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https://www.readbyqxmd.com/read/29233843/cesarean-delivery-rates-among-family-physicians-versus-obstetricians-a-population-based-cohort-study-using-instrumental-variable-methods
#1
Russell Eric Dawe, Jessica Bishop, Amanda Pendergast, Susan Avery, Kelly Monaghan, Norah Duggan, Kris Aubrey-Bassler
BACKGROUND: Previous research suggests that family physicians have rates of cesarean delivery that are lower than or equivalent to those for obstetricians, but adjustments for risk differences in these analyses may have been inadequate. We used an econometric method to adjust for observed and unobserved factors affecting the risk of cesarean delivery among women attended by family physicians versus obstetricians. METHODS: This retrospective population-based cohort study included all Canadian (except Quebec) hospital deliveries by family physicians and obstetricians between Apr...
December 11, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29229610/follow-up-imaging-after-nephrectomy-for-cancer-in-canada-urologists-compliance-with-guidelines-an-observational-study
#2
Alice Dragomir, Armen Aprikian, Anil Kapoor, Antonio Finelli, Frédéric Pouliot, Ricardo Rendon, Peter C Black, Ronald Moore, Rodney H Breau, Jun Kawakami, Darrell Drachenberg, Jean-Baptiste Lattouf, Simon Tanguay
BACKGROUND: Surgical tumour removal remains the preferred treatment for most patients with renal cell carcinoma, and many medical associations have proposed guidelines for the optimal surveillance of patients following surgery. This study evaluated the adherence of Canadian urologists to the follow-up guidelines proposed by the Canadian Urological Association (CUA) in 2009. METHODS: The study cohort was identified from the Canadian Kidney Cancer Information System, a prospectively populated database from 15 academic institutions in 6 Canadian provinces: British Colombia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia...
December 11, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29192095/health-effects-of-exposure-to-second-and-third-hand-marijuana-smoke-a-systematic-review
#3
Hannah Holitzki, Laura E Dowsett, Eldon Spackman, Tom Noseworthy, Fiona Clement
BACKGROUND: Recreational marijuana has been legalized in 11 jurisdictions; Canada will legalize marijuana by July 2018. With this changing landscape, there is a need to understand the public health risks associated with marijuana to support patient-care provider conversations, harm-reduction measures and evidence-informed policy. The objective of this work was to summarize the health effects of exposure to second- and third-hand marijuana smoke. METHODS: In this systematic review, we searched 6 databases from inception to October 2017...
November 24, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29183879/admission-factors-associated-with-international-medical-graduate-certification-success-a-collaborative-retrospective-review-of-postgraduate-medical-education-programs-in-ontario
#4
Lawrence E M Grierson, Mathew Mercuri, Carlos Brailovsky, Gary Cole, Caroline Abrahams, Douglas Archibald, Glen Bandiera, Susan P Phillips, Glenna Stirrett, J Mark Walton, Eric Wong, Inge Schabort
BACKGROUND: The failure rate on certification examinations of The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) is significantly higher for international medical graduates than for Canadian medical school graduates. The purpose of the current study was to generate evidence that supports or refutes the validity of hypotheses proposed to explain the lower success rates. METHODS: We conducted retrospective analyses of admissions and certification data to determine the factors associated with success of international medical graduate residents on the certification examinations...
November 24, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29180377/comparison-of-canadian-public-medication-insurance-plans-and-the-impact-on-out-of-pocket-costs
#5
David J T Campbell, Braden J Manns, Lesley J J Soril, Fiona Clement
BACKGROUND: Research from 2006 documented substantial variation in medication coverage for residents across Canada. Since then, some provinces have implemented major medication plan reforms. We aimed to update the information on publicly funded medication insurance plans available across Canada and to compare out-of-pocket costs across the country. METHODS: We compared provincial medication insurance plans using data from public websites and other public source documents...
November 22, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29167237/changes-in-the-dispensing-of-opioid-medications-in-canada-following-the-introduction-of-a-tamper-deterrent-formulation-of-long-acting-oxycodone-a-time-series-analysis
#6
Tara Gomes, Andrea Mastorakos, J Michael Paterson, Ingrid Sketris, Patricia Caetano, Simon Greaves, David Henry
BACKGROUND: In February 2012, a reformulated tamper-deterrent form of long-acting oxycodone, OxyNeo, was introduced in Canada. We investigated the impact of the introduction of OxyNeo on patterns of opioid prescribing. METHODS: We conducted population-based, cross-sectional analyses of opioid dispensing in Canada between 2008 and 2016. We estimated monthly community pharmacy dispensing of oral formulations of codeine, morphine, hydromorphone and oxycodone, and a transdermal formulation of fentanyl, and converted quantities to milligrams of morphine equivalents (MMEs) per 1000 population...
