Alain Vadeboncoeur | Université de Montréal (original) (raw)

Papers by Alain Vadeboncoeur

BMJ Quality & Safety, May 10, 2010

Objective To develop search strategies for identifying papers on patient safety in MEDLINE, EMBAS... more Objective To develop search strategies for identifying papers on patient safety in MEDLINE, EMBASE and CINAHL. Methods Six journals were electronically searched for papers on patient safety published between 2000 and 2006. Identified papers were divided into two gold standards: one to build and the other to validate the search strategies. Candidate terms for strategy construction were identified using a word frequency analysis of titles, abstracts and keywords used to index the papers in the databases. Searches were run for each one of the selected terms independently in every database. Sensitivity, precision and specificity were calculated for each candidate term. Terms with sensitivity greater than 10% were combined to form the final strategies. The search strategies developed were run against the validation gold standard to assess their performance. A final step in the validation process was to compare the performance of each strategy to those of other strategies found in the literature. Results We developed strategies for all three databases that were highly sensitive (range 95%e100%), precise (range 40%e60%) and balanced (the product of sensitivity and precision being in the range of 30%e40%). The strategies were very specific and outperformed those found in the literature. Conclusion The strategies we developed can meet the needs of users aiming to maximise either sensitivity or precision, or seeking a reasonable compromise between sensitivity and precision, when searching for papers on patient safety in MEDLINE, EMBASE or CINAHL.

University of British Columbia Press eBooks, Jun 16, 2017

Journal of Hypertension, Jun 1, 2022

Journal of Hypertension, 2023

European journal of public health, Nov 1, 2016

Canadian Journal of Emergency Medicine, May 3, 2022

Objectives Emergency department (ED) visits for high blood pressure are increasing in frequency. ... more Objectives Emergency department (ED) visits for high blood pressure are increasing in frequency. We aimed to map those patients' trajectory, from referral sources to the type of care received at the ED to anticipated actions for future high blood pressure concerns, and to better understand their reasons for consulting the ED for high blood pressure values. Methods Between 2018 and 2020, patients who presented to the Montreal Heart Institute's ED for elevated blood pressure were recruited in a prospective observational study including a post hoc structured telephone interview and medical chart review. Five possible referral sources were predetermined. We provided proportions and 95% confidence intervals. Results A total of 100 patients were recruited (female: 59%, mean age: 69 ± 12). A majority (93%, 95% CI 88-98%) possessed a home blood pressure device, among which 46% (95% CI 36-56%) remembered receiving advice for its use. The main referral sources for high blood pressure to the ED were self-reference (53%, 95% CI 43-63%), advice of a lay person (19%, 95% CI 11-27%) or a nurse (13%, 95% CI 6-20%). Mainly, patients reported being concerned by concomitant symptoms or experiencing acute medical consequences (44%, 95% CI 34-54%), having followed the recommendation of a third party (33%, 95% CI 24-42%), or having concerns about their medication (6%, 95% CI 1-11%). Two weeks following their ED visits, consulting ED remained the main choice for future concerns about high blood pressure for 27% of participants. When specifically asked if they would return to the ED for elevated blood pressure, 73% (95% CI 64-83%) said yes. Conclusions Most patients who consulted the ED for elevated blood pressure values were self-referred. More can be done to promote blood pressure education, effective use of personal blood pressure devices, and recommendations for patients and health professionals when confronted with high blood pressure results. Keywords Hypertension • Emergency • Patient-reported experience measures • Blood pressure Résumé Objectifs Les visites aux services d'urgence pour hypertension artérielle (TA) sont de plus en plus fréquentes. Nous avons cherché à cartographier le parcours de ces patients, depuis les sources d'orientation jusqu'au type de soins reçus aux urgences, en passant par les mesures prévues en cas de problèmes futurs de tension artérielle élevée, et à mieux comprendre les raisons pour lesquelles ils consultent les urgences pour des valeurs de tension artérielle élevées.

CJEM, 2017

Introduction: Patients suffering from out-of-hospital cardiac arrest (OHCA) are frequently transp... more Introduction: Patients suffering from out-of-hospital cardiac arrest (OHCA) are frequently transported to the closest hospital after return of spontaneous circulation (ROSC). Percutaneous coronary intervention (PCI) is often indicated as a diagnostic and therapeutic procedure following OHCA. This study aimed to determine the association between the type of destination hospital (PCI-capable or not) and survival to discharge for patients with OHCA and prehospital ROSC. We hypothesized that being transported to a PCI-capable hospital would be associated with a higher survival to discharge. Methods: The present study used a registry of adult OHCA between 2010 and 2015 in Montréal, Canada. We included adult patients with non-traumatic OHCA and prehospital ROSC. The association of interest was evaluated with a multivariate logistic regression model to control for demographic and clinical variables (age, gender, time of day, initial rhythm, witnessed arrest, bystander CPR, presence of firs...

