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

Quebec medical schools slow to adopt pass/fail system.
PMID: 29203622 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Glauser W Tags: CMAJ Source Type: research

Postsecondary campuses responding to record anxiety and depression levels.
PMID: 29203623 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Glauser W Tags: CMAJ Source Type: research

Quebec grants health minister power to impose duties on doctors.
PMID: 29203624 [PubMed - in process] (Source: cmaj)
Source: cmaj - December 4, 2017 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

What to do about the Canadian Resident Matching Service.
PMID: 29180382 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Wilson CR, Bordman ZN Tags: CMAJ Source Type: research

Comparative risk of incident venous thromboembolism in patients with inflammatory bowel disease initiating tumour necrosis factor- α inhibitors or nonbiologic agents: a cohort study.
Comparative risk of incident venous thromboembolism in patients with inflammatory bowel disease initiating tumour necrosis factor-α inhibitors or nonbiologic agents: a cohort study. CMAJ. 2017 Nov 27;189(47):E1438-E1447 Authors: Desai RJ, Gagne JJ, Lii J, Liu J, Friedman S, Kim SC Abstract BACKGROUND: Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism (VTE) by 2 to 3 times. We compared the reduction in risk of incident VTE associated with use of tumour necrosis factor-α (TNF-α) inhibitors versus nonbiologic immunomodulatory agents in patients with IBD. ...
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Desai RJ, Gagne JJ, Lii J, Liu J, Friedman S, Kim SC Tags: CMAJ Source Type: research

Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis.
cal HIV Prevention Working Group of the CIHR Canadian HIV Trials Network PMID: 29180384 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Tan DHS, Hull MW, Yoong D, Tremblay C, O'Byrne P, Thomas R, Kille J, Baril JG, Cox J, Giguere P, Harris M, Hughes C, MacPherson P, O'Donnell S, Reimer J, Singh A, Barrett L, Bogoch I, Jollimore J, Lambert G, Lebouche B, Metz G, Rogers T, Shafran S, Biomed Tags: CMAJ Source Type: research

Treatment of venous thromboembolism in a 22-year-old woman taking an oral contraceptive pill.
PMID: 29180385 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Shafran DM, Wu C Tags: CMAJ Source Type: research

J-waves in hypothermia.
PMID: 29180386 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Hudzik B, Gasior M Tags: CMAJ Source Type: research

Pigmented Bowen disease.
PMID: 29180387 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Zhou LL, Mistry N Tags: CMAJ Source Type: research

Sexual orientation not included in analysis.
PMID: 29180388 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Cornelson BM Tags: CMAJ Source Type: research

Diagnostic coding of routinely collected data.
PMID: 29180389 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Denny K Tags: CMAJ Source Type: research

Is it ever better not to have health insurance?
PMID: 29180390 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Collier R Tags: CMAJ Source Type: research

Winds of growth may signal brewing health spending storm.
PMID: 29180391 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research

Northwest Territories leads Canada in electronic medical record coverage.
PMID: 29180392 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 27, 2017 Category: General Medicine Authors: Webster P Tags: CMAJ Source Type: research

Comparison of Canadian public medication insurance plans and the impact on out-of-pocket costs.
Abstract BACKGROUND: Research from 2006 documented substantial variation in medication coverage for residents across Canada. Since then, some provinces have implemented major medication plan reforms. We aimed to update the information on publicly funded medication insurance plans available across Canada and to compare out-of-pocket costs across the country. METHODS: We compared provincial medication insurance plans using data from public websites and other public source documents. Using 2 hypothetical clinical examples, we determined the amount and type of a patient's out-of-pocket costs for 5 different patie...
Source: cmaj - November 22, 2017 Category: General Medicine Authors: Campbell DJT, Manns BJ, Soril LJJ, Clement F Tags: CMAJ Open Source Type: research

