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Chishtie J, Sapiro N, Wiebe N, Rabatach L, Lorenzetti D, Leung AA, Rabi D, Quan H, Eastwood CA. Use of Epic Electronic Health Record System for Health Care Research: Scoping Review. J Med Internet Res 2023; 25:e51003. [PMID: 38100185 PMCID: PMC10757236 DOI: 10.2196/51003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) enable health data exchange across interconnected systems from varied settings. Epic is among the 5 leading EHR providers and is the most adopted EHR system across the globe. Despite its global reach, there is a gap in the literature detailing how EHR systems such as Epic have been used for health care research. OBJECTIVE The objective of this scoping review is to synthesize the available literature on use cases of the Epic EHR for research in various areas of clinical and health sciences. METHODS We used established scoping review methods and searched 9 major information repositories, including databases and gray literature sources. To categorize the research data, we developed detailed criteria for 5 major research domains to present the results. RESULTS We present a comprehensive picture of the method types in 5 research domains. A total of 4669 articles were screened by 2 independent reviewers at each stage, while 206 articles were abstracted. Most studies were from the United States, with a sharp increase in volume from the year 2015 onwards. Most articles focused on clinical care, health services research and clinical decision support. Among research designs, most studies used longitudinal designs, followed by interventional studies implemented at single sites in adult populations. Important facilitators and barriers to the use of Epic and EHRs in general were identified. Important lessons to the use of Epic and other EHRs for research purposes were also synthesized. CONCLUSIONS The Epic EHR provides a wide variety of functions that are helpful toward research in several domains, including clinical and population health, quality improvement, and the development of clinical decision support tools. As Epic is reported to be the most globally adopted EHR, researchers can take advantage of its various system features, including pooled data, integration of modules and developing decision support tools. Such research opportunities afforded by the system can contribute to improving quality of care, building health system efficiencies, and conducting population-level studies. Although this review is limited to the Epic EHR system, the larger lessons are generalizable to other EHRs.
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Affiliation(s)
- Jawad Chishtie
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Natalie Sapiro
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
| | - Natalie Wiebe
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | | | - Diane Lorenzetti
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Alexander A Leung
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Doreen Rabi
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Cathy A Eastwood
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Lega IC, Yale JF, Chadha A, Paty B, Roscoe R, Snider M, Steier J, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Senior P, Rabi D, Sherifali D. Hypoglycemia in Adults. Can J Diabetes 2023; 47:548-559. [PMID: 37821214 DOI: 10.1016/j.jcjd.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
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Chambers A, McKay D, Farnsworth K, Morrison AE, Witteman HO, Senior P, Halperin IJ, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Kim J, Lewis J, MacDonald B, Mackay D, Mansell K, Senior P, Rabi D, Sherifali D. Do-It-Yourself Automated Insulin Delivery: A Health-care Practitioner User's Guide. Can J Diabetes 2023; 47:389-397.e8. [PMID: 37532366 DOI: 10.1016/j.jcjd.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
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Halperin IJ, Chambers A, Covello L, Farnsworth K, Morrison AE, Schuklenk U, Witteman HO, Senior P, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Kim J, Lewis J, MacDonald B, Mackay D, Mansell K, Rabi D, Senior P, Sherifali D. Do-It-Yourself Automated Insulin Delivery: A Position Statement. Can J Diabetes 2023; 47:381-388. [PMID: 37532365 DOI: 10.1016/j.jcjd.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
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Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, Melamed OC, Vallis M, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Houlden R, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Rabi D, Sherifali D, Senior P. Diabetes and Mental Health. Can J Diabetes 2023; 47:308-344. [PMID: 37321702 DOI: 10.1016/j.jcjd.2023.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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Cheung AK, Whelton PK, Muntner P, Schutte AE, Moran AE, Williams B, Sarafidis P, Chang TI, Daskalopoulou SS, Flack JM, Jennings G, Juraschek SP, Kreutz R, Mancia G, Nesbitt S, Ordunez P, Padwal R, Persu A, Rabi D, Schlaich MP, Stergiou GS, Tobe SW, Tomaszewski M, Williams KA, Mann JFE. International Consensus on Standardized Clinic Blood Pressure Measurement - A Call to Action. Am J Med 2023; 136:438-445.e1. [PMID: 36621637 PMCID: PMC10159895 DOI: 10.1016/j.amjmed.2022.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Alfred K Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Andrew E Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Bryan Williams
- Department of Medicine, University College London, London, UK
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University, Thessaloniki, Greece
| | - Tara I Chang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University Montreal, Canada
| | - John M Flack
- Department of Internal Medicine, Southern Illinois School of Medicine, Springfield, Ill
| | | | - Stephen P Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | | | | | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Doreen Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, Royal Perth Hospital Research Foundation, University of Western Australia, Perth, WA, Australia
| | - George S Stergiou
- Hypertension Centre STRIDE, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kim A Williams
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Ky
| | - Johannes F E Mann
- KfH Kidney Center, Munich, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
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Osei-Tutu K, Ereyi-Osas W, Sivananthajothy P, Rabi D. L’antiracisme comme compétence fondamentale: repenser le référentiel CanMEDS dans une optique antiraciste. CMAJ 2023; 195:E289-E291. [PMID: 36810221 PMCID: PMC9943576 DOI: 10.1503/cmaj.220521-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- Kannin Osei-Tutu
- Départements de médecine familiale (Osei-Tutu), des sciences de santé communautaires (Ereyi-Osas, Sivananthajothy) et de médecine (Rabi), École de médecine Cumming; Institut O'Brien de santé publique (Osei-Tutu, D. Rabi), Université de Calgary, Calgary, Alb.
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Affiliation(s)
- Kannin Osei-Tutu
- Departments of Family Medicine (Osei-Tutu), Community Health Sciences (Ereyi-Osas, Sivananthajothy) and Medicine (Rabi), Cumming School of Medicine; O'Brien Institute for Public Health (Osei-Tutu, Rabi), University of Calgary, Calgary, Alta.
| | - Whitney Ereyi-Osas
- Departments of Family Medicine (Osei-Tutu), Community Health Sciences (Ereyi-Osas, Sivananthajothy) and Medicine (Rabi), Cumming School of Medicine; O'Brien Institute for Public Health (Osei-Tutu, Rabi), University of Calgary, Calgary, Alta
| | - Priatharsini Sivananthajothy
- Departments of Family Medicine (Osei-Tutu), Community Health Sciences (Ereyi-Osas, Sivananthajothy) and Medicine (Rabi), Cumming School of Medicine; O'Brien Institute for Public Health (Osei-Tutu, Rabi), University of Calgary, Calgary, Alta
| | - Doreen Rabi
- Departments of Family Medicine (Osei-Tutu), Community Health Sciences (Ereyi-Osas, Sivananthajothy) and Medicine (Rabi), Cumming School of Medicine; O'Brien Institute for Public Health (Osei-Tutu, Rabi), University of Calgary, Calgary, Alta
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Babione J, Panjwani D, Murphy S, Kelly J, Van Dyke J, Santana M, Kaufman J, Sargious P, Rabi D. Alignment of patient-centredness definitions with real-life patient and clinician experiences: A qualitative study. Health Expect 2022; 26:419-428. [PMID: 36462198 PMCID: PMC9854319 DOI: 10.1111/hex.13674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION Patient-centred care (PCC) has come to the forefront for many institutions, funding agencies and clinicians, and is integrated into care. Does a disconnect in understanding still exist between patients, healthcare organizations and clinicians in what PCC means and how outstanding issues might be addressed? METHODS We conducted interviews and focus groups with self-reported chronic care patients and clinicians providing care to these patients exploring PCC experiences, expectations and practices. These data were initially analysed using inductive thematic analysis. This paper reports on the findings of a secondary analysis examining the alignment between patients and clinicians on five key predetermined dimensions of PCC. RESULTS Eighteen patients participated, representing a range of chronic conditions. Thirty-eight clinicians participated. One thousand and three hundred patient and 1800 clinician codes were identified and grouped into 5 main topics with 140 unique themes (patients) and 9 main topics with 54 unique themes (clinicians). A total of 166 quotes (patient = 93, clinician = 73) were identified for this PCC definition alignment analysis. Partial or complete alignment of patient and clinician perspectives was seen on most dimensions. Key disconnects were observed in patient involvement, patient empowerment and clinician-patient communication. Only 18% of patients reported experiencing patient-centred communication, whereas 57% of clinicians reported using patient-focused communication approaches. CONCLUSION Overall, study patients and clinicians endorse that many PCC elements occur. This study highlights key differences between patients and clinicians, suggesting persistent challenges. Clinician participants relayed their PCC approaches of informing and educating patients; however, patients often perceive these approaches as didactic, role-diminishing and noncollaborative. Collaborative approaches, such as shared decision-making, hold promise to bridge persistent PCC gaps and should be integrated into medical education programmes. PATIENT OR PUBLIC CONTRIBUTION This project was conceived and executed with a co-design approach wherein patients with chronic conditions who are trained in research (i.e., see descriptions of Patient and Community Engagement Research in the text) were involved in all stages of the research project alongside other researchers on the project team. Healthcare providers were involved as participants and as principal investigators in the project.
