Biomedical subjects

Marsha M Cohen

Publications and source records attributed to Marsha M Cohen.

At least 19 recordsLinked to original sources

PubMed2006

Air travel in women with lymphangioleiomyomatosis.

BACKGROUND AND OBJECTIVE: The safety of air travel in patients with pneumothorax-prone pulmonary diseases, such as lymphangioleiomyomatosis (LAM), has not been studied to any great extent. A questionnaire-based evaluation of air travel in patients with LAM was conducted to determine experiences aboard commercial aircraft. METHODS: A survey was sent to women listed in the US LAM Foundation registry (n = 389) and the UK LAM Action registry (n = 59) to assess air travel, including problems occurring during flight. Women reporting a pneumothorax in flight were followed up to ascertain further details about the incident. RESULTS: 327 (73%) women completed the survey. 308 women answered the travel section, of whom 276 (90%) had "ever" travelled by aeroplane for a total of 454 flights. 95 (35%) women had been advised by their doctor to avoid air travel. Adverse events reported included shortness of breath (14%), pneumothorax (2%, 8/10 confirmed by chest radiograph), nausea or dizziness (8%), chest pain (12%), unusual fatigue (11%), oxygen desaturation (8%), headache (9%), blue hands (2%), haemoptysis (0.4%) and anxiety (22%). 5 of 10 patients with pneumothorax had symptoms that began before the flight: 2 occurred during cruising altitude, 2 soon after landing and 1 not known. The main symptoms were severe chest pain and shortness of breath. DISCUSSION AND CONCLUSION: Adverse effects occurred during air travel in patients with LAM, particularly dyspnoea and chest pain. Hypoxaemia and pneumothorax were reported. The decision to travel should be individualised; patients with unexplained shortness of breath or chest pain before scheduled flights should not board. Patients with borderline oxygen saturations on the ground should be evaluated for supplemental oxygen therapy during flight. Although many women had been advised not to travel by air, most travelled without the occurrence of serious adverse effects.

Adult↗

PubMed2006

Adding insult to injury: intimate partner violence among women and men reporting activity limitations.

PURPOSE: Women with activity limitations (ALs) are at risk for Intimate partner violence (IPV). This study examined IPV in men versus women with ALs. METHODS: Data from the Canadian 1999 General Social Survey compared physical, sexual, emotional, and financial IPV from a current/expartner in 5 years for men and women with ALs compared with those without ALs. Logistic regression examined sex differences in IPV among those with ALs, adjusting for sociodemographic factors. RESULTS: Rates of physical (11.9% versus 7.8%; p < 0.0001), sexual (3.5% versus 1.4%; p < 0.0001), emotional (27.1% versus 17.7%; p < 0.0001), and financial (7.5% versus 3.4%; p < 0.0001) IPV were greater in women with compared with without ALs. A similar pattern was seen for men, with greater rates of physical (9.2% versus 6.6%; p = 0.006), emotional (22.6% versus 18.2%; p = 0.002), and financial (2.6% versus 1.4%; p = 0.005) IPV in men with ALs than men without ALs. Risk factors for IPV included younger age, being divorced/separated or single, and having lower income and poorer health. Women with ALs were more likely than men to experience any IPV (29.1% versus 24.9%) and more severe and more incidents of IPV. In multivariable analysis, women were no longer at greater risk for "any IPV" after adjusting for sociodemographic variables (odds ratio = 1.09; 95% confidence interval, 0.88-1.36). CONCLUSION: This is the first study to document IPV rates in men with ALs. Women with ALs were more likely to be divorced/separated, living in poverty, and in poorer health than men with ALs. These factors accounted for sex differences in IPV rates.

Activities of Daily Living↗

PubMed2006

The association between length of stay in Canada and intimate partner violence among immigrant women.

OBJECTIVE: We examined the prevalence of intimate partner violence (IPV) among recent (0-9 years) and nonrecent (>/= 10 years) immigrant women in Canada to determine whether differences in IPV were associated with length of stay in Canada. METHODS: We analyzed data from the 1999 General Social Survey, a national cross-sectional telephone survey. We used weighted logistic regression analysis to examine the effect of length of stay in Canada on IPV and controlled for socio-cultural and other factors associated with IPV. RESULTS: The crude prevalence of IPV was similar among recent and nonrecent immigrant women. However, after adjustment, the risk for IPV was significantly lower among recent immigrant women compared with nonrecent immigrant women. Country of origin, age, marital status, and having an activity limitation (physical/mental disability or health problem) also were associated with a higher risk for IPV. CONCLUSIONS: Our findings have important implications for both prevention and detection of IPV among immigrant women.

