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Rowe BH, Singh M, Villa-Roel C, Leiter LA, Hramiak I, Edmonds ML, Lang E, Sivilotti M, Scheuermeyer F, Worster A, Riley J, Afilalo M, Stiell I, Yale JF, Woo VC, Campbell S. Acute management and outcomes of patients with diabetes mellitus presenting to Canadian emergency departments with hypoglycemia. Can J Diabetes 2015; 39 Suppl 4:9-18. [PMID: 26541486 DOI: 10.1016/j.jcjd.2015.09.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/29/2014] [Accepted: 04/01/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This retrospective chart audit examined the demographics, investigations, management and outcomes of adult patients with diabetes mellitus presenting to Canadian emergency departments (EDs). METHODS All sites conducted a search of their electronic medical records using International Classification of Diseases, Tenth Revision, codes to identify ED visits for hypoglycemia between 2008 and 2010. Patient characteristics, demographics, ED management, ED resources and outcome are reported. RESULTS A total of 1039 patients over the age of 17 years were included in the study; 347 (33.4%) were classified as type 1 diabetes and 692 (66.6%) were classified as type 2 diabetes. Type 2 diabetes patients were significantly older (73 vs. 49 years; p<0.0001) and had more chronic conditions recorded on their chart (all p<0.001). Most subjects arrived by ambulance, and triage scores revealed severe presentations in 39% of cases. Treatments for hypoglycemia were common (75.7%) during prehospital transport; 38.5% received intravenous glucose and 40.1% received glucagon. Hypoglycemia treatments in the ED included oral (76.8%), intravenous (29.6%) and continuous infusion (27.7%) of glucose. Diagnostic testing (81.9%) commonly included electrocardiograms (51.9%), chest radiography (37.5%) and head computed tomography scans (14.5%). Most patients (73.5%) were discharged; however, more subjects with type 2 diabetes required admission (30.3 vs. 8.8%). Discharge instructions were documented in only 55.5% of patients, and referral to diabetes services occurred in fewer than 20% of cases. Considerable variation existed in the management of hypoglycemia across EDs. CONCLUSIONS Patients with diabetes presenting to an ED with hypoglycemia consume considerable healthcare resources, and practice variation exists. Emergency departments should develop protocols for the management of hypoglycemia, with attention to discharge planning to reduce recurrence.
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Huynh T, Gagnon R, Mansour S, Rinfret S, Montigny M, Afilalo M, Kouz S, Lauzon C, Nguyen M, Eisenberg M, Harvey R, Dery J, L'Allier P, Schampaert E, Tardif J. LONG-TERM STATIN USE AND ADHERENCE IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: INSIGHTS FROM THE AMI-QUÉBEC REGISTRY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Huynh T, Gagnon R, Iftikhar U, Rinfret S, Mansour S, Montigny M, Afilalo M, Kouz S, Lauzon C, Nguyen M, Harvey R, Eisenberg M, L'Allier P, Tardif J, Schampaert E. LONGTERM RECURRENT ISCHEMIC CARDIOVASCULAR EVENTS AMONG PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: INSIGHTS FROM THE AMI-QUÉBEC REGISTRY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Afilalo M, Soucy N, Xue X, Colacone A, Jourdenais E, Boivin JF. Characteristics and Needs of Psychiatric Patients With Prolonged Hospital Stay. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:181-8. [PMID: 26174218 PMCID: PMC4459245 DOI: 10.1177/070674371506000405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/01/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds. METHODS This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed. RESULTS A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). CONCLUSIONS Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients.
