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Nicole Mittmann, Natasha K Stout, Anna N A Tosteson, Amy Trentham-Dietz, Oguzhan Alagoz, Martin J Yaffe
BACKGROUND: The implementation of population-wide breast cancer screening programs has important budget implications. We evaluated the cost-effectiveness of various breast cancer screening scenarios in Canada from a publicly funded health care system perspective using an established breast cancer simulation model. METHODS: Breast cancer incidence, outcomes and total health care system costs (screening, investigation, diagnosis and treatment) for the Canadian health care environment were modelled...
February 8, 2018: CMAJ Open
Michael R Law, Lucy Cheng, Ashra Kolhatkar, Laurie J Goldsmith, Steven G Morgan, Anne M Holbrook, Irfan A Dhalla
BACKGROUND: Many Canadians face substantial out-of-pocket charges for prescription drugs. Prior work suggests that this causes some patients to not take their medications as prescribed; however, we have little understanding of whether charges for prescription medicines lead patients to forego basic needs or to use more health care services. Our study aimed to quantify the consequences of patient charges for medicines in Canada. METHODS: As part of the 2016 Canadian Community Health Survey, we designed and fielded cross-sectional questions to 28 091 Canadians regarding prescription drug affordability, consequent use of health care services and trade-offs with other expenditures...
February 5, 2018: CMAJ Open
Valerie Leung, Julie Hui-Chih Wu, Bradley J Langford, Gary Garber
BACKGROUND: Antimicrobial resistance is an important public health issue globally and in Canada. To understand the current state of antimicrobial stewardship programs in Ontario health care facilities, Public Health Ontario conducted a voluntary survey of hospitals in the province. METHODS: The Ontario Antimicrobial Stewardship Program Landscape Survey was distributed online to hospitals, targeting front-line antimicrobial stewardship clinicians. The survey was open for 5 weeks in fall 2016...
February 2, 2018: CMAJ Open
Victoria Kaestner, Jonathan B Edmiston, Vinay Prasad
BACKGROUND: Despite the abundant research on financial conflict of interest regarding provider behaviour and the interpretation and results of research, little is known about the relation between these conflicts in academia and the trajectory of one's academic career. We performed a study to examine whether the presence of financial ties to drug makers among academics is associated with research productivity. METHODS: We hand-searched 3 high-impact general medical journals (New England Journal of Medicine, JAMA and The Lancet) and 3 high-impact oncology journals that publish original science (The Lancet Oncology, Journal of Clinical Oncology and Journal of the National Cancer Institute) to identify physicians based in the United States who were first or last authors on original papers on hematologic or oncologic topics that appeared in 2015...
January 30, 2018: CMAJ Open
Hugues Sampasa-Kanyinga, Hayley A Hamilton, Allana G LeBlanc, Jean-Philippe Chaput
BACKGROUND: Cannabis use can have serious detrimental effects in children and adolescents. It is therefore important to continually assess the use of cannabis among young people in order to inform prevention efforts. We assessed the prevalence of cannabis use among middle and high school students in Ontario and examined its association with demographic and behavioural factors. METHODS: Data were obtained from the 2015 Ontario Student Drug Use and Health Survey, a province-wide school-based survey of students in grades 7 through 12...
January 23, 2018: CMAJ Open
Sarthak Sinha, Kyle Ricord, Patricia Harasym, Jeff A Biernaskie, Duncan Nickerson, Vincent A Gabriel
BACKGROUND: The increasing consideration of cannabis legalization in Canada and the United States has motivated physicians to assess its prospective impact on the health care system. Health care providers in the burns community are concerned about injuries sustained as a result of the illegal manufacturing of cannabis oil because it involves highly flammable reagents. METHODS: We report a retrospective case series of patients with cannabis oil burns (identified by evidence of combustion during cannabis oil manufacturing) treated from April 2012 to March 2014 at the Foothills Medical Centre in Calgary, Alberta, Canada...
