Recurrent community-acquired pneumonia in patients starting acid-suppressing drugs.

Background: Several studies suggest that proton pump inhibitors (PPIs) and histamine 2-receptor antagonists (H2s) increase risk of community-acquired pneumonia. To test this hypothesis, we examined a prospective population-based cohort predisposed to pneumonia: elderly patients (> or =65 years) who had survived hospitalization for pneumonia.

Methods: This study featured a nested case-control design where cases were patients hospitalized for recurrent pneumonia (> or =30 days after initial episode) and controls were age, sex, and incidence-density sampling matched but never had recurrent pneumonia.

Prevalence of cardiovascular risk factors and disease in people with schizophrenia: a population-based study.

Objective: To evaluate the prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D) in people with schizophrenia.

Method: We conducted a period-prevalence study using a population-based cohort from Alberta administrative databases. Schizophrenia was identified using billing codes; all other individuals served as non-schizophrenic controls.

Analyzing composite outcomes in cardiovascular studies: traditional Cox proportional hazards versus quality-of-life-adjusted survival approaches.

Background: Composite outcomes that weight each component equally are commonly used to study treatment effects. We hypothesized that each component of a composite outcome would differentially affect patients' overall health-related quality of life (HRQL).

Methods: We tested our hypothesis using data from 2 published clinical studies of treatment for heart failure, one comparing metformin and sulfonylurea and the other comparing digoxin and placebo.

Costs and consequences of direct-to-consumer advertising for clopidogrel in Medicaid.

Background: Direct-to-consumer advertising (DTCA) is assumed to be a major driver of rising pharmaceutical costs. Yet, research on how it affects costs is limited. Therefore, we studied clopidogrel, a commonly used and heavily marketed antiplatelet agent, which was first sold in 1998 and first direct-to-consumer advertised in 2001.

The Enhancing Secondary Prevention in Coronary Artery Disease trial.

Background: Proven efficacious therapies are sometimes underused in patients with chronic cardiac conditions, resulting in suboptimal outcomes. We evaluated whether evidence summaries, which were either unsigned or signed by local opinion leaders, improved the quality of secondary prevention care delivered by primary care physicians of patients with coronary artery disease.

Methods: We performed a randomized trial, clustered at the level of the primary care physician, with 3 study arms: control, unsigned statements or opinion leader statements.

Prevalence and predictors of vertebral fracture in patients with chronic obstructive pulmonary disease.

Objectives: Patients with COPD are at risk for osteoporosis-related vertebral compression fractures (VCF) which predispose to more fractures and worsening pulmonary function. Our objectives were to: 1 document VCF prevalence in COPD patients; and 2 determine the independent correlates of VCF.

Methods: From 2004-2006, we prospectively recruited consecutive consenting COPD patients presenting with acute exacerbation at three Canadian Emergency Departments (ED).

The unhealthy state of health policy research.

Health policies often represent large-scale natural experiments with poorly understood risks and benefits. Unfortunately, researchers often stray from the core principles of study design required to provide valid evidence. The result is that policymakers and the public do not always know what to believe.

Forced euvolemic diuresis with mannitol and furosemide for prevention of contrast-induced nephropathy in patients with CKD undergoing coronary angiography: a randomized controlled trial.

Background: Contrast-induced nephropathy is common in patients with coronary angiography. Mechanistically, forced euvolemic diuresis with mannitol and furosemide ought to prevent contrast-induced nephropathy. Our objectives are to: (1) undertake a randomized trial testing this hypothesis, and (2) conduct a meta-analysis of our findings with 2 earlier studies.

Safety and efficacy of corticosteroids for the treatment of septic shock: A systematic review and meta-analysis.

Background: Septic shock is common and results in significant morbidity and mortality. Adjunctive treatment with corticosteroids is common, but definitive data are lacking. We aimed to determine the efficacy and safety of corticosteroid therapy among patients with septic shock.

Effect of modification of the physicochemical properties of ICAM-1-derived peptides on internalization and intracellular distribution in the human leukemic cell line HL-60.

The objective of this work is to test the hypothesis that increasing the hydrophilicity of DOX-peptide conjugates may modify their entry mechanisms into HL-60 cells from passive diffusion to receptor-mediated uptake. To test this hypothesis, the entry mechanisms and the intracellular disposition of DOX-cIBR7, DOX-PEGcIBR7, FITC-cIBR, and FITC-cIBR7 were evaluated in HL-60 cells. To increase the hydrophilicity of the peptide, the cIBR peptide (cyclo(1,12)Pen-PRGGSVLVTGC) was modified to cIBR7 peptide (cyclo(1,8)CPRGGSVC) by removing the hydrophobic residues at the C-terminus.

