Sunnybrook Health Sciences Centre

About: Sunnybrook Health Sciences Centre is a healthcare organization based out in Toronto, Ontario, Canada. It is known for research contribution in the topics: Population & Breast cancer. The organization has 7689 authors who have published 15236 publications receiving 523019 citations. The organization is also known as: Sunnybrook.

Epidemiology of sepsis and septic shock in critical care units: comparison between sepsis-2 and sepsis-3 populations using a national critical care database

Abstract: Background New sepsis and septic shock definitions could change the epidemiology of sepsis because of differences in criteria. We therefore compared the sepsis populations identified by the old and new definitions. Methods We used a high-quality, national, intensive care unit (ICU) database of 654 918 consecutive admissions to 189 adult ICUs in England, from January 2011 to December 2015. Primary outcome was acute hospital mortality. We compared old (Sepsis-2) and new (Sepsis-3) incidence, outcomes, trends in outcomes, and predictive validity of sepsis and septic shock populations. Results From among 197 724 Sepsis-2 severe sepsis and 197 142 Sepsis-3 sepsis cases, we identified 153 257 Sepsis-2 septic shock and 39 262 Sepsis-3 septic shock cases. The extrapolated population incidence of Sepsis-3 sepsis and Sepsis-3 septic shock was 101.8 and 19.3 per 100 000 person-years, respectively, in 2015. Sepsis-2 severe sepsis and Sepsis-3 sepsis had similar incidence, similar mortality and showed significant risk-adjusted improvements in mortality over time. Sepsis-3 septic shock had a much higher Acute Physiology And Chronic Health Evaluation II (APACHE II) score, greater mortality and no risk-adjusted trends in mortality improvement compared with Sepsis-2 septic shock. ICU admissions identified either as Sepsis-3 sepsis or septic shock and as Sepsis-2 severe sepsis or septic shock had significantly greater risk-adjusted odds of death compared with non-sepsis admissions (P Conclusions In an ICU database, compared with Sepsis-2, Sepsis-3 identifies a similar sepsis population with 92% overlap and much smaller septic shock population with improved predictive validity.

Wisconsin card sorting test as a measure of frontal pathology: A review

Abstract: We reviewed studies of the Wisconsin Card Sorting Test (WCST) in which the test was administered to subjects with and without evidence of focal frontal-lobe dysfunction. This review indicated that few studies had investigated the differential performance of normals and those with frontal dysfunction. The evidence that frontal patients perform more poorly than nonfrontal patients is weak. There is insubstantial evidence to conclude that the WCST is a measure of dorsolateral-frontal dysfunction. The clinical utility of the test as a measure of frontal-lobe dysfunction is not supported nor is the use of the test as a marker of frontal dysfunction for research purposes.

A primer on PDSA: executing plan–do–study–act cycles in practice, not just in name

Abstract: Plan-do–study–act (PDSA) cycles are the building blocks of iterative healthcare improvement.1 Although frequently regarded as separate from research,2 this quality improvement method remains rooted in the scientific method. The P in PDSA usually stands for ‘plan’ but could just as easily refer to ‘predict’. Each cycle combines prediction with a test of change (in effect, hypothesis testing), analysis and a conclusion regarding the best step forward—usually a prediction of what to do for the next PDSA cycle.3 Too often, however, improvement teams go through the motions of PDSA cycles without really embracing its spirit or applying its scientific method. For example, an improvement team might talk about having used PDSA when in reality the original change idea remained roughly unchanged throughout the project, with no refinements to the intervention or the plan to implement it. Quality improvement rarely works out so smoothly. Even among published studies, which presumably include better than average projects, the application of PDSA falls short, with less than half of studies meeting minimum characteristics of PDSA.4 Sometimes PDSA seems more like a quality improvement catch phrase than it does a recognisable scientific process. In this paper, we review a recent improvement project5 to draw examples of real-world application of PDSA. This project was not chosen to place it on a pedestal in terms of the improvements achieved but rather to demonstrate PDSA methodology and highlight the benefits of putting it into practice. Urinary catheter overuse contributes to unnecessary patient harms including local trauma, decreased mobility, delirium and infection.6 As in many institutions, the practice at our tertiary care hospital in Toronto had been to leave decisions about insertion and removal of urinary catheters to the discretion of individual physicians without any systematic process to reassess them. Clinicians and infection control …