Adriane Lewin - Academia.edu (original) (raw)

Papers by Adriane Lewin

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, Jan 22, 2015

♦ Background: In general, efforts to standardize care based on group consensus practice guideline... more ♦ Background: In general, efforts to standardize care based on group consensus practice guidelines have resulted in lower morbidity and mortality. Although there are published guidelines regarding insertion and perioperative management of peritoneal dialysis (PD) catheters, variation in practice patterns between centers may exist. The objective of this study is to understand variation in PD catheter insertion practices in preparation for conducting future studies. ♦ Methods: An electronic survey was developed by the research committee of the International Society for Peritoneal Dialysis - North American Research Consortium (ISPD-NARC) to be completed by physicians and nurses involved in PD programs across North America. It consisted of 45 questions related to 1) organizational characteristics; 2) PD catheter insertion practices; 3) current quality-improvement initiatives; and 4) interest in participation in PD studies. Invitation to participate in the survey was given to nephrologis...

Open medicine : a peer-reviewed, independent, open-access journal, 2011

Physicians often experience work-related stress that may lead to personal harm and impaired profe... more Physicians often experience work-related stress that may lead to personal harm and impaired professional performance. Biofeedback has been used to manage stress in various populations. To determine whether a biofeedback-based stress management tool, consisting of rhythmic breathing, actively self-generated positive emotions and a portable biofeedback device, reduces physician stress. Randomized controlled trial measuring efficacy of a stress-reduction intervention over 28 days, with a 28-day open-label trial extension to assess effectiveness. Urban tertiary care hospital. Forty staff physicians (23 men and 17 women) from various medical practices (1 from primary care, 30 from a medical specialty and 9 from a surgical specialty) were recruited by means of electronic mail, regular mail and posters placed in the physicians' lounge and throughout the hospital. Physicians in the intervention group were instructed to use a biofeedback-based stress management tool three times daily. Pa...

IJC Heart & Vessels, 2014

Background: People with schizophrenia are at significantly greater risk of cardiovascular disease... more Background: People with schizophrenia are at significantly greater risk of cardiovascular disease-related mortality. We set out to determine if people with and without schizophrenia who undergo coronary artery catheterization differ with respect to coronary anatomy, coronary artery disease management, or outcome. Methods and results: This study used provincial administrative data and a clinical registry that included all individuals who undergo coronary catheterization in Alberta, Canada. Individuals with schizophrenia were identified in hospital discharge data using ICD-9 codes. We identified 271 Albertans with a hospital discharge diagnosis of schizophrenia and a subsequent coronary catheterization and were matched with 1083 controls without schizophrenia that had undergone a coronary catheterization. Extent of coronary disease was assessed using 1) left ventricular ejection fraction; 2) the Duke Jeopardy Score (a valid measure of myocardium at risk for ischemic injury); and 3) a categorical assessment of coronary anatomy risk. People with schizophrenia were less likely to be categorized as high risk on the Duke coronary index (p b .005) and more likely to be categorized as having a normal coronary anatomy (p b .05). Significant differences in mortality were found among those with and without schizophrenia both before and after adjustment for clinical differences. Conclusions: Our results suggest that people with schizophrenia have less severe coronary atherosclerosis, and are less likely to receive revascularization. Despite less severe coronary atherosclerosis, individuals with schizophrenia had a significantly higher mortality following catheterization. Interventions to increase therapeutic adherence and clinical follow up of patients with mental illness may improve health outcomes.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2014

People with kidney allograft failure represent an increasing fraction of all those starting dialy... more People with kidney allograft failure represent an increasing fraction of all those starting dialysis therapy. We sought to summarize prognosis following kidney allograft failure and identify potentially beneficial interventions or modifiable risk factors. We searched MEDLINE and EMBASE (inception to 1 October 2013) and article reference lists without language restriction and selected cohort studies of all-cause mortality and fatal infection-related and cardiovascular events in people starting dialysis following kidney allograft failure. Two reviewers independently extracted data on study design, participant characteristics, dialysis modality, transplant nephrectomy, immunosuppression strategy, transplant-naive comparators and risk of bias. Discrepancies were resolved with a third reviewer. Forty studies comprising 249 716 participants met the inclusion criteria. The first year of dialysis therapy was associated with the highest mortality. By random effects meta-analysis, annual risk...