Changes in the dispensing of opioid medications in Canada following the introduction of a tamper-deterrent formulation of long-acting oxycodone: a time series analysis.
Abstract BACKGROUND: In February 2012, a reformulated tamper-deterrent form of long-acting oxycodone, OxyNeo, was introduced in Canada. We investigated the impact of the introduction of OxyNeo on patterns of opioid prescribing. METHODS: We conducted population-based, cross-sectional analyses of opioid dispensing in Canada between 2008 and 2016. We estimated monthly community pharmacy dispensing of oral formulations of codeine, morphine, hydromorphone and oxycodone, and a transdermal formulation of fentanyl, and converted quantities to milligrams of morphine equivalents (MMEs) per 1000 population. We used time...
Source: cmaj - November 22, 2017 Category: General Medicine Authors: Gomes T, Mastorakos A, Paterson JM, Sketris I, Caetano P, Greaves S, Henry D, Canadian Network for Observational Drug Effect Studies Investigators Tags: CMAJ Open Source Type: research

Health of health care workers in Canadian nursing homes and pediatric hospitals: a cross-sectional study.
Abstract BACKGROUND: Poor health of health care workers affects quality of care, but research and health data for health care workers are scarce. Our aim was to compare physical/mental health among health care worker groups 1) within nursing homes and pediatric hospitals, 2) between the 2 settings and 3) with the physical/mental health of the Canadian population. METHODS: Using cross-sectional data collected as part of the Translating Research in Elder Care program and the Translating Research on Pain in Children program, we examined the health of health care workers. In nursing homes, 169 registered nurses, ...
Source: cmaj - November 21, 2017 Category: General Medicine Authors: Hoben M, Knopp-Sihota JA, Nesari M, Chamberlain SA, Squires JE, Norton PG, Cummings GG, Stevens BJ, Estabrooks CA Tags: CMAJ Open Source Type: research

A call for clarity and quality in medical writing.
PMID: 29158452 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 20, 2017 Category: General Medicine Authors: Collier R Tags: CMAJ Source Type: research

Healing racism in Canadian health care.
PMID: 29158453 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 20, 2017 Category: General Medicine Authors: Boyer Y Tags: CMAJ Source Type: research

Direct medical costs of motorcycle crashes in Ontario.
Abstract BACKGROUND: There is no reliable estimate of costs incurred by motorcycle crashes. Our objective was to calculate the direct costs of all publicly funded medical care provided to individuals after motorcycle crashes compared with automobile crashes. METHODS: We conducted a population-based, matched cohort study of adults in Ontario who presented to hospital because of a motorcycle or automobile crash from 2007 through 2013. For each case, we identified 1 control absent a motor vehicle crash during the study period. Direct costs for each case and control were estimated in 2013 Canadian dollars from th...
Source: cmaj - November 20, 2017 Category: General Medicine Authors: Pincus D, Wasserstein D, Nathens AB, Bai YQ, Redelmeier DA, Wodchis WP Tags: CMAJ Source Type: research

Acute strongyloidiasis in a child recently returned from vacation in Cuba.
PMID: 29158455 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 20, 2017 Category: General Medicine Authors: Alabi A, Boggild AK, Bitnun A Tags: CMAJ Source Type: research

Subarachnoid hemorrhage.
PMID: 29158456 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 20, 2017 Category: General Medicine Authors: Fernando SM, Perry JJ Tags: CMAJ Source Type: research

The importance of study design in the assessment of nonnutritive sweeteners and cardiometabolic health.
PMID: 29158457 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 20, 2017 Category: General Medicine Authors: Sievenpiper JL, Khan TA, Ha V, Viguiliouk E, Auyeung R Tags: CMAJ Source Type: research

Response to "The importance of study design in the assessment of nonnutritive sweeteners and cardiometabolic health".
Response to "The importance of study design in the assessment of nonnutritive sweeteners and cardiometabolic health". CMAJ. 2017 Nov 20;189(46):E1426 Authors: Azad MB, MacKay DS, Zarychanski R PMID: 29158458 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 20, 2017 Category: General Medicine Authors: Azad MB, MacKay DS, Zarychanski R Tags: CMAJ Source Type: research

The timing of ingestion may influence the effect of nonnutritive sweeteners on cardiometabolic health: a potentially overlooked factor.
PMID: 29158459 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 20, 2017 Category: General Medicine Authors: Nakajima K, Iwane T, Higuchi R Tags: CMAJ Source Type: research

Climate change is already making us sick.
PMID: 29158460 [PubMed - in process] (Source: cmaj)
Source: cmaj - November 20, 2017 Category: General Medicine Authors: Vogel L Tags: CMAJ Source Type: research