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Biomedical subjects

Lisa Cicutto

Publications and source records attributed to Lisa Cicutto.

15 recordsLinked to original sources
PubMed2006

Case verification of children with asthma in Ontario.

Asthma is an important chronic childhood illness. A population-based surveillance program could measure the burden of illness, but first, the validity of an administrative diagnosis of asthma must be confirmed. The objective was to evaluate the accuracy of population-based outpatient administrative data in identifying children with asthma for the purpose of on-going asthma surveillance and research. Twenty-one primary care physician (PCP) clinics in Ontario participated. Patients under 18 yr old were categorized into three diagnosis categories according to administrative data diagnosis codes: asthma, asthma-related, and non-asthma. In each PCP clinic, for each diagnosis category, 10 charts were randomly selected for abstraction. A panel of experts (blind to the code) reviewed the abstracted charts and identified them as asthma or non-asthma. The reviewers' diagnosis was considered the gold standard. The accuracy of the administrative data diagnosis coding was analyzed using the concepts of diagnostic test evaluation. Six hundred and thirty patient charts were abstracted and reviewed. Overall agreement between the diagnosis provided by expert chart review and the administrative data diagnosis code was 84.8% (p < 0.001), and was 60.2%, 94.8% and 99.5% for the asthma, asthma-related, and non-asthma categories, respectively. Additionally, the sensitivity and specificity were 91.4% and 82.9%, respectively. Agreement between the administrative data diagnosis code and the PCP chart diagnosis was 99.4% (p < 0.001). An administrative data diagnosis code of asthma is sensitive and specific for identifying asthma. By using the results of this study as a starting point, future research will create a cohort of children with asthma to be used for population-based surveillance and research.

Asthma↗
PubMed2006

Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD.

The present supplement summarizes the proceedings of the symposium "Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD", which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients' associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals. This important event provided a unique opportunity for all participants to discuss key issues in improving the care of patients with asthma and COPD. These two diseases are responsible for an enormous human and socioeconomic burden around the world. Many reports have indicated that current evidence-based guidelines are underused by physicians and others, and that there are many barriers to an effective translation of recommendations into day-to-day care. There is therefore a need to develop more effective ways to communicate key information to both caregivers and patients, and to promote appropriate health behaviours. This symposium contributed to the initiation of what could become the "Canadian Asthma and COPD Campaign", aimed at improving care and, hence, the quality of life of those suffering from these diseases. It is hoped that this event will be followed by other meetings that focus on how to improve the transfer of key recommendations from evidence-based guidelines into current care, and how to stimulate research to accomplish this.

Asthma↗
PubMed2006

The Ontario Asthma Regional Variation Study: emergency department visit rates and the relation to hospitalization rates.

BACKGROUND: Hospitalization rates for asthma vary more than threefold across regions of Ontario. It is not known whether this variation is primarily due to regional differences in the rate of emergency department (ED) visits or hospital admissions. OBJECTIVE: To determine the variation in ED visit rates for asthma in Ontario, and the relation between ED visit rates and hospitalization rates. DESIGN, SETTING, AND PATIENTS: We studied patients with an ED disposition diagnosis of asthma in a stratified sample of 16 hospitals (pediatric facilities, 13; adult facilities, 14) over a 1-year period. Pediatric patients were defined as those patients who were </= 19 years of age. MEASUREMENTS: Direct age-standardized and sex-standardized ED visit and hospitalization rates, and the percentages of patients presenting to EDs and subsequently admitted to the hospital were calculated for each site. High/low ratios (ie, extremal quotients [EQ]), weighted coefficients of variation (CVs), and the systematic component of variation (SCV) were used to summarize the variation among hospitals. RESULTS: The total number of ED visits for asthma at participating sites was 12,518 (7,825 children and 4,693 adults). A total of 847 children (10.8%) and 322 adults (6.9%) were admitted to the hospital. Age-standardized and sex-standardized ED visit rates ranged from 8.7 to 25.2 per 1,000 population for children (EQ, 2.9; CV, 30.9%; SCV, 173; p < 0.001) and 1.7 to 10.1 per 1,000 population for adults (EQ, 5.9; CV, 52.9; SCV, 445; p < 0.001). The proportion of pediatric and adult ED visits resulting in admission to the hospital varied significantly by site (p < 0.001) and was inversely related to ED visit rates in children (p < 0.001) but not in adults. ED visit rates were related to hospitalization rates in children (p = 0.042) and adults (p < 0.0001), but only accounted for 4% and 27%, respectively, of the variation in hospitalization rates. CONCLUSION: Hospitalization rates for asthma in Ontario are primarily influenced by the variation in the percentage of ED visitors admitted to the hospital rather than the ED visit rate.

