Browsing by Author "Doig, Christopher"

Now showing 1 - 9 of 9
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    A comparison between the APACHE II and Charlson Index Score for predicting hospital mortality in critically ill patients
    (BioMed Central, 2009-07-30) Quach, Susan; Hennessy, Deirdre A.; Faris, Peter; Fong, Andrew; Quan, Hude; Doig, Christopher
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    Epidemiology of severe acute renal failure and prognosis for renal recovery in critically ill patients
    (2005) Bagshaw, Sean Michael; Doig, Christopher; Laupland, Kevin B.
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    Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review
    (2024-08-15) Krewulak, Karla D.; Jaworska, Natalia; Lee, Laurie; Louis, Julia S.; Dmitrieva, Olesya; Leia, Madison P.; Doig, Christopher; Niven, Daniel J.; Parhar, Ken K. S.; Rochwerg, Bram; West, Andrew; Stelfox, Henry T.; Leigh, Jeanna P.; Fiest, Kirsten M.
    Abstract Background We aimed to synthesize the qualitative evidence on the impacts of COVID-19-related restricted family presence policies from the perspective of patients, families, and healthcare professionals from neonatal (NICU), pediatric (PICU), or adult ICUs. Methods We searched MEDLINE, EMBASE, Cochrane Databases of Reviews and Clinical Trials, CINAHL, Scopus, PsycINFO, and Web of Science. Two researchers independently reviewed titles/abstracts and full-text articles for inclusion. Thematic analysis was completed following appraising article quality and assessing confidence in the individual review findings using standardized tools. Results We synthesized 54 findings from 184 studies, revealing the impacts of these policies in children and adults on: (1) Family integrated care and patient and family-centered care (e.g., disruption to breastfeeding/kangaroo care, dehumanizing of patients); (2) Patients, families, and healthcare professionals (e.g., negative mental health consequences, moral distress); (3) Support systems (e.g., loss of support from friends/families); and (4) Relationships (e.g., loss of essential bonding with infant, struggle to develop trust). Strategies to mitigate these impacts are reported. Conclusion This review highlights the multifaceted impacts of restricted visitation policies across distinct care settings and strategies to mitigate the harmful effects of these policies and guide the creation of compassionate family presence policies in future health crises. Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290263 .
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    Integration of metabolic and inflammatory mediator profiles as a potential prognostic approach for septic shock in the intensive care unit
    (Critical Care, BioMed Central, 2015-01-15) Mickiewicz, Beata; Tam, Patrick; Jenne, Craig N; Leger, Caroline; Wong, Josee; Winston, Brent W; Doig, Christopher; Kubes, Paul; Vogel, Hans J
    Introduction Septic shock is a major life-threatening condition in critically ill patients and it is well known that early recognition of septic shock and expedient initiation of appropriate treatment improves patient outcome. Unfortunately, to date no single compound has shown sufficient sensitivity and specificity to be used as a routine biomarker for early diagnosis and prognosis of septic shock in the intensive care unit (ICU). Therefore, the identification of new diagnostic tools remains a priority for increasing the survival rate of ICU patients. In this study, we have evaluated whether a combined nuclear magnetic resonance spectroscopy-based metabolomics and a multiplex cytokine/chemokine profiling approach could be used for diagnosis and prognostic evaluation of septic shock patients in the ICU. Methods Serum and plasma samples were collected from septic shock patients and ICU controls (ICU patients with the systemic inflammatory response syndrome but not suspected of having an infection). 1H Nuclear magnetic resonance spectra were analyzed and quantified using the targeted profiling methodology. The analysis of the inflammatory mediators was performed using human cytokine and chemokine assay kits. Results By using multivariate statistical analysis we were able to distinguish patient groups and detect specific metabolic and cytokine/chemokine patterns associated with septic shock and its mortality. These metabolites and cytokines/chemokines represent candidate biomarkers of the human response to septic shock and have the potential to improve early diagnosis and prognosis of septic shock. Conclusions Our findings show that integration of quantitative metabolic and inflammatory mediator data can be utilized for the diagnosis and prognosis of septic shock in the ICU.
