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54. Quality of Chronic Kidney Disease Management in Canadian Primary Care

Author

Bello, Aminu K, Ronksley, Paul E, Tangri, Navdeep, Kurzawa, Julia, Osman, Mohamed A, Singer, Alexander, Grill, Allan K, Nitsch, Dorothea, Queenan, John A, Wick, James, Lindeman, Cliff, Soos, Boglarka, Tuot, Delphine S, Shojai, Soroush, Brimble, K Scott, Mangin, Dee, and Drummond, Neil

Abstract

Importance: Although patients with chronic kidney disease (CKD) are routinely managed in primary care settings, no nationally representative study has assessed the quality of care received by these patients in Canada. Objective: To evaluate the current state of CKD management in Canadian primary care practices to identify care gaps to guide development and implementation of national quality improvement initiatives. Design, Setting, and Participants: This cross-sectional study leveraged Canadian Primary Care Sentinel Surveillance Network data from January 1, 2010, to December 31, 2015, to develop a cohort of 46 162 patients with CKD managed in primary care practices. Data analysis was performed from August 8, 2018, to July 31, 2019. Main Outcomes and Measures: The study examined the proportion of patients with CKD who met a set of 12 quality indicators in 6 domains: (1) detection and recognition of CKD, (2) testing and monitoring of kidney function, (3) use of recommended medications, (4) monitoring after initiation of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), (5) management of blood pressure, and (6) monitoring for glycemic control in those with diabetes and CKD. The study also analyzed associations of divergence from these quality indicators. Results: The cohort comprised 46 162 patients (mean [SD] age, 69.2 [14.0] years; 25 855 [56.0%] female) with stage 3 to 5 CKD. Only 4 of 12 quality indicators were met by 75% or more of the study cohort. These indicators were receipt of an outpatient serum creatinine test within 18 months after confirmation of CKD, receipt of blood pressure measurement at any time during follow-up, achieving a target blood pressure of 140/90 mm Hg or lower, and receiving a hemoglobin A1c test for monitoring diabetes during follow-up. Indicators in the domains of detection and recognition of CKD, testing and monitoring of kidney function (specifically, urine albumin to creatinine ratio testing), use of recommended medications, and appropriate monitoring after initiation of treatment with ACEIs or ARBs were not met. Only 6529 patients (18.4%) with CKD received a urine albumin test within 6 months of CKD diagnosis, and 3954 (39.4%) had a second measurement within 6 months of an abnormal baseline urine albumin level. Older age (≥85 years) and CKD stage 5 were significantly associated with not satisfying the criteria for the quality indicators across all domains. Across age categories, younger patients (aged 18-49 years) and older patients (≥75 years) were less likely to be tested for albuminuria (314 of 1689 patients aged 18-49 years [18.5%], 1983 of 11 919 patients aged 75-84 years [61.6%], and 614 of 5237 patients aged ≥85 years [11.7%] received the urine albumin to creatinine ratio test within 6 months of initial estimated glomerular filtration rate

Published
2019

56. Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study

Author

Bitto, Adenike, Gray, Ronald H., Simpson, Joe L., Queenan, John T., Kambic, Robert T., Perez, Alfredo, Mena, Patricio, Barbato, Michele, Li, Chuanjun, and Jennings, Victoria

Subjects
Natural family planning -- Health aspects, Pregnancy, Complications of -- Risk factors, Government, Health care industry
Abstract

Objectives. The purpose of this study was to determine prospectively whether unplanned pregnancies are associated with adverse pregnancy outcomes among users of natural family planning. Methods. Women who became pregnant while using natural family planning were identified in five centers worldwide: there were 373 unplanned and 367 planned pregnancies in this cohort. The subjects were followed up at 16 and 32 weeks' gestation and after delivery. The risks of spontaneous abortion, low birthweight, and preterm birth were estimated after adjustment by logistic regression. Results. The women with unplanned pregnancies were more likely to be at the extremes of age, to report more medical problems before and during the index pregnancy, and to seek antenatal care later in gestation than the women with planned pregnancies. However, women with planned pregnancies reported a higher rate of spontaneous abortion in previous pregnancies (28.8%) than did women with unplanned pregnancies (12.9%). There were no significant differences in the rates of spontaneous abortion, low birthweight, or preterm birth between the two groups. Conclusions. No increased risk of adverse pregnancy outcomes was observed among women who experienced an unplanned pregnancy while using natural family planning. (Am J Public Health. 1997;87:338-343)

