Procalcitonin-Guided Antibiotic Prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the Emergency Department.

Purpose: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be caused by viral, bacterial, or environmental factors. Recent studies have suggested that procalcitonin serum levels may help reduce unnecessary antibiotic use without statistically significant differences in rates of treatment failure for AECOPD. The purpose of this quality improvement project was to create a procalcitonin-based algorithm to aid emergency department (ED) clinicians in the management of patients with AECOPD who do not require hospitalization and to evaluate its efficacy and practicality.

Design and implementation of a population-based registry of Implantable Cardioverter Defibrillators (ICDs) in Ontario.

Background: There are scarce population-based data on the use, complication rates, and outcomes of patients receiving implantable cardioverter defibrillators (ICDs).

Objective: This study sought to describe the methodology of the Ontario ICD Database, a prospective study of all ICD recipients in Ontario, Canada.

Methods: In this registry, web-based data collection will be performed in all patients referred to a cardiac electrophysiologist for consideration of an ICD.

The Ontario printed educational message (OPEM) trial to narrow the evidence-practice gap with respect to prescribing practices of general and family physicians: a cluster randomized controlled trial, targeting the care of individuals with diabetes and hypertension in Ontario, Canada.

Background: There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM); however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message.

Urban emergency department overcrowding: defining the problem and eliminating misconceptions.

Study Objective: To develop an operational definition and a parsimonious list of postulated determinants for urban emergency department (ED) overcrowding.

Methods: A panel was formed from clinical and administrative experts in pre-hospital, ED and hospital domains. Key studies and reports were reviewed in advance by panel members, an experienced health services researcher facilitated the panel's discussions, and a formal content analysis of audiotaped recordings was conducted.

The prevalence of hypovitaminosis D and secondary hyperparathyroidism in obese Black Americans.

Context: Both obesity (body mass index, BMI > or = 30 kg/m2) and Black race are associated with a higher risk of vitamin D deficiency and secondary hyperparathyroidism. We hypothesized the risk of hypovitaminosis D would therefore be extraordinarily high in obese Black adults.

Objective: To study the effects of race and adiposity on 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (iPTH).

A voluntary privacy standard for health services and policy research: legal, ethical and social policy issues in the Canadian context.

In this review, the authors describe how one group of Canadian researchers has begun to address current privacy protection challenges with the end goal of developing a Canadian national standard for privacy protection specific to health services and policy research (HSPR). They provide a concise description of some of the key messages and issues that resulted from a recent series of HSPR workshops and describe some of the workshop outcomes in terms of their legal, ethical and social/policy significance. The review ends with a brief description of some future directions for research and development in this area.

The consistency of panelists' appropriateness ratings: do experts produce clinically logical scores for rectal cancer treatment?

Objective: To quantify the clinical consistency of expert panelists' ratings of appropriateness of pre-operative and post-operative chemotherapy plus radiation for rectal cancer.

Methods: A panel of nine physicians (two surgeons, four medical oncologists, three radiation oncologists) rated the appropriateness of providing pre-operative and post-operative treatments for rectal cancer, utilizing a modified-Delphi (RAND/UCLA) approach. Clinical scenarios were paired so that each component of a pair differed by only one clinical feature (e.

The costs of safeguarding privacy: one research organization's experience.

While academic health research has always observed strict vigilance in the guardianship of the rich information found in health databases, new legislation faced by all organizations ups the ante even higher. Research organizations like the Institute for Clinical Evaluative Sciences are delving into even more rigorous policies to keep sensitive information secure while preserving the value that dedicated research provides. The costs of implementing privacy protections are of great concern to Canadian researchers.

Parkinsonism in Ontario: comorbidity associated with hospitalization in a large cohort.

To study comorbidity in patients with Parkinsonism (PKM), relative hospitalization rates from 1994 to 1999 for 15,304 cases were compared with 30,608 controls. After correction for differential survival, the rates were higher for cases compared to controls for aspiration pneumonia (6.34; 95% confidence interval [CI], 5.

Burden of parkinsonism: a population-based study.

Parkinson's disease (PD) is associated with a significant burden of illness and cost to society, which has been difficult to quantify. Our objective was to use linked administrative databases from the population of Ontario, Canada, to assess the prevalence of parkinsonism, physician- and drug-related costs, and hospital utilization for parkinsonian patients compared with age/sex matched controls. An inception cohort of parkinsonian cases from 1993/1994 was age and sex matched (1:2) to controls and followed for 6 years.