Browsing by Author "Wilson, Todd"

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    Patient perspectives on engagement in decision-making in early management of non-ST elevation acute coronary syndrome: a qualitative study
    (2017-11-28) Wilson, Todd; Miller, Jean; Teare, Sylvia; Penman, Colin; Pearson, Winnie; Marlett, Nancy J; Shklarov, Svetlana; Diane Galbraith, P.; Southern, Danielle A; Knudtson, Merril L; Norris, Colleen M; James, Matthew T; Wilton, Stephen B
    Abstract Background Surveys of patients suggest many want to be actively involved in treatment decisions for acute coronary syndromes. However, patient experiences of their engagement and participation in early phase decision-making have not been well described. Methods We performed a patient led qualitative study to explore patient experiences with decision-making processes when admitted to hospital with non-ST elevation acute coronary syndrome. Trained patient-researchers conducted the study via a three-phase approach using focus groups and semi-structured interviews and employing grounded theory methodology. Results Twenty patients discharged within one year of a non-ST elevation acute coronary syndrome participated in the study. Several common themes emerged. First, patients characterized the admission and early treatment of ACS as a rapidly unfolding process where they had little control. Participants felt they played a passive role in early phase decision-making. Furthermore, participants described feeling reduced capacity for decision-making owing to fear and mental stress from acute illness, and therefore most but not all participants were relieved that expert clinicians made decisions for them. Finally, once past the emergent phase of care, participants wanted to retake a more active role in their treatment and follow-up plans. Conclusions Patients admitted with ACS often do not take an active role in initial clinical decisions, and are satisfied to allow the medical team to direct early phase care. These results provide important insight relevant to designing patient-centered interventions in ACS and other urgent care situations.
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    Risk Prediction of Acute Kidney Injury Following, Major, Non-Cardiac Surgery
    (2016) Wilson, Todd; James, Matthew; de Koning, Lawrence; Quinn, Rob; Zarnke, Kelly
    Acute kidney injury (AKI) is a serious complication of major, non-cardiac surgery. Risk prediction models for AKI may be useful for informed consent processes and to identify high-risk patients to target with perioperative prevention and early intervention strategies. This thesis includes a systematic review of published prediction models for AKI following, major, non-cardiac surgery. Although seven models were identified, most were derived in small, single center cohorts, and none were externally validated. The second part of the thesis reports derivation and internal validation of five risk prediction models and a risk index based on readily available preoperative variables for predicting severe AKI requiring dialysis after major, non-cardiac surgery. The final risk index showed excellent discrimination (c-statistic 0.89) and was well calibrated. Further research to externally validate this risk index and evaluate the clinical impact of its use is needed to establish its role in perioperative care.