Adolescent↗

PubMed2006

Help-seeking rates for intimate partner violence (IPV) among Canadian immigrant women.

We examined rates of help seeking for intimate partner violence (IPV) among recent (0-9 years in Canada) and non-recent (10+ years in Canada) immigrant women. Data from a national, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social service use. Recent immigrant women, compared with non-recent immigrant women, were significantly more likely to report IPV to police and less likely to use social services. Findings have important implications for prevention and detection of IPV in immigrant communities and in future research.

Adult↗

PubMed2005

Patients' perceptions versus medical testing of function in women with lymphangioleiomyomatosis (LAM).

Lymphangioleiomyomatosis (LAM), a rare pulmonary disease that occurs primarily in women is characterized by progressive cystic lung lesions causing respiratory failure, which may require lung transplantation. It has been observed that in diseases of the lungs, objective medical tests frequently do not translate to subjective functional status. However, patient's perceptions of functional status directly impact quality of life. In order to evaluate this relationship in LAM, a cross sectional study of 31 lung transplant candidates and 43 lung transplant recipients with LAM was conducted to evaluate functional status. Objective tests (Pulmonary function tests, PFTs, 6 min walk) were obtained in 19 candidates and 23 recipients, and subjective function was assessed in all women using the Functional Performance Inventory. For both groups statistically significant relationships emerged between forced vital capacity with subjective measures of function including total, social and recreational function (P < 0.05). As well diffusing capacity related significantly to total function, ability to maintain household chores, body care, and social function (P < 0.05), where higher scores were associated with better subjective function. Forced expiratory volume in one second was not found to significantly relate to subjective function in these groups, except the physical exercise domain in transplant recipients. However, despite better PFT results in double lung transplant recipients, no differences were found in subjective measures of function between single and double lung recipients. Results suggest that clinicians need to better recognize that certain aspects of spirometry/6 min walk tests do not necessarily correlate well with patient's perceptions of their function. This has implications for the assessment and follow-up of women living with LAM; considering subjective aspects of function may help focus interventions and improve quality of life.

Adult↗

PubMed2005

Predictors of women's physical health problems after childbirth.

The objectives of this study were to document the extent and the correlates of common physical health symptoms in women two months after childbirth. Of special interest was determining whether violence and depression histories increase the risk for experiencing these symptoms. Participants were recruited in six Toronto-area hospitals and were interviewed by telephone 8-10 weeks later. Two hundred of the 332 (60.2%) women who were approached completed the study. Most women (96%) reported at least one physical health symptom 2 months postnatally (Mean = 3.4, SD = 2.0). Stepwise logistic regression was conducted for each outcome. Antenatal depression was a significant predictor of excessive fatigue and bad headaches. Sick leave during pregnancy predicted postpartum backaches. Adult emotional abuse and household income were associated with bowel problems. Episiotomy, maternal complications, and planned pregnancy predicted perineal pain. Finally, being Canadian born and having an assisted vaginal delivery increased the risk for hemorrhoids while cesarean section decreased the risk. A high prevalence of physical symptoms was found in women after childbirth. History of depression and violence were implicated in the occurrence of some of these symptoms. Other important predictors included demographic, maternal, and delivery-related factors.

Adult↗

PubMed2005

Intimate partner violence among Canadian women with activity limitations.

OBJECTIVE: To determine the prevalence of intimate partner violence (IPV) in the previous five years among women reporting activity limitations (AL). DESIGN AND SETTING: A community based, representative telephone survey of Canadians aged 15 and over. AL was assessed by the question: "Does a long term physical or mental condition or health problem reduce the amount or the kind of activity that you can do at home, at school, at work or in other activities?" Response categories were: often, sometimes, or never. PARTICIPANTS: 8771 women who had a current/former partner of whom 1483 reported AL. MAIN RESULTS: IPV was reported more often for AL (often or sometimes) compared with no AL women (emotional abuse (27.1, 26.4 v 17.7%, p<0.0001), physical-severe (7.3, 6.7 v 3.6%, p<0.0001), sexual abuse (3.5, 3.6 v 1.4%, p<0.0001)), or any IPV (30.5, 27.8 v 19.6%, p<0.0001). Adjusting for age, marital status, education, income, employment, children in the household, Aboriginal or visible minority status, place of birth, urban or rural residence, region of Canada, time in current residence, and religious attendance, AL women had higher odds of IPV (adjusted odds ratio: AL often=2.12; 95% CI: 1.64, 2.74; AL sometimes: OR=1.64; 95% CI:1.40, 2.29). CONCLUSION: These findings call for increased recognition of violence that occurs in the lives of women with AL. This community based study suggests that abuse among those reporting AL is high. Women with AL represent a high risk group to be targeted in terms of IPV prevention and intervention.