Diabetology & Metabolic Syndrome, 2014

Objective: The identification of sex-based disparities in the use of effective medications in hig... more Objective: The identification of sex-based disparities in the use of effective medications in high-risk populations can lead to interventions to minimize disparities in health outcomes. The objective of this study was to determine sex-specific rates of cardioprotective medication use in a large population-level administrative-health database from a universal-payer environment. Research design and methods: This observational, population-based cohort study used provincial administrative data to compare the utilization of cardioprotective medications between women and men in the first year following a diabetes diagnosis. Competing risks regression was used to calculate crude and adjusted sub-hazard ratios for time-tofirst angiotensin-converting-enzyme inhibitor, angiotensin receptor blocker, or statin dispensations. Results: There were 15,120 (45.4%) women and 18,174 (54.6%) men with diabetes in the study cohort. Overall cardioprotective medication use was low for both primary and secondary prevention for both women and men. In the year following a diabetes diagnosis, women were less likely to use a statin relative to men (adjusted sub-hazard ratio [aSHR] 0.90, 95% confidence interval [CI] 0.85 to 0.96), angiotensin-converting-enzyme inhibitors (aSHR 0.90, 95% CI 0.86 to 0.94), or any cardioprotective medication (aSHR 0.93, 95% CI 0.90 to 0.97). Conclusions: Cardioprotective medication use was not optimal in women or men. We also identified a health care gap with cardioprotective medication use being lower in women with diabetes compared to men. Closing this gap has the potential to reduce the impact of cardiovascular disease in women with diabetes.

Circulation, 2012

Background-Cardiac rehabilitation (CR) is an efficacious yet underused treatment for patients wit... more Background-Cardiac rehabilitation (CR) is an efficacious yet underused treatment for patients with coronary artery disease.

Cardiovascular Diabetology, 2009

A meta-analysis suggested the use of rosiglitazone was associated with an increased risk for card... more A meta-analysis suggested the use of rosiglitazone was associated with an increased risk for cardiovascular (CV) events. Rosiglitazone remained available for use as more definitive safety trials were ongoing. This issue was reported in the lay media.

Canadian Journal of Diabetes, 2013

Canadian Journal of Diabetes, 2008

Canadian Journal of Cardiology, 2011

The clinical correlates of coronary collaterals and the effects of coronary collaterals on progno... more The clinical correlates of coronary collaterals and the effects of coronary collaterals on prognosis are incompletely understood. We performed a study of 55,751 patients undergoing coronary angiography to evaluate the correlates of angiographically apparent coronary collaterals, and to evaluate their association with survival. The characteristic most strongly associated with the presence of collaterals was a coronary occlusion (odds ratio [OR], 28.9; 95% confidence interval [CI], 27.1-30.6). Collaterals were associated with improved adjusted survival overall (hazard ratio [HR] 0.89; 95% CI, 0.85-0.95), and in both acute coronary syndrome (ACS) (HR 0.90; 95% CI, 0.84-0.96) and non-ACS (HR 0.84; 95% CI, 0.77-0.92) patients. Collaterals were associated with improved survival in those receiving angioplasty (HR 0.78; 95% CI, 0.71-0.85) and those with low risk anatomy treated medically (HR 0.84; 95% CI, 0.72-0.98), but not for those treated with coronary bypass graft surgery or those with high-risk anatomy treated without revascularization. The major correlate of coronary collaterals is the presence/extent of obstructive coronary artery disease. Collaterals are associated with better survival overall and in both ACS and non-ACS presentations, but not for those treated with coronary artery bypass graft (CABG) or those with high-risk anatomy who are not revascularized.

