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Search Results: 1 - 10 of 859 matches for " Clare Atzema "
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Physician-Rated Utility of Procedure Videos for Teaching Procedures in the Emergency Department, Overall and during Emergency Department Crowding  [PDF]
Clare L. Atzema, R. Alexandra Stefan, Refik Saskin, Greg Michlik, Peter C. Austin
International Journal of Clinical Medicine (IJCM) , 2012, DOI: 10.4236/ijcm.2012.37A133

Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department improves the quality of teaching of procedures, and whether videos are particularly beneficial during periods of emergency department crowding. Methods: In this single-centre, prospective, before and after study standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each emergency department shift in the before (August 2008-March 2009) and after (August 2009-March 2010) phase. Online procedure videos were introduced on emergency department computers in the after phase. The primary outcome measure was EP rating of the quality of teaching provided (5-point Likert scale). The interaction between crowding and videos was also assessed, to determine whether videos provide a specific additional benefit during periods of emergency department crowding. Results: There were 1159 procedures performed by 192 trainees. Median procedures performed per shift was 1.0 (IQR 0 - 2.0). Mean EP rating of teaching provided was significantly higher in the group that viewed videos, at 4.2 versus 3.7 (p < 0.001). In the adjusted analysis, EP ratings increased by 0.5 with a video (p < 0.001), while the odds of a score of 5.0 were 2.2 times greater if a video was viewed (p = 0.03). The interaction of crowding and procedure videos was not significant (the use of videos increased the average score by 0.24 in times of crowding compared to times of non-crowding, p

Emergency department length of stay for patients requiring mechanical ventilation: a prospective observational study
Louise Rose, Sara Gray, Karen Burns, Clare Atzema, Alex Kiss, Andrew Worster, Damon C. Scales, Gordon Rubenfeld, Jacques Lee
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-30
Abstract: Prospective observational study of ED LOS for all patients receiving mechanical ventilation at four metropolitan EDs in Toronto, Canada over two six-month periods in 2009 and 2010.We identified 618 mechanically ventilated patients which represented 0.5% (95% CI 0.4%–0.5%) of all ED visits. Of these, 484 (78.3%) received invasive ventilation, 118 (19.1%) received NIV; 16 received both during the ED stay. Median Kaplan-Meier estimated duration of ED stay for all patients was 6.4?h (IQR 2.8–14.6). Patients with trauma diagnoses had a shorter median (IQR) LOS, 2.5?h (1.3–5.1), compared to ventilated patients with non-trauma diagnoses, 8.5?h (3.3–14.0) (p <0.001). Patients requiring NIV had a longer ED stay (16.6?h, 8.2–27.9) compared to those receiving invasive ventilation exclusively (4.6?h, 2.2–11.1) and patients receiving both (15.4?h, 6.4–32.6) (p <0.001). Longer ED LOS was associated with ED site and lower priority triage scores. Shorter ED LOS was associated with intubation at another ED prior to transfer.While patients requiring mechanical ventilation represent a small proportion of overall ED visits these critically ill patients frequently experienced prolonged ED stay especially those treated with NIV, assigned lower priority triage scores at ED presentation, and non-trauma patients.
Speak Fast, Use Jargon, and Don’t Repeat Yourself: A Randomized Trial Assessing the Effectiveness of Online Videos to Supplement Emergency Department Discharge Instructions
Clare L. Atzema, Peter C. Austin, Libo Wu, Michael Brzozowski, Michael J. Feldman, Michael McDonnell, Laurie Mazurik
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077057
Abstract: Background Emergency department discharge instructions are variably understood by patients, and in the setting of emergency department crowding, innovations are needed to counteract shortened interaction times with the physician. We evaluated the effect of viewing an online video of diagnosis-specific discharge instructions on patient comprehension and recall of instructions. Methods In this prospective, single-center, randomized controlled trial conducted between November 2011 and January 2012, we randomized emergency department patients who were discharged with one of 38 diagnoses to either view (after they left the emergency department) a vetted online video of diagnosis-specific discharge instructions, or to usual care. Patients were subsequently contacted by telephone and asked three standardized questions about their discharge instructions; one point was awarded for each correct answer. Using an intention-to-treat analysis, differences between groups were assessed using univariate testing, and with logistic regression that accounted for clustering on managing physician. A secondary outcome measure was patient satisfaction