{"title":"A moment of mourning suspended in air.","authors":"Amy LeBlanc","doi":"10.1503/cmaj.240788","DOIUrl":"10.1503/cmaj.240788","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 37","pages":"E1269"},"PeriodicalIF":9.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"L’engagement du <i>JAMC</i> à l’égard des groupes en quête d’équité.","authors":"Kirsten Patrick","doi":"10.1503/cmaj.241356-f","DOIUrl":"10.1503/cmaj.241356-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 37","pages":"E1278-E1279"},"PeriodicalIF":9.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keerat Grewal, Andrew Calzavara, Shelley L McLeod, Antoine Eskander, David W Savage, Cameron Thompson, Bjug Borgundvaag, Howard Ovens, Sheldon Cheskes, Kerstin de Wit, Jonathan Irish, Monika K Krzyzanowska, Rachel Walsh, Rohit Mohindra, Venkatesh Thiruganasambandamoorthy, Rinku Sutradhar
Background: Although suspicions of cancer may be raised in patients who visit the emergency department, little is known about emergency department use before a cancer diagnosis. We sought to describe emergency department use among patients in Ontario within the 90 days before confirmed cancer diagnosis and to evaluate factors associated with this emergency department use.
Methods: We conducted a retrospective, population-based study of patients aged 18 years or older who had a confirmed cancer diagnosis in Ontario from 2014 to 2021 using linked administrative databases. The primary outcome was any emergency department visit within 90 days before the cancer diagnosis date. We used multivariable logistic regression to evaluate factors associated with emergency department use, such as demographics (e.g., age, sex, rurality, Ontario Health region, indicators of marginalization), comorbidities, previous emergency department visits and hospital admissions, continuity of primary care, type of cancer, and year of cancer diagnosis.
Results: We included 651 071 patients with cancer. Of these, 229 683 (35.3%) had an emergency department visit within 90 days before diagnosis, 51.4% of whom were admitted to hospital from the emergency department. Factors associated with increased odds of emergency department use before cancer diagnosis included rurality (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.13-1.17), residence in northern Ontario (North East region OR 1.14, 95% CI 1.10-1.17 and North West region OR 1.27, 95% CI 1.21-1.32, v. Toronto region), and living in the most marginalized areas (material resources OR 1.37, 95% CI 1.35-1.40 and housing OR 1.09, 95% CI 1.06-1.11, v. least marginalized quintile). We observed significant variation in emergency department use by cancer type, with high odds of emergency department use among patients with intracranial, pancreatic, liver or gallbladder, or thoracic cancer.
Interpretation: Emergency department use is common before cancer diagnosis, with about one-third of patients with cancer in Ontario using the emergency department before diagnosis. Understanding why patients visit the emergency department before cancer diagnosis is important, particularly for patients who live in rural or marginalized areas, or those who have specific cancer types.
背景：尽管到急诊科就诊的患者可能会被怀疑患有癌症，但人们对癌症确诊前使用急诊科的情况知之甚少。我们试图描述安大略省患者在确诊癌症前 90 天内使用急诊科的情况，并评估与使用急诊科相关的因素：我们利用关联的行政数据库，对 2014 年至 2021 年期间安大略省确诊癌症的 18 岁或以上患者进行了一项基于人群的回顾性研究。主要结果是癌症确诊日期前 90 天内的急诊就诊情况。我们使用多变量逻辑回归评估了与急诊室就诊相关的因素，如人口统计学（如年龄、性别、乡村、安大略省卫生区、边缘化指标）、合并症、之前的急诊室就诊和入院情况、初级保健的连续性、癌症类型和癌症诊断年份：我们纳入了 651071 名癌症患者。其中，229 683人（35.3%）在确诊前90天内曾到急诊科就诊，其中51.4%的患者是从急诊科入院的。与癌症确诊前去急诊科就诊的几率增加相关的因素包括：农村（几率比 [OR] 1.15，95% 置信区间 [CI] 1.13-1.17）、居住在安大略省北部（东北部地区 OR 1.14，95% 置信区间 [CI] 1.10-1.17 和西北地区 OR 1.27，95% CI 1.21-1.32，与多伦多地区相比），以及居住在最边缘化的地区（物质资源 OR 1.37，95% CI 1.35-1.40 和住房 OR 1.09，95% CI 1.06-1.11，与最不边缘化的五分位数相比）。我们观察到，不同癌症类型的患者使用急诊室的情况差异很大，颅内癌、胰腺癌、肝癌、胆囊癌或胸腺癌患者使用急诊室的几率很高：在癌症确诊前使用急诊科很常见，安大略省约有三分之一的癌症患者在确诊前使用急诊科。了解患者在癌症确诊前到急诊科就诊的原因非常重要，尤其是对于那些生活在农村或边缘地区的患者，或者那些患有特定癌症类型的患者。
{"title":"Emergency department use before cancer diagnosis in Ontario, Canada: a population-based study.","authors":"Keerat Grewal, Andrew Calzavara, Shelley L McLeod, Antoine Eskander, David W Savage, Cameron Thompson, Bjug Borgundvaag, Howard Ovens, Sheldon Cheskes, Kerstin de Wit, Jonathan Irish, Monika K Krzyzanowska, Rachel Walsh, Rohit Mohindra, Venkatesh Thiruganasambandamoorthy, Rinku Sutradhar","doi":"10.1503/cmaj.240952","DOIUrl":"10.1503/cmaj.240952","url":null,"abstract":"<p><strong>Background: </strong>Although suspicions of cancer may be raised in patients who visit the emergency department, little is known about emergency department use before a cancer diagnosis. We sought to describe emergency department use among patients in Ontario within the 90 days before confirmed cancer diagnosis and to evaluate factors associated with this emergency department use.