Influence of weight status in the response to Step-2 maintenance therapies in children with asthma.

Introduction: Overweight children with asthma may display impaired response to inhaled corticosteroids (ICS), possibly due to non-eosinophilic inflammation or weight-related lung compression; these mechanisms may differentially affect response to ICS and leukotriene receptor antagonists (LTRAs). We assessed whether weight status modified the response to low-dose ICS and LTRA Step-2 monotherapy.

Methods: A historical cohort study from clinical data linked to administrative databases was conducted among children aged 2-18 years with specialist-diagnosed asthma who were initiating or continuing a Step-2 monotherapy from 2000 to 2007 at the Montreal Children's Hospital Asthma Centre.

Weight status and nonadherence to asthma maintenance therapy among children enrolled in a public drug insurance plan.

The pediatric obese-asthma phenotype is associated with poor control, perhaps because of medication nonadherence. This study aimed to assess whether weight status is associated with nonadherence in children prescribed new asthma maintenance therapies. A historical cohort was constructed from a clinical database linking individual patient and prescription data to Quebec's prescription claims registry.

The Importance of Relevance: Willingness to Share eHealth Data for Family Medicine Research.

To determine the proportion of family medicine patients unwilling to allow their eHealth data to be used for research purposes, and evaluate how patient characteristics and the relevance of research impact that decision. Cross-sectional questionnaire. Acute care respiratory clinic or an outpatient family medicine clinic in Montreal, Quebec.

The Impact of Antidepressant Therapy on Glycemic Control in Canadian Primary Care Patients With Diabetes Mellitus.

Depression is common in people with diabetes and is associated with poor glycemic control. Evidence suggests that certain antidepressants (AD) increase the risk of poor control. Few population-based studies have examined the impact of individual ADs on glycemic control.

The obese-asthma phenotype in children: An exacerbating situation?

Background: Current evidence regarding the relationship between childhood obesity, decreased response to inhaled corticosteroids (ICSs), and poor asthma control is conflicting.

Objectives: We assessed whether obesity (1) is associated with time to first exacerbation among children with asthma initiating step 3 maintenance therapies and (2) modifies the effectiveness of step 3 therapies.

Methods: A retrospective cohort study was conducted from clinical data linked to health and drug administrative databases.

The Experience of Patients Engaged in Co-designing Care Processes.

This article presents the experiences of patients engaged in co-designing care under a program entitled, "Transforming Care at the Bedside," based at an academic health sciences center. This descriptive, qualitative study collected data through individual interviews. Participants included patients from 5 units in an academic health sciences center in Quebec, Canada.

Effective Strategies to Spread Redesigning Care Processes Among Healthcare Teams.

Purpose: The purpose of this study was to describe how spread strategies facilitate the successful implementation of the Transforming Care at the Bedside (TCAB) program and their impact on healthcare workers and patients in a major Canadian healthcare organization.

Design: This study used a qualitative and descriptive design with focus groups and individual interviews held in May 2014. Participants included managers and healthcare providers from eight TCAB units in a university health center in Quebec, Canada.

Transforming Care at the Bedside: managers' and health care providers' perceptions of their change capacities.

Background: The Transforming Care at the Bedside (TCAB) project engages frontline health care providers as the leaders of change and improvement efforts in their work environment. This study explored how health care providers and managers from three TCAB units in a university-affiliated health care center perceived the development of their change capacities following their involvement in this program.

Method: This descriptive, qualitative study involved focus groups and individual interviews.

CE: Original research: the perceptions of health care team members about engaging patients in care redesign.

Objective: This study sought to explore the perceptions of health care workers about engaging patients as partners on care redesign teams under a program called Transforming Care at the Bedside (TCAB), and to examine the facilitating factors, barriers, and effects of such engagement.

Design: This descriptive, qualitative study collected data through focus groups and individual interviews. Participants included health care providers and managers from five units at three hospitals in a university-affiliated health care center in Canada.

The effect of transforming care at the bedside initiative on healthcare teams' work environments.

Background: Different initiatives have been implemented in healthcare organizations to improve efficiency, such as transforming care at the bedside (TCAB). However, there are important gaps in understanding the effect of TCAB on healthcare teams' work environments.

Aim: The specific aim of the study is to describe findings regarding the TCAB initiative effects on healthcare teams' work environments.

The effect of obesity on antibiotic treatment failure: a historical cohort study.

Purpose: Obesity, a major health issue, is also an important risk factor for infections. Evidence demonstrates that excess weight affects the disposition of antibiotics but little work has been done to explore if this results in antibiotic treatment failure (ATF). ATF has serious adverse health outcomes and may increase treatment resistance.

Outlier detection for a hierarchical Bayes model in a study of hospital variation in surgical procedures.

One of the most important aspects of profiling healthcare providers or services is constructing a model that is flexible enough to allow for random variation. At the same time, we wish to identify those institutions that clearly deviate from the usual standard of care. Here, we propose a hierarchical Bayes model to study the choice of surgical procedure for rectal cancer using data previously analysed by Simons et al.

