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1. Challenges and Strategies for Improving COPD Primary Care Services in Quebec: Results of the Experience of the COMPAS+ Quality Improvement Collaborative

Author

Vachon B, Giasson G, Gaboury I, Gaid D, Noël De Tilly V, Houle L, Bourbeau J, and Pomey MP

Subjects
copd, quality of care, primary care, quality improvement collaborative, interprofessional collaboration, Diseases of the respiratory system, RC705-779
Abstract

Brigitte Vachon,1,2 Guylaine Giasson,3 Isabelle Gaboury,3,4 Dina Gaid,1 Véronique Noël De Tilly,5 Lise Houle,6 Jean Bourbeau,7 Marie-Pascale Pomey8,9 1School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 2Centre de recherche du CIUSSS de l’Est de Montréal, Montreal, Quebec, Canada; 3Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada; 4Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada; 5Convergence Santé, Montreal, Québec, Canada; 6Institut national d’excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada; 7Center of Innovative Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; 8Public Health School, Department of Management, Evaluation and Health Policy, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 9Centre de recherche de Centre hospitalier universitaire de l’Université de Montréal, Montreal, Quebec, CanadaCorrespondence: Brigitte VachonSchool of Rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, Quebec, H3C 3J7, Canada, Tel +1 514 343-2094, Email brigitte.vachon@umontreal.caIntroduction: Management of chronic obstructive pulmonary disease (COPD) remains a challenge in primary care and multiple barriers can limit implementation of COPD guidelines. Since 2016, a quality improvement (QI) collaborative, called COMPAS+, has been implemented across the province of Quebec (Canada) to support improvement of chronic disease management in primary care. The aim of this study was to describe the main COPD quality problems reported by participating teams and the strategies they proposed and implemented to improve COPD primary care services in Quebec.Methods: Sixteen sites in four different regions of Quebec were engaged in the COMPAS+ intervention to improve primary care services delivered to people living with COPD. A total of 14 workshop reports, 31 QI action plans and 4 regional final reports underwent content analysis. Key COPD quality problems were first identified and, for each of them, root causes were classified according to the domains and constructs of the Consolidated Framework for Implementation Research. Proposed strategies were organized according to the intervention function types described in the Behavior Change Wheel.Results: Four key COPD quality problems were identified: 1) lack of organization/coordination of COPD services, 2) lack of screening services coordination, 3) lack of interprofessional communication and collaboration and 4) lack of treatment adherence. Main root causes explaining these quality gaps were 1) lack of awareness of COPD, 2) lack of professional knowledge, 3) lack of definition of professional roles, 4) lack of resources and tools for COPD prevention, diagnosis, and follow-up, 5) lack of communication tools, 6) lack of integration of the patient-as-partner approach, and 7) lack of adaptation of patient education to their specific needs. Multiple strategies were proposed to improve healthcare professionals’ education and interprofessional collaboration and communication.Conclusion: QI collaborative activities can support achieving understanding of QI challenges healthcare organizations face to improve COPD services.Keywords: COPD, quality of care, primary care, quality improvement collaborative, interprofessional collaboration

Published
2022

2. Treating asthma with omega-3 fatty acids: where is the evidence? A systematic review

Author

Sampson M, Barnes D, Kourad K, Tran K, Dales RE, Schachter HM, Reisman J, Morrison A, Gaboury I, and Blackman J

Subjects
Other systems of medicine, RZ201-999
Abstract

Abstract Background Considerable interest exists in the potential therapeutic value of dietary supplementation with the omega-3 fatty acids. Given the interplay between pro-inflammatory omega-6 fatty acids, and the less pro-inflammatory omega-3 fatty acids, it has been thought that the latter could play a key role in treating or preventing asthma. The purpose was to systematically review the scientific-medical literature in order to identify, appraise, and synthesize the evidence for possible treatment effects of omega-3 fatty acids in asthma. Methods Medline, Premedline, Embase, Cochrane Central Register of Controlled Trials, CAB Health, and, Dissertation Abstracts were searched to April 2003. We included randomized controlled trials (RCT's) of subjects of any age that used any foods or extracts containing omega-3 fatty acids as treatment or prevention for asthma. Data included all asthma related outcomes, potential covariates, characteristics of the study, design, population, intervention/exposure, comparators, and co interventions. Results Ten RCT's were found pertinent to the present report. Conclusion Given the largely inconsistent picture within and across respiratory outcomes, it is impossible to determine whether or not omega-3 fatty acids are an efficacious adjuvant or monotherapy for children or adults. Based on this systematic review we recommend a large randomized controlled study of the effects of high-dose encapsulated omega-3 fatty acids on ventilatory and inflammatory measures of asthma controlling diet and other asthma risk factors. This review was limited because Meta-analysis was considered inappropriate due to missing data; poorly or heterogeneously defined populations, interventions, intervention-comparator combinations, and outcomes. In addition, small sample sizes made it impossible to meaningfully assess the impact on clinical outcomes of co-variables. Last, few significant effects were found.

