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Breton M, Ann Smithman M, Lamoureux‐Lamarche C, Dumas Pilon M, Keely E, Farrell G, Singer A, Woods P, Bibeau C, Nabelsi V, Gaboury I, Gagnon M, Steele Gray C, Shaw J, Hudon C, Aubrey‐Bassler K, Bush P, Côté‐Boileau É, Gagnon J, Visca R, Liddy C. DISSEMINATION, IMPLEMENTATION, AND IMPACT. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13409] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- M. Breton
- University of Sherbrooke Longueuil QC Canada
| | | | | | - M. Dumas Pilon
- Collège québécois des médecins de famille Laval QC Canada
| | - E. Keely
- Department of Medicine University of Ottawa Ottawa ON Canada
| | | | - A. Singer
- University of Manitoba Winnipeg MB Canada
| | | | | | - V. Nabelsi
- Université du Québec en Outaouais Gatineau QC Canada
| | - I. Gaboury
- University of Sherbrooke Longueuil QC Canada
| | | | | | - J. Shaw
- Women's College Hospital Toronto ON Canada
| | - C. Hudon
- University of Sherbrooke Sherbrooke QC Canada
| | | | - P. Bush
- McGill University Montréal QC Canada
| | | | - J. Gagnon
- McGill University Montréal QC Canada
| | - R. Visca
- McGill University Montréal QC Canada
| | - C. Liddy
- Family Medicine C.T. Lamont Primary Health Care Research Centre Bruyère Research Institute Ottawa ON Canada
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Beaulieu MC, Gaboury I, Carrier N, Dobkin P, Gervais F, Gendron F, Roberge P, Dagenais P, Roux S, Boire G. PARE0016 MINDFULNESS-BASED STRESS REDUCTION TO IMPROVE DEPRESSIVE SYMPTOMS AND RHEUMATOID ARTHRITIS-RELATED CLINICAL OUTCOMES: RESULTS FROM A FEASIBILITY AND ACCEPTABILITY TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6339] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Despite available highly effective pharmacological treatments, up to 30% of current rheumatoid arthritis (RA) patients remain in quasi-remission, where inflammation is controlled but patients still report unacceptable levels of negative impact of RA (high Patient Global Assessment (PGA) on a 0-10 visual analog scale). PGA levels correlated with depressive symptoms assessed by Center for Epidemiologic Studies- Depression (CES-D) scores. Mindfulness-Based Stress Reduction (MBSR) is relatively inexpensive and reduces both anxiety and depression in several conditions.Objectives:To complete a feasibility and acceptability study paving the way for a randomized controlled trial (RCT) of MBSR to improve depressive symptoms and clinical outcomes in RA patients in quasi-remission.Methods:A standardized 8-week MBSR program in adults with controlled inflammatory disease (stable SJC ≤ 2/66 and normal CRP; stable treatments) but high CES-D scores (2 groups), high CES-D or anxiety scores (1 group), or PGA higher than Physician Evaluation of Disease Activity (EVA) by ≥2 (1 group). Feasibility was documented using process indicators. Outcomes were measured at baseline and 6 months after the end of MBSR. Disease activity scores (SDAI) and questionnaires on depressive symptoms (CES-D), HAQ, sleep (VAS), fatigue and pain (SF-36), anxiety (GAD-7), PGA were collected. Qualitative interviews based on a theoretical framework of acceptability were conducted following the post-MBSR evaluation.Results:We report on the first 21 patients (mean age 59, 91% females) having completed their 6-month follow up evaluation. Factors leading to higher recruitment rates were 1) using pragmatic scores to identify eligible patients (e.g. EVA and PGA), 2) no formal clinical evaluation of mental health and no emphasis on depression in the recruitment material.MBSR had a highly significant positive impact on depressive symptoms (p=0.003) and anxiety (p=0.025) (Figure), and positive impact on quality of sleep and HAQ. No change in SDAI or joint counts was noted.During a qualitative interview of 13 participants, most reported that MBSR helped them control their reactions to daily stressful situations. Perceptions were almost uniformly positive towards MBSR, and most appeared to have integrated some part of it in their daily life. No side effects were reported.Conclusion:Although recruitment was challenging, a MBSR trial in RA patients in quasi-remission was found acceptable and feasible. Positive impacts on mood and on clinical outcomes were observed. Anxiety and depression scores appear the most sensitive to change and are recommended as the primary outcome for an eventual RCT. MBSR added to conventional treatments might help empower RA patients towards self-management.Acknowledgments:Grant support from Canadian Initiative for Outcomes in Rheumatology cAre (CIORA)Disclosure of Interests:Marie-Claude Beaulieu: None declared, Isabelle Gaboury: None declared, Nathalie Carrier: None declared, Patricia Dobkin: None declared, France Gervais: None declared, Françoise Gendron: None declared, Pasquale Roberge: None declared, Pierre Dagenais: None declared, Sophie Roux: None declared, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer