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Huynh T, Kouz S, Afilalo M, Rinfret S, Schampaert E, Mansour S, Montigny M, Eisenberg M, Lauzon C, Dery JP, Nguyen M, L’Allier P, Harvey R, Boudreault C, Tardif JC. KNOWLEDGE TRANSLATION TO IMPROVE PRESCRIPTION OF EVIDENCE-BASED MEDICAL THERAPY FOR PATIENTS ADMITTED WITH ACUTE CORONARY SYNDROMES: INSIGHTS FROM THE AMI-OPTIMA STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60005-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Huynh T, Tardif JC, Segal E, L’Allier P, Nguyen M, Dery JP, Afilalo M, Mansour S, Montigny M, Eisenberg M, Ross D, Whittom L, Kouz S, Harvey R, Vadeboncoeur A, Lauzon C, Lynch A, Schampaert E. KNOWLEDGE TRANSLATION TO REDUCE DELAYS OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION: INSIGHTS FROM THE AMI-ON TIME STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60134-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Afilalo M, Soucy N, Xue X, Colacone A, Jourdenais E, Boivin JF. Hospital stay on acute care units for non-acute reasons: Effects of patient pre-hospitalization and admission factors. Healthc Manage Forum 2015; 28:34-39. [PMID: 25838569 DOI: 10.1177/0840470414551906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study identifies patient risk factors present prior to an acute hospitalization that are associated with occupying acute care beds for non-acute reasons on the 30th day of a hospitalization. Data from 952 adult patients were obtained, among which 333 (35%) were evaluated as non-acute on their 30th day. Inability to move in and out of the bed, cognitive impairment, receiving home or community healthcare services prior to hospitalization, unavailable family resources, a secondary diagnosis within the mental and behavioural category, and age ≥75 years were found to increase the risk of occupying acute care beds for non-acute reasons, while patients with a feeding tube were less likely to be non-acute at day 30.
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Huynh T, Tardif J, Segal E, Nguyen M, Dery J, Afilalo M, Mansour S, Montigny M, Harvey R, Kouz S, Eisenberg M, Lynch A, Whittom L, Vadeboncoeur A, Lauzon C, Schampaert E. KNOWLEDGE TRANSLATION TO REDUCE DELAYS OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS IN QUÉBEC - INSIGHTS FROM THE AMI ON TIME STUDY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Rowe BH, Singh M, Villa-Roel C, Leiter LA, Hramiak I, Edmonds ML, Lang E, Sivilotti M, Scheuermeyer F, Worster A, Riley J, Afilalo M, Stiell I, Yale JF, Woo VC, Campbell S. Acute management and outcomes of patients with diabetes mellitus presenting to Canadian emergency departments with hypoglycemia. Can J Diabetes 2014; 39:55-64. [PMID: 25175314 DOI: 10.1016/j.jcjd.2014.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/29/2014] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This retrospective chart audit examined the demographics, investigations, management and outcomes of adult patients with diabetes mellitus presenting to Canadian emergency departments (EDs). METHODS All sites conducted a search of their electronic medical records using International Classification of Diseases, Tenth Revision, codes to identify ED visits for hypoglycemia between 2008 and 2010. Patient characteristics, demographics, ED management, ED resources and outcome are reported. RESULTS A total of 1039 patients over the age of 17 years were included in the study; 347 (33.4%) were classified as type 1 diabetes and 692 (66.6%) were classified as type 2 diabetes. Type 2 diabetes patients were significantly older (73 vs. 49 years; p<0.0001) and had more chronic conditions recorded on their chart (all p<0.001). Most subjects arrived by ambulance, and triage scores revealed severe presentations in 39% of cases. Treatments for hypoglycemia were common (75.7%) during prehospital transport; 38.5% received intravenous glucose and 40.1% received glucagon. Hypoglycemia treatments in the ED included oral (76.8%), intravenous (29.6%) and continuous infusion (27.7%) of glucose. Diagnostic testing (81.9%) commonly included electrocardiograms (51.9%), chest radiography (37.5%) and head computed tomography scans (14.5%). Most patients (73.5%) were discharged; however, more subjects with type 2 diabetes required admission (30.3 vs. 8.8%). Discharge instructions were documented in only 55.5% of patients, and referral to diabetes services occurred in fewer than 20% of cases. Considerable variation existed in the management of hypoglycemia across EDs. CONCLUSIONS Patients with diabetes presenting to an ED with hypoglycemia consume considerable healthcare resources, and practice variation exists. Emergency departments should develop protocols for the management of hypoglycemia, with attention to discharge planning to reduce recurrence.
