Acute Post-Prandial Cognitive Effects of Brown Seaweed Extract in Humans.

(Poly)phenols and, specifically, phlorotannins present in brown seaweeds have previously been shown to inhibit α-amylase and α-glucosidase, key enzymes involved in the breakdown and intestinal absorption of carbohydrates. Related to this are observations of modulation of post-prandial glycemic response in mice and increased insulin sensitivity in humans when supplemented with seaweed extract. However, no studies to date have explored the effect of seaweed extract on cognition.

Using decision trees for measuring gender equity in the timing of angiography in patients with acute coronary syndrome: a novel approach to equity analysis.

Background: Methods to measure or quantify equity in health care remain scarce, if not difficult to interpret. A novel method to measure health equity is presented, applied to gender health equity, and illustrated with an example of timing of angiography in patients following a hospital admission for an acute coronary syndrome.

Methods: Linked administrative hospital discharge and survey data was used to identify a retrospective cohort of patients hospitalized with Acute Coronary Syndrome (ACS) between 2002 and 2008 who also responded to the Canadian Community Health Survey (CCHS), was analyzed using decision trees to determine whether gender impacted the delay to angiography following an ACS.

The importance of place of residence in patient satisfaction.

Objective: To determine the effect of patients' place of residence on their evaluations of care, and to explore related policy implications.

Study Design: We used a conditional regression analysis of stratum matched case controls to examine whether place of residence of patients living in the Greater Toronto Area (GTA) or in Ontario outside of the GTA affects patient satisfaction with their experiences during hospitalization.

Setting: One hundred and six acute care hospitals located in the province of Ontario, Canada.

The Value of Performance Measurement in Promoting Improvements in Women's Health.

Objectives: To determine the factors associated with the use and impact of performance data relevant to women's health.

Methods: We developed a survey on six levels of information use based on Knott and Wildavsky's (1980) policy utilization framework and used this survey to determine Ontario hospital administrators' use of women's health report indicators. We related responses to this survey to six potentially relevant organizational factors, such as women's health as a written hospital priority, a women's health program and hospital budget size, using correlation and multiple-regression analysis.

A one-year economic evaluation of six alternative strategies in the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care.

Background: The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinalsymptoms remains controversial.

Objective: To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting.

Methods: The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes.

Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993-2004).

Aim: This paper is a report of an analysis of the career trajectories of nurses 1 year after leaving hospitals.

Background: Although hospitals are traditionally the largest employers of nurses, technological advances and budgetary constraints have resulted in many countries in relative shrinkage of the hospital sector and a shift of care (and jobs) into home/community settings. It has been often assumed that nurses displaced from hospitals will move to work in the other workplaces, especially the community sector.

Selecting predictors of cancer patients' overall perceptions of the quality of care received.

Background: The goal of this study was to identify aspects of care (predictors) that can most easily be modified to produce an improvement in the score of patients' overall evaluations of the quality of care received.

Patients And Methods: Our sample consisted of 2247 cancer patients hospitalized in Ontario acute care hospitals in 1999/2000. We sought predictors of patients' overall perceptions of the quality of care by applying a methodology that minimizes the improvement of the predictors while gaining a desired increase in the score of the dependent variable.

Developing an efficient model to select emergency department patient satisfaction improvement strategies.

Study Objective: Patient satisfaction is an important performance measure for emergency departments (EDs), but the most efficient ways of improving satisfaction are unclear. This study uses optimization techniques to identify the best possible combination of predictors of overall patient satisfaction to help guide improvement efforts.

Methods: The results of a satisfaction survey from 20,500 patients who visited 123 EDs were used to develop ordinal logistic regression models for overall quality of care, overall medical treatment, willingness to recommend the ED to others, and willingness to return to the same ED.

Validation of a decision model for preventive pharmacological strategies in postmenopausal women.

Background: Benefits and risks of a combined hormone replacement therapy (HRT) based on randomized clinical trial emerged on various disease endpoints in 2002. The Women's Health Initiative (WHI) provides an important health answer for healthy postmenopausal women, such as do not use combined HRT to prevent chronic disease, because of the elevated risk of coronary artery disease (CHD), stroke and venous thromboembolism. In March 2004, the NIH stopped the drugs in the estrogen-alone trial after finding an increase risk of stroke and no effect, neither an increase or a decrease, on risk of CHD after an average of 7 years in the trial.

Effect of delay in initiating radiotherapy for patients with early stage breast cancer.

Aims: For early stage breast cancer, a standard treatment option is partial mastectomy followed by radiation treatment. The 5-year risk of local recurrence ranges from 6-9%. Variable waiting times for radiation treatment of breast cancer in our institution provided an opportunity to evaluate the impact of waiting time on the risk of local recurrence.

Neovastat (AE-941) in refractory renal cell carcinoma patients: report of a phase II trial with two dose levels.

Background: renal cell carcinoma (RCC) is a potential target for anti-angiogenic drugs because of its high vascularization. Neovastat (AE-941) is an inhibitor of angiogenesis with a mechanism of action that could prove beneficial in the treatment of RCC. Patients and design A phase II trial was conducted to identify the long-term safety profile of Neovastat in advanced cancer patients and to obtain preliminary information on its efficacy in solid tumors refractory to standard treatments.

