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Article ; Online: Torsades de pointes associated with remdesivir treatment for COVID-19 pneumonia.

Fung, Jollee St / Levitan, Mark / Landry, Sarah / McIsaac, Sarah

Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada

2023 Volume 8, Issue 1, Page(s) 99–104

Abstract: Background: Prolonged QT interval (QTc) can be a serious adverse event from SARS-CoV-2 infection and associated treatment, including remdesivir.: Methods: We present a case of a 55-year-old woman with COVID-19 pneumonia who was treated with ... ...

Abstract	Background: Prolonged QT interval (QTc) can be a serious adverse event from SARS-CoV-2 infection and associated treatment, including remdesivir. Methods: We present a case of a 55-year-old woman with COVID-19 pneumonia who was treated with remdesivir. The QTc on admission was 483 ms. After three doses of remdesivir, she had an episode of non-sustained ventricular tachycardia. Repeat QTc was significantly prolonged at 609 ms. She experienced a polymorphic ventricular tachycardic cardiac arrest the next morning, thought to be secondary to torsades de pointes. Results: Transthoracic echocardiogram showed normal biventricular function. Electrolytes were within normal limits. In the absence of other QTc-prolonging medications, remdesivir was thought to be inciting agent. Following discontinuation of remdesivir, the patient's QTc returned to baseline. Conclusions: There is a risk for cardiac events from QTc prolongation effects of SARS-CoV-2 infection and associated treatment. We recommend pharmacological profile review and cardiac monitoring for patients receiving remdesivir.
Language	English
Publishing date	2023-03-01
Publishing country	Canada
Document type	Journal Article
ISSN	2371-0888
ISSN (online)	2371-0888
DOI	10.3138/jammi-2022-0010
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Impact of community-based interventions on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis.

Simmons, Kayla M / McIsaac, Sarah M / Ohle, Robert

Scientific reports

2023 Volume 13, Issue 1, Page(s) 10231

Abstract: Survival following out-of-hospital cardiac arrest (OHCA) remains low, typically less than 10%. Bystander cardiopulmonary resuscitation (CPR) and bystander-AED use have been shown to improve survival by up to fourfold in individual studies. Numerous ... ...

Abstract	Survival following out-of-hospital cardiac arrest (OHCA) remains low, typically less than 10%. Bystander cardiopulmonary resuscitation (CPR) and bystander-AED use have been shown to improve survival by up to fourfold in individual studies. Numerous community-based interventions have been implemented worldwide in an effort to enhance rates of bystander-CPR, bystander-AED use, and improve OHCA survival. This systematic review and meta-analysis aims to evaluate the effect of such interventions on OHCA outcomes. Medline and Embase were systematically searched from inception through July 2021 for studies describing the implementation and effect of one or more community-based interventions targeting OHCA outcomes. Two reviewers screened articles, extracted data, and evaluated study quality using the Newcastle-Ottawa Scale. For each outcome, data were pooled using random-effects meta-analysis. Of the 2481 studies identified, 16 met inclusion criteria. All included studies were observational. They reported a total of 1,081,040 OHCAs across 11 countries. The most common interventions included community-based CPR training (n = 12), community-based AED training (n = 9), and dispatcher-assisted CPR (n = 8). Health system interventions (hospital or paramedical services) were also described in 11 of the included studies. Evidence certainty among all outcomes was low or very low according to GRADE criteria. On meta-analysis, community-based interventions with and without health system interventions were consistently associated with improved OCHA outcomes: rates of bystander-CPR, bystander-AED use, survival, and survival with a favorable neurological outcome. Bystander CPR-14 studies showed a significant increase in post-intervention bystander-CPR rates (n = 285 752; OR 2.26 [1.74, 2.94]; I
MeSH term(s)	Humans ; Cardiopulmonary Resuscitation/methods ; Out-of-Hospital Cardiac Arrest/therapy ; Hospitals ; Patient Discharge ; MEDLINE
Language	English
Publishing date	2023-06-23
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-35735-y
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Article ; Online: Mortality and risk factors associated with misdiagnosis of acute aortic syndrome in Ontario, Canada: a population-based study.

Ohle, Robert / Savage, David W / Caswell, Joseph / McIsaac, Sarah / Yadav, Krishan / Conlon, Michael

Emergency medicine journal : EMJ

2024 Volume 41, Issue 3, Page(s) 145–150

Abstract: Introduction: Acute aortic syndrome (AAS) is a life-threatening aortic emergency. It describes three diagnoses: acute aortic dissection, acute intramural haematoma and penetrating atherosclerotic ulcer. Unfortunately, there are no accurate estimates of ... ...

