Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2178039
Aditi S. Shah, R. Jen, I. Laher, J. Leung, A. Allen, Stephan Van Eden, N. Ayas
Abstract PURPOSE: The purpose of this study was to characterize the associations between inflammatory and oxidative stress biomarkers, demographic, polysomnographic and spirometric parameters in patients with suspected obstructive sleep apnea (OSA) and/or obstructive airway disease. METHODS: This was a cross-sectional exploratory study of patients referred to the University of British Columbia Sleep Clinic who had a diagnostic polysomnogram for suspected OSA. All patients had samples collected for measurements of IL-10, IL-6, e-selectin, endostatin, VCAM-1, ICAM-1, PDGF, thrombospondin-2, 8-OHdG, 8-isoprostane and superoxide dismutase. Spearman correlation and multiple linear regression were used to identify predictors of biomarkers. RESULTS: A total of 63 patients were included: 65% male, mean age 53 years and body mass index (BMI) 33 kg/m2. Inflammatory biomarkers were associated with female sex (IL-6, coefficient 0.51, p = 0.032), FEV1 (IL-6, coefficient −0.02, p = 0.013) and BMI (VCAM-1, coefficient 0.009, p = 0.051). The oxidative stress marker, 8-OHdG, was associated with hypoxemia in rapid eye movement (REM) sleep (coefficient 0.006, p = 0.02). Age and BMI were both independently associated with percentage of time spent below SpO2 90%. REM sleep and patients with overlap conditions and OSA had greater degree of REM and nonrapid eye movement (NREM) sleep hypoxemia than control group. Lastly, there were no differences in oxidative or inflammatory biomarkers between control, OSA, obstructive airway disease and overlap groups though the number of patients in each group were small. CONCLUSION: Female sex, lower FEV1 and increased BMI were independent predictors of increased inflammatory biomarker levels. The oxidative stress marker 8-OHdG was associated with hypoxemia indices of REM. Larger studies are warranted to delineate biomarker profiles in patients with overlap conditions.
{"title":"Biomarkers in patients with suspected obstructive sleep apnea and obstructive lung disease: Associations among polysomnographic, demographic and spirometric parameters","authors":"Aditi S. Shah, R. Jen, I. Laher, J. Leung, A. Allen, Stephan Van Eden, N. Ayas","doi":"10.1080/24745332.2023.2178039","DOIUrl":"https://doi.org/10.1080/24745332.2023.2178039","url":null,"abstract":"Abstract PURPOSE: The purpose of this study was to characterize the associations between inflammatory and oxidative stress biomarkers, demographic, polysomnographic and spirometric parameters in patients with suspected obstructive sleep apnea (OSA) and/or obstructive airway disease. METHODS: This was a cross-sectional exploratory study of patients referred to the University of British Columbia Sleep Clinic who had a diagnostic polysomnogram for suspected OSA. All patients had samples collected for measurements of IL-10, IL-6, e-selectin, endostatin, VCAM-1, ICAM-1, PDGF, thrombospondin-2, 8-OHdG, 8-isoprostane and superoxide dismutase. Spearman correlation and multiple linear regression were used to identify predictors of biomarkers. RESULTS: A total of 63 patients were included: 65% male, mean age 53 years and body mass index (BMI) 33 kg/m2. Inflammatory biomarkers were associated with female sex (IL-6, coefficient 0.51, p = 0.032), FEV1 (IL-6, coefficient −0.02, p = 0.013) and BMI (VCAM-1, coefficient 0.009, p = 0.051). The oxidative stress marker, 8-OHdG, was associated with hypoxemia in rapid eye movement (REM) sleep (coefficient 0.006, p = 0.02). Age and BMI were both independently associated with percentage of time spent below SpO2 90%. REM sleep and patients with overlap conditions and OSA had greater degree of REM and nonrapid eye movement (NREM) sleep hypoxemia than control group. Lastly, there were no differences in oxidative or inflammatory biomarkers between control, OSA, obstructive airway disease and overlap groups though the number of patients in each group were small. CONCLUSION: Female sex, lower FEV1 and increased BMI were independent predictors of increased inflammatory biomarker levels. The oxidative stress marker 8-OHdG was associated with hypoxemia indices of REM. Larger studies are warranted to delineate biomarker profiles in patients with overlap conditions.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"39 1","pages":"86 - 92"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90157174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2177213
W. Michaelchuk, T. Colella, R. Goldstein, D. Brooks