Activities of Daily Living↗

PubMed2005

What determines patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a community hospital setting?

The Iowa Satisfaction with Anesthesia Scale (ISAS) is a reliable and valid tool to measure patient satisfaction with monitored anesthesia care. We used the ISAS to discover determinants of patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a small community hospital. The ISAS (scored 1 to 6) was administered to 306 patients immediately after cataract surgery. All patients received topical local anesthesia and IV sedation administered by an anesthesiologist. Patient satisfaction was high: mean ISAS was 5.6 (sd 0.46; range: 3.3-6.0). The incidence of intraoperative and postoperative pain was 13% and 37%; other adverse events were infrequent (<5%). In multivariable logistic regression, significant predictors of satisfaction were postoperative pain (odds ratio [OR]: 4.84; 99% confidence interval [CI]: 2.21, 10.60), surgeon (OR: 0.21; 99% CI: 0.05, 0.91), and preoperative anxiety (OR: 1.17; 99% CI: 1.03, 1.34). ISAS mean scores (OR = 0.28; 99% CI: 0.13, 0.59) and preoperative anxiety (OR = 1.12; 99% CI: 0.99, 1.28) emerged as significant predictors of low rating of quality of experience. Our results indicate that the ISAS can be used to track patient satisfaction with monitored cataract care. Pain during and after cataract surgery is common and is a major reason for lower patient satisfaction with their cataract care.

Aged↗

PubMed2005

Changing help-seeking rates for intimate partner violence in Canada.

The adverse physical and psychological sequelae of intimate partner violence (IPV) are well documented, as are government initiatives in Canada since the early 1990s to address the problem through public awareness campaigns and service enhancement programs. While these initiatives have been designed to encourage abused women to come forward, there has been little research examining changes over time in help-seeking rates among this group. To fill this void, we compared data from two large Canadian population-based, cross-sectional telephone surveys: the 1993 Violence Against Women Survey (1993-VAWS) and the 1999 General Social Survey (1999-GSS). Among women who reported physical and/or sexual violence by a current or previous partner, we examined differences in rates of disclosure of abuse, help-seeking by type of service, and barriers to service use. Abused women in the 1999-GSS were significantly more likely than those in the 1993-VAWS to have reported disclosing a violent incident(s) to a family member (66.4% v. 43.9%), friend or neighbor (67.4% v. 45.4%), doctor or nurse (31.9% v. 23.0%), and/or minister, priest, or cleric (11.5% v. 7.3%). The 1999-GSS cohort was also more likely to have presented to a shelter or transition house (11.0% v. 7.8%), a crisis center (17.3% v. 4.2%), a counselor or psychologist (39.1% v. 14.7%), a women's center (11.2% v. 3.4%), and/or a community or family center (15.4% v. 4.7%). Among those women who did not seek help, fewer in the 1999-GSS reported that they did not know of any services (6.4% v. 17.0%), or that services were not available (0.8% v. 14.5%). Although we found a demonstrable increase in the numbers of abused women seeking help, overall, rates of service utilization were still low as late as 1999, highlighting the importance of continued government commitment to funding IPV initiatives.

Adult↗

PubMed2004

Violence against Canadian Women.

HEALTH ISSUE: Exposure to violence as children or as adults places a woman at higher risk of poor health outcomes, both physical and psychological. Abused women use more health care services and have poorer social functioning than non-abused women. Knowledge of the prevalence of violence against women, and of which women are at risk, should assist in the planning of services for abuse prevention and treatment of the health consequences of abuse. KEY FINDINGS: The highest rates of any partner violence were in Alberta (25.5%) and British Columbia (23%). The lowest rates were in Ontario (18.8%). Women aged 15-24 had the highest rates in all regions in Canada, compared with older women. Aboriginal women in Manitoba/Saskatchewan and Alberta had higher rates of violence (57.2% and 56.6% respectively) than non-Aboriginal women (20.6%). Lower rates of partner-related violence were reported among women not born in Canada (18.4%) than among Canadian-born women (21.7%). Visible minority women reported lower rates of lifetime sexual assault (5.7%) than non-visible minority women (12.3%). Perceptions of violence may vary by ethnicity. DATA GAPS AND RECOMMENDATIONS: More information is required concerning the prevalence of violence among Aboriginal women, immigrant and refugee women, women with disabilities, lesbian women and pregnant women. Future national population-based surveys need better questions on the health consequences of violence and related resource utilization. Further research is needed to identify the health care system's role in prevention, management and rehabilitation as they relate to violence against women. Future programs and policies must be based on valid, reliable and comprehensive empirical data.