Adolescent↗
PubMed2005

A training program for certified asthma educators: assessing performance.

BACKGROUND: Evidence-based asthma guidelines identify asthma education as an essential element of care. In Canada, a process for certifying asthma educators was established to help provide asthma education to patients. A critical component to certifying asthma educators is their training and evaluation. The purpose of the study was to identify an approach to evaluate participants and to determine if specific characteristics influenced participants' success. METHODS: Participants completed a questionnaire that collected demographic, practice, and learner characteristics. Assessment strategies and criteria used to determine the level of success included 1) a written asthma knowledge score; 2) a written educational theory score, and 3) a practice teaching skill score based on three encounters with standardized patients. Standardized patient encounters were scored by using a standard checklist of essential teaching functions. RESULTS: Participants (n = 73) represented a broad range of health professions (respiratory therapists, nurses, pharmacists, and physiotherapists). The average score for written asthma knowledge, educational theory, and practice skill assessment was 82.0 +/- 8.0%, 68.6 +/- 16.2%, and 80.3 +/- 9.7%, respectively. Moderate interrelationships were observed between the practice teaching skills score and years of practice in asthma (r = 0.35; p < 0.01) and percentage of workdays dedicated to asthma care (r = 0.30; p < 0.05). Moderately strong relationships were observed among the three standardized patient encounters. However, there were no associations between participant scores on the written asthma or educational theory examination and the practice skill assessment scores. CONCLUSIONS: Participants of an asthma educator training program represent a wide range of disciplines, practice settings, and experience. It is important that asthma educator training programs assess both written knowledge and practice assessments to evaluate participants.

Adult↗
PubMed2005

Breaking the access barrier: evaluating an asthma center's efforts to provide education to children with asthma in schools.

OBJECTIVE: To evaluate an asthma education program for children with asthma that is delivered in their school by certified asthma educators from a local hospital-based asthma center. STUDY DESIGN: Randomized controlled trial. SETTING: Twenty-six elementary schools located in a suburb of Toronto. PARTICIPANTS: A total of 256 children in grades 2 to 5 with asthma and their parents were randomized to control and experimental groups. INTERVENTION: Children in the experimental group received the "Roaring Adventures of Puff" asthma education program over the course of six weekly 1-h sessions. Those in the control group continued receiving usual care. MEASUREMENTS AND RESULTS: Data collection involved measuring asthma quality of life, self-efficacy for managing asthma, school absenteeism, days of interrupted activity, health services use, and parental loss of time from work. Quality of life and self-efficacy data were collected from the children at baseline and 2 months. Telephone parental interviews conducted over 1 year were used to collect data on the remaining variables. Unpaired t test, analysis of variance, and chi2 test were used to determine whether differences existed between the groups. The results are reported as the mean +/- SD. The experimental group demonstrated higher scores than the control group for self-efficacy (3.6 +/- 0.7 vs 3.8 +/- 0.9, respectively; p < 0.05) and quality of life (5.0 +/- 1.4 vs 5.5 +/- 1.4, respectively; p < 0.05). At 1 year, the experimental group demonstrated fewer mean urgent health-care visits (2.5 +/- 2.5 vs 1.7 +/- 1.9 visits per year, respectively; p < 0.01), days of missed school (4.3 +/- 5.7 vs 3.0 +/- 4.4 days per year, respectively; p > 0.05), and days of interrupted activity (9.1 +/- 10.5 vs 6.2 +/- 7.3 days per year; p < 0.01) related to asthma than the control group. There were no differences between the groups for parental work absenteeism or scheduled asthma visits. CONCLUSION: Providing an asthma education program to children in their school can significantly improve quality of life and reduce the burden of childhood asthma.

