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Article ; Online: A time-course prediction model of global COVID-19 mortality

Mark Ciaccio / Chris Schneiderman / Abhishek Pandey / Robert Fowler / Kevin Chiou / Gage Koeller / David Hallett / Whitney Krueger / Leon Raskin

Frontiers in Public Health, Vol

2023 Volume 11

Abstract: IntroductionThe COVID-19 pandemic has caused over 6 million deaths worldwide and is a significant cause of mortality. Mortality dynamics vary significantly by country due to pathogen, host, social and environmental factors, in addition to vaccination and ...

Abstract	IntroductionThe COVID-19 pandemic has caused over 6 million deaths worldwide and is a significant cause of mortality. Mortality dynamics vary significantly by country due to pathogen, host, social and environmental factors, in addition to vaccination and treatments. However, there is limited data on the relative contribution of different explanatory variables, which may explain changes in mortality over time. We, therefore, created a predictive model using orthogonal machine learning techniques to attempt to quantify the contribution of static and dynamic variables over time.MethodsA model was created using Partial Least Squares Regression trained on data from 2020 to rank order the significance and effect size of static variables on mortality per country. This model enables the prediction of mortality levels for countries based on demographics alone. Partial Least Squares Regression was then used to quantify how dynamic variables, including weather and non-pharmaceutical interventions, contributed to the overall mortality in 2020. Finally, mortality levels for the first 60 days of 2021 were predicted using rolling-window Elastic Net regression.ResultsThis model allowed prediction of deaths per day and quantification of the degree of influence of included variables, accounting for timing of occurrence or implementation. We found that the most parsimonious model could be reduced to six variables; three policy-related variables – COVID-19 testing policy, canceled public events policy, workplace closing policy; in addition to three environmental variables – maximum temperature per day, minimum temperature per day, and the dewpoint temperature per day.ConclusionCountry and population-level static and dynamic variables can be used to predict COVID-19 mortality, providing an example of how broad temporal data can inform a preparation and mitigation strategy for both COVID-19 and future pandemics and assist decision-makers by identifying population-level contributors, including interventions, that have the greatest ...
Keywords	COVID-19 ; machine learning ; mortality ; partial least squares regression ; elastic net ; Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The effect of end-of-life decision-making tools on patient and family-related outcomes of care among ethnocultural minorities

Ayah Nayfeh / Lesley Gotlib Conn / Craig Dale / Sarah Kratina / Brigette Hales / Tracey Das Gupta / Anita Chakraborty / Ru Taggar / Robert Fowler

PLoS ONE, Vol 17, Iss

A systematic review

2022 Volume 8

Abstract: Background End-of-life decision-making tools are used to establish a shared understanding among patients, families and healthcare providers about medical treatment and goals of care. This systematic review aimed to understand the availability and effect ... ...

Abstract	Background End-of-life decision-making tools are used to establish a shared understanding among patients, families and healthcare providers about medical treatment and goals of care. This systematic review aimed to understand the availability and effect of end-of-life decision-making tools on: (i) goals of care and advance care planning; (ii) patient and/or family satisfaction and well-being; and (iii) healthcare utilization among racial/ethnic, cultural, and religious minorities. Methods A search was conducted in four electronic databases (inception to June 2021). Articles were screened for eligibility using pre-specified criteria. We focused on adult patients (aged ≥18 years) and included primary research articles that used quantitative, qualitative, and mixed-methods designs. Complementary quality assessment tools were used to generate quality scores for individual studies. Extracted data were synthesized by outcome measure for each type of tool, and an overall description of findings showed the range of effects. Results Among 14,316 retrieved articles, 37 articles were eligible. We found that advance care planning programs (eleven studies), healthcare provider-led interventions (four studies), and linguistically-tailored decision aids (three studies) increased the proportion of patients documenting advance care plans. Educational tools (three studies) strongly reduced patient preferences for life-prolonging care. Palliative care consultations (three studies) were strongly associated with do-not-resuscitate orders. Advance care planning programs (three studies) significantly influenced the quality of patient-clinician communication and healthcare provider-led interventions (two studies) significantly influenced perceived patient quality of life. Conclusion This review identified several end-of-life decision-making tools with impact on patient and family-related outcomes of care among ethnocultural minorities. Advance care planning programs, healthcare provider-led interventions and decision aids increased ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The effect of end-of-life decision-making tools on patient and family-related outcomes of care among ethnocultural minorities

