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A study was conducted to evaluate the increased risk of adverse events in men having undergone cataract surgery on having being recommended Tamsulosin or other drugs to treat benign prostatic hyperplasia (BPH). Results indicated that use of Tamsulosin within 14 days of cataract surgery led to many adverse ophthalmic events.

Importance: Although wait times for hip fracture surgery have been linked to mortality and are being used as quality-of-care indicators worldwide, controversy exists about the duration of the wait that leads to complications.Objective: To use population-based wait-time data to identify the optimal time window in which to conduct hip fracture surgery before the risk of complications increases.Design, Setting, and Participants: Population-based, retrospective cohort study of adults undergoing hip fracture surgery between April 1, 2009, and March 31, 2014, at 72 hospitals in Ontario, Canada. Risk-adjusted restricted cubic splines modeled the probability of each complication according to wait time. The inflection point (in hours) when complications began to increase was used to define early and delayed surgery. To evaluate the robustness of this definition, outcomes among propensity-score matched early and delayed surgical patients were compared using percent absolute risk differences (RDs, with 95% CIs).Exposure: Time elapsed from hospital arrival to surgery (in hours).Main Outcomes and Measures: Mortality within 30 days. Secondary outcomes included a composite of mortality or other medical complications (myocardial infarction, deep vein thrombosis, pulmonary embolism, and pneumonia).Results: Among 42 230 patients with hip fracture (mean [SD] age, 80.1 years [10.7], 70.5% women) who met study entry criteria, overall mortality at 30 days was 7.0%. The risk of complications increased when wait times were greater than 24 hours, irrespective of the complication considered. Compared with 13 731 propensity-score matched patients who received surgery earlier, 13 731 patients who received surgery after 24 hours had a significantly higher risk of 30-day mortality (898 [6.5%] vs 790 [5.8%]; % absolute RD, 0.79; 95% CI, 0.23-1.35) and the composite outcome (1680 [12.2%]) vs 1383 [10.1%]; % absolute RD, 2.16; 95% CI, 1.43-2.89).Conclusions and Relevance: Among adults undergoing hip fracture surgery, increased wait time was associated with a greater risk of 30-day mortality and other complications. A wait time of 24 hours may represent a threshold defining higher risk. [ABSTRACT FROM AUTHOR]

Background: A recent post hoc analysis of a large randomized trial in patients with cerebrovascular disease suggested that statins may increase the risk of intracerebral hemorrhage (ICH). Objective: To examine the association between statins and ICH in patients with recent ischemic stroke in a population-based setting. Design: Retrospective propensity-matched cohort study with accrual from July 1, 1994, to March 31, 2008. Setting: Ontario, Canada. Participants: A total of 17 872 patients aged 66 years and older who initiated statin therapy following acute ischemic stroke and were followed for a median of 4.2 years (interquartile range, 2.4-5.0 years). To enhance causal inference, we conducted several tests of specificity to exclude healthy user bias in this sample. Main Outcome Measure: Hospitalization or emergency department visit for ICH defined using validated diagnosis coding. Results: Overall, 213 episodes of ICH occurred. In the primary analysis comparing statin users with nonusers, we found no association between statins and ICH (hazard ratio=0.87; 95% confidence interval, 0.65-1.17). Subgroup and dose-response analyses yielded similar results. In tests of specificity, statin therapy was not associated with bone mineral density testing, vitamin D or B12 screening, gastrointestinal endoscopy, or elective knee arthroplasty, suggesting that results were not due to healthy user bias or differences in quality of care. Conclusion: Statin exposure following ischemic stroke was not associated with ICH. [ABSTRACT FROM AUTHOR]

The article discusses a study about the relationship between opioid dose and opioid-related mortality in patients with non-malignant pain in Ontario. The study involved patients ranging in age from 15 to 64 who were eligible for publicly funded prescription drug coverage and had received an opioid from August 1, 1997 to December 31, 2006. Results showed that the risk of opioid-related death was highest in patients who were treated with 200 milligrams or more of morphine daily.

A research letter to the editor focusing on generic warfarin substitution is presented.

The article looks at the role of warfarin therapy in enabling persistence of atrial fibrillation patients. The study was done on senior residents in Ontario aged 66 and older who were provided the warfarin treatment from April 1, 1997 and March 31, 2008, where the therapy was evaluated through Kaplan-Meier curves. Results showed that persistence with the therapy was lower than their younger counterparts.

Importance: Opioid prescribing and overdose are leading public health problems in North America, yet the precise public health burden has not been quantified., Objective: To examine the burden of opioid-related mortality across the United States over time., Design, Setting, and Participants: This study used a serial cross-sectional design in which cross sections were examined at different time points to investigate deaths from opioid-related causes in the United States between January 1, 2001, and December 31, 2016., Main Outcomes and Measures: Opioid-related deaths, defined as those in which a prescription or illicit opioid contributed substantially to an individual's cause of death as determined by death certificates. We compared the percentage of deaths attributable to opioids and the associated person-years of life lost by age group., Results: Between 2001 and 2016, the number of opioid-related deaths in the United States increased by 345%, from 9489 to 42 245 deaths (33.3 to 130.7 deaths per million population). By 2016, men accounted for 67.5% of all opioid-related deaths, and the median (interquartile range) age at death was 40 (30-52) years. The percentage of deaths attributable to opioids increased in a similar fashion. In 2001, 0.4% of deaths (1 in 255) were opioid related, rising to 1.5% of deaths (1 in 65) by 2016, an increase of 292%. This burden was highest among adults aged 24 to 35 years. In this age group, 20.0% of deaths were attributable to opioids in 2016. Among those aged 15 to 24 years, 12.4% of deaths were attributable to opioids in 2016. Overall, opioid-related deaths resulted in 1 681 359 years of life lost (5.2 per 1000 population) in the United States in 2016, most of which (1 125 711 years of life lost) were among men. Adults aged 25 to 34 years had 12.9 years of life lost per 1000 population, and those aged 35 to 44 years had 9.9 years of life lost per 1000 population., Conclusions and Relevance: Premature death from opioid-related causes imposes an enormous public health burden across the United States. The recent increase in deaths attributable to opioids among those aged 15 to 34 years highlights a need for targeted programs and policies that focus on improved addiction care and harm reduction measures in this high-risk population.