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Huynh T, Kouz S, Yan AT, Danchin N, O'Loughlin J, Schampaert E, Yan RT, Rinfret S, Tardif JC, Eisenberg MJ, Afilalo M, Chong A, Dery JP, Nguyen M, Lauzon C, Mansour S, Ko DT, Tu JV, Goodman S. Canada Acute Coronary Syndrome Risk Score: a new risk score for early prognostication in acute coronary syndromes. Am Heart J 2013; 166:58-63. [PMID: 23816022 DOI: 10.1016/j.ahj.2013.03.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 03/17/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite the availability of several acute coronary syndrome (ACS) prognostic risk scores, there is no appropriate score for early-risk stratification at the time of the first medical contact with patients with ACS. The primary objective of this study is to develop a simple risk score that can be used for early-risk stratification of patients with ACS. METHODS We derived the risk score from the Acute Myocardial Infarction in Quebec and Canada ACS-1 registries and validated the risk score in 4 other large data sets of patients with ACS (Canada ACS-2 registry, Canada-GRACE, EFFECT-1, and the FAST-MI registries). The final risk score is named the Canada Acute Coronary Syndrome Risk Score (C-ACS) and ranged from 0 to 4, with 1 point assigned for the presence of each of these variables: age ≥75 years, Killip >1, systolic blood pressure <100 mm Hg, and heart rate >100 beats/min. The primary end points were short-term (inhospital or 30-day) and long-term (1- or 5-year) all-cause mortality. RESULTS The C-ACS has good predictive values for short- and long-term mortality of patients with ST-segment elevation myocardial infarction and non-ST-segment elevation ACS. The negative predictive value of a C-ACS score ≥1 is excellent at ≥98% (95% CI 0.97-0.99) for short-term mortality and ≥93% (95% CI 0.91-0.96) for long-term mortality. In other words, a C-ACS score of 0 can potentially identify correctly ≥97% short-term survivors and ≥91% long-term survivors. CONCLUSION The C-ACS risk score permits rapid stratification of patients with ACS. Because this risk score is simple and easy to memorize and calculate, it can be rapidly applied by health care professionals without advanced medical training.
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Abstract
Background: Chronic non–cancer-related pain affects a large proportion of the adult population
and is often difficult to manage effectively. Although opioid analgesics have been used to relieve
chronic pain of different etiologies, opioids are associated with a range of side effects that
may reduce patient quality of life and lead to reduced compliance with treatment.Tapentadol
is a centrally acting analgesic with 2 mechanisms of action, µ-opioid receptor agonism and
norepinephrine reuptake inhibition, that is available in an extended-release formulation for the
management of chronic pain.
Objective: To review the efficacy of tapentadol extended release (ER) for the management of
moderate to severe chronic nociceptive and neuropathic pain.
Methods: Efficacy results are summarized for four 15-week phase 3 studies of tapentadol ER
in patients with moderate to severe chronic osteoarthritis knee pain (2 studies; ClinicalTrials.gov
Identifiers: NCT00421928 and NCT00486811), low back pain (NCT00449176), and pain related to
diabetic peripheral neuropathy (DPN; NCT00455520); a one-year phase 3 study of tapentadol ER in
patients with moderate to severe chronic osteoarthritis pain or low back pain (NCT00361504); and
a pooled analysis of data from the 15-week studies in patients with osteoarthritis knee pain or low
back pain. A summary of the comparative tolerability for tapentadol ER and the active comparator
used in these studies, oxycodone controlled release (CR), is provided.
Results: Results of these studies showed that tapentadol ER (100 - 250 mg bid) was effective
for the management of moderate to severe chronic osteoarthritis knee pain, low back pain, and
pain related to DPN. Tapentadol ER (100 - 250 mg bid) has been shown to provide comparable
pain relief to oxycodone HCl CR (20 - 50 mg bid) for chronic osteoarthritis knee pain and low back
pain over up to one year of treatment. Tapentadol ER (100 - 250 mg bid) was associated with an
improved tolerability profile, particularly gastrointestinal tolerability profile, and with lower rates of
treatment discontinuations and adverse event-related discontinuations compared with oxycodone
HCl CR (50 - 250 mg bid) over up to one year of treatment in patients with osteoarthritis knee
pain and low back pain.
Limitations: Differences in the design and duration of these phase 3 studies may limit
comparisons of the efficacy results; nevertheless, this summary of efficacy results demonstrates the
broad efficacy of tapentadol ER for different types of nociceptive and neuropathic pain.
Conclusions: Tapentadol ER (100 - 250 mg bid) is effective for moderate to severe osteoarthritis
pain, low back pain, and pain related to DPN and provides efficacy similar to that of oxycodone HCl
CR (20 - 50 mg bid) for patients with osteoarthritis and low back pain. Tapentadol ER treatment
has been associated with better gastrointestinal tolerability and compliance with therapy than
oxycodone CR, which suggests that tapentadol ER may be a better option for the long-term
management of chronic pain.