Published
2006
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6. DISSEMINATION, IMPLEMENTATION, AND IMPACT

Author

Breton, M., primary, Ann Smithman, M., additional, Lamoureux‐Lamarche, C., additional, Dumas Pilon, M., additional, Keely, E., additional, Farrell, G., additional, Singer, A., additional, Woods, P., additional, Bibeau, C., additional, Nabelsi, V., additional, Gaboury, I., additional, Gagnon, M.‐P., additional, Steele Gray, C., additional, Shaw, J., additional, Hudon, C., additional, Aubrey‐Bassler, K., additional, Bush, P., additional, Côté‐Boileau, É., additional, Gagnon, J., additional, Visca, R., additional, and Liddy, C., additional

Published
2020
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12. World Congress Integrative Medicine & Health 2017: part two Berlin, Germany. 3-5 May 2017 Abstracts

Author

Ee, C, Thuraisingam, S, Pirotta, M, French, S, Xue, C, Teede, H, Kristoffersen, AE, Sirois, F, Stub, T, Engler, J, Joos, S, Güthlin, C, Felenda, J, Beckmann, C, Stintzing, F, Evans, R, Bronfort, G, Keefe, D, Taberko, A, Hanson, L, Haley, A, Ma, H, Jolton, J, Yarosh, L, Keefe, F, Nam, J, Ojala, L, Kreitzer, MJ, Fink, C, Kraft, K, Flower, A, Lewith, G, Harman, K, Stuart, B, Bishop, FL, Frawley, J, Füleki, L, Kiss, E, Vancsik, T, Krenacs, T, Funabashi, M, Pohlman, KA, Mior, S, Thiel, H, Hill, MD, Cassidy, DJ, Westaway, M, Yager, J, Hurwitz, E, Kawchuk, GN, O’Beirne, M, Vohra, S, Gaboury, I, Morin, C, Gaertner, K, Torchetti, L, Frei-Erb, M, Kundi, M, Frass, M, Gallo, E, Maggini, V, Comite, M, Sofi, F, Baccetti, S, Vannacci, A, Di Stefano, M, Monechi, MV, Gori, L, Rossi, E, Firenzuoli, F, Mediati, RD, Ballerini, G, Gardiner, P, Lestoquoy, AS, Negash, L, Stillman, S, Shah, P, Liebschutz, J, Adelstein, P, Farrell-Riley, C, Brackup, I, Penti, B, Saper, R, Sampedro, IG, Carvajal, G, Gleiss, A, Gross, MM, Brendlin, D, Röttger, J, Stritter, W, Seifert, G, Grzanna, N, Stange, R, Guendling, PW, Gu, W, Lu, Y, Wang, J, Zhang, C, Bai, H, He, Y, Zhang, X, Zhang, Z, Wang, D, Meng, F, Hagel, A, Albrecht, H, Vollbracht, C, Dauth, W, Hagel, W, Vitali, F, Ganzleben, I, Schultis, H, Konturek, P, Stein, J, Neurath, M, Raithel, M, Krick, B, Haller, H, Klose, P, Dobos, G, Kümmel, S, Cramer, H, Saha, FJ, Kowoll, A, Ebner, B, Berger, B, Choi, K-E, He, L, Wang, H, He, X, Gu, C, Zhang, Y, Zhao, L, Tong, X, Ho, RST, Chung, VCH, Wu, X, Wong, CHL, Wu, JCY, Wong, SYS, Lau, AYL, Sit, RWS, Wong, W, Holmes, M, Bishop, F, Calman, L, Newell, D, Field, J, Htut, WL, Han, D, Choi, DI, Choi, SJ, Kim, HY, Hwang, JH, Huang, CW, Jang, BH, Chen, FP, Ko, SG, Huang, W, Jin, D, Lian, F, Jang, S, Kim, KH, Lee, EK, Sun, SH, Go, HY, Ko, Y, Park, S, Shin, YC, Janik, H, Greiffenhagen, N, Bolte, J, Jaworski, M, Adamus, M, Dobrzynska, A, Jeitler, M, Jaspers, J, von