Objectives The purpose of this study was to test the value of gait speed, a clinical marker for frailty, to improve the prediction of mortality and major morbidity in elderly patients undergoing ...cardiac surgery. Background It is increasingly difficult to predict the elderly patient's risk posed by cardiac surgery because existing risk assessment tools are incomplete. Methods A multicenter prospective cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009. Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and/or valve replacement or repair. The primary predictor was slow gait speed, defined as a time taken to walk 5 m of ≥6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity. Results The cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years; 34% were female patients. Sixty patients (46%) were classified as slow walkers before cardiac surgery. Slow walkers were more likely to be female (43% vs. 25%, p = 0.03) and diabetic (50% vs. 28%, p = 0.01). Thirty patients (23%) experienced the primary composite end point of mortality or major morbidity after cardiac surgery. Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score (odds ratio: 3.05; 95% confidence interval: 1.23 to 7.54). Conclusions Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery.
To estimate the diagnostic accuracy of Stratus optical coherence tomography (OCT) for glaucoma screening in high-risk populations.
Cross-sectional evaluation of a diagnostic test for screening.
Three ...hundred thirty-three community-based volunteer participants with risk factors for glaucoma.
The optic nerve and peripapillary retinal nerve fiber layer (RNFL) of participants' eyes were scanned using the Stratus OCT. Based on an ophthalmologic examination and frequency doubling perimetry, eyes were classified into 4 categories: normal, possible glaucoma, probable glaucoma, and definitive glaucoma.
The sensitivities, specificities, positive and negative likelihood ratios of the RNFL, optic disc parameters, and their combinations were calculated.
The right eyes were retained for analyses. After excluding eyes with missing data or with poor quality scans, the data of 210 right eyes were analyzed. Six eyes had definitive glaucoma. Combining the best performing optic nerve head parameters (cup diameter or cup/disc vertical ratio or cup/disc area ratio) and RNFL parameters (superior average or inferior average or overall average) using AND-logic resulted in a sensitivity of 67% (95% confidence interval CI, 24%-94%), specificity of 96% (95% CI, 92%-98%), a positive likelihood ratio of 17.08 (95% CI, 7.06-41.4), and a negative likelihood ratio of 0.35 (95% CI, 0.11-1.08).
When adequate quality scans may be obtained, the Stratus has moderate sensitivity and high specificity for definitive glaucoma. Specificity is increased when parameters from both the optic nerve head and RNFL scans are combined.
BRIEF REPORTS Johanne Monette, MD, MSc; Mark A. Miller, MD, MSc; Monette, Michèle ...
Journal of the American Geriatrics Society (JAGS),
08/2007, Letnik:
55, Številka:
8
Journal Article
Recenzirano
To assess the effect of an educational intervention aimed at optimizing antibiotic prescribing in long-term care (LTC) facilities. Cluster randomized, controlled trial. Eight public LTC facilities in ...the Montreal area. Thirty-six physicians. The educational intervention consisted of mailing an antibiotic guide to physicians along with their antibiotic prescribing profile covering the previous 3 months. Targeted infections were urinary tract, lower respiratory tract, skin and soft tissues, and septicemia of unknown origin. In the prescribing profile, each antibiotic was classified as adherent or nonadherent to the guide. Physicians in the experimental group received the intervention twice, 4 months apart, whereas physicians in the control group provided usual care. Data on antibiotic prescriptions were collected over four 3-month periods: preintervention, postintervention I, postintervention II, and follow-up. A generalized estimating equation (GEE) model was used to compare the proportion of nonadherent antibiotic prescriptions of the experimental and control groups. By the end of the study, nonadherent antibiotic prescriptions decreased by 20.5% in the experimental group, compared with 5.1% in the control group. Based on the GEE model, during postintervention II, physicians in the experimental group were 64% less likely to prescribe nonadherent antibiotics than those in the control group (odds ratio=0.36, 95% confidence interval=0.18-0.73). An educational intervention combining an antibiotic guide and a prescribing profile was effective in decreasing nonadherent antibiotic prescriptions. Repetition of the intervention at regular intervals may be necessary to maintain its effectiveness. PUBLICATION ABSTRACT
Laboratory-based risk factors for cytomegalovirus retinitis Hodge, William G., MD, PhD, FRCSC; Boivin, Jean-François, MD, ScD, FRCPC; Shapiro, Stanley H., PhD ...
Canadian journal of ophthalmology,
12/2004, Letnik:
39, Številka:
7
Journal Article
Recenzirano
Abstract Background: Very few studies have investigated risk factors for cytomegalovirus (CMV) retinitis. Identifying these risk factors will have many benefits, including helping establish screening ...regimens, examination frequency regimens, and targeted prophylaxis with oral therapy with valganciclovir or other anti-CMV agents. The purpose of this study was to determine the laboratory-based risk factors for CMV retinitis in patients with AIDS. Methods: We conducted a case-control study involving 120 patients in whom CMV retinitis had been diagnosed in 1990-99 and 159 patients without CMV retinitis from the same period.The sampling was from a primary study base in eastern Ontario and western Quebec of patients with AIDS and CD4 counts less than 50 cells/μL at the time of diagnosis of retinitis in the case subjects or an analogous date for the control subjects.There were two components to the study. In the first component (n = 279) we examined standard-of-care laboratory tests (hematologic and nutrition variables) done during the study period. In the second component (n = 57), which was a subset of the first, we examined laboratory tests (HLA type, qualitative and quantitative CMV polymerase chain reaction PCR and HIV load) on stored blood samples from the eastern Ontario site. Multivariate logistic regression was used to model the data and control for confounding. We developed a systematic model-building strategy, from assumption testing to model building to model checking. Results: A low hemoglobin concentration was a statistically significant predictor of CMV retinitis (odds ratio OR 0.96, 95% confidence interval CI 0.94–0.98). Both qualitative CMV PCR (OR 21.71, 95% Cl 1.80–261.67) and quantitative CMV PCR (OR 33.03,95% CI 2.32–469.39) were strong predictors of CMV retinitis. Among the 80 HLA types tested, HLA-Bw4 (OR 11.68, 95% CI 1.29–105.82) and HLA-DRBI 15 (OR 9.34, 95% CI 1.14–76.41) were significant predictors of CMV retinitis, whereas HLA-Cw7 was protective against CMV retinitis (OR 0.09, 95% CI 0.01–0.67). Interpretation: We have identified laboratory variables that elevate (or decrease) the risk of CMV retinitis.These findings may be useful to clinicians and health policy experts in developing rational guidelines for screening, examination frequency and targeted prophylaxis for patients with AIDS.
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