Rise of women in medicine not matched by leadership roles.
PMID: 29661820 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 16, 2018 Category: General Medicine Authors: Glauser W Tags: CMAJ Source Type: research

Review calls for major overhaul of federally funded health organizations.
PMID: 29661821 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 16, 2018 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

Chronic pain associations struggle to raise awareness of "silent epidemic".
Chronic pain associations struggle to raise awareness of "silent epidemic". CMAJ. 2018 Apr 16;190(15):E483-E484 Authors: Collier R PMID: 29661822 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 16, 2018 Category: General Medicine Authors: Collier R Tags: CMAJ Source Type: research

Intradermal pre-exposure rabies vaccination in a Canadian travel clinic: 6-year retrospective observational study.
Abstract 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. The number of travellers who received pre-exposure rabies prophylaxis before and after the intro...
Source: cmaj - April 5, 2018 Category: General Medicine Authors: Kong LY, Vincelette J, Laplante G, Duchesne JA, Libman M, Barkati S Tags: CMAJ Open Source Type: research

Evaluation of the cost-effectiveness of evolocumab in the FOURIER study: a Canadian analysis.
Abstract 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 corona...
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Lee TC, Kaouache M, Grover SA Tags: CMAJ Open Source Type: research

Mobile cell phone technology puts the future of health care in our hands.
PMID: 29615420 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Wilson K Tags: CMAJ Source Type: research

Photoplethysmography using a smartphone application for assessment of ulnar artery patency: a randomized clinical trial.
Abstract BACKGROUND: Radial artery access is commonly performed for coronary angiography and invasive hemodynamic monitoring. Despite limitations in diagnostic accuracy, the modified Allen test (manual occlusion of radial and ulnar arteries followed by release of the latter and assessment of palmar blush) is used routinely to evaluate the collateral circulation to the hand and, therefore, to determine patient eligibility for radial artery access. We sought to evaluate whether a smartphone application may provide a superior alternative to the modified Allen test. METHODS: We compared the modified Allen test wi...
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Di Santo P, Harnett DT, Simard T, Ramirez FD, Pourdjabbar A, Yousef A, Moreland R, Bernick J, Wells G, Dick A, Le May M, Labinaz M, So D, Motazedian P, Jung RG, Chandrasekhar J, Mehran R, Chong AY, Hibbert B Tags: CMAJ Source Type: research

Kidney age, not kidney disease.
PMID: 29615422 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Stevens RJ, Evans J, Oke J, Smart B, Hobbs FDR, Holloway E, Horwood J, Judd M, Locock L, McLellan J, Perera R Tags: CMAJ Source Type: research

Mycobacterium avium complex infection presenting as persistent ascites.
PMID: 29615423 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Auguste BL, Patel AD, Siemieniuk RA Tags: CMAJ Source Type: research

Cutaneous lymphoid hyperplasia (pseudolymphoma).
PMID: 29615424 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Zhou LL, Mistry N Tags: CMAJ Source Type: research

The Canadian Medical Association and medical marijuana.
PMID: 29615425 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Kumar R Tags: CMAJ Source Type: research

Is aldosteronism really a relatively common cause of hypertension?
PMID: 29615426 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Egidi G, Schmiemann G, Gebhardt K Tags: CMAJ Source Type: research

Medicine changing as women make up more of physician workforce.
PMID: 29615427 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Glauser W Tags: CMAJ Source Type: research

Parliament debates junk food ads, vaping.
PMID: 29615428 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

Patient complaints about Canadian doctors on the rise.
PMID: 29615429 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

Diffuse skin thickening, myalgias and joint stiffness in a 41-year-old man.
Authors: PMID: 29615430 [PubMed - in process] (Source: cmaj)
Source: cmaj - April 3, 2018 Category: General Medicine Tags: CMAJ Source Type: research

Physician follow-up and long-term use of evidence-based medication for patients with hypertension who were discharged from an emergency department: a prospective cohort study.
Abstract 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 em...
Source: cmaj - April 3, 2018 Category: General Medicine Authors: Atzema CL, Yu B, Schull MJ, Jackevicius CA, Ivers NM, Lee DS, Rochon P, Austin PC Tags: CMAJ Open Source Type: research

Development of a provisional essential medicines list for children in Canada: consensus process.
Abstract 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. Literature relevant to each suggestion was presented to clinician-scientists, who used a modified nominal group technique to ma...
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Woods H, Oronsaye E, Bali A, Rajakulasingam Y, Lee T, Umali N, Cohen E, Finkelstein Y, Offringa M, Persaud N Tags: CMAJ Open Source Type: research

Tackling smoking cessation systematically among inpatients with heart disease.
PMID: 29581160 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Reid RD, Mullen KA, Pipe AL Tags: CMAJ Source Type: research