Canadian Journal of Cardiology, 2012

Canadian Journal of Cardiology, 2013

Prior Canadian studies of cardiac procedure rates showed changes over time and regional variabili... more Prior Canadian studies of cardiac procedure rates showed changes over time and regional variability, but more recent Canadian cardiac procedure rates are unknown. We performed a study using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry to evaluate the temporal trends and geographic distribution of cardiac procedures in Alberta from April 1, 2003 through March 31, 2010. Rates were age- and sex-standardized by means of the 1996 Canadian census. While the raw number of cardiac catheterizations in Alberta was nearly uniform through the study period, age- and sex-standardized cardiac catheterizations declined from a rate of 480 per 100,000 in 2003 to a rate of 430 per 100,000 in 2010. The percutaneous coronary intervention (PCI) rates also declined, from a rate of 186 per 100,000 in 2003 to 170 per 100,000 in 2010. The rates for coronary artery bypass grafts declined from 84 per 100,000 in 2003 to 42 per 100,000 in 2010. There was geographic variability, with northern regions characterized by rates that were higher than the provincial average rates, and southern regions characterized by rates lower than the provincial average. During the study period, age- and sex-standardized rates of cardiac catheterization and PCI in Alberta declined, reversing previous trends of increasing PCI rates. The rates of coronary artery bypass grafts in Alberta declined significantly, suggesting a change in practice consistent with that seen elsewhere. There are geographic differences in rates of cardiac procedures. These data have implications for other regions of Canada, for which registry data may not be available.

Canadian Journal of Cardiology, 2011

BMC Medical Education, 2013

Background: Extended duty hours for residents are associated with negative consequences. Strategi... more Background: Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality health care, and medical education experience. Methods: This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre-and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples. Results: Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision. Conclusions: The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.

The Annals of Thoracic Surgery, 2011

Background. Although bilateral internal thoracic artery (BITA) grafting in coronary artery bypass... more Background. Although bilateral internal thoracic artery (BITA) grafting in coronary artery bypass grafting (CABG) is associated with low morbidity and good long-term results, controversy exists about the age after which BITA grafting is no longer beneficial. We sought to determine if such an age cutoff point exists.

American Journal of Kidney Diseases, 2013

Erythropoiesis-stimulating agent (ESA) doses are often increased in hospitalized dialysis patient... more Erythropoiesis-stimulating agent (ESA) doses are often increased in hospitalized dialysis patients in response to acute anemia with unknown consequences. We sought to determine whether increases in ESA dose during hospital admission were associated with changes in transfusion requirement and risk of exceeding recommended hemoglobin targets. Retrospective cohort study. Linked administrative, laboratory, and blood transfusion data were used to identify a total of 700 hospitalizations involving 484 long-term hemodialysis patients between 2004 and 2008 in the Calgary Health Region, Canada. Change in ESA dose was determined by comparing the average weekly dose over the 6 weeks preceding admission to that administered during the 14 days following admission. Cox proportional hazards models adjusted for baseline patient characteristics were used to model the association between changes in ESA dose and outcomes, including exceeding recommended hemoglobin targets, receipt of blood transfusion, cardiovascular outcomes, and death. There was a significant increase in the risk of exceeding recommended hemoglobin targets as the ESA dose was increased by ≥40 μg/wk (equivalent darbepoetin alfa dose) above baseline (HR, 2.21; 95% CI, 1.19-4.10). However, an increase in ESA dose was not associated with reduced need for blood transfusion, risk of cardiovascular outcomes, or death. Residual confounding by clinical events that may lead to changes in the management of patients and may have influenced the observed relationship between predictor and outcomes. Increasing the ESA dose at hospitalization in hemodialysis patients is associated with higher risk of exceeding recommended hemoglobin targets, but does not appear to be associated with the need for transfusion, risk of cardiovascular outcomes, or death.

