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Assadzadeh LD, Gallant A, Zhao Y, Gorenko-Lévêque S, Chekkal A, Mbuko BD, Pierre N, Dirks M, Groleau V, Lapointe A, Ngwanou D, Piché N, Deslandres C, Gravel J, Jantchou P. 158 - Impact de la pandémie COVID19 sur l'ingestion de corps étrangers par les enfants au Québec. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9340453 DOI: 10.1016/j.respe.2022.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Contexte Plus de 90 % des cas d'ingestions de corps étrangers en pédiatrie se produisent à domicile. Notre hypothèse était que le temps supplémentaire passé par les enfants à domicile durant la pandémie COVID-19 serait associé à une augmentation du nombre de cas d'ingestions de corps étrangers et leur sévérité. Nos objectifs étaient de comparer l'incidence d'ingestions pédiatriques de corps étrangers et le taux de cas sévères (hospitalisation, complications ou interventions par endoscopie) avant et pendant la pandémie. Méthodes Toutes les consultations pédiatriques au CHU Sainte-Justine de Montréal pour ingestion de corps étrangers entre mars 2018 et février 2020 (pré-pandémie) ainsi qu'entre mars 2020 et février 2021 (pandémie) ont été incluses (n=614). L'incidence d'ingestions de corps étrangers a été calculée en rapportant le nombre de cas au nombre de visites aux urgences selon les périodes. Les différences entre les deux groupes ont été analysées par un test T de Student ou Chi-carré. Résultats L’âge médian des patients était de 3,5 ans [(interquartile: 1,6-5,9); 54 % garçons]. Le nombre mensuel moyen de cas (min-max) durant la pandémie [20,0 (12-28)] était significativement plus élevé qu'avant la pandémie [15,5 (8-24)] (p=0,02). Le taux d'incidence a doublé, passant de 23,2 pour 10 000 visites aux urgences en pré-pandémie à 51,6 pour 10 000 visites pendant la pandémie (p=0,0002). Près d'un quart de la cohorte a dû être hospitalisé. Le taux d'hospitalisations (>1 jour) est resté stable entre les deux périodes: 6,95 % pré-pandémie et 7,08 % pendant la pandémie. Les taux d'endoscopies (21,3 %) et de complications (4,6 %) étaient similaires entre les deux périodes. Discussion/Conclusion L'incidence d'ingestions de corps étrangers au CHU Sainte-Justine a augmenté significativement durant la pandémie comparativement aux deux années précédentes. Les taux élevés de cas sévères, bien que stables durant la pandémie, témoignent de l'impact considérable des ingestions de corps étrangers en pédiatrie. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
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Zhao Y, Dehbidi Assadzadeh L, Gallant A, Gorenko-Lévêque S, Chekkal A, Djoukam Mbuko B, Pierre N, Dirks M, Groleau V, Lapointe A, Ngwanou D, Piché N, Deslandres C, Gravel J, Jantchou P. A22 IMPACT OF COVID-19 PANDEMIC ON FOREIGN BODY INGESTION IN CHILDREN AND ADOLESCENTS: A CROSS-SECTIONAL STUDY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859177 DOI: 10.1093/jcag/gwab049.021] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Foreign Body Ingestions (FBI), sometimes associated with severe complications, are a common reason for emergency unit visits in children. In Quebec, since March 2020, the restrictions in response to the COVID-19 pandemic have increased the time children spend at home. We hypothesized that this could contribute to a rise in FBI incidence and severity.
Aims
The primary objective of our study was to evaluate the incidence as well as the clinical presentation of FBI cases seen at CHU Sainte-Justine Children’s Hospital in Montreal (CHUSJ) during the COVID-19 pandemic as compared to the two previous years. Our secondary objectives were to estimate the rate of severe FBI (involving hospitalisations and/or complications) and to evaluate the nature of the foreign bodies that were ingested.
Methods
All children referred to or who presented at CHUSJ for FBI between March 2018 and February 2020 (pre-pandemic) as well as between March 2020 and February 2021 (pandemic) were included (n=690). Cases of food impaction were excluded (n=78). Incidence of FBI was calculated by dividing the number of FBI cases by the total number of emergency department visits per period. Differences between the two groups were analyzed by Student T test or Chi-square test.
Results
Between March 2018 and February 2021, 612 patients (median age 3.5 years (1.6–5.9); 54% male) were eligible. The mean monthly number of FBI cases (min-max) in 2020–2021 was 18.6 (9–28), significantly higher than the year 2018 [16.6 (8–22)] and the year 2019 [15.5 (9–24)]; p=0.04. The incidence rate of FBI doubled during the pandemic as compared to the prepandemic group: respectively 57.5/10,000 emergency department visits and 23.2/10,000 visits (p=0.002). Almost one fourth of the cohort was hospitalized. The hospitalization rate (>1 day) was similar between the 2 periods: 8.8% before the pandemic and 7.1% during the pandemic. Digestive endoscopy was performed in 21.5% of cases, a rate similar before and during the pandemic. A total of 3.3% of the children developed complications related to FBI. This rate remained stable between the two periods. The most frequently ingested objects were coins (25.0%), toys (10.8%), button batteries (10.6%), magnets (6.2%), and jewellery (6.2%). There was no significant difference in the nature of FB ingested between the 2 periods although the number of magnet ingestions increased during the pandemic (18 per year vs 10 per year).
Conclusions
The incidence of FBI increased significantly during the pandemic in comparison with the two previous years. The high hospitalization and complications rates, although stable during the pandemic, underline the significant impact of pediatric FBI.
