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Search Results: 1 - 10 of 6168 matches for " Karen EA Burns "
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Hemofiltration compared to hemodialysis for acute kidney injury: systematic review and meta-analysis
Jan O Friedrich, Ron Wald, Sean M Bagshaw, Karen EA Burns, Neill KJ Adhikari
Critical Care , 2012, DOI: 10.1186/cc11458
Abstract: MEDLINE, EMBASE and CENTRAL databases and conference abstracts were searched to June 2012 for parallel-group or crossover randomized and quasi-randomized controlled trials (RCTs) evaluating hemofiltration vs. hemodialysis in patients with AKI. Two authors independently selected studies and abstracted data on study quality and outcomes. Additional information was obtained from trial authors. We pooled data using random-effects models.Of 6,657 citations, 19 RCTs (10 parallel-group and 9 crossover) met inclusion criteria. Sixteen trials used continuous RRT. Study quality was variable. The primary analysis included three parallel-group trials comparing similar doses of hemofiltration and hemodialysis; sensitivity analyses included trials comparing combined hemofiltration-hemodialysis or dissimilar doses. We found no effect of hemofiltration on mortality (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.73 to 1.25, P = 0.76; three trials, n = 121 (primary analysis); RR 1.10, 95% CI 0.88 to 1.38, P = 0.38; eight trials, n = 540 (sensitivity analysis)) or other clinical outcomes (RRT dependence in survivors, vasopressor use, organ dysfunction) compared to hemodialysis. Hemofiltration appeared to shorten time to filter failure (mean difference (MD) -7 hours, 95% CI (-19,+5), P = 0.24; two trials, n = 50 (primary analysis); MD -5 hours, 95% CI (-10, -1), P = 0.01; three trials, n = 113 (including combined hemofiltration-hemodialysis trials comparing similar doses); MD -6 hours, 95% CI (-10, -1), P = 0.02; five trials, n = 383 (sensitivity analysis)). Data primarily from crossover RCTs suggested that hemofiltration increased clearance of medium to larger molecules, including inflammatory cytokines, compared to hemodialysis, although almost no studies measured changes in serum concentrations. Meta-analyses were based on very limited data.Data from small RCTs do not suggest beneficial clinical outcomes from hemofiltration, but confidence intervals were wide. Hemofiltration
Wean Earlier and Automatically with New technology (the WEAN study): a protocol of a multicentre, pilot randomized controlled trial
Karen EA Burns, Maureen O Meade, Martin R Lessard, Sean P Keenan, Francois Lellouche
Trials , 2009, DOI: 10.1186/1745-6215-10-81
Abstract: A pilot weaning randomized controlled trial (RCT) is underway in the ICUs of 8 Canadian hospitals. We will randomize 90 critically ill adults requiring invasive ventilation for at least 24 hours and identified at an early stage of the weaning process to either Automated Weaning (SmartCare?) or Protocolized Weaning. The results of a National Weaning Survey informed the design of the Protocolized Weaning arm. Both weaning protocols are operationalized in Pressure Support mode, include opportunities for Spontaneous Breathing Trials, and share a common sedation protocol, oxygen titration parameters, and extubation and reintubation criteria. The primary outcome of the WEAN study is to evaluate compliance with the proposed weaning and sedation protocols. A key secondary outcome of the pilot RCT is to evaluate clinician acceptance of the weaning and sedation protocols. Prior to initiating the WEAN Study, we conducted a run-in phase, involving two patients per centre (randomizing the first participant to either weaning strategy and assigning the second patient to the alternate strategy) to ensure that participating centres could implement the weaning and sedation protocols and complete the detailed case report forms.Mechanical ventilation studies are difficult to implement; requiring protocols to be operationalized continuously and entailing detailed daily data collection. As the first multicentre weaning RCT in Canada, the WEAN Study seeks to determine the feasibility of conducting a large scale future weaning trial and to establish a collaborative network of ICU clinicians dedicated to advancing the science of weaning.ISRCTN43760151Weaning is the process during which mechanical ventilation is gradually or abruptly withdrawn. In addition, it is the time during which work of breathing is transferred from the ventilator back to the patient until fully autonomous breathing is resumed. Weaning accounts for approximately 40% of the total time spent on mechanical ventilation [1,
Optimal Mode of clearance in critically ill patients with Acute Kidney Injury (OMAKI) - a pilot randomized controlled trial of hemofiltration versus hemodialysis: a Canadian Critical Care Trials Group project
Ron Wald, Jan O Friedrich, Sean M Bagshaw, Karen EA Burns, Amit X Garg, Michelle A Hladunewich, Andrew A House, Stephen Lapinsky, David Klein, Neesh I Pannu, Karen Pope, Robert M Richardson, Kevin Thorpe, Neill KJ Adhikari
