Alyson Campbell, L. Hartling, Samantha Louie-Poon, S. Scott
BACKGROUND Bronchiolitis affects more than one-third of children less than age 2 years and can cause substantial anxiety for parents, leading them to seek information on how to care for their sick child. The aim of our qualitative study was to explore the information needs and preferences of parents caring for a child with bronchiolitis. METHODS We used a qualitative descriptive approach. Participants were recruited by means of purposive sampling from Oct. 1, 2017, to Mar. 15, 2018 from the Stollery Children's Hospital emergency department, a specialized pediatric emergency department in Edmonton. Individual semistructured interviews were conducted. RESULTS Fifty-three parents were recruited to participate, of whom 30 could not be reached after 4 contact attempts and 8 refused. Thus, 15 parents participated (16 children). Three major themes were identified: 1) parents' information needs about bronchiolitis, 2) parents' preferred information sources and 3) parents' preferred information delivery formats. Participants indicated that they want and require credible, easy-to-understand information about bronchiolitis in a variety of formats, and especially valued information obtained directly from a health care professional or an evidence-based website. INTERPRETATION This study provides important information about parents' information needs concerning bronchiolitis in children. Identifying the information that parents want and value in relation to acute pediatric illnesses is imperative to developing innovative educational approaches for parents that reflect patient-centred care.
{"title":"Parents' information needs and preferences related to bronchiolitis: a qualitative study.","authors":"Alyson Campbell, L. Hartling, Samantha Louie-Poon, S. Scott","doi":"10.9778/cmajo.20190092","DOIUrl":"https://doi.org/10.9778/cmajo.20190092","url":null,"abstract":"BACKGROUND\u0000Bronchiolitis affects more than one-third of children less than age 2 years and can cause substantial anxiety for parents, leading them to seek information on how to care for their sick child. The aim of our qualitative study was to explore the information needs and preferences of parents caring for a child with bronchiolitis.\u0000\u0000\u0000METHODS\u0000We used a qualitative descriptive approach. Participants were recruited by means of purposive sampling from Oct. 1, 2017, to Mar. 15, 2018 from the Stollery Children's Hospital emergency department, a specialized pediatric emergency department in Edmonton. Individual semistructured interviews were conducted.\u0000\u0000\u0000RESULTS\u0000Fifty-three parents were recruited to participate, of whom 30 could not be reached after 4 contact attempts and 8 refused. Thus, 15 parents participated (16 children). Three major themes were identified: 1) parents' information needs about bronchiolitis, 2) parents' preferred information sources and 3) parents' preferred information delivery formats. Participants indicated that they want and require credible, easy-to-understand information about bronchiolitis in a variety of formats, and especially valued information obtained directly from a health care professional or an evidence-based website.\u0000\u0000\u0000INTERPRETATION\u0000This study provides important information about parents' information needs concerning bronchiolitis in children. Identifying the information that parents want and value in relation to acute pediatric illnesses is imperative to developing innovative educational approaches for parents that reflect patient-centred care.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 4 1","pages":"E640-E645"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43698300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-23Print Date: 2019-07-01DOI: 10.9778/cmajo.20190075
Fei Men, Craig Gundersen, Marcelo L Urquia, Valerie Tarasuk
Background: Food insecurity, defined as inadequate access to food owing to financial constraints, has been associated with poor disease management. Because cost-related nonadherence to prescription drugs is a possible explanation for such association, we examined the link between food insecurity and cost-related medication nonadherence in Canada.
Methods: Drawing on data for adult respondents (age ≥ 18 yr) who participated in the Canadian Community Health Survey 2016 Rapid Response module on prescription medication use, we assessed the association between household food insecurity and cost-related nonadherence to prescription drugs in the previous 12 months. We further examined the self-perceived health consequences of cost-related nonadherence among nonadherents. We applied Poisson models with bootstrap weights adjusting for sociodemographic characteristics.
Results: Of the 11 172 respondents in our sample, 930 (8.3%) reported cost-related nonadherence. Food insecurity affected 10.5% (95% confidence interval [CI] 9.1% to 11.8%) of adherents and 47.9% (95% CI 38.1% to 57.7%) of nonadherents. After adjustment for confounders, moderate and severe food insecurity were associated with 3.83 (95% CI 2.44 to 6.03) and 5.05 (95% CI 3.27 to 7.81) times higher prevalence of cost-related nonadherence, respectively, relative to food security. Despite being associated with lower probability of cost-related nonadherence, having drug insurance did not change the relation between food insecurity and cost-related nonadherence (p > 0.1 for all interactions). Severe food insecurity was correlated with higher prevalence of health deterioration and greater use of health care services as perceived consequences of cost-related nonadherence (p < 0.01 for both).
Interpretation: Food-insecure adults in Canada have a higher likelihood of cost-related nonadherence to prescription medications than their food-secure counterparts, which may constitute a burden on their health and lead to greater use of health care services.