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Roux S, Gaboury I, Gionet-Landry N, Garant MP, Beaulieu MC, Carrier N, Cabana F, Boire G. Using a sequential explanatory mixed method to evaluate the therapeutic window of opportunity for initiating osteoporosis treatment following fragility fractures. Osteoporos Int 2018; 29:961-971. [PMID: 29445831 DOI: 10.1007/s00198-017-4374-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/08/2017] [Accepted: 12/27/2017] [Indexed: 12/23/2022]
Abstract
UNLABELLED Interventions targeting patients with recent fragility fracture and their physician were most successful at initiating osteoporosis treatment during the first 12 months. This window of opportunity had already closed after 1 year. The reasons for declining or accepting the intensive intervention were explored in patients still untreated at 12 months. INTRODUCTION A fragility fracture (FF) event identifies patients most likely to benefit from osteoporosis treatment. Nonetheless, most FF patients go untreated. Our objective was to determine how long an incident FF remains a strong incentive to initiate osteoporosis treatment. METHODS A total of 1086 men and women over age 50 with a recent FF event were assigned to either standard care (SC), to minimal (MIN), or intensive (INT) interventions targeting patients and their family physician to initiate osteoporosis treatment. Inpatients with FF (mainly hip) evaluated by rheumatologists were also included in a specialized group (SPE; n = 324). At 1 year, untreated patients in both the SC and the MIN groups were offered an INT intervention. The cohort was followed through 48 months. A qualitative analysis of patient-centered decision-making associated with initiation of treatment was conducted. RESULTS In MIN and INT groups, osteoporosis treatment was initiated in 41.0 and 54.3% of untreated patients by 12 months, respectively, compared to 68.4% in SPE and 18.9% in SC groups; initiation rates drastically dropped thereafter. Over 4863 patient-years of follow-up, the rates of new FF were 3.4 per 100 patient-years, without significant differences between patients with initial major or minor FF, nor between control or intervention groups. Failure by patients and physicians to recognize FF as a sign of underlying bone disease contributed the most to lack of treatment. CONCLUSION While incident FFs are an ideal opportunity for starting osteoporosis treatment, 1 year later, the therapeutic window of opportunity has already closed.
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Affiliation(s)
- S Roux
- Division of Rheumatology, Department of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
- Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Sherbrooke, QC, Canada
| | - I Gaboury
- Department of Family Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - N Gionet-Landry
- Division of Rheumatology, Department of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - M-P Garant
- Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Sherbrooke, QC, Canada
| | - M-C Beaulieu
- Department of Family Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - N Carrier
- Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Sherbrooke, QC, Canada
| | - F Cabana
- Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Sherbrooke, QC, Canada
- Division of Orthopedic Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - G Boire
- Division of Rheumatology, Department of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.
- Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Sherbrooke, QC, Canada.
- CIUSSS de l'Estrie-CHUS, 3001, 12th Avenue North, Division of Rheumatology, Room 3853, Sherbrooke, Québec, J1H 5N4, Canada.