Published
1997

60. WIC Program

Author

Gartner, Lawrence M., Black, Linda Sue, Lawrence, Ruth A., Naylor, Audrey J., O’Hare, Donna, Schanler, Richard J., Lenihan, Alice, Queenan, John, Krebs, Nancy, and Crase, Betty

Published
2001

61. Age and resting follicle number predict response to gonadotropin stimulation in in vitro fertilization cycles

Author

Addy, Douglas M., Whitman-Elia, Gail F., and Queenan, John T., Jr.

Subjects
Fertilization in vitro, Human -- Research, Health
Abstract

A woman's age and the number of resting ovarian follicles determine her response to fertility drugs during in vitro fertilization, according to a study of 90 women. The size of the ovaries and the amount of blood flowing to the ovaries have no relationship to the woman's response to fertility drugs.

Published
2002

63. Acute prolactin and oxytocin responses and milk yield to infant suckling and artificial methods of expression in lactating women

Author

Zinaman, Michael J., Hughes, Vergie, Queenan, John T., Labbok, Miriam H., and Albertson, Barry

Subjects
Breast feeding -- Physiological aspects, Lactation -- Physiological aspects
Abstract

Breast-feeding is today the major form of infant nutrition in the immediate postpartum period. Despite this, recent trends in modern life-styles have raised obstacles to successful lactation. These include infant illness and maternal responsibilities outside the home, both requiring separation from the mother. While the hormonal dynamics of infant suckling are understood, little is known about the effects of artificial methods of milk expression. A variety of breast pumps exist in the current US market which vary considerably in price and effectiveness. To understand better the ability of these pumps to assist women in the maintenance of lactation, the current study was undertaken to evaluate their effects on milk yield and prolactin and oxytocin release when compared to natural infant suckling. Twenty-three women who were exclusively breast-feeding their infants were randomly assigned to serially use several pumping methods, as well as infant suckling, with blood being taken at 10-minute intervals to determine the hormonal responses. The results reveal variability in the proclatin responses to the artificial pumping methods, with the greatest responses found with an electric pulsatile pump; these responses compare favorably with those of natural infant suckling. Other methods were less successful in causing prolactin elevations. No differences were seen among the methods in the oxytocin response. The results of this study demonstrate striking differences in the ability of breast-pumping methods to produce an acute and sustained prolactin rise in breast-feeding mothers. The large discrepancies found suggest the need for further studies to enable women and health care providers to choose the most appropriate method for milk expression. Pediatrics 1992; 89:437-440; breast-feeding, nutrition, milk expression, lactation.

Published
1992

65. Prevalence and Demographics of CKD in Canadian Primary Care Practices: A Cross-sectional Study

Author

Bello, Aminu K., primary, Ronksley, Paul E., additional, Tangri, Navdeep, additional, Kurzawa, Julia, additional, Osman, Mohamed A., additional, Singer, Alexander, additional, Grill, Allan, additional, Nitsch, Dorothea, additional, Queenan, John A., additional, Wick, James, additional, Lindeman, Cliff, additional, Soos, Boglarka, additional, Tuot, Delphine S., additional, Shojai, Soroush, additional, Brimble, Scott, additional, Mangin, Dee, additional, and Drummond, Neil, additional

Published
2019
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72. Slacker for a week

Author

Queenan, John

Subjects
Middle aged men -- Personal narratives, Post-baby boom generation -- Personal narratives, Fashion and beauty, General interest
Abstract

A fortysomething man talks about being twentysomething for a week. His activities include watching the film 'Reality Bites,' reading the magazine 'Details' and getting a new haircut and clothes.