Ayah Nayfeh / Lesley Gotlib Conn / Craig Dale / Sarah Kratina / Brigette Hales / Tracey Das Gupta / Anita Chakraborty / Ru Taggar / Robert Fowler

PLoS ONE, Vol 17, Iss 8, p e

A systematic review.

2022 Volume 0272436

Abstract	Background End-of-life decision-making tools are used to establish a shared understanding among patients, families and healthcare providers about medical treatment and goals of care. This systematic review aimed to understand the availability and effect of end-of-life decision-making tools on: (i) goals of care and advance care planning; (ii) patient and/or family satisfaction and well-being; and (iii) healthcare utilization among racial/ethnic, cultural, and religious minorities. Methods A search was conducted in four electronic databases (inception to June 2021). Articles were screened for eligibility using pre-specified criteria. We focused on adult patients (aged ≥18 years) and included primary research articles that used quantitative, qualitative, and mixed-methods designs. Complementary quality assessment tools were used to generate quality scores for individual studies. Extracted data were synthesized by outcome measure for each type of tool, and an overall description of findings showed the range of effects. Results Among 14,316 retrieved articles, 37 articles were eligible. We found that advance care planning programs (eleven studies), healthcare provider-led interventions (four studies), and linguistically-tailored decision aids (three studies) increased the proportion of patients documenting advance care plans. Educational tools (three studies) strongly reduced patient preferences for life-prolonging care. Palliative care consultations (three studies) were strongly associated with do-not-resuscitate orders. Advance care planning programs (three studies) significantly influenced the quality of patient-clinician communication and healthcare provider-led interventions (two studies) significantly influenced perceived patient quality of life. Conclusion This review identified several end-of-life decision-making tools with impact on patient and family-related outcomes of care among ethnocultural minorities. Advance care planning programs, healthcare provider-led interventions and decision aids increased ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Point-of-care diagnostic tests for influenza in the emergency department

Stephen Mac / Ryan O'Reilly / Neill K J Adhikari / Robert Fowler / Beate Sander

PLoS ONE, Vol 15, Iss 11, p e

A cost-effectiveness analysis in a high-risk population from a Canadian perspective.

2020 Volume 0242255

Abstract: Background Our objective was to assess the cost-effectiveness of novel rapid diagnostic tests: rapid influenza diagnostic tests (RIDT), digital immunoassays (DIA), rapid nucleic acid amplification tests (NAAT), and other treatment algorithms for ... ...

Abstract	Background Our objective was to assess the cost-effectiveness of novel rapid diagnostic tests: rapid influenza diagnostic tests (RIDT), digital immunoassays (DIA), rapid nucleic acid amplification tests (NAAT), and other treatment algorithms for influenza in high-risk patients presenting to hospital with influenza-like illness (ILI). Methods We developed a decision-analytic model to assess the cost-effectiveness of diagnostic test strategies (RIDT, DIA, NAAT, clinical judgement, batch polymerase chain reaction) preceding treatment; no diagnostic testing and treating everyone; and not treating anyone. We modeled high-risk 65-year old patients from a health payer perspective and accrued outcomes over a patient's lifetime. We reported health outcomes, quality-adjusted life years (QALYs), healthcare costs, and net health benefit (NHB) to measure cost-effectiveness per cohort of 100,000 patients. Results Treating everyone with no prior testing was the most cost-effective strategy, at a cost-effectiveness threshold of $50,000/QALY, in over 85% of simulations. This strategy yielded the highest NHB of 15.0344 QALYs, but inappropriately treats all patients without influenza. Of the novel rapid diagnostics, NAAT resulted in the highest NHB (15.0277 QALYs), and the least number of deaths (1,571 per 100,000). Sensitivity analyses determined that results were most impacted by the pretest probability of ILI being influenza, diagnostic test sensitivity, and treatment effectiveness. Conclusions Based on our model, treating high-risk patients presenting to hospital with influenza-like illness, without performing a novel rapid diagnostic test, resulted in the highest NHB and was most cost-effective. However, consideration of whether treatment is appropriate in the absence of diagnostic confirmation should be taken into account for decision-making by clinicians and policymakers.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: COVID-19 pandemic

