Publications by authors named "Tanuseputro P"
Introduction: Long-term care (LTC) residents require extensive assistance with daily activities due to physical and cognitive impairments. Medical treatment for LTC residents, when not aligned with residents' wishes, can cause discomfort without providing substantial benefits. Predictive models can equip providers with tools to guide treatment recommendations that support person-centred medical decision-making.
View Article and Find Full Text PDFBackground And Aims: The expanded use of virtual care may worsen pre-existing disparities in use and delivery of end-of-life care among certain groups of people. We measured the use of virtual care in the last three months of life before and after the introduction of virtual care fee codes that funded care delivery at the start of COVID-19 on March 14, 2020, and identified changes in the characteristics of people using it.
Methods: We used linked clinical and administrative datasets to study use of virtual care in the last three months of life among 411,564 adults who died between January 25, 2018, and November 30, 2022.
Objective: The COVID-19 pandemic highlighted and exacerbated health inequities worldwide. While several studies have examined the impact of individual social factors on COVID infection, our objective was to examine how interactions of social factors were associated with the risk of testing positive for SARS-CoV-2 during the first two years of the pandemic.
Study Design And Setting: We conducted an observational cohort study using linked health administrative data for Ontarians tested for SARS-CoV-2 between January 1st, 2020, and December 31st, 2021.
Objectives: To examine transitions to a nursing home among residents of assisted living relative to community-dwelling home care recipients.
Design: Population-based retrospective cohort study emulating a target trial.
Setting And Participants: Linked, individual-level health system data were obtained from older adults (≥65 years of age) who made an incident application for a bed in a nursing home in Ontario, Canada, between April 1, 2014, and March 31, 2019, and were followed until December 31, 2019.
Article Synopsis
- COVID-19 triage protocols are developed to manage resource shortages in ICUs and have sparked ethical debates, particularly regarding potential biases against certain groups based on age, frailty, or perceived social value.
- The online Democratic Deliberation conducted in May and June 2022 in Quebec and Ontario aimed to gather public opinions on acceptable considerations and values that should guide these protocols.
- Analysis revealed three main themes: the need for public acceptance of the protocols, essential considerations to include in triage decisions, and conditions that could enhance acceptance, with participants generally favoring prioritization based on survival prognosis and advocating for structured decision-making to reduce subjectivity.
Development and Validation of a Survival Prediction Model for Patients With Pancreatic Cancer.
Clin Transl Gastroenterol
December 2024
Article Synopsis
- A survival prognostication model was developed for pancreatic ductal adenocarcinoma (PDAC) patients using clinical data, patient-reported symptoms, and treatment specifics to aid in their treatment decisions.
- The study analyzed data from 17,450 PDAC patients in Ontario over a 13-year period, finding significant predictors of survival, including tumor location, disease stage, hospitalizations, heart failure, and various pain and performance scores.
- The model demonstrated good predictive accuracy with a C index of 0.76, suggesting it could enhance shared decision-making between patients and healthcare providers regarding treatment options.
Objective: To measure the association between types of serious illness and the use of different physician-delivered care models near the EOL during the COVID-19 pandemic.
Design, Setting And Participants: Population-based cohort study using health administrative datasets in Ontario, Canada, for adults aged ≥18 years in their last 90 days of life who died of cancer or terminal noncancer illness and received physician-delivered care models near the end-of-life between March 14, 2020 and January 24, 2022.
Exposure: The type of serious illness (cancer or terminal noncancer illness).
Introduction: A clinical prediction tool to estimate life expectancy in community-dwelling individuals living with dementia could inform healthcare decision-making and prompt future planning. An existing Ontario-based tool for community-dwelling elderly individuals does not perform well in people living with dementia specifically. This study seeks to develop and validate a clinical prediction tool to estimate survival in community-dwelling individuals living with dementia receiving home care in Ontario, Canada.
View Article and Find Full Text PDFImportance: Interest in and use of hallucinogens has been increasing rapidly. While a frequently raised concern is that hallucinogens may be associated with an increased risk of psychosis, there are limited data on this association.
Objectives: To examine whether individuals with an emergency department (ED) visit involving hallucinogen use have an increased risk of developing a schizophrenia spectrum disorder (SSD).
Background: Online democratic deliberation (ODD) may foster public engagement in new health strategies by providing opportunities for knowledge exchange between experts, policy makers, and the public. It can favor decision-making by generating new points of view and solutions to existing problems. Deliberation experts recommend gathering feedback from participants to optimize future implementation.
