Browsing by Author "Johnson, David W."
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Item Open Access Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas(2024-05-08) Ghimire, Anukul; Shah, Samveg; Chauhan, Utkarsh; Ibrahim, Kwaifa S.; Jindal, Kailash; Kazancioglu, Rumeyza; Luyckx, Valerie A.; MacRae, Jennifer M.; Olanrewaju, Timothy O.; Quinn, Robert R.; Ravani, Pietro; Shah, Nikhil; Thompson, Stephanie; Tungsanga, Somkanya; Vachharanjani, Tushar; Arruebo, Silvia; Caskey, Fergus J.; Damster, Sandrine; Donner, Jo-Ann; Jha, Vivekanand; Levin, Adeera; Malik, Charu; Nangaku, Masaomi; Saad, Syed; Tonelli, Marcello; Ye, Feng; Okpechi, Ikechi G.; Bello, Aminu K.; Johnson, David W.Abstract Background There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. Methods Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. Results Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). Conclusions High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.Item Open Access How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review(2016-12-18) Hartling, Lisa; Ali, Samina; Dryden, Donna M.; Chordiya, Pritam; Johnson, David W.; Plint, Amy C.; Stang, Antonia; McGrath, Patrick J.; Drendel, Amy L.Background. Fear of adverse events and occurrence of side effects are commonly cited by families and physicians as obstructive to appropriate use of pain medication in children. We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (ud_less_than18 years) treated in ambulatory settings. Methods. A comprehensive search was performed to July 2015, including review of national data registries. Two reviewers screened articles for inclusion, assessed methodological quality, and extracted data. Risks (incidence rates) were pooled using a random effects model. Results. Forty-four studies were included; 23 reported on adverse events. Based on limited current evidence, acetaminophen, ibuprofen, and opioids have similar nausea and vomiting profiles. Opioids have the greatest risk of central nervous system adverse events. Dual therapy with a nonopioid/opioid combination resulted in a lower risk of adverse events than opioids alone. Conclusions. Ibuprofen and acetaminophen have similar reported adverse effects and notably less adverse events than opioids. Dual therapy with a nonopioid/opioid combination confers a protective effect for adverse events over opioids alone. This research highlights challenges in assessing medication safety, including lack of more detailed information in registry data, and inconsistent reporting in trials.Item Open Access Impact of emergency department probiotic treatment of pediatric gastroenteritis: study protocol for the PROGUT (Probiotic Regimen for Outpatient Gastroenteritis Utility of Treatment) randomized controlled trial(BioMed Central, 2014-05-14) Freedman, Stephen B; Williamson-Urquhart, Sarah; Schuh, Suzanne; Sherman, Philip M.; Farion, Ken J.; Gouin, Serge; Willan, Andrew R.; Goeree, Ron; Johnson, David W.; Karen Black; Schnadower, David; Gorelick, Marc HItem Open Access Impacts of the SARS-CoV-2 pandemic on the seasonal pattern of hospitalizations for acute respiratory diseases among children in Alberta, Canada(2024) Lukac, Christine D; Simms, Brett; Kwong, Grace P.S.; Holodinsky, Jessalyn K.; Johnson, David W.; Kellner, James D.Introduction: Acute infectious respiratory diseases (ARD) among children generally have a biennial pattern – peak incidence is highest every other winter. This seasonal pattern of ARD was interrupted in 2020 by SARS-CoV-2 and non-pharmaceutical interventions (NPI). We conducted a population based retrospective cohort study in Alberta, that measured the impact on (i) the weekly incidence of hospitalizations to quantify healthcare use, (ii) the weekly percent of PICU admissions to monitor clinical severity, and (iii) the weekly average age at discharge to characterise the affected population. Methods: From Apr 2003-Dec 2023, all hospital discharges and PICU admissions for ARD (i.e. bronchiolitis, pneumonia, influenza-like-illness, and croup) among children < 18 years old were identified in the provincial hospital Discharge Abstract Database. Weekly incidence of hospital discharge was calculated using population denominators. Weekly percent PICU admissions was calculated using all hospital discharges as the denominator. Weekly average age at discharge was calculated from birth to discharge in months. Seasonal autoregressive-integrated-moving-average (SARIMA) models predicted the expected weekly outcomes from Apr 2020 onward. Incidence ratios and percent change compared observed versus expected outcomes. Analyses were conducted in R version 4.2.2 (2022-10-31) and R studio build 2022.12.0+353. Results: There were 63,776 hospitalizations for ARD among children from Apr 2003-Dec 2023: 22,963 (36.01%) for bronchiolitis, 23,977 (37.44%) for pneumonia, 10,833 (16.97%) for influenza-like-illness, and 4,984 (7.81%) for