Quebec Hospitals Research Articles

Patients’ experience using an app for home remote monitoring of heart failure for a university hospital in Quebec, Canada

BackgroundThe use of mobile health apps for remote monitoring has considerable potential for patient care. However, more research is needed to gather patients’ experience with their use. This study evaluates heart failure patients’ experience of the effects of remote monitoring on the management of heart failure (HF) using a smartphone app, the challenges faced in such use, and patients’ suggestions for improving the efficacy of this device.MethodA qualitative study was conducted with all patients who had used the TakeCare™ app for at least three months during the exploratory phase of the Continuum project. Patients were recruited before COVID-19 began, and they used the app during this period. The app allows patients to submit their daily vital signs and answer questions about their symptoms to help the clinical professionals adjust their treatment plan as needed. Individual interviews were conducted by telephone or videoconference using a semi-structured individual interview guide. All interviews were recorded, transcribed and analyzed using the thematic analysis method.ResultsOf the 29 patients invited, 5 had since died, 10 did not respond, two gave positive feedback on the app but declined the interview, and 12 patients agreed to participate in an individual interview. The participants all liked the app’s ease of use. They particularly praised the contribution it made to monitoring their disease, both by themselves and by clinicians. The app also allowed them to stay connected to their clinical team and have better access to healthcare professionals. Patients suggested, as an improvement, that the feedback and communication features should be personalized to make them more individualized and interactive.ConclusionThe TakeCare™ smartphone app was well received by patients with heart failure. Its use could facilitate better remote monitoring of heart conditions in the home as well as improve access to clinical teams.

Implementation of Artificial Intelligence-Based Diabetic Retinopathy Screening in a Tertiary Care Hospital in Quebec: Prospective Validation Study.

Diabetic retinopathy (DR) affects about 25% of people with diabetes in Canada. Early detection of DR is essential for preventing vision loss. We evaluated the real-world performance of an artificial intelligence (AI) system that analyzes fundus images for DR screening in a Quebec tertiary care center. We prospectively recruited adult patients with diabetes at the Centre hospitalier de l'Université de Montréal (CHUM) in Montreal, Quebec, Canada. Patients underwent dual-pathway screening: first by the Computer Assisted Retinal Analysis (CARA) AI system (index test), then by standard ophthalmological examination (reference standard). We measured the AI system's sensitivity and specificity for detecting referable disease at the patient level, along with its performance for detecting any retinopathy and diabetic macular edema (DME) at the eye level, and potential cost savings. This study included 115 patients. CARA demonstrated a sensitivity of 87.5% (95% CI 71.9-95.0) and specificity of 66.2% (95% CI 54.3-76.3) for detecting referable disease at the patient level. For any retinopathy detection at the eye level, CARA showed 88.2% sensitivity (95% CI 76.6-94.5) and 71.4% specificity (95% CI 63.7-78.1). For DME detection, CARA had 100% sensitivity (95% CI 64.6-100) and 81.9% specificity (95% CI 75.6-86.8). Potential yearly savings from implementing CARA at the CHUM were estimated at CAD $245,635 (US $177,643.23, as of July 26, 2024) considering 5000 patients with diabetes. Our study indicates that integrating a semiautomated AI system for DR screening demonstrates high sensitivity for detecting referable disease in a real-world setting. This system has the potential to improve screening efficiency and reduce costs at the CHUM, but more work is needed to validate it.

Assisted Reproductive Technology During COVID-19: A Population-Based Study Of Pregnancy Outcomes.