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Affiliation(s)
- Julie Babione
- Department of Medicine, Cumming School of Medicine, O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Dilshaan Panjwani
- Department of Medicine, Cumming School of Medicine, O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Sydney Murphy
- Department of Medicine, Cumming School of Medicine, O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Jenny Kelly
- Department of Medicine, Cumming School of Medicine, O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Jessica Van Dyke
- Department of Medicine, Cumming School of Medicine, O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Maria Santana
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Jaime Kaufman
- Department of Medicine, Cumming School of Medicine, O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Peter Sargious
- Department of Medicine, Cumming School of Medicine, W21C Research and Innovation Centre, O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Doreen Rabi
- Department of Medicine, Cumming School of Medicine, W21C Research and Innovation Centre, O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
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MacKay D, Chan C, Dasgupta K, Dominy C, Gagner M, Jin S, Kim J, Little JP, MacDonald B, McInnes N, Reichert S, Bajaj HS, Bajaj HS, Gilbert J, Houlden R, Kim J, MacDonald B, MacKay D, Mansell K, Rabi D, Senior P, Sherifali D. Remission of Type 2 Diabetes: Diabetes Canada Clinical Practice Guidelines Expert Working Group. Can J Diabetes 2022; 46:753-761.e8. [PMID: 36567079 DOI: 10.1016/j.jcjd.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jin S, Bajaj HS, Brazeau AS, Champagne J, MacDonald B, MacKay D, Reichert SM, Vallis M, Bajaj HS, Gilbert J, Houlden R, Kim J, MacDonald B, MacKay D, Mansell K, Rabi D, Senior P, Sherifali D. Remission of Type 2 Diabetes: User's Guide: Diabetes Canada Clinical Practice Guidelines Expert Working Group. Can J Diabetes 2022; 46:762-774. [PMID: 36567080 DOI: 10.1016/j.jcjd.2022.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gosselin Boucher V, Bacon S, Voisard B, Dragomir AI, Gemme C, Larue F, Labbé S, Szczepanik G, Corace K, Campbell T, Vallis M, Garber G, Rouleau C, Diodati JG, Rabi D, Sultan S, Lavoie K. Assessing Physician's Motivational Communication Skills: 5-Step Mixed Methods Development Study of the Motivational Communication Competency Assessment Test. JMIR Med Educ 2022; 8:e31489. [PMID: 35749167 PMCID: PMC9270716 DOI: 10.2196/31489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/25/2022] [Accepted: 02/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Training physicians to provide effective behavior change counseling using approaches such as motivational communication (MC) is an important aspect of noncommunicable chronic disease prevention and management. However, existing evaluation tools for MC skills are complex, invasive, time consuming, and impractical for use within the medical context. OBJECTIVE The objective of this study is to develop and validate a short web-based tool for evaluating health care provider (HCP) skills in MC-the Motivational Communication Competency Assessment Test (MC-CAT). METHODS Between 2016 and 2021, starting with a set of 11 previously identified core MC competencies and using a 5-step, mixed methods, integrated knowledge translation approach, the MC-CAT was created by developing a series of 4 base cases and a scoring scheme, validating the base cases and scoring scheme with international experts, creating 3 alternative versions of the 4 base cases (to create a bank of 16 cases, 4 of each type of base case) and translating the cases into French, integrating the cases into the web-based MC-CAT platform, and conducting initial internal validity assessments with university health students. RESULTS The MC-CAT assesses MC competency in 20 minutes by presenting HCPs with 4 out of a possible 16 cases (randomly selected and ordered) addressing various behavioral targets (eg, smoking, physical activity, diet, and medication adherence). Individual and global competency scores were calculated automatically for the 11 competency items across the 4 cases, providing automatic scores out of 100. From the factorial analysis of variance for the difference in competency and ranking scores, no significant differences were identified between the different case versions across individual and global competency (P=.26 to P=.97) and ranking scores (P=.24 to P=.89). The initial tests of internal consistency for rank order among the 24 student participants were in the acceptable range (α=.78). CONCLUSIONS The results suggest that MC-CAT is an internally valid tool to facilitate the evaluation of MC competencies among HCPs and is ready to undergo comprehensive psychometric property analyses with a national sample of health care providers. Once psychometric property assessments have been completed, this tool is expected to facilitate the assessment of MC skills among HCPs, skills that will better support patients in adopting healthier lifestyles, which will significantly reduce the personal, social, and economic burdens of noncommunicable chronic diseases.
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Affiliation(s)
- Vincent Gosselin Boucher
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Simon Bacon
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Brigitte Voisard
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Anda I Dragomir
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Claudia Gemme
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Florent Larue
- Faculty of Medicine of Montpellier, Montpellier, France
| | - Sara Labbé
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Geneviève Szczepanik
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
| | - Kimberly Corace
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
| | - Tavis Campbell
- Total Cardiology Cardiac Rehabilitation, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Gary Garber
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Codie Rouleau
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Jean G Diodati
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Serge Sultan
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Kim Lavoie
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
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Mele BS, Holroyd-Leduc JM, Harasym P, Dumanski SM, Fiest K, Graham ID, Nerenberg K, Norris C, Parsons Leigh J, Pilote L, Pruden H, Raparelli V, Rabi D, Ruzycki SM, Somayaji R, Stelfox HT, Ahmed SB. Healthcare workers' perception of gender and work roles during the COVID-19 pandemic: a mixed-methods study. BMJ Open 2021; 11:e056434. [PMID: 35139035 PMCID: PMC8718936 DOI: 10.1136/bmjopen-2021-056434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES A high functioning healthcare workforce is a key priority during the COVID-19 pandemic. We sought to determine how work and mental health for healthcare workers changed during the COVID-19 pandemic in a universal healthcare system, stratified by gender factors. DESIGN A mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey (7 May-15 July 2020). Phase 2 was semistructured interviews offered to all respondents upon survey completion to describe how experiences may have differed by gender identity, roles and relations. SETTING National universal healthcare system (Canada). PARTICIPANTS 2058 Canadian healthcare worker survey respondents (87% women, 11% men, 1% transgender or Two-Spirit), including 783 health professionals, 673 allied health professionals, 557 health support staff. Of the 63 unique healthcare worker types reported, registered nurses (11.5%), physicians (9.9%) and pharmacists (4.5%) were most common. Forty-six healthcare workers were interviewed. MAIN OUTCOME MEASURES Reported pandemic-induced changes to occupational leadership roles and responsibilities, household and caregiving responsibilities, and anxiety levels by gender identity. RESULTS Men (19.8%) were more likely to hold pandemic leadership roles compared with women (13.4%). Women (57.5%) were more likely to report increased domestic responsibilities than men (45%). Women and those with dependents under the age of 10 years reported the greatest levels of anxiety during the pandemic. Interviews with healthcare workers further revealed a perceived imbalance in leadership opportunities based on gender identity, a lack of workplace supports disproportionately affecting women and an increase in domestic responsibilities influenced by gender roles. CONCLUSIONS The COVID-19 pandemic response has important gendered effects on the healthcare workforce. Healthcare workers are central to effective pandemic control, highlighting an urgent need for a gender-transformative pandemic response strategy.
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Affiliation(s)
- Bria Scriven Mele
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna M Holroyd-Leduc
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Patricia Harasym
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M Dumanski
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Kirsten Fiest
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Ian D Graham
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kara Nerenberg
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Louise Pilote
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Harlan Pruden
- Faculty of Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Valeria Raparelli
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Doreen Rabi
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
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14
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Watson KE, Al Hamarneh YN, Rabi D, Daskalopoulou SS, Tsuyuki RT. Reply. Can Pharm J (Ott) 2021; 154:139. [PMID: 34104263 DOI: 10.1177/17151635211005764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Lunney M, Thomas C, Rabi D, Bello AK, Tonelli M. Video Visits Using the Zoom for Healthcare Platform for People Receiving Maintenance Hemodialysis and Nephrologists: A Feasibility Study in Alberta, Canada. Can J Kidney Health Dis 2021; 8:20543581211008698. [PMID: 33996106 PMCID: PMC8082995 DOI: 10.1177/20543581211008698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Demand for virtual visits (an online synchronous medical appointment between a health care provider and patient) is increasing due to the COVID-19 pandemic. There may be additional benefits of virtual visits as they appear to be convenient and potentially cost-saving to patients. People receiving maintenance hemodialysis require ongoing care from their nephrologist and may benefit from virtual visits; however, the optimal model for a virtual kidney clinic is unknown. Objective: To codesign and assess the feasibility of a virtual (video) kidney clinic model with clinic staff, nephrologists, and patients receiving maintenance hemodialysis, to be used for routine follow-up visits. Design: Mixed-methods study. Setting: Two main kidney clinics in central Calgary, Alberta. Participants: Adults with kidney failure receiving maintenance hemodialysis, nephrologists, and clinic staff. Methods: First, we individually interviewed clinic staff and nephrologists to assess the needs of the clinic to deliver virtual visits. Then, we used participant observation with patients and nephrologists to codesign the virtual visit model. Finally, we used structured surveys to evaluate the patients’ and nephrologists’ experiences when using the virtual model. Results: Eight video visits (8 patients; 6 nephrologists) were scheduled between October 2019 and February 2020 and 7 were successfully completed. Among completed visits, all participants reported high satisfaction with the service, were willing to use it again, and would recommend it to others. Three main themes were identified with respect to factors influencing visit success: IT infrastructure, administration, and process. Limitations: Patients received training on how to use the videoconference platform by the PhD student, whom also set up the technical components of the visit for the nephrologist. This may have overestimated the feasibility of virtual visits if this level of support is not available in future. Second, interviews were not audio-recorded and thematic analysis relied on field notes. Conclusions: Video visits for routine follow-up care between people receiving hemodialysis and nephrologists were acceptable to patients and nephrologists. Video visits appear to be feasible if clinics are equipped with appropriate equipment and IT infrastructure, physicians are remunerated appropriately, and patients receive training on how to use software as needed.
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Affiliation(s)
- Meaghan Lunney
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Chandra Thomas
- Department of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Aminu K Bello
- Division of Nephrology & Immunology, University of Alberta, Edmonton, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
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Dragomir AI, Boucher VG, Bacon SL, Gemme C, Szczepanik G, Corace K, Campbell TS, Vallis MT, Garber G, Rouleau C, Rabi D, Diodati JG, Ghali W, Lavoie KL. An international Delphi consensus study to define motivational communication in the context of developing a training program for physicians. Transl Behav Med 2021; 11:642-652. [PMID: 32145022 PMCID: PMC7963284 DOI: 10.1093/tbm/ibaa015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Poor health behaviors (e.g., smoking, poor diet, and physical inactivity) are major risk factors for noncommunicable chronic diseases (NCDs). Evidence supporting traditional advice-giving approaches to promote behavior change is weak or short lived. Training physicians to improve their behavior change counseling/communication skills is important, yet the evidence for the efficacy and acceptability of existing training programs is lacking and there is little consensus on the core competencies that physicians should master in the context of NCD management. The purpose of this study is to generate an acceptable, evidence-based, stakeholder-informed list of the core communication competencies that physicians should master in the context of NCD management. Using a modified Delphi process for consensus achievement, international behavior change experts, physicians, and allied health care professionals completed four phases of research, including eight rounds of online surveys and in-person meetings over 2 years (n = 13-17 participated in Phases I, III, and IV and n = 39-46 in Phase II). Eleven core communication competencies were identified: reflective listening, expressing empathy, demonstrating acceptance, tolerance, and respect, responding to resistance, (not) negatively judging or blaming, (not) expressing hostility or impatience, eliciting "change-talk"/evocation, (not) being argumentative or confrontational, setting goals, being collaborative, and providing information neutrally. These competencies were used to define a unified approach for conducting behavior change counseling in medical settings: Motivational Communication. The results may be used to inform and standardize physician training in behavior change counseling and communication skills to reduce morbidity and mortality related to poor health behaviors in the context of NCD prevention and management.
