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Tianhua Huang, Shelley Dougan, Mark Walker, Christine M Armour, Nan Okun
BACKGROUND: In 2014, Ontario augmented its publicly funded multiple-marker screening program for prenatal aneuploidy by incorporating cell-free fetal DNA (cffDNA) analysis for high-risk pregnancies. We assessed trends in the use of multiple-marker screening, cffDNA screening and prenatal diagnostic testing before and after implementation of public funding. METHODS: We conducted a descriptive study based on data from the Better Outcomes Registry & Network (BORN) Ontario...
October 2018: CMAJ Open
Joel Lexchin
BACKGROUND: The independent French drug bulletin, La revue Prescrire (henceforth Prescrire ), annually releases a list of drugs to avoid. The aim of this analysis was to review the status of the 2017 list of drugs in Canada to determine whether they had been approved for marketing, their therapeutic status and whether they have been recommended for listing on public drug plans. METHODS: This descriptive analysis reviewed a list of drugs compiled by Prescrire . The status of each drug in Canada was assessed through the Drug Product Database...
July 2018: CMAJ Open
JoAnn Harrold, Mélissa Langevin, Nick Barrowman, Ann E Sprague, Deshayne B Fell, Katherine A Moreau, Thierry Lacaze-Masmonteil, Suzanne Schuh, Gary Joubert, Andrea Moore, Tanya Solano, Roger L Zemek
BACKGROUND: Parents take neonates to the emergency department for many reasons, often nonurgent, pressuring an already burdened system. We aimed to characterize these visits and families to identify potential strategies to decrease neonatal emergency department visits. METHODS: We developed and implemented a survey that explored characteristics of neonates and parents/guardians evaluated in the emergency department, perspectives of parents and use of health care services...
July 2018: CMAJ Open
Janet Chung-Hall, Geoffrey T Fong, Pete Driezen, Lorraine Craig
BACKGROUND: The Canadian government has committed to an endgame target of less than 5% tobacco use by 2035. The aims of this study were to assess baseline levels of support for potential endgame policies among Canadian smokers, by province/region, demographic characteristics and smoking-related correlates, and to identify predictors of support. METHODS: We analyzed data for 3215 adult (age ≥ 18 yr) smokers from the Canadian arm of the 2016 International Tobacco Control Four Country Smoking and Vaping Survey...
July 2018: CMAJ Open
Alby Richard, Joël Richard, Wendy Johnston, Janis Miyasaki
BACKGROUND: In the Canadian context, health literacy has been shown to depend on place of birth, education level, socioeconomic status, language spoken and geographic location. This study seeks to determine whether currently available advance directive documentation in Canada is written in accordance with the average reading level of the population and to assess whether recommendations for health literacy are currently being met. METHODS: A cross-sectional study design was used...
July 2018: CMAJ Open
Lorraine J Breault, Katherine Rittenbach, Kelly Hartle, Robbie Babins-Wagner, Catherine de Beaudrap, Yamile Jasaui, Emily Ardell, Scot E Purdon, Ashton Michael, Ginger Sullivan, Aakai'naimsskai'piiaakii Sharon Ryder Unger, Lorin Vandall-Walker, Brad Necyk, Kiara Krawec, Elizabeth Manafò, Ping Mason-Lai
BACKGROUND: To support patient-oriented setting of priorities for depression research in Alberta, the Patient Engagement Platform of the Alberta Strategy for Patient Oriented Research's Support for People and Patient-Oriented Research and Trials Unit and Alberta Health Services' Addiction and Mental Health Strategic Clinical Network, along with partners in addictions and mental health, designed the Alberta Depression Research Priority Setting Project. The aim of the project was to survey patients, caregivers and clinicians/researchers in Alberta about what they considered to be the most important unanswered questions about depression...
July 2018: CMAJ Open
Nicholas Brousseau, Dominique Gagnon, Maryline Vivion, Vanessa Poliquin, Isabelle Boucoiran, Bruce Tapiéro, Eve Dubé
BACKGROUND: Vaccination of all pregnant women with an acellular pertussis-containing vaccine (tetanus, diphtheria, pertussis [Tdap]) was recently recommended in Canada, ideally between 27 and 32 weeks of gestation. This study aimed to describe the existing model of prenatal care in Quebec and determine to what extent maternal vaccination against pertussis could be integrated into this model. METHODS: In Quebec, health care is organized around Local Community Service Centres (LCSCs) that serve specific geographic areas...
July 2018: CMAJ Open
C Marius Hoogerboord, Adrian R Levy, Min Hu, Gordon Flowerdew, Geoffrey Porter
BACKGROUND: Evidence from randomized controlled trials published since 2004 shows that elective laparoscopic colectomy for colon cancer improves short-term postoperative outcomes with equivalent oncologic outcomes compared to open colectomy. The objective of this study was to examine the uptake of elective laparoscopic colectomy in Canada and compare its use among Canadian provinces. METHODS: In this descriptive analysis, we identified from hospital discharge abstracts all patients in the Canadian provinces (except Quebec) who underwent elective colectomy for colon cancer between 2004/05 and 2014/15...