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    Investigating musculoskeletal changes in critically ill patients with computed tomography (CT) imaging
    (2024-05-23) Smith, Ainsley Catherine Joan; Manske, Sarah Lynn; Herzog, Walter; Doig, Christopher; Wong, Andy Kin On; MacInnis, Martin
    Critical care patients are susceptible to musculoskeletal changes during their stay in the intensive care unit (ICU). Intensive care unit acquired weakness (ICU-AW) is a common complication of critical illness that is characterized by a significant loss of muscle strength. ICU-AW can lead to long-term weakness, fractures, physical impairment, and reduced quality of life. Evaluating musculoskeletal health in the ICU can be challenging as patients are often non-responsive and unstable. However, critical care patients typically undergo computed tomography (CT) imaging for their clinical care, which can be repurposed for musculoskeletal assessment. The purpose of this thesis was to use clinically acquired CT images and electronic medical record data to investigate the effects of critical illness on the musculoskeletal system. CT imaging provides measures of muscle cross-sectional area, indicating muscle atrophy; muscle density, indicating muscle quality; and bone mineral density (BMD), indicating fracture risk. First, I adapted and validated a CT internal calibration method for reliable muscle density analysis. I then applied this internal calibration method to clinically acquired CT images of critical care patients, and I found that critical care patients undergo a significant reduction in psoas and thigh muscle density over the course of critical illness. Further, I applied CT internal calibration to evaluate BMD changes in critical care patients, and no changes were observed. In a larger cohort, I used clinically acquired CT images to determine that critical care patients experience significant psoas muscle atrophy during their ICU stay. Using electronic medical record data, I found that this muscle atrophy was associated with length of time in the ICU and quantity of muscle at ICU admission. Further, rate of muscle atrophy was associated with ICU mortality. The findings from this thesis provide insight into the effects of critical illness on the musculoskeletal system, the risk factors and mechanisms associated with muscle loss in the ICU, and the utility of clinically acquired CT imaging for retrospective musculoskeletal assessment.
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    Long-term health related recovery and outcomes in survivors of intensive care
    (2013-04-04) Solverson, Kevin; Doig, Christopher
    Our objective was to create a follow-up clinic for survivors of critical illness in order to examine objective physical functioning, mental health and sleep quality and relate these findings to health related quality of life (HRQL) and ICU risk factors. 56 patients were evaluated at 2 months post hospital discharge and 19 patients at 4 months. At 2 months post hospital discharge we found that: Patients had reduced muscle strength and physical functioning and neither were association with ICU risk factors; Reduced muscle strength was correlated with poor physical functioning; Patients’ HRQL was associated with decreased physical functioning; Anxiety was common and found to correlate with poor HRQL and physical functioning; Objective sleep quality was poor and predicted by increased severity of critical illness. Long-term physical and mental morbidity is common in critical illness survivors and impacts HRQL. ICU follow-up clinics should be considered in all survivors of critical illness.
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    Psychological Distress in Emergency Medical Services Practitioners: Identifying and Measuring the Issues
    (2017) Lefevre, Nicola Louise; Doig, Christopher; Mitchell, Ian; Page, Stacy; Guichon, Juliet; McLaughlin, Kevin
    This thesis investigates psychological distress in Emergency Medical Services practitioners through three pieces of inter-related research. The first examines the prevalence of compassion fatigue in all health care practitioners by systematic review of literature. The second conceptualizes three manifestations of distress (compassion fatigue, burnout, and post-traumatic stress disorder), places them in the context of EMS work by describing practitioners’ experience, and broadly strategizes ways to address them. The third measures the presence of compassion fatigue, burnout, and post-traumatic stress disorder in a sample of EMS practitioners through a survey based study. Overall, the research showed that EMS practitioners are experiencing psychological distress as compassion fatigue, burnout and PTSD, and that compassion fatigue has been identified across diverse practitioner groups in health care. Recommendations are consistently made that further research needs to be conducted to investigate root causes, and that education and support programs would be of benefit to practitioners.
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    The applicability of meta-analyses to guide clinical practice in critical care
    (2005) Delaney, Anthony; Doig, Christopher
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    Validation of an ICD-10 coded case definition for the identification of patients diagnosed with sepsis and severe sepsis using administrative data
    (2015-02-10) Jolley, Rachel; Doig, Christopher
    Background: We assessed the validity of existing ICD case definitions used to identify sepsis in administrative data and validated and optimized an existing ICD-10-CA coding algorithm to identify patients diagnosed with sepsis. Methods: Standard systematic review methodology was applied to assess the validity of ICD case definitions for sepsis. The CIHI ICD-10-CA coding algorithm for sepsis was validated and optimized using a randomly selected cohort of ICU and non-ICU patients. Sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Twelve studies were identified in the systematic review with a range of diagnostic accuracy reported indicating that sepsis is highly under-coded. We increased the accuracy of the CIHI ICD-10-CA coding algorithm for sepsis (Sn: 71.9%, NPV: 66.6%) and severe sepsis (Sn: 65.1%, NPV: 70.1%) while slightly decreasing Sp and PPV. Conclusions: Sepsis is highly under-coded in administrative data. The new definition has a much higher sensitivity and negative predictive value.