We assessed the impact of the COVID-19 pandemic on the pregnancy outcomes of patients who used assisted reproductive technology. We conducted a population-based cohort study of 443,101 patients who conceived naturally or with assisted reproductive technology between December 2015 and July 2021 and had a delivery in hospitals of Quebec, Canada. The main exposure measure was use of assisted reproductive technology before or during the pandemic. Outcomes included preeclampsia, preterm birth, and other pregnancy complications. We used adjusted log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI) for the association of assisted reproductive technology with adverse pregnancy outcomes compared with natural conception before vs. during the pandemic. In secondary analyses, we examined the association of COVID-19 infection with pregnancy outcomes among women who used assisted reproductive technology. Compared with natural conception, assisted reproductive technology was associated with an increased risk of preeclampsia (RR 1.43; 95% CI 1.21-1.68), preterm birth (RR 2.07; 95% CI 1.84-2.33), and low birth weight (RR 1.94; 95% CI 1.72-2.20) during the pandemic. However, the same risks were also present before the pandemic. Compared with no infection, COVID-19 infection was not associated with adverse outcomes among women who conceived with assisted reproductive technology. This study suggests that the COVID-19 pandemic did not significantly impact the pregnancy outcomes of women who underwent assisted reproductive procedures in Quebec. The findings are reassuring for patients concerned about the potential reproductive effects of the pandemic.

Women’s Experiences of Mechanical Balloon Catheter Induction With Self-Traction

ObjectiveTo explore women’s experiences of mechanical labor induction using a balloon catheter with self-traction. DesignDescriptive qualitative. SettingBirth unit of an urban hospital in Quebec, Canada. ParticipantsFourteen women who experienced labor induction with a balloon catheter using self-traction. MethodsWe conducted individual structured interviews between May 2022 and January 2023 to collect data that we subsequently analyzed using the manifest content analysis approach of Graneheim et al. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). ResultsWe identified five categories: Expectations, Pain or Comfort Experienced, Emotions Felt, Support From Nursing Staff, and Appreciation of the Procedure. The participants anticipated rapid, effective induction, expressed concerns about potential discomfort, and appreciated control of their experiences. We found a generally positive trend in terms of appreciation for all categories. ConclusionThe positive experiences of participants underline the promising potential of the balloon catheter method of labor induction with self-traction. Given the continuing growth in labor induction rates, it becomes necessary to continue efforts to offer services specifically geared to women’s needs. Offering an additional option such as self-traction is a step in this direction.

Évaluation de la pratique pharmaceutique en établissement de santé : une étude exploratoire comparant les processus en France et au Québec

To ensure compliance with the legal and normative framework, the professional orders, which supervise the practice of pharmacy have established a professional inspection process. In addition to this process, other external organizations also require an accreditation, authorization, certification or validation process for professional practices. The main objective is to identify and compare the methods of evaluating pharmaceutical practice in hospitals in France and Quebec. In order to identify and compare the methods of evaluating pharmaceutical practice in hospitals in France and Quebec, our approach allowed us to identify more organizations in France (i.e., High Authority of Health, Regional Health Agencies, the National Order of Pharmacists, the Nuclear Safety Agency, the Biomedicine Agency and the National Agency for the Safety of Medicines and Health Products) than in Quebec (i.e., Accreditation Canada, Ordre des pharmaciens du Québec and Health Canada). The study highlights the legal framework and applicable standards, the surveyors, the evaluation methods and the particularities for the evaluation of the hospital, the pharmacy department and the members of the department. This study highlights the evaluation processes of pharmaceutical practice in hospitals. In France, as in Quebec, we recognize the importance of the drug circuit in the hospital, the development and operation of a pharmacy department and the practice of pharmacy. While there are more similarities for the assessment of the drug circuit in hospitals and pharmacy department, important differences are observed for the assessment of individuals. We believe that the publication of a comparative analysis can contribute to discussions and exchanges to benefit from the best practices of each country.

Machine Learning Informed Diagnosis for Congenital Heart Disease in Large Claims Data Source

BackgroundWith an increasing interest in using large claims databases in medical practice and research, it is a meaningful and essential step to efficiently identify patients with the disease of interest. ObjectivesThis study aims to establish a machine learning (ML) approach to identify patients with congenital heart disease (CHD) in large claims databases. MethodsWe harnessed data from the Quebec claims and hospitalization databases from 1983 to 2000. The study included 19,187 patients. Of them, 3,784 were labeled as true CHD patients using a clinician developed algorithm with manual audits considered as the gold standards. To establish an accurate ML-empowered automated CHD classification system, we evaluated ML methods including Gradient Boosting Decision Tree, Support Vector Machine, Decision tree, and compared them to regularized logistic regression. The Area Under the Precision Recall Curve was used as the evaluation metric. External validation was conducted with an updated data set to 2010 with different subjects. ResultsAmong the ML methods we evaluated, Gradient Boosting Decision Tree led the performance in identifying true CHD patients with 99.3% Area Under the Precision Recall Curve, 98.0% for sensitivity, and 99.7% for specificity. External validation returned similar statistics on model performance. ConclusionsThis study shows that a tedious and time-consuming clinical inspection for CHD patient identification can be replaced by an extremely efficient ML algorithm in large claims database. Our findings demonstrate that ML methods can be used to automate complicated algorithms to identify patients with complex diseases.

Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial

Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery. We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559. 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52-0·99]; p=0·042; adjusted risk difference -1·2% [95% CI -2·0 to -0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33-0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups. A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture. Canadian Institutes of Health Research (CIHR, MOP-142448).

2 Excessive Exercise among Youth with a New Diagnosis of Restrictive Eating Disorder before and during the COVID-19 Pandemic

Abstract Background During the COVID-19 pandemic, Canadian youth with anorexia nervosa (AN) and atypical anorexia nervosa (AAN) presented at higher rates with more severe illness. This trend was found to be more pronounced in Canadian jurisdictions where public health measures included full school closures and confinement. Disease severity in AN is multifactorial, however, excessive exercise can be associated with more severe illness. Due to closures, many adolescents turned to unregulated exercise regimes within their homes. The contribution of excessive exercise to the rise of new onset AN during the pandemic remains unknown. Objectives To determine the rate of excessive exercise among newly diagnosed adolescents with AN/AAN during the COVID-19 pandemic compared to the five preceding years. Design/Methods This was a secondary analysis of a prospectively collected intake registry of all new diagnoses of AN and AAN completed between January 1st, 2015, and November 30th, 2020 at two large, urban, tertiary paediatric hospitals in Quebec. Baseline demographic information and clinical assessment variables were collected based on standardized assessment forms. Excessive exercise was self-reported and defined as >10 hours per week of moderate or vigorous physical activity at the time of diagnosis. Medical hospitalization within 1 week of assessment was used as a marker of medical severity. The primary outcome of excessive exercise was compared between the period of pandemic public health preventive measures (March 2020 to November 2020) and the pre-pandemic period (January 2015 to February 2020). Variables were compared before and during the pandemic using Chi square testing. Results Overall, 817 patients with new diagnoses of AN/AAN met inclusion criteria during the study period (pre=647; during=170), with 40 patients (pre=34/647 and during =6/170) excluded due to missing data on exercise frequency. Overall, median patient age was 15.9 (IQR 13.8-16.9) years; 93% female; and 59% diagnosed with AAN. During the pandemic, mean hospitalization rate increased from 2.2 to 7.2 patients per month (p=0.001). Hospitalization within one week of diagnosis increased from 23% to 40% (136/613 vs. 65/16; p=0.001). The rate of excessive exercise did not differ before versus during the pandemic overall (27% vs. 24%; p=0.48) nor in patients requiring admission (40/136 [29%] vs. 23/65[36%]; p=0.39). Conclusion Excessive exercise in isolation does not appear to explain the increased rate and severity of new AN/AAN diagnoses since the pandemic in this cohort. Further studies are needed to better elucidate other drivers which may have contributed to the severity of eating disorders during this period.

Residual Psychomotor Skills of Orderlies After a Novel Chest Compression Training Intervention.

High-quality chest compressions are essential to favorable patient outcomes after in-hospital cardiac arrest. Without frequent training, however, skill in performing compressions declines considerably. The Timely Chest Compression Training (T-CCT) intervention was introduced in 2019 as a quality improvement initiative to address this problem. The long-term impact of the T-CCT is unknown. A cohort study was conducted at a university-affiliated hospital in Quebec, Canada. Chest compression performance among orderlies was measured by using a subtractive scoring model and mannequins. The association of exposure to the T-CCT 10 months earlier with having an excellent chest compression performance (score ≥90 out of 100), after adjusting for potential confounders, was examined. A total of 412 orderlies participated in the study. More than half (n = 232, 56%) had been exposed to the T-CCT, and the rest (n = 180, 44%) had not. Nearly half (n = 106, 46%) of orderlies exposed to the T-CCT had an excellent performance, compared with less than one-third (n = 53, 30%) of nonexposed orderlies. In univariable analysis, previous exposure to the T-CCT was associated with 1.53 times greater risk of having an excellent performance (risk ratio, 1.53; 95% CI, 1.17-1.99). This effect remained after adjustment for potential confounders (risk ratio, 1.57; 95% CI, 1.19-2.07). The results of this study suggest that the T-CCT has a lasting effect on the psychomotor skills of orderlies 10 months after initial exposure. Further research should investigate the impact of the intervention on patient outcomes after in-hospital cardiac arrest.