November 22, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29162609/health-of-health-care-workers-in-canadian-nursing-homes-and-pediatric-hospitals-a-cross-sectional-study
#7
Matthias Hoben, Jennifer A Knopp-Sihota, Maryam Nesari, Stephanie A Chamberlain, Janet E Squires, Peter G Norton, Greta G Cummings, Bonnie J Stevens, Carole A Estabrooks
BACKGROUND: Poor health of health care workers affects quality of care, but research and health data for health care workers are scarce. Our aim was to compare physical/mental health among health care worker groups 1) within nursing homes and pediatric hospitals, 2) between the 2 settings and 3) with the physical/mental health of the Canadian population. METHODS: Using cross-sectional data collected as part of the Translating Research in Elder Care program and the Translating Research on Pain in Children program, we examined the health of health care workers...
November 21, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29117991/availability-of-naloxone-in-canadian-pharmacies-a-population-based-survey
#8
Alex M Cressman, Graham Mazereeuw, Qi Guan, Wenting Jia, Tara Gomes, David N Juurlink
BACKGROUND: Naloxone is life-saving when administered after opioid overdose. In March 2016, the Canadian government made the antidote available without prescription, but anecdotal reports suggest members of the public have difficulty in procuring it. We examined the availability of naloxone in community pharmacies across Canada. METHODS: We identified community pharmacies in Canada (n = 10 296) and randomly selected 506, stratified using proportionate allocation by population size...
November 8, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29054883/the-role-of-patient-and-physician-advocacy-in-reducing-wait-times-for-cancer-care-a-qualitative-analysis
#9
Maria Mathews, Donna Bulman, Dana Ryan
BACKGROUND: There is growing interest in the role of physician as health advocate; however, few studies have documented advocacy from the patient's perspective. To address this gap, we examined the experiences of patients with cancer from the onset of symptoms to the start of treatment in Newfoundland and Labrador and aimed to describe wait times and efforts to improve timeliness of care from the patients' perspective. METHODS: We conducted qualitative interviews with 60 participants aged 19 years or more with breast, colorectal, lung or prostate cancer who were recruited from a survey of patients with cancer that was carried out as an earlier part of a larger study...
October 17, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29051158/family-veto-in-organ-donation-in-canada-framing-within-english-language-newspaper-articles
#10
Samantha J Anthony, Maeghan Toews, Timothy Caulfield, Linda Wright
BACKGROUND: Because organ transplantation relies on public support for donation, an analysis of public discourse around organ donation is essential. We investigated the portrayal of family veto - when a family overrides the deceased person's prior legally executed wishes to donate - in Canadian news media. METHODS: Using the Canadian Newsstream database, we identified articles published in English-language newspapers addressing family veto between 2000 and 2016...
October 17, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29042408/impact-of-restricting-diagnostic-imaging-reimbursement-for-uncomplicated-low-back-pain-in-ontario-a-population-based-interrupted-time-series-analysis
#11
Benjamin Fine, Susan E Schultz, Lawrence White, David Henry
BACKGROUND: In 2012, the Ontario government withdrew public insurance coverage of imaging tests for uncomplicated low back pain. We studied the impact of this restriction on test ordering by physicians. METHODS: We compared the numbers of lumbar spine radiography, computed tomography (CT) and single-segment magnetic resonance imaging (MRI) studies ordered by physicians in the 3 years before and after the policy change. We linked claims data from the Ontario Health Insurance Program with physician details to calculate rates per test-ordering physician...
October 13, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29025737/use-of-hospital-related-health-care-among-health-links-enrollees-in-the-central-ontario-health-region-a-propensity-matched-difference-in-differences-study
#12
Luke Mondor, Kevin Walker, Yu Qing Bai, Walter P Wodchis
BACKGROUND: Health Links are a new model of providing care coordination for high-cost, high-needs patients in Ontario. We evaluated use of hospital-related health care services among Health Links patients in the Central Local Health Integration Network (LHIN) of Ontario in the year before versus after program enrolment and compared rates of use with those among similar patients with complex needs not enrolled in the program (comparator group). METHODS: We identified all patients who received a Health Links coordinated care plan before Jan...
October 12, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28986347/relation-between-family-physician-retention-and-avoidable-hospital-admission-in-newfoundland-and-labrador-a-population-based-cross-sectional-study
#13
John C Knight, Maria Mathews, Kris Aubrey-Bassler
BACKGROUND: Physician turnover, involving physicians' leaving clinical practice in a specific area, may disrupt continuity of care, leading to poorer health outcomes and greater use of health care services. The purpose of this study was to investigate the relation between family physician retention and avoidable hospital admission for ambulatory-care-sensitive conditions. METHODS: We conducted a population-based cross-sectional study using provincial health administrative data for residents of Newfoundland and Labrador who held a provincial health card between 2001 and 2009...