BMC Psychiatry

Background Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain ... more Background Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain unknown. We aimed to determine the one-year progression of burnout and mental health since pandemic onset, and verify if protective factors against psychological distress at the beginning of the COVID-19 pandemic (Cyr et al. in Front Psychiatry; 2021) remained associated when assessed several months later. Methods We used validated questionnaires (Maslach Burnout Inventory, Hospital Anxiety and Depression and posttraumatic stress disorder [PTSD] Checklist for DSM-5 scales) to assess burnout and psychological distress in 410 healthcare workers from Quebec, Canada, at three and 12 months after pandemic onset. We then performed multivariable regression analyses to identify protective factors of burnout and mental health at 12 months. As the equivalent regression analyses at three months post-pandemic onset had already been conducted in the previous paper, we could compare the protective fac...

Journal of Geriatric Emergency Medicine

Introduction Senior-friendly emergency department (ED) care is emerging to address large numbers ... more Introduction Senior-friendly emergency department (ED) care is emerging to address large numbers of older adults in healthcare and implementation is variable. We aimed to explore key healthcare providers' perspectives on factors affecting implementation of senior-friendly ED care during the first five years of Senior-Friendly Hospital Initiative in the Province of Quebec, Canada. Methods We conducted a descriptive qualitative study of four urban EDs. Key healthcare providers involved in care within the ED or after discharge to the community were purposefully selected. Semi-structured telephone interviews were conducted in participants' preferred language, English or French. Recorded interviews were transcribed. A deductive-inductive thematic analysis was performed focusing on factors affecting implementation at the three following levels: provider-level (ED frontline staff, multidisciplinary, geriatric, and community providers), organizational-level (ED and hospital), and structural-level (health system and policies). Results In total, 33 providers participated. The sample included 13 ED frontline nurses and physicians, 13 multidisciplinary and geriatric ED care providers, and seven community partners from the local government health centers working closely with these EDs. Analysis of participants' perceptions revealed one theme representing implementation at the provider level (attitude to senior-friendly care), six themes representing the organizational level (managerial support, staff training, protocols for care and tools, space and equipment, multidisciplinary support, hospital services support), and three themes representing the structural level (health information system, healthcare network, and staff and budget). Conclusion Healthcare providers identified themes that can inform the development, effectiveness, and sustainability of other senior-friendly ED programs. Overall, successful implementation of senior-friendly ED care primarily depends on providers' attitudes, but it requires a multidimensional approach and continuous support from organizations and healthcare systems.

Prehospital Emergency Care, 2013

The prehospital electrocardiogram (ECG) allows earlier identification of acute ST-segment elevati... more The prehospital electrocardiogram (ECG) allows earlier identification of acute ST-segment elevation myocardial infarction (STEMI). Its utility for detection of other acute cardiac events, as well as for transient ST-segment abnormalities no longer present when the first hospital ECG is performed, is not well characterized. We sought to examine whether the prehospital ECG adds supplemental information to the first ECG obtained in hospital, by comparing data on possible cardiac ischemia and arrhythmias provided by the two ECGs, in ambulance patients later diagnosed as having cardiac disorders, including STEMI. Ambulance personnel acquired 12-lead ECGs for patients suspected of having an acute ischemic event, prior to transport to hospital. The first emergency department 12-lead ECG was provided by medical records at the receiving hospital, and the principal hospital diagnosis for the event was extracted from chart data. Two cardiologists, blinded to the hospital diagnosis, provided their consensus interpretation of 1,209 pairs of ECGs, noting the presence or absence of specific abnormalities on each tracing. Among the 82 patients who had an eventual hospital diagnosis of STEMI, the study cardiologists identified 71 with ST-segment elevations on the ECGs they examined. The vast majority of these (97%) were observed on both ECGs, but the prehospital ECG showed ST-segment elevation for two additional patients (3%). No additional instances were seen only on the hospital ECG. Among the 116 patients with a hospital diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI), the cardiologists identified 36 with ST-segment depressions: 28 (78%) of these were present on both ECGs, seven (19%) only on the prehospital ECG, and one (3%) only on the hospital ECG. Among the 567 patients with any cardiac hospital diagnosis, the cardiologists identified 87 with arrhythmias: 73 (84%) on both ECGs, 12 (14%) only on the prehospital ECG, and two (2%) only on the hospital ECG. Beyond identifying ST-segment elevation earlier, prehospital ECGs detect important transient abnormalities, information not otherwise available from the first emergency department ECG. These data can expedite diagnosis and clinical management decisions among patients suspected of having an acute cardiac event. The prehospital ECG should be fully integrated into emergency medicine practice.

CJEM, 2018

Introduction: Les patients souffrant dun arrêt cardiaque extra hospitalier (ACEH) sont fréquemmen... more Introduction: Les patients souffrant dun arrêt cardiaque extra hospitalier (ACEH) sont fréquemment traités à laide de soins avancés en réanimation cardiovasculaire (SARC). Dans ce contexte, des bicarbonates de sodium sont parfois administrés à des patients en arrêt cardiaque réfractaire chez qui une acidose métabolique importante, une hyperkaliémie ou une intoxication est suspectée. Puisquil ny a que peu dévidences quant à cet usage, lobjectif de la présente étude est dévaluer lassociation entre le traitement à laide de bicarbonate de sodium (une dose ou plus) et le devenir (retour de circulation spontané et survie au congé) chez les patients souffrant dun ACEH. Methods: La présente étude de cohorte a été réalisée à partir des bases de données de la Corporation dUrgences-santé dans la région de Montréal entre 2010 et 2015. Les patients adultes ayant souffert dun ACEH dorigine médicale traités en préhospitalier par des paramédics de soins avancés prodiguant des SARC ont été inclus. L...