{"title":"Prescription medication nonadherence associated with food insecurity: a population-based cross-sectional study.","authors":"Fei Men, Craig Gundersen, Marcelo L Urquia, Valerie Tarasuk","doi":"10.9778/cmajo.20190075","DOIUrl":"https://doi.org/10.9778/cmajo.20190075","url":null,"abstract":"<p><strong>Background: </strong>Food insecurity, defined as inadequate access to food owing to financial constraints, has been associated with poor disease management. Because cost-related nonadherence to prescription drugs is a possible explanation for such association, we examined the link between food insecurity and cost-related medication nonadherence in Canada.</p><p><strong>Methods: </strong>Drawing on data for adult respondents (age ≥ 18 yr) who participated in the Canadian Community Health Survey 2016 Rapid Response module on prescription medication use, we assessed the association between household food insecurity and cost-related nonadherence to prescription drugs in the previous 12 months. We further examined the self-perceived health consequences of cost-related nonadherence among nonadherents. We applied Poisson models with bootstrap weights adjusting for sociodemographic characteristics.</p><p><strong>Results: </strong>Of the 11 172 respondents in our sample, 930 (8.3%) reported cost-related nonadherence. Food insecurity affected 10.5% (95% confidence interval [CI] 9.1% to 11.8%) of adherents and 47.9% (95% CI 38.1% to 57.7%) of nonadherents. After adjustment for confounders, moderate and severe food insecurity were associated with 3.83 (95% CI 2.44 to 6.03) and 5.05 (95% CI 3.27 to 7.81) times higher prevalence of cost-related nonadherence, respectively, relative to food security. Despite being associated with lower probability of cost-related nonadherence, having drug insurance did not change the relation between food insecurity and cost-related nonadherence (<i>p</i> > 0.1 for all interactions). Severe food insecurity was correlated with higher prevalence of health deterioration and greater use of health care services as perceived consequences of cost-related nonadherence (<i>p</i> < 0.01 for both).</p><p><strong>Interpretation: </strong>Food-insecure adults in Canada have a higher likelihood of cost-related nonadherence to prescription medications than their food-secure counterparts, which may constitute a burden on their health and lead to greater use of health care services.</p>","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 3","pages":"E590-E597"},"PeriodicalIF":0.0,"publicationDate":"2019-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-09Print Date: 2019-07-01DOI: 10.9778/cmajo.20190040
Len Kelly, Cai-Lei Matsumoto, Yoko Schreiber, Janet Gordon, Hannah Willms, Christopher Olivier, Sharen Madden, Josh Hopko, Sheldon W Tobe
Background: The prevalence of adult chronic kidney disease and cardiovascular comorbidities in Canadian Indigenous communities is largely unknown. We conducted a study to document the prevalence of chronic kidney disease and concurrent diabetes mellitus, hypertension and dyslipidemia in a First Nations population in northwest Ontario.
Methods: In this observational study, we used retrospective data collected from regional electronic medical records of 16 170 adults (age ≥ 18 yr) from 26 First Nations communities in northwest Ontario from May 2014 to May 2017. Demographic and laboratory data included age, gender, prescribed medications, estimated glomerular filtration rate, urine albumin:creatinine ratio, low-density lipoprotein cholesterol (LDL-C) level and glycated hemoglobin (HbA1c) concentration. We identified patients with diabetes by an HbA1c concentration of 6.5% or higher, or the use of a diabetic medication, those with dyslipidemia by an elevated LDL-C level (≥ 2.0 mmol/L) or use of lipid-lowering medication, and those with hypertension by use of antihypertensive medication.
Results: Of the 16 170 adults residing in the communities, 5224 unique patients (32.3%) had renal testing (albumin:creatinine ratio and/or estimated glomerular filtration rate). The age-adjusted prevalence of chronic kidney disease was 14.5%, and the prevalence of stage 3-5 chronic kidney disease (estimated glomerular filtration rate < 60 mL/min) was 7.0%. Most patients with chronic kidney disease (1487 [80.0%]) had at least 1 cardiovascular comorbidity. A total of 1332 patients (71.6%) had diabetes, 1313 (70.6%) had dyslipidemia, and 1098 (59.1%) had hypertension; all 3 comorbidities were present in 716 patients (38.5%).
Interpretation: We document a high prevalence of advanced chronic kidney disease in this First Nations population, 7.0%, double the rate in the general population. High rates of cardiovascular comorbidities were also common in these patients with chronic kidney disease, which places them at increased risk for cardiovascular disease.
