Browsing by Author "Faris, Peter D."

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    Assessment of the magnitude of geographic variation and socioeconomic contextual effects on children’s dental caries: a multilevel cross-sectional analysis of a population-based sample
    (2019-02-22) Shi, Congshi; McLaren, Lindsay; Faris, Peter D.; Aparicio-Ting, Fabiola E.; Patterson, Steven M.
    Background: Revealing geographic variation and assessing area contextual influences are important for reducing social inequalities in dental caries. The objective of this study was to investigate area contextual effects on children’s dental caries. Methods: This cross-sectional study included data from Grade 1 and 2 school children attending schools in the Public or Catholic school systems in the urban areas of Calgary and Edmonton in 2013/2014, in Canada. Three sources of data were used: (a) open mouth examinations, (b) parents’ questionnaires, and (c) Pampalon Material Deprivation Index derived from census data. Two dental caries outcomes were considered: (1) presence of dental caries, and (2) caries experience. Data were analyzed using multilevel modelling with two levels: school children (level 1) and dissemination area in which the child’s school was located (level 2). Results: The analytic sample included 5,677 school children attending school in 220 DAs. The study confirmed the existence of geographic variation; levels of dental caries were significantly higher among children attending schools in the most materially-deprived DAs than among those in the least materially-deprived DAs. After controlling for different population compositions in those areas, the DA-level variance represented a small but significant part (5-9%) of total variance in dental caries. Although the highest risk of having dental caries was found in the most materially-deprived DAs, the largest number of children at risk were more thinly spread across all deprivation quintiles. Conclusions: The school DA’s context may have an impact on children’s dental caries, beyond individual- and family-level factors. The study findings are relevant to Alberta Health Services’ practice of basing their selection of targeted areas for dental public health programming on school-DA’s material deprivation level and delivering preventive services to children attending schools in those selected DAs. Specifically, although risk of dental caries is highest in the most deprived quintiles, strategies focusing exclusively on the highest deprivation areas would miss many of the vulnerable children. Multilevel interventions are thus necessary to reduce social inequalities in children’s dental caries.
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    Canadian Pregnancy Outcomes in Rheumatoid Arthritis and Systemic Lupus Erythematosus
    (Hindawi Publishing Corporation, 2011-08-15) Barnabe, Cheryl; Faris, Peter D.; Quan, Hude
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    Canadian Pregnancy Outcomes in Rheumatoid Arthritis and Systemic Lupus Erythematosus
    (2011-10-19) Barnabe, Cheryl; Faris, Peter D.; Quan, Hude
    Objective. To describe obstetrical and neonataloutcomes in Canadian women with rheumatoid arthritis (RA) orsystemic lupus erythematosus (SLE). Methods. Anadministrative database of hospitalizations for neonatal delivery(1998–2009) from Calgary, Alberta was searched to identifywomen with RA (38 pregnancies) or SLE (95 pregnancies), and womenfrom the general population matched on maternal age and year ofdelivery (150 and 375 pregnancies, resp.). Conditionallogistic regression was used to calculate odds ratios (OR) formaternal and neonatal outcomes, adjusting for parity. Results. Women with SLE had increased odds forpreeclampsia or eclampsia (SLE OR 2.16 (95% CI 1.10–4.21;); RA OR 2.33 (95% CI 0.76–7.14; )). Women with SLEhad increased odds for cesarean section after adjustment fordysfunctional labour, instrumentation and previous cesareansection (OR 3.47 (95% CI 1.67–7.22; )). Neonates born towomen with SLE had increased odds of prematurity (SLE OR 6.17(95% CI 3.28–11.58; ); RA OR 2.66 (95% CI 0.90–7.84;)) and of SGA (SLE OR 2.54 (95% CI 1.42–4.55; ); RAOR 2.18 (95% CI 0.84–5.66; )) after adjusting for maternalhypertension. There was no excess risk of congenital defects inneonates. Conclusions. There is increased obstetrical and neonatal morbidityin Canadian women with RA or SLE.
