Population-based assessment of emergency room visits and hospitalizations among women receiving adjuvant chemotherapy for early breast cancer.

Purpose: Adjuvant chemotherapy is considered standard care for patients with lymph node (LN) -positive and high-risk LN-negative early breast cancer (EBC). Although chemotherapy-associated toxicities are documented in clinical trials, the impact of toxicities on emergency room (ER) visits and hospitalizations (ER + Hs) at a population level with contemporary chemotherapy is unknown. We undertook a population-based study of ER + Hs in patients with EBC receiving adjuvant chemotherapy compared with noncancer controls (NCCs).

Transdermal contraception and the renin-angiotensin-aldosterone system in premenopausal women.

The oral contraceptive pill (OCP) activates the renin-angiotensin-aldosterone system (RAAS) through first-pass hepatic metabolism. Although usually benign, RAAS activation may have detrimental effects on renal and hemodynamic function in some women. Since combined hormonal contraception with the transdermal patch (EVRA) does not undergo first-pass hepatic metabolism, we hypothesized that the RAAS response would be different from that of OCP subjects.

USPIO-related T1 and T2 mapping MRI of cartilage in a rabbit model of blood-induced arthritis: a pilot study.

Ultrasmall paramagnetic iron oxide (USPIO)-enhanced MRI is promising for evaluating inflammation. The aims of this study were to investigate the effect of USPIO on cartilage T1 and T2 mapping, and to evaluate a proposed rapid vs. conventional T2 map method for imaging cartilage in a blood-induced arthritis model.

The percutaneous cecostomy tube in the management of fecal incontinence in children.

Purpose: To retrospectively evaluate experience with percutaneous cecostomies and their long-term outcomes.

Materials And Methods: Between June 1994 and March 2009, 290 patients (mean age, 10.1 y) with fecal incontinence underwent percutaneous cecostomy tube placement and subsequent tube management.

Solitary liver lesions in children: interobserver agreement and accuracy of MRI diagnosis.

Purpose: The purpose of the study was to evaluate interobserver agreement (IOA) and accuracy of magnetic resonance imaging (MRI) diagnosis of pediatric solitary liver lesions (PSLLs).

Methods: Fifty consecutive MRIs performed for PSLLs were reviewed to assess IOA and agreement between consensus imaging diagnosis and final diagnosis indicating accuracy using kappa statistics.

Results: In 39/50 cases, the MRI diagnosis given by two readers matched with substantial IOA (kappa=0.

Use of mental health care for nonpsychotic conditions by immigrants in different admission classes and by refugees in Ontario, Canada.

Background: Most Canadian newcomers are admitted in the economic, family, or refugee class, each of which has its own selection criteria and experiences. Evidence has shown various risks for mental health disorders across admission classes, but the respective service-use patterns for people in these classes are unknown. In this study, we compared service use for nonpsychotic mental health disorders by newcomers in various admission classes with that of long-term residents (i.

The urinary cytokine/chemokine signature of renal hyperfiltration in adolescents with type 1 diabetes.

Objective: Urinary cytokine/chemokine levels are elevated in adults with type 1 diabetes (T1D) exhibiting renal hyperfiltration. Whether this observation extends to adolescents with T1D remains unknown. Our first objective was to determine the relationship between hyperfiltration and urinary cytokines/chemokines in normotensive, normoalbuminuric adolescents with T1D using GFR(cystatin).

Evolving practice patterns in the management of acute colonic diverticulitis: a population-based analysis.

Background: There is increasing evidence to support the use of percutaneous abscess drainage, laparoscopy, and primary anastomosis in managing acute diverticulitis.

Objective: The aim of this study was to evaluate how practices have evolved and to determine the effects on clinical outcomes.

Design: This is a population-based retrospective cohort study using administrative discharge data.

Foodscapes of southern Ontario: neighbourhood deprivation and access to healthy and unhealthy food retail.

Objectives: We examined whether access to retail sources of healthy and unhealthy food varies according to level of neighbourhood material deprivation in three Ontario regions and whether urban form characteristics help to explain any such variations.

Methods: Food retail (FR) outlets were identified from a commercial database for 804 urban neighbourhoods in Toronto, Brampton/Mississauga and Hamilton, Ontario. The median number of healthy and unhealthy FR outlets and percentage of outlets that were unhealthy were derived using 720-metre network buffers based on dissemination blocks and aggregated up to neighbourhood level (census tract).

Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis.

Background/aim: Established indications for surgery in necrotizing enterocolitis (NEC) are pneumoperitoneum and failure to improve or clinical deterioration with medical treatment alone. It has been proposed that infants with intestinal necrosis may benefit from surgery in the absence of one of these indications yet the diagnosis of definitive intestinal necrosis is challenging. Recent data suggest that abdominal ultrasound (US) examination focused on the gastrointestinal tract and the peritoneal cavity may be of utility in this regard.

On the analysis of composite measures of quality in medical research.

Composite endpoints are commonplace in biomedical research. The complex nature of many health conditions and medical interventions demand that composite endpoints be employed. Different approaches exist for the analysis of composite endpoints.

Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation.

Background: The objectives of this paper are to describe the planned implementation and evaluation of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER 2) program which originated from the BETTER trial. The pragmatic trial, informed by the Chronic Care Model, demonstrated the effectiveness of an approach to Chronic Disease Prevention and Screening (CDPS) involving the use of a new role, the prevention practitioner. The desired goals of the program are improved clinical outcomes, reduction in the burden of chronic disease, and improved sustainability of the health-care system through improved CDPS in primary care.

Self-report measures of well-being predict incident harm due to self-neglect in cognitively impaired seniors who live alone.