{"title":"Prevalence of chronic kidney disease and cardiovascular comorbidities in adults in First Nations communities in northwest Ontario: a retrospective observational study.","authors":"Len Kelly, Cai-Lei Matsumoto, Yoko Schreiber, Janet Gordon, Hannah Willms, Christopher Olivier, Sharen Madden, Josh Hopko, Sheldon W Tobe","doi":"10.9778/cmajo.20190040","DOIUrl":"https://doi.org/10.9778/cmajo.20190040","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of adult chronic kidney disease and cardiovascular comorbidities in Canadian Indigenous communities is largely unknown. We conducted a study to document the prevalence of chronic kidney disease and concurrent diabetes mellitus, hypertension and dyslipidemia in a First Nations population in northwest Ontario.</p><p><strong>Methods: </strong>In this observational study, we used retrospective data collected from regional electronic medical records of 16 170 adults (age ≥ 18 yr) from 26 First Nations communities in northwest Ontario from May 2014 to May 2017. Demographic and laboratory data included age, gender, prescribed medications, estimated glomerular filtration rate, urine albumin:creatinine ratio, low-density lipoprotein cholesterol (LDL-C) level and glycated hemoglobin (HbA<sub>1c</sub>) concentration. We identified patients with diabetes by an HbA<sub>1c</sub> concentration of 6.5% or higher, or the use of a diabetic medication, those with dyslipidemia by an elevated LDL-C level (≥ 2.0 mmol/L) or use of lipid-lowering medication, and those with hypertension by use of antihypertensive medication.</p><p><strong>Results: </strong>Of the 16 170 adults residing in the communities, 5224 unique patients (32.3%) had renal testing (albumin:creatinine ratio and/or estimated glomerular filtration rate). The age-adjusted prevalence of chronic kidney disease was 14.5%, and the prevalence of stage 3-5 chronic kidney disease (estimated glomerular filtration rate < 60 mL/min) was 7.0%. Most patients with chronic kidney disease (1487 [80.0%]) had at least 1 cardiovascular comorbidity. A total of 1332 patients (71.6%) had diabetes, 1313 (70.6%) had dyslipidemia, and 1098 (59.1%) had hypertension; all 3 comorbidities were present in 716 patients (38.5%).</p><p><strong>Interpretation: </strong>We document a high prevalence of advanced chronic kidney disease in this First Nations population, 7.0%, double the rate in the general population. High rates of cardiovascular comorbidities were also common in these patients with chronic kidney disease, which places them at increased risk for cardiovascular disease.</p>","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 3","pages":"E568-E572"},"PeriodicalIF":0.0,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie Y Cheng, F. Saxena, S. Seung, C. Earle, Kelvin K. W. Chan, N. Mittmann
BACKGROUND The aim of this study was to characterize the demographic characteristics and investigate the cost of a publicly funded system, the Ontario Trillium Drug Program (TDP), for an oncology patient population. METHODS We ascertained all TDP claims between April 1997 and December 2016 from the Ontario Drug Benefit database to assess use and cost. Each drug was classified as a cancer treatment drug, cancer supportive therapy drug or noncancer drug. We also identified a cohort of patients with cancer with least 1 TDP claim, for whom we examined demographic and claims-related characteristics. RESULTS Over the study period, 50 975 293 TDP claims totalling $4.8 billion were made. Although the proportion of cancer claims among all TDP claims remained constant between 1997 and 2016, the total annual cost of cancer treatment drugs increased nearly 40-fold. Imatinib and lenalidomide together accounted for nearly half of the cost of all cancer treatment drugs. We identified a cohort of 49 892 patients with cancer, of whom 18 631 (37.3%) were enrolled in the TDP before their cancer diagnosis and 31 261 (62.7%) were enrolled after their diagnosis. The former were more likely than the latter to be in lower income quintiles and to have more chronic conditions. Significant differences were also found in the distribution of cancer diagnoses between the 2 groups. INTERPRETATION In the TDP, use increased over time and differed across cancer diagnoses and drugs. These results have public health and policy implications as antineoplastic drug costs continue to rise and place a burden on patients.