Outcomes and characteristics of patients hospitalized for COVID-19 in British Columbia, Ontario and Quebec during the Omicron wave.

Omicron is the current predominant variant of concern of SARS-CoV-2. We hypothesized that vaccination alters outcomes of patients hospitalized with COVID-19 during the Omicron wave and that these patients have different characteristics and outcomes than in previous waves. This is a substudy of the Host Response Mediators in Coronavirus (COVID-19) Infection (ARBs CORONA I) trial, which included adults admitted to hospital with acute COVID-19 up to July 2022 from 9 hospitals in British Columbia, Ontario and Quebec. We excluded emergency department visits without hospital admission, readmissions and admissions for another reason. Using adjusted regression analysis, we compared mortality and organ dysfunction between vaccinated (≥ 2 doses) and unvaccinated patients during the Omicron wave, as well as between all patients in the Omicron and first 3 waves of the COVID-19 pandemic. During the Omicron wave, 28-day mortality was significantly lower in vaccinated (n = 19/237) than unvaccinated hospitalized patients (n = 12/127) (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.15-0.89); vaccinated patients had lower risk of admission to the intensive care unit, invasive ventilation and acute respiratory distress syndrome and shorter hospital length of stay. Patients hospitalized during the Omicron wave had more comorbidities than in previous waves, and lower 28-day mortality than in waves 1 and 2 (adjusted OR 0.38, 95% CI 0.24-0.59; and 0.42, 95% CI 0.26-0.65) but not wave 3 (adjusted OR 0.81, 95% CI 0.43-1.51) and had less organ dysfunction than in the first 2 waves. Patients who were at least double vaccinated had lower mortality than unvaccinated patients hospitalized during the Omicron wave. Patients hospitalized during the Omicron wave had more chronic disease and lower mortality than in the first 2 waves, but not wave 3. Changes in vaccination, treatments and predominant SARS-CoV-2 variant may have decreased mortality in patients hospitalized during the Omicron wave.

Hospitalization for child maltreatment and other types of injury during the COVID-19 pandemic

BackgroundThe possibility that child maltreatment was misclassified as unintentional injury during the COVID-19 pandemic has not been evaluated. ObjectiveWe assessed if child maltreatment hospitalizations changed during the pandemic, and if the change was accompanied by an increase in unintentional injuries. Participants and settingThis study included children aged 0–4 years who were admitted for maltreatment or unintentional injuries between April 2006 and March 2021 in hospitals of Quebec, Canada. MethodsWe used interrupted time series regression to estimate the effect of the pandemic on hospitalization rates for maltreatment, compared with unintentional transport accidents, falls, and mechanical force injuries. We assessed if the change in maltreatment hospitalization was accompanied by an increase in specific types of unintentional injury. ResultsHospitalizations for child maltreatment decreased from 16.3 per 100,000 (95 % CI 9.1–23.4) the year before the pandemic to 13.2 per 100,000 (95 % CI 6.7–19.7) during the first lockdown. Hospitalizations for most types of unintentional injury also decreased, but injuries due to falls involving another person increased from 9.0 to 16.5 per 100,000. Hospitalization rates for maltreatment and unintentional injury remained low during the second lockdown, but mechanical force injuries involving another person increased from 3.8 to 8.1 per 100,000. ConclusionsHospitalizations for child maltreatment may have been misclassified as unintentional injuries involving another person during the pandemic. Children admitted for these types of unintentional injuries may benefit from closer assessment to rule out maltreatment.