croup. Of the hospitalizations, 4,167 (6.53%) included a PICU admission. The average weekly incidence of hospitalization for ARD per 100,000 children decreased 12.71-fold during Dec 2020-Feb 2021 (0.82 observed vs. 10.42 [95%CI 5.11, 15.73] expected) and increased 1.51-fold during Dec 2022-Feb 2023 (16.28 observed vs. 10.77 [95%CI 4.71, 16.83] expected). The average percentage of PICU admissions steadily increased from 4.07% (95%CI 1.22%, 6.91%) in Dec 2003-Feb 2004 to 10.48% (95%CI 8.36%, 12.60%) in Dec 2019-Feb 2020. There was no significant change in the percentage of PICU admissions in Dec 2020-Feb 2021 and Dec 2022-Feb 2023, 11.17% (95%CI 0.00%, 26.32%) and 11.86% (95%CI 9.33%, 14.39%) respectively. During each winter season, the average age at discharge decreased to 25 months (95%CI 17.85, 33.74) annually. Similar patterns for incidence of hospitalizations, percent PICU admissions, and average age at discharge were observed for bronchiolitis, pneumonia, influenza-like-illness, and croup. Discussion: SARS-CoV-2 and NPI had significant impacts on provincial hospitalization for ARD among children. Initially hospitalizations for ARD decreased 12.71-fold during Dec 2020-Feb 2021. With SARS-CoV-2 vaccine availability, increased population immunity, and relaxation of NPI, hospitalizations for ARD increased 1.51-fold during Dec 2022-Feb 2023. However, there was no change in clinical severity based on percent PICU admissions, and no change in affected population based on average age at discharge.Item Open Access Patient-reported outcome measures in pediatric asthma care: using theoretical domains framework to explore healthcare providers’ perceptions(2022-08-19) Bele, Sumedh; Rabi, Sarah; Zhang, Muning; Oddone Paolucci, Elizabeth; Johnson, David W.; Quan, Hude; Santana, Maria J.Abstract Background Patient-reported outcome measures (PROMs) play an important role in promoting and supporting patient and family-centered care. Implementing interventions like PROMs in routine clinical care require key stakeholders to change their behavior. The aim of this study was to utilize the Theoretical Domains Framework (TDF) to identify barriers and enablers to the implementation of PROMs in pediatric outpatient asthma clinics from healthcare providers’ perspective. Methods This TDF-guided qualitative descriptive study is part of a larger multi-phase project to develop the KidsPRO program, an electronic platform to administer, collect, and use PROMs in pediatrics. Semi-structured qualitative interviews were conducted with 17 participants, which included pediatricians, nurses, allied health professionals and administrative staff from outpatient asthma clinics. All the interviews were transcribed, deductively coded, inductively grouped in themes, and categorized into barriers and enablers. Results We identified 33 themes within 14 TDF domains, which were further categorized and tabulated into 16 barriers and 17 enablers to implementing PROMs in asthma clinics. Barriers to behavioral change were attributed to personal, clinical, non-clinical, and other system-level factors; they ranged from limited awareness of PROMs to language barriers and patient’s complex family background. Enablers ranged from a personal commitment to providing patient and family-centered care to administering PROMs electronically. Conclusion This implementation of science-based systematic inquiry captured the complexity of PROMs implementation in pediatric outpatient clinical care for asthma. Considering the consistency in barriers and enablers to implementing PROMs across patient populations and care settings, many findings of this study will be directly applicable to other pediatric healthcare settings.Item Open Access Study protocol for Vascular Access outcome measure for function: a vaLidation study In hemoDialysis (VALID)(2022-11-19) Viecelli, Andrea K.; Teixeira-Pinto, Armando; Valks, Andrea; Baer, Richard; Cherian, Roy; Cippà, Pietro E.; Craig, Jonathan C.; DeSilva, Ranil; Jaure, Allison; Johnson, David W.; Kiriwandeniya, Charani; Kopperschmidt, Pascal; Liu, Wen-J; Lee, Timmy; Lok, Charmaine; Madhan, Krishan; Mallard, Alistair R.; Oliver, Veronica; Polkinghorne, Kevan R.; Quinn, Rob R.; Reidlinger, Donna; Roberts, Matthew; Sautenet, Bénédicte; Hooi, Lai S.; Smith, Rob; Snoeijs, Maarten; Tordoir, Jan; Vachharajani, Tushar J.; Vanholder, Raymond; Vergara, Liza A.; Wilkie, Martin; Yang, Bing; Yuo, Theodore H.; Zou, Li; Hawley, Carmel M.Abstract Background A functioning vascular access (VA) is crucial to providing adequate hemodialysis (HD) and considered a critically important outcome by patients and healthcare professionals. A validated, patient-important outcome measure for VA function that can be easily measured in research and practice to harvest reliable and relevant evidence for informing patient-centered HD care is lacking. Vascular Access outcome measure for function: a