with the videos, on a 10-point scale. Results Among 133 patients enrolled, mean age was 46.1 (s.d.D. 21.5) and 55% were female. Patients in the video group had 19% higher mean scores (2.5, s.d. 0.7) than patients in the control group (2.1, s.d. 0.8) (p=0.002). After adjustment for patient age, sex, first language, triage acuity score, and clustering, the odds of achieving a fully correct score (3 out of 3) were 3.5 (95% CI, 1.7 to 7.2) times higher in the video group, compared to the control group. Among those who viewed the videos, median rating of the videos was 10 (IQR 8 to 10). Conclusions In this single-center trial, patients who viewed an online video of their discharge instructions scored higher on their understanding of key concepts around their diagnosis and subsequent care. Those who viewed the videos found them to be a helpful addition to standard care. Trial Registration ClinicalTrials.gov NCT01361932 http://clinicaltrials.gov/ct2/show/NCT01?361932?term=nct01361932&rank=1
Prediction of Emergent Heart Failure Death by Semi-Quantitative Triage Risk Stratification
Harriette G. C. Van Spall, Clare Atzema, Michael J. Schull, Gary E. Newton, Susanna Mak, Alice Chong, Jack V. Tu, Thérèse A. Stukel, Douglas S. Lee
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0023065
Abstract: Objectives Generic triage risk assessments are widely used in the emergency department (ED), but have not been validated for prediction of short-term risk among patients with acute heart failure (HF). Our objective was to evaluate the Canadian Triage Acuity Scale (CTAS) for prediction of early death among HF patients. Methods We included patients presenting with HF to an ED in Ontario from Apr 2003 to Mar 2007. We used the National Ambulatory Care Reporting System and vital statistics databases to examine care and outcomes. Results Among 68,380 patients (76±12 years, 49.4% men), early mortality was stratified with death rates of 9.9%, 1.9%, 0.9%, and 0.5% at 1-day, and 17.2%, 5.9%, 3.8%, and 2.5% at 7-days, for CTAS 1, 2, 3, and 4–5, respectively. Compared to lower acuity (CTAS 4–5) patients, adjusted odds ratios (aOR) for 1-day death were 1.32 (95%CI; 0.93–1.88; p = 0.12) for CTAS 3, 2.41 (95%CI; 1.71–3.40; p<0.001) for CTAS 2, and highest for CTAS 1: 9.06 (95%CI; 6.28–13.06; p<0.001). Predictors of triage-critical (CTAS 1) status included oxygen saturation <90% (aOR 5.92, 95%CI; 3.09–11.81; p<0.001), respiratory rate >24 breaths/minute (aOR 1.96, 95%CI; 1.05–3.67; p = 0.034), and arrival by paramedic (aOR 3.52, 95%CI; 1.70–8.02; p = 0.001). While age/sex-adjusted CTAS score provided good discrimination for ED (c-statistic = 0.817) and 1-day (c-statistic = 0.724) death, mortality prediction was improved further after accounting for cardiac and non-cardiac co-morbidities (c-statistics 0.882 and 0.810, respectively; both p<0.001). Conclusions A semi-quantitative triage acuity scale assigned at ED presentation and based largely on respiratory factors predicted emergent death among HF patients.
The Influence of Tunable LED Lighting Systems on Consumer Food Label Perceptions  [PDF]
Greg Clare, Nahide Hancer
Food and Nutrition Sciences (FNS) , 2016, DOI: 10.4236/fns.2016.77058
Abstract: A study was conducted in a grocery store simulation lab at a large Mid-Western university to measure consumer perceptions of meat package label design variations under different LED lighting conditions. A quasi-experimental approach using a multi-group between-within subjects’ post-test only design measured participants’ responses to the novel meat labels. Philip’s HUE consumer LED light bulbs were varied with different colors over beef steak package labels from 2700 K (RED) - 7000 K (BLUE). Goose neck lamps over the packages were used to create the display lighting simulations. The researchers determined that there was evidence of label and lighting interactions which influenced consumer perceptions of nutrition label information both between and within subject groups.
CCP11 Group Meeting—Towards the Functional Analysis of Microarrays
Clare Sansom
Comparative and Functional Genomics , 2002, DOI: 10.1002/cfg.201
Abstract: The CCP11 project [2] aims to foster bioinformatics in the UK through conferences, workshops and the provision of Web resources. In March 2002, CCP11 held a meeting in Manchester, UK, on the functional analysis of microarrays. This was part of Manchester BioinformaticsWeek—three consecutive short bioinformatics meetings held in the attractive setting of the Chancellor's Conference Centre at the University of Manchester. The other meetings in the series were a workshop on ontologies and the 12th Annual MASAMB (Mathematical and Statistical Aspects of Molecular Biology) Conference. Many delegates were able to attend more than one meeting, which led to a useful cross-fertilization of ideas across the bioinformatics community. The CCP11 meeting shared with MASAMB a strong emphasis on the statistical analysis and interpretation of data—most often image intensity data.