Abstract	Introduction: Acute aortic syndrome (AAS) is a life-threatening aortic emergency. It describes three diagnoses: acute aortic dissection, acute intramural haematoma and penetrating atherosclerotic ulcer. Unfortunately, there are no accurate estimates of the miss rate for AAS, risk factors for missed diagnosis or its effect on outcomes. Methods: A population-based retrospective cohort study of anonymously linked data for residents of Ontario, Canada, was carried out. Incident cases of AAS were identified between 2003 and 2018 using a validated algorithm based on ICD codes and death. Before multivariate modelling, all categorical variables were analysed for an association with missed AAS diagnosis using χ Results: There were 1299 cases of AAS (age mean (SD) 68.03±14.70, woman 500 (38.5%), rural areas (n=111, 8.55%)) over the study period. Missed cases accounted for 163 (12.5%) of the cohort. Mortality (non-missed AAS 59.7% vs missed AAS 54.6%) and surgical intervention (non-missed AAS 31% vs missed AAS 30.7%) were similar in missed and non-missed cases. However, lower acuity (Canadian triage acuity scale >2 (OR 2.45 95% CI 1.71 to 3.52) (the scale is from 1 to 5, with 1 indicating high acuity) had a higher odds of being a missed case and non-ambulatory presentation (OR 0.47 95% CI 0.33 to 0.67) and presenting to a teaching (OR 0.60 95% CI 0.40 to 0.90)) or cardiac centre (OR 0.41 95% CI 0.27 to 0.62) were associated with a lower odds of being a missed case. Conclusions: The high rate of misdiagnosis has remained stable for over a decade. Non-teaching and non-cardiac hospitals had a higher incidence of missed cases. Mortality and rates of surgery were not associated with a missed diagnosis of AAS. Educational interventions should be prioritised in non-teaching hospitals and non-cardiac centres.
MeSH term(s)	Female ; Humans ; Ontario/epidemiology ; Retrospective Studies ; Aortic Dissection ; Risk Factors ; Diagnostic Errors ; Acute Disease
Language	English
Publishing date	2024-02-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2023-213331
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Article ; Online: Advancing assessment of responsive feeding environments and practices in child care.

Campbell, Julie E / McIsaac, Jessie-Lee D / Young, Margaret / Dickson, Elizabeth / Caldwell, Sarah / Barich, Rachel / Rossiter, Misty

Journal of nutritional science

2024 Volume 13, Page(s) e14

Abstract: Child care environments offer an ideal setting for feeding interventions. CELEBRATE Feeding is an approach implemented in child care environments in two Maritime Provinces in Canada to support responsive feeding (RF) to foster children's self-efficacy, ... ...

Abstract	Child care environments offer an ideal setting for feeding interventions. CELEBRATE Feeding is an approach implemented in child care environments in two Maritime Provinces in Canada to support responsive feeding (RF) to foster children's self-efficacy, self-regulation, and healthy relationships with food. This study aimed to describe RF in child care using established and enhanced scoring frameworks. The Environment and Policy Assessment and Observation (EPAO) was modified to reflect RF environments and practices, resulting in our modified EPAO and a
MeSH term(s)	Humans ; Child ; Child Care ; Child Day Care Centers ; Meals ; Canada
Language	English
Publishing date	2024-03-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2656288-1
ISSN	2048-6790 ; 2048-6790
ISSN (online)	2048-6790
ISSN	2048-6790
DOI	10.1017/jns.2024.10
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Article ; Online: Impact of community-based interventions on out-of-hospital cardiac arrest outcomes

Kayla M. Simmons / Sarah M. McIsaac / Robert Ohle

Scientific Reports, Vol 13, Iss 1, Pp 1-

a systematic review and meta-analysis

2023 Volume 15

Abstract: Abstract Survival following out-of-hospital cardiac arrest (OHCA) remains low, typically less than 10%. Bystander cardiopulmonary resuscitation (CPR) and bystander-AED use have been shown to improve survival by up to fourfold in individual studies. ... ...

