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Deborah J. Cook

Bio: Deborah J. Cook is an academic researcher from McMaster University. The author has contributed to research in topics: Intensive care & Intensive care unit. The author has an hindex of 173, co-authored 907 publications receiving 148928 citations. Previous affiliations of Deborah J. Cook include McMaster University Medical Centre & Queen's University.


Papers
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Journal ArticleDOI
TL;DR: In particular, the absence of pupillary light reflexes, corneal reflexes or motor response to pain, at three days post-injury, can predict poor outcome with apparent 100% accuracy.
Abstract: Purpose: To determine the neurological clinical signs predicting poor outcome in patients with coma of hypoxic/ anoxic origin through a systematic review and critical appraisal of the literature. Data sources: A structured search was performed using MEDLINE; search terms were 'prognosis' and 'coma'. Study selection: Articles published since 1980 were selected if they studied an adult population, had a sample size greater than 50 patients, focused on bedside clinical signs, and addressed long-term recovery and functional status. Data extraction: We reviewed all selected articles and abstracted pertinent information. Results: The overall outcome in hypoxic/anoxic coma is quite poor, with 65% of patients dying within two weeks and 10% surviving to one year. In particular, the absence of pupillary light reflexes, corneal reflexes or motor response to pain, at three days post-injury, can predict poor outcome with apparent 100% accuracy. Conclusions: The absence of any of three simple clinical signs correlates ...

3 citations

Journal ArticleDOI
TL;DR: Author details Department of Clinical Epidemiology & Biostatistics, McMaster University, 501-25 Charlton Avenue East, Hamilton, ON L8N 1Y2, Canada.
Abstract: Author details Department of Clinical Epidemiology & Biostatistics, McMaster University, 501-25 Charlton Avenue East, Hamilton, ON L8N 1Y2, Canada. St. Joseph’s Healthcare Hamilton, McMaster University, 501-25 Charlton Avenue East, Hamilton, ON L8N 1Y2, Canada. Department of Medicine, McMaster University, Hamilton, ON, Canada. Interdepartmental Division of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada. Intensive Care Unit, Monash Medical Centre, Melbourne, VIC, Australia. Department of Critical Care Medicine, Queens University Kingston, Kingston, ON, Canada. University Health Network, University of Toronto, Toronto, ON, Canada. Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. Division of Critical Care, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Duke Clinical Research Institute, Duke University, Durham, NC, USA. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Canada. Department of Clinical Epidemiology & Biostatistics, McMaster University, 25 Main St. West, Suite 2000, 20th floor, Hamilton, ON L8P 1H1, Canada. Centre for Evaluation of Medicines, St. Joseph’s Healthcare Hamilton, 25 Main St. West, Suite 2000, 20th floor, Hamilton, ON L8P 1H1, Canada.

3 citations

Journal ArticleDOI
TL;DR: Treatment of patients with presumed pneumonia in a tertiary care intensive care unit is characterized to identify potential areas for improvement in care and four quality improvement strategies were rationalization of antibiotic use during rounds, nurses' reporting of culture results, review of antibiotic appropriateness by a pharmacist, and redesign of the clinical information system.
Abstract: Background Little information is available on the types, causes, and treatment of pneumonia in intensive care unit patients in usual clinical practice. Objective To characterize treatment of patients with presumed pneumonia in a tertiary care intensive care unit and to identify potential areas for improvement in care. Methods In a prospective, cohort study, the sample consisted of all consecutive patients treated in an intensive care unit during a 3-month period. For patients with presumed pneumonia, data were collected on incidence of pneumonia, diagnostic investigations, microbial isolates, and antibiotics prescribed. Results Of 194 admissions, 73 patients were treated for pneumonia: 47 had community-acquired pneumonia; 12 had hospital-acquired pneumonia; 12 had ventilator-associated pneumonia, both early (7) and late (5); and 2 had intensive care unit-acquired pneumonia. Approximately 71% of patients had microbiological tests performed. Among 54 microbial isolates, 51.9% were gram-positive bacteria, 31.5% were gram-negative bacteria, and 9.3% were Candida species. The most commonly used antimicrobials were quinolones (54 of 192 prescriptions) and cephalosporins (33); each patient received a median of 3 antibiotics. Conclusions Most cases of pneumonia were community acquired. The most common causative organisms were gram-positive cocci. Four quality improvement strategies were rationalization of antibiotic use during rounds, nurses' reporting of culture results, review of antibiotic appropriateness by a pharmacist, and redesign of the clinical information system.