Key words: Chronic pain, tapentadol ER, osteoarthritis pain, low back pain, diabetic peripheral
neuropathy, oxycodone CR, opioid, analgesic
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Afilalo M, Morlion B. Efficacy of tapentadol ER for managing moderate to severe chronic pain. Pain Physician 2013; 16:27-40. [PMID: 23340531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Chronic non-cancer-related pain affects a large proportion of the adult population and is often difficult to manage effectively. Although opioid analgesics have been used to relieve chronic pain of different etiologies, opioids are associated with a range of side effects that may reduce patient quality of life and lead to reduced compliance with treatment.Tapentadol is a centrally acting analgesic with 2 mechanisms of action, μ-opioid receptor agonism and norepinephrine reuptake inhibition, that is available in an extended-release formulation for the management of chronic pain. OBJECTIVE To review the efficacy of tapentadol extended release (ER) for the management of moderate to severe chronic nociceptive and neuropathic pain. METHODS Efficacy results are summarized for four 15-week phase 3 studies of tapentadol ER in patients with moderate to severe chronic osteoarthritis knee pain (2 studies; ClinicalTrials.gov Identifiers: NCT00421928 and NCT00486811), low back pain (NCT00449176), and pain related to diabetic peripheral neuropathy (DPN; NCT00455520); a one-year phase 3 study of tapentadol ER in patients with moderate to severe chronic osteoarthritis pain or low back pain (NCT00361504); and a pooled analysis of data from the 15-week studies in patients with osteoarthritis knee pain or low back pain. A summary of the comparative tolerability for tapentadol ER and the active comparator used in these studies, oxycodone controlled release (CR), is provided. RESULTS Results of these studies showed that tapentadol ER (100 - 250 mg bid) was effective for the management of moderate to severe chronic osteoarthritis knee pain, low back pain, and pain related to DPN. Tapentadol ER (100 - 250 mg bid) has been shown to provide comparable pain relief to oxycodone HCl CR (20 - 50 mg bid) for chronic osteoarthritis knee pain and low back pain over up to one year of treatment. Tapentadol ER (100 - 250 mg bid) was associated with an improved tolerability profile, particularly gastrointestinal tolerability profile, and with lower rates of treatment discontinuations and adverse event-related discontinuations compared with oxycodone HCl CR (50 - 250 mg bid) over up to one year of treatment in patients with osteoarthritis knee pain and low back pain. LIMITATIONS Differences in the design and duration of these phase 3 studies may limit comparisons of the efficacy results; nevertheless, this summary of efficacy results demonstrates the broad efficacy of tapentadol ER for different types of nociceptive and neuropathic pain. CONCLUSIONS Tapentadol ER (100 - 250 mg bid) is effective for moderate to severe osteoarthritis pain, low back pain, and pain related to DPN and provides efficacy similar to that of oxycodone HCl CR (20 - 50 mg bid) for patients with osteoarthritis and low back pain. Tapentadol ER treatment has been associated with better gastrointestinal tolerability and compliance with therapy than oxycodone CR, which suggests that tapentadol ER may be a better option for the long-term management of chronic pain.
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Nguyen V, Kouz S, Afilalo M, Schampaert E, Tardif J, Nguyen M, Rinfret S, Eisenberg M, Blais C, Montigny M, Dery J, Huynh T. 790 Impact of Beta-Blockers on Long-Term Survival in the Reperfusion Era. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Afilalo M, Stern E, Oughton M. Evaluation and management of seasonal influenza in the emergency department. Emerg Med Clin North Am 2012; 30:271-305, viii. [PMID: 22487108 PMCID: PMC7127178 DOI: 10.1016/j.emc.2011.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Seasonal influenza causes significant morbidity and mortality, primarily due to increased complication rates among the elderly population and patients with chronic diseases. Timely diagnosis of influenza and early recognition of an influenza outbreak or epidemic are key components in preventing influenza-related complications, hospitalizations, and deaths. Emergency departments are the most frequent points of entry for most influenza cases and are well positioned to identify and manage influenza community outbreaks and epidemics. Emergency departments need specific infection control measures to curb the spread of influenza in the Emergency Department and hospital during the influenza season.