Funding Agencies
None
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Affiliation(s)
- Y Zhao
- Universite de Montreal Faculte de Medecine, Montreal, QC, Canada
| | | | - A Gallant
- Universite de Montreal Faculte de Medecine, Montreal, QC, Canada
| | | | - A Chekkal
- Universite de Sherbrooke Faculte de Medecine et des Sciences de la Sante, Sherbrooke, QC, Canada
| | - B Djoukam Mbuko
- Universite de Montreal Faculte de Pharmacie, Montreal, QC, Canada
| | - N Pierre
- Metabolic and Cardiovascular Health Axis, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - M Dirks
- Metabolic and Cardiovascular Health Axis, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - V Groleau
- Metabolic and Cardiovascular Health Axis, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - A Lapointe
- Metabolic and Cardiovascular Health Axis, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - D Ngwanou
- Metabolic and Cardiovascular Health Axis, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - N Piché
- Metabolic and Cardiovascular Health Axis, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - C Deslandres
- Service de gastro-entérologie, CHU Sainte-Justine, Montréal, QC, Canada
| | - J Gravel
- Metabolic and Cardiovascular Health Axis, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - P Jantchou
- Pediatrics, Sainte Justine University Hospital, Montreal, QC, Canada
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de Vries M, Gravel J, Horn D, McLeod S, Varner C. Comparative efficacy of opioids for older adults presenting to the emergency department with acute pain: Systematic review. Can Fam Physician 2019; 65:e538-e543. [PMID: 31831503 PMCID: PMC6907377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To systematically review the literature for studies comparing the efficacy of opioid analgesics for older adults (≥ 65 years) presenting to the emergency department (ED) with acute pain. DATA SOURCES The Cochrane Library, MEDLINE, EMBASE, Web of Science, and CINAHL were searched up to August or September 2017. Reference lists were searched for potential articles and ClinicalTrials.gov was searched for unpublished trials. STUDY SELECTION Randomized controlled trials (RCTs) were sought that compared the efficacy of 2 or more opioid analgesics for acute pain in older patients (≥ 65 years) in the ED. Two reviewers independently screened abstracts, assessed study quality, and extracted data. SYNTHESIS After screening titles and abstracts of 1315 citations, the full texts of 63 studies were reviewed and 1 RCT met the inclusion criteria. This study randomized older adult patients presenting to an urban academic ED with acute, severe pain to receive a single dose of either 0.0075 mg/kg intravenous hydromorphone or 0.05 mg/kg intravenous morphine. This study found no clinical or statistical difference between the 2 treatments. CONCLUSION The lack of published research in this area demonstrates a considerable gap in knowledge of the comparative efficacy of opioid analgesics in the growing older adult patient population. Physicians are often uncertain in their choice of analgesia, potentially contributing to the undertreatment of pain. It is clear that well designed RCTs are urgently needed.
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Affiliation(s)
- Maaike de Vries
- Doctoral student at the Institute of Health Policy, Management and Evaluation at the University of Toronto in Ontario.
| | - Jonathan Gravel
- Emergency medicine resident in the Department of Medicine and the Department of Family Medicine at McMaster University in Hamilton, Ont
| | - Daphne Horn
- Lead, Library Services, at Scarborough Health Network in Ontario
| | - Shelley McLeod
- Research Director at the Schwartz/Reisman Emergency Medicine Institute at Sinai Health Systems and Assistant Professor in the Department of Family and Community Medicine at the University of Toronto
| | - Catherine Varner
- Emergency physician at Mount Sinai Hospital, Clinician Investigator at the Schwartz/Reisman Emergency Medicine Institute at Sinai Health Systems, and Assistant Professor in the Department of Family and Community Medicine at the University of Toronto
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Gravel J, Schmitzer AR. Imidazolium and benzimidazolium-containing compounds: from simple toxic salts to highly bioactive drugs. Org Biomol Chem 2018; 15:1051-1071. [PMID: 28045182 DOI: 10.1039/c6ob02293f] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The toxicity of simple imidazolium and benzimidazolium salts started to be more and more investigated in the last few years and was taken in consideration in the context of microorganisms, plants and more evolved organisms' exposure. However, the toxicity of these salts can be exploited in the development of different biological applications by incorporating them in the structure of compounds that specifically target microorganisms and cancer cells. We highlight in this minireview the way researchers became aware of the inherent problem of the stability and bioaccumulation of imidazolium and benzimidazolium salts and how they found inspiration to exploit their toxicity by incorporating them into new highly potent drugs.
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Affiliation(s)
- J Gravel
- Département de Chimie- Université de Montréal, 2900 Edouard Montpetit CP 6128 Succursalle Centre Ville Montréal Québec, Canada H3C 3J7.
| | - A R Schmitzer
- Département de Chimie- Université de Montréal, 2900 Edouard Montpetit CP 6128 Succursalle Centre Ville Montréal Québec, Canada H3C 3J7.
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Grandjean-Blanchet C, Emeriaud G, Beaudin M, Gravel J. RETROSPECTIVE EVALUATION OF THE BIG SCORE TO PREDICT MORTALITY IN PEDIATRIC BLUNT TRAUMA. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.027] [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: 11/13/2022] Open
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Nicole M, Desjardins MP, Dery J, Gravel J. EVALUATION OF BEDSIDE SONOGRAPHY PERFORMED BY EMERGENCY PHYSICIANS TO DETECT ACUTE APPENDICITIS IN CHILDREN IN THE EMERGENCY DEPARTMENT. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.024] [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: 11/13/2022] Open
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Alix-Séguin L, Desjardins MP, Gaucher N, Lebel D, Gravel J, Gouin S. EFFECT ON PAIN OF AN ORAL SUCROSE SOLUTION VERSUS PLACEBO IN CHILDREN 1 TO 3 MONTHS OLD NEEDING NASOPHARYNGEAL ASPIRATION; A RANDOMIZED CONTROLLED TRIAL. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.025] [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: 11/13/2022] Open
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Trottier ED, Gravel J, Ali S, Meckler G, Blanchet M, Stang A, Porter R, Lemay S, Dubrovsky AS, Chan M, Jain R, Principi T, Joubert G, Kam A, Thull-Freedman J, Neto G, Lagacé M. Treating and Reducing Anxiety and Pain in the Paediatric Emergency Department (The Trapped 2 Survey): Time for Action – A Pediatric Emergency Research Canada (Perc) Project. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e70b] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Multiples barriers to appropriate analgesia provision are reported in the paediatric emergency department (PED), including limited accessibility to effective strategies.
OBJECTIVES: To evaluate the improvement in the accessibility of pain and anxiety management strategies in PEDs in Canada, after the creation of a national pediatric pain quality improvement collaborative, through Pediatric Emergency Research Canada.
DESIGN/METHODS: In 2013, the TRAPPED 1 survey was administered across Canadian PEDs, in order to evaluate the resources in place for pain and anxiety management. Subsequent to the TRAPPED 1, a pain Quality Improvement Collaborative was created to stimulate the implementation of new pain and anxiety management strategies through the sharing of information between PEDs. The TRAPPED 2 survey involved a cross sectional survey similar to TRAPPED 1, after a two year interval. Its main focus was to evaluate the improvement in the accessibility of specific, preferred strategies reported by each centre, after participating in this collaborative between December 2014 to November 2015, and then working to implement change within their own PEDs.