January 18, 2018: CMAJ Open
Prakesh S Shah, Sarah D McDonald, Jon Barrett, Anne Synnes, Kate Robson, Jonathan Foster, Jean-Charles Pasquier, K S Joseph, Bruno Piedboeuf, Thierry Lacaze-Masmonteil, Karel O'Brien, Sandesh Shivananda, Nils Chaillet, Petros Pechlivanoglou
BACKGROUND: Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. METHODS: Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems...
January 18, 2018: CMAJ Open
Michael J Hayes, Victoria Kaestner, Sham Mailankody, Vinay Prasad
BACKGROUND: In a 2003 paper in BMJ, the authors made the tongue-in-cheek observation that there are no randomized controlled trials (RCTs) of parachutes. This paper has been widely read, cited and used to argue that RCTs are impractical or unnecessary for some medical practices. We performed a study to identify and evaluate claims that a medical practice is akin to a parachute. METHODS: Using Google Scholar, we identified all citations to the 2003 paper. We searched for claims that a specific practice was akin to a parachute...
January 15, 2018: CMAJ Open
Pia Pace-Asciak, Sanjiv K Bhimrao, Frederick K Kozak, Brian D Westerberg
BACKGROUND: There is growing concern that neckties worn by health care professionals may contribute to infections contracted in health care settings. We evaluated the evidence for health-care-associated infections resulting from neckties and whether the evidence is sufficient to warrant a tieless policy in Canada. METHODS: We performed a systematic review to determine whether neckties worn by health care professionals colonize harmful pathogenic bacteria and whether they contribute to the spread of infection to patients in the inpatient or outpatient setting...
January 12, 2018: CMAJ Open
David Hammond, Jessica L Reid, Sara Zukowski
BACKGROUND: Energy drink consumption has increased dramatically among young Canadians, with anecdotal evidence of adverse health effects. There is a lack of population-based studies to examine the prevalence of adverse events from energy drinks, particularly among young people. The current study sought to assess adverse events from energy drinks among a population-based sample of youth and young adults in Canada. METHODS: An online survey was conducted in 2015 with a national sample of youth (aged 12-17 yr) and young adults (aged 18-24 yr) recruited from a consumer panel...
January 9, 2018: CMAJ Open
Alex I Aspinall, Abdel A Shaheen, Golasa S Kochaksaraei, Breean Haslam, Samuel S Lee, Gisela Macphail, Jeff Kapler, Oscar E Larios, Kelly W Burak, Mark G Swain, Meredith A Borman, Carla S Coffin
BACKGROUND: High hepatitis C cure rates have been observed in registration trials with second-generation direct-acting antivirals. Real-world data also indicate high sustained viral response (SVR) rates. Our objective was to determine real-world SVR rates for patients infected with hepatitis C virus (HCV) who were treated with second-generation direct-acting antivirals in the first 18 months of their availability in Canada. METHODS: Four centres in Calgary contributed their treatment data for a diverse patient population including those who had or had not undergone liver transplantation, those coinfected with HIV and vulnerable populations...
January 5, 2018: CMAJ Open
Claire de Oliveira, Sharada Weir, Jagadish Rangrej, Murray D Krahn, Nicole Mittmann, Jeffrey S Hoch, Kelvin K W Chan, Stuart Peacock
BACKGROUND: Resource and cost issues are a growing concern in health care. Thus, it is important to have an accurate estimate of the economic burden of care. Previous work has estimated the economic burden of cancer care for Canada; however, there is some concern this estimate is too low. The objective of this analysis was to provide a comprehensive revised estimate of this burden. METHODS: We used a case-control prevalence-based approach to estimate direct annual cancer costs from 2005 to 2012...
January 4, 2018: CMAJ Open
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No abstract text is available yet for this article.
January 3, 2018: CMAJ Open
Charlie Tan, Erin Graves, Hong Lu, Anna Chen, Shudong Li, Kevin L Schwartz, Nick Daneman
BACKGROUND: Antimicrobials are frequently prescribed to community-dwelling older adults. Our aim was to examine the prevalence, quantity and indications of antimicrobial prescriptions to older residents of Ontario. METHODS: We conducted a population-based analysis of outpatient antimicrobial prescriptions to residents of Ontario aged 65 years or more from 2006 to 2015. Antimicrobial prescriptions, infectious disease diagnoses and prescriber information were determined from linked health care databases...
