A5089357211- Pharmaceutical Practices and Patient Outcomes
- Frailty in Older Adults
- Cardiac, Anesthesia and Surgical Outcomes
- Health Systems, Economic Evaluations, Quality of Life
- Hip and Femur Fractures
- Patient Safety and Medication Errors
- Obstructive Sleep Apnea Research
- Medication Adherence and Compliance
- Electronic Health Records Systems
- Emergency and Acute Care Studies
- Nutrition and Health in Aging
- Neuroscience of respiration and sleep
- Dementia and Cognitive Impairment Research
- Geriatric Care and Nursing Homes
- Tracheal and airway disorders
- Blood Pressure and Hypertension Studies
- Hospital Admissions and Outcomes
- Musculoskeletal pain and rehabilitation
- Nasal Surgery and Airway Studies
- Balance, Gait, and Falls Prevention
- Pharmacovigilance and Adverse Drug Reactions
- Glioma Diagnosis and Treatment
- Opioid Use Disorder Treatment
- Pharmaceutical studies and practices
- Simulation-Based Education in Healthcare
University of Ottawa
2016-2025
Ottawa Hospital
2016-2025
The University of Adelaide
2024-2025
Ottawa Hospital Research Institute
2012-2025
Stanford University
2022-2024
LAC+USC Medical Center
2021-2023
Hong Kong University of Science and Technology
2023
University of Hong Kong
2023
Committee on Publication Ethics
2021
University of Toronto
2017-2021
Objective: To compare the accuracy of modified Fried Index (mFI) and Clinical Frailty Scale (CFS) to predict death or patient-reported new disability 90 days after major elective surgery. Background: The association frailty with outcomes, comparisons between preoperative instruments are poorly described. Methods: This was a prospective multicenter cohort study. We determined status in individuals ≥65 years having noncardiac surgery using mFI CFS. Outcomes included (primary); safety...
Scalable deprescribing interventions may reduce polypharmacy and the use of potentially inappropriate medications (PIMs); however, few studies have been large enough to evaluate impact that on adverse drug events (ADEs).To effect an electronic decision support tool ADEs after hospital discharge among older adults with polypharmacy.This was a cluster randomized clinical trial (≥65 years) hospitalized patients expected survival more than 3 months who were admitted 1 11 acute care hospitals in...
Primary nonadherence is probably an important contributor to suboptimal disease management, but methodological challenges have limited investigation of it.To estimate the incidence primary in care and drug, patient, physician characteristics that are associated with nonadherence.A prospective cohort patients all their incident prescriptions from electronic health records between 2006 2009 linked provincial drug insurer data on drugs dispensed community-based pharmacies were assembled.Quebec,...
OBJECTIVES: To estimate the dose‐related risk of injuries in older adults associated with use low‐, medium‐, and high‐potency opioids. DESIGN: Historical population‐based cohort study: 2001 to 2003. SETTING: Quebec, Canada's, universal healthcare system. PARTICIPANTS: Four hundred three thousand thirty‐nine aged 65 older. MEASUREMENTS: Population‐based health databases were used measure preexisting factors for 2001/02 drug during follow‐up (2003). Type dose opioids measured as time‐dependent...
To develop and validate a preoperative frailty index (pFI) for use in population-based health administrative (HA) data.Frailty is robust predictor of adverse postoperative outcomes. Population-level measures used surgical studies have significant methodological limitations. Frailty indices (FIs) are well-defined approach to measuring with well-described methods development evaluation. An appropriate FI HA data has not been derived or evaluated.Retrospective cohort study using linked Canada....
Older adults with frailty are at an increased risk of adverse outcomes after surgery. Exercise before surgery (exercise prehabilitation) may reduce events and improve recovery However, adherence exercise therapy is often low, especially in older populations. The purpose this study was to qualitatively assess the barriers facilitators participating prehabilitation from perspective people intervention arm a randomized trial.This research ethics approved, nested descriptive qualitative within...
Objective: To develop and evaluate the acceptability use of an integrated electronic prescribing drug management system (MOXXI) for primary care physicians. Design: A 20-month follow-up study MOXXI (Medical Office XXIst Century) implementation in 28 physicians 13,515 consenting patients. Measurement: was developed to enhance patient safety by integrating demographics, retrieving active drugs from pharmacy systems, generating automated problem list, providing prescription, stop order, alerts,...
Prescribing alerts generated by computerized drug decision support (CDDS) may prevent drug-related morbidity. However, the vast majority of are ignored because clinical irrelevance. The ability to customize commercial alert systems should improve physician acceptance can select circumstances and types that viewed. We tested effectiveness two approaches medication customization reduce prevalence prescribing problems: on-physician-demand versus computer-triggered support. Physicians in each...
Medication reconciliation at admission, transfer and discharge has been designated as a required hospital practice to reduce adverse drug events. However, implementation challenges have resulted in poor adherence. The aim of this study was assess the processes carry out medication reconciliation: health professionals involved, tasks time devoted general settings. A time-and-motion design used. Using systematic sample patients admitted discharged from geriatric, medical surgical units two...
Context Computerized drug alerts for psychotropic drugs are expected to reduce fall-related injuries in older adults. However, physicians over-ride most because they believe the benefit of exceeds risk.
OBJECTIVES Polypharmacy is common, costly, and harmful for hospitalized older adults. Scalable strategies to reduce the burden of potentially inappropriate medications (PIMs) are needed. We sought leverage medication reconciliation in adults by pairing with MedSafer, an electronic decision support tool deprescribing. DESIGN This was a nonrandomized controlled before‐and‐after study. SETTING The study took place on four internal medicine clinical teaching units. PARTICIPANTS Subjects were...
BACKGROUND: Guidelines recommend routine preoperative frailty assessment for older people. However, the degree to which instruments improve predictive accuracy when added traditional risk factors is poorly described. Our objective was measure gained in predicting outcomes important patients adding Clinical Frailty Scale (CFS), Fried Phenotype (FP), or Index (FI) factors. METHODS: This an analysis of a multicenter prospective cohort elective noncardiac surgery ≥65 years age. Each instrument...
Abstract Background Frailty is a risk factor for adverse postoperative outcomes. Hospitals that perform higher volumes of surgery have better outcomes than low-volume providers. We hypothesized frail patients undergoing elective at hospitals cared volume similarly would improved Methods conducted retrospective, population-based cohort study using linked administrative data in Ontario, Canada. identified all adult major, noncardiac who were according to the validated Johns Hopkins Adjusted...
<h3>Importance</h3> Adverse drug events (ADEs) account for up to 16% of emergency department (ED) visits and 7% hospital admissions. Medication reconciliation is required accreditation because it can reduce medication discrepancies, but there no evidence that reducing discrepancies reduces ADEs or other adverse outcomes. <h3>Objective</h3> To evaluate whether electronic ADEs, outcomes compared with usual care. <h3>Design, Setting, Participants</h3> This cluster randomized trial involved 3491...