Publications by authors named "Laura McLean"

8 Publications

  • Page 1 of 1

Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU.

J Hum Lact 2021 Feb 13:890334421993467. Epub 2021 Feb 13.

10051 Princess Margaret Hospital, Toronto, Canada.

Background: Mother's milk improves outcomes. Referral neonatal intensive care units face unique lactation challenges with maternal-infant separation and maternal pump dependency. Little is known about lactation resource allocation in this high-risk population.

Research Aims: To determine differences in human milk outcomes, (1) the proportion of infants fed exclusive or any mother's milk and (2) recorded number and volume of pumped mothers' milk bottles, between two models of lactation care in a referral neonatal intensive care unit.

Methods: This retrospective, longitudinal, two-group comparison study utilized medical record individual feeding data for infants admitted at ≤ Day 7 of age and milk room storage records from reactive and proactive care model time periods (April, 2017-March, 2018; May, 2018-April, 2019). The reactive care model ( = 509 infants, 58% male, median birth weight and gestational age of 37 weeks,) involved International Board Certified Lactation Consultant referral for identified lactation problems; whereas, the proactive model ( = 472 infants, 56% male, median birth weight and gestational age 37 weeks) increased International Board Certified Lactation Consultant staffing, who then saw all admissions. Comparisons were performed using chi square, Mann Whitney, and tests.

Results: A proactive lactation approach was associated with an increase in the receipt of any mother's milk from 74.3% to 80.2% ( = .03) among participants in the proactive model group. Additionally, their milk room mean monthly bottle storage increased from 5153 ( 788) to 6620 ( 1314) bottles ( < .01).

Conclusions: In this retrospective study at a tertiary referral neonatal intensive care unit, significant improvement inhuman milk outcomes suggests that increased resources for proactive lactation care may improve mother's milk provision for a high-risk population.
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http://dx.doi.org/10.1177/0890334421993467DOI Listing
February 2021

No clinical benefit in mortality associated with hydroxychloroquine treatment in patients with COVID-19.

Int J Infect Dis 2021 Mar 1;104:34-40. Epub 2021 Jan 1.

Clinical Services Group, HCA Healthcare, United States.

Background: The use of hydroxychloroquine (HCQ), with or without concurrent administration of azithromycin (AZM), for treatment of COVID-19 has received considerable attention. The purpose of this study was to determine whether HCQ administration is associated with improved mortality in COVID-19 patients.

Methods: We conducted a retrospective analysis of data collected during the care process for COVID-19 positive patients discharged from facilities affiliated with a large healthcare system in the United States as of April 27, 2020. Patients were categorized by treatment with HCQ (in addition to standard supportive therapy) or receipt of supportive therapy with no HCQ. Patient outcomes were evaluated for in-hospital mortality. Patient demographics and clinical characteristics were accounted for through a multivariable regression analysis.

Results: A total of 1669 patients were evaluated (no HCQ, n = 696; HCQ, n = 973). When adjusting for patient characteristics, receipt of AZM, and severity of disease at admission, there was no beneficial effect of receipt of HCQ on the risk of death. In this population, there was an 81% increase in the risk of mortality among patients who received HCQ at any time during their hospital stay versus no HCQ exposure (OR: 1.81, 95% CI: 1.20-2.77, p = 0.01).

Conclusions: In this retrospective analysis, we found that there was no benefit of administration of HCQ on mortality in COVID-19 patients. These results support recent changes to clinical trials that discourage the use of HCQ in COVID-19 patients.
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http://dx.doi.org/10.1016/j.ijid.2020.12.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834474PMC
March 2021

Changes in hospitalized coronavirus disease 2019 (COVID-19) patient characteristics and resource use in a system of community hospitals in the United States.

Infect Control Hosp Epidemiol 2021 Feb 12;42(2):228-229. Epub 2020 Oct 12.

Clinical Services Group, HCA Healthcare, Nashville, Tennessee.