October 6, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28974533/enhancing-access-to-cervical-and-colorectal-cancer-screening-for-women-in-rural-and-remote-northern-alberta-a-pilot-study
#14
Silvina C Mema, Huiming Yang, Sherry Elnitsky, Zhichang Jiang, Marcus Vaska, Linan Xu
BACKGROUND: Women in rural and remote northern Alberta access breast cancer screening through a mobile mammogram program (Screen Test). The Enhanced Access to Cervical and Colorectal Cancer Screening (EACS) project was a 2-year pilot that aimed to integrate cervical and colorectal cancer screening with the Screen Test program. This study compares cervical and colorectal cancer screening uptake among women screened through the pilot (Screen Test-EACS) versus Screen Test. METHODS: Screen Test-EACS was offered between 2013 and 2015 in selected rural and remote sites, with a focus on hard-to-reach women living in First Nations, Métis and Hutterite communities...
October 3, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28951445/breast-cancer-survival-by-molecular-subtype-a-population-based-analysis-of-cancer-registry-data
#15
Saber Fallahpour, Tanya Navaneelan, Prithwish De, Alessia Borgo
BACKGROUND: The relation between breast cancer molecular subtype and survival has been studied in several jurisdictions, but limited information is available for Ontario. The aim of this study was to determine breast cancer survival by molecular subtype and to assess the effect on survival of selected demographic and tumour-based characteristics. METHODS: We extracted 29 833 breast cancer cases (in 26 538 girls and women aged ≥ 15 yr) diagnosed between 2010 and 2012 from the Ontario Cancer Registry...
September 25, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28947426/self-reported-versus-health-administrative-data-implications-for-assessing-chronic-illness-burden-in-populations-a-cross-sectional-study
#16
Martin Fortin, Jeannie Haggerty, Steven Sanche, José Almirall
BACKGROUND: Various data sources may be used to document the presence of chronic medical conditions. This study examined the agreement between self-reported and health administrative data. METHODS: A randomly selected cohort of participants aged 25-75 years recruited by telephone from the general population of Quebec reported on the presence of 1 or more chronic conditions from a candidate list of 12 conditions: diabetes, hypertension, thyroid disorder, any cardiac disease, cancer diagnosis in the previous 5 years (including melanoma but excluding other skin cancers), asthma, osteoarthritis, rheumatoid arthritis or lupus, osteoporosis, chronic obstructive pulmonary disease, intestinal disease and hypercholesterolemia...
September 25, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28928168/factors-that-support-successful-transition-to-the-community-among-women-leaving-prison-in-british-columbia-a-prospective-cohort-study-using-participatory-action-research
#17
Patricia A Janssen, Mo Korchinski, Sarah L Desmarais, Arianne Y K Albert, Lara-Lisa Condello, Marla Buchanan, Alison Granger-Brown, Vivian R Ramsden, Lynn Fels, Jane A Buxton, Carl Leggo, Ruth Elwood Martin
BACKGROUND: In Canada, the number of women sentenced to prison has almost doubled since 1995. In British Columbia, the rate of reincarceration is 70% within 2 years. Our aim was to identify factors associated with recidivism among women in British Columbia. METHODS: We prospectively followed women after discharge from provincial corrections centres in British Columbia. We defined recidivism as participation in criminal activity disclosed by participants during the year following release...
September 13, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28912143/the-relation-between-promotional-spending-on-drugs-and-their-therapeutic-gain-a-cohort-analysis
#18
Joel Lexchin
BACKGROUND: Whether drug promotion helps or hinders appropriate prescribing by physicians is debated. This study examines the most heavily promoted drugs and the therapeutic value of those drugs to help determine whether doctors should be using promotional material to inform themselves about drugs. METHODS: Lists were constructed of the 50 most heavily promoted drugs (amount of money spent on journal advertisements and visits by sales representatives) and the 50 top-selling drugs (by dollar value) for 2013, 2014 and 2015...
September 13, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28903976/working-hard-but-working-differently-a-qualitative-study-of-the-impact-of-generational-change-on-rural-health-care
#19
David Snadden, Mark Alexander Kunzli
BACKGROUND: There is limited literature evaluating generational change in the physician workforce and the adjustments required of practices, practitioners and the health care system as a whole. The purpose of this study was to explore rural practitioners' experiences of their current contexts relevant to recruitment and retention and to determine how practices are responding to changing aspirations of new practitioners. METHODS: We used qualitative methods. Participants were selected to ensure diversity of career stage...
September 12, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28899946/secondary-prevention-treatment-after-acute-stroke-in-older-south-asian-chinese-and-other-canadians-a-retrospective-data-analysis
#20
Nadia A Khan, Finlay A McAlister, Louise Pilote, Anita Palepu, Hude Quan, Michael D Hill, Jiming Fang, Moira K Kapral
BACKGROUND: Little is known about whether there are differences in medication use between older patients of Chinese descent, those of South Asian descent and other Canadian patients after acute ischemic or primary intracerebral hemorrhagic stroke. The aim of this population-based study was to evaluate potential ethnic differences in secondary prevention pharmacotherapy after acute stroke. METHODS: Using health administrative data, we conducted a retrospective analysis of all patients aged 66 years or more admitted to hospital with acute stroke in Ontario (1997-2011) and British Columbia (1997-2009)...
September 11, 2017: CMAJ Open
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