Identifying Obstructive Sleep Apnea in Administrative Data: A Study of Diagnostic Accuracy.

Background: Health administrative (HA) databases are increasingly used to identify surgical patients with obstructive sleep apnea (OSA) for research purposes, primarily using diagnostic codes. Such means to identify patients with OSA are not validated. The authors determined the accuracy of case-ascertainment algorithms for identifying patients with OSA with the use of HA data.

Penile amputation and successful reattachment and the role of winter shunt in postoperative viability: A case report and literature review.

Traumatic self-amputation of the penis by a psychotic patient is rare. Microvascular replantation is the favored management approach. There are no known cases of self-amputation followed by ingestion of the stump and subsequent replantation.

Critical appraisal of clinical practice guidelines in pediatric infectious diseases.

Background: There is a need to critically appraise clinical practice guidelines in order to ensure safe and effective practices are being implemented to optimize patient care. Appraising guidelines within one therapeutic area enable recommendations for improvement during guideline creation and dissemination.

Objectives: Study objectives were to systematically appraise selected published guidelines used in the treatment of pediatric infectious diseases and to make recommendations for improvement throughout the development and dissemination processes.

Critical care capacity in Canada: results of a national cross-sectional study.

Introduction: Intensive Care Units (ICUs) provide life-supporting treatment; however, resources are limited, so demand may exceed supply in the event of pandemics, environmental disasters, or in the context of an aging population. We hypothesized that comprehensive national data on ICU resources would permit a better understanding of regional differences in system capacity.

Methods: After the 2009-2010 Influenza A (H1N1) pandemic, the Canadian Critical Care Trials Group surveyed all acute care hospitals in Canada to assess ICU capacity.

Brachytherapy improves biochemical failure-free survival in low- and intermediate-risk prostate cancer compared with conventionally fractionated external beam radiation therapy: a propensity score matched analysis.

Purpose: To compare, in a retrospective study, biochemical failure-free survival (bFFS) and overall survival (OS) in low-risk and intermediate-risk prostate cancer patients who received brachytherapy (BT) (either low-dose-rate brachytherapy [LDR-BT] or high-dose-rate brachytherapy with external beam radiation therapy [HDR-BT+EBRT]) versus external beam radiation therapy (EBRT) alone.

Methods And Materials: Patient data were obtained from the ProCaRS database, which contains 7974 prostate cancer patients treated with primary radiation therapy at four Canadian cancer institutions from 1994 to 2010. Propensity score matching was used to obtain the following 3 matched cohorts with balanced baseline prognostic factors: (1) low-risk LDR-BT versus EBRT; (2) intermediate-risk LDR-BT versus EBRT; and (3) intermediate-risk HDR-BT+EBRT versus EBRT.

A randomized comparison between ultrasound- and fluoroscopy-guided c7 medial branch block.

Background: Because of its location in the lower neck and anatomical variability, the C7 medial branch represents a challenging target for local anesthetic blocks. Although ultrasound (US) guidance offers an alternative to fluoroscopy for C3 to C6 cervical medial branch blocks (CMBBs), its use at the C7 level has not been examined. We hypothesized that US, using a biplanar imaging technique, could provide a shorter performance time than conventional fluoroscopy for C7 CMBB.

Critical appraisal of the SHARP trial: the results may be dull.

Purpose: The goal of this commentary was to provide a critical analysis of the SHARP (Study of Heart and Renal Protection) trial. Published in 2011, this study has been used by clinicians to justify the prescribing of statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) ±ezetimibe in patients with chronic kidney disease.

Methods: We conducted a critical appraisal of the SHARP trial and associated documents (ie, US Food and Drug Administration review, SHARP protocol).

Susceptibility of clinical Moraxella catarrhalis isolates in British Columbia to six empirically prescribed antibiotic agents.

Background: Moraxella catarrhalis is a commensal organism of the respiratory tract that has emerged as an important pathogen for a variety of upper and lower respiratory tract infections including otitis media and acute exacerbations of chronic bronchitis. Susceptibility testing of M catarrhalis is not routinely performed in most diagnostic laboratories; rather, a comment predicting susceptibility based on the literature is attached to the report. The most recent Canadian report on M catarrhalis antimicrobial susceptibility was published in 2003; therefore, a new study at this time was of interest and importance.