{"title":"Demographic characteristics and cost of treatment among oncology patients in a publicly funded system, the Ontario Trillium Drug Program: a retrospective cohort study.","authors":"Stephanie Y Cheng, F. Saxena, S. Seung, C. Earle, Kelvin K. W. Chan, N. Mittmann","doi":"10.9778/cmajo.20190011","DOIUrl":"https://doi.org/10.9778/cmajo.20190011","url":null,"abstract":"BACKGROUND\u0000The aim of this study was to characterize the demographic characteristics and investigate the cost of a publicly funded system, the Ontario Trillium Drug Program (TDP), for an oncology patient population.\u0000\u0000\u0000METHODS\u0000We ascertained all TDP claims between April 1997 and December 2016 from the Ontario Drug Benefit database to assess use and cost. Each drug was classified as a cancer treatment drug, cancer supportive therapy drug or noncancer drug. We also identified a cohort of patients with cancer with least 1 TDP claim, for whom we examined demographic and claims-related characteristics.\u0000\u0000\u0000RESULTS\u0000Over the study period, 50 975 293 TDP claims totalling $4.8 billion were made. Although the proportion of cancer claims among all TDP claims remained constant between 1997 and 2016, the total annual cost of cancer treatment drugs increased nearly 40-fold. Imatinib and lenalidomide together accounted for nearly half of the cost of all cancer treatment drugs. We identified a cohort of 49 892 patients with cancer, of whom 18 631 (37.3%) were enrolled in the TDP before their cancer diagnosis and 31 261 (62.7%) were enrolled after their diagnosis. The former were more likely than the latter to be in lower income quintiles and to have more chronic conditions. Significant differences were also found in the distribution of cancer diagnoses between the 2 groups.\u0000\u0000\u0000INTERPRETATION\u0000In the TDP, use increased over time and differed across cancer diagnoses and drugs. These results have public health and policy implications as antineoplastic drug costs continue to rise and place a burden on patients.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 3 1","pages":"E516-E523"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44955713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND On Oct. 17, 2018, Canada legalized recreational cannabis with the dual goals of reducing youth use and eliminating the illicit cannabis market. We examined factors associated with access to physical cannabis stores across Canada 6 months following legalization. METHODS We extracted the address and operating hours of all legal cannabis stores in Canada from online government and private listings. We conducted a descriptive study examining the association between private/hybrid (mixture of government and private stores) and government-only retail models with 4 measures of physical access to cannabis: store density, weekly hours of operation, median distance to the nearest school and relative availability of cannabis stores between low- and high-income neighbourhoods. RESULTS Six months after legalization, there were 260 cannabis retail stores across Canada: 181 privately run stores, 55 government-run stores and 24 stores in the hybrid retail system. Compared to jurisdictions with a government-run model, jurisdictions with a private/hybrid retail model had 49% (95% confidence interval 10%-200%) more stores per capita, retailers were open on average 9.2 more hours per week, and stores were located closer to schools (median 166.7 m). In both retail models, there was over twice the concentration of cannabis stores in neighbourhoods in the lowest income quintile compared to the highest income quintile. INTERPRETATION Marked differences in physical access to cannabis retail are emerging between jurisdictions with private/hybrid retail models and those with government-only retail models. Ongoing surveillance including monitoring differences in cannabis use and harms across jurisdictions is needed.
{"title":"Access to cannabis retail stores across Canada 6 months following legalization: a descriptive study.","authors":"D. Myran, Catherine R L Brown, P. Tanuseputro","doi":"10.9778/cmajo.20190012","DOIUrl":"https://doi.org/10.9778/cmajo.20190012","url":null,"abstract":"BACKGROUND\u0000On Oct. 17, 2018, Canada legalized recreational cannabis with the dual goals of reducing youth use and eliminating the illicit cannabis market. We examined factors associated with access to physical cannabis stores across Canada 6 months following legalization.\u0000\u0000\u0000METHODS\u0000We extracted the address and operating hours of all legal cannabis stores in Canada from online government and private listings. We conducted a descriptive study examining the association between private/hybrid (mixture of government and private stores) and government-only retail models with 4 measures of physical access to cannabis: store density, weekly hours of operation, median distance to the nearest school and relative availability of cannabis stores between low- and high-income neighbourhoods.\u0000\u0000\u0000RESULTS\u0000Six months after legalization, there were 260 cannabis retail stores across Canada: 181 privately run stores, 55 government-run stores and 24 stores in the hybrid retail system. Compared to jurisdictions with a government-run model, jurisdictions with a private/hybrid retail model had 49% (95% confidence interval 10%-200%) more stores per capita, retailers were open on average 9.2 more hours per week, and stores were located closer to schools (median 166.7 m). In both retail models, there was over twice the concentration of cannabis stores in neighbourhoods in the lowest income quintile compared to the highest income quintile.\u0000\u0000\u0000INTERPRETATION\u0000Marked differences in physical access to cannabis retail are emerging between jurisdictions with private/hybrid retail models and those with government-only retail models. Ongoing surveillance including monitoring differences in cannabis use and harms across jurisdictions is needed.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 3 1","pages":"E454-E461"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44963896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandra Kilian, T. K. Fellows, Ryan Giroux, Jason Pennington, A. Kuper, C. Whitehead, Lisa Richardson
BACKGROUND Given the history of unethical research in Indigenous communities, there is often apprehension among Indigenous communities toward research carried out by non-Indigenous researchers. We examined the approaches, experiences and motivations among non-Indigenous researchers at a research-intensive Canadian university conducting research with Indigenous communities to understand approaches to ethical research with Indigenous peoples. METHODS We performed a critical constructivist qualitative study incorporating decolonizing methodologies. We conducted semistructured interviews with 8 non-Indigenous University of Toronto researchers with a research focus/interest related to Indigenous health between August and October 2017. The interviews were transcribed and thematically analyzed through an iterative process. Shared experiences among the researchers were arranged into primary themes. RESULTS We identified 4 primary themes related to the conduct of Indigenous research by non-Indigenous researchers: 1) relationships with communities are foundational to the research process, 2) non-Indigenous researchers experience a personal self-reflective journey grounded in reconciliation, allyship and privilege, 3) accepted knowledge frameworks in Indigenous research are familiar to most but are inconsistently applied and 4) institutions act as barriers to and facilitators of ethical conduct of Indigenous research. Four core principles - relationships, trust, humility and accountability - unified the primary themes. INTERPRETATION We identified strengths and areas for improvement of current policies and practices in Indigenous research by non-Indigenous researchers. Although non-Indigenous researchers value relationships, and their research is informed by Indigenous knowledge, institutional barriers to implementing recommended elements exist, and certain policy statements such as the Tri-Council Policy Statement 2 lack applicability to secondary data analysis for some non-Indigenous researchers.