Efficacy and cost of HMG-CoA reductase inhibitors in the treatment of patients with primary hyperlipidemia.

Background: Screening for hyperlipidemia is a substantial cost burden, as is its treatment. The choice of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and the dose level may have significant implications for both efficient and cost effective therapy.

Objective: To compare the efficiency and cost of statins.

Associates of health status in patients with systemic lupus erythematosus.

Objective: To determine the health status of patients with systemic lupus erythematosus (SLE) and to identify the associations of this domain.

Methods: One hundred ninety-five consecutively attending patients with SLE were studied at 2 centers. Health status was measured by 8 composite scales of the Medical Outcomes Study Short Form 36 (SF-36).

Predicting the short term direct medical costs incurred by patients with rheumatoid arthritis.

Objective: With increasing interest in revising the mechanisms of health care funding, the ability to anticipate patients' medical expenditures as well as to identify potentially modifiable predictors would be informative for health care providers, payers, and policy makers.

Methods: Eight hundred fifty-eight patients with rheumatoid arthritis from 2 Canadian centers reported semi-annually on their health services utilization and health status for up to 12 years. Annual direct costs were calculated using 1994 Canadian prices.

Identifying adults at low risk for significant hyperlipidemia: a validated clinical index.

The objective of this study was to develop and validate a simple clinical index to identify individuals at increased risk of an elevated CHL/HDL ratio. Using recursive partitioning, factors associated with an elevated CHL/HDL ratio were identified among 1993 men and 1631 women in the Lipid Research Clinic Prevalence Study. These factors were weighted using logistic regression analyses to develop a clinical index that was validated on 486 men and 484 women reported in the Santé Québec cardiovascular health survey.

Can computerized risk profiles help patients improve their coronary risk? The results of the Coronary Health Assessment Study (CHAS).

Background: The Coronary Health Assessment Study (CHAS) was developed to determine the feasibility of using patient-specific, multifactorial computerized coronary risk profiles as a clinical decision aid to support primary prevention of CHD.

Methods: Study participants included 253 community based physicians, randomized into profile and control groups, and 958 of their patients. The profile group physicians received coronary risk profiles for their patients within 10 working days after the baseline patient assessment providing early feedback.

Predictors of delay in starting radiation treatment for patients with early stage breast cancer.

Purpose: To describe the factors predicting waiting time for radiation treatment in early breast cancer.

Materials And Methods: Between January 1992 and December 1993, 739 patients with Stage I and II breast cancer were treated with conservative treatment at three McGill University Hospitals. Waiting time was defined as the interval between the date of surgery and the date of the first radiation treatment.

Estimating the benefits of modifying risk factors of cardiovascular disease: a comparison of primary vs secondary prevention.

Objectives: To compare the potential years of life saved (YOLS) associated with risk factor modification in the primary and secondary prevention of cardiovascular disease (CVD).

Methods: The CVD life expectancy model estimates the risk of death due to coronary disease, stroke, and other causes based on the levels of independent risk factors (such as age, blood pressure, and blood lipid levels) found in the cohort of the Lipid Research Clinics. The model was validated by comparing its predictions with the observed fatal outcomes of 9 randomized clinical trials.

Economic benefits of a routine second dose of combined measles, mumps and rubella vaccine in Canada.

Objective: To evaluate the potential economic benefits of a program for a second routine dose of combined measles, mumps and rubella (MMR) vaccine, administered to children in Canada.

Design: Both published and unpublished data from the United States and Canada were incorporated into a linear model. This information was supplemented with opinions on probability and resource use from interviews with a Canadian panel of physicians and practitioners.

Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study.

Objective: To perform the first prospective longitudinal study of direct (health services utilized) and indirect costs (diminished productivity represented by income loss) incurred by patients with rheumatoid arthritis (RA) in Saskatoon and Montreal, followed for up to 12 and 4 years, respectively.

Methods: 1063 patients reported on health status, health services utilization, and diminished productivity every 6 months.

Results: Annual direct costs were $3788 (1994 Canadian dollars) in the late 1980s and $4656 in the early 1990s.

The effect of tobacco tax cuts on cigarette smoking in Canada.

Objective: To assess the effect of the tobacco tax cuts made in 1994 on the smoking habits of Canadians.

Design: Population-based retrospective cohort study.

Data: Data from the Survey on Smoking in Canada conducted by Statistics Canada on 11,119 respondents 15 years of age and older, who were interviewed about their smoking habits on 4 occasions, approximately every 3 months from January 1994 to February 1995.

A multicenter randomized double-blind placebo-controlled trial of adjunctive corticosteroids in the treatment of Pneumocystis carinii pneumonia complicating the acquired immune deficiency syndrome.

A multicenter placebo-controlled trial of early short-term high-dose methylprednisolone enrolled 78 patients with moderate to severe Pneumocystis carinii pneumonia (PCP) complicating HIV infection. The mean pressure of oxygen (PO2) at study entry was 55 mm Hg for the 71 patients who had blood gases monitored while breathing room air. Patients were randomized to receive methylprednisolone (40 mg) or placebo parenterally twice daily for 10 days, and the first dose of study medication was given within 24 h of the first dose of antimicrobial therapy for PCP.