Abstract RATIONALE: Individuals with chronic obstructive pulmonary disease (COPD) exhibit reduced physical activity (PA) and increased sedentary behavior (SB), both of which are independent predictors of mortality. Wearable technology providing vibration movement prompts may be effective in decreasing SB. This study aimed to assess the feasibility and perceptions of a vibration based FitBit™ SB change strategy in individuals with COPD. METHODS Individuals with stable COPD wore a FitBit™ with movement prompts enabled and disabled for one week each (order randomized). Feasibility and perceptions of the wearable device were assessed in each condition. A validated activity monitor (ActivPAL4™) was used to measure PA and SB. MAIN RESULTS: Of the 28 participants connected with, 19 (68%) expressed interest. A total of 18 of the 19 (95%) interested were eligible to participate, and 15 of 28 (54%) enrolled. All 15 participants completed the study with no dropouts. Nine (64%) participants identified the device as affordable. Perceptions toward the devices were generally positive or agreeable and were unaffected by the device condition (with or without prompts; P > 0.05). Responses to additional open-ended questions revealed that participants thought the device was helpful for breaking up sitting time, the timing of vibration reminders was perceived as confusing by some, and accessibility of the devices and individual preferences are important considerations. CONCLUSIONS The wearable device SB reduction strategy was feasible and participants had positive perceptions toward using it. Individualization and accessibility of device are important considerations.
{"title":"Wearable device for sedentary behavior change in chronic obstructive pulmonary disease is feasible and acceptable","authors":"W. Michaelchuk, T. Colella, R. Goldstein, D. Brooks","doi":"10.1080/24745332.2023.2177213","DOIUrl":"https://doi.org/10.1080/24745332.2023.2177213","url":null,"abstract":"Abstract RATIONALE: Individuals with chronic obstructive pulmonary disease (COPD) exhibit reduced physical activity (PA) and increased sedentary behavior (SB), both of which are independent predictors of mortality. Wearable technology providing vibration movement prompts may be effective in decreasing SB. This study aimed to assess the feasibility and perceptions of a vibration based FitBit™ SB change strategy in individuals with COPD. METHODS Individuals with stable COPD wore a FitBit™ with movement prompts enabled and disabled for one week each (order randomized). Feasibility and perceptions of the wearable device were assessed in each condition. A validated activity monitor (ActivPAL4™) was used to measure PA and SB. MAIN RESULTS: Of the 28 participants connected with, 19 (68%) expressed interest. A total of 18 of the 19 (95%) interested were eligible to participate, and 15 of 28 (54%) enrolled. All 15 participants completed the study with no dropouts. Nine (64%) participants identified the device as affordable. Perceptions toward the devices were generally positive or agreeable and were unaffected by the device condition (with or without prompts; P > 0.05). Responses to additional open-ended questions revealed that participants thought the device was helpful for breaking up sitting time, the timing of vibration reminders was perceived as confusing by some, and accessibility of the devices and individual preferences are important considerations. CONCLUSIONS The wearable device SB reduction strategy was feasible and participants had positive perceptions toward using it. Individualization and accessibility of device are important considerations.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"22 1","pages":"79 - 85"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73599628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2176798
S. Alsubheen, C. Ellerton, R. Goldstein, D. Brooks
Abstract BACKGROUND The psychometric properties of loneliness measures have not been reported in individuals with chronic obstructive pulmonary disease (COPD). This study aimed to assess the validity and reliability of the University of California and Los Angeles Loneliness Scale (UCLA-LS) version 3 for use in this population. METHODS The UCLA-LS was administered at baseline and again after 1 to 2 weeks for test-retest reliability assessment. Intraclass Correlation Coefficient (ICC) was used to assess reliability and estimate minimal detectable change (MDC). Construct validity was established by assessing known groups, and convergent and divergent validity. RESULTS Of the 47 individuals included in this study, 40 persons (87%) reported moderate to high loneliness levels. The UCLA-LS discriminated (p < 0.03) between groups based on marital status, with higher loneliness levels for single (mean difference [MD] = 8 points) and widowed (MD = 7 points) compared to married individuals. The scale had moderate to strong associations with measures of depression (ρ = 0.69-0.72; p < 0.001), anxiety (ρ = 0.46-0.52; p < 0.03), and quality of life (Chronic respiratory questionnaire [CRQ]-Fatigue: ρ = −0.51-−0.53; CRQ-Emotional function: ρ = −0.59-−0.57; CRQ-Mastery: ρ = −0.43-−0.46; p < 0.003). The UCLA-LS showed excellent test-retest reliability with ICC values of 0.96. To detect a change in version 3 UCLA-LS, the MDC score should equal or exceed 7.8 points. CONCLUSION UCLA-LS demonstrated excellent known groups, convergent and divergent validity, and test-retest reliability. These findings may help improve the interpretability of loneliness levels in individuals with COPD.