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Affiliation(s)
- Anda I Dragomir
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Vincent Gosselin Boucher
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada
| | - Claudia Gemme
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Geneviève Szczepanik
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - Kimberly Corace
- Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Tavis S Campbell
- TotalCardiology Rehabilitation, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary Canada
| | - Michael T Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Gary Garber
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Public Health Ontario, Ontario Agency for Health Protection and Promotion, Toronto, Canada
| | - Codie Rouleau
- TotalCardiology Rehabilitation, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Jean G Diodati
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - William Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
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Watson KE, Al Hamarneh YN, Rabi D, Daskalopoulou SS, Tsuyuki RT. Hypertension Canada's 2020 hypertension guidelines for pharmacists: An update. Can Pharm J (Ott) 2021; 154:19-25. [PMID: 33598055 DOI: 10.1177/1715163520975809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kaitlyn E Watson
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Yazid N Al Hamarneh
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Doreen Rabi
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Alberta
| | | | - Ross T Tsuyuki
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Alberta
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18
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Liu X, Bertazzon S, Villeneuve PJ, Johnson M, Stieb D, Coward S, Tanyingoh D, Windsor JW, Underwood F, Hill MD, Rabi D, Ghali WA, Wilton SB, James MT, Graham M, McMurtry MS, Kaplan GG. Temporal and spatial effect of air pollution on hospital admissions for myocardial infarction: a case-crossover study. CMAJ Open 2020; 8:E619-E626. [PMID: 33037069 PMCID: PMC7567508 DOI: 10.9778/cmajo.20190160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In studies showing associations between ambient air pollution and myocardial infarction (MI), data have been lacking on the inherent spatial variability of air pollution. The aim of this study was to determine whether the long-term spatial distribution of air pollution influences short-term temporal associations between air pollution and admission to hospital for MI. METHODS We identified adults living in Calgary who were admitted to hospital for an MI between 2004 and 2012. We evaluated associations between short-term exposure to air pollution (ozone [O3], nitrogen dioxide [NO2], sulfur dioxide [SO2], carbon monoxide [CO], particulate matter < 10 μm in diameter [PM10] and particulate matter < 2.5 μm in diameter [PM2.5]), and hospital admissions for MI using a time-stratified, case-crossover study design. Air Quality Health Index (AQHI) scores were calculated from a composition of O3, NO2 and PM2.5. Conditional logistic regression models were stratified by low, medium and high levels of neighbourhood NO2 concentrations derived from land use regression models; results of these analyses are presented as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS From 2004 to 2012, 6142 MIs were recorded in Calgary. Individuals living in neighbourhoods with higher long-term air pollution concentrations were more likely to be admitted to hospital for MI after short-term elevations in air pollution (e.g., 5-day average NO2: OR 1.20, 95% CI 1.03-1.40, per interquartile range [IQR]) as compared with regions with lower air pollution (e.g., 5-day average NO2: OR 0.90, 95% CI 0.78-1.04, per IQR). In high NO2 tertiles, the AQHI score was associated with MI (e.g., 5-day average OR 1.13, 95% CI 1.02-1.24, per IQR; 3-day average OR 1.13, 95% CI 1.04-1.23, per IQR). INTERPRETATION Our results show that the effect of air pollution on hospital admissions for MI was stronger in areas with higher NO2 concentrations than that in areas with lower NO2 concentrations. Individuals living in neighbourhoods with higher traffic-related pollution should be advised of the health risks and be attentive to special air quality warnings.
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Affiliation(s)
- Xiaoxiao Liu
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Stefania Bertazzon
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Paul J Villeneuve
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Markey Johnson
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Dave Stieb
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Stephanie Coward
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Divine Tanyingoh
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Joseph W Windsor
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Fox Underwood
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Michael D Hill
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Doreen Rabi
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - William A Ghali
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Stephen B Wilton
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Matthew T James
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Michelle Graham
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - M Sean McMurtry
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta
| | - Gilaad G Kaplan
- Departments of Community Health Sciences (Liu, Coward, Tanyingoh, Windsor, Underwood, Rabi, Ghali, James, Kaplan) and of Geography (Liu, Bertazzon), University of Calgary, Calgary, Alta.; Department of History, Archaeology, Geography, Fine & Performing Arts (Bertazzon), University of Florence, Florence, Italy; School of Mathematics and Statistics and Department of Neuroscience, and CHAIM Research Centre (Villeneuve), Carleton University, Ottawa, Ont.; Air Health Science Division (Johnson), Health Canada, Ottawa, Ont.; Environmental Health Science and Research Bureau (Stieb), Health Canada, Vancouver, BC; Departments of Medicine (Coward, Tanyingoh, Windsor, Underwood, Hill, Rabi, Wilton, James, Kaplan); of Clinical Neurosciences (Hill, Ghali); and of Cardiac Sciences (Wilton), University of Calgary, Calgary, Alta.; Department of Medicine (Graham, McMurtry), University of Alberta; Mazankowski Alberta Heart Institute (McMurtry), Edmonton, Alta.
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19
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Gasbarrino K, Labos C, Mastropietro V, Hales L, Khan N, Rabi D, Daskalopoulou SS. Sex differences in the efficacy of antihypertensive treatment in preventing cardiovascular outcomes and reducing blood pressure: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e036128. [PMID: 32169929 PMCID: PMC7069325 DOI: 10.1136/bmjopen-2019-036128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hypertension is a leading cause of mortality worldwide and its prevalence is expected to rise over the next decade. Sex differences exist in the epidemiology and pathophysiology of hypertension. It is well established that antihypertensive treatment can significantly reduce the risk for stroke and other cardiovascular disease events. However, it remains unclear whether this effect is dependent on sex. In this protocol, we outlined a systematic review and meta-analysis to evaluate the effects of antihypertensive therapy in (1) reducing blood pressure and (2) preventing cardiovascular morbidity and mortality outcomes for each sex separately. METHODS AND ANALYSIS The following electronic databases will be searched: Medline, Embase, The Cochrane Library, PubMed, Cumulative Index of Nursing and Allied Health Literature Plus, Web of Science, grey literature (Google Scholar) and several trial registries. Search strategies will be designed to identify human adult (≥18) randomised (and non-randomised) controlled trials, prospective and retrospective cohort studies, and case-control studies concerning 'sex-specific differences associated with the efficacy of antihypertensive treatment'. A preliminary search strategy was developed for Medline (1946-16 September 2019). Two investigators will independently review each article included in the final analysis. Primary outcomes investigated are cardiovascular morbidity and mortality and systolic and diastolic blood pressure. Pooled analyses will be conducted using the random-effects model. Publication bias will be assessed by visual inspection of funnel plots and by Begg's and Egger's statistical tests. Between-studies heterogeneity will be measured using the I2 test (p<0.10). Sources of heterogeneity will be explored by sensitivity, subgroup and metaregression analyses. ETHICS AND DISSEMINATION This is the first meta-analysis that will comprehensively compare the efficacy of antihypertensive treatment regimens between men and women. Findings will be shared through scientific conferences and societies, social media and consumer advocacy groups. Results will be used to inform the current guidelines for management of hypertension in men and women by demonstrating the importance of implementing sex-specific recommendations. Ethical considerations are not applicable for this protocol.
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Affiliation(s)
- Karina Gasbarrino
- Medicine, Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | | | - Lindsay Hales
- Medical Library, McGill University Health Centre, Montreal, Canada
| | - Nadia Khan
- Medicine, The University of British Columbia, Vancouver, Canada
| | - Doreen Rabi
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Canada
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20
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LUNNEY M, Finlay J, Rabi D, Thomas C, Bello A, Tonelli M. SUN-185 eVisits in rural hemodialysis care: stakeholder perspectives on possible impact, optimal design, and usability. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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21
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Khokhar B, Quan H, Kaplan GG, Butalia S, Rabi D. Exploring novel diabetes surveillance methods: a comparison of administrative, laboratory and pharmacy data case definitions using THIN. J Public Health (Oxf) 2019; 40:652-658. [PMID: 28977382 DOI: 10.1093/pubmed/fdx096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 01/17/2023] Open
Abstract
Background The objective of this study was to identify patients with diabetes in a comprehensive primary care electronic medical records database using a number of different case definitions (clinical, pharmacy, laboratory definitions and a combination thereof) and understand the differences in patient populations being captured by each definition. Methods Data for this population-based retrospective cohort study was obtained from The Health Information Network (THIN). THIN is a longitudinal, primary care medical records database of over 9 million patients in UK. Primary outcome was a diagnosis of diabetes, defined by the presence of a diabetes read code, or an abnormal laboratory result, or a prescription for an Oral Anti-diabetic drug or insulin. A 2-year washout period was applied prior to the index of diabetes to avoid inclusion of prevalent cases for each case definition. Results This study demonstrated that different case definitions of diabetes identify different sub-populations of patients. When the cohorts were observed based on any measure of central tendency, each of the cohorts were reasonably comparable to each other. However, the distribution of each of the cohorts when grouped by age categories and sex, reveal differences. For example, using pharmacy case definition results in a bimodal distribution among women, one between 1-19 year and 35-39 age categories, and then again between 60-64 and 85 years-however, the histogram becomes more normally distributed when metformin was removed from the case definition. Conclusion Our results suggest that clinical, pharmacy, laboratory case definitions identify different sub-populations and using multiple case definitions is likely required to optimally identify the entire diabetes population within THIN. Our study also suggests that age and sex of patients may affect the indexing of diabetes in THIN and is critical to better understand these variations.