View Article and Find Full Text PDFBackground: Language and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care model in EoL care from the perspectives of palliative care physicians.
View Article and Find Full Text PDFCanada's healthcare system is experiencing a health and human resource (HHR) crisis. The available evidence of the scope of the problem and potential solutions, however, is not commensurate with the scale and urgency of the crisis. The use of linked health administrative data to study the health, well-being and work patterns of the health workforce offers critical insights into how the workforce is functioning at a population level.
View Article and Find Full Text PDFBackground: Appropriate use of medication is a key indicator of the quality of care provided in long-term care (LTC). The objective of this study was to determine whether resident-facility language concordance/discordance is associated with the odds of potentially inappropriate prescribing of antipsychotics (PIP-AP) in LTC.
Methods: We conducted a population-based, retrospective cohort study of LTC residents in Ontario, Canada from 2010 to 2019.
Objectives: To develop and validate a model to predict time-to-LTC admissions among individuals with dementia.
Design: Population-based retrospective cohort study using health administrative data.
Setting And Participants: Community-dwelling older adults (65+) in Ontario living with dementia and assessed with the Resident Assessment Instrument for Home Care (RAI-HC) between April 1, 2010 and March 31, 2017.
Exposure to procedural ionizing radiation and cancer risk among physicians.
Occup Med (Lond)
November 2024
Background: Physicians in certain specialities are routinely exposed to procedural ionizing radiation. Their risk of cancer is unknown, including by cancer sub-types.
Aims: To assess cancer risk among exposed physicians.
Background: Nephrologists routinely provide end-of-life care for patients with kidney failure (KF) on maintenance dialysis. Involvement of primary care and palliative care physicians may enhance this experience.
Objective: The objective was to describe outpatient care patterns in the last year of life and the end-of-life acute care utilization for patients with KF on maintenance dialysis.
Objective: To examine transitions to an assisted living facility among community-dwelling older adults who received publicly funded home care services.
Design: Nested case-control study.
Setting And Participants: Linked, population-level health system administrative data were obtained from adults aged 65 years and older who received home care services in Ontario, Canada, from April 1, 2018, to December 31, 2019.
Article Synopsis
- * A study in Ontario analyzed data from over 6,000 patients with eating disorders, revealing significant correlations between electrolyte issues and increased risks of hospitalization, cardiac events, and mortality.
- * The most common electrolyte abnormalities found were hypokalaemia and hyponatraemia, with those affected showing a higher mortality rate (15.7%) compared to those without such abnormalities (5.6%).
Objectives: Our primary objective was to determine if more comprehensive advance care planning (ACP) documentation was associated with fewer transfers to hospital in the last year of life. Our secondary objective was to determine the impact of ACP processes and practices on hospital transfers in the last year of life.
Design: Retrospective cohort study.
Article Synopsis
- * Out of 56,419 residents analyzed, 17% were on OACs; after 30 days, mortality was slightly higher among OAC users (12.0%) compared to non-users (9.9%), but this difference was not statistically significant.
- * While OAC use didn't increase 30-day mortality risk, it was associated with a higher risk of major hemorrhage (1.3% vs. 0.8%), suggesting careful consideration is needed when prescribing OACs to frail elderly individuals at
Aim: To investigate whether the physician-encounter interval for patients with type 2 diabetes (T2D) can be optimized from 2-3 to 4-6 months among those with a calculated 10-year cardiovascular disease (CVD) risk score of less than 20% without compromising their long-term outcomes.
Materials And Methods: Using territory-wide public electronic medical records in Hong Kong, we emulated a target trial to compare the effectiveness of the physician-encounter intervals of 4-6 versus 2-3 months for T2D patients without prior CVDs and with a predicted risk for CVDs of less than 20% (i.e.
Background: Parents have reported increased symptoms of depression and anxiety during the COVID-19 pandemic. This study evaluated changes in mental health and addiction (MHA)-related health service use among mothers and other birthing parents during the COVID-19 pandemic.
Methods: We conducted a repeated cross-sectional study using health administrative data in Ontario, Canada.
Article Synopsis
- The study examined how the disease trajectory and care setting affect burdensome transitions to hospitals at the end of life for older adults in Ontario, focusing on individuals aged 65 and above who died between 2015 and 2018.
- It found that over 40% of participants had organ failure, and the majority received long-term care (LTC), with significant interactions noted between disease types and care options influencing hospital transitions.
- Specifically, patients with organ failure had a higher likelihood of being hospitalized early and late, compared to those with terminal illness, while frailty increased the odds of early hospital transitions only in those receiving non-end-of-life home care.