Reducing the cost of inequality.
PMID: 29358209 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 22, 2018 Category: General Medicine Authors: Hancock T Tags: CMAJ Source Type: research

The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families.
Abstract BACKGROUND: Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. METHODS: Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs...
Source: cmaj - January 18, 2018 Category: General Medicine Authors: Shah PS, McDonald SD, Barrett J, Synnes A, Robson K, Foster J, Pasquier JC, Joseph KS, Piedboeuf B, Lacaze-Masmonteil T, O'Brien K, Shivananda S, Chaillet N, Pechlivanoglou P, Canadian Preterm Birth Network Investigators Tags: CMAJ Open Source Type: research

Most medical practices are not parachutes: a citation analysis of practices felt by biomedical authors to be analogous to parachutes.
Abstract BACKGROUND: In a 2003 paper in BMJ, the authors made the tongue-in-cheek observation that there are no randomized controlled trials (RCTs) of parachutes. This paper has been widely read, cited and used to argue that RCTs are impractical or unnecessary for some medical practices. We performed a study to identify and evaluate claims that a medical practice is akin to a parachute. METHODS: Using Google Scholar, we identified all citations to the 2003 paper. We searched for claims that a specific practice was akin to a parachute. For each practice, we identified the desired outcome of the practice, and s...
Source: cmaj - January 15, 2018 Category: General Medicine Authors: Hayes MJ, Kaestner V, Mailankody S, Prasad V Tags: CMAJ Open Source Type: research

Health care professionals' neckties as a source of transmission of bacteria to patients: a systematic review.
Abstract BACKGROUND: There is growing concern that neckties worn by health care professionals may contribute to infections contracted in health care settings. We evaluated the evidence for health-care-associated infections resulting from neckties and whether the evidence is sufficient to warrant a tieless policy in Canada. METHODS: We performed a systematic review to determine whether neckties worn by health care professionals colonize harmful pathogenic bacteria and whether they contribute to the spread of infection to patients in the inpatient or outpatient setting. We searched PubMed (1966 to 2017) and Emb...
Source: cmaj - January 12, 2018 Category: General Medicine Authors: Pace-Asciak P, Bhimrao SK, Kozak FK, Westerberg BD Tags: CMAJ Open Source Type: research

Adverse effects of caffeinated energy drinks among youth and young adults in Canada: a Web-based survey.
Abstract BACKGROUND: Energy drink consumption has increased dramatically among young Canadians, with anecdotal evidence of adverse health effects. There is a lack of population-based studies to examine the prevalence of adverse events from energy drinks, particularly among young people. The current study sought to assess adverse events from energy drinks among a population-based sample of youth and young adults in Canada. METHODS: An online survey was conducted in 2015 with a national sample of youth (aged 12-17 yr) and young adults (aged 18-24 yr) recruited from a consumer panel. Respondents reported prior c...
Source: cmaj - January 9, 2018 Category: General Medicine Authors: Hammond D, Reid JL, Zukowski S Tags: CMAJ Open Source Type: research

Laying the digital and analytical foundations for Canada's future health care system.
PMID: 29311097 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Mamdani M, Laupacis A Tags: CMAJ Source Type: research

Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults: a multicentre case-control study.
ject PI12/02079 Working Group Abstract BACKGROUND: The effectiveness of repeated vaccination for influenza to prevent severe cases remains unclear. We evaluated the effectiveness of influenza vaccination on preventing admissions to hospital for influenza and reducing disease severity. METHODS: We conducted a case-control study in 20 hospitals in Spain during the 2013/14 and 2014/15 influenza seasons. Community-dwelling adults aged 65 years or older who were admitted to hospital for laboratory-confirmed influenza were matched with inpatient controls by sex, age, hospital and admission date. The effectiveness o...
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Casado I, Domínguez Á, Toledo D, Chamorro J, Astray J, Egurrola M, Fernández-Sierra MA, Martín V, Morales-Suárez-Varela M, Godoy P, Castilla J, Project PI12/02079 Working Group Tags: CMAJ Source Type: research

Perineural spread of skin cancer presenting as diplopia.
PMID: 29311099 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Mullen SJ, Coret-Simon J, Rodriguez AR Tags: CMAJ Source Type: research

Lancisi sign in a 69-year-old man with severe tricuspid regurgitation.
PMID: 29311100 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Jud P, Verheyen N Tags: CMAJ Source Type: research

Doctors share responsibility for damaging discourse.
PMID: 29311101 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Conway K Tags: CMAJ Source Type: research

