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Journal of the American Geriatrics Society, 2018
To distribute the EMPOWER patient education brochure and use hospitalization as an opportunity to... more To distribute the EMPOWER patient education brochure and use hospitalization as an opportunity to reduce inappropriate sedatives. DESIGN: Participants were sequentially recruited until we achieved 30-day follow-up telephone and pharmacy records for 50 individuals. The proportion meeting the primary outcome was compared with that of a control cohort and with rates of cessation achieved in the community. SETTING: Fifty-two-bed medical clinical teaching unit in Montr eal, Canada. PARTICIPANTS: Inpatients aged 65 and older who were chronic, regular sedative users. MEASUREMENTS: The primary outcome was short-term sustained cessation 30-days after discharge. As a secondary outcome, we compared self-reported sleep disturbance before and after the intervention. RESULTS: Sedatives were deprescribed in 32 of 50 (64%) participants who received the EMPOWER brochure, which was significantly higher than our historical rate of 21% (p<.001). Participants did not report significant worsening in their quality of sleep after sedative cessation. CONCLUSION: Hospitalized individuals are willing to deprescribe, and contact with the healthcare system provides the opportunity to initiate the process with educational brochures. This type of intervention requires few resources and is feasible and inexpensive.
BMC Infectious Diseases, 2020
Background Pneumocystis jirovecii pneumonia (PJP) can be challenging to diagnose, often requiring... more Background Pneumocystis jirovecii pneumonia (PJP) can be challenging to diagnose, often requiring bronchoscopy. Since most patients suspected of PJP undergo imaging, we hypothesized that the findings of these studies could help estimate the probability of disease prior to invasive testing. Methods We created a cohort of patients who underwent bronchoscopy specifically to diagnose PJP and conducted a nested case-control study to compare the radiographic features between patients with (n = 72) and without (n = 288) pathologically proven PJP. We used multivariable logistic regression to identify radiographic features independently associated with PJP. Results Chest x-ray findings poorly predicted the diagnosis of PJP. However, multivariable analysis of CT scan findings found that “increased interstitial markings” (OR 4.3; 95%CI 2.2–8.2), “ground glass opacities” (OR 3.3; 95%CI 1.2–9.1) and the radiologist’s impression of PJP being “possible” (OR 2.0; 95%CI 1.0–4.1) or “likely” (OR 9.3;...
Journal of the American Geriatrics Society, 2018
To distribute the EMPOWER patient education brochure and use hospitalization as an opportunity to... more To distribute the EMPOWER patient education brochure and use hospitalization as an opportunity to reduce inappropriate sedatives. DESIGN: Participants were sequentially recruited until we achieved 30-day follow-up telephone and pharmacy records for 50 individuals. The proportion meeting the primary outcome was compared with that of a control cohort and with rates of cessation achieved in the community. SETTING: Fifty-two-bed medical clinical teaching unit in Montr eal, Canada. PARTICIPANTS: Inpatients aged 65 and older who were chronic, regular sedative users. MEASUREMENTS: The primary outcome was short-term sustained cessation 30-days after discharge. As a secondary outcome, we compared self-reported sleep disturbance before and after the intervention. RESULTS: Sedatives were deprescribed in 32 of 50 (64%) participants who received the EMPOWER brochure, which was significantly higher than our historical rate of 21% (p<.001). Participants did not report significant worsening in their quality of sleep after sedative cessation. CONCLUSION: Hospitalized individuals are willing to deprescribe, and contact with the healthcare system provides the opportunity to initiate the process with educational brochures. This type of intervention requires few resources and is feasible and inexpensive.
BMC Infectious Diseases, 2020
Background Pneumocystis jirovecii pneumonia (PJP) can be challenging to diagnose, often requiring... more Background Pneumocystis jirovecii pneumonia (PJP) can be challenging to diagnose, often requiring bronchoscopy. Since most patients suspected of PJP undergo imaging, we hypothesized that the findings of these studies could help estimate the probability of disease prior to invasive testing. Methods We created a cohort of patients who underwent bronchoscopy specifically to diagnose PJP and conducted a nested case-control study to compare the radiographic features between patients with (n = 72) and without (n = 288) pathologically proven PJP. We used multivariable logistic regression to identify radiographic features independently associated with PJP. Results Chest x-ray findings poorly predicted the diagnosis of PJP. However, multivariable analysis of CT scan findings found that “increased interstitial markings” (OR 4.3; 95%CI 2.2–8.2), “ground glass opacities” (OR 3.3; 95%CI 1.2–9.1) and the radiologist’s impression of PJP being “possible” (OR 2.0; 95%CI 1.0–4.1) or “likely” (OR 9.3;...