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    Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis
    (BioMed Central, 2014-01-04) Roberts, Derek J.; Leigh-Smith, Simon; Faris, Peter D.; Ball, Chad G.; Robertson, Helen Lee; Blackmore, Christopher; Dixon, Elijah; Kirkpatrick, Andrew W.; Kortbeek, John B.; Stelfox, Henry Thomas
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    Derivation and Internal Validation of a Prediction Model for Hand Fracture Referral Among Pediatric Patients
    (2019-06-18) Hartley, Rebecca Lauren; Ronksley, Paul Everett; Faris, Peter D.; Fraulin, Frankie O. G.; Harrop, Alan Robertson
    Pediatric hand fractures are common however, which fractures should be referred for specialist care remains unclear. This thesis aimed to develop a prediction model to identify which acute pediatric hand fractures required referral to a hand surgeon. Data was collected on consecutively referred pediatric hand fractures to a plastic surgery clinic over two years. The primary outcome was necessary referral, defined as fractures that required surgery, closed reduction or more than four appointments. Multivariable logistic regression with bootstrapping was used to derive and internally validate a model, which was then translated into a risk index. Of 1,173 fractures, 417 (35.6%) met criteria for a necessary referral. The multivariable model identified six significant predictors: angulation, condylar involvement, dislocation or subluxation, displacement, open fractures, and rotation and had strong performance (C-statistic 0.88). The risk index, with a threshold 1 point, had a sensitivity of 96.4% and specificity of 45.5%. A simple prediction model was developed to identify which acute pediatric hand fractures required referral to a hand surgeon. While these results require external validation prior to clinical use, this tool may help identify high risk patients and allow for targeted referral.
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    Do coder characteristics influence validity of ICD-10 hospital discharge data?
    (BioMed Central, 2010-04-21) Hennessy, Deirdre A.; Quan, Hude; Faris, Peter D.; Beck, Cynthia A.
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    Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease
    (BMC Pulmonary Medicine, 2018-05-30) Pendharkar, Sachin R.; Ospina, Maria B.; Gadotti, D. A.; Hirani, Naushad; Graham, Jim Allen; Faris, Peter D.; Bhutani, Mohit; Leigh, Richard A.; Mody, Christopher H.; Strickland, Michael K.
    Background: Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay. Methods: The order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital. The primary outcome was length of stay for patients admitted during order set implementation period, compared to the previous 12 months. Secondary outcomes included length of stay of patients admitted with and without order set after implementation, all-cause readmissions, and emergency department visits. Results: There were 556 admissions prior to and 857 admissions after order set implementation, for which the order set was used in 47%. There was no difference in overall length of stay after implementation (median 6.37 days (95% confidence interval 5.94, 6.81) pre-implementation vs. 6.02 days (95% confidence interval 5.59, 6.46) post-implementation, p = 0.26). In the post-implementation period, order set use was associated with a 1.15-day reduction in length of stay (95% confidence interval − 0.5, − 1.81, p = 0.001) compared to patients admitted without the order set. There was no difference in readmissions. Conclusions: Use of a computerized guidelines-based admission order set for COPD exacerbations reduced hospital length of stay without increasing readmissions. Interventions to increase order set use could lead to greater improvements in length of stay and quality of care. Keywords: Length of stay, Clinical decision support, Chronic obstructive pulmonary disease, Quality improvement
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    Evaluating the Association Between Delirium in the Intensive Care Unit and Subsequent Neuropsychiatric Disorders Post-Stay
    (2018-08-03) Brown, Kyla Nicole; Stelfox, Henry Thomas; Fiest, Kirsten; Faris, Peter D.; Patten, Scott Burton