Ten years of Genome Biology
Clare Garvey
Genome Biology , 2010, DOI: 10.1186/gb-2010-11-1-101
Abstract: Over the past decade we have witnessed a revolution in biology, and especially in molecular biology and genetics. No longer are experiments restricted to the study of a particular gene in one of a small number of model organisms. Today, a more global approach is being embraced, which has not only given rise to the field of systems biology, but has also touched all areas of biological and medical research, bringing them closer together and blurring the lines that previously defined individual disciplines. And our expectations are now much higher. It no longer satisfies us to know simply that a given transcription factor activates a particular gene. We now want to know about all of the regulatory sites for a gene and what other factors might modulate transcription factor binding and gene activation. Horizons and expectations have broadened, but what has driven this shift in attitude? It surely has to be the technological advances in the field of genomics over the past decade, such as chromatin immunoprecipitation coupled to DNA microarray (ChIP-chip) or sequencing (ChIP-seq), next-generation sequencing, RNA-seq and new techniques in proteomics.Techniques aside, the past decade will surely be best remembered as the decade of the genome. Since the White House press release [http://www.ornl.gov/sci/techresources/Human_Genome/project/clinton1.shtml webcite] in June 2000 in which the completion of the initial sequence of the human genome was announced - followed by publications in 2001 in Nature and Science - many draft genomes from other organisms have been published. The chimpanzee, chicken, honeybee and Arabidopsis have most recently been followed by the giant panda. The speed with which new genomes can now be sequenced has been facilitated by the development of powerful new sequencing technologies and assembly methods. It is now possible to assemble de novo a large genome, such as that of the giant panda, using only short reads provided by next-generation DNA sequencin
A decade and genome of change
Clare Garvey
Genome Biology , 2010, DOI: 10.1186/gb-2010-11-5-120
Abstract: Ten years ago, Bill Clinton, the then US president, announced at an historic event at the White House that the international Human Genome Project and Celera Genomics corporation had completed the initial draft of the human genome. President Clinton pledged the US's commitment to continue to translate this genomic advance into healthcare and therapeutic strategies, as well as protecting private genetic information. Little did he know of the impending cuts in exactly this area during the Bush years - ah, but let's not go there. The genomics field since then has progressed at a phenomenal rate, with advances in the field being nothing short of monumental.At around the same time as this historic announcement, Genome Biology [1] was launched. This new journal was quite unlike other journals in that it was open access and published online. In an accompanying column to this editorial, Greg Petsko [2], Genome Biology's long-term and beloved-of-many columnist, discusses Genome Biology's launch, in addition to charting our success and the unique approach that has seen Genome Biology, in a relatively short period of time, take its place as a premier journal for genomics research. To mark some of the developments in the genomics field in the past decade, and to celebrate Genome Biology's tenth birthday, we have commissioned a series of reviews focusing on key areas from the last ten years, ranging from the human microbiome to the cancer genome projects. The themes of these reviews will also be discussed at Genome Biology's inaugural conference, which is being hosted jointly with our sister journal, Genome Medicine [3], in Boston in October [4].Technological developments over the past decade have been the catalyst of innovation and progress, driving the genomics field forward at a dizzying pace. Along with these technological advances have come some revisions of the very gene count estimates that were announced ten years ago. Strikingly, current estimates are nowhere near the or
T Cell Polarization at the Virological Synapse
Clare Jolly
Viruses , 2010, DOI: 10.3390/v2061261
Abstract: Cell-to-cell spread of HIV-1 between CD4+ T cells takes place at multimolecular structures called virological synapses. A defining feature of the virological synapse is polarization of viral assembly and budding at sites of T cell-T cell contact. Recent work is beginning to address how viral proteins are targeted to the virological synapse and the molecular mechanisms that regulate HIV-1 egress by cell-to-cell spread. This review discusses our current understanding of these processes and considers how T cell polarization during other forms of intercellular communication may provide insight into HIV-1 assembly and dissemination.
Feedback on the FDA's February 2006 draft guidance on Patient Reported Outcome (PRO) measures from a developer of PRO measures
Clare Bradley
Health and Quality of Life Outcomes , 2006, DOI: 10.1186/1477-7525-4-78
Abstract: The US Department of Health and Human Services Food and Drug Administration (FDA) made public in February 2006 a document entitled 'Guidance for Industry Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims DRAFT GUIDANCE'. I have a particular interest in this draft guidance as I specialise in the design, development and use of PRO measures and license them for use in clinical trials, other research and routine clinical practice. My measures include:? the Diabetes Treatment Satisfaction Questionnaire (DTSQ) in its status (DTSQs) and change (DTSQc) forms [1-6] and related measures for other conditions including the HIVTSQ, RTSQ, RetTSQ, GHerpTSQ, ThyTSQ [7-12], and the newly designed DTSQ-Teen and DTSQ-Parent. The DTSQs and DTSQc are fully linguistically validated in 65 language versions? the Well-being Questionnaire (e.g. W-BQ12) [3,13-18] generic measure of well-being is psychometrically validated for a range of populations including those who have diabetes (type 1 and type 2) macular disease and growth hormone deficiency and fully linguistically validated in 37 language versions? the ADDQoL measure of the impact of diabetes on quality of life [4,19] with related measures for other conditions including RDQoL, RetDQoL, MacDQoL, HDQoL, A-RHDQoL, ThyDQoL, ADDQoL Teen [12,20-27] and recently designed ADDQoL Jnr (for 5–8 year olds) and ADDQoL Jnr+ (for 9–12 year olds). The ADDQoL, MacDQoL and RetDQoL are linguistically validated in 16–25 language versions.I welcome the FDA guidance as a much needed source of information about the standards required in PRO design, linguistic validation and psychometric validation. I recognise that the guidance may be very useful in encouraging good practice.I was one of the 56 individuals/organisations who submitted comments on the draft FDA guidelines by their deadline of 4th April. My original comments can be viewed with others on the FDA website [28]. I also attended a meeting in Washington
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