BMC Anesthesiology, 2010

We sought to evaluate agreement between a new and widely implemented method of temperature measur... more We sought to evaluate agreement between a new and widely implemented method of temperature measurement in critical care, temporal artery thermometry and an established method of core temperature measurement, bladder thermometry as performed in clinical practice. Temperatures were simultaneously recorded hourly (n = 736 observations) using both devices as part of routine clinical monitoring in 14 critically ill adult patients with temperatures ranging >/=1 degrees C prior to consent. The mean difference between temporal artery and bladder temperatures measured was -0.44 degrees C (95% confidence interval, -0.47 degrees C to -0.41 degrees C), with temporal artery readings lower than bladder temperatures. Agreement between the two devices was greatest for normothermia (36.0 degrees C to < 38.3 degrees C) (mean difference -0.35 degrees C [95% confidence interval, -0.37 degrees C to -0.33 degrees C]). The temporal artery thermometer recorded higher temperatures during hypothermia (< 36 degrees C) (mean difference 0.66 degrees C [95% confidence interval, 0.53 degrees C to 0.79 degrees C]) and lower temperatures during hyperthermia (>/=38.3 degrees C) (mean difference -0.90 degrees C [95% confidence interval, -0.99 degrees C to -0.81 degrees C]). The sensitivity for detecting fever (core temperature >/=38.3 degrees C) using the temporal artery thermometer was 0.26 (95% confidence interval, 0.20 to 0.33), and the specificity was 0.99 (95% confidence interval, 0.98 to 0.99). The positive likelihood ratio for fever was 24.6 (95% confidence interval, 10.7 to 56.8); the negative likelihood ratio was 0.75 (95% confidence interval, 0.68 to 0.82). Temporal artery thermometry produces somewhat surprising disagreement with an established method of core temperature measurement and should not to be used in situations where body temperature needs to be measured with accuracy.

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, Jan 22, 2015

♦ Background: In general, efforts to standardize care based on group consensus practice guideline... more ♦ Background: In general, efforts to standardize care based on group consensus practice guidelines have resulted in lower morbidity and mortality. Although there are published guidelines regarding insertion and perioperative management of peritoneal dialysis (PD) catheters, variation in practice patterns between centers may exist. The objective of this study is to understand variation in PD catheter insertion practices in preparation for conducting future studies. ♦ Methods: An electronic survey was developed by the research committee of the International Society for Peritoneal Dialysis - North American Research Consortium (ISPD-NARC) to be completed by physicians and nurses involved in PD programs across North America. It consisted of 45 questions related to 1) organizational characteristics; 2) PD catheter insertion practices; 3) current quality-improvement initiatives; and 4) interest in participation in PD studies. Invitation to participate in the survey was given to nephrologis...

Open medicine : a peer-reviewed, independent, open-access journal, 2011

Physicians often experience work-related stress that may lead to personal harm and impaired profe... more Physicians often experience work-related stress that may lead to personal harm and impaired professional performance. Biofeedback has been used to manage stress in various populations. To determine whether a biofeedback-based stress management tool, consisting of rhythmic breathing, actively self-generated positive emotions and a portable biofeedback device, reduces physician stress. Randomized controlled trial measuring efficacy of a stress-reduction intervention over 28 days, with a 28-day open-label trial extension to assess effectiveness. Urban tertiary care hospital. Forty staff physicians (23 men and 17 women) from various medical practices (1 from primary care, 30 from a medical specialty and 9 from a surgical specialty) were recruited by means of electronic mail, regular mail and posters placed in the physicians' lounge and throughout the hospital. Physicians in the intervention group were instructed to use a biofeedback-based stress management tool three times daily. Pa...