Asthma↗
PubMed2004

Self-care issues from the perspective of individuals with chronic obstructive pulmonary disease.

This study explored factors that influence self-care from the perspective of individuals with Chronic Obstructive Pulmonary Disease (COPD). Seven focus groups were held with individuals who had physician diagnosed COPD and experienced daily symptoms that limited activities. Forty-two subjects participated in the study. All sessions were audiotaped, transcribed and coded independently. The main theme identified was surviving COPD: the context for living and the two sub-themes identified were adjusting physically and emotionally to COPD. Participants discussed their self-care practices within the context of the purpose and meaning of life. Although participants experienced major physical limitations, the issues highlighted were those of individuals striving to survive with COPD and to hold on to some quality of life through adjusting physically and emotionally. Individuals with COPD have developed strategies to adapt to the disease, compensate for limitations, and integrate self-care activities for managing COPD into their daily routine. Health professionals should use approaches that support the whole needs of the individual to achieve the best quality of life for individuals with COPD and their families.

Activities of Daily Living↗
PubMed2004

Factors affecting attainment of paid employment after lung transplantation.

BACKGROUND: Limited data exist regarding return to or attainment of paid employment after lung transplantation. Accordingly, the purpose of our study was to identify the issues relating to paid employment after this procedure. METHODS: We conducted a mailed survey using Dillman's protocol. We mailed questionnaires to surviving Toronto General Hospital lung transplant recipients (n = 190). We used descriptive statistics, t-tests, and chi-square tests to analyze the data. RESULTS: A total of 117 lung transplant recipients completed the questionnaires (70% response rate). The mean age of respondents was 51 +/- 13 years. Fifty-one percent of the sample were women and 72% were married. Cystic fibrosis and chronic obstructive pulmonary disease were the most frequent pre-transplant diagnoses. Fifty-six percent of participants had paid employment at some point before transplant. After transplant, 37% of respondents obtained employment. Individuals who obtained paid employment were more likely to be younger (p = 0.002), to have university degrees (p = 0.02), to report higher health ratings (p = 0.001), and to feel physically able to work (p = 0.01). They also were more likely to express a desire to enter the paid workforce (p < 0.0001); to describe receiving physician encouragement to work (p < 0.0001); to identify the possibility of obtaining paid employment as a primary motivator for the transplantation (p = 0.01); and to report that their previous jobs were available after transplantation (p = 0.01). All individuals who did not obtain paid employment cited personal or transplant-related factors. CONCLUSIONS: Medical and social factors influence attainment of paid employment after lung transplantation. Important components of the pre-transplant assessment are discussion of expectations about attaining employment and openly exploring the recipient's motivation for employment.

Adolescent↗
PubMed2004

Evaluation of a questionnaire to assess compliance with anti-asthma medications.

Compliance with anti-asthma medication is essential in controlling symptoms and exacerbations in patients with asthma. Unfortunately, not all patients adhere to their treatment regimen, and it is difficult for clinicians to estimate a patient's compliance, since there is no simple and accurate method currently available to assist in its assessment. The objective of this study was to assess the validity and accuracy of utilizing clinical information regarding a patient's prescription refill frequency, inhaler emptying rate, reported forgetfulness, and short-acting bronchodilator usage to predict daily, anti-inflammatory intake. A questionnaire based on the clinical information described above was administered verbally to asthma patients with varying disease severities. Patient responses were compared to the patient's own pharmacy records. Questions that correlated significantly with pharmacy records were subsequently fit into a multiple regression model. Out of 147 eligible participants, 70 completed the questionnaire and had comprehensive pharmacy data available. There was a significant correlation between daily anti-inflammatory intake as estimated by pharmacy records and daily anti-inflammatory intake as determined by inhaler emptying rate (p<0.05), reported forgetfulness (p<0.05), and short-acting bronchodilator usage (p<0.05). These items were fit into a multiple regression model, which was predictive of daily anti-inflammatory intake as determined by pharmacy records. The sensitivity and specificity of our regression model in detecting non-compliance was 44% and 86%, respectively. We conclude that by inquiring into a patient's inhaler emptying rate, reported forgetfulness, and short-acting bronchodilator usage, a clinician may be able to more accurately estimate a patient's daily intake of anti-inflammatory medication.

Adult↗