Canadian Geriatrics Journal, 2018

Background: For many women urinary incontinence is seen as a normal part of growing older. In a r... more Background: For many women urinary incontinence is seen as a normal part of growing older. In a recent study, 68.5% older community dwelling Canadian women felt this to be so but if incontinent were no less likely to seek treatment than women who did not hold this belief. The aim of this descriptive study was to explore other health related factors associated with holding this belief. Methods: This was a secondary analysis of baseline data collected as part of a CIHR funded randomised controlled trial which evaluated whether continence promotion and self-management improved Health Related Quality of Life in community dwelling older women. Results: The sample included 4446 women, mean (SD) age 78.23 (8.99) and mean (SD) BMI of 26.55 (5.55). Women who felt incontinence was normal for aging were older (77.4v 78,3, p=0.04), had a higher BMI (25.6v 26.3, p=0.03), reported lower levels of general health and energy, were more likely to report limitations in their daily activities and reported a higher frequency of feeling downhearted. Discussion: The belief that incontinence is a normal consequence of aging appears to be related to lower reported levels of health and physical activity in older women. As such this belief may be held as an additional facet of "unhealthy aging" for these older women, or may reflect an overall pessimistic outlook on life or acceptance of consequence of comorbid conditions. Conclusions: Educational workshops aimed at education and self management of incontinence delivered to community dwelling older women have demonstrable altered this attitude. Geriatricians have a key role to play in ensuring that incontinence does not remain an unaddressed condition

CJEM, 2003

* p < 0.00000003 for before-after comparisons in both study groups. † 34% of EPs preferred the ch... more * p < 0.00000003 for before-after comparisons in both study groups. † 34% of EPs preferred the characters on ER (and regretted Dr. Green's death).

CJEM, 2020

Introduction: For rhythm control of acute atrial flutter (AAFL) in the emergency department (ED),... more Introduction: For rhythm control of acute atrial flutter (AAFL) in the emergency department (ED), choices include initial drug therapy or initial electrical cardioversion (ECV). We compared the strategies of pharmacological cardioversion followed by ECV if necessary (Drug-Shock), and ECV alone (Shock Only). Methods: We conducted a randomized, blinded, placebo-controlled trial (1:1 allocation) comparing two rhythm control strategies at 11 academic EDs. We included stable adult patients with AAFL, where onset of symptoms was <48 hours. Patients underwent central web-based randomization stratified by site. The Drug-Shock group received an infusion of procainamide (15mg/kg over 30 minutes) followed 30 minutes later, if necessary, by ECV at 200 joules x 3 shocks. The Shock Only group received an infusion of saline followed, if necessary, by ECV x 3 shocks. The primary outcome was conversion to sinus rhythm for ≥30 minutes at any time following onset of infusion. Patients were followed...

Journal of Nuclear Cardiology

Objective Evaluate the impact of 82-Rubidium positron emission tomography (PET) myocardial perfus... more Objective Evaluate the impact of 82-Rubidium positron emission tomography (PET) myocardial perfusion imaging (MPI) availability on patient management presenting at the emergency department (ED) with chest pain (CP). Methods This is a single-center retrospective study of clinical databases. Patients presenting with CP with a non-definitive suspicion of acute coronary syndrome (ACS) at the ED between April 2016 and February 2020 were divided into 2 groups based on PET availability. The proportion of invasive coronary angiography (ICA) without significant coronary artery disease (CAD), length of stay (LoS), and additional downstream testing were evaluated. Results There were 21,242 ED visits for CP without definitive ACS: 5,492 when PET is not available and 15,750 when PET is available. When PET is available, proportion of patients undergoing a MPI study was greater (20.7% vs 17.6%, P<0.0001), proportion of ICA without significant CAD was similar (18.5% vs 21.4%, P=0.24), and median...

Perspective infirmière : revue officielle de l'Ordre des infirmières et infirmiers du Québec, 2010

Apres avoir ecrit sur le systeme de sante, la mort et sur la medecine elle-meme, le docteur Alain... more Apres avoir ecrit sur le systeme de sante, la mort et sur la medecine elle-meme, le docteur Alain Vadeboncoeur a eu envie de relaxer un peu et de partager les moments etranges et cocasses qui ponctuent sa vie a l’urgence. Avec la sensibilite qu’on lui connait, il raconte les petits travers des gens du metier (et les siens !), les rencontres loufoques, les contrastes etonnants entre certains drames et leurs repercussions insolites... et meme comment son prefacier, le comedien et realisateur Simon Olivier Fecteau, a un jour tente de le tuer. En poursuivant son exploration du milieu de la medecine, Alain Vadeboncoeur nous devoile le cote givre que les professionnels de la sante ont parfois un peu de difficulte a reveler en public.