Coronavirus disease 2019 (COVID-19) has migrated to regions that were initially spared, and it is likely that different populations are currently at risk for illness. Herein, we present our observations of the change in characteristics and resource use of COVID-19 patients over time in a national system of community hospitals to help inform those managing surge planning, operational management, and future policy decisions.
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http://dx.doi.org/10.1017/ice.2020.1264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588714PMC
February 2021

Patient characteristics and admitting vital signs associated with coronavirus disease 2019 (COVID-19)-related mortality among patients admitted with noncritical illness.

Infect Control Hosp Epidemiol 2021 04 15;42(4):399-405. Epub 2020 Sep 15.

Clinical Services Group, HCA Healthcare, Nashville, Tennessee.

Objective: To determine risk factors for mortality among COVID-19 patients admitted to a system of community hospitals in the United States.

Design: Retrospective analysis of patient data collected from the routine care of COVID-19 patients.

Setting: System of >180 acute-care facilities in the United States.

Participants: All admitted patients with positive identification of COVID-19 and a documented discharge as of May 12, 2020.

Methods: Determination of demographic characteristics, vital signs at admission, patient comorbidities and recorded discharge disposition in this population to construct a logistic regression estimating the odds of mortality, particular for those patients characterized as not being critically ill at admission.

Results: In total, 6,180 COVID-19+ patients were identified as of May 12, 2020. Most COVID-19+ patients (4,808, 77.8%) were admitted directly to a medical-surgical unit with no documented critical care or mechanical ventilation within 8 hours of admission. After adjusting for demographic characteristics, comorbidities, and vital signs at admission in this subgroup, the largest driver of the odds of mortality was patient age (OR, 1.07; 95% CI, 1.06-1.08; P < .001). Decreased oxygen saturation at admission was associated with increased odds of mortality (OR, 1.09; 95% CI, 1.06-1.12; P < .001) as was diabetes (OR, 1.57; 95% CI, 1.21-2.03; P < .001).

Conclusions: The identification of factors observable at admission that are associated with mortality in COVID-19 patients who are initially admitted to non-critical care units may help care providers, hospital epidemiologists, and hospital safety experts better plan for the care of these patients.
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http://dx.doi.org/10.1017/ice.2020.461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520636PMC
April 2021

Patient characteristics and admitting vital signs associated with coronavirus disease 2019 (COVID-19)-related mortality among patients admitted with noncritical illness.

Infect Control Hosp Epidemiol 2021 04 15;42(4):399-405. Epub 2020 Sep 15.

Clinical Services Group, HCA Healthcare, Nashville, Tennessee.

Objective: To determine risk factors for mortality among COVID-19 patients admitted to a system of community hospitals in the United States.

Design: Retrospective analysis of patient data collected from the routine care of COVID-19 patients.

Setting: System of >180 acute-care facilities in the United States.

Participants: All admitted patients with positive identification of COVID-19 and a documented discharge as of May 12, 2020.

Methods: Determination of demographic characteristics, vital signs at admission, patient comorbidities and recorded discharge disposition in this population to construct a logistic regression estimating the odds of mortality, particular for those patients characterized as not being critically ill at admission.

Results: In total, 6,180 COVID-19+ patients were identified as of May 12, 2020. Most COVID-19+ patients (4,808, 77.8%) were admitted directly to a medical-surgical unit with no documented critical care or mechanical ventilation within 8 hours of admission. After adjusting for demographic characteristics, comorbidities, and vital signs at admission in this subgroup, the largest driver of the odds of mortality was patient age (OR, 1.07; 95% CI, 1.06-1.08; P < .001). Decreased oxygen saturation at admission was associated with increased odds of mortality (OR, 1.09; 95% CI, 1.06-1.12; P < .001) as was diabetes (OR, 1.57; 95% CI, 1.21-2.03; P < .001).

Conclusions: The identification of factors observable at admission that are associated with mortality in COVID-19 patients who are initially admitted to non-critical care units may help care providers, hospital epidemiologists, and hospital safety experts better plan for the care of these patients.
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http://dx.doi.org/10.1017/ice.2020.461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520636PMC
April 2021

The appeal of the Functional Fitness MOT to older adults and health professionals in an outpatient setting: a mixed-method feasibility study.

