Lehana Thabane

BackgroundSeniors with recurrent hospitalizations who are taking multiple medications including high-risk medications are at particular risk for serious adverse medication events. We will assess whether an expert Clinical Pharmacology and Toxicology (CPT) medication management intervention during hospitalization with follow-up post-discharge and communication with circle of care is feasible and can decrease drug therapy problems amongst this group.MethodsThe design is a pragmatic pilot randomized trial with 1:1 patient-level concealed randomization with blinded outcome assessment and data analysis. Participants will be adults 65 years and older admitted to internal medicine services for more than 2 days, who have had at least one other hospitalization in the prior year, taking five or more chronic medications including at least one high-risk medication. The CPT intervention identifies medication targets …

Knee arthritis is a leading cause of limited function and long-term disability in older adults. Despite a technically successful total knee arthroplasty (TKA), around 20% of patients continue to have persisting pain with reduced function, and low quality of life. Many of them continue using opioids for pain control, which puts them at risk for potential long-term adverse effects such as dependence, overdose and risk of falls. Although persisting pain and opioid use after TKA have been recognised to be important issues, individual strategies to decrease their burden have limitations and multi-component interventions, despite their potential, have not been well studied. In this study, we propose a multi-component pathway including personalized pain management, facilitated by a pain management coordinator. The objectives of this pilot trial are to evaluate feasibility (recruitment, retention, and adherence), along with opioid-free pain control at 8 weeks after TKA. This is a protocol for a multicentre pilot randomised controlled trial using a 2-arm parallel group design. Adult participants undergoing unilateral total knee arthroplasty will be considered for inclusion and randomised to control and intervention groups. Participants in the intervention group will receive support from a pain management coordinator who will facilitate a multicomponent pain management pathway including (1) preoperative education on pain and opioid use, (2) preoperative risk identification and mitigation, (3) personalized post-discharge analgesic prescriptions and (4) continued support for pain control and recovery up to 8 weeks post-op. Participants in the control group will undergo …

Falls and hip fractures are a major health concern among older adults in long term care (LTC) with almost 50% of residents experiencing a fall annually. Hip fractures are one of the most important and frequent fall-related injuries in LTC. The purpose of this study was to determine the feasibility (recruitment rate and adaptations) of implementing the PREVENT (Person-centred Routine Fracture PreEVENTion) model in practice, with a subobjective to understand facilitators and barriers. The model includes a multifactorial intervention on diet, exercise, environmental adaptations, hip protectors, medications (including calcium and vitamin D), and medication reviews to treat residents at high risk of fracture. Our secondary outcomes aimed to assess change in knowledge uptake of the guidelines among healthcare providers and in the proportion of fracture prevention prescriptions post-intervention. We conducted a mixed-methods non-experimental design study in three LTC homes across southern Ontario. A local champion was selected to guide the implementation. We reported recruitment rates using descriptive statistics and adaptations using content analysis. We reported changes in knowledge uptake using the paired sample t-test and the percentage of osteoporosis medications prescriptions using absolute change. Within five months, we recruited three LTC homes. We required two months to identify and train the local champion over three 1.5-hour train-the-trainer sessions, and the champion required three months to deliver the intervention to the healthcare team. We identified several facilitators, barriers, and adaptations. Benefits of the model …

OBJECTIVES:To implement an early rehabilitation bundle in two Canadian PICUs.DESIGN AND SETTING:Implementation study in the PICUs at McMaster Children’s Hospital (site 1) and London Health Sciences (site 2).PATIENTS:All children under 18 years old admitted to the PICU were eligible for the intervention.INTERVENTIONS:A bundle consisting of: 1) analgesia-first sedation; 2) delirium monitoring and prevention; and 3) early mobilization.MEASUREMENTS AND MAIN RESULTS:Primary outcomes were the duration of implementation, bundle compliance, process of care, safety, and the factors influencing implementation. Secondary endpoints were the impact of the bundle on clinical outcomes such as pain, delirium, iatrogenic withdrawal, ventilator-free days, length of stay, and mortality. Implementation occurred over 26 months (August 2018 to October 2020). Data were collected on 1,036 patients …

