Cost Effectiveness of Case Detection Strategies for the Early Detection of COPD.

Objectives: The value of early detection and treatment of chronic obstructive pulmonary disease (COPD) is currently unknown. We assessed the cost effectiveness of primary care-based case detection strategies for COPD.

Methods: A previously validated discrete event simulation model of the general population of COPD patients in Canada was used to assess the cost effectiveness of 16 case detection strategies.

Development and Validation of the Evaluation Platform in COPD (EPIC): A Population-Based Outcomes Model of COPD for Canada.

Background: We report the development, validation, and implementation of an open-source population-based outcomes model of chronic obstructive pulmonary disease (COPD) for Canada.

Methods: Evaluation Platform in COPD (EPIC) is a discrete-event simulation model of Canadians 40 years of age or older. Three core features of EPIC are its open-population design (incorporating projections of future population growth, aging, and smoking trends), its incorporation of heterogeneity in lung function decline and burden of exacerbations, and its modeling of the natural history of COPD from inception.

Heterogeneity in the respiratory symptoms of patients with mild-to-moderate COPD.

Background: The burden of symptoms varies markedly between patients with COPD and is only weakly correlated with lung function impairment. While heterogeneity in lung function decline and exacerbations have been previously studied, the extent of heterogeneity in symptoms and the factors associated with this heterogeneity are not well understood.

Methods: A sample of the general Canadian population ≥40 years with persistent airflow limitation was followed for up to 3 years.

Long-term effects of inhaled corticosteroids on bone mineral density in older women with asthma or COPD: a registry-based cohort study.

Unlabelled: We assessed the association between long-term inhaled corticosteroid (ICS) use and bone mineral density (BMD) in older women with chronic respiratory disease. Women with > 50% adherence to ICS use had very slightly accelerated BMD loss at the total hip compared with those with lower or ICS use.

Introduction: This study evaluated the impact of long-term ICS therapy on bone loss in older women with asthma or chronic obstructive pulmonary disease (COPD).

Relative impact characteristic curve: a graphical tool to visualize and quantify the clinical utility and population-level consequences of implementing markers.

Purpose: Receiver operating characteristic (ROC) curve analysis is a popular method for evaluating the performance of (bio)markers. However, the standard ROC curve does not directly connect marker performance to patient-related outcomes. Our aim was to fill this gap by proposing a conceptually similar graphical tool that carries information about the clinical uitility of markers.

The diagnostic performance of patient symptoms in screening for COPD.

It is recommended that screening for COPD be restricted to symptomatic individuals, but supporting evidence is lacking. We determined the performance of wheeze, cough, phlegm, and dyspnea in discriminating COPD versus non-COPD in a population-based sample of 1332 adults. Area Under the Receiver Operating Curves (AUC) indicated that symptoms had modest performance whether assessed individually (AUCs 0.

Characterizing undiagnosed chronic obstructive pulmonary disease: a systematic review and meta-analysis.

Background: A significant proportion of patients with chronic obstructive pulmonary disease (COPD) remain undiagnosed. Characterizing these patients can increase our understanding of the 'hidden' burden of COPD and the effectiveness of case detection interventions.

Methods: We conducted a systematic review and meta-analysis to compare patient and disease factors between patients with undiagnosed persistent airflow limitation and those with diagnosed COPD.

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates.

Background: COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing.

Aim: The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD.

A Systematic Review of Health Economics Simulation Models of Chronic Obstructive Pulmonary Disease.

Background: Many decision-analytic models with varying structures have been developed to inform resource allocation in chronic obstructive pulmonary disease (COPD).

Objectives: To review COPD models for their adherence to the best practice modeling recommendations and their assumptions regarding important aspects of the natural history of COPD.

Methods: A systematic search of English articles reporting on the development or application of a decision-analytic model in COPD was performed in MEDLINE, Embase, and citations within reviewed articles.

Asthma control and productivity loss in those with work-related asthma: A population-based study.

Objective: In Canada, asthma is the third leading cause of work loss, yet little is known about the associated productivity loss. The goal of this study was to look at the relationship between asthma control and productivity loss, particularly contrasting those with work-related asthma (WRA) and non-work-related asthma (NWRA).

Methods: A population-based random sample of adults with asthma in British Columbia, Canada, was prospectively recruited.

The Canadian Registry for Pulmonary Fibrosis: Design and Rationale of a National Pulmonary Fibrosis Registry.

Background. The relative rarity and diversity of fibrotic interstitial lung disease (ILD) have made it challenging to study these diseases in single-centre cohorts. Here we describe formation of a multicentre Canadian registry that is needed to describe the outcomes of fibrotic ILD and to enable detailed healthcare utilization analyses that will be the cornerstone for future healthcare planning.

Identifying flares in rheumatoid arthritis: reliability and construct validation of the OMERACT RA Flare Core Domain Set.