R.T. Noel Gibney / Cynthia Blackman / Melanie Gauthier / Eddy Fan / Robert Fowler / Curtis Johnston / R. Jeremy Katulka / Samuel Marcushamer / Kusum Menon / Tracey Miller / Bojan Paunovic / Teddie Tanguay

FACETS, Vol 7, Iss , Pp 1411-

the impact on Canada’s intensive care units

2022 Volume 1472

Abstract: The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic ... ...

Abstract	The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces. Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions. This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.
Keywords	COVID-19 ; critical care ; pediatric intensive care ; intensive care units ; public health ; critical care nursing ; Education ; L ; Science ; Q
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Canadian Science Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Motivating factors, barriers and facilitators of participation in COVID-19 clinical research

Jennifer L Y Tsang / Robert Fowler / Deborah J Cook / Karen E A Burns / Kylee Hunter / Victoria Forcina / Anna Hwang / Erick Duan / Lisa Patterson / Alexandra Binnie

PLoS ONE, Vol 17, Iss 4, p e

A cross-sectional survey of Canadian community intensive care units.

2022 Volume 0266770

Abstract: Only a small proportion of COVID-19 patients in Canada have been recruited into clinical research studies. One reason is that few community intensive care units (ICUs) in Canada participate in research. The objective of this study was to examine the ... ...

Abstract	Only a small proportion of COVID-19 patients in Canada have been recruited into clinical research studies. One reason is that few community intensive care units (ICUs) in Canada participate in research. The objective of this study was to examine the motivating factors, barriers and facilitators to research participation amongst Canadian community ICU stakeholders. A cross-sectional online survey was distributed between May and November 2020. The survey focused on 6 domains: participant demographics, ICU characteristics, ICU research infrastructure, motivating factors, perceived barriers, and perceived facilitators. Responses were received from 73 community ICU stakeholders, representing 18 ICUs. 7/18 ICUs had a clinical research program. Participants rated their interest in pandemic research at a mean of 5.2 (Standard Deviation [SD] = 1.9) on a 7-point Likert scale from 'not interested' to 'very interested'. The strongest motivating factor for research participation was the belief that research improves clinical care and outcomes. The most significant facilitators of research involvement were the availability of an experienced research coordinator and dedicated external funding to cover start-up costs, while the most significant barriers to research involvement were a lack of start-up funding for a research coordinator and a lack of ICU research experience. Canadian Community ICU stakeholders are interested in participating in pandemic research but lack basic infrastructure, research personnel, research experience and start-up funding. Evolution of a research support model at community hospitals, where most patients receive acute care, may increase research participation and improve the generalizability of funded research in Canada.
Keywords	Medicine ; R ; Science ; Q
Subject code	306
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: End-of-Life Decision Making

David Frost / Robert Fowler

MedEdPORTAL, Vol

How Patients, Substitutes, and Physicians Make Decisions

2011 Volume 7

Abstract: Abstract This tool was created to address a perceived gap in the education of our postgraduate internal medicine trainees around the practical aspects of end-of-life decision making. Based on an extensive up-to-date literature review of the topic, the ... ...