{"title":"Exploring the approaches of non-Indigenous researchers to Indigenous research: a qualitative study.","authors":"Alexandra Kilian, T. K. Fellows, Ryan Giroux, Jason Pennington, A. Kuper, C. Whitehead, Lisa Richardson","doi":"10.9778/cmajo.20180204","DOIUrl":"https://doi.org/10.9778/cmajo.20180204","url":null,"abstract":"BACKGROUND\u0000Given the history of unethical research in Indigenous communities, there is often apprehension among Indigenous communities toward research carried out by non-Indigenous researchers. We examined the approaches, experiences and motivations among non-Indigenous researchers at a research-intensive Canadian university conducting research with Indigenous communities to understand approaches to ethical research with Indigenous peoples.\u0000\u0000\u0000METHODS\u0000We performed a critical constructivist qualitative study incorporating decolonizing methodologies. We conducted semistructured interviews with 8 non-Indigenous University of Toronto researchers with a research focus/interest related to Indigenous health between August and October 2017. The interviews were transcribed and thematically analyzed through an iterative process. Shared experiences among the researchers were arranged into primary themes.\u0000\u0000\u0000RESULTS\u0000We identified 4 primary themes related to the conduct of Indigenous research by non-Indigenous researchers: 1) relationships with communities are foundational to the research process, 2) non-Indigenous researchers experience a personal self-reflective journey grounded in reconciliation, allyship and privilege, 3) accepted knowledge frameworks in Indigenous research are familiar to most but are inconsistently applied and 4) institutions act as barriers to and facilitators of ethical conduct of Indigenous research. Four core principles - relationships, trust, humility and accountability - unified the primary themes.\u0000\u0000\u0000INTERPRETATION\u0000We identified strengths and areas for improvement of current policies and practices in Indigenous research by non-Indigenous researchers. Although non-Indigenous researchers value relationships, and their research is informed by Indigenous knowledge, institutional barriers to implementing recommended elements exist, and certain policy statements such as the Tri-Council Policy Statement 2 lack applicability to secondary data analysis for some non-Indigenous researchers.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 3 1","pages":"E504-E509"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20180204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44406371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olivia Meggetto, L. Peirson, M. Yakubu, Mufiza Farid-Kapadia, Michelle Costa-Fagbemi, S. Baidoobonso, J. Moffatt, Lauren Chun, A. Chiarelli, D. Muradali
BACKGROUND Trans people face uncertain risk for breast cancer and barriers to accessing breast screening. Our objectives were to identify and synthesize primary research evidence on the effect of cross-sex hormones (CSHs) on breast cancer risk, prognosis and mortality among trans people, the benefits and harms of breast screening in this population, and existing clinical practice recommendations on breast screening for trans people. METHODS We conducted 2 systematic reviews of primary research, 1 on the effect of CSHs on breast cancer risk, prognosis and mortality, and the other on the benefits and harms of breast screening, and a third systematic review of guidelines on existing screening recommendations for trans people. We searched PubMed, MEDLINE, Embase, CINAHL, the Cochrane Database of Systematic Reviews and grey literature sources for primary research, guidelines and position statements published in English between 1997 and 2017. Citations were screened by 2 independent reviewers. One reviewer extracted data and assessed methodological quality of included articles; a second reviewer verified these in full. The results were synthesized narratively. RESULTS Four observational studies, 6 guidelines and 5 position statements were included. Observational evidence of very low certainty did not show an effect of CSHs on breast cancer risk in trans men or trans women. Among trans women, painfulness of mammography and ultrasonography was low. There was no evidence on the effect of CSHs on breast cancer prognosis and mortality, or on benefits and other harms of screening. Existing clinical practice documents recommended screening for distinct trans subpopulations; however, recommendations varied. INTERPRETATION The limited evidence does not show an effect of CSHs on breast cancer risk. Although there is insufficient evidence to determine the potential benefits and harms of breast screening, existing clinical practice documents generally recommend screening for trans people; further large-scale prospective comparative research is needed.
