Browsing by Author "Skolnik, Kate"

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    Group B streptococcus (GBS) is an important pathogen in human disease- but what about in cystic fibrosis?
    (2017-10-02) Skolnik, Kate; Nguyen, Austin; Thornton, Christina S; Waddell, Barbara; Williamson, Tyler; Rabin, Harvey R; Parkins, Michael D
    Abstract Background Group B Streptococcus (GBS) is a common commensal capable of causing severe invasive infections. Most GBS infections occur in neonates (often as pneumonia). GBS can also cause infection in adults with diabetes and other immunological impairments but rarely leads to pneumonia in adults. GBS has occasionally been found in the sputum of Cystic Fibrosis (CF) patients, an inherited condition known for progressive lung disease. However, the epidemiology and clinical significance of GBS in CF are not understood. Methods We retrospectively reviewed a large single-centre adult CF population with an associated comprehensive, prospectively collected bacterial biobank beginning in 1978. We identified all individuals with GBS isolated from their sputum on at least one occasion. The primary outcome was risk of pulmonary exacerbation (PEx) at the time of the first GBS isolate compared to the preceding visit. Secondary outcomes included determining: prevalence of GBS infection in a CF population, whether GBS infections where transient or persistent, whether GBS strains were shared among patients, change in % predicted FEV1 at the time of GBS isolate compared to the preceding visit, PEx frequency after the first GBS isolate, change in % predicted FEV1 after the first GBS isolate, and complications of GBS infection. Results GBS was uncommon, infecting 3.5% (11/318) adults within our cohort. Only three individuals developed persistent GBS infection, all lasting > 12 months. There were no shared GBS strains among patients. PEx risk was not increased at initial GBS isolation (RR 5.0, CI 0.69–36.1, p=0.10). In the two years preceding initial GBS isolation compared to the two following years, there was no difference in PEx frequency (median 2, range 0–4 vs 1, range 0 to 5, respectively, p=0.42) or lung function decline, as measured by % predicted FEV1, (median −1.0%, range −19 to 7% vs median −6.0%, range −18 to 22%, p=0.86). There were no invasive GBS infections. Conclusion In adults with CF, GBS is uncommon and is generally a transient colonizer of the lower airways. Despite the presence of structural lung disease and impaired innate immunity in CF, incident GBS infection did not increase PEx risk, PEx frequency, rate of lung function decline, or other adverse clinical outcomes.
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    Hospitalization Costs of Canadian Cystic Fibrosis Patients
    (2020-09-29) Skolnik, Kate; Williamson, Tyler S.; Quon, Bradley S.; Pendharkar, Sachin R.; Ronksley, Paul Everett
    Introduction: Cystic fibrosis (CF) is a genetic disease that can lead to significant morbidity. As the CF population increases and treatment regimens escalate in complexity, CF care costs are expected to rise and could put tremendous strain on health care systems. Our aim was to examine the hospitalization costs of Canadian CF patients. Methods: We performed an analysis of annual CF hospital costs for the 2014 fiscal year using a public payer perspective. Secondary objectives were to examine differences in annual hospital costs for Canadian CF patients (1) by patient characteristics, (2) between provinces, and (3) over time (from 2010 to 2014). Record level data were obtained from the Canadian Institute for Health Information databases. CF patients were defined based on at least one hospital admission with an ICD-10 code of E84. Costs were estimated using a case-mix aggregate costing strategy. Results: In 2014, 953 of 2,702 (35%) Canadians with CF had 1,705 hospitalizations resulting in a total cost of $32.1 million. Mean hospital cost per patient and mean cost per hospitalization were $34,982 and $19,782, respectively. There were no differences in mean cost per hospitalization by age or sex. Mean cost per hospitalization was highest among those admitted for pneumothorax ($22,685), followed by CF pulmonary exacerbation ($21,130) and distal intestinal obstruction syndrome ($18,816). The mean cost per hospitalization was highest for Alberta ($25,229) and lowest for NB ($10,734). Between 2010 and 2014, the total cost of all hospitalizations for CF patients increased by 17% ($27.4 to $32.1 million). Conclusion: Canadian CF hospitalizations are costly; these costs vary by type of admitting diagnosis and are increasing over time. These national estimates will inform health care planning as well as future cost effectiveness analyses for CF interventions.
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    “None of us are lying”: an interpretive description of the search for legitimacy and the journey to access quality health services by individuals living with Long COVID
    (2023-12-12) Brehon, Katelyn; Miciak, Maxi; Hung, Pam; Chen, Shu-Ping; Perreault, Kadija; Hudon, Anne; Wieler, Marguerite; Hunter, Simone; Hoddinott, Lance; Hall, Mark; Churchill, Katie; Brown, Darren A.; Brown, Cary A.; Bostick, Geoffrey; Skolnik, Kate; Lam, Grace; Weatherald, Jason; Gross, Douglas P.
    Abstract Background Understanding of Long COVID has advanced through patient-led initiatives. However, research about barriers to accessing Long COVID services is limited. This study aimed to better understand the need for, access to, and quality of, Long COVID services. We explored health needs and experiences of services, including ability of services to address needs. Methods Our study was informed by the Levesque et al.’s (2013) “conceptual framework of access to health care.” We used Interpretive Description, a qualitative approach partly aimed at informing clinical decisions. We recruited participants across five settings. Participants engaged in one-time, semi-structured, virtual interviews. Interviews were transcribed verbatim. We used reflexive thematic analysis. Best practice to ensure methodological rigour was employed. Results Three key themes were generated from 56 interviews. The first theme illustrated the rollercoaster-like nature of participants’ Long COVID symptoms and the resulting impact on function and health. The second theme highlighted participants’ attempts to access Long COVID services. Guidance received from healthcare professionals and self-advocacy impacted initial access. When navigating Long COVID services within the broader system, participants encountered barriers to access around stigma; appointment logistics; testing and ‘normal’ results; and financial precarity and affordability of services. The third theme illuminated common factors participants liked and disliked about Long COVID services. We framed each sub-theme as the key lesson (stemming from all likes and dislikes) that, if acted upon, the health system can use to improve the quality of Long COVID services. This provides tangible ways to improve the system based directly on what we heard from participants. Conclusion With Long COVID services continuously evolving, our findings can inform decision makers within the health system to better understand the lived experiences of Long COVID and tailor services and policies appropriately.