Journal Article↗

PubMed2004

Is there age bias in the treatment of localized prostate carcinoma?

BACKGROUND: Treatment recommendations for localized prostate carcinoma are based on the patient's remaining life expectancy (RLE), which is influenced by age, comorbidity, and tumor grade. Previous studies have evaluated the influence of age and comorbidity, but to the authors' knowledge not RLE, on actual treatment decisions. METHODS: An age-stratified random sample of 347 patients was generated from a cohort of all patients with newly diagnosed prostate carcinoma in the Ontario Cancer Registry between May 1, 1995 and April 30, 1996 (n = 5192). Chart review was performed to obtain detailed tumor, comorbidity, and treatment information. RLE was estimated from a published model derived from a cohort of 451 men with untreated prostate carcinoma who were followed for 15 years. Multivariable logistic regression was performed to evaluate predictors of treatment, such as radical prostatectomy (RP), radiotherapy (RT), or potentially curative therapy (RP or RT), in relation to patient age, comorbidity, tumor characteristics, and RLE. RESULTS: RP was provided within 6 months of diagnosis to 58.7%, 32.1%, 2.6%, and 0% of patients of ages < 60 years, 60-69 years, 70-79 years, and 80+ years, respectively. The results for RT were 6.4%, 30.9%, 23.4%, and 3.3%, respectively. Increasing comorbidity decreased rates of RP but did not affect use of RT. After controlling for comorbidity and tumor characteristics, older men were found to be treated with RP less often than younger men with similar RLE, whereas RLE did not appear to influence receipt of RT. CONCLUSIONS: Although different mechanisms may account for these results, an age bias may be present among urologists and radiation oncologists treating men with localized prostate carcinoma.

Adult↗

PubMed2004

Posttraumatic stress disorder after pregnancy, labor, and delivery.

OBJECTIVES: Other studies of posttraumatic stress disorder (PTSD) after birth did not include questions about prior traumatic life events. This study sought to determine if a difficult birth was associated with symptoms of PTSD as well as considering sociodemographics, history of violence, depression, social support, and traumatic life events. METHODS: New mothers were recruited on the postpartum ward of six Toronto-area hospitals (n = 253) and were interviewed by telephone 8-10 weeks postpartum (n = 200). We dichotomized the postpartum stress (PTS) into high PTS (answered "yes" to 3 or more items) or low PTS (answered "yes" to 0-2 items). We calculated the odds ratios between difficult birth, other factors, and the binary PTS variable. RESULTS: Results of multivariable logistic regression revealed that no factor suggestive of a difficult birth was significantly related to high PTS scores, except having two or more maternal complications (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.3-12.8). Other independent predictors of high PTS scores were depression during pregnancy (OR = 18.9, 95% CI = 5.8-62.4), having two or more traumatic life events (OR = 3.2, 95% CI = 1.2-8.3), being Canadian born (OR = 3.2, 95% CI = 1.3-8.1), and having higher household income (lowest income group, OR = 0.1, 95% CI = 0.02-0.5), intermediate income group OR = 0.4, 95% CI = 0.2-0.8). CONCLUSIONS: In this study, postpartum stress symptoms appeared to be related more to stressful life events and depression than to pregnancy, labor, and delivery.

Adult↗

PubMed2004

The association between patient age and prostate cancer stage and grade at diagnosis.