Nipple aspirate fluid and ductoscopy to detect breast cancer.

We prospectively performed cytologic assessment and image analysis (IA) on matched nipple aspirate fluid (NAF) and mammary ductoscopy (MD) specimens to determine (1) the accuracy of these methods in cancer detection and (2) whether the two collection methods provide complementary information.NAF and MD specimens were collected from 84 breasts from 75 women (nine bilateral samples) who underwent breast surgery. Cytologic evaluation was performed on all samples.

Impact of patient communication problems on the risk of preventable adverse events in acute care settings.

Background: Up to 50% of adverse events that occur in hospitals are preventable. Language barriers and disabilities that affect communication have been shown to decrease quality of care. We sought to assess whether communication problems are associated with an increased risk of preventable adverse events.

Sampling for conditional inference on case-control data.

The problem of exact conditional inference for discrete multivariate case-control data has two forms. The first is grouped case-control data, where Monte Carlo computations can be done using the importance sampling method of Booth and Butler (1999, Biometrika86, 321-332), or a proposed alternative sequential importance sampling method. The second form is matched case-control data.

Creating non-parametric bootstrap samples using Poisson frequencies.

This article describes how, in the high-level software packages used by non-statisticians, approximate non-parametric bootstrap samples can be created and analyzed without physically creating new data sets, or resorting to complex programming. The comparable performance of this shortcut method, which uses Poisson rather than multinomial frequencies for the numbers of copies of each observation, is demonstrated theoretically by evaluating the bootstrap variance in an example where the classic estimator of the sampling variance of the statistic of interest has a known closed form. For sample sizes of 50 or more, bootstrap standard errors obtained by this shortcut method exceeded those obtained by the standard version by less than 1%.

Fiberoptic ductoscopy findings in women with and without spontaneous nipple discharge.

Background: Fiberoptic ductoscopy (FD), which allows direct visualization of the breast ductal lumen, is performed in women with and without spontaneous nipple discharge (SND). Previous reports suggested that cytologic evaluation of SND may be falsely interpreted as containing malignancy. The purpose of the current study, which was performed prospectively, was to determine whether ductoscopic findings were different in women with versus without SND, and to assess the implications of the differences in SND versus non-SND samples regarding the role of FD in assessing whether a woman has breast carcinoma.

Quantifying postural tremor in workers exposed to low levels of manganese.

The aim of this study was: (1) To determine the minimum number of characteristics necessary to discriminate between postural tremor recorded in control subjects (CO), in subjects exposed to manganese (MN), and in patients with Parkinson's disease (PD), and (2) to examine the continuum of changes between the three groups examined. Workers previously exposed to Mn (n = 10), patients with PD (n = 10), and control subjects (CO) (n = 11) underwent a clinical examination. Blood Mn was measured at the end of exposure time for the MN group and 12 months later at the beginning of the experiment for all groups.

Ductoscopic cytology and image analysis to detect breast carcinoma.

Background: The goal of the prospective study was to determine whether 1) image analysis (IA; including DNA index [DI], S-phase fraction, and the presence or absence of aneuploidy or hypertetraploidy [HT]) of fiberoptic ductoscopy (FD) breast specimens was feasible, 2) IA findings from FD specimens predicted histopathologic evidence of disease, and 3) a combination of IA, cytology, and clinical factors provided complementary information in the diagnosis of breast carcinoma.

Methods: IA and cytologic evaluation were performed on 106 consecutively collected ductoscopic specimens from 88 subjects.

Results: IA was successful in 73 (71%) FD specimens.

Ductoscopic cytology to detect breast cancer.

Purpose: Fiberoptic ductoscopy allows direct visualization of the breast ductal lumen, providing a targeted approach to the diagnosis of intraductal disease. The purpose of this prospective study was to determine whether (1) endoscopic evaluation of the breast could be reliably performed, and (2) ductoscopic data (intraductal distance traveled, visual observations, epithelial and foam cell quantity, cytology) predict whether a woman has breast cancer.

Patients And Methods: Ductoscopic information was collected on intraductal distance traveled, visual observations, epithelial and foam cell quantity, and cytology.

Blood manganese and alcohol consumption interact on mood states among manganese alloy production workers.

Long-term exposure to manganese (Mn) can induce neurotoxic effects including neuromotor, neurocognitive and neuropsychiatric effects, but there is a great interpersonal variability in the occurrence of these effects. It has recently been suggested that blood Mn (MnB) may interact with alcohol use disorders, accentuating neuropsychiatric symptoms. The objective of the present study was to explore a possible interaction between alcohol consumption and MnB on mood states, using an existing data set on Mn exposed workers.

Studies of prognostic factors in end-stage renal disease: an epidemiological and statistical critique.

We reviewed prognostic studies for patients treated with renal replacement therapy by using an electronic database and bibliographic review for 1990 to 1998. Using the inclusion criteria of English language, adult patients, primary article, minimum 50 patients, primary focus on prognostic factors, and mortality outcome, 104 articles were identified. The 104 articles were reviewed for eight epidemiological and seven statistical criteria that addressed the scientific validity and interpretability of results.