3 citations

Journal ArticleDOI
TL;DR: The Hamilton-DONATE pilot study supports the feasibility of a larger cohort study to describe the epidemiology and clinical practices related to deceased donor care in Canada.
Abstract: Improving the medical care of deceased organ donors to increase transplant rates and improve allograft function requires an understanding of the current epidemiology and clinical practices of deceased donation within intensive care units (ICUs). Herein, we report the results of our investigation into the feasibility of a multicentre prospective cohort study addressing the afformentioned issues. We conducted a 12-month prospective observational cohort study in six ICUs and one coronary care unit in Hamilton, Canada. We included consecutive children and adults following consent for deceased organ donation (including neurologic determination of death [NDD] or donation after circulatory death [DCD]). Intensive care unit research staff recorded donor management data from hospital records, extending from one day prior to the consent for organ donation up to the time of organ retrieval. The provincial Organ Donation Organization (ODO) supplemented these data and, additionally, provided data on corresponding organ recipients. We identified, evaluated, and measured three potential obstacles to the feasibility of a national cohort study: obtaining authorization to implement the study with a waiver of research consent, accessibility of transplant recipient data, and the time required to complete very detailed case report forms (CRFs), with valuable lessons learned for implementation in future projects. The local Research Ethics Board and the ODO Privacy Office both authorized the recording of donor and recipient study data with a waiver of research consent. Sixty-seven consecutive consented donors were included (31 NDD and 36 DCD donors); 50 of them provided 144 organs for transplantation to 141 recipients. We identified the age and sex of the recipients as well as the location and date of transplant for all organ recipients in Ontario; however, we obtained no recipient data for six organs transported outside of Ontario. Intensive care unit research staff estimated that future CRF completion will require five to seven hours per patient. The Hamilton-DONATE pilot study supports the feasibility of a larger cohort study to describe the epidemiology and clinical practices related to deceased donor care in Canada. wwwclinicaltrials.gov (NCT02902783). Registered 16 September 2016.

3 citations

Journal ArticleDOI
TL;DR: The Canadian Critical Care Trials Group (CCCTG) and CCCTBG have an explicit mandate to mentor their junior and senior investigators and to foster their independent success.
Abstract: The Canadian Critical Care Trials Group (CCCTG) was created in 1989 to improve the care of critically ill patients through investigator-initiated research and to provide a national forum for continuing education about research methods. In 2004, a group of clinical and basic scientists interested in the basic mechanisms of critical illness formed the Canadian Critical Care Translational Biology Group (CCCTBG). The two groups have grown from the original 25 participants in 1989 to over 300 researchers today. The CCCTG and CCCTBG meet together and currently support over 40 research programs with more than 100 peer-reviewed publications to their credit. The most important ingredients for this success are the collegiality and mentorship of these groups. A research mentor has many potential roles in developing the career of a young investigator, some of which include acting as advisor, advocate, coach, or supervisor, guiding the mentee with intent, commitment, and spirit. Given the need for sustainability and growth, the CCCTG and CCCTBG have an explicit mandate to mentor their junior and senior investigators and to foster their independent success. This mandate is addressed through several activities, including the ‘‘community mentoring’’ model of our thrice yearly meetings, explicit linkage between each young investigator who presents at these meetings and a CCCTG mentor, encouragement of junior members to participate in national committees, interdisciplinary young investigator grants, the Deborah J. Cook Mentorship Award to honour individuals who have made exceptional contributions in this domain, and the creation of the CCCTG Young Investigator Retreat. Dr. I. M. Ball, MD, MSc (&) Departments of Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada e-mail: Ian.Ball@lhsc.on.ca

3 citations


Cited by
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Journal ArticleDOI
TL;DR: Moher et al. as mentioned in this paper introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses, which is used in this paper.
Abstract: David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses

62,157 citations

Journal Article
TL;DR: The QUOROM Statement (QUality Of Reporting Of Meta-analyses) as mentioned in this paper was developed to address the suboptimal reporting of systematic reviews and meta-analysis of randomized controlled trials.
Abstract: Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field,1,2 and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research,3 and some health care journals are moving in this direction.4 As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in 4 leading medical journals in 1985 and 1986 and found that none met all 8 explicit scientific criteria, such as a quality assessment of included studies.5 In 1987, Sacks and colleagues6 evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in 6 domains. Reporting was generally poor; between 1 and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement.7 In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials.8 In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Box 1 Conceptual issues in the evolution from QUOROM to PRISMA

46,935 citations

Journal ArticleDOI
04 Sep 2003-BMJ
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Abstract: Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice? Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important effects of similar magnitude. However, the conclusions are less clear when the included studies have differing results. In an attempt to establish whether studies are consistent, reports of meta-analyses commonly present a statistical test of heterogeneity. The test seeks to determine whether there are genuine differences underlying the results of the studies (heterogeneity), or whether the variation in findings is compatible with chance alone (homogeneity). However, the test is susceptible to the number of trials included in the meta-analysis. We have developed a new quantity, I 2, which we believe gives a better measure of the consistency between trials in a meta-analysis. Assessment of the consistency of effects across studies is an essential part of meta-analysis. Unless we know how consistent the results of studies are, we cannot determine the generalisability of the findings of the meta-analysis. Indeed, several hierarchical systems for grading evidence state that the results of studies must be consistent or homogeneous to obtain the highest grading.2–4 Tests for heterogeneity are commonly used to decide on methods for combining studies and for concluding consistency or inconsistency of findings.5 6 But what does the test achieve in practice, and how should the resulting P values be interpreted? A test for heterogeneity examines the null hypothesis that all studies are evaluating the same effect. The usual test statistic …

45,105 citations

Journal ArticleDOI
TL;DR: A structured summary is provided including, as applicable, background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, limitations, conclusions and implications of key findings.

31,379 citations