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outcomes

Development and Implementation of a National Canadian Spine Surgery Registry

Teaser: 

1Greg McIntosh,2Dr. Michael Craig, 3Dr. Charles Fisher,

1Director of Research Operations, Canadian Spine Outcomes and Research Network.
2Neurosurgery Resident at Vancouver General Hospital, University of British Columbia. 3Professor and Head of the Division of Spine Surgery, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia.

CLINICAL TOOLS

Abstract:The goal of the Canadian Spine Outcomes and Research Network (CSORN) is to develop a registry for Canadian orthopaedic and neurosurgical spine surgeons to participate in prospective multi-centre trials and retrospective reviews utilizing multivariable analyses. The design allows ongoing research and contains clinical details necessary for epidemiological assessment. Currently, 21 hospital sites, representing 9 provinces, participate CSORN. A total of 81 investigators have enrolled over 11,000 spine patients; 78% thoracolumbar and 22% cervical. Predictive models, effectiveness of surgical procedures, wait time issues and patient-surgeon expectations are some of the specific topics already published with CSORN data.
Key Words: registry, spine surgery, data quality, outcomes.

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Collection, feedback and publication of registry data is now a recognized way of informing clinical practice, driving quality improvement and improving patient outcomes.
The Canadian Spine Outcomes and Research Network (CSORN) is a multicentre national initiative that prospectively enrols consecutive patients with spinal pathology requiring surgical treatment.
The CSORN registry is designed to assess the value of operative techniques on patient outcomes.
Both patients and providers can feel powerless to enact any real change over the healthcare system. Patient participation in a properly designed registry gives them the opportunity to contribute to improving healthcare delivery.
The need for documentation of clinical outcomes is as important in spinal surgery as it is in other medical specialties.
If the value of spine surgery is not well established, then the cheapest options, rather than potentially better ones, are more likely to be endorsed.
Registries require fewer resources and often avoid the constraints of randomized clinical trials; as a result, registry findings usually have strong external validity and generalizability.
Collecting quality of life and patient-reported outcome measures data are essential for treatment evaluation.
Patients (and their physicians) should not fear participation in well-designed registries.
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Gender Differences in Stroke among Older Adults

Gender Differences in Stroke among Older Adults

Teaser: 


Guido Falcone, MD, Department of Neurology, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.
Ji Y. Chong, MD, Assistant Professor of Neurology, Columbia University, New York, NY, U.S.A.

Stroke is a common disease in the older population. Many gender differences are seen in the epidemiology, outcomes, and treatment of geriatric stroke. Although these differences are not fully understood, recognition of gender differences may help with appropriate treatment and improve outcomes.
Key words: stroke, gender, outcomes, prevention, treatment.

The Role of Revascularization in Older Patients with Acute Coronary Syndromes

The Role of Revascularization in Older Patients with Acute Coronary Syndromes

Teaser: 


Anna J.M. van de Sande, BSc, Medical Student, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. Visiting Medical Student, Canadian VIGOUR Center, University of Alberta, Edmonton, AB.
Paul W. Armstrong, MD, Professor, Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB.
Padma Kaul, PhD, Assistant Professor, Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB.

The burden of cardiovascular disease increases significantly with age. One of the most complex decisions facing clinicians is whether or not to perform coronary revascularization in an older patient. Our review of recent evidence on revascularization therapies for aging patients with non-ST-elevation acute coronary syndromes found an inverse relationship between age and the use of evidence-based medications as well as revascularization procedures. Older patients undergoing revascularization had a higher likelihood of adverse outcomes compared with younger patients undergoing revascularization. However, older patients who underwent revascularization had significantly better outcomes than their counterparts who did not undergo revascularization, suggesting that they deserve the same consideration as younger patients in the use of coronary interventions.
Key words: acute coronary syndromes, percutaneous coronary intervention, coronary artery bypass graft surgery, evidence-based medications, outcomes.

When is a Systolic Murmur Important?

When is a Systolic Murmur Important?

Teaser: 


Michael A. Borger, MD, PhD, Division of Cardiovascular Surgery, Toronto General Hospital and Department of Surgery, University of Toronto, Toronto, ON.
Tirone E. David, MD, Division of Cardiovascular Surgery, Toronto General Hospital and Department of Surgery, University of Toronto, Toronto, ON.

Systolic murmurs in older adults require investigation with echocardiography. The most common cause is aortic sclerosis, which does not require therapy, followed by aortic stenosis. Surgery is indicated for aortic stenosis in patients with symptoms (fatigue, shortness of breath, angina and/or syncope) and in asymptomatic patients with left ventricular dysfunction or marked hypertrophy. Older aortic stenosis patients can undergo surgery with minimal increased risk, excellent long-term outcomes, and marked improvements in quality of life. Such patients may be referred directly to cardiac surgeons in order to limit age discrimination that may be present within the medical community.
Key words: aortic stenosis, congestive heart failure, aortic valve replacement, quality of life, outcomes.

Outcomes Following Delirium in Critically Ill Older Persons: Need for Future Research

Outcomes Following Delirium in Critically Ill Older Persons: Need for Future Research

Teaser: 

Lynn McNicoll, MD, FRCPC, Department of Internal Medicine, Brown University School of Medicine, Providence, RI.

Delirium in older hospitalized persons in non-critical care settings is associated with higher morbidity, mortality, and worse long-term outcomes. Delirium in critically ill persons is a growing field of research. This article presents recent research indicating a high frequency of delirium in critical care. Several studies have shown that delirium in critical care is associated with poor short-term as well as long-term outcomes, including increased length of stay, persistent cognitive deficits, and hospital and one-year mortality. Further research on strategies to prevent delirium in critical care may improve short- and long-term outcomes.

Key words: delirium, critical care, aging, outcomes, older adults.

An Overview of Delirium in the Critical Care Setting

An Overview of Delirium in the Critical Care Setting

Teaser: 

Yoanna Skrobik, MD, FRCP(C), Director, Adult Critical Care Training Program, Université de Montreal; Associate Professor, Faculty of Medicine, Université de Montreal, Montreal, QC.

Delirium is a morbid and common complication in the critically ill patient. Its recognition is made more difficult by the inability to interview the intubated patient, and by the presence of drugs and confounding comorbidities. Delirium screening (described with the ICDSC and the CAM-ICU) with tools specifically designed for the acute care setting can help the nurse or clinician identify its presence. Risk factors for delirium in the critical care setting differ from those described in other populations. Treatment is currently empiric.
Key words: delirium, critical care, outcomes, intensive care, screening.