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Feber J, Gaboury I, Ni A, Alos N, Arora S, Bell L, Blydt-Hansen T, Clarson C, Filler G, Hay J, Hebert D, Lentle B, Matzinger M, Midgley J, Moher D, Pinsk M, Rauch F, Rodd C, Shenouda N, Siminoski K, Ward LM. Skeletal findings in children recently initiating glucocorticoids for the treatment of nephrotic syndrome. Osteoporos Int 2012; 23:751-60. [PMID: 21494860 PMCID: PMC4000256 DOI: 10.1007/s00198-011-1621-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [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: 10/19/2010] [Accepted: 03/02/2011] [Indexed: 01/27/2023]
Abstract
SUMMARY Eighty children with nephrotic syndrome underwent lumbar spine densitometry and vertebral morphometry soon after glucocorticoid initiation. We found an inverse relationship between glucocorticoid exposure and spine areal bone mineral density (BMD) Z-score and a low rate of vertebral deformities (8%). INTRODUCTION Vertebral fractures are an under-recognized complication of childhood glucocorticoid-treated illnesses. Our goal was to study the relationships among glucocorticoid exposure, lumbar spine areal BMD (LS BMD), and vertebral shape in glucocorticoid-treated children with new-onset nephrotic syndrome. METHODS Lateral thoracolumbar spine radiography and LS BMD were performed in 80 children with nephrotic syndrome (median age 4.4 years; 46 boys) within the first 37 days of glucocorticoid therapy. Genant semiquantitative grading was used as the primary method for vertebral morphometry; the algorithm-based qualitative (ABQ) method was used for secondary vertebral deformity analysis. RESULTS Six of the 78 children with usable radiographs (8%; 95% confidence interval 4 to 16%) manifested a single Genant grade 1 deformity each. All deformities were mild anterior wedging (two at each of T6, T7, and T8). Four of the 78 children (5%; 95% confidence interval 2 to 13%) showed one ABQ sign of fracture each (loss of endplate parallelism; two children at T6 and two at T8). Two of the children with ABQ signs also had a Genant grade 1 deformity in the same vertebral body. None of the children with a Genant or ABQ deformity reported back pain. An inverse relationship was identified between LS BMD Z-score and glucocorticoid exposure. CONCLUSIONS Although we identified an inverse relationship between steroid exposure and LS BMD soon after glucocorticoid initiation for childhood nephrotic syndrome, there was only a low rate of vertebral deformities. The clinical significance of these findings requires further study.
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Affiliation(s)
- J Feber
- University of Ottawa, Ottawa, ON, Canada
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Huber AM, Gaboury I, Cabral DA, Lang B, Ni A, Stephure D, Taback S, Dent P, Ellsworth J, LeBlanc C, Saint-Cyr C, Scuccimarri R, Hay J, Lentle B, Matzinger M, Shenouda N, Moher D, Rauch F, Siminoski K, Ward LM. Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders. Arthritis Care Res (Hoboken) 2010; 62:516-26. [PMID: 20391507 DOI: 10.1002/acr.20171] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Vertebral fractures are an under-recognized problem in children with inflammatory disorders. We studied spine health among 134 children (87 girls) with rheumatic conditions (median age 10 years) within 30 days of initiating glucocorticoid therapy. METHODS Children were categorized as follows: juvenile dermatomyositis (n = 30), juvenile idiopathic arthritis (n = 28), systemic lupus erythematosus and related conditions (n = 26), systemic arthritis (n = 22), systemic vasculitis (n = 16), and other conditions (n = 12). Thoracolumbar spine radiograph and dual x-ray absorptiometry for lumbar spine (L-spine) areal bone mineral density (BMD) were performed within 30 days of glucocorticoid initiation. Genant semiquantitative grading was used for vertebral morphometry. Second metacarpal morphometry was carried out on a hand radiograph. Clinical factors including disease and physical activity, calcium and vitamin D intake, cumulative glucocorticoid dose, underlying diagnosis, L-spine BMD Z score, and back pain were analyzed for association with vertebral fracture. RESULTS Thirteen vertebral fractures were noted in 9 children (7%). Of these, 6 patients had a single vertebral fracture and 3 had 2-3 fractures. Fractures were clustered in the mid-thoracic region (69%). Three vertebral fractures (23%) were moderate (grade 2); the others were mild (grade 1). For the entire cohort, mean +/- SD L-spine BMD Z score was significantly different from zero (-0.55 +/- 1.2, P < 0.001) despite a mean height Z score that was similar to the healthy average (0.02 +/- 1.0, P = 0.825). Back pain was highly associated with increased odds for fracture (odds ratio 10.6 [95% confidence interval 2.1-53.8], P = 0.004). CONCLUSION In pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged glucocorticoid exposure.