Background: Primary care physicians (PCPs) increasingly must identify which of their cognitively impaired patients who live alone are at greatest risk of harm due to self-neglect.

Objectives: To determine whether brief patient self-report measures could accurately do this.

Methods: Participants were ≥65 years, lived alone, and recruited from PCPs' practices, community agencies, a hospital emergency department, and acute care medical units.

Physiologic characterization of inflammatory arthritis in a rabbit model with BOLD and DCE MRI at 1.5 Tesla.

Objective: Our aim was to test the feasibility of blood oxygen level dependent magnetic resonance imaging (BOLD MRI) and dynamic contrast-enhanced (DCE) MRI to monitor periarticular hypoxic/inflammatory changes over time in a juvenile rabbit model of arthritis.

Methods: We examined arthritic and contralateral nonarthritic knees of 21 juvenile rabbits at baseline and days 1,14, and 28 after induction of arthritis by unilateral intra-articular injection of carrageenin with BOLD and DCE MRI at 1.5 Tesla (T).

The magnitude and duration of Clostridium difficile infection risk associated with antibiotic therapy: a hospital cohort study.

Antibiotic therapy is the principal risk factor for Clostridium difficile infection (CDI), but little is known about how risks cumulate over the course of therapy and abate after cessation. We prospectively identified CDI cases among adults hospitalized at a tertiary hospital between June 2010 and May 2012. Poisson regression models included covariates for time since admission, age, hospitalization history, disease pressure, and intensive care unit stay.

Risk of readmission and emergency surgery following nonoperative management of colonic diverticulitis: a population-based analysis.

Objective: To characterize the clinical course of patients with diverticulitis after nonoperative management and determine factors associated with readmission and subsequent emergency surgery.

Background: Clinical course of this disease remains poorly understood; indications for elective colectomy are unclear.

Methods: This was a retrospective cohort study of patients managed nonoperatively after a first episode of diverticulitis in Ontario, Canada (2002-2012).

Effect of payment incentives on cancer screening in Ontario primary care.

Purpose: There is limited evidence for the effectiveness of pay for performance despite its widespread use. We assessed whether the introduction of a pay-for-performance scheme for primary care physicians in Ontario, Canada, was associated with increased cancer screening rates and determined the amounts paid to physicians as part of the program.

Methods: We performed a longitudinal analysis using administrative data to determine cancer screening rates and incentive costs in each fiscal year from 1999/2000 to 2009/2010.

Physical health and gender as risk factors for usage of services for mental illness.

Background: People with comorbid mental and physical illness (PI) experience worse health, inadequate care and increased mortality relative to those without mental illness (MI). The role of gender in this relationship is not fully understood. This study examined gender differences in onset of mental health service usage among people with physical illness (COPD, asthma, hypertension and type II diabetes) compared with a control cohort.

Evidence-based outcomes on diagnostic accuracy of quantitative ultrasound for assessment of pediatric osteoporosis - a systematic review.

Background: Dual-energy absorptiometry (DXA) is the current reference standard for assessing pediatric osteoporosis; however due to its areal nature, it has limitations. Thus, quantitative ultrasound (QUS), a modality free of ionizing radiation, has been proposed as a potential surrogate for DXA.

Objective: To semi-quantitatively assess the diagnostic accuracy of QUS for evaluating pediatric osteoporosis according to the U.

Premature return to play and return to learn after a sport-related concussion: physician's chart review.

Objective: To determine what proportion of patients experience an exacerbation of their symptoms as a result of premature return to play (RTP) and return to learn (RTL) following sport-related concussions.

Design: Retrospective study of electronic medical records from the office-based practice of one family and sport medicine physician who had systematically provided recommendations for cognitive and physical rest based on existing consensus recommendations. Two blinded authors independently reviewed each chart, which included Sport Concussion Assessment Tool (SCAT) and SCAT2 symptom self-report forms to determine whether an athlete had returned to play or learn prematurely.

The effect of health-facility admission and skilled birth attendant coverage on maternal survival in India: a case-control analysis.

Background: Research in areas of low skilled attendant coverage found that maternal mortality is paradoxically higher in women who seek obstetric care. We estimated the effect of health-facility admission on maternal survival, and how this effect varies with skilled attendant coverage across India.

Methods/findings: Using unmatched population-based case-control analysis of national datasets, we compared the effect of health-facility admission at any time (antenatal, intrapartum, postpartum) on maternal deaths (cases) to women reporting pregnancies (controls).

J-shapedness: an often missed, often miscalculated relation: the example of weight and mortality.

We present three considerations in analysing the association between weight and mortality, as well as other relations that might be non-linear in nature. First, authors must graphically plot their independent and dependent variables in a continuous manner. Second, authors should assess the shape of that relation, and note its shape.

Reliability and validity of the Daily Cognitive-Communication and Sleep Profile: a new instrument for monitoring sleep, wakefulness and daytime function.

The Daily Cognitive Communicative and Sleep Profile (DCCASP) is a seven-item instrument that captures daily subjective sleep quality, perceived mood, cognitive, and communication functions. The objective of this study was to evaluate the reliability and validity of the DCCASP. The DCCASP was self-administered daily to a convenience sample of young adults (n = 54) for two two-week blocks, interspersed with a two-week rest period.

Factors associated with primary care physicians' recognition of cognitive impairment in their older patients.

Although there are accurate screens for cognitive impairment, there is as yet no evidence that screening improves outcomes including primary care physicians' (PCP) medical decision making. PCPs' recognition of cognitive impairment being suboptimal, we investigated factors associated with improved recognition. Eligible patients were aged 65 years and above, without documented dementia or previous work-up for dementia, seen consecutively over 2 months by one of 13 PCPs.