Haemorrhagic complications of peripartum anticoagulation: A retrospective chart review.

Background: Women with venous thromboembolism (VTE), thrombophilias or mechanical heart valves may require anticoagulation during pregnancy and postpartum. The incidence of postpartum hemorrhage (PPH) in the literature is 2.9-6%, but the rate while on anticoagulation is not well documented.

Corticosteroids in the treatment of severe community-acquired pneumonia.

Controversy surrounds the use of adjunctive corticosteroids in severe community acquired pneumonia (CAP) as current guidelines either do not address or discourage their use. Double-blind, placebo-controlled, randomized controlled trials examining systemic corticosteroids in the treatment of severe CAP were summarized and their impacts on patient-important outcomes assessed. Four trials describing systemic corticosteroid use in adults with severe CAP were identified.

A prospective validation of biplanar ultrasound imaging for C5-C6 cervical medial branch blocks.

Background: Ultrasound (US) guidance offers an alternative to fluoroscopy for medial branch blocks of the upper cervical spine, but it may be less accurate for blocks at the C5 and C6 levels. We hypothesized that a modified technique using biplanar US imaging would facilitate level identification and provide greater accuracy for the lower cervical spine.

Methods: Forty patients with chronic neck pain underwent US-guided blocks of the C5 and C6 medial branches.

The prostate cancer risk stratification project: database construction and risk stratification outcome analysis.

This investigation reports on the biochemical and clinical outcomes of a newly created pan-Canadian Prostate Cancer Risk Stratification (ProCaRS) database developed by the Genitourinary Radiation Oncologists of Canada (GUROC). GUROC ProCaRS template-compliant data on 7974 patients who underwent radiotherapy were received from 7 unique databases. Descriptive analysis, Cox proportional hazards, and Kaplan-Meier analyses were performed using American Society for Radiation Oncology (ASTRO) biochemical failure-free survival (BFFS), prostate cancer-specific survival, and overall survival.

Determination of susceptibility to fosfomycin and tigecycline of Enterobacteriaceae, particularly Escherichia coli isolates, producing extended-spectrum β-lactamases from multiple regional Canadian hospitals.

Background: The worldwide spread of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, particularly Escherichia coli, has significantly limited therapeutic options, especially for urinary tract infections. Although limited in their indications, fosfomycin and tigecycline are potential agents to treat infections due to ESBL-producing organisms. Although not routinely performed, susceptibility testing to both is necessary to ensure there is not an increase in resistance.

Compatibility and stability of morphine sulphate and naloxone hydrochloride in 0.9% sodium chloride for injection.

Background: Naloxone may be administered in conjunction with morphine to reduce the risk of opioid-induced pruritis. Combining these drugs for coadministration may be beneficial, but little is known about their physical compatibility and stability in combined solutions.

Objective: To describe the physical compatibility and stability of morphine sulphate and naloxone hydrochloride (at various concentrations) in IV admixtures.

Exploring patient perceptions of PSA screening for prostate cancer: risks, effectiveness, and importance.

Objective: To study the beliefs of a group of Canadian men regarding the risks, effectiveness, and importance of routine prostate-specific antigen (PSA) testing when used as a screening tool for prostate cancer.

Design: A 1-page questionnaire designed to gauge patient beliefs about PSA screening.

Setting: Two primary care clinics in Kingston, Ont.

Revisiting the "10% rule" in breast cancer sentinel lymph node biopsy: an approach to minimize the number of sentinel lymph nodes removed.

Background: Sentinel lymph node (SLN) biopsy (SLNB) is an accurate and proven axillary staging procedure for early breast cancer. The aim of this study was to determine if the "10% rule" is applicable to the performance of SLNB at the investigators' institution and if the criteria used for SLNB at their institution could be refined to minimize the number of SLNs removed.

Methods: Retrospective analysis was conducted of a prospectively collected breast cancer SLNB database.

Use of intravenous immune globulin in the ICU: a retrospective review of prescribing practices and patient outcomes.

Rationale: Intravenous immune globulin (IVIG) is a pooled human blood product. Much of IVIG use in Canada is prescribed for 'unlabelled' or 'off-label' indications. Due to costs, risk of use and limited supply, knowledge about the use of IVIG is important.