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Biomedical subjects

Scott K Aberegg

Publications and source records attributed to Scott K Aberegg.

14 recordsLinked to original sources
PubMed2007

Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients.

OBJECTIVE: To determine the association between alcohol dependence (alcoholism not in remission and/or alcohol withdrawal) and sepsis, septic shock, and hospital mortality among intensive care unit (ICU) patients. DESIGN: Retrospective cohort study. SETTING: Two ICUs in an urban hospital. PATIENTS: Patients included 11,651 adult admissions to Denver Health Medical Center from January 1, 1999, to December 31, 2004, with >or=1 ICU day. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of first admissions appearing in the data set (n=9,981), 1,222 (12.2%) had a diagnosis consistent with alcohol dependence. These patients had higher rates of sepsis (12.9% vs. 7.6%, p<.001), organ failure (67.3% vs. 45.8%, p<.001), septic shock (3.6% vs. 2.1%, p=.001), and hospital mortality (9.4% vs. 7.5%, p=.022) on unadjusted analyses. Patients with alcohol dependence also had fewer hospital-free days. After adjustment for factors with known association with sepsis, alcohol dependence was associated with sepsis. This association was modified if the patient received (adjusted odds ratio, 0.92; 95% confidence interval, 0.65-1.31) or did not receive (adjusted odds ratio, 1.91; 95% confidence interval, 1.49-2.44) red cell transfusions. A general predisposition to infections mediated some, but not all, of this association. Results were similar when repeat admissions were included in the analysis. Alcohol dependence was also associated with septic shock and hospital mortality in multivariable analyses. Among those with liver disease and sepsis, alcohol dependence was associated with more than two-fold increased risk-adjusted odds of hospital mortality (adjusted odds ration, 2.31; 95% confidence interval, 1.26-4.24). Similarly, sepsis and liver disease carried higher odds of death for alcohol-dependent patients than for those without alcohol dependence. CONCLUSIONS: Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among ICU patients. The underlying mechanisms of this association require exploration, as an increased rate of infections mediated some, but not all, of this association.

Adolescent↗
PubMed2005

Omission bias and decision making in pulmonary and critical care medicine.

BACKGROUND: Pulmonary and critical care physicians routinely make complex decisions, but little is known about cognitive aspects of this process. Omission bias and status quo bias are well-described cognitive biases that can cause lay decision makers to prefer inaction that preserves the status quo even when changing the status quo through action is more likely to lead to the best outcomes. It is unknown if these biases influence trained decision makers such as pulmonologists. STUDY OBJECTIVES: To determine whether omission bias and status quo bias influence the medical decisions of pulmonologists. DESIGN AND INTERVENTIONS: The study was a randomized controlled trial conducted within a cross-sectional survey of pulmonologists' opinions about the relevance of various factors in pulmonary and critical care decision making. We designed case vignettes that presented patient information with an associated patient management choice. The status quo state and the action/omission distinction were varied in two forms of otherwise identical vignettes. One form of each case vignette pair (A and B) was administered randomly to each prospective respondent during the first mailing of the opinion survey. PARTICIPANTS: Five hundred pulmonologists selected randomly from the membership of the American College of Chest Physicians. MEASUREMENTS AND RESULTS: There were 125 respondents, including 59 for form A and 66 form B (enrollment rate, 25%). In vignettes involving evaluation of pulmonary embolism and treatment of septic shock, respondents were more likely to choose a suboptimal management strategy when an omission option was present that allowed preservation of the status quo (71% vs 53%, p = 0.048; 50% vs 29%, p = 0.016, respectively). In a vignette involving a hypothetical clinical trial and the decision to prescribe tube feeding, the omission option was not significantly associated with the decision to prescribe tube feeding (54% vs 50%, p = 0.67). CONCLUSION: Pulmonary and critical care decisions are susceptible to the influence of omission and status quo bias. Because of the great number of decisions that are made each day involving choices between maintaining or changing the status quo, this finding could have far-reaching implications for patient outcomes, cost-effectiveness, resource utilization, clinical practice variability, and medical errors.

Adult↗
PubMed2004

Medical decision-making and healthcare disparities: The physician's role.

Widespread disparities in US healthcare have been documented with attendant speculation about their causes, including the potential role of the physician as a healthcare decision-maker. However, the current evidence on physician decision-making is inadequate to draw firm conclusions on how it relates to healthcare inequalities. In this article, we review the available evidence on physician decision-making as it relates to healthcare disparities, with an emphasis on its shortcomings, discuss potential sources of bias, including interpersonal factors and physician preferences, and make suggestions for further research in this area.

Clinical Medicine↗
PubMedDate not supplied

Failure to adopt beneficial therapies caused by bias in medical evidence evaluation.

BACKGROUND: Although it is known that many evidence-based therapies are underutilized, the causes of the research-practice gap are not well understood. The authors sought to determine if there is a bias in the evaluation of new evidence that leads to low rates of adoption of beneficial therapies compared to abandonment of harmful ones. METHODS: Two case vignettes describing hypothetical clinical trials were administered to 2 independent samples of pulmonary and critical care practitioners. Each vignette was presented in 2 different ways; in one version, the results of the hypothetical trial showed that a treatment was harmful, and in the other version, the same treatment was shown to be beneficial. Prospective respondents from each sample were randomized to receive 1 version of each vignette (intersubject design). The main outcome was respondent's willingness to apply the results of the hypothetical trial to patient care. RESULTS: There were 174 participants for trial 1 and 138 participants for trial 2 (enrollment rates of 44.2% and 41.8%, respectively). For trial 1, respondents were 2.3 times less likely to change clinical practice based on results indicating benefit as opposed to harm (33.3% v. 76.5%; P < 0.0001). Similarly, for trial 2, respondents were 2.57 times less likely to change practice when trial results showed that early use was beneficial as opposed to showing that early use was harmful (37.1% v. 95.3%; P < 0.0001). CONCLUSIONS: When evaluating clinical trials, physicians demonstrate less willingness to adopt beneficial therapies than to abandon harmful ones. This difference may contribute to the research-practice gap.

Attitude of Health Personnel↗