Abstract	Abstract Survival following out-of-hospital cardiac arrest (OHCA) remains low, typically less than 10%. Bystander cardiopulmonary resuscitation (CPR) and bystander-AED use have been shown to improve survival by up to fourfold in individual studies. Numerous community-based interventions have been implemented worldwide in an effort to enhance rates of bystander-CPR, bystander-AED use, and improve OHCA survival. This systematic review and meta-analysis aims to evaluate the effect of such interventions on OHCA outcomes. Medline and Embase were systematically searched from inception through July 2021 for studies describing the implementation and effect of one or more community-based interventions targeting OHCA outcomes. Two reviewers screened articles, extracted data, and evaluated study quality using the Newcastle–Ottawa Scale. For each outcome, data were pooled using random-effects meta-analysis. Of the 2481 studies identified, 16 met inclusion criteria. All included studies were observational. They reported a total of 1,081,040 OHCAs across 11 countries. The most common interventions included community-based CPR training (n = 12), community-based AED training (n = 9), and dispatcher-assisted CPR (n = 8). Health system interventions (hospital or paramedical services) were also described in 11 of the included studies. Evidence certainty among all outcomes was low or very low according to GRADE criteria. On meta-analysis, community-based interventions with and without health system interventions were consistently associated with improved OCHA outcomes: rates of bystander-CPR, bystander-AED use, survival, and survival with a favorable neurological outcome. Bystander CPR—14 studies showed a significant increase in post-intervention bystander-CPR rates (n = 285 752; OR 2.26 [1.74, 2.94]; I2 = 99%, and bystander AED use (n = 37 882; OR 2.08 [1.44, 3.01]; I2 = 54%) and durvival—10 studies, pooling survival to hospital discharge and survival to 30 days (n = 79 206; OR 1.59 [1.20, 2.10]; I2 = 95%. The results provide ...
Keywords	Medicine ; R ; Science ; Q
Subject code	306
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
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Article ; Online: Can you accurately rule out acute aortic syndrome by restricting imaging of the aorta to the area of the patient's pain?

Ohle, Robert / Van Dusen, Madison / Savage, David W / McIsaac, Sarah / Yadav, Krishan

Emergency radiology

2023 Volume 30, Issue 6, Page(s) 719–723

Abstract: Background: Acute aortic syndrome (AAS) is a life-threatening condition necessitating timely and accurate diagnosis for appropriate treatment. Currently, the only way to rule out the diagnosis is advanced imaging. The most accessible is computed ... ...

Abstract	Background: Acute aortic syndrome (AAS) is a life-threatening condition necessitating timely and accurate diagnosis for appropriate treatment. Currently, the only way to rule out the diagnosis is advanced imaging. The most accessible is computed tomography of the entire aorta. Most scans are negative, exposing patients to radiation, increased time in the emergency department (ED), and non-significant incidental findings. This study investigated whether restricting imaging to the area of aortic-related pain accurately rules out AAS. Methods: A health records review was conducted on consecutive cases from three academic EDs between 2015 and 2020. Data were extracted and verified from multiple sources. Participants included adults diagnosed with AAS based on radiological evidence. The diagnostic performance of the restricted imaging strategy was assessed; sensitivity and likelihood ratios with 95% confidence intervals were calculated. Results: Data from 149 cases of AAS were collected, with the majority presenting with chest pain (46%) or abdominal pain (24%). The restricted imaging strategy demonstrated a sensitivity of 96% (95% CI 91.4-98.5%) in ruling out AAS. In a subset of patients with systolic blood pressure > 90 mmHg and without aortic aneurysm/repair (n = 86), the sensitivity was 100% (95% CI 96-100%). Conclusion: Restricting imaging to the area of pain in hemodynamically stable patients without known aortic aneurysm provides a highly sensitive approach to ruling out AAS.
MeSH term(s)	Adult ; Humans ; Acute Aortic Syndrome ; Aorta ; Aortic Aneurysm/diagnostic imaging ; Aortic Dissection/diagnostic imaging ; Chest Pain/diagnostic imaging ; Acute Disease
Language	English
Publishing date	2023-11-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1425144-9
ISSN	1438-1435 ; 1070-3004
ISSN (online)	1438-1435
ISSN	1070-3004
DOI	10.1007/s10140-023-02179-w
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Article ; Online: Feasibility of a multidisciplinary Transitional Pain Service in spine surgery patients to minimise opioid use and improve perioperative outcomes: a quality improvement study.

Tierney, Sarah / Magnan, Marie-Claude / Zahrai, Amin / McIsaac, Daniel / Poulin, Patricia / Stratton, Alexandra

BMJ open quality

2023 Volume 12, Issue 2

Abstract: Introduction: Spine surgery patients have high rates of perioperative opioid consumption, with a chronic opioid use prevalence of 20%. A proposed solution is the implementation of a Transitional Pain Service (TPS), which provides patient-tailored ... ...