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Affiliation(s)
- Bushra Khokhar
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Sonia Butalia
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,Division of Endocrinology, Department of Medicine, 1820 Richmond Road SW, Calgary, Alberta, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,Division of Endocrinology, Department of Medicine, 1820 Richmond Road SW, Calgary, Alberta, Canada
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22
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Khan N, Bell A, Berg A, Campbell N, Kaczorowski J, Rabi D, Schiffrin EL, Tsuyuki RT. A call to action to implement prescribing authority to pharmacists for hypertension management. Can Pharm J (Ott) 2019; 152:285-287. [PMID: 31534583 DOI: 10.1177/1715163519866144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Logan LM, Jensen SK, Singh N, Peplowski MA, Rabi D, Yipp BG, Hollenberg MD, Beck PL. Proceedings from the 8th Annual University of Calgary Leaders in Medicine Research Symposium. ACTA ACUST UNITED AC 2019; 41:E165-E185. [PMID: 30737977 DOI: 10.25011/cim.v41i4.32220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 11/03/2022]
Abstract
On November 14, 2016, the Leaders in Medicine (LIM) program at the Cumming School of Medicine, University of Calgary hosted its 8th Annual Research Symposium. Professor Stephen Sawcer, Professor of Neurological Genetics at the University of Cambridge and an Honorary Consultant Neurologist at Addenbrooke's Hospital, was the keynote speaker and presented a lecture entitled, "Multiple sclerosis genetics - prospects and pitfalls". This was not only a cutting edge address on genetics but also a thoughtful overview on Dr. Sawcer's career and career choices. We were extremely grateful for the opportunity to have Dr. Sawcer participate in our annual symposium.
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Affiliation(s)
- Lindsey M Logan
- Cumming School of Medicine University of Calgary, Calgary AB.
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24
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Lucko AM, Doktorchik C, Woodward M, Cogswell M, Neal B, Rabi D, Anderson C, He FJ, MacGregor GA, L'Abbe M, Arcand J, Whelton PK, McLean R, Campbell NRC. Percentage of ingested sodium excreted in 24-hour urine collections: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2018; 20:1220-1229. [PMID: 30101426 DOI: 10.1111/jch.13353] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/28/2018] [Accepted: 06/16/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Aaron M Lucko
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, AL, Canada
| | - Chelsea Doktorchik
- Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AL, Canada
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK.,George Institute for Global Health, Newtown, New South Wales, Australia
| | - Mary Cogswell
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Bruce Neal
- George Institute for Global Health, Newtown, New South Wales, Australia
| | - Doreen Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Anderson
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mary L'Abbe
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Paul K Whelton
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Rachael McLean
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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25
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Albrecht L, Wood PW, Fradette M, McAlister FA, Rabi D, Boulanger P, Padwal R. Usability and Acceptability of a Home Blood Pressure Telemonitoring Device Among Community-Dwelling Senior Citizens With Hypertension: Qualitative Study. JMIR Aging 2018; 1:e10975. [PMID: 31518242 PMCID: PMC6716488 DOI: 10.2196/10975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hypertension is a major cause of cardiovascular disease in older individuals. To ensure that blood pressure (BP) levels are within the optimal range, accurate BP monitoring is required. Contemporary hypertension clinical practice guidelines strongly endorse the use of home BP measurement as a preferred method of BP monitoring for individuals with hypertension. The benefits of home BP monitoring may be optimized when measurements are telemonitored to care providers; however, this may be challenging for older individuals with less technological capabilities. OBJECTIVE The objective of this qualitative study was to examine the usability and acceptability of a home BP telemonitoring device among senior citizens. METHODS We conducted a qualitative descriptive study. Following a 1-week period of device use, individual, semistructured interviews were conducted. Interview audio recordings were anonymized, de-identified, and transcribed verbatim. We performed thematic analysis on interview transcripts. RESULTS Seven senior citizens participated in the usability testing of the home BP telemonitoring device. Participants comprised females (n=4) and males (n=3) with a mean age of 86 years (range, 70-95 years). Overall, eight main themes were identified from the interviews: (1) positive features of the device; (2) difficulties or problems with the device; (3) device was simple to use; (4) comments about wireless capability and components; (5) would recommend device to someone else; (6) would use device in future; (7) suggestions for improving the device; and (8) assistance to use device. Additional subthemes were also identified. CONCLUSIONS Overall, the home BP telemonitoring device had very good usability and acceptability among community-dwelling senior citizens with hypertension. To enhance its long-term use, few improvements were noted that may mitigate some of the relatively minor challenges encountered by the target population.
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Affiliation(s)
- Lauren Albrecht
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Peter W Wood
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Miriam Fradette
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Doreen Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Pierre Boulanger
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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26
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Lunney M, Lee R, Tang K, Wiebe N, Bello AK, Thomas C, Rabi D, Tonelli M, James MT. Impact of Telehealth Interventions on Processes and Quality of Care for Patients With ESRD. Am J Kidney Dis 2018; 72:592-600. [PMID: 29699884 DOI: 10.1053/j.ajkd.2018.02.353] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/11/2018] [Indexed: 12/11/2022]
Abstract
Caring for patients with end-stage renal disease (ESRD) requiring dialysis is intensive and expensive. Telehealth may improve the access and efficiency of ESRD care. For this perspective, we systematically reviewed studies that examined the effectiveness of telehealth versus or in addition to usual care for ESRD management. 10 studies were identified, including 7 randomized trials and 3 cohort studies. Study populations, modes of delivery (including telephone, telemetry, or videoconferencing), and the outcomes evaluated varied substantially between studies. Two studies examined telehealth interventions versus standard ESRD care and demonstrated mixed results on processes of care, no differences in laboratory surrogate markers of ESRD care, and reduced or similar rates of hospitalization. Eight studies evaluated the addition of telehealth to usual care and demonstrated no significant improvements in processes of care or surrogate laboratory measures, variable impacts on hospitalization rates, and mixed impacts on some domains of quality of life, including improvement in mental health. Although potential benefits of telehealth in ESRD care have been reported, optimal designs for delivery and elements of care that may be improved through telehealth remain uncertain.
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Affiliation(s)
- Meaghan Lunney
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Raymond Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Karen Tang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Chandra Thomas
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Marcello Tonelli
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Matthew T James
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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27
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Winston K, Grendarova P, Rabi D. Video-based patient decision aids: A scoping review. Patient Educ Couns 2018; 101:558-578. [PMID: 29102063 DOI: 10.1016/j.pec.2017.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/06/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends. METHOD The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted. RESULTS 488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase. CONCLUSION Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations. PRACTICE IMPLICATIONS Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids.
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Affiliation(s)
- Karin Winston
- Alberta Children's Hospital, 2800 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada.
| | - Petra Grendarova
- University of Calgary, Division of Radiation Oncology, Calgary, Canada
| | - Doreen Rabi
- University of Calgary, Department of Medicine, Calgary, Canada
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28
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Walker RL, Ghali WA, Chen G, Khalsa TK, Mangat BK, Campbell NRC, Dixon E, Rabi D, Jette N, Dhanoa R, Quan H. ACSC Indicator: testing reliability for hypertension. BMC Med Inform Decis Mak 2017. [PMID: 28651587 PMCID: PMC5485699 DOI: 10.1186/s12911-017-0487-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. The purpose of this study was to test the inter-physician reliability of judgments of avoidable hospitalizations for one ACSC, uncomplicated hypertension, derived from medical chart review. METHODS We applied the Canadian Institute for Health Information's case definition to obtain a random sample of patients who had an ACSC hospitalization for uncomplicated hypertension in Calgary, Alberta. Medical chart review was conducted by three experienced internal medicine specialists. Implicit methods were used to judge avoidability of hospitalization using a validated 5-point scale. RESULTS There was poor agreement among three physicians raters when judging the avoidability of 82 ACSC hospitalizations for uncomplicated hypertension (κ = 0.092). The κ also remained low when assessing agreement between raters 1 and 3 (κ = 0.092), but the κ was lower (less than chance agreement) for raters 1 and 2 (κ = -0.119) and raters 2 and 3 (κ = -0.008). When the 5-point scale was dichotomized, there was fair agreement among three raters (κ = 0.217). The proportion of ACSC hospitalizations for uncomplicated hypertension that were rated as avoidable was 32.9%, 6.1% and 26.8% for raters 1, 2, and 3, respectively. CONCLUSIONS This study found a low proportion of ACSC hospitalization were rated as avoidable, with poor to fair agreement of judgment between physician raters. This suggests that the validity and utility of this health indicator is questionable. It points to a need to abandon the use of ACSC entirely; or alternatively to work on the development of explicit criteria for judging avoidability of hospitalization for ACSC such as hypertension.
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Affiliation(s)
- Robin L Walker
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
| | - William A Ghali
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
| | - Guanmin Chen
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Tej K Khalsa
- Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Norm R C Campbell
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Department of Medicine, University of Calgary, Calgary, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Canada
| | - Elijah Dixon
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
| | - Nathalie Jette
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Robyn Dhanoa
- Faculty of Nursing, University of Calgary, Calgary, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
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Tang K, Quan H, Rabi D. Measuring medication adherence: standardized definitions are needed to allow for comparisons. Int J Popul Data Sci 2017. [PMCID: PMC8362456 DOI: 10.23889/ijpds.v1i1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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30
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Lithgow K, Edwards A, Rabi D. Smartphone App Use for Diabetes Management: Evaluating Patient Perspectives. JMIR Diabetes 2017; 2:e2. [PMID: 30291051 PMCID: PMC6238843 DOI: 10.2196/diabetes.6643] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/20/2016] [Accepted: 12/22/2016] [Indexed: 11/15/2022] Open
Abstract
Background Finding novel ways to engage patients in chronic disease management has led to increased interest in the potential of mobile health technologies for the management of diabetes. There is currently a wealth of smartphone apps for diabetes management that are available for free download or purchase. However, the usability and desirability of these apps has not been extensively studied. These are important considerations, as these apps must be accepted by the patient population at a practical level if they are to be utilized. Objective The purpose of this study was to gain insight into patient experiences related to the use of smartphone apps for the management of type 1 diabetes. Methods Adults with type 1 diabetes who had previously (or currently) used apps to manage their diabetes were eligible to participate. Participants (n=12) completed a questionnaire in which they were required to list the names of preferred apps and indicate which app functions they had used. Participants were given the opportunity to comment on app functions that they perceived to be missing from the current technology. Participants were also asked whether they had previously paid for an app and whether they would be willing to do so. Results MyFitnessPal and iBGStar were the apps most commonly listed as the best available on the market. Blood glucose tracking, carbohydrate counting, and activity tracking were the most commonly used features. Ten participants fulfilled all eligibility criteria, and indicated that they had not encountered any one app that included all of the functions that they had used. The ability to synchronize an app with a glucometer or insulin pump was the most common function that participants stated was missing from current app technology. One participant had previously paid for a diabetes-related app and the other 9 participants indicated that they would be willing to pay. Conclusions Despite dissatisfaction with the currently available apps, there is interest in using these tools for diabetes management. Adapting existing technology to better meet the needs of this patient population may allow these apps to become more widely utilized.