{"title":"Breast cancer risk and breast screening for trans people: an integration of 3 systematic reviews.","authors":"Olivia Meggetto, L. Peirson, M. Yakubu, Mufiza Farid-Kapadia, Michelle Costa-Fagbemi, S. Baidoobonso, J. Moffatt, Lauren Chun, A. Chiarelli, D. Muradali","doi":"10.9778/cmajo.20180028","DOIUrl":"https://doi.org/10.9778/cmajo.20180028","url":null,"abstract":"BACKGROUND\u0000Trans people face uncertain risk for breast cancer and barriers to accessing breast screening. Our objectives were to identify and synthesize primary research evidence on the effect of cross-sex hormones (CSHs) on breast cancer risk, prognosis and mortality among trans people, the benefits and harms of breast screening in this population, and existing clinical practice recommendations on breast screening for trans people.\u0000\u0000\u0000METHODS\u0000We conducted 2 systematic reviews of primary research, 1 on the effect of CSHs on breast cancer risk, prognosis and mortality, and the other on the benefits and harms of breast screening, and a third systematic review of guidelines on existing screening recommendations for trans people. We searched PubMed, MEDLINE, Embase, CINAHL, the Cochrane Database of Systematic Reviews and grey literature sources for primary research, guidelines and position statements published in English between 1997 and 2017. Citations were screened by 2 independent reviewers. One reviewer extracted data and assessed methodological quality of included articles; a second reviewer verified these in full. The results were synthesized narratively.\u0000\u0000\u0000RESULTS\u0000Four observational studies, 6 guidelines and 5 position statements were included. Observational evidence of very low certainty did not show an effect of CSHs on breast cancer risk in trans men or trans women. Among trans women, painfulness of mammography and ultrasonography was low. There was no evidence on the effect of CSHs on breast cancer prognosis and mortality, or on benefits and other harms of screening. Existing clinical practice documents recommended screening for distinct trans subpopulations; however, recommendations varied.\u0000\u0000\u0000INTERPRETATION\u0000The limited evidence does not show an effect of CSHs on breast cancer risk. Although there is insufficient evidence to determine the potential benefits and harms of breast screening, existing clinical practice documents generally recommend screening for trans people; further large-scale prospective comparative research is needed.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 3 1","pages":"E598-E609"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20180028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42902104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Muratov, Justin Lee, A. Holbrook, J. Michael Paterson, J. R. Guertin, L. Mbuagbaw, T. Gomes, W. Khuu, P. Pequeno, J. Tarride
BACKGROUND Most health care spending is concentrated within a small group of high-cost health care users. To inform health policies, we examined the characteristics of index hospital admissions and their predictors among incident older high-cost users compared to older non-high-cost users in Ontario. METHODS Using Ontario administrative data, we identified incident high-cost users aged 66 years or more and matched them 1:3 on age, gender and Local Health Integration Network with non-high-cost users aged 66 years or more. We defined high-cost users as patients within the top 5% most costly high-cost users during fiscal year 2013/14 but not during 2012/13. An index hospital admission, the main outcome, was defined as the first unplanned hospital admission during 2013/14, with no hospital admissions in the preceding 12 months. Descriptively, we analyzed the attributes of index hospital admissions, including costs. We identified predictors of index hospital admissions using stratified logistic regression. RESULTS Over half (95 375/175 847 [54.2%]) of all high-cost users had an unplanned index hospital admission, compared to 8838/527 541 (1.7%) of non-high-cost users. High-cost users had a poorer health status, longer acute length of stay (mean 7.5 d v. 2.9 d) and more frequent designation as alternate level of care before discharge (20.8% v. 1.7%) than did non-high-cost users. Ten diagnosis codes accounted for roughly one-third of the index hospital admission costs in both cohorts. Although many predictors were similar between the cohorts, a lower risk of an index hospital admission was associated with residence in long-term care, attachment to a primary care provider and recent consultation by a geriatrician among high-cost users. INTERPRETATION The high prevalence of index hospital admissions and the corresponding costs are a distinctive feature of incident older high-cost users. Improved access to specialist outpatient care, home-based social care and long-term care when required are worth further investigation.
