Publications by authors named "Karen Tran"

Preeclampsia is a leading cause of maternal morbidity and adverse perinatal outcomes in Canada. Growing evidence supports the novel blood-based biomarker placental growth factor (PlGF) as a diagnostic test to accelerate the timely diagnosis of preeclampsia, enhancing care for hypertensive pregnant patients. Despite national endorsement, challenges like regional disparities and test standardization hinder PlGF implementation.

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Objectives: Hospitalized community-acquired pneumonia (CAP) patients are admitted for ventilation, vasopressors, and renal replacement therapy (RRT). This study aimed to develop a machine learning (ML) model that predicts the need for such interventions and compare its accuracy to that of logistic regression (LR).

Design: This retrospective observational study trained separate models using random-forest classifier (RFC), support vector machines (SVMs), Extreme Gradient Boosting (XGBoost), and multilayer perceptron (MLP) to predict three endpoints: eventual use of invasive ventilation, vasopressors, and RRT during hospitalization.

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Objective: To evaluate the work productivity loss in people experiencing long COVID symptoms more than 2 years after infection.

Methods: In a cross-sectional study, employed adults from British Columbia, Canada, who had a polymerase chain reaction-confirmed SARS-CoV-2 infection more than 2 years earlier, completed an online survey incorporating the Valuation of Lost Productivity questionnaire. Long COVID status was self-reported.

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Background: Long COVID is a relatively new condition for which patients are asked to employ self-management strategies to manage their symptoms. However, it can be challenging for individuals with long COVID to find reliable and actionable self-management resources. The objective of this project was to develop an online tool for individuals with long COVID that is patient-centered, accessible, and customizable to meet individual needs.

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Introduction: Symptoms from post COVID-19 condition (PCC) can impair functioning in working-age adults. However, there is uncertainty about the relationship between PCC and work outcomes. This study aimed to assess health-related adverse work outcomes in individuals with a PCC history compared with others who had COVID-19.

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Background: Cuffless blood pressure (BP) devices are an emerging technology marketed as providing frequent, nonintrusive and reliable BP measurements. With the increasing interest in these devices, it is important for Hypertension Canada to provide a statement regarding the current place of cuffless BP measurements in hypertension management.

Methods: An overview of the technology in cuffless BP devices, the potential with this technology and the challenges related to determining the accuracy of these devices.

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Article Synopsis
  • The study investigates differences in thrombo-inflammatory responses and outcomes between non-COVID-19 community-acquired pneumonia (CAP) and COVID-19 CAP in hospitalized adults in Canada.
  • Non-COVID-19 CAP patients displayed lower 28-day mortality rates and fewer complications compared to those with COVID-19, indicating a more effective immune response developed over time against bacterial infections.
  • The findings suggest that the complexities of the immune response to COVID-19 resulted in higher mortality rates, highlighting the challenges posed by emerging viruses compared to known pathogens.
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Background: Most Canadians receive their care in community hospitals, yet most clinical research is conducted in academic hospitals. This study aims to compare patients with community acquired pneumonia (CAP) treated in academic and community hospitals with respect to their demographics, clinical characteristics, treatments and outcomes.

Methods: This nested observational cohort substudy of the Community Acquired Pneumonia: Toward InnoVAtive Treatment (CAPTIVATE) trial included 1,329 hospitalized adults with CAP recruited between March 1st, 2018 and September 31st, 2023 from 15 Canadian hospitals.

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Article Synopsis
  • Many adults in the US still have health problems after having COVID-19, which is called post COVID-19 condition (PCC).
  • Research looked at how often these people visit doctors and what makes it hard for them to get medical help.
  • It found that people with PCC go to urgent care and hospitals more than other adults, and they also face more financial and nonfinancial problems when trying to get care.
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  • Researchers investigated the effect of losartan, an angiotensin receptor blocker, on 28-day mortality in hospitalized COVID-19 patients compared to usual care, due to its potential impact on angiotensin levels.
  • The study was stopped early due to safety concerns, showing that adverse events and hypotension were significantly higher in the losartan group (39.8% SAEs and 30.4% hypotension) versus the control group (27.2% SAEs and 15.3% hypotension).
  • There was no significant difference in 28-day mortality (6.5% for losartan vs. 5.9% for usual care), indicating that ARBs should be used cautiously in this patient population to
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Background: Most working-age (18-64) adults have been infected with SARS-CoV-2, and some may have developed post-COVID-19 condition (PCC). However, long-term health-related quality of life (HRQOL) following infection remains uncharacterized.

Methods: In this cross-sectional study, COVID-19 survivors from throughout British Columbia (BC), Canada, completed a questionnaire >2 years after infection.

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  • This study looks at maternal bradycardia (slow heart rate) following childbirth, noting that while tachyarrhythmias are common in pregnancy, there's less info on bradycardia.
  • Researchers reviewed charts of 24 patients treated for post-partum bradycardia, finding that most cases involved sinus bradycardia and symptoms like dyspnea and chest pain.
  • The condition often resolves on its own within a few days, with common underlying issues including preeclampsia and medications, and most cases only needing clinical observation.
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Background: Patient-physician sex discordance (when patient sex does not match physician sex) has been associated with reduced clinical rapport and adverse outcomes including post-operative mortality and unplanned hospital readmission. It remains unknown whether patient-physician sex discordance is associated with "before medically advised" hospital discharge (BMA discharge; commonly known as discharge "against medical advice").