RESULTS: All 15/15 Canadian PEDs responded to TRAPPED 1 in 2013. In 2014, 11/15 agreed to participate in the national pain Quality Improvement Collaborative, with a goal of introducing new pain and anxiety management strategies within their own PEDs. An in-person meeting, email communication, and telephone meetings were employed for information sharing regarding experiences/challenges within each of the participating centres. Newly introduced strategies included education, distraction, nurse-initiated protocols, and policies/education to encourage the use of intranasal (IN) medications. 11/11 centres have responded to the interim follow up surveys in 2015. At the end of the project (Fall 2105), 15/15 Canadian PEDs agreed to complete the final TRAPPED 2 survey. When comparing the results of 2015 with 2013, an increased number of PEDs used face-based pain scales (14/15 vs 6/15) and behavioural scales (5/15 vs 1/15) for pain assessment of school-aged children and infants, respectively. Use of assessment room wall decoration for distraction increased from 7/15 to 11/15. Reminder posters for pain management at triage increased from 4/15 to 6/15. Availability of electronic distraction strategies (e.g. using tablets) increased from 4/15 to 10/15 centres. For skin-piercing procedure, nurses initiated protocols to use topical anesthetic creams and oral sucrose was available in 12/15 centres (compared to 10/15 in 2013), and 14/15 (compared to 12/15 in 2013) respectively. Availability of IN medications increased in the last two years: fentanyl 14/15 (9/15 in 2013) and midazolam in at least 10/15 (8/15 in 2013). 10/11 PEDS involved in the QI strategy reported the implementation of at least one of their strategies identified.
CONCLUSION: This study suggests that the use of a pain Quality Improvement Collaborative may improve the introduction of new strategies in multiple PEDs. It can help guide other centres when introducing new strategies to reduce pain and anxiety for children in community EDs. Future research can focus on the sustainability of the strategies, and as well the effect of the collaborative on the introduction of other pain treatment strategies.
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Desjardins MP, Gouin S, Gaucher N, Lebel D, Gravel J. A Randomized Double-Blind Trial Comparing the Effect on Pain of An Oral Sucrose Solution Versus Placebo in Children 1 To 3 Months Old Needing Urethral Catheterization. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e52a] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Oral sweet solutions have been accepted as effective analgesics for procedures in the neonatal population. However, there have been a limited number of trials in older infants. These studies have conflicting results.
OBJECTIVES: To compare the efficacy of an oral sucrose solution versus placebo in reducing pain during urethral catheterization in infants 1 to 3 months old in the Emergency Department (ED).
DESIGN/METHODS: A randomized, double-blind clinical trial was conducted in a pediatric university-affiliated hospital ED. Infants, 1 to 3 months of age, were recruited and randomly allocated to receive 2 ml of 88% sucrose solution (SUC) or 2 ml of placebo solution (PLA) orally, 2 minutes before planned urethral catheterization. The primary outcome measure was the difference in pain scores as assessed by the Face, Legs, Activity, Cry and Consolability (FLACC) Pain Scale during at 1 min post procedure. Secondary outcome measures were the difference in pain scores using the Neonatal Infant Pain Scale (NIPS), crying time, variations in heart rate and adverse events.
RESULTS: Seventy-six participants were recruited and completed the study, 37 (group SUC) and 39 (group PLA) respectively. The mean difference in FLACC scores compared to baseline was 5.62±1.32 (SUC) vs. 6.21±1.15 (PLA) (p=.51) during catheterization and 2.70±1.21 (SUC) vs. 2.26±1.41 (PLA) at 1 min (p=.64) and 0.66±1.32 (SUC) vs. 1.26±1.00 (PLA) at 3 mins (p=.38). For the NIPS scores, it was 4.27±1.06 (SUC) vs. 4.69±0.92 (PLA) (p=.56) during procedure and 2.05±0.91 (SUC) vs. 1.97±1.19 (PLA) (p=.92) at 1 min and 0.49±0.89 (SUC) vs. 0.89±0.97 (PLA) (p=.54) at 3 mins. The difference in the mean crying time was not different between both groups: 99±34 secs (SUC) vs. 100±25 (PLA) (p=.99). No significant difference was found in participants’ heart rate variations during procedure 23±8 BPM (SUC) vs. 26±7 (PLA) (p=.60) and after 1 min 19±12 BPM (SUC) vs. 17±7 (PLA) (p=.76) and after 3 mins -1±12 BPM (SUC) vs. 3±6 (PLA) (p=.53). No adverse events were reported. The blinding was successful.
CONCLUSION: In infants 1 to 3 months of age undergoing urethral catheterization in the ED, administration of an oral sweet solution did not statistically decrease pain scores as measured by the FLACC and NIPS scales. Participants' heart rate variations and crying time were not significantly decreased when sucrose was provided.
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Gravel J, Elie CR, Khayat M, Schmitzer A. Host–guest strategy to potently camouflage and restore the activity and toxicity of drugs affecting bacterial growth and viability. Med Chem Commun 2016. [DOI: 10.1039/c6md00109b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We demonstrate the application of a controllable drug delivery system, where an active and toxic imidazolium salt can be camouflaged when assembled as an inclusion complex with cyclodextrins.
