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Latest Research

Factors associated with emergency department presentation after total joint arthroplasty: a population-based retrospective cohort study
Bheeshma Ravi MD PhD, Timothy Leroux MD MEd, Peter C. Austin PhD and colleagues
January 28, 2020

Factors associated with emergency department presentation after total joint arthroplasty: a population-based retrospective cohort study

Unplanned visits to the emergency department after total joint arthroplasty are far more common than unplanned readmissions. Using Ontario health administrative databases, this population-based retrospective cohort study characterized the prevalence of presentation to an emergency department for any reason after total joint arthroplasty (hip or knee) between 2011?and 2016, and identified risk factors for such visits. Of the 42?273?total hip recipients and 70?725?total knee recipients included in the study, 5640?(13.3%) and 11?224?(15.9%), respectively, presented to the emergency department within 30?days of surgery. Fewer than 1% required admission, and nearly half (45%) went to a different institution from where they had their surgery. Factors associated with increased risk of an emergency visit included increased patient age, male sex, rural residence and various comorbidities. Given that 1 in 7 patients presented to the emergency department within 30?days of joint arthroplasty, there is a crucial need for strategies to minimize these events, state the authors. Full article

Gender and ademic promotion of nadian general surgeons: a cross-sectional study
Nada Gawad MD MAEd, Alexandre Tran MD MSc, Andre B. Martel MD and colleagues
January 28, 2020

Gender and ademic promotion of nadian general surgeons: a cross-sectional study

After controlling for years in practice, training and research productivity measures, the authors found that female surgeons with faculty appointments in nada were less likely than their male counterparts to receive promotion to full professor. Using publicly available directories, university and hospital websites, and direct communition, the authors developed a cross-sectional database of practising faculty-appointed general surgeons in nada in 2017. A total of 405?surgeons were included, of whom 111?(27.4%) were women. Sixty-eight women (61.3%) and 120?men (40.8%) were assistant professors, and 9 women (8.1%) and 75 men (25.5%) were full professors. Although, on average, women had completed residency more recently than men (15.2 yr v. 19.2 yr, p < 0.001), there was no difference between men and women in the mean number of publitions as residents or per year of practice, number of fellowships pursued or graduate edution. In the multivariable model, gender remained signifintly associated with full professorship (odds ratio 2.79, 95% confidence interval 1.13–6.92), along with years in practice (odds ratio 1.61, 95% confidence interval 1.13–2.30). Given these findings, pervasive inequities in systems of promotion must be addressed, state the authors. Full article

Impact of updated recommendations on acetylsalicylic acid use for primary prevention of rdiovascular disease in nada: a population-based survey
Myriam Khalili MD, Fanny Lepeytre MD, Jason Robert Guertin PhD and colleagues
January 28, 2020

Impact of updated recommendations on acetylsalicylic acid use for primary prevention of rdiovascular disease in nada: a population-based survey

The debate over acetylsalicylic acid (ASA) therapy for primary prevention of rdiovascular disease (CVD) has recently resurfaced. This study aimed to evaluate the prevalence and factors associated with ASA use, and the potential effect of implementing the 2016?US Preventive Services Task Force recommendations for primary CVD prevention in a nadian setting. The authors performed a cross-sectional analysis using data from the RTaGENE study, which included a representative sample (n = 20?004) of the general population of the province of Quebec. A total of 6231?respondents (54.2% of those aged 50–69 yr with no prior history of CVD) were found to be potentially eligible for ASA use for primary CVD prevention (criteria: age 50–69 yr, no past history of myordial infarction or stroke, and a 10-year risk of CVD of at least 10%). Of those, 1379 (22.1%) were receiving prophylactic ASA treatment. Factors found to be related to ASA use included age, male sex, regular medil visits, lower edution level, obesity, hypertension, diabetes and dyslipidemia, but not income or smoking status. Given the observed low prevalent ASA use for primary CVD prevention, implementation of the US Preventive Services Task Force recommendations would have required initiating ASA treatment in a substantial proportion of people in Quebec (885 261 in 2018), with undetermined potential benefits. Full article

Prevalence, incidence and outcomes of diabetes in Ontario First Nations children: a longitudinal population-based cohort study
Rayzel Shulman MD PhD, Morgan Slater PhD, Shahriar Khan MSc and colleagues
January 28, 2020

Prevalence, incidence and outcomes of diabetes in Ontario First Nations children: a longitudinal population-based cohort study

First Nations people are known to have a higher risk of childhood-onset type 2?diabetes. This study, from a partnership between the Chiefs of Ontario and ademic researchers, describes the epidemiologic features and outcomes of diabetes in First Nations children in Ontario, using available Ontario health databases. It showed that First Nations children have strikingly higher rates of diabetes than non-Aboriginal children in Ontario, likely driven by an increased incidence of type 2 diabetes and increased risk for diabetes among First Nations girls. In 2014/15, there were 254?First Nations children and 10?144?other children with diagnosed diabetes in Ontario. From 1995/96 to 2014/15, the prevalence increased from 0.17?to 0.57?per 100?children, and the annual incidence increased from 37?to 94?per 100?000?per year among First Nations children. There is an urgent need for strategies to address modifiable factors associated with the risk of diabetes, improve access to culturally sensitive diabetes re and improve outcomes for First Nations children, say the authors. Full article

