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Jill Tinmouth, Rinku Sutradhar, Ning Liu, Nancy N Baxter, Lawrence Paszat, Linda Rabeneck
BACKGROUND: Colonoscopy is used widely, but its quality is highly variable, which may adversely affect patients. Research and quality-improvement initiatives in a variety of jurisdictions have sought to address this issue, often supported by the use of health administrative data. As these data are generally not collected for these purposes, it is critical to measure their validity before use. The aim of this study was to validate health administrative data definitions for 5 key colonoscopy elements through comparison to the clinical record...
July 2018: CMAJ Open
Zachary Bouck, Graham Mecredy, Noah M Ivers, Ciara Pendrith, Ben Fine, Danielle Martin, Richard H Glazier, Joshua Tepper, Wendy Levinson, R Sacha Bhatia
BACKGROUND: Many evidence-based recommendations advocate against the use of routine chest x-rays for asymptomatic, low-risk outpatients; however, it is unclear how regularly chest x-rays are ordered in primary care. Our study aims to describe the frequency of, and variation in, routine chest x-ray use in low-risk outpatients among primary care physicians. METHODS: In this retrospective cohort study, Ontario residents aged 18 years and older with a periodic health examination (PHE) between Apr...
July 2018: CMAJ Open
F Russell Quinn, David J Gladstone, Noah M Ivers, Roopinder K Sandhu, Lisa Dolovich, Andrea Ling, Juliet Nakamya, Chinthanie Ramasundarahettige, Paul A Frydrych, Sam Henein, Ken Ng, Valerie Congdon, Richard V Birtwhistle, Richard Ward, Jeffrey S Healey
BACKGROUND: Detection of undiagnosed or undertreated ("actionable") atrial fibrillation could increase the use of appropriate oral anticoagulant therapy and reduce the risk of stroke. We sought to compare newer screening technologies with a pulse-check for the detection of atrial fibrillation and to determine whether the detection of actionable atrial fibrillation increases the use of oral anticoagulant agents. METHODS: This prospective multicentre cohort study involved 22 primary care clinics...
July 2018: CMAJ Open
Sara Lanteigne, Mete Erdogan, Alexandra Hetherington, Adam Cameron, Stephen D Beed, Robert S Green
BACKGROUND: People who experience trauma represent a large pool of potential organ donors. Our objective was to describe organ donation by patients with and without trauma in Nova Scotia. METHODS: We performed a retrospective cohort study of all patients with trauma in the Nova Scotia Trauma Registry who were injured between Apr. 1, 2009, and Mar. 31, 2016, and died in hospital, as well as all potential organ donors captured in the Nova Scotia Legacy of Life Donor Registry over the same period...
July 2018: CMAJ Open
Reka Pataky, David A Tran, Andrea Coronado, Riaz Alvi, Darryl Boehm, Dean A Regier, Stuart Peacock
BACKGROUND: Expenditure on systemic therapy for cancer has been increasing quickly owing to population growth, increased use, both in the number of users and in prescription volume, and rising drug prices. Our objective was to describe trends in expenditure in British Columbia and Saskatchewan's cancer care systems and to elucidate these drivers of growth. METHODS: In this trend analysis, we obtained pharmacy dispensing records from the BC Cancer and Saskatchewan Cancer Agency pharmacies for all anticancer therapies dispensed in 2006-2013...
July 2018: CMAJ Open
Stephanie McClean, Krista Baerg, Julie Smith-Fehr, Michael Szafron
BACKGROUND: Leading authorities in North America recommend universal screening via total serum bilirubin (TSB) measurement or transcutaneous bilirubinometry (TcB) for kernicterus prevention. We assessed costs associated with these 2 screening methods in hospital and in urban and rural community settings. METHODS: Our tertiary care centre in Saskatoon, with about 5600 births per year, serves the local population of 300 000; in addition, 30% of patients are referred from outside the local community and surrounding area...
July 2018: CMAJ Open
Sina Waibel, Sabrina T Wong, Alan Katz, Jean-Frederic Levesque, Raji Nibber, Jeannie Haggerty
BACKGROUND: Concordance refers to shared characteristics between a clinician and patient, such as ethnicity or language. The purpose of this study was to examine whether patient-clinician concordance is associated with patient-reported continuity of care (relational, informational and management) and patient-reported impacts of care (quality and empowerment). METHODS: This is a secondary analysis of cross-sectional patient surveys that were administered across British Columbia, Manitoba and Quebec using random digit dialling...