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Affiliation(s)
- A M Huber
- Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
OBJECTIVE Describe intubation conditions and adverse events when using atropine fentanyl +/- succinylcholine as premedication. DESIGN Prospective observational study, as part of a quality improvement initiative. SETTING Two level 3 neonatal intensive care units in Ottawa, Canada PATIENTS 60 infants, median 27 weeks gestation, 1023 g at birth were included. INTERVENTIONS Infants received atropine, fentanyl +/- succinylcholine prior to the intubation. Succinylcholine was given for all infants > or =34 weeks and at the discretion of the physician for those <34 weeks. MAIN OUTCOME MEASURES The primary outcome was the number of attempts. Secondary outcomes were number of attempts and intubation conditions in infants who received and those who did not receive succinylcholine and safety. RESULTS The median number of attempts was 2. 91.7% had excellent or good conditions. The median number of attempts for infants who received succinylcholine was lower (1 vs 2) than those who did not. No serious adverse events were noted. 2 cases of difficult bag and mask ventilation after administration of fentanyl were noted. CONCLUSION Atropine, fentanyl and succinylcholine before non-urgent intubations in newborns has led to a low number of attempts and good intubation conditions with no adverse events.
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Affiliation(s)
- B Lemyre
- University of Ottawa, Ottawa, Ontario, Canada.
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Webber G, Edwards N, Graham ID, Amaratunga C, Gaboury I, Keane V, Ros S, McDowell I. A survey of Cambodian health-care providers' HIV knowledge, attitudes and intentions to take a sexual history. Int J STD AIDS 2009; 20:346-50. [PMID: 19386973 DOI: 10.1258/ijsa.2008.008390] [Citation(s) in RCA: 5] [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: 11/18/2022]
Abstract
Cambodia has one of the highest prevalence rates of HIV in Asia and is scaling up HIV testing. We conducted a cross-sectional survey with 358 health care providers in Phnom Penh, Cambodia to assess readiness for voluntary testing and counselling for HIV. We measured HIV knowledge and attitudes, and predictors of intentions to take a sexual history using the Theory of Planned Behaviour. Over 90% of health care providers correctly answered knowledge questions about HIV transmission, but their attitudes were often not positive towards people living with HIV. The Theory of Planned Behaviour constructs explained 56% of the variance in intention to take a sexual history: the control providers perceive they have over taking a sexual history was the strongest contributor (51%), while social pressure explained a further 3%. Attitudes about taking a sexual history did not contribute to intention. Interventions with Cambodian health care providers should focus on improving skills in sexual history-taking.
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Affiliation(s)
- G Webber
- Department of Family Medicine, University of Ottawa, Ontario, Canada.