Abstract	Introduction: Spine surgery patients have high rates of perioperative opioid consumption, with a chronic opioid use prevalence of 20%. A proposed solution is the implementation of a Transitional Pain Service (TPS), which provides patient-tailored multidisciplinary care. Its feasibility has not been demonstrated in spine surgery. The main objective of this study was to evaluate the feasibility of a TPS programme in patients undergoing spine surgery. Methods: Patients were recruited between July 2020 and November 2021 at a single, tertiary care academic centre. Success of our study was defined as: (1) enrolment: ability to enrol ≥80% of eligible patients, (2) data collection: ability to collect data for ≥80% of participants, including effectiveness measures (oral morphine equivalent (OME) and Visual Analogue Scale (VAS)-perceived analgesic management and overall health) and programme resource requirements measures (appointment attendance, 60-day return to emergency and length of stay), and (3) efficacy: estimate potential programme effectiveness defined as ≥80% of patients weaned back to their intake OME requirements at programme discharge. Results: Thirty out of 36 (83.3%) eligible patients were enrolled and 26 completed the TPS programme. The main programme outcomes and resource measures were successfully tracked for >80% of patients. All 26 patients had the same or lower OME at programme discharge than at intake (intake 38.75 mg vs discharge 12.50 mg; p<0.001). At TPS discharge, patients reported similar overall health VAS (pre 60.0 vs post 70.0; p=0.14), improved scores for VAS-perceived analgesic management (pre 47.6 vs post 75.6; p<0.001) and improved Brief Pain Inventory pain intensity (pre 39.1 vs post 25.0; p=0.02). Conclusion: Our feasibility study successfully met or exceeded our three main objectives. Based on this success and the defined clinical need for a TPS programme, we plan to expand our TPS care model to include other surgical procedures at our centre.
MeSH term(s)	Humans ; Analgesics, Opioid/therapeutic use ; Feasibility Studies ; Quality Improvement ; Pain, Postoperative/drug therapy ; Pain Management
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-06-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2023-002278
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Article ; Online: Epidemiology, mortality and miss rate of acute aortic syndrome in Ontario, Canada: a population-based study.

Ohle, Robert / Savage, David W / McIsaac, Sarah / Yadav, Krishan / Caswell, Joe / Conlon, Michael

CJEM

2023 Volume 25, Issue 1, Page(s) 57–64

Abstract: Introduction: Acute aortic syndrome (AAS) is a life-threatening emergency. It describes three distinct diagnoses: acute aortic dissection, acute intramural hematoma and penetrating atherosclerotic ulcer. There are currently no accurate estimates for ... ...

Abstract	Introduction: Acute aortic syndrome (AAS) is a life-threatening emergency. It describes three distinct diagnoses: acute aortic dissection, acute intramural hematoma and penetrating atherosclerotic ulcer. There are currently no accurate estimates for incidence, mortality or misdiagnosis. Our objectives were to determine the incidence, mortality and miss rate of acute aortic syndrome in the emergency department (ED). Methods: A population-based retrospective cohort study of anonymously linked data for residents of Ontario, Canada, was carried out. Incident cases of acute aortic syndrome were identified between 2003 and 2018 using a validated algorithm based on ICD-10 codes and death. Incidence (number of cases/population of Ontario), mortality, and miss rate were calculated. Miss rate was defined as when a patient was seen in the ED within 14 days prior to an acute aortic syndrome diagnosis with a presenting complaint consistent with acute aortic syndrome. Results: There were 1299 cases of acute aortic syndrome over the study period [age mean (SD) 68.03 ± 14.70; female (n = 500, 38.5%); rural areas (n = 111, 8.6%)]. The overall annual incidence for acute aortic syndrome was 0.61 per 100,000. One year mortality decreased from 47.4 to 29.1%. ED mortality was 14.9%. In the 14 days prior to diagnosis 12.5% of patients were seen in the ED with a presentation consistent with acute aortic syndrome. Conclusions: Annual incidence of acute aortic syndrome was found to be lower than other population-based studies. Also, the burden of mortality is seen in the ED. Education initiatives should focus on the identification of acute aortic syndrome in the ED to address mortality and miss rate.
MeSH term(s)	Humans ; Female ; Ontario/epidemiology ; Acute Aortic Syndrome ; Retrospective Studies ; Aortic Dissection/diagnosis ; Aortic Dissection/epidemiology
Language	English
Publishing date	2023-01-10
Publishing country	England
Document type	Journal Article
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-022-00413-x
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Article ; Online: Overuse of pharmacological treatments for patients with benign paroxysmal positional vertigo in the emergency department.

McGillis, Michaela / Roy, Danielle / Savage, David / McIsaac, Sarah / Nicholls, Jenna / Waltenbury, Danielle / Ohle, Robert

CJEM

2023 Volume 25, Issue 8, Page(s) 710–711

Language	English
Publishing date	2023-07-14
Publishing country	England
Document type	Letter
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-023-00549-4
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Article ; Online: Assessing the learning impact of a self-directed hands only cardiopulmonary resuscitation exhibit at a science museum.

Moskalyk, Marika / Ohle, Robert / Henson, Amy / Pisani, Katrina / McIsaac, Sarah

Resuscitation

2022 Volume 178, Page(s) 10–11

MeSH term(s)	Cardiopulmonary Resuscitation ; Heart Massage ; Humans ; Learning ; Museums
Language	English
Publishing date	2022-06-25
Publishing country	Ireland
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2022.06.017
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