Scheidt, C, Koch, B, Michalsen, A, Steckhan, N, Kessler, C, Huang, W-J, Pang, B, Lian, F-M, Jong, M, Baars, E, Glockmann, A, Hamre, H, Kainuma, M, Murakami, A, Kubota, T, Kobayashi, D, Sumoto, Y, Furusyo, N, Ando, S-I, Shimazoe, T, Kelber, O, Verjee, S, Gorgus, E, Schrenk, D, Kemper, K, Hill, E, Rao, N, Gascon, G, Mahan, J, Kienle, G, Dietrich, J, Schmoor, C, Huber, R, Kim, WH, Ahmed, M, Meggyeshazi, N, Kovago, C, Klaus, AK, Zerm, R, Pranga, D, Ostermann, T, Reif, M, von Laue, HB, Brinkhaus, B, Kröz, M, Recchia, DR, Klein-Laansma, CT, von Hagens, C, Jansen, JP, van Wietmarschen, H, Jong, MC, Sun, S-H, Go, H-Y, Jeon, C-Y, Song, Y-K, Ko, S-G, Koch, AK, Rabsilber, S, Lauche, R, Langhorst, J, Trifunovic-Koenig, M, Koster, E, Delnoij, D, Kroll, L, Weiss, K, Kubo, A, Hendlish, S, Altschuler, A, Connolly, N, Avins, A, Wardle, J, Lee, D, Sibbritt, D, Adams, J, Park, C, Mishra, G, Lechner, J, Lee, I, Chae, Y, Lee, J, Cho, SH, Choi, Y, Lee, JY, Ryu, HS, Yoon, SS, Oh, HK, Hyun, LK, Kim, JO, Yoon, SW, Lee, J-Y, Shin, S-H, Jang, M, Müller, I, Park, S-HJ, Laird, L, Mitchell, S, Li, X, Wang, Y, Zhen, J, Yu, H, Liu, T, Gu, X, Liu, H, Ma, W, Shang, X, Bai, Y, Liu, W, Rooney, C, Smith, A, Lopes, S, Demarzo, M, do Patrocínio Nunes, M, Lorenz, P, Gründemann, C, Heinrich, M, Garcia-Käufer, M, Grunewald, F, Messerschmidt, S, Herrick, A, Gruber, K, Knödler, M, Steinborn, C, Lu, T, Wang, L, Wu, D, Luberto, CM, Hall, DL, Chad-Friedman, E, Lechner, S, Park, ER, Park, E, Goodman, J, Luer, S, Heri, M, von Ammon, K, Landini, I, Lapucci, A, Nobili, S, Mini, E, McDermott, C, Richards, S, Cox, D, Frossell, S, Leydon, G, Eyles, C, Raphael, H, Rogers, R, Selby, M, Adler, C, Allam, J, Bu, X, Zhang, H, Zhang, J, Mikolasek, M, Berg, J, Witt, C, Barth, J, Miskulin, I, Lalic, Z, Miskulin, M, Dumic, A, Sebo, D, Vcev, A, Mohammed, NAA, Im, HB, Mukherjee, A, Kandhare, A, Bodhankar, S, Thakurdesai, P, Munk, N, Evans, E, Froman, A, Kline, M, Bair, MJ, Musial, F, Alræk, T, Hamre, HJ, Björkman, L, Fønnebø, VM, Ni, Q, Tong, X-L, Li, X-L, Liu, W-K, Feng, S, Zhao, X-Y, Zheng, Y-J, Zhao, X-M, Lin, Y-Q, Zhao, T-Y, Phd, HC, Liu, F, Zhao, L-H, Ye, R, Gu, C-J, Peng, W, De Carvalho, D, El-Bayoumi, M, Haig, B, Kelly, K, Wade, DJ, Portalupi, E, Gobo, G, Bellavita, L, Guglielmetti, C, Raak, C, Teuber, M, Molsberger, F, von