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Moore GP, Lawrence SL, Maharajh G, Sumner A, Gaboury I, Lemyre B. Repeated Indomethacin Courses in <27 Week Gestational Age Infants With a Patent Ductus Arteriosus: is it Worthwhile? Paediatr Child Health 2009. [DOI: 10.1093/pch/14.suppl_a.35a] [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: 11/12/2022] Open
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Keays M, Guerra L, Mihill J, Raju G, Al-Asheeri N, Geier P, Gaboury I, Matzinger M, Pike J, Leonard M. Reliability Assessment of Society for Fetal Urology Ultrasound Grading System for Hydronephrosis. J Urol 2008; 180:1680-2; discussion1682-3. [DOI: 10.1016/j.juro.2008.03.107] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Indexed: 11/28/2022]
Affiliation(s)
- M.A. Keays
- Division of Pediatric Urology, University of Ottawa, Ontario, Canada
| | - L.A. Guerra
- Division of Pediatric Urology, University of Ottawa, Ontario, Canada
| | - J. Mihill
- Children's Hospital of Eastern Ontario, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - G. Raju
- Division of Pediatric Urology, University of Ottawa, Ontario, Canada
| | - N. Al-Asheeri
- Division of Pediatric Urology, University of Ottawa, Ontario, Canada
| | - P. Geier
- Division of Nephrology, University of Ottawa, Ontario, Canada
| | - I. Gaboury
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
| | - M. Matzinger
- Department of Pediatric Radiology, University of Ottawa, Ontario, Canada
| | - J. Pike
- Division of Pediatric Urology, University of Ottawa, Ontario, Canada
| | - M.P. Leonard
- Division of Pediatric Urology, University of Ottawa, Ontario, Canada
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Abstract
The study's purpose was to explore the decision-making needs of patients considering treatment options for their depression. Semi-structured interviews were guided by the Ottawa Decision Support Framework. Of 94 participants, 67 were uncertain about their decision. Common decisions identified were whether or not to take medications, attend support groups, undergo electroconvulsive therapy, and location of care. Those feeling certain were more likely to have made a decision (RR 1.37; 95% CI: 1.05, 1.78). However, 40 patients who had 'made a decision' in the recent past were uncertain about their decision. Compared with those who were certain, the uncertain group felt less informed (2.65 vs. 1.64; P < 0.001), less supported (2.63 vs. 1.88; P < 0.001) and less clear about how they valued the benefits and risks of options (2.57 vs. 1.69; P < 0.001). Other influential factors included concerns about confidentiality, distress from depression, embarrassment, panic attacks and lack of energy. Few patients wanted to defer decision making to their physician (n = 8) or family (n = 1). To support decision making, participants identified the need for: discussions with their psychiatrist, nurse or family doctor; access to printed information; and information provided by health professionals and health societies.
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Affiliation(s)
- D Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada.
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Ward LM, Gaboury I, Ladhani M, Zlotkin S. Vitamin D deficiency among Italian children. CMAJ 2007. [DOI: 10.1503/cmaj.1070134] [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: 11/01/2022] Open
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Ward L, Tricco AC, Phuong P, Cranney A, Barrowman N, Gaboury I, Rauch F, Tugwell P, Moher D. Bisphosphonate therapy for children and adolescents with secondary osteoporosis. Cochrane Database Syst Rev 2007; 2007:CD005324. [PMID: 17943849 PMCID: PMC8884163 DOI: 10.1002/14651858.cd005324.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [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: 11/11/2022]
Abstract
BACKGROUND Children with chronic illnesses are at increased risk for reductions in bone strength and subsequent fractures (osteoporosis), either due to the impact of the underlying condition on skeletal development or due to the osteotoxic effect of medications (e.g., glucocorticoids) used to treat the chronic illness. Bisphosphonates are being administered with increasing frequency to children with secondary osteoporosis; however, the efficacy and harm of these agents remains unclear. OBJECTIVES To examine the efficacy and harm of bisphosphonate therapy in the treatment and prevention of secondary osteoporosis in children and adolescents. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (Issue 4, 2006), MEDLINE, EMBASE, CINAHL and ISI Web of Science (inception-December 2006). Further literature was identified through expert contact, key author searches, scanning reference lists of included studies, and contacting bisphosphonate manufacturers. SELECTION CRITERIA Randomized, quasi-randomized, controlled clinical trials, cohort, and case controls of bisphosphonate(s) in children 0-18 years of age with at least one low-trauma fracture event or reductions in bone mineral density in the context of secondary osteoporosis. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed quality. Case series were used for supplemental harms-related data. MAIN RESULTS Six RCTs, two CCTs, and one prospective cohort (n=281 children) were included and classified into osteoporosis due to: 1) neuromuscular conditions (one RCT) and 2) chronic illness (five RCTs, two CCTs, one cohort). Bisphosphonates examined were oral alendronate, clodronate, and intravenous (IV) pamidronate. Study quality varied. Harms data from 23 case series (n=241 children) were used. Heterogeneity precluded statistically combining the results. Percent change or Z-score change in lumbar spine areal BMD from baseline were consistently reported. Two studies carried out between-group analyses; one showed no significant difference (using oral alendronate in anorexia nervosa) while the other demonstrated a treatment effect on lumbar spine with IV pamidronate in burn patients. Frequently reported harms included the acute phase reaction, followed by gastrointestinal complaints, and bone/muscle pain. AUTHORS' CONCLUSIONS The results justify further evaluation of bisphosphonates among children with secondary osteoporosis. However, the evidence does not support bisphosphonates as standard therapy. Short-term (3 years or less) bisphosphonate use appears to be well-tolerated. An accepted criterion for osteoporosis in children, a standardized approach to BMD reporting, and examining functional bone health outcomes (e.g., fracture rates) will allow for appropriate comparisons across studies.
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Affiliation(s)
- L Ward
- Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, 401 Smyth Rd., Research Institute, R250H, Ottawa, Ontario, Canada, K1H 8L1.
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Keays M, Guerra L, Mihill J, Raju G, Al-Asheeri N, Geier P, Gaboury I, Matzinger M, Pike J, Leonard M. MP-02.02: Reliability and validity assessment of society for fetal urology ultrasound grading system for hydronephrosis. Urology 2007. [DOI: 10.1016/j.urology.2007.06.185] [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: 10/22/2022]
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Osmond M, Dalgleish D, Lawson K, MacDonald T, Clifford T, Gaboury I, Correll R, Pitters C. An Assessment of Knowledge, and Beliefs of Pediatric Emergency Nurses Towards the use of Metered-dose Inhaler and Spacer (MDI+S) for the Treatment of Acute Asthma Before and 12 Months after a Practice Change. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.960] [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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Reisman J, Schachter HM, Dales RE, Tran K, Kourad K, Barnes D, Sampson M, Morrison A, Gaboury I, Blackman J. Treating asthma with omega-3 fatty acids: where is the evidence? A systematic review. BMC Complement Altern Med 2006; 6:26. [PMID: 16854238 PMCID: PMC1550729 DOI: 10.1186/1472-6882-6-26] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 07/19/2006] [Indexed: 01/21/2023]
Abstract
Background Considerable interest exists in the potential therapeutic value of dietary supplementation with the omega-3 fatty acids. Given the interplay between pro-inflammatory omega-6 fatty acids, and the less pro-inflammatory omega-3 fatty acids, it has been thought that the latter could play a key role in treating or preventing asthma. The purpose was to systematically review the scientific-medical literature in order to identify, appraise, and synthesize the evidence for possible treatment effects of omega-3 fatty acids in asthma. Methods Medline, Premedline, Embase, Cochrane Central Register of Controlled Trials, CAB Health, and, Dissertation Abstracts were searched to April 2003. We included randomized controlled trials (RCT's) of subjects of any age that used any foods or extracts containing omega-3 fatty acids as treatment or prevention for asthma. Data included all asthma related outcomes, potential covariates, characteristics of the study, design, population, intervention/exposure, comparators, and co interventions. Results Ten RCT's were found pertinent to the present report. Conclusion Given the largely inconsistent picture within and across respiratory outcomes, it is impossible to determine whether or not omega-3 fatty acids are an efficacious adjuvant or monotherapy for children or adults. Based on this systematic review we recommend a large randomized controlled study of the effects of high-dose encapsulated omega-3 fatty acids on ventilatory and inflammatory measures of asthma controlling diet and other asthma risk factors. This review was limited because Meta-analysis was considered inappropriate due to missing data; poorly or heterogeneously defined populations, interventions, intervention-comparator combinations, and outcomes. In addition, small sample sizes made it impossible to meaningfully assess the impact on clinical outcomes of co-variables. Last, few significant effects were found.