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Affiliation(s)
- Kirstie Lithgow
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alun Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Doreen Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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31
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Rannelli LA, MacRae JM, Mann MC, Ramesh S, Hemmelgarn BR, Rabi D, Sola DY, Ahmed SB. Sex differences in associations between insulin resistance, heart rate variability, and arterial stiffness in healthy women and men: a physiology study. Can J Physiol Pharmacol 2016; 95:349-355. [PMID: 28099042 DOI: 10.1139/cjpp-2016-0122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diabetes confers greater cardiovascular risk to women than to men. Whether insulin-resistance-mediated risk extends to the healthy population is unknown. Measures of insulin resistance (fasting insulin, homeostatic model assessment, hemoglobin A1c, quantitative insulin sensitivity check index, glucose) were determined in 48 (56% female) healthy subjects. Heart rate variability (HRV) was calculated by spectral power analysis and arterial stiffness was determined using noninvasive applanation tonometry. Both were measured at baseline and in response to angiotensin II infusion. In women, there was a non-statistically significant trend towards increasing insulin resistance being associated with an overall unfavourable HRV response and increased arterial stiffness to the stressor, while men demonstrated the opposite response. Significant differences in the associations between insulin resistance and cardiovascular physiological profile exist between healthy women and men. Further studies investigating the sex differences in the pathophysiology of insulin resistance in cardiovascular disease are warranted.
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Affiliation(s)
- Luke Anthony Rannelli
- a Faculty of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada
| | - Jennifer M MacRae
- a Faculty of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada.,b Alberta Kidney Disease Network, 1403-29th St. NW, C210, Calgary, AB T2N 2T9, Canada.,c Libin Cardiovascular Institute of Alberta, 1403-29th St. NW, Calgary, AB T2N 2T9, Canada
| | - Michelle C Mann
- a Faculty of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada.,c Libin Cardiovascular Institute of Alberta, 1403-29th St. NW, Calgary, AB T2N 2T9, Canada
| | - Sharanya Ramesh
- a Faculty of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada.,c Libin Cardiovascular Institute of Alberta, 1403-29th St. NW, Calgary, AB T2N 2T9, Canada
| | - Brenda R Hemmelgarn
- a Faculty of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada.,b Alberta Kidney Disease Network, 1403-29th St. NW, C210, Calgary, AB T2N 2T9, Canada.,c Libin Cardiovascular Institute of Alberta, 1403-29th St. NW, Calgary, AB T2N 2T9, Canada.,d Institute for Public Health, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada
| | - Doreen Rabi
- a Faculty of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada.,c Libin Cardiovascular Institute of Alberta, 1403-29th St. NW, Calgary, AB T2N 2T9, Canada.,d Institute for Public Health, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada
| | - Darlene Y Sola
- b Alberta Kidney Disease Network, 1403-29th St. NW, C210, Calgary, AB T2N 2T9, Canada.,c Libin Cardiovascular Institute of Alberta, 1403-29th St. NW, Calgary, AB T2N 2T9, Canada
| | - Sofia B Ahmed
- a Faculty of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada.,b Alberta Kidney Disease Network, 1403-29th St. NW, C210, Calgary, AB T2N 2T9, Canada.,c Libin Cardiovascular Institute of Alberta, 1403-29th St. NW, Calgary, AB T2N 2T9, Canada
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McBrien KA, Manns BJ, Hemmelgarn BR, Weaver R, Edwards AL, Ivers N, Rabi D, Lewanczuk R, Braun T, Naugler C, Campbell D, Saad N, Tonelli M. The association between sociodemographic and clinical characteristics and poor glycaemic control: a longitudinal cohort study. Diabet Med 2016; 33:1499-1507. [PMID: 26526088 DOI: 10.1111/dme.13023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
AIMS People with diabetes and poor glycaemic control are at higher risk of diabetes-related complications and incur higher healthcare costs. An understanding of the sociodemographic and clinical characteristics associated with poor glycaemic control is needed to overcome the barriers to achieving care goals in this population. METHODS We used linked administrative and laboratory data to create a provincial cohort of adults with prevalent diabetes, and a measure of HbA1c that occurred at least 1 year following the date of diagnosis. The primary outcome was poor glycaemic control, defined as at least two consecutive HbA1c measurements ≥ 86 mmol/mol (10%), not including the index measurement, spanning a minimum of 90 days. We used multivariable Cox proportional hazards models to evaluate the association between baseline sociodemographic and clinical factors and poor glycaemic control. RESULTS In this population-based cohort of 169 890 people, younger age was significantly associated with sustained poor glycaemic control, with a hazard ratio (HR) of 3.08, 95% CI (2.79-3.39) for age 18-39 years compared with age ≥ 75 years. Longer duration of diabetes, First Nations status, lower neighbourhood income quintile, history of substance abuse, mood disorder, cardiovascular disease, albuminuria and high LDL cholesterol were also associated with poor glycaemic control. CONCLUSIONS Although our results may be limited by the observational nature of the study, the large geographically defined sample size, longitudinal design and robust definition of poor glycaemic control are important strengths. These findings demonstrate the complexity associated with poor glycaemic control and indicate a need for tailored interventions.
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Affiliation(s)
- K A McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - B J Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - B R Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - R Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - A L Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Toronto, Canada
| | - N Ivers
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - D Rabi
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - R Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Provincial Primary Health Care, Alberta Health Services, Calgary, Canada
| | - T Braun
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
| | - C Naugler
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Laboratory Services, Calgary, Canada
| | - D Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - N Saad
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - M Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Khokhar B, Jette N, Metcalfe A, Cunningham CT, Quan H, Kaplan GG, Butalia S, Rabi D. Systematic review of validated case definitions for diabetes in ICD-9-coded and ICD-10-coded data in adult populations. BMJ Open 2016; 6:e009952. [PMID: 27496226 PMCID: PMC4985868 DOI: 10.1136/bmjopen-2015-009952] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES With steady increases in 'big data' and data analytics over the past two decades, administrative health databases have become more accessible and are now used regularly for diabetes surveillance. The objective of this study is to systematically review validated International Classification of Diseases (ICD)-based case definitions for diabetes in the adult population. SETTING, PARTICIPANTS AND OUTCOME MEASURES Electronic databases, MEDLINE and Embase, were searched for validation studies where an administrative case definition (using ICD codes) for diabetes in adults was validated against a reference and statistical measures of the performance reported. RESULTS The search yielded 2895 abstracts, and of the 193 potentially relevant studies, 16 met criteria. Diabetes definition for adults varied by data source, including physician claims (sensitivity ranged from 26.9% to 97%, specificity ranged from 94.3% to 99.4%, positive predictive value (PPV) ranged from 71.4% to 96.2%, negative predictive value (NPV) ranged from 95% to 99.6% and κ ranged from 0.8 to 0.9), hospital discharge data (sensitivity ranged from 59.1% to 92.6%, specificity ranged from 95.5% to 99%, PPV ranged from 62.5% to 96%, NPV ranged from 90.8% to 99% and κ ranged from 0.6 to 0.9) and a combination of both (sensitivity ranged from 57% to 95.6%, specificity ranged from 88% to 98.5%, PPV ranged from 54% to 80%, NPV ranged from 98% to 99.6% and κ ranged from 0.7 to 0.8). CONCLUSIONS Overall, administrative health databases are useful for undertaking diabetes surveillance, but an awareness of the variation in performance being affected by case definition is essential. The performance characteristics of these case definitions depend on the variations in the definition of primary diagnosis in ICD-coded discharge data and/or the methodology adopted by the healthcare facility to extract information from patient records.
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Affiliation(s)
- Bushra Khokhar
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Jette
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Ceara Tess Cunningham
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Klein R, Menon BK, Rabi D, Stell W, Hill MD. Air, rail and road: Medical Guidelines for Employees with a History of Cerebrovascular Disease. Int J Stroke 2016; 11:860-867. [DOI: 10.1177/1747493016660101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background An acute medical condition following a previous stroke among those who operate trains, airplanes, and commercial vehicles can result in serious accidents. There are guidelines in place to assist physicians and employers in assessing the risks of returning to work after stroke but the extent and comprehensiveness across nations and among safety-critical occupations are not widely known. Methods Medical guidelines currently in place to regulate safety critical occupations including railway engineers, pilots and commercial vehicle drivers were systematically reviewed. Electronic and hand literature searches as well as review of grey literature for Canada, the USA, the UK, and Australia were conducted. Results There is no consistent set of guidelines that address the risk of a second catastrophic event after an initial cerebrovascular event in those employed in safety critical occupations in the four countries assessed. Some broad principles existed between the different countries and occupations but there was major variation in the approach to cerebrovascular disease and its impact on those working in safety-critical occupations. Conclusions A synthesis of current knowledge would assist in establishing risks of a catastrophic event in those who have already suffered from cerebrovascular illness. This will allow the creation of medical guidelines which could be applied to any safety critical occupation in any nation.