July 2018: CMAJ Open
Aileen M Davis, Selahadin Ibrahim, Sheilah Hogg-Johnson, Dorcas E Beaton, Bert M Chesworth, Rajiv Gandhi, Nizar N Mahomed, Anthony V Perruccio, Vaishnav Rajgopal, Rosalind Wong, James P Waddell
BACKGROUND: It has been suggested that total knee replacement is being performed in people with less-severe osteoarthritis. We aimed to determine whether there were differences in the presurgery profile, symptoms and disability of 2 cohorts who underwent total knee replacement over a 10-year period. METHODS: Patients aged 18-85 years undergoing primary total knee replacement for osteoarthritis at 1 of 4 sites in Toronto and Strathroy, Ontario, were recruited in a cohort study during 2006-2008 (cohort 1) and 2012-2015 (cohort 2)...
July 2018: CMAJ Open
Ghislain Hardy, Jo Ann Colas, Deborah Weiss, David Millar, Alan Forster, Mark Walker, Daniel J Corsi
BACKGROUND: Reduction in postpartum length of stay has been advocated within a context of reducing health care system costs and maintaining quality of care. We assessed trends in postpartum length of stay for vaginal and cesarean deliveries at an academic hospital, The Ottawa Hospital, before and after the implementation in 2014 of a novel community-based postpartum outpatient clinic, the Monarch Centre. METHODS: The Monarch Centre model of postpartum care consists of prebooked appointments at the postpartum clinic, scheduled within 48 hours of hospital discharge...
July 2018: CMAJ Open
Terrence McDonald, Judy E Seidel, Alka B Patel, Haifeng Zhu, Allan L Bailey, Kerry A McBrien, Lee A Green
BACKGROUND: Alberta is considering capping daily fee-for-service physician billings, but little is known about high-volume practice in the province and its impact on patient health outcomes. In this initial study, we conducted a descriptive analysis of general practitioners' patient volumes and billing practices in relation to associated practitioner demographic characteristics. METHODS: We conducted a retrospective descriptive analysis of the associations of practitioner characteristics, including full-time versus non-full-time practice, provider sex, years in practice, geographic location and international medical graduate status, with high-volume (> 50 visits/d) practice using general practice billing data from 2011 to 2016...
July 2018: CMAJ Open
Gillian A Lowe, Garth E Lipps, Roger C Gibson, Mia A Jules, Stanley Kutcher
BACKGROUND: Research on depression among Caribbean children has been limited by a lack of valid and reliable measures. We addressed this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Kutcher Adolescent Depression Rating Scale (KADS) among a wide cross-section of the student population attending elementary schools in Jamaica and Barbados. METHODS: Students enrolled in grade 6 in a cross-section of schools in Jamaica and Barbados were invited to participate in the study...
July 2018: CMAJ Open
Iwona A Bielska, Kelly Cimek, Dale Guenter, Kelly O'Halloran, Chloe Nyitray, Linda Hunter, Walter P Wodchis
BACKGROUND: We sought to determine whether patients with a coordinated care plan developed using the Health Links model of care in the Hamilton Niagara Haldimand Brant Local Health Integration Network differed in their use of health care (no. of emergency department visits, inpatient admissions, length of inpatient stay) when compared with a matched control group of patients with no care plans. METHODS: We performed a propensity score-matched study of 12 months pre- and 12 months post-health care use...
May 31, 2018: CMAJ Open
Daniel Meyer, Erwin Karreman, David Kopriva
BACKGROUND: The Canadian Best Practice Recommendations for Stroke Care (2008 update) recommend that patients with neurologic symptoms secondary to severe internal carotid artery stenosis undergo carotid endarterectomy within 14 days of symptom onset to prevent stroke. The purpose of this study was to identify patient and system factors associated with meeting, or failing to meet, the guideline. METHODS: In this case-control study, potential study participants were identified through an electronic search of the Discharge Abstract Database...