Critical Care , 2012, DOI: 10.1186/cc11835
Abstract: This was a multicenter open-label parallel-group pilot randomized trial of CVVH versus CVVHD. Using concealed allocation, we randomized critically ill adults with AKI and hemodynamic instability to CVVH or CVVHD, with a prescribed small solute clearance of 35 mL/kg/hour in both arms. The primary outcome was trial feasibility, defined by randomization of >25% of eligible patients, delivery of >75% of the prescribed CRRT dose, and follow-up of >95% of patients to 60 days. A secondary analysis using a mixed-effects model examined the impact of therapy on illness severity, defined by sequential organ failure assessment (SOFA) score, over the first week.We randomized 78 patients (mean age 61.5 years; 39% women; 23% with chronic kidney disease; 82% with sepsis). Baseline SOFA scores (mean 15.9, SD 3.2) were similar between groups. We recruited 55% of eligible patients, delivered >80% of the prescribed dose in each arm, and achieved 100% follow-up. SOFA tended to decline more over the first week in CVVH recipients (-0.8, 95% CI -2.1, +0.5) driven by a reduction in vasopressor requirements. Mortality (54% CVVH; 55% CVVHD) and dialysis dependence in survivors (24% CVVH; 19% CVVHD) at 60 days were similar.Our results suggest that a large trial comparing CVVH to CVVHD would be feasible. There is a trend toward improved vasopressor requirements among CVVH-treated patients over the first week of treatment.ClinicalTrials.gov: NCT00675818Acute kidney injury (AKI) is a common complication of critical illness, afflicting up to two-thirds of patients admitted to the ICU [1]. A significant minority of patients with AKI requires renal replacement therapy (RRT), and these individuals have high short-term mortality that ranges from 50 to 70% [2]. In an attempt to mitigate these poor outcomes, various components of the RRT prescription have been rigorously examined in large well-designed randomized controlled trials (RCTs) [3-5].The optimal mode of clearance in patients with AKI who requi
A Canadian Critical Care Trials Group project in collaboration with the international forum for acute care trialists - Collaborative H1N1 Adjuvant Treatment pilot trial (CHAT): study protocol and design of a randomized controlled trial
Karen EA Burns, Clarence Chant, Orla Smith, Brian Cuthbertson, Robert Fowler, Deborah J Cook, Peter Kruger, Steve Webb, Jamal Alhashemi, Guillermo Dominguez-Cherit, Carlos Zala, Gordon D Rubenfeld, John C Marshall
Trials , 2011, DOI: 10.1186/1745-6215-12-70
Abstract: A multi-national, pilot randomized controlled trial (RCT) of once daily enteral rosuvastatin versus matched placebo administered for 14 days for the treatment of critically ill patients with suspected, probable or confirmed H1N1 infection. We propose to randomize 80 critically ill adults with a moderate to high index of suspicion for H1N1 infection who require mechanical ventilation and have received antiviral therapy for ≤ 72 hours. Site investigators, research coordinators and clinical pharmacists will be blinded to treatment assignment. Only research pharmacy staff will be aware of treatment assignment. We propose several approaches to informed consent including a priori consent from the substitute decision maker (SDM), waived and deferred consent. The primary outcome of the CHAT trial is the proportion of eligible patients enrolled in the study. Secondary outcomes will evaluate adherence to medication administration regimens, the proportion of primary and secondary endpoints collected, the number of patients receiving open-label statins, consent withdrawals and the effect of approved consent models on recruitment rates.Several aspects of study design including the need to include central randomization, preserve allocation concealment, ensure study blinding compare to a matched placebo and the use novel consent models pose challenges to investigators conducting pandemic research. Moreover, study implementation requires that trial design be pragmatic and initiated in a short time period amidst uncertainty regarding the scope and duration of the pandemic.ISRCTN45190901On June 11, 2009, the World Health Organization (WHO) declared that infection with the Swine Origin Influenza A/H1N1 virus had reached pandemic proportions [1]. Cases were recorded in more than 180 countries and outbreaks that strained national resource capacities were documented in Canada, Australia, Chile, Argentina, and elsewhere.Throughout history, pandemic influenza has posed a recurrent threat t
Stopping randomized trials early for benefit: a protocol of the Study Of Trial Policy Of Interim Truncation-2 (STOPIT-2)
Matthias Briel, Melanie Lane, Victor M Montori, Dirk Bassler, Paul Glasziou, German Malaga, Elie A Akl, Ignacio Ferreira-Gonzalez, Pablo Alonso-Coello, Gerard Urrutia, Regina Kunz, Carolina Culebro, Suzana da Silva, David N Flynn, Mohamed B Elamin, Brigitte Strahm, M Hassan Murad, Benjamin Djulbegovic, Neill KJ Adhikari, Edward J Mills, Femida Gwadry-Sridhar, Haresh Kirpalani, Heloisa P Soares, Nisrin Elnour, John J You, Paul J Karanicolas, Heiner C Bucher, Julianna F Lampropulos, Alain J Nordmann, Karen EA Burns
