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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
Clare L Atzema, Bing Yu, Michael J Schull, Cynthia A Jackevicius, Noah M Ivers, Douglas S Lee, Paula Rochon, Peter C Austin
BACKGROUND: More than 25% of the population has hypertension. The number of patients seeking care for hypertension in emergency departments has increased by more than 60% in the last decade, with less than 10% of these patients subsequently admitted to hospital. Managing physicians recommend early follow-up to patients who are discharged from the emergency department, but there is a paucity of literature assessing the impact or timing of follow-up on patient outcomes. METHODS: Using a population-based cohort design, we included patients more than 65 years of age who were discharged from an Ontario emergency department with a primary diagnosis of hypertension between 2007 and 2014...
April 3, 2018: CMAJ Open
Hannah Woods, Efosa Oronsaye, Anjli Bali, Yathavan Rajakulasingam, Taehoon Lee, Norman Umali, Eyal Cohen, Yaron Finkelstein, Martin Offringa, Nav Persaud
BACKGROUND: Worldwide, many countries have developed a list of essential medicines for children to improve prescribing. We aimed to create an essential medicines list for children in Canada. METHODS: We adapted the previously created preliminary list of essential medicines for adults in Canada and the WHO Model List of Essential Medicines for Children to create a provisional list of essential medicines for children in Canada. Canadian clinicians made suggestions for changes...
March 26, 2018: CMAJ Open
Audrey Charbonneau, Louis-Philippe Charette, Geneviève Rouleau, Mélissa Savary, Alexandra Wilson, Emily Heer, Karine Bériault, Alexandra de Pokomandy
BACKGROUND: Lyme disease is emerging in Canada. This study aimed to describe the use of serologic testing for the disease in the La Pommeraie health region in southern Quebec between 2012 and 2015 and to describe the clinical presentation of laboratory-confirmed cases. METHODS: The medical charts of all patients investigated for Lyme disease at the Brome-Missisquoi-Perkins Hospital's laboratory between 2012 and 2015 were reviewed for results of serologic testing...
March 23, 2018: CMAJ Open
Mina Tadrous, Simon Greaves, Diana Martins, Muhammad M Mamdani, David N Juurlink, Tara Gomes
BACKGROUND: Catastrophic drug coverage programs help those with high drug-costs to reduce the burden of out-of-pocket expenses. We set out to measure changes in utilization, spending and demographic profiles of people accessing Ontario's catastrophic drug program, the Trillium Drug Program. METHODS: We conducted a cross-sectional time-series analysis examining quarterly utilization and spending trends among medications reimbursed by the Trillium Drug Program in Ontario, Canada from Jan...
March 14, 2018: CMAJ Open
Aristithes G Doumouras, Sama Anvari, Margherita Cadeddu, Mehran Anvari, Dennis Hong
BACKGROUND: Screening colonoscopy for the detection of colorectal carcinoma is provided by several specialties. Few studies have assessed geographic variation in the delivery of this care. Our objective was to investigate how geographic and socioeconomic factors affect who provides screening colonoscopy in Canada. METHODS: This was a population-based cohort of all screening colonoscopy procedures performed at publicly funded Canadian health care facilities (excluding those in Quebec) between April 2008 and March 2015...
March 13, 2018: CMAJ Open
Mary J Scourboutakos, Sarah A Murphy, Mary R L'Abbé
BACKGROUND: Restaurant foods have high sodium levels, and efforts have been made to promote reductions. The objective of this study was to understand if salt substitutes and enhancers are associated with changes in sodium levels in fast-food restaurants. METHODS: A longitudinal database (MENU-FLIP) containing nutrition information for Canadian chain restaurants with 20 or more locations nationally was created in 2010 and updated in 2013 and 2016. In 2016, when available, ingredient lists were collected from restaurant websites and searched for the presence of salt substitutes/enhancers...
March 7, 2018: CMAJ Open
Bjug Borgundvaag, Shelley McLeod, Wayne Khuu, Catherine Varner, Mina Tadrous, Tara Gomes
BACKGROUND: Emergency physicians provide primary care to patients and often prescribe opioids for acutely painful self-limiting conditions. The objective of this study was to describe patterns of opioid prescribing by emergency physicians and family physicians and to explore the relation between setting of initiation of opioid treatment and adverse events over the subsequent 2 years. METHODS: This was a population-based cohort study using administrative data from Ontario...
March 1, 2018: CMAJ Open
Chelsea Ekstrand, Ali Jamal, Ron Nguyen, Annalise Kudryk, Jennifer Mann, Ivar Mendez
BACKGROUND: Spatial 3-dimensional understanding of the brain is essential to learning neuroanatomy, and 3-dimensional learning techniques have been proposed as tools to enhance neuroanatomy training. The aim of this study was to examine the impact of immersive virtual-reality neuroanatomy training and compare it to traditional paper-based methods. METHODS: In this randomized controlled study, participants consisted of first- or second-year medical students from the University of Saskatchewan recruited via email and posters displayed throughout the medical school...
February 23, 2018: CMAJ Open
Lauren Jewett, Adil Harroud, Michael D Hill, Robert Côté, Theodore Wein, Eric E Smith, Gord Gubitz, Andrew M Demchuk, Demetrios J Sahlas, David J Gladstone, M Patrice Lindsay
BACKGROUND: Rapid assessment and management of transient ischemic attacks and nondisabling strokes by specialized stroke prevention services reduces the risk of recurrent stroke and improves outcomes. In Canada, with its vast geography and with 16.8% of the population living in rural areas, access to these services is challenging, and considerable variation in access to care exists. The purpose of this multiphase study was to identify sites across Canada providing stroke prevention services, evaluate resource capacity and determine geographic access for Canadians...
February 21, 2018: CMAJ Open
Rachel Whitty, Sandra Porter, Kiran Battu, Pranjal Bhatt, Ellen Koo, Csilla Kalocsai, Peter Wu, Kendra Delicaet, Isaac I Bogoch, Robert Wu, James Downar
BACKGROUND: Many seriously ill and frail inpatients receive potentially inappropriate or harmful medications and do not receive medications for symptoms of advanced illness. We developed and piloted an interprofessional Medication Rationalization (MERA) approach to deprescribing inappropriate medications and prescribing appropriate comfort medications. METHODS: We conducted a single-centre pilot study of inpatients at risk of 6-month mortality from advanced age or morbidity...
February 16, 2018: CMAJ Open
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
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