Abstract	Abstract This tool was created to address a perceived gap in the education of our postgraduate internal medicine trainees around the practical aspects of end-of-life decision making. Based on an extensive up-to-date literature review of the topic, the PowerPoint presentation outlines several facets of end-of-life decision making: (1) components of these decisions and generally accepted definitions, (2) factors affecting patients' decisions, (3) substitute decision-maker accuracy, (4) physician-level factors affecting decision making, and (5) implications for everyday practice. The presentation is intended to be a springboard for an interactive discussion of experiences with end-of-life decisions and is best suited to an audience that has some experience with these situations (e.g., medical or surgical residents, ICU fellows, etc.). The session is 2 hours in duration, with a 10-minute break in the middle. It is possible to reduce the session to just 1 hour, but this will potentially curtail some of the discussion, which is likely to be the most stimulating and highest-rated component of the session. This session is unique in that it provides a forum for discussion, as well as an overview of the current state of the art in the factors known to influence end-of-life decision making. It has been presented as a 1-hour round for medical residents and students in two Toronto teaching hospitals. Although not formally evaluated, it was anecdotally highly rated by trainees at all levels.
Keywords	Decision Making ; Substitute Decision Makers ; Code Status Discussion ; Critical Care ; Medicine (General) ; R5-920 ; Education ; L
Subject code	320
Language	English
Publishing date	2011-06-01T00:00:00Z
Publisher	Association of American Medical Colleges
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Larval exposure to field-realistic concentrations of clothianidin has no effect on development rate, over-winter survival or adult metabolic rate in a solitary bee, Osmia bicornis

Elizabeth Nicholls / Robert Fowler / Jeremy E. Niven / James D. Gilbert / Dave Goulson

PeerJ, Vol 5, p e

2017 Volume 3417

Abstract: There is widespread concern regarding the effects of agro-chemical exposure on bee health, of which neonicotinoids, systemic insecticides detected in the pollen and nectar of both crops and wildflowers, have been the most strongly debated. The majority ... ...

Abstract	There is widespread concern regarding the effects of agro-chemical exposure on bee health, of which neonicotinoids, systemic insecticides detected in the pollen and nectar of both crops and wildflowers, have been the most strongly debated. The majority of studies examining the effect of neonicotinoids on bees have focussed on social species, namely honey bees and bumble bees. However, most bee species are solitary, their life histories differing considerably from these social species, and thus it is possible that their susceptibility to pesticides may be quite different. Studies that have included solitary bees have produced mixed results regarding the impact of neonicotinoid exposure on survival and reproductive success. While the majority of studies have focused on the effects of adult exposure, bees are also likely to be exposed as larvae via the consumption of contaminated pollen. Here we examined the effect of exposure of Osmia bicornis larvae to a range of field-realistic concentrations (0–10 ppb) of the neonicotinoid clothianidin, observing no effect on larval development time, overwintering survival or adult weight. Flow-through respirometry was used to test for latent effects of larval exposure on adult physiological function. We observed differences between male and female bees in the propensity to engage in discontinuous gas exchange; however, no effect of larval clothianidin exposure was observed. Our results suggest that previously reported adverse effects of neonicotinoids on O. bicornis are most likely mediated by impacts on adults.
Keywords	Neonicotinoids ; Pollinators ; Metabolic rate ; Osmia bicornis ; Larval development ; Solitary bee ; Medicine ; R ; Biology (General) ; QH301-705.5
Subject code	590
Language	English
Publishing date	2017-06-01T00:00:00Z
Publisher	PeerJ Inc.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluating the effectiveness of a multifaceted intervention to reduce low-value care in adults hospitalized following trauma

Implementation Science, Vol 18, Iss 1, Pp 1-

a protocol for a pragmatic cluster randomized controlled trial

2023 Volume 11

Abstract: Abstract Background While simple Audit & Feedback (A&F) has shown modest effectiveness in reducing low-value care, there is a knowledge gap on the effectiveness of multifaceted interventions to support de-implementation efforts. Given the need to make ... ...

