Analyses using population-based health administrative data can return erroneous results if case identification is inaccurate ("misclassification bias"). An acetabular fracture (AF) prediction model using administrative data decreased misclassification bias compared to identifying AFs using diagnostic codes. This study measured the accuracy of this AF prediction model in another hospital.
View Article and Find Full Text PDFAccurate weight predictions are essential for weight management program patients. The freely available National Institutes of Health Body Weight Planner (NIH-BWP) returns expected weights over time but overestimates weight when patients consume a low-calorie diet. This study sought to increase the accuracy of NIH-BWP predicted weights for people on low-calorie diets.
View Article and Find Full Text PDFBackground: Many factors have been associated with the risk of toxigenic diarrhea (TCdD). This study derived and internally validated a multivariate model for estimating the risk of TCdD in patients with diarrhea using readily available clinical factors.
Methods: A random sample of 3,050 symptomatic emergency department or hospitalized patients undergoing testing for toxigenic at a single teaching hospital between 2014 and 2018 was created.
Background: Patients with atrial fibrillation have a high mortality rate that is only partially attributable to vascular outcomes. The competing risk of death may affect the expected anticoagulant benefit. We determined if competing risks materially affect the guideline-endorsed estimate of anticoagulant benefit.
View Article and Find Full Text PDFBackground: Misclassification bias (MB) is the deviation of measured from true values due to incorrect case assignment. This study compared MB when cystectomy status was determined using administrative database codes vs. predicted cystectomy probability.
View Article and Find Full Text PDFBackground: Self-reported penicillin allergy labels are common and often inaccurate after assessment. These labels can lead to reduced use of first-line beta-lactam antibiotics and worse outcomes. We measured the impact of a previously performed inpatient proactive systematic penicillin allergy de-labelling program on subsequent antibiotic use.
View Article and Find Full Text PDFBackground: Resource utilization and costs can impede proactive assessment and de-labeling of penicillin allergy among inpatients.
Methods: Our pilot intervention was a proactive penicillin allergy de-labeling program for new inpatients with penicillin allergy. Patients deemed appropriate for a challenge with a low-risk penicillin allergy history were administered 250 mg amoxicillin and monitored for 1 h.
Background: Knowing the probability that patients have a bloodstream infection (BSI) could influence the ordering of blood cultures and interpretation of their preliminary results. Many previous BSI probability models have limited applicability and accuracy. This study used currently recommended modeling techniques and a large sample to derive and validate the Ottawa BSI Model.
View Article and Find Full Text PDFModels predicting individual body weights over time clarify patient expectations in weight loss programs. The accuracy of two commonly used weight prediction models in community living people is unclear. All eligible people entering a weight management program between 1992 and 2015 were included.
View Article and Find Full Text PDFBackground: Plasma and RBC zinc values are unrelated in hospitalized patients. The independent association of these values with important patient outcomes is unknown.
Objectives: Measure the independent association of plasma and RBC zinc with outcomes in hospitalized patients.
Background: Older adults with frailty are at an increased risk of adverse outcomes after surgery. Exercise before surgery (exercise prehabilitation) may reduce adverse events and improve recovery after surgery. However, adherence with exercise therapy is often low, especially in older populations.
View Article and Find Full Text PDFBackground: For patients who initiate dialysis during a hospital admission and continue to require dialysis after discharge, outpatient dialysis management could be improved by better understanding the future likelihood of recovery to dialysis independence and the competing risk of death.
Methods: We derived and validated linked models to predict the subsequent recovery to dialysis independence and death within 1 year of hospital discharge using a population-based cohort of 7657 patients in Ontario, Canada. Predictive variables included age, comorbidities, length of hospital admission, intensive care status, discharge disposition, and prehospital admission eGFR and random urine albumin-to-creatinine ratio.
Background: Patients with atrial fibrillation (AF) have a high rate of all-cause mortality that is only partially attributable to vascular outcomes. While the competing risk of death may affect expected anticoagulant benefit, guidelines do not account for it. We sought to determine if using a competing risks framework materially affects the guideline-endorsed estimate of absolute risk reduction attributable to anticoagulants.