{"title":"Unplanned index hospital admissions among new older high-cost health care users in Ontario: a population-based matched cohort study.","authors":"S. Muratov, Justin Lee, A. Holbrook, J. Michael Paterson, J. R. Guertin, L. Mbuagbaw, T. Gomes, W. Khuu, P. Pequeno, J. Tarride","doi":"10.9778/cmajo.20180185","DOIUrl":"https://doi.org/10.9778/cmajo.20180185","url":null,"abstract":"BACKGROUND\u0000Most health care spending is concentrated within a small group of high-cost health care users. To inform health policies, we examined the characteristics of index hospital admissions and their predictors among incident older high-cost users compared to older non-high-cost users in Ontario.\u0000\u0000\u0000METHODS\u0000Using Ontario administrative data, we identified incident high-cost users aged 66 years or more and matched them 1:3 on age, gender and Local Health Integration Network with non-high-cost users aged 66 years or more. We defined high-cost users as patients within the top 5% most costly high-cost users during fiscal year 2013/14 but not during 2012/13. An index hospital admission, the main outcome, was defined as the first unplanned hospital admission during 2013/14, with no hospital admissions in the preceding 12 months. Descriptively, we analyzed the attributes of index hospital admissions, including costs. We identified predictors of index hospital admissions using stratified logistic regression.\u0000\u0000\u0000RESULTS\u0000Over half (95 375/175 847 [54.2%]) of all high-cost users had an unplanned index hospital admission, compared to 8838/527 541 (1.7%) of non-high-cost users. High-cost users had a poorer health status, longer acute length of stay (mean 7.5 d v. 2.9 d) and more frequent designation as alternate level of care before discharge (20.8% v. 1.7%) than did non-high-cost users. Ten diagnosis codes accounted for roughly one-third of the index hospital admission costs in both cohorts. Although many predictors were similar between the cohorts, a lower risk of an index hospital admission was associated with residence in long-term care, attachment to a primary care provider and recent consultation by a geriatrician among high-cost users.\u0000\u0000\u0000INTERPRETATION\u0000The high prevalence of index hospital admissions and the corresponding costs are a distinctive feature of incident older high-cost users. Improved access to specialist outpatient care, home-based social care and long-term care when required are worth further investigation.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 3 1","pages":"E537-E545"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20180185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41991393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Matthews, M. Brillant, K. Jimoh, W. Singleton, Pam R McLean-Veysey, I. Sketris
BACKGROUND Dentists are regular prescribers of opioid analgesic medications; however, there are few published data on their prescribing practices for children. The aim of this study was to assess opioid prescribing practices of dentists for pediatric patients. METHODS We conducted a retrospective study (2011/12 to 2017/18) using administrative health data of opioid prescribing practices of dentists in Nova Scotia for children and adolescents (age < 18 yr). The main variables of interest were opioid "type" and "load" dentists prescribed (number of dispensed prescriptions/yr, days supplied/prescription and dosage/d per prescription in milligrams of morphine equivalents [MME]). RESULTS Dentists accounted for a mean of 18.3% (standard deviation 1.5%) of all opioid prescribers for the pediatric population annually but were responsible for 59.9% of all opioid prescriptions and 48.6% of total MME dispensed during the 7-year study period. Oral and maxillofacial surgeons were responsible for 80.7% of all dental-related opioids dispensed. Codeine was most frequently prescribed (78.6% of total MME), followed by oxycodone (11.1%). There were significant downward trends over the study period in the total amount of opioid analgesics dispensed (r = -0.903, p < 0.01), primarily due to a reduction in the total amount of codeine dispensed and number of days supplied per prescription (r = -0.837, p < 0.05). Few opioids were dispensed to children less than 12 years. INTERPRETATION Dentists in Nova Scotia reduced prescriptions of opioids in the pediatric population between 2011/12 and 2017/18, which may indicate that current opioid prescribing principles are influencing dentists' prescribing habits. Nonetheless, patients and parents should receive appropriate counselling as to the proper use, risks, storage and potential for misuse of opioids when prescribed.
{"title":"Patterns of opioid prescribing by dentists in a pediatric population: a retrospective observational study.","authors":"D. Matthews, M. Brillant, K. Jimoh, W. Singleton, Pam R McLean-Veysey, I. Sketris","doi":"10.9778/cmajo.20190021","DOIUrl":"https://doi.org/10.9778/cmajo.20190021","url":null,"abstract":"BACKGROUND\u0000Dentists are regular prescribers of opioid analgesic medications; however, there are few published data on their prescribing practices for children. The aim of this study was to assess opioid prescribing practices of dentists for pediatric patients.\u0000\u0000\u0000METHODS\u0000We conducted a retrospective study (2011/12 to 2017/18) using administrative health data of opioid prescribing practices of dentists in Nova Scotia for children and adolescents (age < 18 yr). The main variables of interest were opioid \"type\" and \"load\" dentists prescribed (number of dispensed prescriptions/yr, days supplied/prescription and dosage/d per prescription in milligrams of morphine equivalents [MME]).