Family physician referral rates for lumbar spine computed tomography in Newfoundland and Labrador: a cross-sectional analysis using routinely collected data
Gabrielle S. Logan MSc, Bethan Copsey PhD, Holly Etchegary PhD and colleagues
January 28, 2020

Family physician referral rates for lumbar spine computed tomography in Newfoundland and Labrador: a cross-sectional analysis using routinely collected data

Reducing computed tomography (CT) examinations of the spine is one of Choosing Wisely nada’s initial top 10?recommendations. This study’s objective was to report the age- and-sex standardized rates of lumbar spine CT ordered by family physicians in a health region of Newfoundland and Labrador. Using data from an electronic health record system from 2013?to 2016, the authors examined 14?371?records. The age- and sex-standardized rates of lumbar spine CT per 100?000?were 1225?in 2013, 1393?in 2014, 1556?in 2015?and 1395?in 2016. The rate ratio was 1.137?(95% confidence interval [CI] 1.084–1.194) for the comparison between 2014?and 2013, 1.117?(95% CI 1.067–1.169) between 2015?and 2014, and 0.896?(95% CI 0.857–0.938) between 2016?and 2015. These rates suggest that there was a steady rate of lumbar spine CT examinations ordered by family physicians during the study period. Although there were differences between years, the magnitude of these differences is likely not clinilly relevant, say the authors. Full article

Risk of malaria associated with travel to malaria-endemic areas to visit friends and relatives: a population-based se–control study
Dewdunee H. Marasinghe MScPH, James Cheaveau BSc MBBS, Bonnie Meatherall MD MSc and colleagues
January 28, 2020

Risk of malaria associated with travel to malaria-endemic areas to visit friends and relatives: a population-based se–control study

Using routinely collected data from a population-based laboratory database, the authors conducted a se–control study of symptomatic returning travellers who presented for malaria testing in lgary from 2013?to 2017. There were 251?confirmed malaria ses during the study period, of which 219?were matched to 1129?returning travellers without malaria. Travellers who visited friends and relatives were less likely than other travellers to seek pretravel advice, take prophylaxis and have a visit duration less than 2?weeks. Based on multivariable regression, the odds of a traveller who visited friends and relatives in a malaria-endemic area being diagnosed with malaria was 2.82?(95% confidence interval [CI] 1.42–5.92) times greater than that of other travellers to these regions. Adults (odds ratio [OR] 3.62, 95% CI 1.66–8.84), males (OR 2.70, 95% CI 1.56–4.80), travellers to Afri (OR 11.52, 95% CI 6.33–22.05) and those who did not seek pretravel advice (OR 0.38, 95% CI 0.20–0.70) were more likely to be diagnosed with malaria. These data suggest that targeted strategies to provide pretravel re to travellers who visit friends and relatives may aid in reducing the burden of malaria during after travel. Full article

More Research

Influence of clinil context on interpretation and use of an advance re planning policy: a qualitative study
Marta Shaw PhD, Shelley Raffin Bouchal RN PhD, Lauren Hutchison RN MSc and colleagues
January 7, 2020

ncer incidence, stage at diagnosis and outcomes among Manitoba First Nations people living on and off reserve: a retrospective population-based analysis
Tara C. Horrill BN RN, Lindsey Dahl MSc, Esther Sanderson and colleagues
December 18, 2019

Quality of re with telemedicine for medil assistance in dying eligibility assessments: a mixed-methods study
Stephanie Dion MHA, Ellen Wiebe MD, Michaela Kelly BASc
December 13, 2019

Supporting women at average risk to make informed decisions about mammography when there is no "right" answer: a qualitative citizen deliberation study
Laura Tripp MSc, Julia Abelson PhD
December 13, 2019

Barriers to accessing weight-loss interventions for patients with class II or III obesity in primary re: a qualitative study
Boris Zevin MD PhD, Nancy Dalgarno PhD, Mary Martin MSc and colleagues
December 13, 2019

Monitoring progress toward United Nations commitments: characteristics of nadian legislation to promote tobacco control, physil activity and healthy eating. A descriptive study
Katerina Maximova PhD, Kim D. Raine PhD, Christine Czoli PhD and colleagues
December 13, 2019

Peripheral arterial disease in Ontario First Nations people with diabetes: a longitudinal population-based cohort study
Baiju R. Shah MD PhD, Eliot Frymire MA, Kristen Jacklin PhD and colleagues
December 10, 2019

Kidney disease and re among First Nations people with diabetes in Ontario: a population-based cohort study
Danielle M. Nash MSc PhD, Jade S. Dirk BSc, Eric Mrthur MSc and colleagues
December 10, 2019

Preferences for a self-management e-health tool for patients with chronic kidney disease: results of a patient-oriented consensus workshop
Maoliosa Donald MSc, Heather Beanlands PhD, Sharon Straus MSc MD and colleagues
December 10, 2019

Iron deficiency screening for children at 18 months: a cost-utility analysis
Sarah rsley PhD, Rui Fu MSc, Cornelia M. Borkhoff PhD, Nadine Reid PhD and colleagues
December 4, 2019

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