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Affiliation(s)
- Rebecca Klein
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Doreen Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - William Stell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Padwal R, McAlister FA, Wood PW, Boulanger P, Fradette M, Klarenbach S, Edwards AL, Holroyd-Leduc JM, Alagiakrishnan K, Rabi D, Majumdar SR. Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e107. [PMID: 27343147 PMCID: PMC4938881 DOI: 10.2196/resprot.5775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/03/2016] [Indexed: 12/22/2022] Open
Abstract
Background Diabetes and hypertension are devastating, deadly, and costly conditions that are very common in seniors. Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications. However, blood pressure (BP) must be lowered carefully because seniors are also susceptible to low BP and attendant harms. Achieving “optimal BP control” (ie, avoiding both undertreatment and overtreatment) is the ultimate therapeutic goal in such patients. Regular BP monitoring is required to achieve this goal. BP monitoring at home is cheap, convenient, widely used, and guideline endorsed. However, major barriers prevent proper use. These may be overcome through use of BP telemonitoring—the secure teletransmission of BP readings to a health portal, where BP data are summarized for provider and patient use, with or without protocolized case management. Objective To examine the incremental effectiveness, safety, cost-effectiveness, usability, and acceptability of home BP telemonitoring, used with or without protocolized case management, compared with “enhanced usual care” in community-dwelling seniors with diabetes and hypertension. Methods A 300-patient, 3-arm, pragmatic randomized controlled trial with blinded outcome ascertainment will be performed in seniors with diabetes and hypertension living independently in seniors’ residences in greater Edmonton. Consenting patients will be randomized to usual care, home BP telemonitoring alone, or home BP telemonitoring plus protocolized pharmacist case management. Usual care subjects will receive a home BP monitor but neither they nor their providers will have access to teletransmitted data. In both telemonitored arms, providers will receive telemonitored BP data summaries. In the case management arm, pharmacist case managers will be responsible for reviewing teletransmitted data and initiating guideline-concordant and protocolized changes in BP management. Results Outcomes will be ascertained at 6 and 12 months. Within-study-arm change scores will be calculated and compared between study arms. These include: (1) clinical outcomes: proportion of subjects with a mean 24-hour ambulatory systolic BP in the optimal range (110-129 mmHg in patients 65-79 years and 110-139 mmHg in those ≥80 years: primary outcome); additional ambulatory and home BP outcomes; A1c and lipid profile; medications, cognition, health care use, cardiovascular events, and mortality. (2) Safety outcomes: number of serious episodes of hypotension, syncope, falls, and electrolyte disturbances (requiring third party assistance or medical attention). (3) Humanistic outcomes: quality of life, satisfaction, and medication adherence. (4) Economic outcomes: incremental costs, incremental cost-utility, and cost per mmHg change in BP of telemonitoring ± case management compared with usual care (health payor and societal perspectives). (5) Intervention usability and acceptability to patients and providers. Conclusion The potential benefits of telemonitoring remain largely unstudied and unproven in seniors. This trial will comprehensively assess the impact of home BP telemonitoring across a range of outcomes. Results will inform the value of implementing home-based telemonitoring within supportive living residences in Canada. Trial Registration Clinicaltrials.gov NCT02721667; https://clinicaltrials.gov/ct2/show/NCT02721667 (Archived by Webcite at http://www.webcitation.org/6i8tB20Mc)
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Affiliation(s)
- Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Pelletier R, Khan NA, Cox J, Daskalopoulou SS, Eisenberg MJ, Bacon SL, Lavoie KL, Daskupta K, Rabi D, Humphries KH, Norris CM, Thanassoulis G, Behlouli H, Pilote L. Sex Versus Gender-Related Characteristics: Which Predicts Outcome After Acute Coronary Syndrome in the Young? J Am Coll Cardiol 2016; 67:127-135. [PMID: 26791057 DOI: 10.1016/j.jacc.2015.10.067] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND "Gender" reflects social norms for women and men, whereas "sex" defines biological characteristics. Gender-related characteristics explain some differences in access to care for premature acute coronary syndrome (ACS); whether they are associated with cardiovascular outcomes is unknown. OBJECTIVES This study estimated associations between gender and sex with recurrent ACS and major adverse cardiac events (MACE) (e.g., ACS, cardiac mortality, revascularization) over 12 months in patients with ACS. METHODS We studied 273 women and 636 men age 18 to 55 years from GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-Premature Acute Coronary SYndrome), a prospective observational cohort study, who were hospitalized for ACS between January 2009 and April 2013. Gender-related characteristics (e.g., social roles) were assessed using a self-administered questionnaire, and a composite measure of gender was derived. Outcomes included recurrent ACS and MACE over 12 months. RESULTS Feminine roles and personality traits were associated with higher rates of recurrent ACS and MACE compared with masculine characteristics. This difference persisted for recurrent ACS, after multivariable adjustment (hazard ratio from score 0 to 100: 4.50; 95% confidence interval: 1.05 to 19.27), and was a nonstatistically significant trend for MACE (hazard ratio: 1.54; 95% confidence interval: 0.90 to 2.66). A possible explanation is increased anxiety, the only condition that was more prevalent in patients with feminine characteristics and that rendered the association between gender and recurrent ACS nonstatistically significant (hazard ratio: 3.56; 95% confidence interval: 0.81 to 15.61). Female sex was not associated with outcomes post-ACS. CONCLUSIONS Younger adults with ACS with feminine gender are at an increased risk of recurrent ACS over 12 months, independent of female sex.
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Affiliation(s)
- Roxanne Pelletier
- Divisions of General Internal Medicine and of Clinical Epidemiology, Department of Medicine, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadia A Khan
- Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jafna Cox
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Divisions of Cardiology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Kaberi Daskupta
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - George Thanassoulis
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Hassan Behlouli
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Louise Pilote
- Divisions of General Internal Medicine and of Clinical Epidemiology, Department of Medicine, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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Aghajafari F, Field CJ, Rabi D, Kaplan BJ, Maggiore JA, O'Beirne M, Hanley DA, Eliasziw M, Dewey D, Ross S. Plasma 3-Epi-25-Hydroxycholecalciferol Can Alter the Assessment of Vitamin D Status Using the Current Reference Ranges for Pregnant Women and Their Newborns. J Nutr 2016; 146:70-5. [PMID: 26609169 DOI: 10.3945/jn.115.220095] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/28/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Vitamin D is critical for healthy pregnancies and normal fetal development. It is important to accurately ascertain vitamin D status in mothers and their newborns to establish the optimal vitamin D concentration during pregnancy. There are many different metabolites and epimers of vitamin D in peripheral blood and controversy as to the importance of epimers in estimating vitamin D status in maternal and infant health. OBJECTIVES We undertook this study to measure 25-hydroxyvitamin D metabolites and epimers and their relations in maternal and cord blood and to evaluate the impact of the inclusion of epimers on assessing vitamin D status. METHODS We performed a substudy in a longitudinal cohort of pregnant women and their infants in Alberta, Canada [APrON (Alberta Pregnancy Outcomes and Nutrition) Study]. Maternal and cord blood plasma collected at the time of newborn delivery was stored at -70°C until testing and assayed for 25-hydroxyergocalciferol [25(OH)D2], 25-hydroxycholecalciferol [25(OH)D3], and 3-epi-25-hydroxycholecalciferol [3-epi-25(OH)D3] by using LC-tandem mass spectrometry. The effect of 3-epi-25(OH)D3 on estimates of vitamin D adequacy was explored by using McNemar's chi-square test at both recommended thresholds of 50 and 75 nmol/L. RESULTS Ninety-two pairs of maternal and cord blood samples were obtained. 3-Epi-25(OH)D3 was detected in all samples, comprising 6.0% and 7.8% of 25(OH)D3 in maternal and cord blood, respectively. Positive correlations were found between 25(OH)D3 and 3-epi-25(OH)D3 for both maternal and cord blood (maternal blood: r = 0.34, P = 0.01; cord blood: r = 0.44, P = 0.01). In addition, regression analysis showed a significant association between vitamin D supplementation and 3-epi-25(OH)D3 in maternal and cord blood (β: 0.423; 95% CI: 0.173, 0.672). When 3-epi-25(OH)D3 was not included in plasma vitamin D estimations, 38% of women and 80% of neonates were classified as having an insufficient concentration (<75 nmol/L); however, with 3-epi-25(OH)D3 included, the estimates of insufficiency were significantly lower: 33% and 73% for women and neonates, respectively. CONCLUSIONS Using LC-MS/MS we showed the presence of 3-epi-25(OH)D3 in all samples of pregnant women and their cord blood, and when the 3-epimer was included in the estimation of status the prevalence of vitamin D insufficiency (<75 nmol/L) was significantly lower. Our data suggest that the high use of dietary supplements in this group of women contributes to 3-epi-25(OH)D3 concentrations in both maternal and cord blood. Further research on the role of the epimers in characterizing vitamin D status in pregnancy and infancy is imperative.
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Affiliation(s)
- Fariba Aghajafari
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of
| | | | - Doreen Rabi
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of
| | - Bonnie J Kaplan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of
| | - Jack A Maggiore
- Research and Development, Doctor's Data, Inc., St. Charles, IL; and
| | - Maeve O'Beirne
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of
| | - David A Hanley
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University, Boston, MA
| | - Deborah Dewey
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of
| | - Sue Ross
- Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
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Armstrong M, Rabi D, Southern D, Nanji A, Ghali W, Sigal R. CLINICAL UTILITY OF PRE-EXERCISE SCREENING USING EXERCISE STRESS TESTING IN PEOPLE WITH DIABETES. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Southern DA, Doherty C, De Souza MA, Quan H, Harrop AR, Nickerson D, Rabi D. Charts versus Discharge ICD-10 Coding for Sternal Wound Infection Following Coronary Artery Bypass Grafting. Perspect Health Inf Manag 2015; 12:1e. [PMID: 26396556 PMCID: PMC4558482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Sternal wound infection (SWI) in patients undergoing coronary artery bypass grafting (CABG) can carry a significant risk of morbidity and mortality. The objective of this work is to describe the methods used to identify cases of SWI in an administrative database and to demonstrate the effectiveness of using an International Classification of Diseases, Tenth Revision (ICD-10) coding algorithm for this purpose. METHODS ICD-10 codes were used to identify cases of SWI within one year of CABG between April 2002 and November 2009. We randomly chose 200 charts for detailed chart review (100 from each of the groups coded as having SWI and not having SWI) to determine the utility of the ICD-10 coding algorithm. RESULTS There were 2,820 patients undergoing CABG. Of these, 264 (9.4 percent) were coded as having SWI. Thirty-eight cases of SWI were identified by chart review. The ICD-10 coding algorithm of T81.3 or T81.4 was able to identify incident SWI with a positive predictive value of 35 percent and a negative predictive value of 97 percent. The agreement between the ICD-10 coding algorithm and presence of SWI remained fair, with an overall kappa coefficient of 0.32 (95 percent confidence interval, 0.22-0.43). The effectiveness of identifying deep SWI cases is also presented. CONCLUSIONS This article describes an effective algorithm for identifying a cohort of patients with SWI following open sternotomy in large databases using ICD-10 coding. In addition, alternative search strategies are presented to suit researchers' needs.