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Dery J, De Larochellière R, Cantin B, Nguyen M, Harvey R, Kouz S, Montigny M, Schampaert E, Rinfret S, Afilalo M, Eisenberg M, Kieu A, Lauzon C, Lévesques C, Mansour S, L'Allier P, Tardif J, Huynh T. 232 Type of reperfusion therapy and impact on long-term survival in patients with St-elevation myocardial infarction: Insight from the AMI-Québec Study. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Brożek JL, Akl EA, Compalati E, Kreis J, Terracciano L, Fiocchi A, Ueffing E, Andrews J, Alonso-Coello P, Meerpohl JJ, Lang DM, Jaeschke R, Williams JW, Phillips B, Lethaby A, Bossuyt P, Glasziou P, Helfand M, Watine J, Afilalo M, Welch V, Montedori A, Abraha I, Horvath AR, Bousquet J, Guyatt GH, Schünemann HJ. Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations. Allergy 2011; 66:588-95. [PMID: 21241318 DOI: 10.1111/j.1398-9995.2010.02530.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This is the third and last article in the series about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We describe the factors that influence the strength of recommendations about the use of diagnostic, preventive and therapeutic interventions: the balance of desirable and undesirable consequences, the quality of a body of evidence related to a decision, patients' values and preferences, and considerations of resource use. We provide examples from two recently developed guidelines in the field of allergy that applied the GRADE approach. The main advantages of this approach are the focus on patient important outcomes, explicit consideration of patients' values and preferences, the systematic approach to collecting the evidence, the clear separation of the concepts of quality of evidence and strength of recommendations, and transparent reporting of the decision process. The focus on transparency facilitates understanding and implementation and should empower patients, clinicians and other health care professionals to make informed choices.
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Oughton M, Dascal A, Laporta D, Charest H, Afilalo M, Miller M. Evidence of viremia in 2 cases of severe pandemic influenza A H1N1/09. Diagn Microbiol Infect Dis 2011; 70:213-7. [PMID: 21397429 DOI: 10.1016/j.diagmicrobio.2010.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 12/06/2010] [Accepted: 12/16/2010] [Indexed: 12/01/2022]
Abstract
The recent pandemic of the 2009 pandemic influenza A (H1N1) infrequently caused severe disease. We describe 2 cases of 2009 H1N1 influenza with rapid progression resulting in respiratory failure and need for prolonged intensive care support. Real-time polymerase chain reaction amplification for influenza A (using a Centers for Disease Control and Prevention protocol) and the 2009 H1N1 influenza (using an in-house protocol) was performed on serial respiratory and serum specimens from both patients collected over 3 weeks. Both patients repeatedly demonstrated 2009 H1N1 influenza in respiratory specimens. Evidence of influenza A viremia was also detected in both cases, although it was confirmed as 2009 H1N1 influenza in only one. The presence of viremia in cases of severe 2009 H1N1 influenza has potential prognostic and therapeutic implications. Detection of viremia may be useful as a predictive marker for severe disease. Antiviral agents with low serum levels may be ineffective if administered to patients with influenza viremia.
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Kouz R, Kouz S, Schampaert E, Rinfret S, Tardif JC, Nguyen M, Eisenberg M, Harvey R, Afilalo M, Lauzon C, Dery JP, Mansour S, Huynh T. Effectiveness and safety of glycoprotein IIb/IIIa inhibitors in patients with myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis of observational studies. Int J Cardiol 2010; 153:249-55. [PMID: 20971515 DOI: 10.1016/j.ijcard.2010.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 06/13/2010] [Accepted: 08/08/2010] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Meta-analyses of randomized controlled trials (RCT) showed that glycoprotein IIb/IIIa inhibitors (GPI) are associated with reduced adverse events following primary percutaneous coronary revascularization (PCI). However, the external validity of RCTs is generally limited due to their restricted inclusion of patients. The objective of this study is to evaluate the effectiveness and safety of GPI, as adjuvant therapy for primary PCI in real-life patients with myocardial infarction with ST segment elevation (STEMI) from the general population. METHODS We identified all published peer-reviewed observational studies enrolling STEMI patients who underwent primary PCI. We performed random-effect meta-analyses to determine the association of GPI with major adverse events. RESULTS A total of 11 studies, enrolling 12,253 patients, were retained for this meta-analysis. GPI was associated with approximately 53% reduction in short-term mortality (odds ratio (OR): 0.47, 95% confidence intervals (CI): 0.32-0.68). There was a 62% reduction in long-term mortality associated with GPI (OR: 0.38, 95% CI: 0.30-0.50). GPI was associated with a 62% reduction in 30-day re-infarction (OR: 0.38, 95% CI: 0.24-0.60) and 42% reduction in 30-day repeat PCI (OR: 0.58, 95% CI: 0.36-0.94). A non-significant increase in major bleeding with GPI was observed with an OR of 1.55 (95% CI: 0.92-2.62). CONCLUSIONS GPI is associated with significant reductions in short-term mortality, re-infarction and repeat PCI, long-term mortality and an inconclusive increase in major bleeding. These results provide evidence for the safety and effectiveness of GPI as adjuvant therapy for primary PCI in real-life STEMI patients.