    Individuals without pre-existing neuropsychiatric disorders are reported to be at increased risk of developing a neuropsychiatric disorder after admission to an Intensive Care Unit (ICU). This risk may be attributed to the severity of illness and the nature of therapies provided, including intubation, medically induced coma, and numerous medications. Furthermore, approximately half of ICU patients develop delirium during their stay, which may further add to the burden of neuropsychiatric disorders experienced by these patients. If delirium is not identified and treatment initiated early, patients may be at risk for adverse consequences, such as increased mortality, increased length of hospital stay and further cognitive impairment. Therefore, the objectives of this thesis were to (1) examine the overall prevalence and (2) incidence of neuropsychiatric disorders following a stay in a general systems ICU; and (3) determine the association between delirium in the ICU and an onset of a neuropsychiatric disorders subsequent to the ICU stay. The objectives for this study were addressed in two phases. In phase one, a systematic review and meta-analysis was conducted to address the overall pooled prevalence of depression, anxiety, trauma-and-stressor related, and neurocognitive disorders. Based on the analysis, the overall pooled prevalence of the disorders was: 32% (95% Confidence Interval [CI] 25%-39%), 32% (95% CI 24%-40%), 23% (95% CI 18%- 28%), and 42% (95% CI 25%-60%), respectively. The systematic review revealed a significant association between delirium and neuropsychiatric disorders (specifically trauma-and-stressor related and neurocognitive disorders). In phase two, a retrospective cohort study using administrative databases was conducted. The cumulative incidence for depressive, anxiety, trauma-and-stressor related, and neurocognitive disorders were: 10.6%, 8.9%, 2.5%, and 3.7%, respectively. The study results suggested that for patients who ever had delirium in the ICU, there was a 1.23 times the risk of developing any neuropsychiatric disorder compared to those who never had delirium in the ICU. Early treatment of delirium may be necessary to reduce the morbidity of delirium and possibly the subsequent development of neuropsychiatric disorders post-ICU stay.
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    Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review
    (2021-03-11) Roberts, Derek J.; Bobrovitz, Niklas; Zygun, David A.; Kirkpatrick, Andrew W.; Ball, Chad G.; Faris, Peter D.; Stelfox, Henry T.
    Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.
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    Variation in use of damage control laparotomy for trauma by trauma centers in the United States, Canada, and Australasia
    (2021-10-14) Roberts, Derek J.; Faris, Peter D.; Ball, Chad G.; Kirkpatrick, Andrew W.; Moore, Ernest E.; Feliciano, David V.; Rhee, Peter; D’Amours, Scott; Stelfox, Henry T.
    Abstract Background It is unknown how frequently damage control (DC) laparotomy is used across trauma centers in different countries. We conducted a cross-sectional survey of trauma centers in the United States, Canada, and Australasia to study variations in use of the procedure and predictors of more frequent use of DC laparotomy. Methods A self-administered, electronic, cross-sectional survey of trauma centers in the United States, Canada, and Australasia was conducted. The survey collected information about trauma center and program characteristics. It also asked how often the trauma program director estimated DC laparotomy was performed on injured patients at that center on average over the last year. Multivariable logistic regression was used to identify predictors of a higher reported frequency of use of DC laparotomy. Results Of the 366 potentially eligible trauma centers sent the survey, 199 (51.8%) trauma program directors or leaders responded [United States = 156 (78.4%), Canada = 26 (13.1%), and Australasia = 17 (8.5%)]. The reported frequency of use of DC laparotomy was highly variable across trauma centers. DC laparotomy was used more frequently in level-1 than level-2 or -3 trauma centers. Further, high-volume level-1 centers used DC laparotomy significantly more often than lower volume level-1 centers (p = 0.02). Nearly half (48.4%) of high-volume volume level-1 trauma centers reported using the procedure at least once weekly. Significant adjusted predictors of more frequent use of DC laparotomy included country of origin [odds ratio (OR) for the United States vs. Canada = 7.49; 95% confidence interval (CI) 1.39–40.27], level-1 verification status (OR = 6.02; 95% CI 2.01–18.06), and the assessment of a higher number of severely injured (Injury Severity Scale score > 15) patients (OR per-100 patients = 1.62; 95% CI 1.20–2.18) and patients with penetrating injuries (OR per-5% increase = 1.27; 95% CI 1.01–1.58) in the last year. Conclusions The reported frequency of use of DC laparotomy was highly variable across trauma centers. Those centers that most need to evaluate the benefit-to-risk ratio of using DC laparotomy in different scenarios may include high-volume, level-1 trauma centers, particularly those that often manage penetrating injuries.