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Affiliation(s)
- J. Gravel
- Département de Chimie
- Université de Montréal
- Montréal
- H3C 3J7 Canada
| | - C. R. Elie
- Département de Chimie
- Université de Montréal
- Montréal
- H3C 3J7 Canada
| | - M. Khayat
- Département de Chimie
- Université de Montréal
- Montréal
- H3C 3J7 Canada
| | - A. Schmitzer
- Département de Chimie
- Université de Montréal
- Montréal
- H3C 3J7 Canada
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Gravel J, Gouin S, Chalut D, Crevier L, Décarie JC, Elazhary N, Mâsse B. 26: A Clinical Decision Rule to Identify Skull Fracture Among Young Children with Isolated Head Trauma. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e42b] [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: 11/14/2022] Open
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Lespérance AJ, Lagacé M, Cook R, Gravel J. 155: Impact of a Volunteer Program for Research in a Pediatric Emergency Department. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e90a] [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: 11/13/2022] Open
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Ducharme F, Zemek R, Chauhan B, Gravel J, Chalut D, Poonai N, Laberge S, Quach C, Krajinovic M, Blondeau L, Guimont C, Lemiere C, Guertin MC. 25: Determinants of Oral Corticosteroid Responsiveness in Wheezing Asthmatic Youth (Doorway). Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e42a] [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: 11/12/2022] Open
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Hoeffe J, Desjardins MP, Fischer J, Carrière B, Gravel J. 158: Present and Future of Emergency Point-of-Care Ultrasound in Pediatric Emergency Fellowship Programs in Canada. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e91] [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: 11/13/2022] Open
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Gravel J, Carrière B, D'Angelo A, Crevier L, Beauchamp M, Mâsse B. 153: Ondansetron for Pediatric Concussion: A Pilot Randomized Controlled Trial. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e89b] [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: 11/14/2022] Open
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Ouellet-Pelletier J, Guimont C, Gauthier M, Gravel J. 154: Risk Factors for Adverse Events Following Diagnostic Urethral Catheterization in the Pediatric Emergency Department. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e90] [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: 11/13/2022] Open
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Lafeuille MH, Grittner AM, Gravel J, Bailey RA, Martin S, Garber L, Duh MS, Lefebvre P. Economic simulation of canagliflozin and sitagliptin treatment outcomes in patients with type 2 diabetes mellitus with inadequate glycemic control. J Med Econ 2015; 18:113-25. [PMID: 25350645 DOI: 10.3111/13696998.2014.980503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study examines the association between changes in diabetes-related quality measures (QMs) (HbA1c, systolic and diastolic blood pressure [BP], low-density lipoprotein cholesterol [LDL-C], and body weight) and healthcare costs in Type 2 diabetes mellitus (T2DM) patients. It also performs an economic simulation that evaluates the cost implications of the changes in QMs and of the incidence rates (IRs) of adverse events (AEs) associated with canagliflozin (CANA) and sitagliptin (SITA) treatments in a real-world setting. METHODS Health-insurance claims and electronic medical records from the Reliant Medical Group database (2007-2011) were used to identify adult patients with T2DM receiving metformin and sulfonylurea who did not achieve adequate glycemic control. The association between the changes in QMs and healthcare costs was evaluated using multivariate regression and non-parametric bootstrap methods. AE-related costs were taken from the literature. The cost impact of CANA and SITA outcomes was evaluated using the aforementioned costs and the changes in QMs and the IRs of AEs observed in a recent phase 3 trial comparing CANA and SITA as third oral agent (DIA3015). RESULTS Eight hundred and fifty-six T2DM patients were identified (mean age = 65.8; female 45.4%). The regression analysis found that increases of 1 percentage point in HbA1C and 1% in systolic and diastolic BP, LDL-C, or weight were associated with a per patient per year (PPPY) cost increase of $4476 (p = 0.028) and $566 (p = 0.006), a decrease of $362 (p = 0.070) and $7 (p = 0.817), and an increase of $241 (p = 0.481), respectively. The economic simulation showed that changes in QMs and IRs of AEs equivalent to those reported in DIA3015 would be associated with a reduction in PPPY healthcare costs of $6061 (p = 0.036) for CANA and $2190 (p = 0.098) for SITA. CONCLUSIONS This study suggests that integrated approaches that manage to control a combination of quality measures are most successful at reducing downstream healthcare costs.
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Knopf KB, Duh MS, Lafeuille MH, Gravel J, Lefebvre P, Niculescu L, Ba-Mancini A, Ma E, Shi H, Comenzo RL. Meta-analysis of the efficacy and safety of bortezomib re-treatment in patients with multiple myeloma. Clin Lymphoma Myeloma Leuk 2014; 14:380-8. [PMID: 25023616 DOI: 10.1016/j.clml.2014.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/28/2014] [Accepted: 03/17/2014] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Bortezomib is administered for a finite course; thus, patients might remain sensitive to bortezomib-based therapy at relapse. We report a meta-analysis of bortezomib-based retreatment in relapsed/refractory myeloma. PATIENTS AND METHODS A systematic literature review identified studies of bortezomib-based retreatment in relapsed/refractory myeloma. Proportions of bortezomib-refractory patients and additional prognostic factors were extracted and used in weighted stratified analyses of TTP and OS. Random-effect pooled estimates were calculated for overall response rate (ORR) and rates of common AEs. RESULTS Twenty-three studies (n = 1051 patients) were identified. Bortezomib was administered intravenously in all studies. Across studies in which data were available, pooled, weighted average ORR was 39.1% (95% confidence interval, 30.8%-47.4%), and pooled, weighted average median TTP and OS were 7.5 and 16.6 months, respectively. Patients with fewer previous therapies (≤ 4) and relapsed (not refractory) patients achieved higher ORRs, of 43.4% and 57.2%, respectively. Random-effects meta-regression analysis confirmed that relapsed patients were associated with a higher ORR by 28 to 41 percentage points versus refractory patients. In relapsed patients, median TTP and OS were 8.5 and 19.7 months, respectively. Common Grade 3/4 AEs included thrombocytopenia (35%), neutropenia (15%), anemia (14%), pneumonia (10%), and peripheral neuropathy (3%). CONCLUSION Based on these findings, bortezomib retreatment is well tolerated and appears efficacious in relapsed patients. In an era of new and emerging treatment options for relapsed and/or refractory myeloma, these data indicate that bortezomib retreatment might be a highly effective option in previously treated patients.
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Affiliation(s)
- Kevin B Knopf
- California Pacific Medical Center, Sutter Health, San Francisco, CA.
| | | | | | | | | | | | | | - Esprit Ma
- Millennium: The Takeda Oncology Company, Cambridge, MA
| | - Hongliang Shi
- Millennium: The Takeda Oncology Company, Cambridge, MA
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Trottier ED, Ferlatte N, Gaucher N, Canuel A, Martineau M, Hogue C, Sanchez M, Certain M, Lemay S, Gravel J. 187: Changing Pain Management Practices in a Pediatric ED: Teamwork Works! Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-183] [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: 11/12/2022] Open
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Ouellet-Pelletier J, Guimont C, Gauthier M, Gravel J. 13: Adverse Events Following Diagnostic Uretral Catheterization in the Pediatric Emergency Department. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-13] [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: 11/14/2022] Open
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21
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Trottier ED, Gravel J, Lemay S, Ali S. 31: Treatment and Reduction of Anxiety and Pain in Pediatric Emergency Department: ‘Trapped’ Survey; A Pediatric Emergency Research Canada Study. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-30] [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: 11/14/2022] Open
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Gravel J, Gouin S, Chalut D, Crevier L, Masse B. 182: Evaluation of a Clinical Score for Skull Radiography of Young Children with Isolated Head Trauma. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-178] [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: 11/13/2022] Open
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Ducharme FM, Zemek R, Gravel J, Chalut D, Poonai N, Laberge S, Quach C, Krajinovic M, Guimont C, Lemière C, Guertin MC. Determinants Of Oral corticosteroid Responsiveness in Wheezing Asthmatic Youth (DOORWAY): protocol for a prospective multicentre cohort study of children with acute moderate-to-severe asthma exacerbations. BMJ Open 2014; 4:e004699. [PMID: 24710133 PMCID: PMC3987727 DOI: 10.1136/bmjopen-2013-004699] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Oral corticosteroids are the cornerstone of acute asthma management in the emergency department. Recent evidence has raised doubts about the efficacy of this treatment in preschool-aged children with viral-induced wheezing and in smoking adults. The aims of the study were to: (1) document the magnitude of response to oral corticosteroids in children presenting to the emergency department with moderate or severe asthma; (2) quantify potential determinants of response to corticosteroids and (3) explore the role of gene polymorphisms associated with the responsiveness to corticosteroids. METHODS AND ANALYSIS The design is a prospective cohort study of 1008 children aged 1-17 years meeting a strict definition of asthma and presenting with a clinical score of ≥4 on the validated Pediatric Respiratory Assessment Measure. All children will receive standardised severity-specific treatment with prednisone/prednisolone and cointerventions (salbutamol with/without ipratropium bromide). Determinants, namely viral aetiology, environmental tobacco smoke and single nucleotide polymorphism, will be objectively documented. The primary efficacy endpoint is the failure of emergency department (ED) management within 72 h of the ED visit. Secondary endpoints include other measures of asthma severity and time to recovery within 7 days of the index visit. The study has 80% power for detecting a risk difference of 7.5% associated with each determinant from a baseline risk of 21%, at an α of 0.05. ETHICS AND DISSEMINATION Ethical approval has been obtained from all participating institutions. An impaired response to systemic steroids in certain subgroups will challenge the current standard of practice and call for the immediate search for better approaches. A potential host-environment interaction will broaden our understanding of corticosteroid responsiveness in children. Documentation of similar effectiveness of corticosteroids across determinants will provide the needed reassurance regarding current treatment recommendations. RESULTS Results will be disseminated at international conferences and manuscripts targeted at emergency physicians, paediatricians, geneticists and respirologists. TRIAL REGISTRATION NUMBER This study is registered at Clinicaltrials.gov (NCT02013076).