{"title":"Validity and reliability of the University of California and Los Angeles Loneliness Scale in individuals with chronic obstructive pulmonary disease","authors":"S. Alsubheen, C. Ellerton, R. Goldstein, D. Brooks","doi":"10.1080/24745332.2023.2176798","DOIUrl":"https://doi.org/10.1080/24745332.2023.2176798","url":null,"abstract":"Abstract BACKGROUND The psychometric properties of loneliness measures have not been reported in individuals with chronic obstructive pulmonary disease (COPD). This study aimed to assess the validity and reliability of the University of California and Los Angeles Loneliness Scale (UCLA-LS) version 3 for use in this population. METHODS The UCLA-LS was administered at baseline and again after 1 to 2 weeks for test-retest reliability assessment. Intraclass Correlation Coefficient (ICC) was used to assess reliability and estimate minimal detectable change (MDC). Construct validity was established by assessing known groups, and convergent and divergent validity. RESULTS Of the 47 individuals included in this study, 40 persons (87%) reported moderate to high loneliness levels. The UCLA-LS discriminated (p < 0.03) between groups based on marital status, with higher loneliness levels for single (mean difference [MD] = 8 points) and widowed (MD = 7 points) compared to married individuals. The scale had moderate to strong associations with measures of depression (ρ = 0.69-0.72; p < 0.001), anxiety (ρ = 0.46-0.52; p < 0.03), and quality of life (Chronic respiratory questionnaire [CRQ]-Fatigue: ρ = −0.51-−0.53; CRQ-Emotional function: ρ = −0.59-−0.57; CRQ-Mastery: ρ = −0.43-−0.46; p < 0.003). The UCLA-LS showed excellent test-retest reliability with ICC values of 0.96. To detect a change in version 3 UCLA-LS, the MDC score should equal or exceed 7.8 points. CONCLUSION UCLA-LS demonstrated excellent known groups, convergent and divergent validity, and test-retest reliability. These findings may help improve the interpretability of loneliness levels in individuals with COPD.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"9 1","pages":"70 - 78"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84591186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2176797
S. Desai, Wei Zhang, J. Sutherland, Joel Singer PhD, Xingzuo Zhou, B. Quon
Abstract RATIONALE: Cystic fibrosis (CF) is a progressive multi-organ disease with significant morbidity placing extensive demands on the health care system. No recent estimate of CF health care costs in a Canadian context exists. OBJECTIVES: Provide up-to-date direct cost estimates of the economic burden of CF from the perspective of a Canadian health care system. METHODS: A longitudinal study of retrospective data was completed in British Columbia by linking the Canadian CF Registry with provincial health care administrative databases for the period between 2007 and 2017. MEASUREMENTS: Health care spending (in constant 2017 Canadian dollars) for CF outpatient services, inpatient hospitalizations, medications, and emergency department visits were included. Generalized estimating equations approach for repeated annual cost data over time was used to estimate health care costs. MAIN RESULTS: The overall total direct annual health care spending for CF care in BC increased from $10.6M to $17.2M from 2007 to 2017 ($2017, mean costs per CF patient increased from $31.7K to $42.2K; Cost ratio: 1.33, 95%CI: 1.12-1.57). Outpatient medications, inpatient hospitalizations, outpatient services, and emergency department visits were responsible for 56%, 36%, 7.4% and 0.5% of total costs, respectively. CF adults also showed substantial increases in costs over time (Cost ratio from 2017 relative to 2007: 1.61, 95%CI: 1.17-2.22). CONCLUSIONS: The economic burden of CF increased from 2007 to 2017 driven by rising outpatient medication costs primarily in adults with CF. With approximately 75% of the population eligible for highly effectively cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the economic burden of CF is expected to increase at unprecedented rates.