Interprofessional collaboration in maternity care

African Journal of Midwifery and Women's HealthVol. 17, No. 2 EditorialInterprofessional collaboration in maternity careUnice GoshomiUnice GoshomiCorrespondence to:E-mail Address: [email protected]Social Sciences, Women's University in Africa, Harare, ZimbabweSearch for more papers by this authorUnice GoshomiPublished Online:16 Jun 2023https://doi.org/10.12968/ajmw.2023.0019AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Behruzi R, Klam S, Dehertog M et al.. Understanding factors affecting collaboration between midwives and other health care professionals in a birth center and its affiliated Quebec hospital: a case study. BMC Pregnancy Childbirth. 2017;17(1):1–4. https://doi.org/10.1186/s12884-017-1381-x Crossref, Google ScholarCharalambous C, Rampton B. Language learning, identity, and intercultural communication in contexts of conflict and insecurity. In: Jackson J (ed). The Routledge handbook of language and intercultural communication. Abingdon, Oxfordshire: Routledge; 2020 Crossref, Google ScholarKruk ME, Gage AD, Arsenault C et al.. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 April 2023Volume 17Issue 2ISSN (online): 2052-4293 Metrics History Published online 16 June 2023 Published in print 2 April 2023 Information© MA Healthcare LimitedPDF download

A290 PHENOTYPE AND OUTCOME OF PATIENTS HOSPITALIZED FOR ACUTE PANCREATITIS IN A TERTIARY PEDIATRIC CENTER

Abstract Background A recent meta-analysis of 48 studies, showed an equal prevalence of AP (16%) among the following etiologies; systemic disease, alcohol, medication, genetics, gallstones and infection in North American hospitalized and ambulatory pediatric patients. However, data on the epidemiology of severe pediatric acute pancreatitis (AP) in Canada are lacking. Purpose We aim to evaluate the clinical presentation, etiologies, comorbidities and outcome of pediatric patients with AP admitted to a tertiary hospital in Quebec, Canada. Method A retrospective observational cohort study (January 2014-December 2021) was performed at the CHU Sainte-Justine. Descriptive analyses were performed with SAS statistical softwar Result(s) Among the 214 patients included (110 (51%) males), 58 (27.1%) were already hospitalized at time of AP diagnosis (AP as secondary diagnosis) while 156 (72.9%) were admitted from the emergency room mainly with a presentation of abdominal pain (AP as primary diagnosis). Thirty-two patients (15.0%) were transferred to the ICU due to hemodynamic instability or respiratory failure. Comorbidities included cancer (38 patients (17.7%)), obesity (17 (7.9%)) and inflammatory bowel disease (15 (7.0%)). The three most commonly identified etiologies were medication (19.6%), biliary disease (16.3%) and infection (14,9%). Despite extensive investigations, 26.2% of cases were idiopathic. The main complications were, ascites (48 patients (22.4%)), necrotic pancreatitis (10 (4.6%)) and pancreatic pseudocyst (10 (4.6%)). The median duration of hospitalization for AP as a primary diagnosis was 4 days (interquartile range (IQR) 2-7) as compared to 22 (11-37) for AP as a secondary diagnosis. Conclusion(s) Approximately one third of hospitalized patients had an underlying condition requiring treatments that could cause AP, which explains the high prevalence of drug-induced AP in this report. The longest hospitalizations were associated with AP as secondary diagnosis. Ongoing work will identify factors associated with disease severity and outcome in particular in primary AP. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Tobramycin a Priori Dosing Regimens Based on PopPK Model Simulations in Critically Ill Patients: Are They Transferable?

In recent years, multiple population pharmacokinetic models have been developed for drugs such as tobramycin that need therapeutic drug monitoring. Some of these models have been used to develop a priori dosing regimens for their respective populations. However, these dosing regimens may not apply to other populations. Therefore, this study aimed to evaluate tobramycin population pharmacokinetic models in critically ill patients and establish an adequate dosing regimen. Evaluated models were identified from a literature review of aminoglycoside population pharmacokinetic models in critically ill patients. After retrospective data collection in 2 Quebec hospitals, external evaluation and model re-estimation were performed with NONMEM (v7.5) to assess imprecision and bias values. Dosing regimens were simulated and compared between the best-performing model and its re-estimated counterparts. None of the 3 evaluated models showed acceptable imprecision or bias values in the data sets of the 19 patients. Similar percentages of target attainment were obtained for the original and re-estimated models after the dosing regimen simulations. Although the predictive performance evaluation criteria were inadequate, the original and re-estimated models yielded similar results. This raises the question of what a priori bias and imprecision thresholds should be defined as acceptable for the external evaluation of models to be applied in clinical practice. Studies evaluating the impact of these thresholds are needed.

