Ranking versus rating in peer review of research grant applications.

The allocation of public funds for research has been predominantly based on peer review where reviewers are asked to rate an application on some form of ordinal scale from poor to excellent. Poor reliability and bias of peer review rating has led funding agencies to experiment with different approaches to assess applications. In this study, we compared the reliability and potential sources of bias associated with application rating with those of application ranking in 3,156 applications to the Canadian Institutes of Health Research.

Predictors of frequent emergency department visits among hospitalized cancer patients: a comparative cohort study using integrated clinical and administrative data to improve care delivery.

Background: Frequent emergency department (FED) visits by cancer patients represent a significant burden to the health system. This study identified determinants of FED in recently hospitalized cancer patients, with a particular focus on opioid use.

Methods: A prospective cohort discharged from surgical/medical units of the McGill University Health Centre was assembled.

Developing electronic clinical quality measures to assess the cancer diagnostic process.

Objective: Measures of diagnostic performance in cancer are underdeveloped. Electronic clinical quality measures (eCQMs) to assess quality of cancer diagnosis could help quantify and improve diagnostic performance.

Materials And Methods: We developed 2 eCQMs to assess diagnostic evaluation of red-flag clinical findings for colorectal (CRC; based on abnormal stool-based cancer screening tests or labs suggestive of iron deficiency anemia) and lung (abnormal chest imaging) cancer.

Determinants of long-term opioid use in hospitalized patients.

Background: Long-term opioid use is an increasingly important problem related to the ongoing opioid epidemic. The purpose of this study was to identify patient, hospitalization and system-level determinants of long term opioid therapy (LTOT) among patients recently discharged from hospital.

Design: To be eligible for this study, patient needed to have filled at least one opioid prescription three-months post-discharge.

Global Variations in Event-Based Surveillance for Disease Outbreak Detection: Time Series Analysis.

Background: Robust and flexible infectious disease surveillance is crucial for public health. Event-based surveillance (EBS) was developed to allow timely detection of infectious disease outbreaks by using mostly web-based data. Despite its widespread use, EBS has not been evaluated systematically on a global scale in terms of outbreak detection performance.

Reducing the burden of low back pain: results from a new microsimulation model.

Background: Low back pain (LBP) causes the highest morbidity burden globally. The purpose of the present study was to project and compare the impact of three strategies for reducing the population health burden of LBP: weight loss, ergonomic interventions, and an exercise program.

Methods: We have developed a microsimulation model of LBP in Canada using a new modeling platform called SimYouLate.

Evaluation of Telehealth Service for COVID-19 Outpatients: A Dashboard to Measure Healthcare Quality and Safety.

Due to the COVID-19 pandemic, changes and improvements regarding the organization have been made to adapt quickly at the Emergency Department (ED) of the Hospital Italiano de Buenos Aires, Argentina. This article describes the design, implementation, and use of an electronic dashboard which provided monitoring of patients discharged home, during follow-up with telehealth. It was useful to access essential information to organize and coordinate professional work and patients' surveillance, providing highly relevant data in real-time as proxy variables for quality and safety during home isolation.

In-Hospital Mortality and Glycemic Control in Patients with Hospital Hyperglycemia.

Stress-induced hyperglycemia is a phenomenon that occurs typically in patients hospitalized for acute disease and resolves spontaneously after regression of the acute illness. However, it can also occur in diabetes patients, a fact that is sometimes overlooked. It is thus important to make a proper diabetes diagnosis if hospitalized patients with episodes of hyperglycemia with and without diabetes are studied.

Association of clinical competence, specialty and physician country of origin with opioid prescribing for chronic pain: a cohort study.

Background: Although little is known about why opioid prescribing practices differ between physicians, clinical competence, specialty training and country of origin may play a role. We hypothesised that physicians with stronger clinical competence and communication skills are less likely to prescribe opioids and prescribe lower doses, as do medical specialists and physicians from Asia.

Methods: Opioid prescribing practices were examined among international medical graduates (IMGs) licensed to practise in the USA who evaluated Medicare patients for chronic pain problems in 2014-2015.

Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.

Background: The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower rates of opioid-related mortality, possibly because of differences in prescribing and health system policies. Our aim was to compare opioid prescribing rates in patients without cancer, across 5 centers in 4 countries.

Evaluating Montréal's harm reduction interventions for people who inject drugs: protocol for observational study and cost-effectiveness analysis.

Introduction: The main harm reduction interventions for people who inject drugs (PWID) are supervised injection facilities, needle and syringe programmes and opioid agonist treatment. Current evidence supporting their implementation and operation underestimates their usefulness by excluding skin, soft tissue and vascular infections (SSTVIs) and anoxic/toxicity-related brain injury from cost-effectiveness analyses (CEA). Our goal is to conduct a comprehensive CEA of harm reduction interventions in a setting with a large, dispersed, heterogeneous population of PWID, and include prevention of SSTVIs and anoxic/toxicity-related brain injury as measures of benefit in addition to HIV, hepatitis C and overdose morbidity and mortalities averted.

Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge.

Objective: The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM's potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events.

Materials And Methods: We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care).