{"title":"Economic burden of cystic fibrosis care in British Columbia","authors":"S. Desai, Wei Zhang, J. Sutherland, Joel Singer PhD, Xingzuo Zhou, B. Quon","doi":"10.1080/24745332.2023.2176797","DOIUrl":"https://doi.org/10.1080/24745332.2023.2176797","url":null,"abstract":"Abstract RATIONALE: Cystic fibrosis (CF) is a progressive multi-organ disease with significant morbidity placing extensive demands on the health care system. No recent estimate of CF health care costs in a Canadian context exists. OBJECTIVES: Provide up-to-date direct cost estimates of the economic burden of CF from the perspective of a Canadian health care system. METHODS: A longitudinal study of retrospective data was completed in British Columbia by linking the Canadian CF Registry with provincial health care administrative databases for the period between 2007 and 2017. MEASUREMENTS: Health care spending (in constant 2017 Canadian dollars) for CF outpatient services, inpatient hospitalizations, medications, and emergency department visits were included. Generalized estimating equations approach for repeated annual cost data over time was used to estimate health care costs. MAIN RESULTS: The overall total direct annual health care spending for CF care in BC increased from $10.6M to $17.2M from 2007 to 2017 ($2017, mean costs per CF patient increased from $31.7K to $42.2K; Cost ratio: 1.33, 95%CI: 1.12-1.57). Outpatient medications, inpatient hospitalizations, outpatient services, and emergency department visits were responsible for 56%, 36%, 7.4% and 0.5% of total costs, respectively. CF adults also showed substantial increases in costs over time (Cost ratio from 2017 relative to 2007: 1.61, 95%CI: 1.17-2.22). CONCLUSIONS: The economic burden of CF increased from 2007 to 2017 driven by rising outpatient medication costs primarily in adults with CF. With approximately 75% of the population eligible for highly effectively cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the economic burden of CF is expected to increase at unprecedented rates.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"20 1","pages":"60 - 69"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72517151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2191534
R. Leigh
{"title":"President’s message","authors":"R. Leigh","doi":"10.1080/24745332.2023.2191534","DOIUrl":"https://doi.org/10.1080/24745332.2023.2191534","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"75 1","pages":"49 - 51"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88960560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-04DOI: 10.1080/24745332.2023.2184431
F. Gabrysz-Forget, C. Poirier
Abstract This case presents a patient with severe pulmonary alveolar microlithiasis, a rare genetic condition affecting the sodium-dependent co-transporter of the type II pneumocytes. As the disease progress, calcium-phosphate microlithiases accumulate within the alveoli. This leads to a severe diffuse interstitial disease with classic sand-like calcifications on chest radiography. Lung transplantation remains the only cure.
{"title":"Severe pulmonary alveolar microlithiasis","authors":"F. Gabrysz-Forget, C. Poirier","doi":"10.1080/24745332.2023.2184431","DOIUrl":"https://doi.org/10.1080/24745332.2023.2184431","url":null,"abstract":"Abstract This case presents a patient with severe pulmonary alveolar microlithiasis, a rare genetic condition affecting the sodium-dependent co-transporter of the type II pneumocytes. As the disease progress, calcium-phosphate microlithiases accumulate within the alveoli. This leads to a severe diffuse interstitial disease with classic sand-like calcifications on chest radiography. Lung transplantation remains the only cure.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"53 1","pages":"119 - 120"},"PeriodicalIF":0.8,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79544800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-15DOI: 10.1080/24745332.2022.2150722
Nourhan Kotb, L. Barreto, T. Janaudis-Ferreira
Abstract Post COVID-19 condition is defined as the illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months. The most common symptoms of people with post-COVID condition are symptoms of fatigue, dyspnea, brain fog and post-exertional malaise (PEM). International guidelines on the management of COVID-19 highlight the importance of screening patients for PEM before rehabilitation interventions and carefully monitoring symptoms in response to physical activity to avoid flare-ups. We sought to determine how PEM is being considered in the context of rehabilitation for COVID-19 by reviewing the published literature and registries of clinical trials.