Agreement and prognostic accuracy of three ED vulnerability screeners: findings from a prospective multi-site cohort study

ObjectivesTo evaluate the agreement between three emergency department (ED) vulnerability screeners, including the InterRAI ED Screener, ER2, and PRISMA-7. Our secondary objective was to evaluate the discriminative accuracy of screeners in predicting discharge home and extended ED lengths-of-stay (> 24 h).MethodsWe conducted a nested sub-group study using data from a prospective multi-site cohort study evaluating frailty in older ED patients presenting to four Quebec hospitals. Research nurses assessed patients consecutively with the three screeners. We employed Cohen's Kappa to determine agreement, with high-risk cut-offs of three and four for the PRISMA-7, six for the ER2, and five for the interRAI ED Screener. We used logistic regression to evaluate the discriminative accuracy of instruments, testing them in their dichotomous, full, and adjusted forms (adjusting for age, sex, and hospital academic status).ResultsWe evaluated 1855 older ED patients across the four hospital sites. The mean age of our sample was 84 years. Agreement between the interRAI ED Screener and the ER2 was fair (K = 0.37; 95% CI 0.33–0.40); agreement between the PRISMA-7 and ER2 was also fair (K = 0.39; 95% CI = 0.36–0.43). Agreement between interRAI ED Screener and PRISMA-7 was poor (K = 0.19; 95% CI 0.16–0.22). Using a cut-off of four for PRISMA-7 improved agreement with the ER2 (K = 0.55; 95% CI 0.51–0.59) and the ED Screener (K = 0.32; 95% CI 0.2–0.36). When predicting discharge home, the concordance statistics among models were similar in their dichotomous (c = 0.57–0.61), full (c = 0.61–0.64), and adjusted forms (c = 0.63–0.65), and poor for all models when predicting extended length-of-stay.ConclusionED vulnerability scores from the three instruments had a fair agreement and were associated with important patient outcomes. The interRAI ED Screener best identifies older ED patients at greatest risk, while the PRISMA-7 and ER2 are more sensitive instruments.

How did the disclosure of lobbying targeting Quebec's hospitals become mandatory and with what effect?

AbstractIn 2015 mandatory disclosure activity for lobbying that targeted health and social service centres in Quebec, a sector which consumes a significant share of the annual spending budget, suddenly became a mandatory disclosure activity for lobbyists operating in the province. This research note traces the trajectory of key events that led to this shift towards greater lobbying transparency in the health care sector. The study also analyzes whether this change was followed by increased lobbying registrations for activities targeting health sector institutions. The article's findings suggest that significant change in lobbying regulation may occur accidentally, against the government's will, rather than as a result of an ethical scandal, cross‐jurisdictional learning, or electoral calculations, as the literature suggests. The article's findings also show that the change was followed by an increase of about 969 registered firm lobbyists (p‐value 0.015) and 254 registered lobbyists from covered NGOs (p‐value 0.00).

Mental health and neurocognitive disorder–related hospitalization rates in immigrants and Canadian-born population: a linkage study