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Affiliation(s)
- F M Ducharme
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
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Lafeuille MH, Grittner AM, Gravel J, Bailey RA, Martin S, Garber L, Sheng Duh M, Lefebvre P. Quality measure attainment in patients with type 2 diabetes mellitus. Am J Manag Care 2014; 20:s5-s15. [PMID: 24512194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES This study examined the demographics, comorbidities, clinical characteristics, and treatments of people with type 2 diabetes mellitus (T2DM) treated with metformin and sulfonylurea as well as an elderly subgroup. Achievement of predefined quality measure goals (glycated hemoglobin [A1C], blood pressure [BP], low-density lipoprotein cholesterol [LDL-C], body mass index [BMI]) and their association with diabetes-related healthcare costs were assessed. STUDY DESIGN The study applied a retrospective longitudinal cohort design. METHODS Health insurance claims and electronic medical records from 14,532 adults with T2DM (2007- 2011) were used to identify a sample receiving metformin and sulfonylurea (MET+SU) concomitantly. The index date was the first dispensing of MET+SU after 6 months of eligibility. Clinical characteristics were assessed during baseline. Quality measure attainment (A1C <8%, BP <140/90 mm Hg, LDL-C level <100 mg/dL, BMI <30 kg/m²), was evaluated during the 12 months following the index date. Association between attainment and diabetes-related costs was evaluated using non-parametric bootstrap methods adjusting for imbalance in baseline characteristics between cohorts. RESULTS Among 2044 patients, including 1283 patients 65 years and older, hyperlipidemia, hypertension, and cardiovascular disease were the most common baseline comorbidities. Quality measure goal attainment was 63.9% for A1C, 33.1% for BP, 68.2% for LDL-C level, and 34.4% for BMI, and was associated with significantly lower diabetes-related costs per patient per year compared with nonattainment (adjusted mean cost differences: -$1445 for A1C; -$1218 for BMI; -$2029 for A1C and BMI; -$2073 for A1C, BMI, and BP; all P <.05). CONCLUSION This study highlights the high incidence of comorbidities and potential financial implications of attaining T2DM quality outcomes.
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Affiliation(s)
- Marie-Hélène Lafeuille
- Groupe d'Analyse, Ltée, 1000 De La Gauchetiere West, Suite 1200, Montreal, QC, Canada H3B 4W5. E-mail:
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Lafeuille MH, Gravel J, Lefebvre P, Fastenau J, Muser E, Doshi D, Duh MS. Patterns of relapse and associated cost burden in schizophrenia patients receiving atypical antipsychotics. J Med Econ 2013; 16:1290-9. [PMID: 24006903 DOI: 10.3111/13696998.2013.841705] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify relapse in schizophrenia and the main cost drivers of relapse using a cost-based algorithm. METHODS Multi-state Medicaid data (1997-2010) were used to identify adults with schizophrenia receiving atypical antipsychotics (AP). The first schizophrenia diagnosis following AP initiation was defined as the index date. Relapse episodes were identified based on (1) weeks during the ≥2 years post-index associated with high cost increase from baseline (12 months before the index date) and (2) high absolute weekly cost. A compound score was then calculated based on these two metrics, where the 54% of patients associated with higher cost increase from baseline and higher absolute weekly cost were considered relapsers. Resource use and costs of relapsers during baseline and relapse episodes were compared using incidence rate ratios (IRRs) and bootstrap methods. RESULTS In total, 9793 relapsers were identified with a mean of nine relapse episodes per patient. Duration of relapse episodes decreased over time (mean [median]; first episode: 34 [4] weeks; remaining episodes: 8 [1] weeks). Compared with baseline, resource utilization during relapse episodes was significantly greater in pharmacy, outpatient, and institutional visits (hospitalizations, emergency department visits), with IRRs ranging from 1.9-2.4 (all p < 0.0001). Correspondingly, relapse was associated with a mean (95% CI) incremental cost increase of $2459 ($2384-$2539) per week, with institutional visits representing 53% of the increase. LIMITATIONS Relapsers and relapse episodes were identified using a cost-based algorithm, as opposed to a more clinical definition of relapse. In addition, their identification was based on the assumption from literature that ~54% of schizophrenia patients will experience at least one relapse episode over a 2-year period. CONCLUSIONS Significant cost increases were observed with relapse in schizophrenia, driven mainly by institutional visits.