{"title":"Post-exertional malaise in pulmonary rehabilitation after COVID-19: Are we not giving enough attention?","authors":"Nourhan Kotb, L. Barreto, T. Janaudis-Ferreira","doi":"10.1080/24745332.2022.2150722","DOIUrl":"https://doi.org/10.1080/24745332.2022.2150722","url":null,"abstract":"Abstract Post COVID-19 condition is defined as the illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months. The most common symptoms of people with post-COVID condition are symptoms of fatigue, dyspnea, brain fog and post-exertional malaise (PEM). International guidelines on the management of COVID-19 highlight the importance of screening patients for PEM before rehabilitation interventions and carefully monitoring symptoms in response to physical activity to avoid flare-ups. We sought to determine how PEM is being considered in the context of rehabilitation for COVID-19 by reviewing the published literature and registries of clinical trials.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"30 1","pages":"93 - 118"},"PeriodicalIF":0.8,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82560369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-07DOI: 10.1080/24745332.2023.2165462
Matthew P Munan, Zoe Hsu, J. Bakal, E. MacIntyre
Abstract INTRODUCTION Patients requiring Prolonged Mechanical Ventilation (PMV) are a small but important subset of critically ill patients treated in an Intensive Care Unit (ICU). The purpose of this study is to identify and characterize the PMV population in Alberta, Canada over a period of 10 years and to determine mortality, discharge disposition and healthcare cost. METHODS A search of the Alberta Health Services Enterprise Data Warehouse was performed to characterize all patients with 7 days or more of mechanical ventilation in an acute care hospital in Alberta from 2009-2019. Data linkages were performed to identify survival up to 2 years and Healthcare cost was estimated using resource intensity weight (RIW) score. RESULTS The search identified 11,739 patients ventilated for ≥7 days from 2009-2019. In this cohort, 59% of patients were ventilated for 7-13 days, 20% for 14-20 days and 21% for 21 days or more. The in-hospital survival rate was 68% and the one-year survival from initiation of ventilation was 61%. Of the patients discharged alive, 93% were discharged to community and 7% were discharged to a continuing care center. The median healthcare cost for index hospital admission was $119,627 ($70,549-$200,036) CONCLUSION PMV users require a significant duration of mechanical ventilation, a prolonged stay in the ICU and hospital and high healthcare resource utilization. The majority of these patients survive their index admission and are discharged to community.
{"title":"Prolonged mechanical ventilation in Alberta: A 10 year historical cohort study","authors":"Matthew P Munan, Zoe Hsu, J. Bakal, E. MacIntyre","doi":"10.1080/24745332.2023.2165462","DOIUrl":"https://doi.org/10.1080/24745332.2023.2165462","url":null,"abstract":"Abstract INTRODUCTION Patients requiring Prolonged Mechanical Ventilation (PMV) are a small but important subset of critically ill patients treated in an Intensive Care Unit (ICU). The purpose of this study is to identify and characterize the PMV population in Alberta, Canada over a period of 10 years and to determine mortality, discharge disposition and healthcare cost. METHODS A search of the Alberta Health Services Enterprise Data Warehouse was performed to characterize all patients with 7 days or more of mechanical ventilation in an acute care hospital in Alberta from 2009-2019. Data linkages were performed to identify survival up to 2 years and Healthcare cost was estimated using resource intensity weight (RIW) score. RESULTS The search identified 11,739 patients ventilated for ≥7 days from 2009-2019. In this cohort, 59% of patients were ventilated for 7-13 days, 20% for 14-20 days and 21% for 21 days or more. The in-hospital survival rate was 68% and the one-year survival from initiation of ventilation was 61%. Of the patients discharged alive, 93% were discharged to community and 7% were discharged to a continuing care center. The median healthcare cost for index hospital admission was $119,627 ($70,549-$200,036) CONCLUSION PMV users require a significant duration of mechanical ventilation, a prolonged stay in the ICU and hospital and high healthcare resource utilization. The majority of these patients survive their index admission and are discharged to community.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"53 1","pages":"52 - 59"},"PeriodicalIF":0.8,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86039756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-02DOI: 10.1080/24745332.2023.2167414