Objective: To evaluate whether patient-physician sex discordance is associated with BMA discharge.

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Importance: Psychiatric symptoms are reportedly common among adults with post-COVID-19 condition (PCC). However, nationally representative data regarding symptom prevalence, treatment uptake, and barriers to care are needed to inform the development of care models.

Objectives: To evaluate the prevalence of psychiatric symptoms in US adults with PCC compared with those without PCC and assess treatment uptake and cost-related barriers to treatment.

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Background: COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy.

Methods: Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020-December 2021, and provided with validated home blood pressure (BP) monitor.

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  • ARDS (Acute Respiratory Distress Syndrome) is a critical condition linked mainly to infections like COVID-19, influenza, and bacterial pneumonia, and research is focused on its mechanisms and treatment options.
  • The study aims to compare metabolic profiles of ARDS caused by COVID-19, H1N1 influenza, and bacterial pneumonia to understand their unique metabolic pathways.
  • Results showed distinct metabolic differences based on the infection type, indicating different underlying mechanisms in ARDS associated with each infectious cause.
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Background: Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP).

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  • * Researchers analyzed protein levels in 74 patients at three different time points after diagnosis, using a method called multiple reaction monitoring on 269 peptides, alongside routine lung function tests.
  • * The study found increases in proteins linked to lipid-related pathways over time, while those related to immune responses decreased; it also noted significant differences in protein concentrations between males and females affecting lung function.
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Background: Omicron is the current predominant variant of concern of SARS-CoV-2. We hypothesized that vaccination alters outcomes of patients hospitalized with COVID-19 during the Omicron wave and that these patients have different characteristics and outcomes than in previous waves.

Methods: This is a substudy of the Host Response Mediators in Coronavirus (COVID-19) Infection (ARBs CORONA I) trial, which included adults admitted to hospital with acute COVID-19 up to July 2022 from 9 hospitals in British Columbia, Ontario and Quebec.

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An effective HIV vaccine likely requires the elicitation of neutralizing antibodies (NAbs) against multiple HIV-1 clades. The recently developed cleavage-independent native flexibly linked (NFL) envelope (Env) trimers exhibit well-ordered conformation and elicit autologous tier 2 NAbs in multiple animal models. Here, we investigated whether the fusion of molecular adjuvant C3d to the Env trimers can improve B- cell germinal center (GC) formation and antibody responses.

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Objectives: We sought to 1) identify long COVID phenotypes based on patient reported outcome measures (PROMs) and 2) determine whether the phenotypes were associated with quality of life (QoL) and/or lung function.

Methods: This was a longitudinal cohort study of hospitalized and non-hospitalized patients from March 2020 to January 2022 that was conducted across 4 Post-COVID Recovery Clinics in British Columbia, Canada. Latent class analysis was used to identify long COVID phenotypes using baseline PROMs (fatigue, dyspnea, cough, anxiety, depression, and post-traumatic stress disorder).

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Article Synopsis
  • About 15% of adult Canadians with COVID-19 experience lingering symptoms, termed long COVID, for over 12 weeks, often including cardiovascular issues like fatigue, chest pain, and palpitations.
  • * The diagnosis and treatment of these long COVID symptoms can be complicated, requiring clinicians to consider related conditions like myalgic encephalomyelitis, dysautonomia, and others.
  • * This review provides an overview of the latest evidence on managing long COVID's cardiac effects, incorporating insights from Canadian experts and aiming to guide clinicians in treatment strategies.
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Background: In 2011, policymakers in British Columbia introduced a fee-for-service payment to incentivize infectious diseases physicians to supervise outpatient parenteral antimicrobial therapy (OPAT). Whether this policy increased use of OPAT remains uncertain.

Methods: We conducted a retrospective cohort study using population-based administrative data over a 14-year period (2004-2018).

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Background: Fatigue is a common symptom in hospitalized and non-hospitalized patients recovering from COVID-19, but no fatigue measurement scales or questions have been validated in these populations. The objective of this study was to perform validity assessments of the fatigue severity scale (FSS) and two single-item screening questions (SISQs) for fatigue in patients recovering from COVID-19.

Methods: We examined patients ≥ 28 days after their first SARS-CoV-2 infection who were hospitalized for their acute illness, as well as non-hospitalized patients referred for persistent symptoms.

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Article Synopsis
  • The study aimed to assess if angiotensin receptor blockers (ARBs) or ACE inhibitors improve outcomes for hospitalized COVID-19 patients based on sex, while also investigating sex-related differences in the renin-angiotensin system (RAS).
  • The research involved a prospective cohort study of 1,686 hospitalized patients across 10 Canadian urban hospitals, measuring baseline characteristics and clinical outcomes related to ARB/ACE inhibitor use.
  • Findings revealed that males on ARBs showed reduced need for ventilation and vasopressors compared to those who weren’t on these medications, while no significant benefits were found for females, highlighting a notable sex difference in treatment response.
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