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Afilalo M, Etropolski MS, Kuperwasser B, Kelly K, Okamoto A, Van Hove I, Steup A, Lange B, Rauschkolb C, Haeussler J. Efficacy and Safety of Tapentadol Extended Release Compared with Oxycodone Controlled Release for the Management of Moderate to Severe Chronic Pain Related to Osteoarthritis of the Knee. Clin Drug Investig 2010; 30:489-505. [DOI: 10.2165/11533440-000000000-00000] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Afilalo M, Stegmann JU, Upmalis D. Tapentadol immediate release: a new treatment option for acute pain management. J Pain Res 2010; 3:1-9. [PMID: 21197304 PMCID: PMC3004637 DOI: 10.2147/jpr.s4989] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Indexed: 11/23/2022] Open
Abstract
The undertreatment of acute pain is common in many health care settings. Insufficient management of acute pain may lead to poor patient outcomes and potentially life-threatening complications. Opioids provide relief of moderate to severe acute pain; however, therapy with pure μ-opioid agonists is often limited by the prevalence of side effects, particularly opioid-induced nausea and vomiting. Tapentadol is a novel, centrally acting analgesic with 2 mechanisms of action, μ-opioid receptor agonism and norepinephrine reuptake inhibition. The analgesic effects of tapentadol are independent of metabolic activation and tapentadol has no active metabolites; therefore, in theory, tapentadol may be associated with a low potential for interindividual efficacy variations and drug-drug interactions. Previous phase 3 trials in patients with various types of moderate to severe acute pain have shown that tapentadol immediate release (IR; 50 to 100 mg every 4 to 6 hours) provides analgesia comparable to that provided by the pure μ-opioid agonist comparator, oxycodone HCl IR (10 or 15 mg every 4 to 6 hours), with a lower incidence of nausea, vomiting, and constipation. Findings suggest tapentadol may represent an improved treatment option for acute pain.
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Stang AS, McGillivray D, Bhatt M, Colacone A, Soucy N, Léger R, Afilalo M. Markers of overcrowding in a pediatric emergency department. Acad Emerg Med 2010; 17:151-6. [PMID: 20370744 DOI: 10.1111/j.1553-2712.2009.00631.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this study was to identify markers of overcrowding in pediatric emergency departments (PEDs) according to expert opinion and then to use statistical methods to further explore the underlying construct of overcrowding. METHODS A cross-sectional survey of all PED directors (n = 12) and pediatric emergency medicine fellowship program directors (n = 10) across Canada was conducted to elicit expert opinion on relevant markers of emergency department (ED) crowding. The list of markers was reduced to those specific to the ED for which data could be extracted from one tertiary care PED from an existing computerized patient tracking system. Data representing 2,190 consecutive shifts and 138,361 patient visits were collected between April 2005 and March 2007. Common factor analysis (CFA) was used to determine the underlying factors that best represented overcrowding as determined by markers identified by experts in pediatric emergency medicine RESULTS The main markers of overcrowding identified by the survey included measures of patient volume (25%), ED operational processes (55%), and delays in transferring patients to inpatient beds (13%). Data collected on 41 markers were retained for the CFA. The results of the CFA indicated that the largest portion of variation in the data (48%) was accounted for by markers describing patient volumes and flow through the ED. Measures of admission delays accounted for a smaller proportion of variability (9%). CONCLUSIONS The results suggest that for this tertiary PED, markers of ED operational processes and patient volume may be more relevant for determination of overcrowding than markers reflecting delays in transferring patients to inpatient beds. This study provides a foundation for further research on markers of overcrowding specific to the pediatric setting.