View Article and Find Full Text PDFBackground: Multiple arterial grafting (MAG) and off-pump surgery are strategies proposed to improve outcomes with coronary artery bypass grafting (CABG). This study was conducted to determine the impact of off-pump surgery on outcomes after CABG with MAG in men and women.
Methods: This cohort study used population-based data to identify all Ontarians undergoing isolated CABG with MAG between October 2008 and September 2019.
Background: Selection of empiric antibiotic treatment for community-acquired pneumonia (CAP) that is concordant with clinical practice guidelines has been associated with improved short-term outcomes of this infection, but whether it is also associated with longer-term outcomes is unknown.
Research Question: Is guideline-concordance of the initial antibiotic treatment given to older adult patients hospitalized with CAP associated with the 1-year all-cause and cardiovascular mortality risk of those patients who survive hospitalization for this infection?
Study Design And Methods: A total of 1,909 older (> 65 years of age) patients were identified who survived hospitalization for CAP at The Ottawa Hospital (Ontario, Canada) between 2004 and 2015. Linking patients' information to hospital and provincial data sets, this study analyzed whether the selection of the initial antibiotic therapy for their CAP was concordant with current clinical practice guidelines, and whether guideline-concordance was associated with 1-year all-cause and cardiovascular mortality following their index CAP hospitalization.
Background And Objectives: Regression models incorporating laboratory tests treat unordered tests as missing and are often imputed. Imputation typically assumes that data are "missing at random" (MAR, test's order status is unrelated to its result after accounting for other variables). This study examined the validity of this assumption.
View Article and Find Full Text PDFIncreasing use of hematopoietic stem cell transplantation (HCT) and improvements in recipient outcomes have led to a steady increase in the number of allogeneic HCT survivors. In addition to complications specific to the transplantation process, HCT recipients are at increased risk of developing cardiovascular disease (CVD) and subsequent neoplasm (SN). Strict surveillance of risk factors for CVD and cancer in the general population is recommended as an essential component of long-term follow-up (LTFU) care of HCT survivors, but implementation of this has been suboptimal.
View Article and Find Full Text PDFBackground: Network meta-analysis (NMA) quantifies the relative efficacy of three or more interventions from trials evaluating some, but usually not all, treatments. This study applied the analytical approach of NMA to quantify the relative accuracy of prediction models with distinct patient applicability that are evaluated on the same population ('concurrent external validation').
Methods: We simulated binary events in 5000 patients using a known risk function.
Background: Patient zinc stores are quantified with plasma or red blood cell (RBC) measures. The relationship between these 2 measures of zinc status has not been determined in a broad population of hospitalized patients.
Methods: Both plasma zinc and RBC zinc were prospectively collected and measured in 252 consenting patients admitted urgently to hospital.
Purpose: Epidemiological studies of primary subarachnoid hemorrhage (pSAH) frequently include population-based death registries for case finding. The positive predictive value of pSAH diagnoses in death registries is unknown.
Methods: This cross-sectional study identified all people in Ontario, Canada with pSAH listed as a cause of death between 2013 and 2017.
Clin Microbiol Infect
January 2023
Objective: Accurately estimating the likelihood of bloodstream infection (BSI) can help clinicians make diagnostic and therapeutic decisions. Many multivariate models predicting BSI probability have been published. This study measured the performance of BSI probability models within the same patient sample.
View Article and Find Full Text PDFBackground: Older people (≥65 yr) are at increased risk of morbidity and mortality after emergency general surgery. Risk prediction models are needed to guide decision making in this high-risk population. Existing models have substantial limitations and lack external validation, potentially limiting their applicability in clinical use.
View Article and Find Full Text PDFBackground: Frailty is a state of vulnerability as a result of decreased reserves. Prehabilitation may increase reserve and improve postoperative outcomes. Our objective was to determine if home-based prehabilitation improves postoperative functional recovery in older adults with frailty having cancer surgery.
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