Objective: To evaluate the reliability of concurrent flare identification using 3 methods (patient, rheumatologist and Disease Activity Score (DAS)28 criteria), and construct validity of candidate items representing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Core Domain Set.

Methods: Candidate flare questions and legacy measures were administered at consecutive visits to Canadian Early Arthritis Cohort (CATCH) patients between November 2011 and November 2014. The American College of Rheumatology (ACR) core set indicators were recorded.

Cost-Effectiveness of Bronchial Thermoplasty, Omalizumab, and Standard Therapy for Moderate-to-Severe Allergic Asthma.

Background: Bronchial thermoplasty (BT) is a recently developed treatment for patients with moderate-to-severe asthma. A few studies have suggested the clinical efficacy of this intervention. However, no study has evaluated the cost-effectiveness of BT compared to other alternative treatments for moderate-to-severe allergic asthma, which currently include omalizumab and standard therapy.

Asthma and COPD Overlap Syndrome (ACOS): A Systematic Review and Meta Analysis.

Background: The combination of asthma and chronic obstructive pulmonary disease (COPD), or ACOS is a recently defined syndrome. The epidemiology of the condition is poorly described and previous research has suggested ACOS is associated with worse outcomes than either condition alone. We therefore decided to complete a systematic review of the published literature.

Home-based screening for biliary atresia using infant stool colour cards: a large-scale prospective cohort study and cost-effectiveness analysis.

Objective: Biliary atresia (BA), a leading cause of paediatric liver failure and liver transplantation, manifests by three weeks of life as jaundice with acholic stools. Poor outcomes due to delayed diagnosis remain a problem worldwide. We evaluated and assessed the cost-effectiveness of methods of introducing a BA Infant Stool Colour Card (ISCC) screening programme in Canada.

Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: a simulation study.

Background: Adherence to evidence-based controller treatments for asthma is disappointingly low in many jurisdictions. Quantifying the burden associated with suboptimal adherence in patients with uncontrolled asthma will help establish the priorities for policymakers.

Objective: We sought to quantify the benefits in the United States of improving adherence to controller therapies in adults with uncontrolled asthma in terms of health care costs and quality-adjusted life years (QALYs).

Costs and health outcomes associated with primary vs secondary care after an asthma-related hospitalization: a population-based study.

Background: Patients with a history of asthma-related hospitalizations are at high risk of readmission and generally consume a large amount of health-care resources. It is not clear if the secondary care provided by specialists after an episode of asthma-related hospitalization is associated with better outcomes compared with the primary care provided by general practitioners.

Methods: Using population-based administrative health data from the province of British Columbia, Canada, we created a propensity-score-matched cohort of individuals who received primary vs secondary care in the 60 days after discharge from asthma-related hospitalization.

Detection of activated Rab7 GTPase with an immobilized RILP probe.

The dynamic and coordinated exchange of multiple GTPases between the cytosol and the phagosome membrane represents a critical process during phagosome biogenesis. In particular, acquisition of Rab7 is crucial for progression to the stage where formation of phagolysosomes is observed. Optimal Rab7 effector function requires its conversion to the GTP-bound form where it becomes activated.

Heteroscedastic regression analysis of factors affecting BMD monitoring.

Identifying factors affecting BMD precision and interindividual heterogeneity in BMD change can help optimize BMD monitoring. BMD change for the lumbar spine and total hip for short-term reproducibility (n = 328) and long-term clinical monitoring (n = 2720) populations were analyzed with heteroscedastic regression using linear prediction for mean (monitoring population only) and log-linear prediction for SD (both populations). For clinical monitoring, male sex, baseline body mass index (BMI), and systemic corticosteroid use were associated with greater SD of BMD change.

Optimal decision criterion for detecting change in bone mineral density during serial monitoring: a Bayesian approach.

Unlabelled: Interpretation of change in serial bone densitometry using least significant change (LSC) may not lead to optimal decision making. Using the principles of Bayesian statistics and decision sciences, we developed the Optimal Decision Criterion (ODC) which resulted in 11-12.5% higher rate of correct classification compared with the LSC method.

Leishmania: conserved evolution--diverse diseases.

The landmark completion of the Leishmania major genome sequence and the recent publication of the L. infantum and L. braziliensis genomes revealed the surprising result that, although separated by 15-50 million years of evolution, the Leishmania genomes are highly conserved and have less than 1% species-specific genes.

The value of Bayes theorem in the interpretation of subjective diagnostic findings: what can we learn from agreement studies?

The Bayes theorem is advocated as the appropriate measure for the weight of evidence in medical decision making. It is based on the calculation of posttest probability as a function of the accuracy of the test and pretest probability. Nevertheless, for subjective diagnostic findings, there might be substantial variability in the accuracy among human observers, making the point estimate of posttest probability imprecise.