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Weng TH, Chiu WT, Afilalo M, Choy CS, Tselios C, Yip PK, Lam C. A young man presenting with acute encephalopathy, hemiparesis, and headache. J Emerg Med 2009; 43:258-62. [PMID: 19782500 DOI: 10.1016/j.jemermed.2009.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 05/06/2009] [Accepted: 07/23/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Familial hemiplegic migraine (FHM) is a rare type of migraine. Correct diagnosis is challenging for emergency physicians (EPs) due to its variable clinical picture, as well as its lack of diagnostic biological markers. OBJECTIVES To raise awareness among EPs regarding FHM's diverse clinical picture, and to highlight FHM's diagnostic criteria to facilitate an accurate and timely diagnosis of FHM in patients presenting to the emergency department (ED) with indicative symptomatology. CASE REPORT A 24-year-old male student presented to the ED complaining of dizziness, general weakness, and blurred vision that had developed the previous night. The initial physical examination revealed drowsiness, slow speech production, and slight weakness with paresthesia in all limbs. Detailed communication with the patient's aunt revealed that he had experienced several similar attacks since the age of 12 years, and that there was also an extensive family history of the same symptoms. In addition, 2 h after arrival, the patient experienced severe throbbing headache, vomiting, severe dysphasia, and the weakness shifted to the right side. A computed tomography scan of the brain showed no anomalies. He was admitted with a tentative diagnosis of FHM. CONCLUSION A diagnosis of FHM should be considered if the patient's clinical features include headache and weakness, with a family history of similar symptomatology. However, atypical symptoms of FHM may present as recurrent episodes of unexplained encephalopathy. Crucial elements for making an accurate and timely diagnosis of FHM include a detailed knowledge of weakness-related diseases and an ability to consider FHM in the differential diagnosis, as well as obtaining a thorough family history with repeated neurologic assessments.
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Kuperwasser B, Afilalo M, Etropolski MS, Greene A, Haeussler J, Kelly KM, Lange B. Poster 50: Health-related Functional Status Evaluations in Patients with Osteoarthritis Pain Treated With Tapentadol Extended Release. PM R 2009. [DOI: 10.1016/j.pmrj.2009.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Venugopal R, Lang E, Doyle K, Sinclair D, Unger B, Afilalo M. A workshop to improve workflow efficiency in emergency medicine. CAN J EMERG MED 2008; 10:525-531. [PMID: 19000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The emergency department (ED) environment requires physicians to focus on workflow efficiency (WFE) and manage ED throughput. We sought to determine whether an interactive workshop could be designed and favourably perceived by emergency physicians and residents as a means to improve their self-assessed WFE skills. METHODS The authors designed a 4-station workshop to simulate key components of ED throughput. These included resource management in 1) acute care, 2) minor care, 3) charting and 4) communication skills and patient sign-overs. Anonymous surveys were completed after each workshop using 5-point Likert scales and qualitative responses. Qualitative data encompassed participants' past WFE training experiences and perspectives on the current workshop. Data were analyzed using descriptive statistics. The workshops were administered on 2 separate occasions to different groups of physicians. The first occasion was primarily for residents and the second session was only for practising physicians. RESULTS A total of 22 residents and 24 practising physicians participated. Evaluations were completed by 45 of 46 participants. Ratings of "definitely helpful" or "helpful" as noted for each station were received by 37 of 44 respondents for the sign-over and communication station, by 37 of 44 for the minor care station, by 41 of 44 for the acute care station and by 33 of 43 for the effective charting station. Among all participants, 42 of 45 reported that they felt the overall workshop experience was "helpful" or "definitely helpful." CONCLUSION ED management "flow skills" are valued yet undertaught. A flow workshop designed to improve self-perceived WFE skills yields positive evaluations. Teaching this competency in a workshop setting is both feasible and appreciated by participants. Similar efforts should be considered for inclusion in both graduate and continuing medical education curricula.
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Afilalo M, Oh C, Okamoto A, Van Hove I, Stegmann J, Upmalis D. (224) Tapentadol immediate release compared with oxycodone immediate release for the relief of moderate-to-severe pain in patients with end stage joint disease. THE JOURNAL OF PAIN 2008. [DOI: 10.1016/j.jpain.2008.01.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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