</p><p><strong>Methods: </strong>We conducted a retrospective, population-based study of patients aged 18 years or older who had a confirmed cancer diagnosis in Ontario from 2014 to 2021 using linked administrative databases. The primary outcome was any emergency department visit within 90 days before the cancer diagnosis date. We used multivariable logistic regression to evaluate factors associated with emergency department use, such as demographics (e.g., age, sex, rurality, Ontario Health region, indicators of marginalization), comorbidities, previous emergency department visits and hospital admissions, continuity of primary care, type of cancer, and year of cancer diagnosis.</p><p><strong>Results: </strong>We included 651 071 patients with cancer. Of these, 229 683 (35.3%) had an emergency department visit within 90 days before diagnosis, 51.4% of whom were admitted to hospital from the emergency department. Factors associated with increased odds of emergency department use before cancer diagnosis included rurality (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.13-1.17), residence in northern Ontario (North East region OR 1.14, 95% CI 1.10-1.17 and North West region OR 1.27, 95% CI 1.21-1.32, v. Toronto region), and living in the most marginalized areas (material resources OR 1.37, 95% CI 1.35-1.40 and housing OR 1.09, 95% CI 1.06-1.11, v. least marginalized quintile). We observed significant variation in emergency department use by cancer type, with high odds of emergency department use among patients with intracranial, pancreatic, liver or gallbladder, or thoracic cancer.</p><p><strong>Interpretation: </strong>Emergency department use is common before cancer diagnosis, with about one-third of patients with cancer in Ontario using the emergency department before diagnosis. Understanding why patients visit the emergency department before cancer diagnosis is important, particularly for patients who live in rural or marginalized areas, or those who have specific cancer types.</p>","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 37","pages":"E1252-E1261"},"PeriodicalIF":9.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Malecki, Eyal Cohen, Amol A Verma, Anne S Bassett
{"title":"Closing gaps in care and knowledge for adults with complex genetic conditions.","authors":"Sarah Malecki, Eyal Cohen, Amol A Verma, Anne S Bassett","doi":"10.1503/cmaj.240782","DOIUrl":"10.1503/cmaj.240782","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 37","pages":"E1267-E1268"},"PeriodicalIF":9.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Shorter courses of antibiotics.","authors":"Maria Ivankovic, Kevin L Schwartz","doi":"10.1503/cmaj.240246","DOIUrl":"10.1503/cmaj.240246","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 37","pages":"E1266"},"PeriodicalIF":9.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steven Rowe, Brandon Wayne Collins, Amrah Pirzada, Neal Manning, Luke Y C Chen
{"title":"TAFRO subtype of idiopathic multicentric Castleman disease in a 22-year-old man.","authors":"Steven Rowe, Brandon Wayne Collins, Amrah Pirzada, Neal Manning, Luke Y C Chen","doi":"10.1503/cmaj.240947","DOIUrl":"10.1503/cmaj.240947","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 37","pages":"E1262-E1265"},"PeriodicalIF":9.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ellen G Avery Dr Rer Nat, Daniel R Ricciuto, Julianne V Kus
{"title":"Teigne de la peau glabre ou eczéma marginé de Hebra réfractaires causés par <i>Trichophyton indotineae</i>.","authors":"Ellen G Avery Dr Rer Nat, Daniel R Ricciuto, Julianne V Kus","doi":"10.1503/cmaj.240408-f","DOIUrl":"10.1503/cmaj.240408-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 36","pages":"E1247-E1248"},"PeriodicalIF":9.4,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeremy Wiens, Michael Dunham, Simon Walker, Selena Au
{"title":"Éruptions papuleuses à zone atrophique centrale dite porcelainée et perforations intestinales à répétition chez une femme de 43 ans.","authors":"Jeremy Wiens, Michael Dunham, Simon Walker, Selena Au","doi":"10.1503/cmaj.240353-f","DOIUrl":"10.1503/cmaj.240353-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 36","pages":"E1242-E1246"},"PeriodicalIF":9.4,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chancre on the thumb.","authors":"Zhou Zhu, Jun Li","doi":"10.1503/cmaj.241078","DOIUrl":"10.1503/cmaj.241078","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 36","pages":"E1238"},"PeriodicalIF":9.4,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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