OBJECTIVES: To investigate the association of age with prostate cancer stage and grade, as the latter factors at the time of diagnosis influence management and prognosis, with some studies suggesting that they may change as a function of patient age. PATIENTS AND METHODS: The charts were reviewed of an age-stratified (<60, 60-69, 70-79 and > or = 80 years) random sample of men with newly diagnosed, histologically confirmed prostate cancer in 1995/96 from three geographical areas in Ontario, Canada. Patients were identified using a comprehensive cancer registry, and the chi-square analysis used to examine the relationship between age and stage, logistic regression for the effect of age on clinically localized disease, and linear regression to assess the age and grade relationships. RESULTS: In all, 347 charts were reviewed; more men in the oldest group had T1 and metastatic disease than had younger men (P = 0.034). The proportion of patients with clinically localized disease (T1 and T2) did not change with age (P > 0.10). Tumour grade, as assessed by Gleason score, increased slightly with age (R(2) = 0.017, P = 0.011). Excluding those patients diagnosed by transurethral prostatectomy did not influence either the age/stage or age/grade relationship. Adjusting for prostate-specific antigen level attenuated the age/grade relationship. CONCLUSION: The stage and grade of prostate cancer at diagnosis changes only slightly with age, probably because of a lower intensity of screening and later diagnosis in older men, rather than any change in prostate cancer biology with age.

Adult↗

PubMed2003

Pharmacy provision of emergency contraception: the Ontario emergency contraception pilot project.

OBJECTIVES: To develop and evaluate a program to provide emergency contraception (EC) directly in pharmacies that would recruit and train pharmacists and physician partners, and inform women about the availability of EC in pharmacies. METHODS: Pharmacists and physicians working in the Scarborough, Rexdale, and North York regions of Toronto were recruited to receive a training program on EC. The pharmacists in each pharmacy were linked with a designated physician who retrospectively authorized prescriptions provided under the protocol. Client eligibility for EC was determined using a self-administered questionnaire that was reviewed by the pharmacist. A poster and radio campaign advertised the service, and a telephone hotline informed users of their nearest participating pharmacy. Data on the client's age, reasons for requesting EC, time elapsed from intercourse until presentation, and requests for follow-up referral were analyzed using descriptive methodology. User satisfaction was determined through a mail-back questionnaire. RESULTS: A total of 146 pharmacists practising in 40 pharmacies were linked with 34 physicians. In the 1 year of the project, 6931 prescriptions for EC were provided. Fifty-four percent of the women accessed EC within 24 hours of intercourse. The majority of women were very satisfied with the service, and 21.1% indicated that had they not obtained EC in this way, they would not have obtained it elsewhere. More information about birth control was desired by 10.2% of the women. CONCLUSION: Direct pharmacist provision of EC is an effective pregnancy-prevention strategy that is well accepted by the women who access it.

Adolescent↗

PubMed2003

Emergency contraception: models to increase accessibility.

Much of the recent focus on emergency contraception (EC) has been on the need to increase the availability of EC without a prescription. Barriers to the wider accessibility of EC include the need to use the medication within a 72-hour window, cost, and knowledge about its availability. Concerns about the non-prescription accessibility of EC include missing the opportunity to see a physician, possible reduced use of barrier contraceptives and the resulting increase in sexually transmitted infections, and overuse of EC and underuse of regular contraception. As the wider availability of EC is a reality, and pressure to further increase its access is growing, it is timely that issues surrounding accessibility of EC be discussed. This paper explores the issues around making EC more accessible and the various models of obtaining EC, namely, prescription medication, pharmacist-physician collaboration, pharmacist-dispensed medication, schedule II (behind the counter) medication, or on-the-shelf medication. The ideal model will be the one that provides improved accessibility for adolescents, other low-income women, and indeed for all women. Increased accessibility of EC should also lead to cost savings for the health-care system because of fewer unwanted pregnancies.

Adult↗

PubMed2002

The appropriateness of the pulmonary artery catheter in cardiovascular surgery.

PURPOSE: The pulmonary artery catheter (PAC) is commonly used in anesthesiology and critical care, but its appropriate (where benefit exceeds risk) application is unknown. This study describes current clinical practice attitudes among anesthesiologists in cardiac and vascular surgery in an effort to determine the most appropriate indications for use of the PAC. METHODS: Anonymous, cross-sectional, mailed survey of anesthesiologists in Canada and the USA. Opinions of anesthesiologists about the appropriateness of PAC application were assessed in 36 clinical scenarios, using a nine-point Likert scale. The RAND method was adapted to identify appropriate, inappropriate, and uncertain indications for PAC application. RESULTS: Seventy-seven percent of 345 anesthesiologists responded. They agreed strongly (87%) that use of the PAC is appropriate in patients with severe ventricular impairment and unstable angina. Agreement was also present with ventricular impairment (74%) or unstable angina (55%) alone, but was less strong. A majority (53%) rated the PAC as not appropriate in the routine patient without complicating risk factors. Those who used the PAC more frequently, who had a greater practice volume, and who practised in Canada rated PAC use to be more appropriate in more scenarios. Those who did more continuing medical education rated PAC use to be less appropriate. CONCLUSIONS: While the ideal evaluation of the PAC in clinical practice would be a randomized controlled trial, such an undertaking is time-consuming, expensive, of limited generalizability, and requires clinical equipoise. This study found strong agreement that PAC application is appropriate in some patient scenarios, and agreement that it is inappropriate in others. Description of current practice using this method may identify scenarios where randomized evaluation of the PAC, or other technologies, is likely unnecessary, and others where it is highly likely to be highly beneficial.

