{"title":"La compassion ne doit pas être une ressource limitée dans les soins de santé des personnes transgenres et de la diversité des genres.","authors":"Kirsten Patrick","doi":"10.1503/cmaj.240878-f","DOIUrl":"10.1503/cmaj.240878-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 32","pages":"E1131-E1132"},"PeriodicalIF":9.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364463","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":"<i>Mycoplasma pneumoniae</i>.","authors":"Maude Paquette, Matthew Magyar, Christian Renaud","doi":"10.1503/cmaj.240085","DOIUrl":"10.1503/cmaj.240085","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 32","pages":"E1120"},"PeriodicalIF":9.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364530","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":"Invasive ductal carcinoma of the nipple in a man.","authors":"Chia-Lun Li, Chen-Yi Wu","doi":"10.1503/cmaj.240625","DOIUrl":"10.1503/cmaj.240625","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 32","pages":"E1121"},"PeriodicalIF":9.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364532","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":"Private insurance should have a role in the <i>Pharmacare Act</i>.","authors":"Chris G Bonnett","doi":"10.1503/cmaj.151284-l","DOIUrl":"10.1503/cmaj.151284-l","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 32","pages":"E1124"},"PeriodicalIF":9.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364465","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":"Vaginose bactérienne.","authors":"Michal Braunstein, Amanda Selk","doi":"10.1503/cmaj.231688-f","DOIUrl":"10.1503/cmaj.231688-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 31","pages":"E1094-E1095"},"PeriodicalIF":9.4,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11426343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307165","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":"Notes de la vie sous l’eau.","authors":"Neal Auch","doi":"10.1503/cmaj.240084-f","DOIUrl":"https://doi.org/10.1503/cmaj.240084-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 31","pages":"E1098-E1099"},"PeriodicalIF":9.4,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"My hasty heart.","authors":"Kate Braid","doi":"10.1503/cmaj.240172","DOIUrl":"10.1503/cmaj.240172","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 31","pages":"E1087-E1088"},"PeriodicalIF":9.4,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11426348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307161","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":"A 58-year-old man with subacute digital ischemia of all limbs.","authors":"Marc-Alexandre Lavoie, Alain Milot","doi":"10.1503/cmaj.240399","DOIUrl":"10.1503/cmaj.240399","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 31","pages":"E1076-E1082"},"PeriodicalIF":9.4,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11426347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307157","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":"Alcalose métabolique et hypokaliémie chez une femme de 23 ans.","authors":"Kamel S Kamel, Joshua Shapiro, Ziv Harel","doi":"10.1503/cmaj.240163-f","DOIUrl":"10.1503/cmaj.240163-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 31","pages":"E1089-E1093"},"PeriodicalIF":9.4,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11426351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307158","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}
Mayesha Khan, Xiao Nicole, Alexis Crabtree, Jessica Moe, Trudy Nasmith, Daniel Daly-Grafstein, Jeffrey R Brubacher, Amanda K Slaunwhite, John A Staples
Background: A substantial number of hospital admissions end in patient-initiated departure before medical treatment is complete. Whether "before medically advised" (BMA) discharge increases the risk of subsequent drug overdose remains uncertain.
Methods: We performed a retrospective cohort study using administrative health data from a 20% random sample of residents of British Columbia, Canada. We focused on nonelective, nonobstetric hospital stays occurring between 2015 and 2019. We used survival analysis to compare the rate of fatal or nonfatal illicit drug overdose in the first 30 days after BMA discharge versus the rate after physician-advised discharge.
Results: Overall, 6440 of 189 808 (3.4%) hospital stays ended in BMA discharge. Among 820 overdoses occurring in the first 30 days after any hospital discharge, 755 (92%) involved patients with a history of substance use disorder. Unadjusted overdose rates were 10-fold higher after BMA discharge than after physician-advised discharge, and BMA discharge was associated with subsequent overdose even after adjustment for potential confounders (crude incidence, 2.8% v. 0.3%; adjusted hazard ratio [HR] 1.58; 95% confidence interval [CI] 1.31-1.89). Before medically advised discharge was associated with increases in subsequent emergency department visits (adjusted HR 1.92; 95% CI 1.83-2.02) and unplanned hospital readmissions (adjusted HR 2.07; 95% CI 1.96-2.19), but there was no significant association with the uncommon outcomes of fatal overdose and all-cause mortality.
Interpretation: Before medically advised departure is associated with an increased risk of drug overdose in the first 30 days after discharge. Improved treatment of substance use disorder, expanded access to overdose prevention services, and new means of postdeparture outreach should be explored to reduce this risk.
{"title":"\"Before medically advised\" departure from hospital and subsequent drug overdose: a population-based cohort study.","authors":"Mayesha Khan, Xiao Nicole, Alexis Crabtree, Jessica Moe, Trudy Nasmith, Daniel Daly-Grafstein, Jeffrey R Brubacher, Amanda K Slaunwhite, John A Staples","doi":"10.1503/cmaj.240364","DOIUrl":"10.1503/cmaj.240364","url":null,"abstract":"<p><strong>Background: </strong>A substantial number of hospital admissions end in patient-initiated departure before medical treatment is complete. Whether \"before medically advised\" (BMA) discharge increases the risk of subsequent drug overdose remains uncertain.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using administrative health data from a 20% random sample of residents of British Columbia, Canada. We focused on nonelective, nonobstetric hospital stays occurring between 2015 and 2019. We used survival analysis to compare the rate of fatal or nonfatal illicit drug overdose in the first 30 days after BMA discharge versus the rate after physician-advised discharge.</p><p><strong>Results: </strong>Overall, 6440 of 189 808 (3.4%) hospital stays ended in BMA discharge. Among 820 overdoses occurring in the first 30 days after any hospital discharge, 755 (92%) involved patients with a history of substance use disorder. Unadjusted overdose rates were 10-fold higher after BMA discharge than after physician-advised discharge, and BMA discharge was associated with subsequent overdose even after adjustment for potential confounders (crude incidence, 2.8% v. 0.3%; adjusted hazard ratio [HR] 1.58; 95% confidence interval [CI] 1.31-1.89). Before medically advised discharge was associated with increases in subsequent emergency department visits (adjusted HR 1.92; 95% CI 1.83-2.02) and unplanned hospital readmissions (adjusted HR 2.07; 95% CI 1.96-2.19), but there was no significant association with the uncommon outcomes of fatal overdose and all-cause mortality.</p><p><strong>Interpretation: </strong>Before medically advised departure is associated with an increased risk of drug overdose in the first 30 days after discharge. Improved treatment of substance use disorder, expanded access to overdose prevention services, and new means of postdeparture outreach should be explored to reduce this risk.</p>","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":"196 31","pages":"E1066-E1075"},"PeriodicalIF":9.4,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11426346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307156","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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