Trials , 2009, DOI: 10.1186/1745-6215-10-49
Abstract: We will use sensitive strategies to search for systematic reviews addressing the same clinical question as each of the tRCTs identified in STOPIT-1 and in a subsequent literature search. We will check all RCTs included in each systematic review to determine their similarity to the index tRCT in terms of participants, interventions, and outcome definition, and conduct new meta-analyses addressing the outcome that led to early termination of the tRCT. For each pair of tRCT and systematic review of corresponding non-tRCTs we will estimate the ratio of relative risks, and hence estimate the degree of bias. We will use hierarchical multivariable regression to determine the factors associated with the magnitude of this ratio. Factors explored will include the presence and quality of a stopping rule, the methodological quality of the trials, and the number of total events that had occurred at the time of truncation.Finally, we will evaluate whether Bayesian methods using conservative informative priors to "regress to the mean" overoptimistic tRCTs can correct observed biases.A better understanding of the extent to which tRCTs exaggerate treatment effects and of the factors associated with the magnitude of this bias can optimize trial design and data monitoring charters, and may aid in the interpretation of the results from trials stopped early for benefit.Interim analyses conducted early in the course of a randomized clinical trial (RCTs) may suggest larger than expected treatment effects that are inconsistent with chance. Consequently, investigators and data monitoring committees may conclude that one treatment is superior to the other and decide to stop the trial and release the results, arguing that completing the trial as planned is unadvisable or even unethical. The publicity surrounding such action often captures considerable attention because of the large treatment effects and the dramatic nature of the decision to terminate early.Clinicians, authors of systematic r
Partial Ventilatory Support Modalities in Acute Lung Injury and Acute Respiratory Distress Syndrome—A Systematic Review
Sarah M. McMullen,Maureen Meade,Louise Rose,Karen Burns,Sangeeta Mehta,Robert Doyle,Dietrich Henzler
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0040190
Abstract: The efficacy of partial ventilatory support modes that allow spontaneous breathing in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is unclear. The objective of this scoping review was to assess the effects of partial ventilatory support on mortality, duration of mechanical ventilation, and both hospital and intensive care unit (ICU) lengths of stay (LOS) for patients with ALI and ARDS; the secondary objective was to describe physiologic effects on hemodynamics, respiratory system and other organ function.
OnabotulinumtoxinA Nerve Blocks in the Treatment of Occipital Neuralgia  [PDF]
Andrew Ea, Terence Gray
Pain Studies and Treatment (PST) , 2016, DOI: 10.4236/pst.2016.43005
Abstract: Occipital neuralgia is characterized by severe pain, accompanied by tenderness and trigger points, in the distribution of the greater, lesser, and/or third occipital nerves. Occipital neuralgia is typically idiopathic, but also is characterized as a common form of posttraumatic headache. Typical treatments include nerve blocks with local anesthetic, nerve stimulation, pulsed radiofrequency, and cryoablation. OnabotulinumtoxinA (ONA) has recently been utilized in nerve blocks to treat occipital neuralgia, with the potential for a longer duration of pain relief than local anesthetic. Our study retrospectively examined 63 patients treated for occipital neuralgia, including 19 with ONA. 80 - 155 units of ONA were administered bilaterally in the surrounding musculature. A total of 61 patients, including 17 of those subsequently treated with ONA, were treated with local anesthetic, using a 1:1 mixture of 0.25% bupivacaine and 1% lidocaine, plus triamcinolone. Patients reported VAS pain scores before and after their procedures, and again during 4-week follow-up visits. Information on opioid use, overall pain relief, and duration of full relief was also recorded upon follow-up. Patients treated with ONA exhibited significant decreases in average VAS pain scores from 4.1 ± 2.6 pre-procedure to 2.1 ± 2.4 post-procedure (p = 2 × 10 -5), and 3.0 ± 2.5 4 weeks later (p = 0.0234). Mean overall relief was 75.8% ± 25.0%. Treatment with local anesthetic suggested equally efficacious reduction of VAS scores; however, treatment with ONA showed a significantly higher percentage of overall pain relief leading to follow-up. Opioid use did not exhibit significant change, regardless of treatment type. Our results support the hypothesis that use of Onabotulinum-toxinA in occipital nerve blocks leads to significant decreases in pain, while possibly exhibiting a longer duration of action than that of local anesthetic.