Anesthesia↗

PubMed2002

The use of and preferences for the transesophageal echocardiogram and pulmonary artery catheter among cardiovascular anesthesiologists.

UNLABELLED: The pulmonary artery catheter (PAC), although widely used in anesthesia for cardiac and vascular surgery, remains controversial. Use of transesophageal echocardiography (TEE) by cardiovascular anesthesiologists may be a substitute or a preference compared with the PAC, but this has been incompletely investigated. An anonymous, cross-sectional survey was mailed to anesthesiologists in Canada and the United States. Anesthesiologists described their use of the PAC and TEE during cardiac and vascular surgery, along with their demographic characteristics. Two hundred sixty-five (77%) of 345 anesthesiologists responded. All had the PAC available for use, and 56% had TEE available. Only 23 (11% overall) reported having undergone echocardiography training, half of whom had completed fellowships. Both the PAC and TEE were more often used in cardiac valvular surgery (P = 0.0001) than in aortocoronary bypass or abdominal vascular surgery. Among all anesthesiologists, the PAC remained the preferred monitor in either cardiac or vascular surgery (P = 0.0001), although many indicated a preference for neither monitor. Among anesthesiologists with echocardiography training, TEE was preferred (P = 0.0004). We found that TEE was accessible to more than half of the surveyed anesthesiologists in cardiovascular surgery, but relatively few of them had completed formal training in its use. Only those with completed formal TEE training indicated a significant preference for TEE use and also used it frequently. Given the continuing controversy about the appropriate application of the PAC, concern about the appropriate application of TEE is prudent. The PAC remains the more frequently used and preferred monitor among cardiovascular anesthesiologists. IMPLICATIONS: A survey of anesthesiologists found that pulmonary artery catheter monitoring is currently more frequently used compared with transesophageal echocardiography during cardiac and vascular surgery.

Adult↗

PubMed2002

Pulmonary artery occlusion pressure estimation: how confident are anesthesiologists?

OBJECTIVE: The pulmonary artery catheter is a controversial device, and randomized evaluation of its effectiveness has been demanded. Accurate estimation of pulmonary artery occlusion pressure is important for optimal use of the pulmonary artery catheter. Anesthesiologists use the pulmonary artery catheter frequently but have not been surveyed about confidence in pulmonary artery occlusion pressure estimation. Our objective was to determine the ability of practicing cardiovascular anesthesiologists to estimate pulmonary artery occlusion pressure accurately and measure their confidence in this estimate. DESIGN: Cross-sectional survey. SETTING: All academic and community hospitals in English-speaking Eastern Canada and selected centers in Western Canada and the United States. PATIENTS: Cardiovascular anesthesiologists. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured agreement with expert-defined timing of pulmonary artery occlusion pressure estimation, estimation of a sample pulmonary artery occlusion pressure trace, and management of a hypothetical clinical complication (air embolism). Seventy-seven percent of 345 anesthesiologists responded. Agreement about the optimal timing of pulmonary artery occlusion pressure estimation (89%) and the management of air embolism (85%) was near expectations (expected 90%). However, the pulmonary artery occlusion pressure waveform was interpreted accurately by only 61%, whereas 28% disagreed and 11% were uncertain. Significant positive associations (p =.016) between continuing medical education items and accurate interpretation were observed. CONCLUSIONS: Estimation of a sample pulmonary artery occlusion pressure trace by practicing anesthesiologists was in only modest agreement with expert assessment and published standards. Anesthesiologists demonstrated substantially less confidence in pulmonary artery occlusion pressure estimation than in the optimal timing of pulmonary artery occlusion pressure estimation. Before the effectiveness of the pulmonary artery catheter in clinical care can be systematically assessed, efforts are needed to enhance accuracy and consistency of pulmonary artery occlusion pressure estimation.

Adult↗