Clin Interv Aging 2018 19;13:1815-1829. Epub 2018 Sep 19.

Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK,

Purpose: To understand the views and perceptions regarding the Functional Fitness MOT (FFMOT), a battery of functional tests followed by a brief motivational interview, of both the older people undergoing it and the health professionals delivering it.

Patients And Methods: Physically inactive older adults (n=29) underwent the FFMOT and subsequently attended focus groups to share their perceptions of it and to discuss the barriers, motivators, health behavior change, and scope to improve physical activity (PA) levels. PA levels were recorded at baseline and again at 12 weeks together with a post-intervention questionnaire concerning behavior change. Participating physiotherapists and technical instructors were interviewed.

Results: Most participants felt they had learned about their abilities and comparisons with their peers, had a change in perception about the importance of good balance and strength, and felt the FFMOT helped raise their awareness of local and self-directed physical activity opportunities. Most felt their awareness of the need for PA had not changed, but 25% of participants started a new organized PA opportunity. The health professionals perceived the FFMOT as being easy to administer, educating, and motivating for participants to increase their PA. Space, time, finances, and insecurity about having the necessary skills to conduct the FFMOTs were seen as barriers in implementing the FFMOT in daily practice.

Conclusion: Over half of those offered the FFMOT accepted it, suggesting it is appealing. However, most participants felt they were already active enough and that their awareness of the need for PA had not changed. There were positive perceptions of the FFMOT from both professionals and older people, but both felt the FFMOT could be held in a community venue. The overall findings suggest that the FFMOT is feasible in the clinical setting, but its effectiveness has yet to be determined.
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http://dx.doi.org/10.2147/CIA.S173481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6156115PMC
December 2018

Assessment of the electronic medical record in documenting trauma resuscitations in the pediatric ED.

Am J Emerg Med 2015 Apr 20;33(4):589-90. Epub 2015 Jan 20.

Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE. Electronic address:

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http://dx.doi.org/10.1016/j.ajem.2015.01.020DOI Listing
April 2015

Practice patterns of respirologists in Canada.

Can Respir J 2002 Nov-Dec;9(6):395-400

Section of Respirology, Department of Internal Medicine, University of Manitoba, St Boniface general Hospital, BG034-409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.

The demographics and practice patterns of respirologists in Canada have not been studied. To evaluate the demographic characteristics of respirologists in practice, appraise current respirology manpower and ascertain the utilization of invasive diagnostic and therapeutic procedures (interventional pulmonology), a mail survey of all Canadian respirologists was conducted. The questionnaires were completed by 62% (n=355) of 573 possible participants. Of the respirologists who responded, 69.2% were younger than 50 years of age, 70.3% had been in practice for fewer than 20 years, 64.4% were in full- or part-time academic practice, and 72.9% were based in urban centres with a catchment population of more than 250,000. The current ratio of respirologists to population in Canada, assuming a total population of 31,000,000, is 1:54,101. In the present survey, only 68.3% respirologists practised clinical respirology for 50% or more of their time, and half (49.5%) of respirologists devoted more than 50% of their time on nonrespirology or nonclinical activities. Thus, the more precise respirologist to population ratio appears to be 1:81,000. The current ratio meets the Royal College of Physicians and Surgeons of Canada recommendations, and the current training programs meet present manpower requirements. With respect to the procedures performed, most specialists carried out bedside procedures and flexible bronchoscopy; a much smaller number did invasive procedures such as rigid bronchoscopy (20.8%), transbronchial needle biopsy of lung (43%), transbronchial biopsy of mediastinal lymph nodes (38%), therapeutic bronchoscopy using laser, cryotherapy and stents (8.7%), transthoracic needle biopsy (22.2%) and thoracoscopy (11.3%). Because 97% of pulmonary specialists would like to perform invasive procedures, fellowship programs, mini-residencies and practical courses should provide the necessary training.
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http://dx.doi.org/10.1155/2002/838103DOI Listing
May 2003