Published
1995

73. Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning

Author

Gray, Ronald H., Simpson, Joe L., Kambic, Robert T., Queenan, John T., Mena, Patricio, Perez, Alfredo, and Barbato, Michele

Subjects
Natural family planning -- Health aspects, Miscarriage -- Risk factors, Health
Abstract

The use of natural family planning to time conception may not be associated with an increased risk of miscarriages in most women. However, women using natural family planning who have a history of miscarriage may miscarry when pregnancies are conceived at a suboptimal time in the menstrual cycle. Researchers studied 868 pregnancies where the parents used natural family planning to time intercourse leading to conception. Eighty percent of the women did not have a history of miscarriage, and the rate of miscarriage among these women was a low 10%. Women who had miscarried before experienced a 22.6% rate of miscarriage if they did not conceive at the optimal time in the menstrual cycle. Optimal timing of conception may lead to more successful pregnancies.

Published
1995

77. It's time to phase out "serologic weak D phenotype" and resolve D types with RHD genotyping including weak D type 4.

Author

Flegel, Willy A., Denomme, Gregory A., Queenan, John T., Johnson, Susan T., Keller, Margaret A., Westhoff, Connie M., Katz, Louis M., Delaney, Meghan, Vassallo, Ralph R., Simon, Clayton D., and Sandler, S. Gerald

Subjects
PHENOTYPES, BLOOD transfusion reaction, BLOOD groups, MOLECULAR genetics, RESEARCH, RESEARCH methodology, ALLELES, EVALUATION research, MEDICAL cooperation, COMPARATIVE studies, RH factor, GENOTYPES, RESEARCH funding, RHO(D) immune globulin
Abstract

ABBREVIATIONS ACOG American College of Obstetricians and Gynecologists RhIG Rh immune globulin In 2015, the AABB and the College of American Pathologists sponsored an Interorganizational Work Group on I RHD i Genotyping,[1] inviting the American College of Obstetricians and Gynecologists (ACOG), American Red Cross, America's Blood Centers, and Armed Services Blood Program to recommend organizational representatives. As cost-effective and quicker methods for managing serologic weak D phenotypes become available, the focus should turn to developing protocols for managing patients with I RHD i alleles, who do not have a serologic weak D phenotype, but who are at risk for developing anti-D, such as I RHD*DIIIa i and I RHD*DIVa i . Serological weak D phenotypes: a review and guidance for interpreting the RhD blood type using the RHD genotype. [Extracted from the article]

Published
2020
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78. Recent Trends in the Prescribing of ADHD Medications in Canadian Primary Care.

Author

Morkem, Rachael, Patten, Scott, Queenan, John, and Barber, David

Subjects
HYPERACTIVITY, MENTAL illness, ELECTRONIC health records, METHYLPHENIDATE, SCHOOL children
Abstract

Objective: The aim of this study was to describe the prevalence and incidence of ADHD medication prescribing, by age and gender, from 2005 to 2015 in Canadian primary care. Method: A population-based retrospective cohort study was conducted to evaluate the prescribing of ADHD medications between 2005 and 2015 using electronic medical record data. Yearly prevalence and incidence of ADHD medication prescribing were calculated for preschoolers (up to 5 years old), school-aged children (6-17 years old), and adults (18-65 years old) along with a description of the types of ADHD medications prescribed between 2005 and 2015. Results: Between 2005 and 2015, there was a 2.6-fold increase in the prevalence of ADHD medication prescribing to preschoolers, a 2.5-fold increase in school-aged children, and a fourfold increase in adults. There was a corresponding rise in incidence of prescribing although this rise was moderate and estimates were much lower compared with prevalence. The most commonly prescribed medication was Methylphenidate (65.0% of all ADHD medications prescribed). Conclusion: Although the prevalence of ADHD has remained stable over time, this study found an increase in the prescribing of ADHD medications in all age groups between 2005 and 2015. Incidence of new prescriptions was small relative to prevalence, suggesting that longer term treatments are being adopted. [ABSTRACT FROM AUTHOR]

Published
2020
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82. Colaboradores

