Trends in the coprescription of proton pump inhibitors with clopidogrel: an ecological analysis.

Background: In early 2009, 2 observational studies and a US Food and Drug Administration (FDA) advisory addressed the drug interaction between proton pump inhibitors (PPIs) and clopidogrel. One study suggested that pantoprazole could be used safely in this setting, whereas the other study and the FDA advisory did not distinguish among PPIs. We examined trends in PPI prescribing among clopidogrel recipients in the period following these events.

Ontario's emergency department process improvement program: the experience of implementation.

Objectives: In recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long-Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital-based teams' experiences during the ED process improvement program implementation and the teams' perceptions of the key factors that influenced the program's success or failure.

Socioeconomic status and the use of computed tomography in the emergency department.

Background: Low socioeconomic status (SES) is associated with adverse health outcomes. Possible explanations include differences in health status, access to health care, and care provided by clinicians. We sought to determine whether SES is associated with computed tomography (CT) use in the emergency department (ED).

Extended-release nifedipine and the risk of intestinal obstruction: a population-based study.

Objectives: To examine the risk of bowel obstruction in older adults during treatment with extended-release nifedipine compared with patients treated with amlodipine.

Design: Retrospective cohort study using multiple linked healthcare databases.

Setting: Ontario, Canada from 1 April 1997 to 31 December 2010.

Proton pump inhibitors and the risk of adverse cardiac events.

Background: Recent evidence suggests that proton pump inhibitors (PPIs) might be linked with adverse cardiac events, but a causal relationship is unproven.

Methods: We applied the self-matched case series method to two studies using population-based health care data from Ontario, Canada between 1996 and 2008. The first included subjects aged 66 years or older hospitalized for acute myocardial infarction within 12 weeks following initiation of PPI, while the second included subjects hospitalized for heart failure.

The rise and fall of the thiazolidinediones: impact of clinical evidence publication and formulary change on the prescription incidence of thiazolidinediones.

Background: Numerous factors affect drug utilization including clinical trials, promotional activity, drug safety signals and funding practices. We sought to investigate the impact of cardiovascular safety concerns and public drug formulary restrictions on the use of the thiazolidinediones (TZDs): rosiglitazone and pioglitazone.

Methods: We conducted a population-based cross-sectional time series analysis among more than 1.

Chlorthalidone versus hydrochlorothiazide for the treatment of hypertension in older adults: a population-based cohort study.

Background: Some evidence suggests that chlorthalidone may be superior to hydrochlorothiazide for the treatment of hypertension.

Objective: To compare the effectiveness and safety of chlorthalidone and hydrochlorothiazide in older adults.

Design: Propensity score-matched observational cohort study with up to 5 years of follow-up.

No increase in adverse events during aliskiren use among ontario patients receiving angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers.

Background: Some evidence suggests that the direct renin inhibitor aliskiren may increase the risk of severe hyperkalemia, stroke, or acute kidney injury (AKI) when prescribed with angiotensin-converting enzyme inhibitors (ACEi's) or angiotensin-receptor blockers (ARBs). The extent to which concomitant treatment increases the risk of these outcomes in routine clinical practice is unknown. We addressed this issue with the use of administrative databases.

Rates of hemorrhage during warfarin therapy for atrial fibrillation.

Background: Although warfarin has been extensively studied in clinical trials, little is known about rates of hemorrhage attributable to its use in routine clinical practice. Our objective was to examine incident hemorrhagic events in a large population-based cohort of patients with atrial fibrillation who were starting treatment with warfarin.

Methods: We conducted a population-based cohort study involving residents of Ontario (age ≥ 66 yr) with atrial fibrillation who started taking warfarin between Apr.

Postpartum maternal codeine therapy and the risk of adverse neonatal outcomes: a retrospective cohort study.

Objectives: To examine whether postpartum maternal prescription of codeine was associated with an increased risk of harm to newborns.

Design: Population-based retrospective cohort study.

Setting: Ontario, Canada, from April 1, 1998 to March 1, 2008.

Use of other opioids during methadone therapy: a population-based study.

Aims: To determine the extent to which other opioids are prescribed to patients receiving methadone in Ontario, Canada.

Design: Retrospective cohort study.

Setting: Ontario, Canada from 1 April 2003 to 31 March 2010.

Trimethoprim-sulfamethoxazole induced hyperkalaemia in elderly patients receiving spironolactone: nested case-control study.

Objectives: To characterise the risk of admission to hospital for hyperkalaemia in elderly patients treated with trimethoprim-sulfamethoxazole in combination with spironolactone.

Design: Population based nested case-control study.

Setting: Ontario, Canada, from 1 April 1992 to 1 March 2010.

The experience of living with stroke: a qualitative meta-synthesis.

Objective: The effects of stroke on stroke survivors are profound and cannot adequately be understood from a single approach or point of view. Use of qualitative study, in addition to quantitative research, provides a comprehensive picture of the consequences of stroke grounded in the experience of stroke survivors. The purpose of the present study was to examine the contribution of the published qualitative literature to our understanding of the experience of living with stroke.

The rehabilitation of patients recovering from brainstem strokes: case studies and clinical considerations.

An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke. Two case studies are presented to illustrate some of the difficulties encountered in the rehabilitation of these individuals. Unlike hemispheric stroke, the characteristic consequences of brainstem stroke include ataxia, dysarthria, and diplopia.

Post-traumatic seizure disorder following acquired brain injury.

Objective: The present study aimed to evaluate the effectiveness of prophylactic anticonvulsant pharmacological strategies for the prevention of seizure disorders following acquired brain injury (ABI) to provide guidance for clinical practice based on the best available evidence.

Methods And Main Outcomes: A systematic review of the literature from 1980-2005 was conducted focusing on treatment interventions available for post-traumatic seizures following ABI. The evidence for the efficacy of a given intervention was ranked as strong (supported by at least two randomized controlled trials (RCTs), moderate (supported by a single RCT), or limited (supported by other types of studies in the absence of RCTs).

A systematic review of the rehabilitation of moderate to severe acquired brain injuries.

Objective: To conduct a systematic review of the rehabilitation literature of moderate to severe acquired brain injuries (ABI) from traumatic and non-traumatic causes.

Methods: A review of the literature was conducted for studies looking at interventions in ABI rehabilitation. The methodological quality of each study was determined using the Downs and Black scale for randomized controlled trials (RCTs) and non-RCTs as well as the Physiotherapy Evidence Database (PEDro) scale for RCTs only.

Progress in clinical neurosciences: stroke recovery and rehabilitation.

Background: Recent literature has provided new insights into the role of rehabilitation in neurological recovery post-stroke. The present review combines results of animal and clinical research to provide a summary of published information regarding the mechanisms of neural recovery and impact of rehabilitation.

Methods: Plasticity of the uninjured and post-stroke brain is examined to provide a background for the examination of brain reorganization and recovery following stroke.

Identification of aphasia post stroke: a review of screening assessment tools.

Introduction: Aphasia is one of the most common consequences of stroke. Early identification, diagnosis and treatment of language deficits are important steps in maximizing rehabilitation gains. A routine screening test is an invaluable tool in the identification and appropriate referral of patients with potential communication problems.