Abstract	Abstract Background While simple Audit & Feedback (A&F) has shown modest effectiveness in reducing low-value care, there is a knowledge gap on the effectiveness of multifaceted interventions to support de-implementation efforts. Given the need to make rapid decisions in a context of multiple diagnostic and therapeutic options, trauma is a high-risk setting for low-value care. Furthermore, trauma systems are a favorable setting for de-implementation interventions as they have quality improvement teams with medical leadership, routinely collected clinical data, and performance-linked to accreditation. We aim to evaluate the effectiveness of a multifaceted intervention for reducing low-value clinical practices in acute adult trauma care. Methods We will conduct a pragmatic cluster randomized controlled trial (cRCT) embedded in a Canadian provincial quality assurance program. Level I–III trauma centers (n = 30) will be randomized (1:1) to receive simple A&F (control) or a multifaceted intervention (intervention). The intervention, developed using extensive background work and UK Medical Research Council guidelines, includes an A&F report, educational meetings, and facilitation visits. The primary outcome will be the use of low-value initial diagnostic imaging, assessed at the patient level using routinely collected trauma registry data. Secondary outcomes will be low-value specialist consultation, low-value repeat imaging after a patient transfer, unintended consequences, determinants for successful implementation, and incremental cost-effectiveness ratios. Discussion On completion of the cRCT, if the intervention is effective and cost-effective, the multifaceted intervention will be integrated into trauma systems across Canada. Medium and long-term benefits may include a reduction in adverse events for patients and an increase in resource availability. The proposed intervention targets a problem identified by stakeholders, is based on extensive background work, was developed using a partnership ...
Keywords	Low-value practice ; Trauma system ; Multifaceted intervention ; Cluster randomized controlled trial ; Medicine (General) ; R5-920
Subject code	650
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Describing the characteristics and healthcare use of high-cost acute care users at the end of life

Danial Qureshi / Sarina Isenberg / Peter Tanuseputro / Rahim Moineddin / Kieran Quinn / Christopher Meaney / Kimberlyn McGrail / Hsien Seow / Colleen Webber / Robert Fowler / Amy Hsu

BMC Health Services Research, Vol 20, Iss 1, Pp 1-

a pan-Canadian population-based study

2020 Volume 9

Abstract: Abstract Background A minority of individuals use a large portion of health system resources, incurring considerable costs, especially in acute-care hospitals where a significant proportion of deaths occur. We sought to describe and contrast the ... ...

Abstract	Abstract Background A minority of individuals use a large portion of health system resources, incurring considerable costs, especially in acute-care hospitals where a significant proportion of deaths occur. We sought to describe and contrast the characteristics, acute-care use and cost in the last year of life among high users and non-high users who died in hospitals across Canada. Methods We conducted a population-based retrospective-cohort study of Canadian adults aged ≥18 who died in hospitals across Canada between fiscal years 2011/12–2014/15. High users were defined as patients within the top 10% of highest cumulative acute-care costs in each fiscal year. Patients were categorized as: persistent high users (high-cost in death year and year prior), non-persistent high users (high-cost in death year only) and non-high users (never high-cost). Discharge abstracts were used to measure characteristics and acute-care use, including number of hospitalizations, admissions to intensive-care-unit (ICU), and alternate-level-of-care (ALC). Results We identified 191,310 decedents, among which 6% were persistent high users, 41% were non-persistent high users, and 46% were non-high users. A larger proportion of high users were male, younger, and had multimorbidity than non-high users. In the last year of life, persistent high users had multiple hospitalizations more often than other groups. Twenty-eight percent of persistent high users had ≥2 ICU admissions, compared to 8% of non-persistent high users and only 1% of non-high users. Eleven percent of persistent high users had ≥2 ALC admissions, compared to only 2% of non-persistent high users and < 1% of non-high users. High users received an in-hospital intervention more often than non-high users (36% vs. 19%). Despite representing only 47% of the cohort, persistent and non-persistent high users accounted for 83% of acute-care costs. Conclusions High users – persistent and non-persistent – are medically complex and use a disproportionate amount of acute-care resources ...
Keywords	Acute care ; High-cost user ; End of life ; Public aspects of medicine ; RA1-1270
Subject code	302
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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