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Gravel J, Potter B, Dubois L. Prenatal Exposure to Maternal Cigarette Smoke and Offspring Risk of Excess Weight Is Independent of Both Birth Weight and Catch-Up Growth. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/206120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prenatal exposure to maternal cigarette smoke (PEMCS) is one of the most common insults to the developing fetus and has consistently emerged as an important risk factor for excess weight in the offspring. However, no consensus exists on the mechanism of action or duration of impact. This study seeks to further examine the role of PEMCS on overweight status of children up to age 10. Mother and child pairs (n=1183) were analysed from the Québec Longitudinal Study of Child Development (QLSCD) (1998–2010). Multivariable logistic regression models were used to control for confounders and assess mediation. PEMCS was associated with overweight status at age 10 (OR: 1.70; 95% CI: 1.20–2.43) after adjustment for early life exposures and childhood behaviours. This relationship remained robust after adjustment for birth weight and catch-up growth. Other significant predictors included APGAR score, mother’s immigrant and weight status, family type and child energy intake. The elevated risk of excess weight among the offspring of smoking mothers was not accounted for by other known determinants, and PEMCS appears to play a role independent of birth weight and catch-up growth. Our research suggests that young mothers may be an important audience for targeting preventive strategies.
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Affiliation(s)
- Jonathan Gravel
- Institute of Population Health, University of Ottawa, Ottawa, ON, Canada K1N 6N5
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8MS
| | - Beth Potter
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8MS
| | - Lise Dubois
- Institute of Population Health, University of Ottawa, Ottawa, ON, Canada K1N 6N5
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8MS
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Lafeuille MH, Gravel J, Figliomeni M, Zhang J, Lefebvre P. Burden of illness of patients with allergic asthma versus non-allergic asthma. J Asthma 2013; 50:900-7. [PMID: 23721416 DOI: 10.3109/02770903.2013.810244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Allergic and non-allergic asthma share similar symptoms, but differ in that allergic asthma is triggered by inhaled allergens. This study compared healthcare resource utilization (HCRU) and costs between these groups using US employer-based claims data. METHODS Health insurance claims from Truven Marketscan database (2002Q1-2010Q2) were analyzed. Included patients had ≥2 asthma diagnoses and ≥1 year of eligibility prior to and following the date of first asthma diagnosis. Patients with ≥1 diagnosis for allergic asthma and ≥1 diagnosis for other allergic conditions formed the allergic asthma cohort whereas patients without any of these diagnoses formed the non-allergic asthma cohort. Allergic and non-allergic asthma patients were matched 1:1. HCRU and costs during the study period were compared between cohorts using incidence rate ratios (IRR) and bootstrap methods. RESULTS Sixty four thousand four hundred and seventy three allergic and non-allergic asthma patients were matched (mean age = 30; 57.1% female; mean CCI = 0.2), with 7.1% and 0.36% having received an allergy test during the baseline period, respectively. During the study period, allergic asthma patients had significantly more asthma-related pharmacy dispensings (IRR[95% CI] = 2.25[2.22-2.28], p < 0.001) and asthma-related outpatient visits (IRR[95% CI] = 2.29[2.27-2.32], p < 0.001). Allergic asthma patients incurred 39% greater per-patient-per-year all-cause costs (allergic: $4008; non-allergic: $2889, p < 0.001) and 79% greater asthma-related costs (allergic: $1063; non-allergic: $592, p < 0.001) than non-allergic asthma patients. CONCLUSIONS These results indicate, even in a relatively healthy population, allergic asthma is associated with greater HCRU and costs. Guideline-recommended IgE allergy tests should be employed in distinguishing the two forms of asthma, to optimize patient management and reduce costs.
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Lafeuille MH, Gravel J, Grittner A, Lefebvre P, Ellis L, McKenzie RS. Real-World Corticosteroid Utilization Patterns in Patients with Metastatic Castration-Resistant Prostate Cancer in 2 Large US Administrative Claims Databases. Am Health Drug Benefits 2013; 6:307-316. [PMID: 24991366 PMCID: PMC4031721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Prostate cancer is the most common noncutaneous malignancy in men in the United States. Patients with metastatic castration-resistant prostate cancer (mCRPC) may be treated with secondary hormonal therapy or with chemotherapy, and potentially with concomitant corticosteroids. Corticosteroids can help manage the side effects of chemotherapy and secondary hormonal therapy and ameliorate prostate cancer-related symptoms, although corticosteroids are also associated with adverse effects. With an increasing number of available treatment options for mCRPC, evaluating the real-world concomitant use of corticosteroids in this patient population is important. OBJECTIVE To evaluate the utilization patterns of corticosteroids for the treatment of patients with mCRPC based on real-world data from 2 large claim databases. METHODS This retrospective analysis included medical and pharmacy claims from 2 large publicly available healthcare claims databases covering more than 31 million individuals to identify treatment patterns in adult patients with mCRPC. A total of 2593 patients with mCRPC were identified in data set 1 and 626 patients in data set 2 between 2005 and 2011. The appropriate treatment for castration-resistant prostate cancer (CRPC) was defined as chemotherapy, an antiandrogen, an adrenal androgen blocker, or estrogen. The index date was the date of the first CRPC treatment or the first metastasis diagnosis, whichever occurred later. The observation period spanned from the index date to the end of health insurance eligibility. Study end points included population characteristics, the distribution of mCRPC therapies, and corticosteroid utilization patterns. RESULTS The study population came from the 2 data sets and included 3219 men who were treated for mCRPC. Bone and lymph nodes were the predominant metastatic sites. Bicalutamide was the most common secondary hormonal therapy, and docetaxel was the most common chemotherapy used for these patients. Overall, 73.4% of the patients in data set 1 received concomitant corticosteroids, as did 71.6% of patients in population 2 during the entire period from the index date to the end of eligibility date. In addition, 62.8% and 60.4% of patients, respectively, received concomitant corticosteroids during the secondary hormonal therapy period, and 93.8% and 95.1% of patients, respectively, received concomitant corticosteroids during the chemotherapy period. Similar patterns of corticosteroid use were observed across geographic areas of the United States. CONCLUSION This study shows consistently similar utilization patterns of corticosteroids in patients with mCRPC in 2 large national databases. Using real-world data to inform concomitant corticosteroid use in the treatment of patients with mCRPC may assist healthcare providers with treatment selection and with sequencing decision. Future research is warranted to investigate evolving treatment options for patients with mCRPC.
