichealth.org/en/permalink/ahliterature187449
Source
J Gen Intern Med. 2002 Dec;17(12):933-6
Publication Type
Article
Date
Dec-2002
Author
Taha Taher
Nadia A Khan
P J Devereaux
Bruce W Fisher
William A Ghali
Finlay A McAlister
Author Affiliation
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Source
J Gen Intern Med. 2002 Dec;17(12):933-6
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Canada
Cross-Sectional Studies
Female
Health Care Surveys
Heart Diseases - surgery
Humans
Intraoperative Complications
Male
Middle Aged
Perioperative Care
Physicians
Risk assessment
Risk factors
Abstract
Physicians may use several validated risk indices to estimate perioperative cardiac risk, but there is little evidence for interventions to reduce this risk. We were interested in evaluating how general internists assess, define, communicate, and attempt to modify perioperative cardiac risk.
Cross-sectional survey of all 312 general internists in the Canadian Society of Internal Medicine with Canadian mailing addresses; 117 (38%) responded.
Respondents' mean age was 46 years, 79% were male, and on average they did 17 preoperative consults per month. Of the 104 respondents who routinely performed preoperative assessments, 96% (100/104) informed patients of their perioperative cardiac risk, but 77% did so only subjectively (i.e., stating risk as low, moderate, or high). Respondents provided 8, 27, and 12 different definitions for low, moderate, and high risk, respectively, with marked variability in the range of definitions they provided: from 2% to >50% for "high risk." The 67% of respondents who reported using a perioperative cardiac risk index used a variety of indices and exhibited just as much variability in their risk estimates and definitions as those who didn't use risk indices. While virtually all advised perioperative beta blockade in patients with known coronary artery disease, they varied substantially in the recommended agent or dose; further, these internists were evenly split on whether antiplatelet agents should be held or continued perioperatively.
These physicians differed widely in their assessment of perioperative cardiac risk and their definitions of low, moderate, or high risk. This raises concerns about whether patients (and surgeons) are provided with adequate information to make fully informed decisions about the potential risks of elective surgical operations.
Notes
Cites: N Engl J Med. 1999 Dec 9;341(24):1789-9410588963
Cites: BMJ. 1999 Sep 18;319(7212):731-410487995
Cites: Clin Invest Med. 2000 Apr;23(2):116-2310852661
Cites: N Engl J Med. 1977 Oct 20;297(16):845-50904659
Cites: J Gen Intern Med. 1986 Jul-Aug;1(4):211-93772593
Cites: Ann Intern Med. 1989 Jun 1;110(11):859-662655519
Cites: N Engl J Med. 1995 Dec 28;333(26):1750-67491140
Cites: J Am Coll Cardiol. 1996 Mar 15;27(4):779-868613603
Cites: J Am Coll Cardiol. 1996 Mar 15;27(4):910-488613622
Cites: N Engl J Med. 1996 Dec 5;335(23):1713-208929262
Cites: Ann Intern Med. 1997 Aug 15;127(4):309-129265433
Cites: Ann Intern Med. 1997 Aug 15;127(4):313-289265434
Cites: J Gen Intern Med. 1999 Apr;14(4):236-4210203636
Cites: Arch Intern Med. 1999 Apr 12;159(7):713-710218751
Cites: Circulation. 1999 Sep 7;100(10):1043-910477528
Cites: Lancet. 2000 Apr 15;355(9212):1295-30210776741
PubMed ID
12472929 View in PubMed
Less detail

Association of median household income with burden of coronary artery disease among individuals with diabetes.

https://arctichealth.org/en/permalink/ahliterature145669
Source
Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):48-53
Publication Type
Article
Date
Jan-2010
Author
Doreen M Rabi
Alun L Edwards
Lawrence W Svenson
Michelle M Graham
Merril L Knudtson
William A Ghali
Author Affiliation
Department of Medicine, University of Calgary, Calgary Canada. doreen.rabi@albertahealthservices.ca
Source
Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):48-53
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
Chi-Square Distribution
Coronary Angiography
Coronary Artery Disease - epidemiology - etiology - radiography
Diabetes Complications - epidemiology - etiology - radiography
Family Characteristics
Female
Humans
Income
Linear Models
Male
Middle Aged
Registries
Risk assessment
Risk factors
Severity of Illness Index
Social Class
Abstract
Low income is associated with adverse cardiovascular outcomes. Diabetes is more prevalent among low income groups, and low income patients with diabetes have been shown to have a greater burden of cardiovascular risk factors and worse cardiovascular outcomes. The objective of this study was to determine whether income status was associated with burden of coronary atherosclerosis in patients with diabetes.
All patients with diabetes presenting for cardiac catheterization between January 1, 2000, and December 31, 2002, in Calgary, Canada, were identified through the use of the Alberta Provincial Project for Assessing Outcomes in Coronary Heart Disease (APPROACH) database. This clinical database was merged with Canadian 2001 Census data on median household income per dissemination area using patient postal code data, and income quintiles were derived. Clinical profiles, severity of coronary atherosclerosis, and myocardial jeopardy were compared across income quintiles. Mean scores for severity and jeopardy were compared across income quintiles using analysis of variance. Multivariate linear regression was used to control for baseline differences across income groups. A total of 4596 patients were eligible for inclusion in this study. Clinical profiles differed significantly across income quintiles, with the highest income quintile being younger (P
PubMed ID
20123671 View in PubMed
Less detail

96 records – page 1 of 10.