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Affiliation(s)
- Danielle A Southern
- Danielle A. Southern, MSc, is a research associate with the O'Brien Institute for Public Health and the Department of Community Health Sciences of the University of Calgary, in Calgary, Alberta, Canada
| | - Christopher Doherty
- Christopher Doherty, MD, MPH, FRCSC, is an assistant professor at the Roth | McFarlane Hand and Upper Limb Centre at the University of Western Ontario Schulich School of Medicine and Dentistry in London, Ontario, Canada
| | - Michael A De Souza
- Michael A. De Souza is a research assistant in the Department of Biological Sciences at the University of Calgary in Calgary, Alberta, Canada
| | - Hude Quan
- Hude Quan, PhD, is a professor at the O'Brien Institute for Public Health and the Department of Community Health Sciences of the University of Calgary in Calgary, Alberta, Canada
| | - A Robertson Harrop
- A. Robertson Harrop, MD, MSc, is section chief of plastic surgery in the Department of Surgery at the University of Calgary in Calgary, Alberta, Canada
| | - Duncan Nickerson
- Duncan Nickerson, MD, FRCSCS, FACS, is medical director at the Calgary Firefighters' Burn & Treatment Centre at Foothills Medical Centre and clinical associate professor in the Section of Plastic Surgery in the Department of Surgery at the University of Calgary in Calgary, Alberta, Canada
| | - Doreen Rabi
- Doreen Rabi, MD, is an assistant professor in the Departments of Medicine, Community Health Sciences, and Cardiac Sciences at the University of Calgary in Calgary, Alberta, Canada
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Khokhar B, Jones J, Ronksley PE, Armstrong MJ, Caird J, Rabi D. Effectiveness of mobile electronic devices in weight loss among overweight and obese populations: a systematic review and meta-analysis. BMC Obes 2014. [PMID: 26217509 PMCID: PMC4511017 DOI: 10.1186/s40608-014-0022-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Mobile electronic devices, such as mobile phones and PDAs, have emerged as potentially useful tools in the facilitation and maintenance of weight loss. While RCTs have demonstrated a positive impact of mobile interventions, the extent to which mobile electronic devices are more effective than usual care methods is still being debated. Results Electronic databases were systematically searched for RCTs evaluating the effectiveness of mobile electronic device interventions among overweight and obese adults. Weighted mean difference for change in body weight was the primary outcome. The search strategy yielded 559 citations and of the 108 potentially relevant studies, six met the criteria. A total of 632 participants were included in the six studies reporting a mean change in body weight. Using a random-effects model, the WMD for the effect of using mobile electronic devices on reduction in body weight was −1.09 kg (95% CI −2.12, −0.05). When stratified by the type of mobile electronic device used, it suggests that interventions using mobile phones were effective at achieving weight loss, WMD = −1.78 kg (95% CI −2.92, −0.63). Conclusions This systematic review and meta-analysis suggests that mobile electronic devices have the potential to facilitate weight loss in overweight and obese populations, but further work is needed to understand if these interventions have sustained benefit and how we can make these mHealth tools most effective on a large scale. As the field of healthcare increasingly utilizes novel mobile technologies, the focus must not be on any one specific device but on the best possible use of these tools to measure and understand behavior. As mobile electronic devices continue to increase in popularity and the associated technology continues to advance, the potential for the use of mobile devices in global healthcare is enormous. More RCTs with larger sample sizes need to be conducted to look at the cost-effectiveness, technical and financial feasibility of adapting such mHealth interventions in a real clinical setting.
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Affiliation(s)
- Bushra Khokhar
- Institute of Public Health, University of Calgary, Calgary, Canada
| | | | - Paul E Ronksley
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Marni J Armstrong
- Department of Cardiovascular and Respiratory Sciences, University of Calgary, Calgary, Canada
| | - Jeff Caird
- Institute of Public Health, University of Calgary, Calgary, Canada ; W21C, University of Calgary, Calgary, Canada
| | - Doreen Rabi
- Institute of Public Health, University of Calgary, Calgary, Canada
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Austin A, Pelletier R, Rabi D, Behlouli H, Pilote L, Investigators GP. FACTORS ASSOCIATED WITH STUDY COMPLETION IN PATIENTS WITH PREMATURE ACUTE CORONARY SYNDROME. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Doherty C, Nickerson D, Southern DA, Kieser T, Appoo J, Dawes J, De Souza MA, Harrop AR, Rabi D. Trends in postcoronary artery bypass graft sternal wound dehiscence in a provincial population. Plast Surg (Oakv) 2014. [DOI: 10.1177/229255031402200311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Danielle A Southern
- Department of Community Health Sciences; Calgary, Alberta
- Institute for Public Health, University of Calgary; Calgary, Alberta
| | - Teresa Kieser
- Libin Cardiovascular Institute of Alberta; Calgary, Alberta
- Division of Cardiac Surgery, Department of Surgery; Calgary, Alberta
| | - Jehangir Appoo
- Libin Cardiovascular Institute of Alberta; Calgary, Alberta
- Division of Cardiac Surgery, Department of Surgery; Calgary, Alberta
| | | | | | | | - Doreen Rabi
- Department of Community Health Sciences; Calgary, Alberta
- Institute for Public Health, University of Calgary; Calgary, Alberta
- Department of Medicine, University of Calgary, Calgary, Alberta
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Yang J, Nijjar A, Quan H, Shah BR, Rabi D, Ignaszewski A, Khan NA. Utilization of health resources in South Asian, Chinese and white patients with diabetes mellitus. Prim Care Diabetes 2014; 8:165-170. [PMID: 24289947 DOI: 10.1016/j.pcd.2013.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 10/29/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
Abstract
AIMS We sought to determine whether there are differences in health resource utilization among South Asian (SA), Chinese and White patients with newly diagnosed diabetes mellitus. METHODS We used province-wide administrative data from British Columbia, Canada (1997-2006) to determine proportion of patients with ≥2 visits/year for all outpatient and family physician (FP) visits, proportion of patients with at least one annual visit to specialists, ophthalmology/optometry and hospital admissions by ethnic group. RESULTS There were 9529 South Asian, 14,084 Chinese and 143,630 White patients with newly diagnosed diabetes in the study. Over 90% of each of the ethnic groups visited their FP ≥2 visits/year. Chinese patients were less likely to visit FP, ophthalmology/optometrists and specialists compared to White patients. SA patients had fewer ophthalmology/optometry visits compared to White populations. White patients had higher rates of hospitalization. CONCLUSION Although all groups had high proportion of patients with appropriate frequency of FP visits, other aspects of health care utilization varied significantly by ethnicity.
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Affiliation(s)
- Jiao Yang
- Division of Cardiology, University of British Columbia, BC, Canada.
| | - Aman Nijjar
- Department of Medicine, University of British Columbia, BC, Canada; Center for Health Evaluation and Outcome Sciences, BC, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Baiju R Shah
- Division of Endocrinology, University of Toronto, ON, Canada
| | - Doreen Rabi
- Division of Endocrinology, University of Calgary, AB, Canada
| | | | - Nadia A Khan
- Department of Medicine, University of British Columbia, BC, Canada; Center for Health Evaluation and Outcome Sciences, BC, Canada
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Reyes-Bahamonde J, Raimann JG, Canaud B, Etter M, Kooman JP, Levin NW, Marcelli D, Marelli C, Power A, Van Der Sande FM, Thijssen S, Usvyat LA, Wang Y, Kotanko P, Blank PR, Szucs TD, Gibertoni D, Torroni S, Mandreoli M, Rucci P, Fantini MP, Santoro A, Van Der Veer SN, Nistor I, Bernaert P, Bolignano D, Brown EA, Covic A, Farrington K, Kooman J, Macias J, Mooney A, Van Munster BC, Van Den Noortgate N, Topinkova E, Wirnsberger G, Jager KJ, Van Biesen W, Stubnova V, Os I, Grundtvig M, Waldum B, Wu HY, Peng YS, Wu MS, Chu TS, Chien KL, Hung KY, Wu KD, Carrero JJ, Huang X, Sui X, Ruiz JR, Hirth V, Ortega FB, Blair SN, Coppolino G, Bolignano D, Rivoli L, Presta P, Mazza G, Fuiano G, Marx S, Petrilla A, Hengst N, Lee WC, Ruggajo P, Skrunes R, Svarstad E, Skjaerven R, Reisaether AV, Vikse BE, Fujii N, Hamano T, Akagi S, Watanabe T, Imai E, Nitta K, Akizawa T, Matsuo S, Makino H, Scalzotto E, Corradi V, Nalesso F, Zaglia T, Neri M, Martino F, Zanella M, Brendolan A, Mongillo M, Ronco C, Occelli F, Genin M, Deram A, Glowacki F, Cuny D, Mansurova I, Alchinbayev M, Malikh MA, Song S, Shin MJ, Rhee H, Yang BY, Kim I, Seong EY, Lee DW, Lee SB, Kwak IS, Isnard Bagnis C, Speyer E, Beauger D, Caille Y, Baudelot C, Mercier S, Jacquelinet C, Gentile SM, Briancon S, Yu TM, Li CY, Krivoshiev S, Borissova AM, Shinkov A, Svinarov D, Vlachov J, Koteva A, Dakovska L, Mihaylov G, Popov A, Polner K, Mucsi I, Braunitzer H, Kiss A, Nadasdi Z, Haris A, Zdrojewski L, Zdrojewski T, Rutkowski B, Minami S, Hesaka A, Yamaguchi S, Iwahashi E, Sakai S, Fujimoto T, Sasaki K, Fujita Y, Yokoyama K, Dey V, Farrah T, Traynor J, Spalding E, Robertson S, Geddes CC, Mann MC, Hobbs A, Hemmelgarn BR, Roberts D, Ahmed SB, Rabi D, Elewa U, Fernandez B, Alegre ER, Mahillo I, Egido J, Ortiz A, Marx S, Pomerantz D, Vietri J, Zewinger S, Speer T, Kleber ME, Scharnagl H, Woitas R, Pfahler K, Seiler S, Heine GH, Lepper PM, Marz W, Silbernagel G, Fliser D, Caldararu CD, Gliga ML, Tarta ID, Szanto A, Carlan O, Dogaru GA, Battaglia Y, Del Prete MA, De Gregorio MG, Errichiello C, Gisonni P, Russo L, Scognamiglio B, Storari A, Russo D, Kuma A, Serino R, Miyamoto T, Tamura M, Otsuji Y, Kung LF, Naito S, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, Kang YU, Kim HY, Choi JS, Kim CS, Bae EH, Ma SK, Kim SW, Muthuppalaniappan VM, Byrne C, Sheaff M, Rajakariar R, Blunden M, Delmas Y, Loirat C, Muus P, Legendre C, Douglas K, Hourmant M, Herthelius M, Trivelli A, Goodship T, Bedrosian CL, Licht C, Marks A, Black C, Clark L, Prescott G, Robertson L, Simpson W, Simpson W, Fluck N, Wang SL, Hsu YH, Pai HC, Chang YM, Liu WH, Hsu CC, Shvetsov M, Nagaytseva S, Gerasimov A, Shalyagin Y, Ivanova E, Shilov E, Zhang Y, Zuo W, Marx S, Manthena S, Newmark J, Zdrojewski L, Rutkowski M, Zdrojewski T, Bandosz P, Gaciong Z, Solnica B, Rutkowski B, Wyrzykowski B, Ensergueix G, Karras A, Levi C, Chauvet S, Trivin C, Ficheux M, Augusto JF, Boudet R, Chambaraud T, Boudou-Rouquette P, Tubiana-Mathieu N, Aldigier JC, Jacquot C, Essig M, Thervet E, Oh YJ, Lee CS, Malho Guedes A, Silva AP, Goncalves C, Sampaio S, Morgado E, Santos V, Bernardo I, Leao Neves P, Onuigbo M, Agbasi N. CKD GENERAL AND CLINICAL EPIDEMIOLOGY 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Pelletier R, Humphries KH, Shimony A, Bacon SL, Lavoie KL, Rabi D, Karp I, Tsadok MA, Pilote L. Sex-related differences in access to care among patients with premature acute coronary syndrome. CMAJ 2014; 186:497-504. [PMID: 24638026 DOI: 10.1503/cmaj.131450] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Access to care may be implicated in disparities between men and women in death after acute coronary syndrome, especially among younger adults. We aimed to assess sex-related differences in access to care among patients with premature acute coronary syndrome and to identify clinical and gender-related determinants of access to care. METHODS We studied 1123 patients (18-55 yr) admitted to hospital for acute coronary syndrome and enrolled in the GENESIS-PRAXY cohort study. Outcome measures were door-to-electrocardiography, door-to-needle and door-to-balloon times, as well as proportions of patients undergoing cardiac catheterization, reperfusion or nonprimary percutaneous coronary intervention. We performed univariable and multivariable logistic regression analyses to identify clinical and gender-related determinants of timely procedures and use of invasive procedures. RESULTS Women were less likely than men to receive care within benchmark times for electrocardiography (≤ 10 min: 29% v. 38%, p = 0.02) or fibrinolysis (≤ 30 min: 32% v. 57%, p = 0.01). Women with ST-segment elevation myocardial infarction (MI) were less likely than men to undergo reperfusion therapy (primary percutaneous coronary intervention or fibrinolysis) (83% v. 91%, p = 0.01), and women with non-ST-segment elevation MI or unstable angina were less likely to undergo nonprimary percutaneous coronary intervention (48% v. 66%, p < 0.001). Clinical determinants of poorer access to care included anxiety, increased number of risk factors and absence of chest pain. Gender-related determinants included feminine traits of personality and responsibility for housework. INTERPRETATION Among younger adults with acute coronary syndrome, women and men had different access to care. Moreover, fewer than half of men and women with ST-segment elevation MI received timely primary coronary intervention. Our results also highlight that men and women with no chest pain and those with anxiety, several traditional risk factors and feminine personality traits were at particularly increased risk of poorer access to care.
