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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
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
Leslie Martin, Ameen Patel, Katrina Piggott, Arthur Wong, Alexandra Patel, Matthew Patel, Yudong Liu, Sukhbinder Dhesy-Thind, Parveen Wasi, John J You
BACKGROUND: Allied health care professionals can contribute meaningfully to goals-of-care discussions with seriously ill hospitalized patients and their families. We sought to explore the perspective of hospital-based allied health care professionals on their role in goals-of-care discussions and to identify barriers to their participation. METHODS: We surveyed allied health care professionals (social workers, physiotherapists, occupational therapists, registered dietitians, speech-language pathologists and pharmacists) on internal medicine, hematology-oncology, medical oncology and radiation oncology wards at 2 tertiary care hospitals in Hamilton, Ontario, from April 2013 to May 2014...
April 2018: CMAJ Open
Pen Li, Alison Graver, Sarah Hosseini, Sunita Mulpuru, Lorraine Cake, Lynn Kachuik, Tinghua Zhang, Kayvan Amjadi
BACKGROUND: Tunnelled pleural catheters used to treat malignant pleural effusions may achieve pleurodesis. We aimed to identify factors associated with higher pleurodesis rates and earlier catheter removal. METHODS: We retrospectively reviewed a prospective database of tunnelled pleural catheters inserted consecutively between May 2006 and June 2013 for confirmed malignant pleural effusion. The cohort included patients who underwent medical thoracoscopy. Clinical, radiologic and pleural fluid data were recorded...
April 2018: CMAJ Open
Amir Rastpour, Mehmet A Begen, Alexander V Louie, Gregory S Zaric
BACKGROUND: Longer waiting times in cancer care are associated with lower care quality and wait-related patient dissatisfaction. We analyzed the variability and median of waiting times from when a patient seeks care to first treatment for the 4 most prevalent cancer types in Ontario. METHODS: Using retrospective health administrative data, we identified patients with a new diagnosis of prostate, breast, lung or colorectal cancer in Ontario between 2002 and 2012...
April 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
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