May 15, 2018: CMAJ Open
Ari Bitnun, Terry Lee, Jason Brophy, Lindy M Samson, Fatima Kakkar, Wendy Vaudry, Ben Tan, Deborah M Money, Joel Singer, Laura J Sauvé, Ariane Alimenti
BACKGROUND: Vertical HIV transmission has declined in Canada, but missed opportunities for prevention continue to occur. We sought to determine the adequacy, and changes over time in adequacy, of uptake of maternal and neonatal antiretroviral therapy for the prevention of vertical HIV transmission, and to determine the vertical transmission rate over time and according to adequacy of antenatal antiretroviral therapy during the combination antiretroviral therapy era in Canada. METHODS: The Canadian Perinatal HIV Surveillance Program collects data annually through retrospective chart review concerning HIV-infected women and their infants...
May 10, 2018: CMAJ Open
Luke Witherspoon, Johnathan L Lau, Rodney H Breau, Christopher Knee, Michael Fung Kee Fung, Robin Morash, Ranjeeta Mallick, Ilias Cagiannos, Christopher Morash, Luke T Lavallée
BACKGROUND: Canadian guidelines recommend against population-based screening for prostate cancer because of the risk of overdiagnosis and overtreatment. We sought to assess whether a higher proportion of patients receiving surgery had clinically significant cancer over time. METHODS: All hospitals in Eastern Ontario that perform prostatectomy participate in a Prostate Cancer Community of Practice, which prospectively maintains a database for the region. Using these data, we conducted a retrospective cohort study that included all patients who underwent prostatectomy from 2009 to 2015 in the region...
April 30, 2018: CMAJ Open
Martina Kelly, Tim Dornan, Tamara Pringsheim
BACKGROUND: Quetiapine is an antipsychotic that is widely prescribed off-label by family physicians despite evidence that safer alternatives exist. The aim of this research was to explore, in-depth, family physicians' reasons for this behaviour. METHODS: We conducted qualitative interviews with 15 urban family physicians in Alberta between October 2015 and April 2016. Participants were purposively selected based on sex, years of experience and practice type. Interviews explored participants' experiences prescribing quetiapine...
April 30, 2018: CMAJ Open
Susy S Hota, Salman Surangiwala, Aimee S Paterson, Bryan Coburn, Susan M Poutanen
BACKGROUND: There is growing evidence that fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection, but little guidance exists for implementation of FMT programs. The objective of this study is to describe the program characteristics and protocols of 9 planned or operating FMT programs in the Southern Ontario Fecal Microbiota Transplantation (SOFT) Movement, to help guide future FMT program implementation. METHODS: A 59-item survey was administered electronically to clinical leads of the SOFT Movement on June 2, 2016...
April 18, 2018: CMAJ Open
Jens Detollenaere, Pauline Boeckxstaens, Sara Willems
BACKGROUND: Previous research has shown that person-centred care has beneficial effects on several health-related outcomes. We investigated the association between a general practitioner's person-centred attitude and financially driven postponement of care in European countries. METHODS: In this cross-sectional study, data were collected within the Quality and Costs of Primary Care in Europe study, which included 69 201 patients and 7183 general practitioners from 31 European countries (all 27 European Union member states, 2 candidate states [former Yugoslav Republic of Macedonia and Turkey], Norway and Switzerland)...
April 18, 2018: CMAJ Open
Ling Yuan Kong, Jean Vincelette, Gaétan Laplante, Jo-Anne Duchesne, Michael Libman, Sapha Barkati
BACKGROUND: The intradermal route of vaccine administration for pre-exposure rabies prophylaxis, endorsed by the Canadian National Advisory Committee on Immunization, was implemented at a large travel clinic in Montréal in 2008. We evaluated the effect of intradermal vaccination availability on uptake of pre-exposure rabies prophylaxis and rates of seroconversion with intradermal vaccination. METHODS: We conducted a retrospective cross-sectional study using data from December 2008 to December 2014...
April 5, 2018: CMAJ Open
Todd C Lee, Mohammed Kaouache, Steven A Grover
BACKGROUND: Evolocumab, a proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, has been shown to reduce low-density lipoprotein levels by up to 60%. Despite the absence of a reduction in overall or cardiovascular mortality in the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial, some believe that, with longer treatment, such a benefit might eventually be realized. Our aim was to estimate the potential mortality benefit over a patient's lifetime and the cost per year of life saved (YOLS) for an average Canadian with established coronary artery disease...
April 3, 2018: CMAJ Open
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