Marrie, Thomas J.
Permanent URI for this collectionhttps://hdl.handle.net/10222/21720
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Item Open Access The International Community-Acquired Pneumonia (CAP) Collaboration Cohort (ICCC) study: rationale, design and description of study cohorts and patients(2012-05) Myint, P. K.; Kwok, C. S.; Majumdar, S. R.; Eurich, D. T.; Clark, A. B.; Espana, P. P.; Man, S. Y.; Huang, D. T.; Yealy, D. M.; Angus, D. C.; Capelastegui, A.; Rainer, T. H.; Marrie, T. J.; Fine, M. J.; Loke, Y. K.OBJECTIVE: To improve the understanding of the determinants of prognosis and accurate risk stratification in community-acquired pneumonia (CAP). DESIGN: Multicentre collaboration of prospective cohorts. SETTING: 6 cohorts from the USA, Canada, Hong Kong and Spain. PARTICIPANTS: From a published meta-analysis of risk stratification studies in CAP, the authors identified and pooled individual patient-level data from six prospective cohort studies of CAP (three from the USA, one each from Canada, Hong Kong and Spain) to create the International CAP Collaboration Cohort. Initial essential inclusion criteria of meta-analysis were (1) prospective design, (2) in English language, (3) reported 30-day mortality and transfer to an intensive or high dependency care and (4) minimum 1000 participants. Common baseline patient characteristics included demographics, history and physical examination findings, comorbidities and laboratory and radiographic findings. PRIMARY AND SECONDARY OUTCOME MEASURES: This paper reports the rationale, hypotheses and analytical framework and also describes study cohorts and patients. The authors aim to (1) compare the prognostic accuracy of existing CAP risk stratification tools, (2) assess patient-level determinants of prognosis, (3) improve risk stratification by combined use of scoring systems and (4) understand prognostic factors for specific patient groups. RESULTS: The six cohorts assembled from 1991 to 2007 included 13 784 patients (median age 71 years, 54% men). Aside from one randomised controlled study, the remaining five were cohort studies, but all had similar inclusion criteria. Overall, there was 0%-6% missing data. A total of 6159 (44%) had severe pneumonia by Pneumonia Severity Index class IV/V. Mortality at 30 days was 8% (1036). Admission to intensive care or high dependency unit was also 8% (1059). CONCLUSIONS: International CAP Collaboration Cohort provides a pooled multicentre data set of patients with CAP, which will help us to better understand the prognosis of CAP.Item Open Access Willingness to volunteer during an influenza pandemic: perspectives from students and staff at a large Canadian university(2008-03) Rosychuk, R. J.; Bailey, T.; Haines, C.; Lake, R.; Herman, B.; Yonge, O.; Marrie, T. J.BACKGROUND: A future influenza pandemic will require greater demand on numerous essential services and a reduced capacity to meet that demand. Recruitment of volunteers is an important issue for pre-pandemic planning. OBJECTIVES: To identify factors and attitudes towards volunteerism in the event of a pandemic of influenza. PARTICIPANTS/METHODS: A 42-item web-questionnaire was administered to all faculty, staff and students at the University of Alberta. Respondents indicated their willingness to volunteer. Responses were dichotomized and logistic regression models were developed to capture the association between willingness to volunteer and (i) demographic and information source variables, (ii) risk perception and general knowledge, and (iii) volunteering attitudes and priority access variables. RESULTS: Many factors predicted willingness to volunteer and several involved interactions with other variables. Individuals who were older, relied on University Health Centre information and who had past volunteerism experience were generally more likely to be willing to volunteer. Those willing to volunteer were more likely to think spread could be prevented by covering mouth when coughing/sneezing, and treatment would include drinking fluids. Those who thought influenza would be treated by antibiotics were less willing to volunteer. Likely volunteers thought that healthcare students should be encouraged to volunteer if there was a healthcare worker shortage. CONCLUSION: This study provides guidance for those who are preparing universities to deal with pandemic influenza. The results suggest factors that might be important in the recruitment of volunteers during an influenza pandemic and these factors might be relevant for other sectors as well.Item Open Access Statins and outcomes in patients admitted to hospital with community acquired pneumonia: population based prospective cohort study(2006-11) Majumdar, S. R.; McAlister, F. A.; Eurich, D. T.; Padwal, R. S.; Marrie, T. J.OBJECTIVES: To determine whether statins reduce mortality or need for admission to intensive care in patients admitted to hospital with community acquired pneumonia; and to assess whether previously reported improvements in sepsis related outcomes were a result of the healthy user effect. DESIGN: Population based prospective cohort study. SETTING: Six hospitals in Capital Health, Edmonton, Alberta, Canada. PARTICIPANTS: Adults admitted to hospital with pneumonia and categorised according to use of statins for at least one week before admission and during hospital stay. MAIN OUTCOME MEASURES: Composite of in-hospital mortality or admission to an intensive care unit. RESULTS: Of 3415 patients with pneumonia admitted to hospital, 624 (18%) died or were admitted to an intensive care unit. Statin users were less likely to die or be admitted to an intensive care unit than non-users (50/325 (15%) v 574/3090 (19%), odds ratio 0.80, P=0.15). After more complete adjustment for confounding, however, the odds ratios changed from potential benefit (0.78, adjusted for age and sex) to potential harm (1.10, fully adjusted including propensity scores, 95% confidence interval 0.76 to 1.60). CONCLUSIONS: Statins are not associated with reduced mortality or need for admission to an intensive care unit in patients with pneumonia; reports of benefit in the setting of sepsis may be a result of confounding.Item Open Access Use of intravenous antibiotics for the treatment of community-acquired pneumonia in the emergency department(2005-03) Carrie, A. G.; Marrie, T. J.STUDY OBJECTIVE: To determine the extent of intravenous (IV) antibiotic use for community-acquired pneumonia (CAP) in emergency departments, the practice patterns in seven emergency departments serving the adult residents of one Canadian city were observed. METHODS: An observational study of nonhospitalized adults diagnosed with CAP in seven emergency departments was conducted between November 15, 2000, and November 19, 2002. Data related to antibiotic treatment of CAP administered in the emergency department and patient-specific characteristics potentially predictive of IV treatment were collected. RESULTS: A total of 3512 subjects were identified, of which 4.9% received treatment with IV antibiotics. Cefuroxime and levofloxacin were the most commonly used IV agents, while orally-treated subjects primarily received a macrolide or levofloxacin. The proportion of subjects receiving IV antibiotics differed significantly among the seven sites: 1.4%-10.6% (p > 0.0001). Logistic regression identified a number of independent predictors of receipt of IV antibiotics including risk class, temperature, respiratory rate, study year, presence of vomiting, prior antibiotic treatment, and personal care home residence. However, these predictors did not explain intersite differences. CONCLUSION: Only a small proportion of patients (4.9%) presenting to the emergency department with CAP received IV antibiotics. While patient demographics and severity indicators influenced the likelihood of receipt of IV antibiotics, considerable intersite variation existed, despite adjustment for such factors.Item Open Access Echinococcal disease in Alberta, Canada: more than a calcified opacity(2005-05) Somily, A.; Robinson, J. L.; Miedzinski, L. J.; Bhargava, R.; Marrie, T. J.BACKGROUND: Most cases of echinococcal disease (ED) acquired in Canada are thought to be due to the sylvatic form of Echinococcus granulosus, which may be more benign than ED due to either Echinococcus multilocularis or the pastoral form of E. granulosus. There are limited descriptions of the clinical course and outcome of Canadian patients with ED in the modern era. METHODS: A retrospective chart review was performed of patients hospitalized with echinococcal disease (ED) from 1991 to 2001 in Edmonton, Alberta. RESULTS: Forty-two cases of ED were identified of which 19 were definite, 3 probable, and 20 possible. Further analysis was limited to the 22 definite and probable cases, of which 77% were female and 41% aboriginal, with an age range of 5 to 87 years. Nine patients (40%) had pulmonary involvement and 11 (50%) hepatic involvement. One patient had an intracardiac mass presenting as a cerebrovascular event and one had a splenic cyst. Seven of the 22 patients had combined surgical resection and medical treatment, six had surgical resection of the cyst alone, four had cyst aspiration, one had medical treatment alone and four had no specific treatment. There was no mortality attributable to ED but three patients died of unrelated illnesses. CONCLUSION: Echinococcal disease in northern Alberta has a marked diversity of clinical presentations, and generally has a good prognosis despite a wide variety of therapeutic interventions.