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Doherty C, Nickerson D, Southern DA, Kieser T, Appoo J, Dawes J, De Souza MA, Harrop AR, Rabi D. Trends in postcoronary artery bypass graft sternal wound dehiscence in a provincial population. Plast Surg (Oakv) 2014; 22:196-200. [PMID: 25332650 PMCID: PMC4173869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND It appears that the medical profile of patients undergoing coronary artery bypass graft (CABG) surgery has changed. The impact of this demographic shift on CABG outcomes, such as sternal wound dehiscence, is unclear. OBJECTIVES To quantify the incidence and trends of sternal wound dehiscence, quantify the demographic shift of those undergoing CABG and identify patient factors predictive of disease. METHODS A prospective analysis was performed on a historical cohort of consecutive patients who underwent CABG (without valve replacement) in Alberta between April 1, 2002 and November 30, 2009. The incidence and trends of sternal wound dehiscence were determined. In addition, the trend of the mean Charlson index score and European System for Cardiac Operative Risk Evaluation (EuroSCORE) (capturing patient comorbidities) was analyzed. Univariable analysis and multivariable models were performed to determine factors predictive of wound dehiscence. RESULTS A total of 5815 patients underwent CABG during the study period. The incidence proportion of sternal wound dehiscence in Alberta was 1.86% and the incidence rate was 1.98 cases per 100 person-years. Although both the EuroSCORE and Charlson scores significantly increased over the study period, the incidence of sternal wound dehiscence did not change significantly. Factors predictive of sternal wound dehiscence were diabetes (OR 2.97 [95% CI 1.73 to 5.10]), obesity (OR 1.55 [95% CI 1.05 to 2.27]) and female sex (OR 1.90 [95% CI 1.26 to 2.87]). CONCLUSIONS The incidence proportion of sternal wound dehiscence in Alberta was comparable with the incidence previously published in the literature. While patients undergoing CABG had worsening medical profiles, the incidence of sternal wound dehiscence did not appear to be increasing significantly.
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Affiliation(s)
| | - Duncan Nickerson
- Section of Plastic Surgery, Department of Surgery, University of Calgary
| | - Danielle A Southern
- Department of Community Health Sciences, University of Calgary
- Institute for Public Health, University of Calgary
| | - Teresa Kieser
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta
- Division of Cardiac Surgery, Department of Surgery, University of Calgary, Calgary, Alberta
| | - Jehangir Appoo
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta
- Division of Cardiac Surgery, Department of Surgery, University of Calgary, Calgary, Alberta
| | - Jeffery Dawes
- Section of Plastic Surgery, Department of Surgery, University of Calgary
| | - Michael A De Souza
- Department of Biological Sciences, University of Calgary, Calgary, Alberta
| | - Alan R Harrop
- Section of Plastic Surgery, Department of Surgery, University of Calgary
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary
- Institute for Public Health, University of Calgary
- Department of Medicine, University of Calgary, Calgary, Alberta
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Walker RL, Chen G, McAlister FA, Campbell NRC, Hemmelgarn BR, Dixon E, Ghali W, Rabi D, Tu K, Jette N, Quan H. Hospitalization for uncomplicated hypertension: an ambulatory care sensitive condition. Can J Cardiol 2013; 29:1462-9. [PMID: 23916738 DOI: 10.1016/j.cjca.2013.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/17/2013] [Accepted: 05/01/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hospitalizations for ambulatory care sensitive conditions (ACSC) represent an indirect measure of access and quality of community care. This study explored hospitalization rates for 1 ACSC, uncomplicated hypertension, and the factors associated with hospitalization. METHODS A cohort of patients with incident hypertension, and their covariates, was defined using validated case definitions applied to International Classification of Disease administrative health data in 4 Canadian provinces between fiscal years 1997 and 2004. We applied the Canadian Institute for Health Information's case definition to detect all patients who had an ACSC hospitalization for uncomplicated hypertension. We employed logistic regression to assess factors associated with an ACSC hospitalization for uncomplicated hypertension. RESULTS The overall rate of hospitalizations for uncomplicated hypertension in the 4 provinces was 3.7 per 1000 hypertensive patients. The risk-adjusted rate was lowest among those in an urban setting (2.6 per 1000; 95% confidence interval [CI], 2.3-2.7), the highest income quintile (3.4 per 1000; 95% CI, 2.8-4.2), and those with no comorbidities (3.6 per 1000; 95% CI, 3.2-3.9). Overall, Newfoundland had the highest adjusted rate (5.7 per 1000; 95% CI, 4.9-6.7), and British Columbia had the lowest (3.7 per 1000; 95% CI, 3.4-4.2). The adjusted rate declined from 5.9 per 1000 in 1997 to 3.7 per 1000 in 2004. CONCLUSIONS We found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, which might reflect improvements in community care. Geographic variations in the rate of hospitalizations indicate disparity among the provinces and those residing in rural regions.
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Affiliation(s)
- Robin L Walker
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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McBrien KA, Manns BJ, Chui B, Klarenbach SW, Rabi D, Ravani P, Hemmelgarn B, Wiebe N, Au F, Clement F. Health care costs in people with diabetes and their association with glycemic control and kidney function. Diabetes Care 2013; 36:1172-80. [PMID: 23238665 PMCID: PMC3631826 DOI: 10.2337/dc12-0862] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 10/18/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the association between laboratory-derived measures of glycemic control (HbA1c) and the presence of renal complications (measured by proteinuria and estimated glomerular filtration rate [eGFR]) with the 5-year costs of caring for people with diabetes. RESEARCH DESIGN AND METHODS We estimated the cumulative 5-year cost of caring for people with diabetes using a province-wide cohort of adults with diabetes as of 1 May 2004. Costs included physician visits, hospitalizations, ambulatory care (emergency room visits, day surgery, and day medicine), and drug costs for people >65 years of age. Using linked laboratory and administrative clinical and costing data, we determined the association between baseline glycemic control (HbA1c), proteinuria, and kidney function (eGFR) and 5-year costs, controlling for age, socioeconomic status, duration of diabetes, and comorbid illness. RESULTS We identified 138,662 adults with diabetes. The mean 5-year cost of diabetes in the overall cohort was $26,978 per patient, excluding drug costs. The mean 5-year cost for the subset of people >65 years of age, including drug costs, was $44,511 (Canadian dollars). Cost increased with worsening kidney function, presence of proteinuria, and suboptimal glycemic control (HbA1c >7.9%). Increasing age, Aboriginal status, socioeconomic status, duration of diabetes, and comorbid illness were also associated with increasing cost. CONCLUSIONS The cost of caring for people with diabetes is substantial and is associated with suboptimal glycemic control, abnormal kidney function, and proteinuria. Future studies should assess if improvements in the management of diabetes, assessed with laboratory-derived measurements, result in cost reductions.
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Affiliation(s)
- Kerry A. McBrien
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Braden J. Manns
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Betty Chui
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Doreen Rabi
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Pietro Ravani
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Flora Au
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Tobe SW, Poirier L, Tremblay G, Lindsay P, Reid D, Campbell NRC, Khan N, Quinn RR, Rabi D. Challenges and scientific considerations in hypertension management reflected in the 2012 recommendations of the Canadian Hypertension Education Program. Open Med 2012; 6:e127-33. [PMID: 23687527 PMCID: PMC3654508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 09/03/2012] [Accepted: 09/03/2012] [Indexed: 12/05/2022]
Abstract
This article provides the scientific rationale and background information for the Canadian Hypertension Education Program's 2012 recommendations for the management of hypertension. It also summarizes the key new recommendations and the theme for 2012, which is the prevention of hypertension. The full recommendations are available at www.hypertension.ca.
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