Smoking abstinence 1 year after acute coronary syndrome: follow-up from a randomized controlled trial of varenicline in patients admitted to hospital.
Abstract BACKGROUND: Patients who continue to smoke after acute coronary syndrome are at increased risk of reinfarction and death. We previously found use of varenicline to increase abstinence 24 weeks after acute coronary syndrome; here we report results through 52 weeks. METHODS: The EVITA trial was a multicentre, double-blind, randomized, placebo-controlled trial of varenicline for smoking cessation in patients admitted to hospital with acute coronary syndrome. Participants were randomly assigned (1:1) to receive varenicline or placebo for 12 weeks, in conjunction with low-intensity counselling. Smoking ab...
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Windle SB, Dehghani P, Roy N, Old W, Grondin FR, Bata I, Iskander A, Lauzon C, Srivastava N, Clarke A, Cassavar D, Dion D, Haught H, Mehta SR, Baril JF, Lambert C, Madan M, Abramson BL, Eisenberg MJ, EVITA Investigators Tags: CMAJ Source Type: research

Person-level changes in oxycodone use after the introduction of a tamper-resistant formulation in Australia.
Abstract BACKGROUND: Australia introduced tamper-resistant controlled-release (CR) oxycodone in April 2014. We quantified the impact of the reformulation on dispensing, switching and poisonings. METHODS: We performed interrupted time-series analyses using population-representative national dispensing data from 2012 to 2016. We measured dispensing of oxycodone CR (≥ 10 mg), discontinuation of use of strong opioids and switching to other strong opioids after the reformulation compared with a historical control period. Similarly, we compared calls about intentional opioid poisoning using data from a regional ...
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Schaffer AL, Buckley NA, Degenhardt L, Larance B, Cairns R, Dobbins TA, Pearson SA Tags: CMAJ Source Type: research

Human granulocytic anaplasmosis acquired from a blacklegged tick in Ontario.
PMID: 29581163 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Edginton S, Guan TH, Evans G, Srivastava S Tags: CMAJ Source Type: research

Low-risk ankle injuries in children.
PMID: 29581164 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Ben-Yakov M, Boutis K Tags: CMAJ Source Type: research

Fueling the culture of distrust in physicians.
PMID: 29581165 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Alam N Tags: CMAJ Source Type: research

Creating the conditions that allow health for all to emerge.
PMID: 29581166 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Sturmberg JP Tags: CMAJ Source Type: research

Most Quebec medical residents show signs of burnout.
PMID: 29581167 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

Medical trainees want benefit of doubt when reporting harassment.
PMID: 29581168 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

Are provincial medical associations taking physician mental health seriously enough?
PMID: 29581169 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Owens B Tags: CMAJ Source Type: research

Public health in the Anthropocene.
PMID: 29581170 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 26, 2018 Category: General Medicine Authors: Hancock T Tags: CMAJ Source Type: research

Vulnerable populations: an area CMAJ will continue to champion.
PMID: 29555858 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Patrick K, Flegel K, Stanbrook MB Tags: CMAJ Source Type: research

Exploring the concept of vulnerability in health care.
PMID: 29555859 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Clark B, Preto N Tags: CMAJ Source Type: research

Food insecurity and breastfeeding.
PMID: 29555860 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: van den Heuvel M, Birken C Tags: CMAJ Source Type: research

Relation between household food insecurity and breastfeeding in Canada.
Abstract BACKGROUND: Qualitative studies have suggested that food insecurity adversely affects infant feeding practices. We aimed to determine how household food insecurity relates to breastfeeding initiation, duration of exclusive breastfeeding and vitamin D supplementation of breastfed infants in Canada. METHODS: We studied 10 450 women who had completed the Maternal Experiences - Breastfeeding Module and the Household Food Security Survey Module of the Canadian Community Health Survey (2005-2014) and who had given birth in the year of or year before their interview. We used multivariable Cox proportional h...
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Orr SK, Dachner N, Frank L, Tarasuk V Tags: CMAJ Source Type: research

Cancer incidence and survival among M étis adults in Canada: results from the Canadian census follow-up cohort (1992-2009).
We examined responses to the 1991 long-form census, including self-reported Métis ancestry linked to national mortality and cancer databases for followup from 1992 to 2009. We estimated age-standardized incidence rates and 5-year relative survival. We determined relative risk (RR) of cancer among Métis and non-Aboriginal adults using Poisson regression, and estimated excess mortality rate ratios using ethnicity-specific life tables. RESULTS: For all cancers and both sexes combined, cancer incidence was similar for Métis and non-Aboriginal adults. However, incidence was significantly higher among M...
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Mazereeuw MV, Withrow DR, Nishri ED, Tjepkema M, Vides E, Marrett LD Tags: CMAJ Source Type: research