Tax changes should be seen as a gateway to a larger discussion on reform of public health care in Canada.
PMID: 29311102 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Ratti J, Beder M, Brcic V, Bloch G, Barron L, Dutt M, Green S Tags: CMAJ Source Type: research

Are medical associations relevant to young doctors?
PMID: 29311103 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Glauser W Tags: CMAJ Source Type: research

New ammunition in the fight to label unhealthy foods.
PMID: 29311104 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

A short history of pain management.
PMID: 29311105 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Collier R Tags: CMAJ Source Type: research

Study by proponent of neck vein-widening therapy for MS finds treatment ineffective.
PMID: 29311106 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Owens B Tags: CMAJ Source Type: research

Considering transparency and value for fairer drug prices.
PMID: 29311107 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Webster P Tags: CMAJ Source Type: research

Some medical associations see modest growth despite challenges.
PMID: 29311108 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 8, 2018 Category: General Medicine Authors: Glauser W Tags: CMAJ Source Type: research

Real-world treatment of hepatitis C with second-generation direct-acting antivirals: initial results from a multicentre Canadian retrospective cohort of diverse patients.
We report high SVR rates in a real-world diverse cohort of HCV-infected patients treated with second-generation direct-acting antivirals. The results highlight the importance of conducting real-world analyses to elucidate clinical factors associated with poorer outcomes that may not be identified in registration trials. PMID: 29305405 [PubMed] (Source: cmaj)
Source: cmaj - January 5, 2018 Category: General Medicine Authors: Aspinall AI, Shaheen AA, Kochaksaraei GS, Haslam B, Lee SS, Macphail G, Kapler J, Larios OE, Burak KW, Swain MG, Borman MA, Coffin CS Tags: CMAJ Open Source Type: research

The economic burden of cancer care in Canada: a population-based cost study.
The objective of this analysis was to provide a comprehensive revised estimate of this burden. METHODS: We used a case-control prevalence-based approach to estimate direct annual cancer costs from 2005 to 2012. We used patient-level administrative health care data from Ontario to correctly attribute health care costs to cancer. We employed the net cost method (cost difference between patients with cancer and control subjects without cancer) to account for costs directly and indirectly related to cancer and its sequelae. Using average patient-level cost estimates from Ontario, we applied proportions from national healt...
Source: cmaj - January 4, 2018 Category: General Medicine Authors: de Oliveira C, Weir S, Rangrej J, Krahn MD, Mittmann N, Hoch JS, Chan KKW, Peacock S Tags: CMAJ Open Source Type: research

Correction: Comparison of Canadian public medication insurance plans and the impact on out-of-pocket costs.
Authors: PMID: 29305404 [PubMed - in process] (Source: cmaj)
Source: cmaj - January 3, 2018 Category: General Medicine Tags: CMAJ Open Source Type: research

A decade of outpatient antimicrobial use in older adults in Ontario: a descriptive study.
Abstract BACKGROUND: Antimicrobials are frequently prescribed to community-dwelling older adults. Our aim was to examine the prevalence, quantity and indications of antimicrobial prescriptions to older residents of Ontario. METHODS: We conducted a population-based analysis of outpatient antimicrobial prescriptions to residents of Ontario aged 65 years or more from 2006 to 2015. Antimicrobial prescriptions, infectious disease diagnoses and prescriber information were determined from linked health care databases. Our analyses were primarily focused on antibiotics, which account for most antimicrobial use. ...
Source: cmaj - December 21, 2017 Category: General Medicine Authors: Tan C, Graves E, Lu H, Chen A, Li S, Schwartz KL, Daneman N Tags: CMAJ Open Source Type: research

Case-control study of household contacts to examine immunological protection from Bordetella pertussis transmission - study protocol.
roft NS, Canadian Immunization Research Network Provincial Collaborative Network Abstract BACKGROUND: There is mounting evidence that the recent resurgence of pertussis in many countries is in part related to the acellular vaccine, which has been administered in Canada since 1997. This vaccine elicits a different cell-mediated immune response than the previously used whole-cell vaccine, and its effectiveness wanes over time. The aim of this study is to understand the immunological, demographic and clinical factors that mediate protection from pertussis on exposure. METHODS: This is a household case-control st...
Source: cmaj - December 19, 2017 Category: General Medicine Authors: Bolotin S, Johnson C, Quach S, Ambrose A, DeCoutere S, Deeks SL, Drews S, Faheem A, Green K, Halperin SA, Hoang L, Jamieson F, Kollmann T, Marchand-Austin A, McCormack D, McGeer A, Murti M, Bba AO, Rebbapragada A, Vanderkooi OG, Wang J, Warshawsky B, Crow Tags: CMAJ Open Source Type: research

Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data.
Abstract BACKGROUND: Given the changing landscape of primary care, there may be fewer primary care physicians available to provide a broad range of services to patients of all age groups and health conditions. We sought to identify physicians with comprehensive primary care practices in Ontario using administrative data, investigating how many and what proportion of primary care physicians provided comprehensive primary care and how this changed over time. METHODS: We identified the pool of active primary care physicians in linked population-based databases for Ontario from 1992/93 to 2014/15. After excluding...
Source: cmaj - December 19, 2017 Category: General Medicine Authors: Schultz SE, Glazier RH Tags: CMAJ Open Source Type: research

Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: a descriptive evaluation.
We describe the evaluation of Choosing Wisely Canada's Students and Trainees Advocating for Resource Stewardship (STARS) campaign, a student-led campaign to advance resource stewardship education in medical schools across Canada. METHODS: We evaluated the campaign 6 months after its launch, in November 2015. STARS students were administered a telephone survey eliciting a description of the initiatives that they had implemented or planned to implement at their schools to promote resource stewardship, and exploring their perceptions of facilitators of and barriers to successful implementation of their initiatives. We us...
Source: cmaj - December 19, 2017 Category: General Medicine Authors: Cardone F, Cheung D, Han A, Born KB, Alexander L, Levinson W, Wong BM Tags: CMAJ Open Source Type: research

Rates of colonization with extended-spectrum β-lactamase-producing Escherichia coli in Canadian travellers returning from South Asia: a cross-sectional assessment.
In this study, travel to India was associated with the highest risk of acquiring ESBL-producing E. coli relative to travel to other countries in South Asia. Nonbusiness travel, consuming foods with the local population and the use of antibiotics while travelling were associated with an increased risk of acquiring these antibiotic-resistant organisms while in India. Trial registration: ClinicalTrials.gov, no. NCT01296165. PMID: 29246886 [PubMed] (Source: cmaj)
Source: cmaj - December 13, 2017 Category: General Medicine Authors: Peirano G, Gregson DB, Kuhn S, Vanderkooi OG, Nobrega DB, Pitout JDD Tags: CMAJ Open Source Type: research

Manual review of electronic medical records as a reference standard for case definition development: a validation study.
Abstract BACKGROUND: The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) previously carried out a validation study of case definitions for 8 chronic diseases (diabetes mellitus, hypertension, osteoarthritis, depression, dementia, chronic obstructive pulmonary disease, parkinsonism and epilepsy) using direct review of "raw" electronic medical record data. Although effective, this method is time-consuming and can present methodological and organizational challenges. We aimed to determine whether the processed and standardized data contained with the CPCSSN database might function as a referenc...
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Williamson T, Miyagishima RC, Derochie JD, Drummond N Tags: CMAJ Open Source Type: research

Cesarean delivery rates among family physicians versus obstetricians: a population-based cohort study using instrumental variable methods.
Abstract 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. 1, 2006, and Mar. 31, ...
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Dawe RE, Bishop J, Pendergast A, Avery S, Monaghan K, Duggan N, Aubrey-Bassler K Tags: CMAJ Open Source Type: research

Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study.
We examined trends in resource use and patient characteristics over the study period. RESULTS: There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median ...
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Verma AA, Guo Y, Kwan JL, Lapointe-Shaw L, Rawal S, Tang T, Weinerman A, Cram P, Dhalla IA, Hwang SW, Laupacis A, Mamdani MM, Shadowitz S, Upshur R, Reid RJ, Razak F Tags: CMAJ Open Source Type: research

Follow-up imaging after nephrectomy for cancer in Canada: urologists' compliance with guidelines. An observational study.
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. A total of 1982 patients who underwent radical or partial nephrectomy for stage pT1-3N0M0 renal cancer between January 2011 and June 2016 were included in the cohort. Numbers of abdominal and chest imaging tests performed d...
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Dragomir A, Aprikian A, Kapoor A, Finelli A, Pouliot F, Rendon R, Black PC, Moore R, Breau RH, Kawakami J, Drachenberg D, Lattouf JB, Tanguay S Tags: CMAJ Open Source Type: research

Health services research: a special CMAJ focus.
PMID: 29229709 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Patrick K, Mamdani M, Stanbrook MB, Kelsall D Tags: CMAJ Source Type: research

Financial incentives for physicians to improve health care.
PMID: 29229710 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Lavergne MR Tags: CMAJ Source Type: research

Physician retirement: gender, geography, flexibility and pensions.
PMID: 29229711 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Silver MP Tags: CMAJ Source Type: research