Author

Abdel-Razeq, Sonya S., Abrahams, Vikki M., Aminoff, Michael J., Bahtiyar, Mert Ozan, Beall, Marie H., Benirschke, Kurt, Berghella, Vincenzo, Bixel, Kristin, Blanchard, Daniel G., Bodnar, Lisa M., Branch, D. Ware, Bromley, Bryann, Buhimschi, Catalin S., Campbell, Katherine Harper, Catalano, Patrick, Catov, Janet M., Chambers, Christina, Chien, Edward K.S., Christian, Beth, Chung, Raymond T., Cohn, David E., Copel, Joshua A., D’Alton, Mary E., Daniels, Lori B., De Paepe, Monique E., Dombrowski, Mitchell P., Douglas, Vanja C., Duff, Patrick, Dugoff, Lorraine, Fineman, Jeffrey R., Friedman, Jan M., Ghidini, Alessandro, Gilner, Jennifer, Grantz, Katherine Laughon, Greenberg, James M., Gregg, Anthony R., Grobman, William, Haberman, Beth, Hahn, Michael E., Han, Christina S., Harding, Richard, Harper, Lorie M., Hauguel-de Mouzon, Sylvie, Hawkins, Joy L., Himes, Katherine P., Hull, Andrew D., Iams, Jay D., Jobe, Alan H., Jones, Hendrée E., Kaimal, Anjali J., Kamath-Rayne, Beena D., Karumanchi, S. Ananth, Kelly, Thomas F., Kennedy, Anne, Kilpatrick, Sarah J., Kitahara, Sumire, Kuller, Jeffrey A., LaCoursiere, D. Yvette, Lawrence, Robert M., Lawrence, Ruth A., Lee, Richard H., Leung, Ann, Liu, James H., Lockwood, Charles J., Lye, Stephen J., Macones, George A., Mahendroo, Mala, Malone, Fergal D., Maltepe, Emin, Mastrobattista, Joan M., Mercer, Brian M., Merz, C. Noel Bairey, Meschia, Giacomo, Mesiano, Sam, Metz, Torri, Moise, Kenneth J., Jr., Monga, Manju, Montaney, Laura A., Monteagudo, Ana, Moore, Thomas R., Mor, Gil, Muglia, Louis J., Nader, Shahla, Nageotte, Michael P., Narendran, Vivek, Nathan, Amy T., Norwitz, Errol R., Običan, Sarah Gloria, Odibo, Anthony O., Pettker, Christian, Plante, Lauren A., Prasad, Mona R., Pretorius, Dolores H., Pringle, Patricia, Queenan, John, Rajkovic, Aleksandar, Ramaswamy, Bhuvaneswari, Rapini, Ronald P., Reddy, Uma M., Resnik, Robert, Richardson, Bryan S., Roberts, Drucilla J., Rodger, Marc, Ross, Michael G., Salmon, Jane E., Sammaritano, Lisa Rose, Savides, Thomas J., Schibler, Kurt, Scott, James R., Sfakianaki, Anna Katerina, Shipp, Thomas D., Silver, Robert M., Simhan, Hyagriv N., Sklansky, Mark, Smid, Marcela, Sottile, Peter, Thadhani, Ravi, Thorp, John M., Jr., Timor-Tritsch, Ilan E., Tita, Alan, Tuuli, Methodius G., Walker, David, Wapner, Ronald J., Whitty, Janice E., Wilkins, Isabelle, Williams, Zev, Wolf, Richard B., Woodward, Paula J., Yonkers, Kimberly A., and Young, Brett

Published
2020
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86. Harnessing the power of longitudinal data

Author

Barber, David, Morkem, Rachael, Queenan, John A., and Barber, Karen Hall

Subjects
Canada, Models, Statistical, Datasets as Topic, Humans, Longitudinal Studies, College, Sentinel Surveillance
Published
2016

93. Using EMRs to fuel quality improvement

Author

Greiver, Michelle, Drummond, Neil, Birtwhistle, Richard, Queenan, John, Lambert-Lanning, Anita, and Jackson, Dave

Subjects
Canada, Primary Health Care, Outcome Assessment, Health Care, Electronic Health Records, Humans, College, Family Practice, Quality Improvement, Sentinel Surveillance
Published
2015