BackgroundFindings from randomised controlled trials (RCTs) are synthesised through meta-analyses, which inform evidence-based decision-making. When key details regarding trial outcomes are not fully reported, knowledge synthesis and uptake of findings into clinical practice are impeded.AimsOur study assessed reporting of primary outcomes in RCTs for older adults with major depressive disorder (MDD).MethodTrials published between 2011 and 2021, which assessed any intervention for adults aged ≥65 years with a MDD diagnosis, and that specified a single primary outcome were considered for inclusion in our study. Outcome reporting assessment was conducted independently and in duplicate with a 58-item checklist, used in developing the CONSORT-Outcomes statement, and information in each RCT was scored as ‘fully reported’, ‘partially reported’ or ‘not reported’, as applicable.ResultsThirty-one …

1. Lee A, McArthur C, Ioannidis G, Mayhew A, Adachi JD, Griffith LE, et al.(2023) Associations between Social Isolation Index and changes in grip strength, gait speed, bone mineral density (BMD), and selfreported incident fractures among older adults: Results from the Canadian Longitudinal Study on Aging (CLSA). PLoS ONE 18 (10): e0292788. https://doi. org/10.1371/journal. pone. 0292788 PMID: 37851659

The DEEP cohort is the first population-based cohort of pregnant population in China that longitudinally documented drug uses throughout the pregnancy life course and adverse pregnancy outcomes. The main goal of the study aims to monitor and evaluate the safety of drug use through the pregnancy life course in the Chinese setting. The DEEP cohort is developed primarily based on the population-based data platforms in Xiamen, a municipal city of 5 million population in southeast China. Based on these data platforms, we developed a pregnancy database that documented health care services and outcomes in the maternal and other departments. For identifying drug uses, we developed a drug prescription database using electronic healthcare records documented in the platforms across the primary, secondary and tertiary hospitals. By linking these two databases, we developed the DEEP cohort. All the …

BackgroundOral anticoagulants (OACs) are commonly prescribed, have well-documented benefits for important clinical outcomes but have serious harms as well. Rates of OAC-related adverse events including thromboembolic and hemorrhagic events are especially high shortly after hospital discharge. Expert OAC management involving virtual care is a research priority given its potential to reach remote communities in a more feasible, timely, and less costly way than in-person care. Our objective is to test whether a focused, expert medication management intervention using a mix of in-person consultation and virtual care follow-up, is feasible and effective in preventing anticoagulation-related adverse events, for patients transitioning from hospital to home.Methods and analysisA randomized, parallel, multicenter design enrolling consenting adult patients or the caregivers of cognitively impaired patients about to be …

EQUATOR Networkが提供するガイドラインの紹介 Guidelines for Reporting Outcomes in Trial Reports The CONSORT-Outcomes 2022 Extensionの和訳 | CiNii Research CiNii 国立情報学 研究所 学術情報ナビゲータ[サイニィ] 詳細へ移動 検索フォームへ移動 論文・データをさがす 大学 図書館の本をさがす 日本の博士論文をさがす English 検索 タイトル 人物/団体名 所属機関 ISSN DOI 期間 ~ 本文リンク 本文リンクあり データソース JaLC IRDB Crossref DataCite NDL NDL-Digital RUDA JDCat NINJAL CiNii Articles CiNii Books CiNii Dissertations DBpedia Nikkei BP KAKEN Integbio MDR PubMed LSDB Archive 公共データカタログ ムーンショット型研究開発 事業 すべて 研究データ 論文 本 博士論文 プロジェクト [2023年10月31日掲載]CiNii Dissertations及び CiNii BooksのCiNii Researchへの統合について 新「国立国会図書館サーチ」公開によるCiNiiサービス への影響について EQUATOR Networkが提供するガイドラインの紹介 Guidelines for Reporting …