Smart about medications (SAM): a digital solution to enhance medication management following hospital discharge.

Objective: To outline the development of a software solution to improve medication management after hospital discharge, including its design, data sources, intrinsic features, and to evaluate the usability and the perception of use by end-users.

Materials And Methods: Patients were directly involved in the development using a User Center Design (UCD) approach. We conducted usability interviews prior to hospital discharge, before a user started using the application.

Association of Opioid Consumption Profiles After Hospitalization With Risk of Adverse Health Care Events.

Importance: Although better pain management has guided policies for opioid use over the past few decades, evidence is limited regarding how patterns of use are associated with the risk of potentially avoidable opioid-related adverse events.

Objective: To estimate the risk of harms associated with opioid dose and duration of use, and to ascertain whether the risk is modified by treatment indication and age.

Design, Setting, And Participants: This ad hoc cohort study followed up patients who were enrolled in a cluster randomized trial of medication reconciliation between October 1, 2014, and November 30, 2016, 12 months after they were discharged from the McGill University Health Centre in Montreal, Quebec, Canada.

Postoperative duration of opioid use and acute healthcare services use in cancer patients hospitalized for thoracic surgery.

Background: Postoperative pain control is an important cancer care component. However, opioid consumption has resulted in a surge of adverse events, with thoracic surgery patients having the highest rate of persistent use. The effect of opioid duration post-discharge and the risk of increased acute healthcare use in this population remains unclear.

Detection of adverse drug events in e-prescribing and administrative health data: a validation study.

Background: Administrative health data are increasingly used to detect adverse drug events (ADEs). However, the few studies evaluating diagnostic codes for ADE detection demonstrated low sensitivity, likely due to narrow code sets, physician under-recognition of ADEs, and underreporting in administrative data. The objective of this study was to determine if combining an expanded ICD code set in administrative data with e-prescribing data improves ADE detection.

Concurrent prescriptions for opioids and benzodiazepines and risk of opioid overdose: protocol for a retrospective cohort study using linked administrative data.

Introduction: Opioid overdoses have increased substantially over the last 20 years, with over 400 000 deaths in North America. While opioid prescribing has been a target of research, benzodiazepine and opioid co-intoxication has emerged as a potential risk factor. Our aim was to assess the risk of opioid overdose associated with concurrent use of opioids and benzodiazepines relative to opioids alone.

Incidence and Variables Associated With Inconsistencies in Opioid Prescribing at Hospital Discharge and Its Associated Adverse Drug Outcomes.

Objectives: Opioid-related medication errors (MEs) can have a significant impact on patient health and contribute to opioid misuse. The objective of this study was to estimate the incidence of and variables associated with the receipt of an opioid prescription and opioid-related MEs (omissions, duplications, or dose changes) at hospital discharge. We also determined rates of adverse drug events and risks of emergency department visits, readmissions, or death 30 days and 90 days post discharge associated with MEs.

Emergency department visits and hospital readmissions in an Argentine health system.

Background And Goal Of Study: The scope of health in the Sustainable Development Goals is much broader than the Millennium Development Goals, spanning functions such as health-system access and quality of care. Hospital readmission rate and ED-visits within 30 days from discharge are considered low-cost quality indicators. This work assesses an indicator of quality of care in a tertiary referral hospital in Argentina, using data available from clinical records.

Democracy and Mobility: A preliminary analysis of global adherence to non-pharmaceutical interventions for COVID-19.

In the absence of vaccines or therapeutics, and with cases of COVID-19 continuing to grow each day, most countries are relying on non-pharmaceutical interventions (NPIs) to reduce the spread of SARS-CoV-2. The goal of NPIs - decreasing mobility in order to decrease contact - comes with competing socioeconomic costs and incentives that are not well-understood. Using Google's Community Mobility data, we visualized changes in mobility and explored the effect of economic, social, and governmental factors on mobility via regression.

Failure to follow medication changes made at hospital discharge is associated with adverse events in 30 days.

Objective: To evaluate the hypothesis that nonadherence to medication changes made at hospital discharge is associated with an increased risk of adverse events in the 30 days postdischarge.

Study Setting: Patients admitted to hospitals in Montreal, Quebec, between 2014 and 2016.

Study Design: Prospective cohort study.

Both New and Chronic Potentially Inappropriate Medications Continued at Hospital Discharge Are Associated With Increased Risk of Adverse Events.

Background: Admission to hospital provides the opportunity to review patient medications; however, the extent to which the safety of drug regimens changes after hospitalization is unclear.

Objective: To estimate the number of potentially inappropriate medications (PIMs) prescribed to patients at hospital discharge and their association with the risk of adverse events 30 days after discharge.

Design: Prospective cohort study.

Multinational Investigation of Fracture Risk with Antidepressant Use by Class, Drug, and Indication.

Objectives: Antidepressants increase the risk of falls and fracture in older adults. However, risk estimates vary considerably even in comparable populations, limiting the usefulness of current evidence for clinical decision making. Our aim was to apply a common protocol to cohorts of older antidepressant users in multiple jurisdictions to estimate fracture risk associated with different antidepressant classes, drugs, doses, and potential treatment indications.