ObjectivesMental health and neurocognitive conditions are important causes of hospitalization among immigrants, though patterns may vary by immigrant category, world region of origin, and time since arrival in Canada. This study uses linked administrative data to explore differences in mental health hospitalization rates between immigrants and individuals born in Canada.MethodsHospital records from the Discharge Database and the Ontario Mental Health Reporting System for 2011 to 2017 were linked to the 2016 Longitudinal Immigrant Database and to Statistics Canada’s 2011 Canadian Census Health and Environment Cohort. Age-standardized hospitalization rates for mental health–related conditions (ASHR-MHs) were derived for immigrants and the Canadian-born population. ASHR-MHs overall and for leading mental health conditions were compared between immigrants and the Canadian-born population, stratified by sex and selected immigration characteristics. Quebec hospitalization data were not available.ResultsOverall, immigrants had lower ASHR-MHs compared to the Canadian-born population. Mood disorders were leading causes of mental health hospitalization for both cohorts. Psychotic, substance-related, and neurocognitive disorders were also leading causes of mental health hospitalization, although there was variation in their relative importance between subgroups. Among immigrants, ASHR-MHs were higher among refugees and lower among economic immigrants, those from East Asia, and those who arrived in Canada most recently.ConclusionDifferences in hospitalization rates among immigrants from various immigration streams and world regions, particularly for specific types of mental health conditions, highlight the importance of future research that incorporates both inpatient and outpatient mental health services to further understand these relationships.

Predicting severity in COVID-19 disease using sepsis blood gene expression signatures

Severely-afflicted COVID-19 patients can exhibit disease manifestations representative of sepsis, including acute respiratory distress syndrome and multiple organ failure. We hypothesized that diagnostic tools used in managing all-cause sepsis, such as clinical criteria, biomarkers, and gene expression signatures, should extend to COVID-19 patients. Here we analyzed the whole blood transcriptome of 124 early (1–5 days post-hospital admission) and late (6–20 days post-admission) sampled patients with confirmed COVID-19 infections from hospitals in Quebec, Canada. Mechanisms associated with COVID-19 severity were identified between severity groups (ranging from mild disease to the requirement for mechanical ventilation and mortality), and established sepsis signatures were assessed for dysregulation. Specifically, gene expression signatures representing pathophysiological events, namely cellular reprogramming, organ dysfunction, and mortality, were significantly enriched and predictive of severity and lethality in COVID-19 patients. Mechanistic endotypes reflective of distinct sepsis aetiologies and therapeutic opportunities were also identified in subsets of patients, enabling prediction of potentially-effective repurposed drugs. The expression of sepsis gene expression signatures in severely-afflicted COVID-19 patients indicates that these patients should be classified as having severe sepsis. Accordingly, in severe COVID-19 patients, these signatures should be strongly considered for the mechanistic characterization, diagnosis, and guidance of treatment using repurposed drugs.

Association of Endometriosis and Severe Maternal Morbidity.

To evaluate the association between endometriosis and risk of severe maternal morbidity (SMM). We conducted a population-based retrospective cohort study of 2,412,823 deliveries at hospitals in Quebec, Canada, between 1989 and 2019. The exposure was surgically confirmed endometriosis. Patients were classified as having active endometriosis during pregnancy, inactive endometriosis during pregnancy, a diagnosis of endometriosis postpregnancy, or no endometriosis. The outcome was SMM, including by a range of life-threatening maternal conditions during pregnancy or up to 42 days postdelivery. We computed rates of SMM and used log binomial regression to assess the association with endometriosis (risk ratio [RR]; 95% CI), adjusted for maternal characteristics. Severe maternal morbidity occurred in 46.2 of 1,000 patients with endometriosis, compared with 30.7 of 1,000 patients without endometriosis. Relative to no exposure, endometriosis was associated with 1.43 times the risk of SMM (95% CI 1.36-1.51). Patients with endometriosis that was active during pregnancy had a greater risk of SMM (RR 1.93; 95% CI 1.76-2.11). Active endometriosis was associated with the risk of severe preeclampsia and eclampsia, severe hemorrhage, hysterectomy, cardiac complications, embolism, shock, sepsis, and intensive care unit admission. Inactive endometriosis was less strongly associated with these outcomes. Pregnant patients with endometriosis, especially active endometriosis, have a greater risk of SMM and may benefit from closer follow-up to prevent severe complications of pregnancy.

Efficacy and safety of extended duration to perioperative thromboprophylaxis with low molecular weight heparin on disease-free survival after surgical resection of colorectal cancer (PERIOP-01): multicentre, open label, randomised controlled trial

ObjectiveTo determine the efficacy and safety of extended duration perioperative thromboprophylaxis by low molecular weight heparin when assessing disease-free survival in patients undergoing resection for colorectal cancer.DesignMulticentre, open label, randomised...