Wound care is a complex procedure and the related research may include many variables. Deficiencies in the sample inclusion and exclusion criteria may limit the generalizability of randomized controlled trials (RCTs) for wound patients in the real world. This study aimed to evaluate deficiencies in reporting the inclusion and exclusion criteria and the characteristics of patients in RCTs of pressure injuries (PI) therapeutic interventions. We conducted a systematic methodological review in which 40 full text RCTs of PI treatment interventions published in English, from 2008 to 2020, were identified. Data on the general characteristics of the included RCTs and data about inclusion/exclusion criteria and characteristics of patients were collected. The inclusion/exclusion criteria were categorized into five domains (definition of disease, precision, safety, ethical/legal and administrative). Study duration (in weeks) was 8.0 …

MethodsWe searched Medline (via PubMed) for RCTs that enrolled newborns or their birthing parents, reported outcomes in the children, and were published between January 1, 2020, and December 31, 2022. The search was limited to selected high-impact general medical journals (Lancet, New England Journal of Medicine, Journal of the American Medical Association, British Medical Journal), and pediatric specialty journals (JAMA Pediatrics, Pediatrics, Lancet Child and Adolescent Health). We did not intend to perform a systematic review of imputation practices in all recently published perinatal and neonatal trials. Instead, we examined a small sample of target journals for perinatal and neonatal RCTs with high impact factors to examine best-case scenarios of current imputation practices.

ObjectiveAssessment of the certainty of evidence (CoE) from network meta-analysis is critical to convey the strength of inferences for clinical decision-making. Both the GRADE Working Group (GWG) and the CINeMA framework have been designed to assess the CoE of treatment effects informed by network meta-analysis; however, the concordance of results is uncertain.Study design and settingWe assessed the CoE for treatment effects of individual opioids on pain relief and physical functioning from a network meta-analysis for chronic noncancer pain using the GWG approach and the CINeMA framework. Both approaches evaluate the CoE as high, moderate, low or very low. We quantified the number of discrepant CoE ratings between approaches, and the magnitude of the difference (i.e., 1-level, 2-levels, or 3-levels).ResultsAcross 105 comparisons among individual opioids for pain relief, the GWG and CINeMA …

MethodsRetrospective cohort study of all children (3-18 years) with an incident hypertension diagnosis from 1996-2021 in Ontario, identified using provincial administrative health databases with validated case definitions. Children with prior hypertension or kidney replacement therapy were excluded. Each case was matched with five pediatric controls without hypertension by age, sex, birthweight, maternal gestational hypertension, prior co-morbidities (chronic kidney disease, diabetes mellitus, and cardiovascular surgery), and a propensity score for hypertension. Children were followed until death (0.7%), provincial emigration (11.2%), or March 2022 (88.1%). The primary outcome was major adverse cardiac events (MACE; a composite of cardiovascular death, stroke, myocardial infarction or unstable angina hospitalization, or coronary intervention). Secondary outcomes were individual cardiovascular events …

BackgroundDespite guidelines supporting antithrombotic therapy use in atrial fibrillation (AF), under-prescribing persists. We assessed whether computerized clinical decision support (CDS) would enable guideline-based antithrombotic therapy for AF patients in primary care.MethodsThis cluster randomized trial of CDS versus usual care (UC) recruited participants from primary care practices across Nova Scotia, following them for 12 months. The CDS tool calculated bleeding and stroke risk scores and provided recommendations for using oral anticoagulants (OAC) per Canadian guidelines.ResultsFrom June 14, 2014 - December 15, 2016, 203 primary care providers (99 UC, 104 CDS) with access to high-speed Internet were recruited, enrolling 1145 eligible patients (543 UC, 590 CDS) assigned to the same treatment arm as their provider. Patient mean age was 72.3 years; most were male (350, 64.5% UC, 351 …