IJC Heart & Vessels, 2014

Background: People with schizophrenia are at significantly greater risk of cardiovascular disease... more Background: People with schizophrenia are at significantly greater risk of cardiovascular disease-related mortality. We set out to determine if people with and without schizophrenia who undergo coronary artery catheterization differ with respect to coronary anatomy, coronary artery disease management, or outcome. Methods and results: This study used provincial administrative data and a clinical registry that included all individuals who undergo coronary catheterization in Alberta, Canada. Individuals with schizophrenia were identified in hospital discharge data using ICD-9 codes. We identified 271 Albertans with a hospital discharge diagnosis of schizophrenia and a subsequent coronary catheterization and were matched with 1083 controls without schizophrenia that had undergone a coronary catheterization. Extent of coronary disease was assessed using 1) left ventricular ejection fraction; 2) the Duke Jeopardy Score (a valid measure of myocardium at risk for ischemic injury); and 3) a categorical assessment of coronary anatomy risk. People with schizophrenia were less likely to be categorized as high risk on the Duke coronary index (p b .005) and more likely to be categorized as having a normal coronary anatomy (p b .05). Significant differences in mortality were found among those with and without schizophrenia both before and after adjustment for clinical differences. Conclusions: Our results suggest that people with schizophrenia have less severe coronary atherosclerosis, and are less likely to receive revascularization. Despite less severe coronary atherosclerosis, individuals with schizophrenia had a significantly higher mortality following catheterization. Interventions to increase therapeutic adherence and clinical follow up of patients with mental illness may improve health outcomes.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2014

People with kidney allograft failure represent an increasing fraction of all those starting dialy... more People with kidney allograft failure represent an increasing fraction of all those starting dialysis therapy. We sought to summarize prognosis following kidney allograft failure and identify potentially beneficial interventions or modifiable risk factors. We searched MEDLINE and EMBASE (inception to 1 October 2013) and article reference lists without language restriction and selected cohort studies of all-cause mortality and fatal infection-related and cardiovascular events in people starting dialysis following kidney allograft failure. Two reviewers independently extracted data on study design, participant characteristics, dialysis modality, transplant nephrectomy, immunosuppression strategy, transplant-naive comparators and risk of bias. Discrepancies were resolved with a third reviewer. Forty studies comprising 249 716 participants met the inclusion criteria. The first year of dialysis therapy was associated with the highest mortality. By random effects meta-analysis, annual risk...

Diabetology & Metabolic Syndrome, 2014

Objective: The identification of sex-based disparities in the use of effective medications in hig... more Objective: The identification of sex-based disparities in the use of effective medications in high-risk populations can lead to interventions to minimize disparities in health outcomes. The objective of this study was to determine sex-specific rates of cardioprotective medication use in a large population-level administrative-health database from a universal-payer environment. Research design and methods: This observational, population-based cohort study used provincial administrative data to compare the utilization of cardioprotective medications between women and men in the first year following a diabetes diagnosis. Competing risks regression was used to calculate crude and adjusted sub-hazard ratios for time-tofirst angiotensin-converting-enzyme inhibitor, angiotensin receptor blocker, or statin dispensations. Results: There were 15,120 (45.4%) women and 18,174 (54.6%) men with diabetes in the study cohort. Overall cardioprotective medication use was low for both primary and secondary prevention for both women and men. In the year following a diabetes diagnosis, women were less likely to use a statin relative to men (adjusted sub-hazard ratio [aSHR] 0.90, 95% confidence interval [CI] 0.85 to 0.96), angiotensin-converting-enzyme inhibitors (aSHR 0.90, 95% CI 0.86 to 0.94), or any cardioprotective medication (aSHR 0.93, 95% CI 0.90 to 0.97). Conclusions: Cardioprotective medication use was not optimal in women or men. We also identified a health care gap with cardioprotective medication use being lower in women with diabetes compared to men. Closing this gap has the potential to reduce the impact of cardiovascular disease in women with diabetes.