Sugar-sweetened beverages as the new tobacco: examining a proposed tax policy through a Canadian social justice lens.
PMID: 29555863 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Riediger ND, Bombak AE Tags: CMAJ Source Type: research

Proctocolitis caused by lymphogranuloma venereum.
PMID: 29555864 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Weiss E, Sano M Tags: CMAJ Source Type: research

Aspergilloma.
PMID: 29555865 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: L'Huillier AG, Bogoch II Tags: CMAJ Source Type: research

Bill S-206 is ill-suited to achieve its stated objectives.
PMID: 29555866 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Giordano AD Tags: CMAJ Source Type: research

The authors respond to "Bill S-206 is ill-suited to achieve its stated objectives".
The authors respond to "Bill S-206 is ill-suited to achieve its stated objectives". CMAJ. 2018 Mar 19;190(11):E338 Authors: Piggott T, Freeman LK PMID: 29555867 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Piggott T, Freeman LK Tags: CMAJ Source Type: research

Responding to inflight medical emergencies can be stressful for doctors.
PMID: 29555868 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Glauser W Tags: CMAJ Source Type: research

Federal budget invests heavily in research, Indigenous health.
PMID: 29555869 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Eggertson L Tags: CMAJ Source Type: research

Mostly praise for 2018 federal budget from science and health care communities.
PMID: 29555870 [PubMed - in process] (Source: cmaj)
Source: cmaj - March 19, 2018 Category: General Medicine Authors: Collier R Tags: CMAJ Source Type: research

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study.
Abstract 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. The main outcome of interest was the proportion of colonoscopy procedures performed...
Source: cmaj - March 13, 2018 Category: General Medicine Authors: Doumouras AG, Anvari S, Cadeddu M, Anvari M, Hong D Tags: CMAJ Open Source Type: research

Association between salt substitutes/enhancers and changes in sodium levels in fast-food restaurants: a cross-sectional analysis.
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. Changes in sodium levels (per serving) and the prevalence of salt substitutes/enhancers in 222 foods from 12 of the leading fast-food r...
Source: cmaj - March 7, 2018 Category: General Medicine Authors: Scourboutakos MJ, Murphy SA, L'Abbé MR Tags: CMAJ Open Source Type: research

Opioid prescribing and adverse events in opioid-naive patients treated by emergency physicians versus family physicians: a population-based cohort study.
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. Opioid-naive patients aged 15-64 years who received an opioid prescription for noncancer pain from an emergency or family physician between Apr. 1, 2008, and Mar. 31, 2012 were eligible for inclusion. RESULTS: A total of 34 713 and 45 952 patients were initiated on an opioid by ...
Source: cmaj - March 1, 2018 Category: General Medicine Authors: Borgundvaag B, McLeod S, Khuu W, Varner C, Tadrous M, Gomes T Tags: CMAJ Open Source Type: research

Immersive and interactive virtual reality to improve learning and retention of neuroanatomy in medical students: a randomized controlled study.
Abstract 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. Participants were randomly assigned t...
Source: cmaj - February 23, 2018 Category: General Medicine Authors: Ekstrand C, Jamal A, Nguyen R, Kudryk A, Mann J, Mendez I Tags: CMAJ Open Source Type: research

Secondary stroke prevention services in Canada: a cross-sectional survey and geospatial analysis of resources, capacity and geographic access.
Lindsay MP Abstract 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. METHODS: We developed a S...
Source: cmaj - February 21, 2018 Category: General Medicine Authors: Jewett L, Harroud A, Hill MD, Côté R, Wein T, Smith EE, Gubitz G, Demchuk AM, Sahlas DJ, Gladstone DJ, Lindsay MP Tags: CMAJ Open Source Type: research

A pilot study of a Medication Rationalization (MERA) intervention.
Abstract 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. The MERA team reviewed the patients' medications and made recommendations on the basis of guidelines. We measured end points fo...
Source: cmaj - February 16, 2018 Category: General Medicine Authors: Whitty R, Porter S, Battu K, Bhatt P, Koo E, Kalocsai C, Wu P, Delicaet K, Bogoch II, Wu R, Downar J Tags: CMAJ Open Source Type: research

Cost-effectiveness of mammography from a publicly funded health care system perspective.
Abstract 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. The model predicted costs (in 2012 dollars), life-years gained and quality-adjusted life-years (QALYs) ga...
Source: cmaj - February 8, 2018 Category: General Medicine Authors: Mittmann N, Stout NK, Tosteson ANA, Trentham-Dietz A, Alagoz O, Yaffe MJ Tags: CMAJ Open Source Type: research

The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey.
Abstract 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 affordabilit...
Source: cmaj - February 5, 2018 Category: General Medicine Authors: Law MR, Cheng L, Kolhatkar A, Goldsmith LJ, Morgan SG, Holbrook AM, Dhalla IA Tags: CMAJ Open Source Type: research