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Affiliation(s)
- J Reisman
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - HM Schachter
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - RE Dales
- The Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - K Tran
- Canadian Coordinating Office for Health Technology Assessment, Ottawa, ON, Canada
| | - K Kourad
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - D Barnes
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - M Sampson
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - A Morrison
- Canadian Coordinating Office for Health Technology Assessment, Ottawa, ON, Canada
| | - I Gaboury
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - J Blackman
- Complementary Medicine Program, University of Maryland, Baltimore, MD, USA
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Abstract
AIMS To describe the prevalence of impaired glucose tolerance and obesity in offspring of mothers whose pregnancies were complicated by gestational diabetes mellitus (GDM) in a low-risk population and to investigate the effect on these outcomes of minimal intervention compared with tight control for management of GDM. METHODS Eighty-nine children (mean age 9.1 years, 93% Caucasian) were recruited through a follow-up study of women previously involved in a randomized controlled trial of minimal intervention (control group) vs. tight glycaemic control (treatment group) for GDM. Fasting blood glucose (FBG) and 2-h glucose tolerance tests (2hGTT) were performed on offspring and body mass index (BMI) calculated. Glucose tolerance and BMI of treatment groups were compared using non-inferiority tests (non-inferiority margin -15%). RESULTS Of those offspring, 6.9% (5/72) had abnormal glucose metabolism [four children had impaired glucose tolerance (IGT) and one had Type 2 diabetes mellitus (DM) (all Caucasian)]. Of the four children with IGT, three were male, three had normal BMI, and three had a family history of Type 2 diabetes. Of the 71 offspring who underwent 2hGTT, 25/25 (100%) of the control offspring and 46/46 (100%) of the treatment offspring had normal FBG (FBG < 5.7 mmol/l). Twenty-five of 25 (100%) of control and 42/46 (91.3%) of the treatment offspring had normal glucose tolerance (2hGTT < 7.8 mmol/l) (% difference 8.7, 95% CI -5.6, 20.3). BMI < 85th percentile was found in 25/33 (75.8%) of the treatment group and 44/52 (84.6%) of the control group (difference in percentage -8.9, 95% CI -27.2, 7.8). CONCLUSIONS School-age children of mothers with GDM are at risk of IGT and overweight, even if from a low-risk ethnic population. FBG was not adequate for screening this population. Minimal intervention for glycaemic control in GDM pregnancies appears to be as effective as tight control for preventing IGT in childhood but not for preventing obesity.
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Affiliation(s)
- J C Malcolm
- Division of Endocrinology and Metabolism, University of Ottawa, Ontario, Canada
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McKinnon A, Moineau G, Gaboury I, Grant V, Pitters C. 76 Unscheduled Return Visits for Gastroenteritis to a Pediatric Emergency Department. Paediatr Child Health 2004. [DOI: 10.1093/pch/9.suppl_a.42aa] [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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Norris M, King WJ, Le Saux N, Sampson M, Gaboury I, Moher D. 44 Trainee Perception of a Point of Care Clinical Evidence Module for Bronchiolitis. Paediatr Child Health 2004. [DOI: 10.1093/pch/9.suppl_a.32aa] [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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Schachter HM, Reisman J, Tran K, Dales B, Kourad K, Barnes D, Sampson M, Morrison A, Gaboury I, Blackman J. Health effects of omega-3 fatty acids on asthma. Evid Rep Technol Assess (Summ) 2004:1-7. [PMID: 15133885 PMCID: PMC4781132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Al-Mogbil MH, Plint A, Gaboury I, Pitters C, Martin L. Evaluating an Asthma Critical Pathway in Pediatric Emergency Department. Paediatr Child Health 2003. [DOI: 10.1093/pch/8.suppl_b.32b] [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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