Circulation, 2012

Background-Cardiac rehabilitation (CR) is an efficacious yet underused treatment for patients wit... more Background-Cardiac rehabilitation (CR) is an efficacious yet underused treatment for patients with coronary artery disease.

Cardiovascular Diabetology, 2009

A meta-analysis suggested the use of rosiglitazone was associated with an increased risk for card... more A meta-analysis suggested the use of rosiglitazone was associated with an increased risk for cardiovascular (CV) events. Rosiglitazone remained available for use as more definitive safety trials were ongoing. This issue was reported in the lay media.

Canadian Journal of Diabetes, 2013

Canadian Journal of Diabetes, 2008

Canadian Journal of Cardiology, 2011

The clinical correlates of coronary collaterals and the effects of coronary collaterals on progno... more The clinical correlates of coronary collaterals and the effects of coronary collaterals on prognosis are incompletely understood. We performed a study of 55,751 patients undergoing coronary angiography to evaluate the correlates of angiographically apparent coronary collaterals, and to evaluate their association with survival. The characteristic most strongly associated with the presence of collaterals was a coronary occlusion (odds ratio [OR], 28.9; 95% confidence interval [CI], 27.1-30.6). Collaterals were associated with improved adjusted survival overall (hazard ratio [HR] 0.89; 95% CI, 0.85-0.95), and in both acute coronary syndrome (ACS) (HR 0.90; 95% CI, 0.84-0.96) and non-ACS (HR 0.84; 95% CI, 0.77-0.92) patients. Collaterals were associated with improved survival in those receiving angioplasty (HR 0.78; 95% CI, 0.71-0.85) and those with low risk anatomy treated medically (HR 0.84; 95% CI, 0.72-0.98), but not for those treated with coronary bypass graft surgery or those with high-risk anatomy treated without revascularization. The major correlate of coronary collaterals is the presence/extent of obstructive coronary artery disease. Collaterals are associated with better survival overall and in both ACS and non-ACS presentations, but not for those treated with coronary artery bypass graft (CABG) or those with high-risk anatomy who are not revascularized.

Canadian Journal of Cardiology, 2012

Canadian Journal of Cardiology, 2013

Prior Canadian studies of cardiac procedure rates showed changes over time and regional variabili... more Prior Canadian studies of cardiac procedure rates showed changes over time and regional variability, but more recent Canadian cardiac procedure rates are unknown. We performed a study using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry to evaluate the temporal trends and geographic distribution of cardiac procedures in Alberta from April 1, 2003 through March 31, 2010. Rates were age- and sex-standardized by means of the 1996 Canadian census. While the raw number of cardiac catheterizations in Alberta was nearly uniform through the study period, age- and sex-standardized cardiac catheterizations declined from a rate of 480 per 100,000 in 2003 to a rate of 430 per 100,000 in 2010. The percutaneous coronary intervention (PCI) rates also declined, from a rate of 186 per 100,000 in 2003 to 170 per 100,000 in 2010. The rates for coronary artery bypass grafts declined from 84 per 100,000 in 2003 to 42 per 100,000 in 2010. There was geographic variability, with northern regions characterized by rates that were higher than the provincial average rates, and southern regions characterized by rates lower than the provincial average. During the study period, age- and sex-standardized rates of cardiac catheterization and PCI in Alberta declined, reversing previous trends of increasing PCI rates. The rates of coronary artery bypass grafts in Alberta declined significantly, suggesting a change in practice consistent with that seen elsewhere. There are geographic differences in rates of cardiac procedures. These data have implications for other regions of Canada, for which registry data may not be available.

Canadian Journal of Cardiology, 2011

BMC Medical Education, 2013

Background: Extended duty hours for residents are associated with negative consequences. Strategi... more Background: Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality health care, and medical education experience. Methods: This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre-and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples. Results: Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision. Conclusions: The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.