Payment incentives for community-based psychiatric care in Ontario, Canada.
Abstract BACKGROUND: In September 2011, the government of Ontario implemented payment incentives to encourage the delivery of community-based psychiatric care to patients after discharge from a psychiatric hospital admission and to those with a recent suicide attempt. We evaluated whether these incentives affected supply of psychiatric services and access to care. METHODS: We used administrative data to capture monthly observations for all psychiatrists who practised in Ontario between September 2009 and August 2014. We conducted interrupted time-series analyses of psychiatrist-level and patient-level data to...
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Rudoler D, de Oliveira C, Cheng J, Kurdyak P Tags: CMAJ Source Type: research

Patterns of physician retirement and pre-retirement activity: a population-based cohort study.
We examined the patterns and timing of retirement by age, sex, specialty and location using linear and logistic regression models. RESULTS: Of the 4572 physicians who met the inclusion criteria, 1717 (37.6%) retired during the study period. The average age at retirement was 65.1 (standard deviation 7.8) years. Controlling for other demographic and practice characteristics, we found that women and physicians working in rural areas retired earlier, by 4.1 (95% confidence interval [CI] -4.9 to -3.2) years and 2.3 (95% CI -3.4 to -1.1) years, respectively. We found no difference in retirement age by specialty. We identifi...
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Hedden L, Lavergne MR, McGrail KM, Law MR, Cheng L, Ahuja MA, Barer ML Tags: CMAJ Source Type: research

Testing and treatment for obstructive sleep apnea in Canada: funding models must change.
PMID: 29229714 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Pendharkar SR, Povitz M, Bansback N, George CFP, Morrison D, Ayas NT, Canadian Sleep and Circadian Network Tags: CMAJ Source Type: research

A 15-year-old boy with sickle cell disease, chest pain and respiratory distress.
PMID: 29229715 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Pastore YD, Robitaille N, Naessens V, Canadian Haemoglobinopathy Association (CanHaem) Tags: CMAJ Source Type: research

Disseminated blastomycosis in a 57-year-old man working in construction.
PMID: 29229716 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Dalcin D, Sandre R Tags: CMAJ Source Type: research

Generic drug names: no art, no science, just enhanced safety.
PMID: 29229717 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Saibil F Tags: CMAJ Source Type: research

Smoking is the first cause of morbidity and death in psychiatric settings.
PMID: 29229718 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Braillon A Tags: CMAJ Source Type: research

New association for health humanities coming in 2018.
PMID: 29229719 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

Medication costs driving seniors to food banks.
PMID: 29229720 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Webster P Tags: CMAJ Source Type: research

Opioid prescriptions still rising but for smaller quantities.
PMID: 29229721 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

Doctor who supported tax reforms removed from board of Doctors Nova Scotia.
PMID: 29229722 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 11, 2017 Category: General Medicine Authors: Collier R Tags: CMAJ Source Type: research

Charting age-associated cognitive decline.
PMID: 29203615 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Costa A Tags: CMAJ Source Type: research

Validation and diagnostic accuracy of predictive curves for age-associated longitudinal cognitive decline in older adults.
e R Abstract BACKGROUND: The Mini-Mental State Examination continues to be used frequently to screen for cognitive impairment in older adults, but it remains unclear how to interpret changes in its score over time to distinguish age-associated cognitive decline from an early degenerative process. We aimed to generate cognitive charts for use in clinical practice for longitudinal evaluation of age-associated cognitive decline. METHODS: We used data from the Canadian Study of Health and Aging from 7569 participants aged 65 years or older who completed a Mini-Mental State Examination at baseline, and at 5 and 10...
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Bernier PJ, Gourdeau C, Carmichael PH, Beauchemin JP, Verreault R, Bouchard RW, Kröger E, Laforce R Tags: CMAJ Source Type: research

Diagnosis and treatment of obstructive sleep apnea in adults.
PMID: 29203617 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Laratta CR, Ayas NT, Povitz M, Pendharkar SR Tags: CMAJ Source Type: research

Congenitally transmitted Chagas disease in Canada: a family cluster.
PMID: 29203618 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Plourde PJ, Kadkhoda K, Ndao M Tags: CMAJ Source Type: research

Majocchi granuloma in a 58-year-old man with treatment-resistant annular scaling plaque.
PMID: 29203619 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Roy SF, Davar S Tags: CMAJ Source Type: research

Could changes in pharmacotherapy peripregnancy contribute to the shift in means of suicide?
PMID: 29203620 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Leong CM Tags: CMAJ Source Type: research

Mental health care and suicide in pregnancy and postpartum.
PMID: 29203621 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Mintzes B Tags: CMAJ Source Type: research