96. Contributors

Author

Abdel-Razeq, Sonya S., Abrahams, Vikki M., Aminoff, Michael J., Bahtiyar, Mert Ozan, Beall, Marie H., Benirschke, Kurt, Berghella, Vincenzo, Bixel, Kristin, Blanchard, Daniel G., Bodnar, Lisa M., Branch, D. Ware, Bromley, Bryann, Buhimschi, Catalin S., Campbell, Katherine Harper, Catalano, Patrick, Catov, Janet M., Chambers, Christina, Chien, Edward K.S., Christian, Beth, Chung, Raymond T., Cohn, David E., Copel, Joshua A., D'Alton, Mary E., Daniels, Lori B., De Paepe, Monique E., Dombrowski, Mitchell P., Douglas, Vanja C., Duff, Patrick, Dugoff, Lorraine, Fineman, Jeffrey R., Friedman, Jan M., Ghidini, Alessandro, Gilner, Jennifer, Grantz, Katherine Laughon, Greenberg, James M., Gregg, Anthony R., Grobman, William, Haberman, Beth, Hahn, Michael E., Han, Christina S., Harding, Richard, Harper, Lorie M., Hauguel-de Mouzon, Sylvie, Hawkins, Joy L., Himes, Katherine P., Hull, Andrew D., Iams, Jay D., Jobe, Alan H., Jones, Hendrée E., Kaimal, Anjali J., Kamath-Rayne, Beena D., Karumanchi, S. Ananth, Kelly, Thomas F., Kennedy, Anne, Kilpatrick, Sarah J., Kitahara, Sumire, Kuller, Jeffrey A., LaCoursiere, D. Yvette, Lawrence, Robert M., Lawrence, Ruth A., Lee, Richard H., Leung, Ann, Liu, James H., Lockwood, Charles J., Lye, Stephen J., Macones, George A., Mahendroo, Mala, Malone, Fergal D., Maltepe, Emin, Mastrobattista, Joan M., Mercer, Brian M., Bairey Merz, C. Noel, Meschia, Giacomo, Mesiano, Sam, Metz, Torri, Moise, Kenneth J., Jr., Monga, Manju, Montaney, Laura A., Monteagudo, Ana, Moore, Thomas R., Mor, Gil, Muglia, Louis J., Nader, Shahla, Nageotte, Michael P., Narendran, Vivek, Nathan, Amy T., Norwitz, Errol R., Običan, Sarah Gloria, Odibo, Anthony O., Pettker, Christian, Plante, Lauren A., Prasad, Mona R., Pretorius, Dolores H., Pringle, Patricia, Queenan, John, Rajkovic, Aleksandar, Ramaswamy, Bhuvaneswari, Rapini, Ronald P., Reddy, Uma M., Resnik, Robert, Richardson, Bryan S., Roberts, Drucilla J., Rodger, Marc, Ross, Michael G., Salmon, Jane E., Sammaritano, Lisa Rose, Savides, Thomas J., Schibler, Kurt, Scott, James R., Sfakianaki, Anna Katerina, Shipp, Thomas D., Silver, Robert M., Simhan, Hyagriv N., Sklansky, Mark, Smid, Marcela, Sottile, Peter, Thadhani, Ravi, Thorp, John M., Jr., Timor-Tritsch, Ilan E., Tita, Alan, Tuuli, Methodius G., Walker, David, Wapner, Ronald J., Whitty, Janice E., Wilkins, Isabelle, Williams, Zev, Wolf, Richard B., Woodward, Paula J., Yonkers, Kimberly A., and Young, Brett

Published
2019
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97. Farewell

Author

Queenan, John T.

Subjects
Contemporary OB/GYN (Periodical) -- Officials and employees, Editors -- Appointments, resignations and dismissals, Health
Abstract

The year was 1972 and I was on a journey to our nation's capital to attend an FDA meeting. At that time, I was professor and chairman of the Department [...]

Published
2001

98. And the seasons, they go round and round

Author

Queenan, John T.

Subjects
Health
Abstract

It's difficult to turn over the reins when you've served proudly as the Editor in Chief of a magazine for 28 years--particularly one that's been number one in readership for [...]

Published
2001

99. From books to bytes, or how e-publishing = education

Author

Queenan, John T.

Subjects
Internet -- Usage, Physicians -- Education, Obstetrics, Gynecology, Health
Abstract

In medieval times, a scholar was lucky to have his teachings transcribed on parchment by monks. Done by hand, transcription was a tedious, painstaking, and extremely time-consuming process. As a [...]

Published
2001

100. Resolving to make a resolution

Author

Queenan, John T.

Subjects
Smoking -- Health aspects, Teenage girls, Health
Abstract

It's that time of year again when everyone makes resolutions. How many people vow to start exercising or dieting on January 1, only to break their vow a few days [...]

Published
2001

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