Risk of heart failure in patients with recent-onset type 2 diabetes: population-based cohort study.

Background: Although thiazolidinediones precipitate fluid retention in clinical trials, current guidelines advocate their use for patients with diabetes who are felt to be at low risk for heart failure (HF).

Methods And Results: An inception cohort study was conducted using Saskatchewan Health databases spanning the years 1991 to 1999 (before use of thiazolidinediones) to compare incidence rates of new HF in patients with recent-onset diabetes vs. the general population.

Preoperative statin use and infection after cardiac surgery: a cohort study.

Background: It has been suggested that the routine use of statins preoperatively would reduce the risk of postoperative infection. We conducted this study to explore whether preoperative statin use was associated with infection after cardiac surgery (recipients of which have a higher-than-average risk of postoperative infection).

Methods: We performed secondary analysis of data collected in a prospective cohort study of adults who underwent nontransplant cardiac surgery in a university hospital during the period January 1999 through December 2005.

Metformin treatment in diabetes and heart failure: when academic equipoise meets clinical reality.

Objective: Metformin has had a 'black box' contraindication in diabetic patients with heart failure (HF), but many believe it to be the treatment of choice in this setting. Therefore, we attempted to conduct a pilot study to evaluate the feasibility of undertaking a large randomized controlled trial with clinical endpoints.

Study Design: The pilot study was a randomized double blinded placebo controlled trial.

Maintenance of improved lipid levels following attendance at a cardiovascular risk reduction clinic: a 10-year experience.

Background: Specialty cardiovascular risk reduction clinics (CRRC) increase the proportion of patients attaining recommended lipid targets; however, it is not known if the benefits are sustained after discharge. We evaluated the impact of a CRRC on lipid levels and assessed the long-term effect of a CRRC in maintaining improved lipid levels following discharge.

Methods: The medical records of consecutive dyslipidemic patients discharged > 6 months from a tertiary hospital CRRC from January 1991 to January 2001 were retrospectively reviewed.

Facilitated bone mineral density testing versus hospital-based case management to improve osteoporosis treatment for hip fracture patients: additional results from a randomized trial.

Objective: We previously demonstrated that a case manager intervention improved osteoporosis (OP) treatment within 6 months of hip fracture compared with usual care. The second phase of the randomized trial compared a less intensive intervention, facilitated bone mineral density (BMD) testing, with usual care and the case manager intervention.

Methods: We initially randomized 220 hip fracture patients to either an OP case manager intervention or usual care.

Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial.

Background: In a randomized trial of patients with hip fractures, we previously demonstrated that a hospital-based case manager could increase rates of appropriate osteoporosis treatment to 51% compared with 22% for usual care (P < .001). Alongside that trial, we conducted an economic analysis.

Admission hyperglycemia predicts a worse outcome in stroke patients treated with intravenous thrombolysis.

Objective: Admission hyperglycemia has been associated with worse outcomes in ischemic stroke. We hypothesized that hyperglycemia (glucose >8.0 mmol/l) in the hyperacute phase would be independently associated with increased mortality, symptomatic intracerebral hemorrhage (SICH), and poor functional status at 90 days in stroke patients treated with intravenous tissue plasminogen activator (IV-tPA).

Post-thrombotic syndrome after total hip arthroplasty is uncommon.

Background: Deep vein thrombosis (DVT), usually asymptomatic, is common after total hip arthroplasty (THA). Post-thrombotic syndrome (PTS) is a potential late complication of DVT, but there is limited data on its occurrence.

Patients And Methods: This was a prospective cohort study of subjects at one hospital who had participated in a trial of thromboprophylaxis for THA and who had postoperative venography.

Long-term morbidity and mortality after hospitalization with community-acquired pneumonia: a population-based cohort study.

Little is known about the long-term sequelae of community-acquired pneumonia (CAP). Therefore, we describe the long-term morbidity and mortality of patients after pneumonia requiring hospitalization. We specifically hypothesized that the Pneumonia Severity Index (PSI), designed to predict 30-day pneumonia-related mortality, would also be associated with longer-term all-cause mortality.