The Annals of Thoracic Surgery, 2011

Background. Although bilateral internal thoracic artery (BITA) grafting in coronary artery bypass... more Background. Although bilateral internal thoracic artery (BITA) grafting in coronary artery bypass grafting (CABG) is associated with low morbidity and good long-term results, controversy exists about the age after which BITA grafting is no longer beneficial. We sought to determine if such an age cutoff point exists.

American Journal of Kidney Diseases, 2013

Erythropoiesis-stimulating agent (ESA) doses are often increased in hospitalized dialysis patient... more Erythropoiesis-stimulating agent (ESA) doses are often increased in hospitalized dialysis patients in response to acute anemia with unknown consequences. We sought to determine whether increases in ESA dose during hospital admission were associated with changes in transfusion requirement and risk of exceeding recommended hemoglobin targets. Retrospective cohort study. Linked administrative, laboratory, and blood transfusion data were used to identify a total of 700 hospitalizations involving 484 long-term hemodialysis patients between 2004 and 2008 in the Calgary Health Region, Canada. Change in ESA dose was determined by comparing the average weekly dose over the 6 weeks preceding admission to that administered during the 14 days following admission. Cox proportional hazards models adjusted for baseline patient characteristics were used to model the association between changes in ESA dose and outcomes, including exceeding recommended hemoglobin targets, receipt of blood transfusion, cardiovascular outcomes, and death. There was a significant increase in the risk of exceeding recommended hemoglobin targets as the ESA dose was increased by ≥40 μg/wk (equivalent darbepoetin alfa dose) above baseline (HR, 2.21; 95% CI, 1.19-4.10). However, an increase in ESA dose was not associated with reduced need for blood transfusion, risk of cardiovascular outcomes, or death. Residual confounding by clinical events that may lead to changes in the management of patients and may have influenced the observed relationship between predictor and outcomes. Increasing the ESA dose at hospitalization in hemodialysis patients is associated with higher risk of exceeding recommended hemoglobin targets, but does not appear to be associated with the need for transfusion, risk of cardiovascular outcomes, or death.

BMC Anesthesiology, 2010

We sought to evaluate agreement between a new and widely implemented method of temperature measur... more We sought to evaluate agreement between a new and widely implemented method of temperature measurement in critical care, temporal artery thermometry and an established method of core temperature measurement, bladder thermometry as performed in clinical practice. Temperatures were simultaneously recorded hourly (n = 736 observations) using both devices as part of routine clinical monitoring in 14 critically ill adult patients with temperatures ranging >/=1 degrees C prior to consent. The mean difference between temporal artery and bladder temperatures measured was -0.44 degrees C (95% confidence interval, -0.47 degrees C to -0.41 degrees C), with temporal artery readings lower than bladder temperatures. Agreement between the two devices was greatest for normothermia (36.0 degrees C to < 38.3 degrees C) (mean difference -0.35 degrees C [95% confidence interval, -0.37 degrees C to -0.33 degrees C]). The temporal artery thermometer recorded higher temperatures during hypothermia (< 36 degrees C) (mean difference 0.66 degrees C [95% confidence interval, 0.53 degrees C to 0.79 degrees C]) and lower temperatures during hyperthermia (>/=38.3 degrees C) (mean difference -0.90 degrees C [95% confidence interval, -0.99 degrees C to -0.81 degrees C]). The sensitivity for detecting fever (core temperature >/=38.3 degrees C) using the temporal artery thermometer was 0.26 (95% confidence interval, 0.20 to 0.33), and the specificity was 0.99 (95% confidence interval, 0.98 to 0.99). The positive likelihood ratio for fever was 24.6 (95% confidence interval, 10.7 to 56.8); the negative likelihood ratio was 0.75 (95% confidence interval, 0.68 to 0.82). Temporal artery thermometry produces somewhat surprising disagreement with an established method of core temperature measurement and should not to be used in situations where body temperature needs to be measured with accuracy.