Peri-operative risk factors of chronic kidney disease after liver transplantation.

Background: Chronic kidney disease (CKD) is a frequent long-term complication after liver transplantation (LT) and is associated with poor long-term survival. The aim of our study was to identify the risk factors of developing post-transplant CKD at 1 year, during the pre-operative, peri-operative, and post-LT phases.

Methods: All consecutive patients who underwent primary LT between July 2013 and February 2018 were analyzed.

Endoscopic management of concomitant biliary and duodenal malignant obstruction: Impact of the timing of drainage for one . two procedures and the modalities of biliary drainage.

Background And Objectives: Concomitant biliary and duodenal malignant obstruction are a severe condition mainly managed by duodenal and biliary stenting, which can be performed simultaneously (SAMETIME) or in two distinct procedures (TWO-TIMES). We conducted a single-center retrospective study to evaluate the feasibility of a SAMETIME procedure and the impact of endoscopic ultrasound (EUS)-hepaticogastrostomy in double malignant obstructions.

Patients And Methods: From January 1, 2011, to January 1, 2018, patients with concomitant malignant bilioduodenal obstruction treated endoscopically were included.

Recent data on hepatitis E.

Purpose Of Review: Hepatitis E virus (HEV) has gained increased global recognition in recent years, particularly in developed countries. We summarized here a selection of the literature published since the 1st of June, 2017.

Recent Findings: Longitudinal studies are increasingly conducted in Europe, to determine trends in HEV prevalence.

Improving knowledge translation of clinical practice guidelines for epilepsy.

Background: Clinical practice guidelines (CPGs) have the potential to improve quality of care. However, implementation of CPGs into the clinical care of people with epilepsy is less than optimal. This study aimed to examine barriers and facilitators to the use of CPGs for the care of people with epilepsy.

Knowledge translation of clinical practice guidelines among neurologists: A mixed-methods study.

Objectives: Clinical practice guidelines have the potential to improve care, but are often not optimally implemented. Improving guideline use in clinical practice may improve care. The objective of this study was to identify the barriers and facilitators (determinants) of guidelines use among neurologists and to propose a strategy to improve guideline implementation.

Treatment options for metastatic colorectal cancer in patients with liver dysfunction due to malignancy.

Background: The survival of colorectal cancer patients is frequently determined by the extent of metastatic invasion to the liver; in cases of major involvement, therapeutic strategies are limited because the liver is necessary for drug metabolism.

Material And Methods: We have reviewed articles about the pharmacokinetic profiles of each drug used in colorectal cancer patients with hepatic dysfunction to determine which of these treatments are most feasible.

Results: Some drugs appear to be feasible options for patients with hepatic insufficiency.

Heterogeneity of metastatic pancreatic adenocarcinoma: Lung metastasis show better prognosis than liver metastasis-a case control study.

The prognosis of metastatic pancreatic ductal adenocarcinoma (PDAC) is grim, with a median overall survival of under 1 year. In our clinical practice, we observed a few cases of isolated lung metastases from PDAC with unusually long outcomes. We compared these cases in a case-control study of lung-only vs.

Effect of physician specialist alternative payment plans on administrative health data in Calgary: a validation study.

Background: There are concerns that alternate payment plans for physicians may be associated with erosion of data quality, given that physicians are paid regardless of whether claims are submitted. Our objective was to determine the proportion of claims submitted by physician specialists using fee-for-service and alternative payment plans, and to identify and compare the validity of information coded in physician billing claims submitted by these specialists in Calgary.

Methods: We conducted a survey of physician specialists to determine their plan status and obtained consent to use physicians' claims data from 4 acute care hospitals in Calgary.

[Preliminary study for the implementation of standardized rounded doses of cytotoxic druqs].

Background: "Dose-banding" is a concept of cytotoxic drugs standardization allowing the preparation in advance of standardized rounded doses (SRD covering the most frequently prescribed doses rounded to +/-5%. Standard doses will be prepared in advance by batch in order to increase production capacity and at the same time to regulate pharmacy workflow as well as to reduce patient waiting time.