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Affiliation(s)
| | - Jonathan Gravel
- Mr Gravel is Economist, Groupe d'Analyse, Ltée, Montreal, Quebec, Canada
| | - Amanda Grittner
- Ms Grittner is Economist, Groupe d'Analyse, Ltée, Montreal, Quebec, Canada
| | - Patrick Lefebvre
- Mr Lefebvre is Vice President, Groupe d'Analyse, Ltée, Montreal, Quebec, Canada
| | - Lorie Ellis
- Dr Ellis is Associate Director, Janssen Scientific Affairs, Titusville, NJ
| | - R Scott McKenzie
- Dr McKenzie is Senior Director, Janssen Scientific Affairs, Titusville, NJ
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Lafeuille MH, Gravel J, Zhang J, Gorsh B, Figliomeni M, Lefebvre P. Association between consistent omalizumab treatment and asthma control. J Allergy Clin Immunol Pract 2012; 1:51-7. [PMID: 24229822 DOI: 10.1016/j.jaip.2012.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/28/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Omalizumab is indicated for patients with moderate-to-severe allergic asthma with inadequately controlled symptoms. OBJECTIVE We evaluated the association between consistent omalizumab treatment and asthma control. METHODS Health insurance claims from the MarketScan database (2002Q1-2011Q2) were analyzed. Asthmatic patients with ≥12 months of continuous insurance coverage after the first omalizumab claim (index date) after 6 months of continuous omalizumab use were included. A 12-month landmark period was used to assess treatment consistency, defined as uninterrupted treatment without a gap of ≥28 days in omalizumab use. The effect of consistent omalizumab treatment on asthma control between months 13 and 24 was evaluated. Multivariate time-varying Cox regressions were also conducted to assess the adjusted effect of treatment interruption on asthma control from month 1 to month 24. RESULTS A total of 3044 patients (mean age, 48.5 years; female, 62%) formed the study population. Patients consistent with omalizumab treatment at 12 months (39% of patients) were less likely to have an uncontrolled asthma event during months 13 to 24 with only 49% of patients experiencing one event compared with 54% in the non consistent subgroup (P = .02). In addition, consistent omalizumab treatment at 12 months was associated with a 51% reduction in the mean number of asthma-related emergency department (ED) visits per patient and a 28% reduction in asthma-related hospitalizations. Multivariate analyses corroborated these findings (hazard ratio for consistent vs non-consistent: risk of short-acting β2-agonists prescription, oral corticosteroids prescription, ED visit, or hospitalization, 0.76; 95% CI, 0.69-0.83]). CONCLUSION This analysis showed that consistent omalizumab treatment was associated with significant reductions in ED visits and hospitalizations.
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Levy A, Donoghue A, Bailey B, Thompson N, Jamoulle O, Gravel J. External Validation of Scoring Instruments to Evaluate Pediatric Resuscitations. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.20ab] [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: 11/12/2022] Open
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Gravel J, Fitzpatrick E, Millar K, Curtis S, Joubert G, Boutis K, Guimont C, Goldman RD, Dubrovsky S, Porter R, Beer D, Osmond MH. Validity of the Canadian Triage and Acuity Scale for Children: A Multi-Centre, Database Study. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.21aa] [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: 11/13/2022] Open
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Gravel J, Potter B, Dubois L. P2-102 Developmental trajectories of body mass index in childhood: is maternal smoking during pregnancy a critical exposure? Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976i.37] [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: 11/04/2022]
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Abstract
The pathophysiology of gestational hypertensive disorders is incompletely defined. T lymphocytes are implicated. Both T and natural killer (NK) cells express RAS and, in implantation sites, NK cells are highly enriched. We hypothesized that T cells and/or NK cells contribute to circulatory control during pregnancy. Using radiotelemetry of arterial pressure, heart rate, and activity, mice without T and B cells (genotypes BALB/c-Rag2(-/-) and NOD.scid) were examined at baseline and across pregnancy. These strains differ in NK cell competency, with Rag2(-/-) being normal and NOD.scid impaired. Circulatory features differed between these inbred strains. Rag2(-/-); had blood pressure responses to pregnancy that did not differ from congenic normal mice. NOD.scid had higher midgestational blood pressure compared with normoglycemic NOD mice (3-5 mm Hg greater than NOD; P < 0.004). In comparison to controls, both T and B strains had much higher heart rates after first trimester that did not remit until parturition (>30 bpm greater than control; P < 0.0001). NOD.scid had additional anomalies, including 90% depletion of circulating NK cells and elevated (57%) proliferation of uterine NK cells within implantation sites. These data demonstrate immune control of midgestational heart rate and suggest NK cells contribute to midpregnancy regulation of mean arterial pressure.
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Affiliation(s)
- Suzanne D Burke
- Departments of Anatomy and Cell Biology, Queen's University, Kingston, Ontario, Canada
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Gravel J, Potter B, Dubois L. Parental smoking and childhood obesity: Is maternal smoking during pregnancy the critical exposure? Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)52039-8] [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: 11/26/2022]
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Gaucher N, Bailey B, Gravel J. Who Are the Children Leaving the Emergency Department with out Being Seen by a Physician? Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.52aa] [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: 11/13/2022] Open
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Gaucher N, Bailey B, Gravel J. Impact of Physicians' Characteristics On the Risk of Admission Among Children Visiting a Pediatric Emergency Department. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.52a] [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: 11/14/2022] Open
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Gaucher N, Bailey B, Gravel J. Triage Nurses' Counseling in fluence Return Visits of Children Leaving the Emergency Department Before Being Seen by a Physician. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.52ab] [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: 11/14/2022] Open
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Burke SD, Barrette VF, Gravel J, Carter ALI, Hatta K, Zhang J, Chen Z, Leno-Durán E, Bianco J, Leonard S, Murrant C, Adams MA, Croy BA. Uterine NK cells, spiral artery modification and the regulation of blood pressure during mouse pregnancy. Am J Reprod Immunol 2010; 63:472-81. [PMID: 20175772 DOI: 10.1111/j.1600-0897.2010.00818.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Reproductive success in mammals involves coordinated changes in the immune and cardiovascular as well as in the neuroendocrine and reproductive systems. This review addresses studies that identify potential links for NK cells and T cells with the local and systemic cardiovascular adaptations of pregnancy. The studies reviewed have utilized immunohistochemisty and in vivo analyses of vascular parameters by ultrasound, chronic monitoring of hemodynamics via radiotelemetric recording and intravital microscopy. At the uterine level, functional subsets of uterine natural killer cells were identified. These included subsets expressing molecules important for vasoregulation, in addition to those previously identified for angiogenesis. Spiral arteries showed conducted responses that could account for conceptus control of vasoactivity and mouse gestational blood pressure 5-phase pattern. Vascular immunology is an emerging transdisciplinary field, critical for both reproductive immunology and cardiovascular disease.