vaLidation study In hemoDialysis (VALID) aims to assess the accuracy and feasibility of measuring a core outcome for VA function established by the international Standardized Outcomes in Nephrology (SONG) initiative. Methods VALID is a prospective, multi-center, multinational validation study that will assess the accuracy and feasibility of measuring VA function, defined as the need for interventions to enable and maintain the use of a VA for HD. The primary objective is to determine whether VA function can be measured accurately by clinical staff as part of routine clinical practice (Assessor 1) compared to the reference standard of documented VA procedures collected by a VA expert (Assessor 2) during a 6-month follow-up period. Secondary outcomes include feasibility and acceptability of measuring VA function and the time to, rate of, and type of VA interventions. An estimated 612 participants will be recruited from approximately 10 dialysis units of different size, type (home-, in-center and satellite), governance (private versus public), and location (rural versus urban) across Australia, Canada, Europe, and Malaysia. Validity will be measured by the sensitivity and specificity of the data acquisition process. The sensitivity corresponds to the proportion of correctly identified interventions by Assessor 1, among the interventions identified by Assessor 2 (reference standard). The feasibility of measuring VA function will be assessed by the average data collection time, data completeness, feasibility questionnaires and semi-structured interviews on key feasibility aspects with the assessors. Discussion Accuracy, acceptability, and feasibility of measuring VA function as part of routine clinical practice are required to facilitate global implementation of this core outcome across all HD trials. Global use of a standardized, patient-centered outcome measure for VA function in HD research will enhance the consistency and relevance of trial evidence to guide patient-centered care. Trial registration Clinicaltrials.gov: NCT03969225. Registered on 31st May 2019.Item Open Access The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention(2023-05-06) Wine, Osnat; McNeil, Deborah; Kromm, Seija K.; Foss, Karen; Caine, Vera; Clarke, Denise; Day, Nathaniel; Johnson, David W.; Rittenbach, Katherine; Wood, Stephen; Hicks, MattAbstract Background Neonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model’s key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation’s impact/outcomes. Methods A stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation. Discussion The primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources. Trial registration ClinicalTrials.gov, NCT0522662. Registered February 4th, 2022.Item Open Access Uptake of pediatric patient-reported outcome and experience measures and challenges associated with their implementation in Alberta: a mixed-methods study(2023-07-18) Bele, Sumedh; Rabi, Sarah; Zhang, Muning; Ahmed, Sadia; Paolucci, Elizabeth O.; Johnson, David W.; Quan, Hude; Santana, Maria J.Abstract Background Implementing Patient-reported Outcome Measures (PROMs) and Patient-reported Experience Measures (PREMs) is an effective way to deliver patient- and family-centered care (PFCC). Although Alberta Health Services (AHS) is Canada's largest and fully integrated health system, PROMs and PREMs are yet to be routinely integrated into the pediatric healthcare system. This study addresses this gap by investigating the current uptake, barriers, and enablers for integrating PROMs and PREMs in Alberta's pediatric healthcare system. Methods Pediatric clinicians and academic researchers with experience using PROMs and PREMs were invited to complete a quantitative survey. Additionally, key stakeholders were qualitatively interviewed to understand current challenges in implementing pediatric PROMs and PREMs within AHS. Quantitative data gathered from 22 participants were descriptively analyzed, and qualitative data from 14 participants were thematically analyzed. Results Participants identified 33 PROMs and 6 PREMs showing diversity in the types of pediatric PROMs and PREMs currently being used in Alberta and their mode of administration. The qualitatively identified challenges were associated with patients, family caregivers, and clinicians. The absence of system-level support, such as integration within electronic medical records, is considered a significant system-level challenge. Conclusions The significant variation in the types of PROMs and PREMs used, the rationale for their use, and their mode of administration demonstrate the diverse and sporadic use of these measures in Alberta. These findings highlight the need for province-wide uniform implementation of pediatric PROMs and PREMs in Alberta. Our results could benefit healthcare organizations in developing evidence-based PROM and PREM implementation strategies in pediatrics.