July 2018: CMAJ Open
Cheri Deal, Susan Kirsch, Jean-Pierre Chanoine, Sarah Lawrence, Elizabeth Cummings, Elizabeth T Rosolowsky, Seth D Marks, Nan Jia, Christopher J Child
BACKGROUND: Country-specific data on outcomes of treatment with recombinant human growth hormone are lacking. We present such data for children treated with growth hormone in Canada. METHODS: We describe characteristics and outcomes of 850 children (mean age at baseline 8.5 yr) treated with growth hormone constituting the Canadian cohort of the multinational phase IV prospective observational Genetics and Neuroendocrinology of Short-stature International Study (GeNeSIS)...
July 2018: CMAJ Open
Peter S Graves, Stephen R Graves, Tanvir Minhas, Rebecca E Lewinson, Isabelle A Vallerand, Ryan T Lewinson
BACKGROUND: Emergency department efficiency is a priority across Canada. In the United States, scribes may increase the number of patients seen per hour per physician; however, Canadian data are lacking. We sought to implement scribes in a Canadian emergency department with the hypothesis that scribes would increase the number of patients seen per hour per physician. METHODS: We conducted a 4-month quality improvement pilot study in a community emergency department in Ottawa, Ontario...
July 2018: CMAJ Open
Cedric Manlhiot, Vivek Rao, Barry Rubin, Douglas S Lee
BACKGROUND: Outcomes for coronary artery bypass surgery are of broadening interest, but the impact of data type on quality reporting has not been fully examined. We compared the performance of administrative and clinical data-based risk adjustment models at a tertiary-quaternary care hospital. METHODS: We used a prospective study design to test two risk adjustment models, one from administrative (Canadian Institute for Health Information [CIHI] Cardiac Care Quality Indicator) and one from clinical data (Society of Thoracic Surgeons), on cardiac surgical procedures performed between 2013 and 2016 ( n = 1635)...
July 2018: CMAJ Open
Catherine Yang, Abdool S Yasseen, Jennifer Stimec, Elizabeth Rea, Valerie Waters, Ray Lam, Shaun K Morris, Ian Kitai
BACKGROUND: There are few data about the utility of the Canadian tuberculosis medical surveillance system for detecting tuberculosis in children and adolescents. We sought to assess the prevalence of tuberculosis infection and disease in children and adolescents referred by the tuberculosis medical surveillance program who were evaluated at The Hospital for Sick Children (SickKids) tuberculosis program. METHODS: We retrospectively studied clinical records, radiographic findings and results of interferon-γ release assays (IGRAs) of all children less than 18 years of age referred by the tuberculosis medical surveillance program and evaluated at SickKids between November 2012 and June 2016...
July 2018: CMAJ Open
Timothy Jackson, David Schramm, Husein Moloo, Lee Fairclough, Azusa Maeda, Tricia Beath, Avery Nathens
BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) collaborative in Ontario, the Ontario Surgical Quality Improvement Network (ON-SQIN), was launched in January 2015. We describe its approaches to support surgical quality improvement and examine its early impact on member hospitals. METHODS: All Ontario hospitals that participated in the ON-SQIN and NSQIP were included in this quality-improvement study. The primary intervention was the introduction of the ON-SQIN, and the secondary interventions included a community of practice and access to quality-improvement resources and tools...
July 2018: CMAJ Open
Claire Johnson, Jean-Philippe Chaput, Maikol Diasparra, Catherine Richard, Lise Dubois
BACKGROUND: Very little is known about how incarceration influences a person's weight in Canada. We sought to determine how inmates' weights change during their incarceration in Canadian federal penitentiaries. METHODS: We performed a retrospective, longitudinal cohort study to examine weight change in Canadian federal penitentiaries. To participate, inmates had to have been incarcerated for at least 6 months at the time of the study. Current anthropometric data were measured or taken from medical records, then compared with anthropometric data from the beginning of incarceration (mean follow-up of 5...
July 2018: CMAJ Open
K Ally Memedovich, Laura E Dowsett, Eldon Spackman, Tom Noseworthy, Fiona Clement
BACKGROUND: With impending marijuana legislation in Canada, a broad understanding of the harms associated with marijuana use is needed to inform the clinical community and public, and to support evidence-informed public policy development. The purpose of the review was to synthesize the evidence on adverse health effects and harms of marijuana use. METHODS: We searched MEDLINE, The Cochrane Database of Systematic Reviews, Embase, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Health Technology Assessment Database from the inception of each database to May 2018...
July 2018: CMAJ Open
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
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