R. Leigh
{"title":"President’s message","authors":"R. Leigh","doi":"10.1080/24745332.2023.2167414","DOIUrl":"https://doi.org/10.1080/24745332.2023.2167414","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"9 1","pages":"1 - 3"},"PeriodicalIF":0.8,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78530210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-02DOI: 10.1080/24745332.2022.2156936
Duaa Fatima, W. Tsai, J. Corrigan, I. Ogah, A. Ip-Buting, H. Sharpe, C. Laratta, P. Peller, S. Pendharkar
Abstract RATIONALE: Geography is an increasingly recognized barrier to the diagnosis and treatment of chronic diseases, yet no prior studies have investigated its influence on the patient-borne burden of obstructive sleep apnea (OSA) care. OBJECTIVE: We aimed to determine if wait times and costs of OSA care differ between rural and urban adults. METHODS: We conducted a secondary analysis of data from a prospective cohort study comparing OSA treatment outcomes among urban and rural adults. Participants were recruited at the time of continuous positive airway pressure (CPAP) initiation for uncomplicated OSA. Residential postal codes were translated into geographic census areas to classify participants as urban (community size > 100,000) or rural. Participants were administered a questionnaire exploring wait times and costs of OSA care at baseline and three months. RESULTS: We enrolled 242 participants (100 rural). Twenty-six percent of respondents waited at least six months to seek medical attention for possible OSA, with no difference between groups. Wait times for diagnosis and treatment were three months or less for 91 and 93% of respondents, respectively. However, rural respondents experienced longer delays from first assessment to diagnosis and from diagnosis to treatment. Fewer individuals with rural residence were supported by government funding for diagnostic testing or CPAP. Rural participants more commonly reported additional appointment-related costs and greater total costs of care. CONCLUSION: Rural patients experience longer wait times and a greater financial burden for OSA care. The findings of this study will inform the development of novel models of OSA care sensitive to the needs of unique populations.
{"title":"Exploring patient-borne costs and wait times for obstructive sleep apnea (OSA) care among rural and urban adults","authors":"Duaa Fatima, W. Tsai, J. Corrigan, I. Ogah, A. Ip-Buting, H. Sharpe, C. Laratta, P. Peller, S. Pendharkar","doi":"10.1080/24745332.2022.2156936","DOIUrl":"https://doi.org/10.1080/24745332.2022.2156936","url":null,"abstract":"Abstract RATIONALE: Geography is an increasingly recognized barrier to the diagnosis and treatment of chronic diseases, yet no prior studies have investigated its influence on the patient-borne burden of obstructive sleep apnea (OSA) care. OBJECTIVE: We aimed to determine if wait times and costs of OSA care differ between rural and urban adults. METHODS: We conducted a secondary analysis of data from a prospective cohort study comparing OSA treatment outcomes among urban and rural adults. Participants were recruited at the time of continuous positive airway pressure (CPAP) initiation for uncomplicated OSA. Residential postal codes were translated into geographic census areas to classify participants as urban (community size > 100,000) or rural. Participants were administered a questionnaire exploring wait times and costs of OSA care at baseline and three months. RESULTS: We enrolled 242 participants (100 rural). Twenty-six percent of respondents waited at least six months to seek medical attention for possible OSA, with no difference between groups. Wait times for diagnosis and treatment were three months or less for 91 and 93% of respondents, respectively. However, rural respondents experienced longer delays from first assessment to diagnosis and from diagnosis to treatment. Fewer individuals with rural residence were supported by government funding for diagnostic testing or CPAP. Rural participants more commonly reported additional appointment-related costs and greater total costs of care. CONCLUSION: Rural patients experience longer wait times and a greater financial burden for OSA care. The findings of this study will inform the development of novel models of OSA care sensitive to the needs of unique populations.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"1 1","pages":"21 - 27"},"PeriodicalIF":0.8,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74479173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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