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Affiliation(s)
- Suzanne D Burke
- Department of Anatomy and Cell Biology, Queen's University, Kingston, ON, Canada
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Morrison J, Lucas N, Gravel J. The Role of Abdominal X-Rays in the Diagnosis of Intussusception when Interpreted by Pediatric Emergency Physicians. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.suppl_a.22ab] [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: 11/14/2022] Open
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Gravel J, Roy M, Carière B. Efficacy of a Mnemonic to Improve Knowledge of the Ottawa Ankle and Foot Rule; a Randomized Controlled Trial. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.suppl_a.21a] [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: 11/14/2022] Open
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Martel B, Guimond JC, Gariépy JF, Gravel J, Auclair F, Kolta A, Lund JP, Dubuc R. Respiratory rhythms generated in the lamprey rhombencephalon. Neuroscience 2007; 148:279-93. [PMID: 17618060 DOI: 10.1016/j.neuroscience.2007.05.023] [Citation(s) in RCA: 30] [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] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Revised: 05/22/2007] [Accepted: 05/24/2007] [Indexed: 10/23/2022]
Abstract
Brainstem networks generating the respiratory rhythm in lampreys are still not fully characterized. In this study, we described the patterns of respiratory activities and we identified the general location of underlying neural networks. In a semi-intact preparation including the brain and gills, rhythmic discharges were recorded bilaterally with surface electrodes placed over the vagal motoneurons. The main respiratory output driving rhythmic gill movements consisted of short bursts (40.9+/-15.6 ms) of discharge occurring at a frequency of 1.0+/-0.3 Hz. This fast pattern was interrupted by long bursts (506.3+/-174.6 ms) recurring with an average period of 37.4+/-24.9 s. After isolating the brainstem by cutting all cranial nerves, the frequency of the short respiratory bursts did not change significantly, but the slow pattern was less frequent. Local injections of a glutamate agonist (AMPA) and antagonists (6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) or D,L-amino-5-phosphonopentanoic acid (AP5)) were made over different brainstem regions to influence respiratory output. The results were similar in the semi-intact and isolated-brainstem preparations. Unilateral injection of AP5 or CNQX over a rostral rhombencephalic region, lateral to the rostral pole of the trigeminal motor nucleus, decreased the frequency of the fast respiratory rhythm bilaterally or stopped it altogether. Injection of AMPA at the same site increased the rate of the fast respiratory rhythm and decreased the frequency of the slow pattern. The activity recorded in this area was synchronous with that recorded over the vagal motoneurons. After a complete transverse lesion of the brainstem caudal to the trigeminal motor nucleus, the fast rhythm was confined to the rostral area, while only the slow activity persisted in the vagal motoneurons. Our results support the hypothesis that normal breathing depends on the activity of neurons located in the rostral rhombencephalon in lampreys, whereas the caudal rhombencephalon generates the slow pattern.
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Affiliation(s)
- B Martel
- Centre de Recherche en Sciences Neurologiques, Université de Montréal, Casier Postal 6128, Succursale Centre-Ville, Montréal, Québec, Canada H3C 3J7
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Bailey B, Bergeron S, Gravel J, Daoust R. Comparison of Four Pain Scales in Children with Acute Abdominal Pain in a Pediatric Emergency Department. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.952] [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: 11/10/2022]
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Bailey B, Bergeron S, Gravel J, Bussieres JF, Bensoussan A. Efficacy and Impact of Intravenous Morphine before Surgical Consult in Children with Right Lower Quadrant Pain Suggestive of Appendicitis: A Randomized Controlled Trial. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.951] [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: 11/10/2022]
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Gravel J, Manzano S. Safety of the Modification of the Triage Level for Children 6 to 36 Months Old with Fever. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.954] [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: 11/10/2022]
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Gravel J, Gouin S, Bailey B, Roy M, Bergeron S, Amre D. Evaluation of the Validity of a Computerized Version of the Canadian Triage and Acuity Scale in a Pediatric Emergency Department. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.903] [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: 11/10/2022]
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Gravel J, Brocard F, Gariépy JF, Lund JP, Dubuc R. Modulation of respiratory activity by locomotion in lampreys. Neuroscience 2006; 144:1120-32. [PMID: 17137720 DOI: 10.1016/j.neuroscience.2006.10.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 10/10/2006] [Accepted: 10/10/2006] [Indexed: 11/25/2022]
Abstract
In vertebrates, locomotion is associated with changes in respiratory activity, but the neural mechanisms by which this occurs remain unknown. We began examining this in lampreys using a semi-intact preparation of young adult Petromyzon marinus, in which respiratory and locomotor behaviors can be recorded simultaneously with the activity of the underlying neural control systems. Spontaneous fictive respiration was recorded with suction electrodes positioned over the glossopharyngeal or the rostral vagal motor nucleus. In this preparation, locomotor activity, characterized by symmetrical tail movements (electromyogram recordings), was evoked by mechanical stimulation of the skin. During locomotion, the mean respiratory frequency and the mean area of the motor bursts were significantly increased (81.6+/-28.6% and 62.8+/-25.4%, respectively; P<0.05). The frequency returned to normal 92+/-51 s after the end of locomotion. There were fluctuations in the instantaneous respiratory and locomotor frequencies that were rhythmical but antiphasic for the two rhythmic activities. The changes in respiratory activity were also examined during bouts of locomotion occurring spontaneously, and it was found that a modification in respiratory activity preceded the onset of spontaneous locomotion by 3.5+/-2.6 s. This suggests that the early respiratory changes are anticipatory and are not caused by feedback generated by locomotion. The increase in respiratory frequency during locomotion induced by sensory stimulation persisted after removal of the mesencephalon. When both the mesencephalon and spinal cord were removed, resulting in the isolation of the rhombencephalon, changes in the respiratory activity were also present following skin stimulations that would have normally induced locomotion. Altogether, the results suggest that respiratory changes are programmed to adjust ventilation prior to motor activity, and that a central rhombencephalic mechanism is involved.
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Affiliation(s)
- J Gravel
- Département de Physiologie, Université de Montréal, Casier Postal 6128, Succursale Centre-ville, Montréal, Québec, Canada H3C 3J7
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Gravel J, Gouin S, Opatrny L. 26 Predictors of Failure to Measure Vital Signs at Triage in a Pediatric Emergency Department. Paediatr Child Health 2004. [DOI: 10.1093/pch/9.suppl_a.27a] [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: 11/12/2022] Open
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Gravel J. Evaluation of the Canadian Paediatric Triage and Acuity Scale in an Emergency Department. Acad Emerg Med 2002. [DOI: 10.1197/aemj.9.5.523-a] [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: 11/10/2022]
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Gravel J. Evaluation of the Pediatric Risk of Admission (PRISA) Score in a Pediatric Emergency Department. Acad Emerg Med 2002. [DOI: 10.1197/aemj.9.5.441-b] [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: 11/10/2022]
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Gravel J, Bergeron S, Amre D, Gouin S. Evaluation of the Canadian Pediatric Triage and Acuity Scale in an Emergency Department. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.19aa] [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: 11/12/2022] Open
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