ObjectiveTo explore if older adults with osteosarcopenia are at a greater risk of falls, fractures, frailty, and worsening life satisfaction and activities of daily living (ADL) compared to those with normal bone mineral density (BMD) and without sarcopenia.DesignThe baseline and 3-year follow-up of a longitudinal study.Setting and ParticipantsCommunity-dwelling people aged 65 years or older in Canada.MethodsCaucasian participants 65 years or older that completed the Canadian Longitudinal Study on Aging (CLSA) 2015 baseline interview, physical measurements and 3-year follow-up were included. Osteopenia/osteoporosis was defined as BMD T score below −1 SD according to the World Health Organization, and sarcopenia was defined as low grip strength and/or low gait speed according to the Sarcopenia Definition Outcomes Consortium. Osteosarcopenia was defined as the coexistence of osteopenia …

Purpose Retinal non‐perfusion (RNP) is fundamental to disease onset and progression in diabetic retinopathy (DR). Whether anti‐vascular endothelial growth factor (anti‐VEGF) therapy can modify RNP progression is unclear. This investigation quantified the impact of anti‐VEGF therapy on RNP progression compared with laser or sham at 12 months. Methods A systematic review and meta‐analysis of randomised controlled trials (RCTs) were performed; Ovid MEDLINE, EMBASE and CENTRAL were searched from inception to 4th March 2022. The change in any continuous measure of RNP at 12 months and 24 months was the primary and secondary outcomes, respectively. Outcomes were reported utilising standardised mean differences (SMD). The Cochrane Risk of Bias Tool version‐2 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines informed risk of …

Introduction Obstetric care is a highly active area in the development and application of prognostic prediction models. The development and validation of these models often require the utilization of advanced statistical techniques. However, failure to adhere to rigorous methodological standards could greatly undermine the reliability and trustworthiness of the resultant models. Consequently, the aim of our study was to examine the current statistical practices employed in obstetric care and offer recommendations to enhance the utilization of statistical methods in the development of prognostic prediction models. Material and methods We conducted a cross‐sectional survey using a sample of studies developing or validating prognostic prediction models for obstetric care published in a 10‐year span (2011–2020). A structured questionnaire was developed to investigate the statistical issues in five domains, including …

BackgroundGiven the dire need for health and rehabilitation services internationally, exacerbated during the COVID-19 pandemic, there is a critical need to develop tools to support service delivery. This need is palpable in the Global South where tools developed in Eurocentric contexts are not always adaptable, applicable, or relevant. It is for this reason that the researchers present three case studies of tool development using pilot and feasibility studies in South Africa and share the lessons learned from these studies.ObjectivesTo describe three case studies that developed new tools for health and rehabilitation services using pilot and feasibility studies.To synthesize lessons learned from these case studies on the development of tools.MethodThe researchers describe three case studies that were developed. The case studies are summarized as follows: aims and objectives, context, problem, study design …

Objective:The objective of this review is to determine the costs and benefits of non-invasive liver tests versus liver biopsy in patients with chronic liver diseases.Introduction:Hepatic diseases can lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma. In the past, liver biopsy was the only option for diagnosing fibrosis degree; however, it is an invasive procedure that depends on the sample size to be able to deliver an accurate diagnosis. In recent years, non-invasive liver tests have been increasingly used to estimate liver fibrosis degree, however, there is a lack of economic assessments of technology implementation outcomes.Inclusion criteria:This review will include partial (cost studies) and complete economic evaluation studies on hepatitis B, hepatitis C, alcoholic liver disease, and non-alcoholic fatty liver disease that compare non-invasive liver tests with liver biopsies. Studies published in English, French …

Study objectiveComputed tomography pulmonary angiogram (CTPA) is overused during pulmonary embolism (PE) testing in the emergency department (ED), whereas prediction rules and D-dimer are underused. We report the adherence, clinical benefit, and safety of a D-dimer-only strategy to guide need for PE imaging in the ED.MethodsThis was a prospective multicenter implementation study in 2 EDs with historical and external controls. Patients with suspected PE underwent D-dimer testing and imaging (CTPA or ventilation-perfusion scan) when D-dimer levels were 500 ng/mL or more. PE was ruled out if D-dimer was less than 500 ng/mL or with negative imaging. The primary implementation outcome was the proportion of patients tested for PE in adherence with the pathway. The primary clinical benefit outcome was the proportion of patients tested for PE who received pulmonary imaging. The primary safety …