Purpose: To identify anticancer drugs suitable for dose banding and to fix standardized doses.

Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times.

Background: Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level.

Species specific thyroid signal transduction: conserved physiology, divergent mechanisms.

In the literature, data obtained in signal transduction from various species thyroids and cells lines are often integrated in a common model. We investigate qualitatively and systematically, using the same protocol, the control by TSH of the two main functions of the thyrocytes, the synthesis and the secretion of thyroid hormones. In all species investigated, the TSH receptor activates both.

Colonoscopy and its complications across a Canadian regional health authority.

Background: Defining the complication rate of endoscopy performed across an entire city will capture usual as opposed to referral center data.

Objective: Our purpose was to evaluate the current practice of colonoscopy and complications associated with lower GI endoscopy in usual clinical practice.

Design: All admissions within 30 days of an outpatient lower GI endoscopy at any of the 6 adult-care Winnipeg hospitals were identified.

Patients hospitalized for medical conditions in Winnipeg, Canada: appropriateness and level of care.

A medical record review of patients hospitalized for medical conditions in Winnipeg, Canada during 1998/99 was completed using InterQual utilization review instruments. On admission, 95% of patients required the services provided in an acute care facility. Fifty-eight percent of days in hospital following the day of admission required an acute care setting, and 42% required an alternate level of care.

Measuring and managing waiting times: what's to be done?

On September 11, 2000, the First Ministers of Canada issued a communiqué pledging to develop and report on waiting times for a number of diagnostic and treatment services. Reporting is to begin by September 2002. Given this commitment, what are the ideal characteristics of such a data collection system? This article defines and evaluates methods of measuring waiting times, and recommends a prioritized waiting-time information system to permit both measurement and management.

Managing health services: how the Population Health Information System (POPULIS) works for policymakers.

University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for answering such questions as: Which populations need more physician services? Which need fewer? Are high-risk populations poorly served? or do they have poor health outcomes despite being well served? Does high utilization represent overuse? or is it related to high need? More specifically, this system provides decision makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served.

Waiting times for surgical procedures.

Objectives: Polls show that nearly two thirds of Canadians believe that waiting times prior to surgery have increased in recent years. A study was undertaken in Manitoba to determine whether public perceptions about long and increasing waits were valid.

Research Design: Using administrative data, waiting times for 10 types of surgery-ranging from coronary artery bypass surgery and mastectomy to cataract surgery and hernia repairs-were studied over a 5-year period.

Assessing the extent to which hospitals are used for acute care purposes.

Objectives: The degree to which Manitobans were appropriately hospitalized for medical conditions was assessed using a retrospective chart review of a sample of patients in 26 hospitals.

Research Design: A standardized set of object-based, nondiagnostic criteria (Inter-Qual) was used by trained abstractors to assess the patient at admission and for each day of stay.

Results: A high percentage of admissions and days of care were inappropriate.

Managing health services: how administrative data and population-based analyses can focus the agenda.

University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for providing answers to such questions as: which populations need more physician services? Which need fewer? Are high-risk populations poorly served or do they have poor health outcomes despite being well served? Does high utilization represent overuse or utilization related to high need? More specifically, this system provides decision-makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics, and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served.

Inappropriate hospital use by patients receiving care for medical conditions: targeting utilization review.

Objective: To describe characteristics associated with inappropriate hospital use by patients in Manitoba in order to help target concurrent utilization review. Utilization review was developed to reduce inappropriate hospital use but can be a very resource-intensive process.

Design: Retrospective chart review of a sample of adult patients who received care for medical conditions in a sample of Manitoba hospitals during the fiscal year 1993-94; assessment of patients at admission and for each day of stay with the use of a standardized set of objective, nondiagnosis-based criteria (InterQual).

Private health care in Canada: savior or siren?

In canada, health care is publicly insured and available to all at no charge. Recently, financial pressures have threatened the system and led to considerable debate about how to save it. One proposal is to permit privately funded health care alongside the public system, resulting in what is popularly called a two-tiered system.