OnabotulinumtoxinA in the Treatment of Occipital Neuralgia Following Gunshot Injury  [PDF]
Andrew Ea, Terence Gray
Pain Studies and Treatment (PST) , 2016, DOI: 10.4236/pst.2016.44007
Abstract: Occipital neuralgia, while typically idiopathic in presentation, is a common form of posttraumatic headache. It is associated with severe pain in the greater, lesser, and/or third occipital nerves, and often accompanied by tenderness or trigger points in the surrounding musculature. OnabotulinumtoxinA (ONA) has been recently utilized in nerve blocks to treat occipital neuralgia, but current literature supporting such use is scarce. We describe a case of occipital neuralgia in a patient following C1 fracture and vertebral artery dissection due to gunshot injury. Successful treatment with bilateral ONA nerve blocks led to an 80% - 90% improvement in pain, with decreased Visual Analog Scale (VAS) pain scores immediately following treatment and upon follow-up 1 month later.
Gender Differences in the Validity of Career Interest Inventories  [PDF]
Stephanie T. Burns
Psychology (PSYCH) , 2014, DOI: 10.4236/psych.2014.58089
Abstract:

Predictive validity (including hit rates, kappa coefficients, and chance expectancy rates) between standard scoring and person matching was compared by gender based upon ex post facto data collected on 5143 medical students who had taken a career interest inventory and entered their medical residency. Hit rate accuracy for person matching with females and males in this study was lower than standard scoring. However, person matching demonstrated greater gender balancing in first match hit rates. Additionally, person matching increased career interest inventory validity over standard scoring as it has the greater ability to a) differentiate between and b) assign to specific occupational groups for females and males. Furthermore, person matching has the potential to offer female and male test takers the ability to receive narrative career data, which could improve the career decision making process over the scoring reports of career interest inventories using standard scoring.

Rational Choice Theory: Toward a Psychological, Social, and Material Contextualization of Human Choice Behavior  [PDF]
Tom Burns, Ewa Roszkowska
Theoretical Economics Letters (TEL) , 2016, DOI: 10.4236/tel.2016.62022
Abstract: The main purpose of this paper is to provide a brief overview of the rational choice approach, followed by an identification of several of the major criticisms of RCT and its conceptual and empirical limitations. It goes on to present a few key initiatives to develop alternative, more realistic approaches which transcend some of the limitations of Rational Choice Theory (RCT). Finally, the article presents a few concluding reflections and a table comparing similarities and differences between the mainstream RCT and some of the initial components of an emerging choice theory. Our method has been to conduct a brief selective review of rational choice theoretical formulations and applications as well as a review of diverse critical literature in the social sciences where rational choice has been systematically criticized. We have focused on a number of leading contributors (among others, several Nobel Prize Recipients in economics, who have addressed rational choice issues). So this article makes no claim for completeness. The review maps a few key concepts and assumptions underpinning the conceptual model and empirical applications of RCT. It reviews also a range of critical arguments and evidence of limitations. It identifies selected emerging concepts and theoretical revisions and adaptations to choice theory and what they entail. The results obtained, based on our literature reviews and analyses, are the identification of several major limitations of RCT as well as selected modifications and adaptations of choice theory which overcome or promise to overcome some of the RCT limitations. Thus, the article with Table 1 in hand provides a point of departure for follow-up systematic reviews and more precise questions for future theory development. The criticisms and adaptations of RCT have contributed to greater realism, empirical relevance, and increased moral considerations. The developments entail, among other things: the now well-known cognitive limitations (“bounded rationality”) and, for instance, the role of satisficing rather than maximizing in decision-making to deal with cognitive complexity and the uncertainties of multiple values; choice situations are re-contextualized with psychology, sociology, economic, and material conditions and factors which are taken into account explicitly and insightfully in empirical and theoretical work. Part of the contextualization concerns the place of multiple values, role and norm contradictions, and moral dilemmas in much choice behavior. In conclusion, the article suggests that the adaptations and
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