\u0000\u0000\u0000RESULTS\u0000Dentists accounted for a mean of 18.3% (standard deviation 1.5%) of all opioid prescribers for the pediatric population annually but were responsible for 59.9% of all opioid prescriptions and 48.6% of total MME dispensed during the 7-year study period. Oral and maxillofacial surgeons were responsible for 80.7% of all dental-related opioids dispensed. Codeine was most frequently prescribed (78.6% of total MME), followed by oxycodone (11.1%). There were significant downward trends over the study period in the total amount of opioid analgesics dispensed (r = -0.903, p < 0.01), primarily due to a reduction in the total amount of codeine dispensed and number of days supplied per prescription (r = -0.837, p < 0.05). Few opioids were dispensed to children less than 12 years.\u0000\u0000\u0000INTERPRETATION\u0000Dentists in Nova Scotia reduced prescriptions of opioids in the pediatric population between 2011/12 and 2017/18, which may indicate that current opioid prescribing principles are influencing dentists' prescribing habits. Nonetheless, patients and parents should receive appropriate counselling as to the proper use, risks, storage and potential for misuse of opioids when prescribed.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 3 1","pages":"E497-E503"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41570441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Callum, C. Yeh, A. Petrosoniak, M. McVey, S. Cope, Troy Thompson, Victoria Chin, K. Karkouti, A. Nathens, K. Murto, S. Beno, J. Pendergrast, A. Mcdonald, R. MacDonald, N. Adhikari, A. Alam, D. Arnold, Lee Barratt, A. Beckett, Sue Brenneman, Hina Chaudhry, Allison Collins, Margaret A. Harvey, J. Lampron, C. Margarido, A. McFarlan, B. Nascimento, Wendy E. Owens, M. Pai, S. Rizoli, T. Ruijs, R. Skeate, Teresa Skelton, M. Sholzberg, Kelly Syer, Jami-Lynn Viveiros, Josée Thériault, A. Tinmouth, R. van Heest, S. White, Michelle P. Zeller, K. Pavenski
BACKGROUND A massive hemorrhage protocol (MHP) enables rapid delivery of blood components in a patient who is exsanguinating pending definitive hemorrhage control, but there is variability in MHP implementation rates, content and compliance owing to challenges presented by infrequent activation, variable team performance and patient acuity. The goal of this project was to identify the key evidence-based principles and quality indicators required to develop a standardized regional MHP. METHODS A modified Delphi consensus technique was performed in the spring and summer of 2018. Panellists used survey links to independently review and rate (on a 7-point Likert scale) 43 statements and 8 quality indicators drafted by a steering committee composed of transfusion medicine specialists and technologists, and trauma physicians. External stakeholder input from all hospitals in Ontario was sought. RESULTS Three rounds were held with 36 experts from diverse clinical backgrounds. Consensus was reached for 42 statements and 8 quality indicators. Additional modifications from external stakeholders were incorporated to form the foundation for the proposed MHP. INTERPRETATION This MHP template will provide the basis for the design of an MHP toolkit, including specific recommendations for pediatric and obstetrical patients, and for hospitals with limited availability of blood components or means to achieve definitive hemorrhage control. We believe that harmonization of MHPs in our region will simplify training, increase uptake of evidence-based interventions, enhance communication, improve patient comfort and safety, and, ultimately, improve patient outcomes.
{"title":"A regional massive hemorrhage protocol developed through a modified Delphi technique.","authors":"J. Callum, C. Yeh, A. Petrosoniak, M. McVey, S. Cope, Troy Thompson, Victoria Chin, K. Karkouti, A. Nathens, K. Murto, S. Beno, J. Pendergrast, A. Mcdonald, R. MacDonald, N. Adhikari, A. Alam, D. Arnold, Lee Barratt, A. Beckett, Sue Brenneman, Hina Chaudhry, Allison Collins, Margaret A. Harvey, J. Lampron, C. Margarido, A. McFarlan, B. Nascimento, Wendy E. Owens, M. Pai, S. Rizoli, T. Ruijs, R. Skeate, Teresa Skelton, M. Sholzberg, Kelly Syer, Jami-Lynn Viveiros, Josée Thériault, A. Tinmouth, R. van Heest, S. White, Michelle P. Zeller, K. Pavenski","doi":"10.9778/cmajo.20190042","DOIUrl":"https://doi.org/10.9778/cmajo.20190042","url":null,"abstract":"BACKGROUND\u0000A massive hemorrhage protocol (MHP) enables rapid delivery of blood components in a patient who is exsanguinating pending definitive hemorrhage control, but there is variability in MHP implementation rates, content and compliance owing to challenges presented by infrequent activation, variable team performance and patient acuity. The goal of this project was to identify the key evidence-based principles and quality indicators required to develop a standardized regional MHP.\u0000\u0000\u0000METHODS\u0000A modified Delphi consensus technique was performed in the spring and summer of 2018. Panellists used survey links to independently review and rate (on a 7-point Likert scale) 43 statements and 8 quality indicators drafted by a steering committee composed of transfusion medicine specialists and technologists, and trauma physicians. External stakeholder input from all hospitals in Ontario was sought.\u0000\u0000\u0000RESULTS\u0000Three rounds were held with 36 experts from diverse clinical backgrounds. Consensus was reached for 42 statements and 8 quality indicators. Additional modifications from external stakeholders were incorporated to form the foundation for the proposed MHP.\u0000\u0000\u0000INTERPRETATION\u0000This MHP template will provide the basis for the design of an MHP toolkit, including specific recommendations for pediatric and obstetrical patients, and for hospitals with limited availability of blood components or means to achieve definitive hemorrhage control. We believe that harmonization of MHPs in our region will simplify training, increase uptake of evidence-based interventions, enhance communication, improve patient comfort and safety, and, ultimately, improve patient outcomes.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":"7 3 1","pages":"E546-E561"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47409329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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