December 21, 2017: CMAJ Open
Shelly Bolotin, Caitlin Johnson, Susan Quach, Ardith Ambrose, Sarah DeCoutere, Shelley L Deeks, Steven Drews, Amna Faheem, Karen Green, Scott A Halperin, Linda Hoang, Frances Jamieson, Tobias Kollmann, Alex Marchand-Austin, Deirdre McCormack, Allison McGeer, Michelle Murti, Alison Orth Bba, Anu Rebbapragada, Otto G Vanderkooi, Jun Wang, Bryna Warshawsky, Natasha S Crowcroft
BACKGROUND: There is mounting evidence that the recent resurgence of pertussis in many countries is in part related to the acellular vaccine, which has been administered in Canada since 1997. This vaccine elicits a different cell-mediated immune response than the previously used whole-cell vaccine, and its effectiveness wanes over time. The aim of this study is to understand the immunological, demographic and clinical factors that mediate protection from pertussis on exposure. METHODS: This is a household case-control study protocol...
December 19, 2017: CMAJ Open
Franco Cardone, Daphne Cheung, Angela Han, Karen B Born, Lisa Alexander, Wendy Levinson, Brian M Wong
BACKGROUND: Resource stewardship is being increasingly recognized as an essential competency for physicians, but medical schools are just beginning to integrate this into education. We describe the evaluation of Choosing Wisely Canada's Students and Trainees Advocating for Resource Stewardship (STARS) campaign, a student-led campaign to advance resource stewardship education in medical schools across Canada. METHODS: We evaluated the campaign 6 months after its launch, in November 2015...
December 19, 2017: CMAJ Open
Susan E Schultz, Richard H Glazier
BACKGROUND: Given the changing landscape of primary care, there may be fewer primary care physicians available to provide a broad range of services to patients of all age groups and health conditions. We sought to identify physicians with comprehensive primary care practices in Ontario using administrative data, investigating how many and what proportion of primary care physicians provided comprehensive primary care and how this changed over time. METHODS: We identified the pool of active primary care physicians in linked population-based databases for Ontario from 1992/93 to 2014/15...
December 19, 2017: CMAJ Open
Gisele Peirano, Daniel B Gregson, Susan Kuhn, Otto G Vanderkooi, Diego B Nobrega, Johann D D Pitout
BACKGROUND: A previous study in Calgary showed that travel to India was associated with high risk of community-onset infections with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. We performed a follow-up study to determine the rate of rectal acquisition of ESBL-producing E. coli among travellers to South Asia and to identify the behaviours putting such travellers at high risk for acquiring ESBL-producing E. coli. METHODS: The study was performed at a travel clinic in Calgary...
December 13, 2017: CMAJ Open
Tyler Williamson, Rebecca C Miyagishima, Janeen D Derochie, Neil Drummond
BACKGROUND: The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) previously carried out a validation study of case definitions for 8 chronic diseases (diabetes mellitus, hypertension, osteoarthritis, depression, dementia, chronic obstructive pulmonary disease, parkinsonism and epilepsy) using direct review of "raw" electronic medical record data. Although effective, this method is time-consuming and can present methodological and organizational challenges. We aimed to determine whether the processed and standardized data contained with the CPCSSN database might function as a reference standard for case definition validation...
December 11, 2017: CMAJ Open
Amol A Verma, Yishan Guo, Janice L Kwan, Lauren Lapointe-Shaw, Shail Rawal, Terence Tang, Adina Weinerman, Peter Cram, Irfan A Dhalla, Stephen W Hwang, Andreas Laupacis, Muhammad M Mamdani, Steven Shadowitz, Ross Upshur, Robert J Reid, Fahad Razak
BACKGROUND: The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. METHODS: This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr...
December 11, 2017: CMAJ Open
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