Rath, U, Reichelt, U, Schwanebeck, U, Zeil, S, Vogelberg, C, Veintimilla, DR, Mery, GT, Villavicencio, MM, Moran, SH, Sachse, C, Gündlin, PW, Sahebkarkhorasani, M, Azizi, H, Schumann, D, Sundberg, T, Leach, MJ, Seca, S, Greten, H, Selliah, S, Shakya, A, Sherbakova, A, Ulrich-Merzenich, G, Abdel-Aziz, H, Sibinga, E, Webb, L, Ellen, J, Skrautvol, K, Nåden, D, Song, R, Grabowska, W, Osypiuk, K, Diaz, GV, Bonato, P, Park, M, Hausdorff, J, Fox, M, Sudarsky, LR, Tarsy, D, Novakowski, J, Macklin, EA, Wayne, PM, Hwang, I, Ahn, S, Lee, M-A, Sohn, MK, Sorokin, O, Heydeck, D, Borchert, A, Hohmann, C-D, Kühn, H, Kirschbaum, C, Stalder, T, Stöckigt, B, Teut, M, Suhr, R, Sulmann, D, Streeter, C, Gerbarg, P, Silveri, M, Brown, R, Jensen, J, Rutert, B, Eggert, A, Längler, A, Holmberg, C, Sun, J, Deng, X, Li, W-Y, Wen, B, Robinson, N, Liu, J-P, Sung, HK, Yang, N, Shin, SM, Jung, H, Kim, YJ, Jung, WS, Park, TY, Suzuki, K, Ito, T, Uchida, S, Kamohara, S, Ono, N, Takamura, M, Yokochi, A, Maruyama, K, Tapia, P, Thabaut, K, Thronicke, A, Steele, M, Matthes, H, Herbstreit, C, Schad, F, Tian, J, Yang, L, Tian, T, Tian, X, Wang, C, Chai, QY, Zhang, L, Xia, R, Huang, N, Fei, Y, Liu, J, Trent, N, Miraglia, M, Dusek, J, Pasalis, E, Khalsa, SB, Trifunovic-König, M, Koch, A, Uebelacker, L, Tremont, G, Gillette, L, Epstein-Lubow, G, Strong, D, Abrantes, A, Tyrka, A, Tran, T, Gaudiano, B, Miller, I, Ullmann, G, Li, Y, Vaidya, S, Marathe, V, Vale, AC, Motta, J, Donadão, F, Valente, AC, Valente, LCC, Ghelman, R, Vesovic, D, Jevdic, D, Jevdic, A, Jevdic, K, Djacic, M, Letic, D, Bozic, D, Markovic, M, Dunjic, S, Ruscuklic, G, Baksa, D, Vrca, K, Vincent, A, Wahner-Roedler, D, Whipple, M, Vogelius, MM, Friesecke, I, Gündling, PW, Mahapatra, S, Hynes, R, Van Rooy, K, Looker, S, Ghosh, A, Bauer, B, Cutshall, S, Walach, H, Flores, AB, Ofner, M, Kastner, A, Schwarzl, G, Schwameder, H, Alexander, N, Strutzenberger, G, Wang, S, Shi, J, Hao, Y, Wu, J, Qiu, Z, Wang, Y-H, Lou, C-J, Watts, S, Wayne, P, Vergara-Diaz, G, Gow, B, Miranda, J, Sudarsky, L, Macklin, E, Wode, K, Bergqvist, J, Bernhardsson, B-M, Nordberg, JH, Sharp, L, Henriksson, R, Woo, Y, Hyun, MK, Wu, H, Wang, T-F, Zhao, Y, Wei, Y, Tian, L, Wang, X, Wu, R, Han, M, Caldwell, PHY, Liu, S, Chai, Q, Guo, Z, Liu, Z, Yang, IJ, Lincha, VR, Ahn, SH, Lee, DU, Shin, HM, Sung, H, Kim, Y, Yap, A, Kwan, YH, Tan, CS, Ibrahim, S, Ang, SB, Yayi, A, Yoo, JE, Yoo, HR, Jang, SB, Lee, HL, Youssef, A, Ezzat, S, Motaal, AA, El-Askary, H, Yu, X, Cui, Y, Yun, Y, Ahn, J-H, Jang, B-H, Kim, K-S, Choi, I, Glinz, A, ten Brink, F, Büssing, A, Gutenbrunner, C, Helbrecht, B, Fang, T, Shen, Z, Zhang, R, Wu, F, Li, M, Xuan, X, Shen, X, Ren, K, Berman, B, Zheng, Z, Wan, Y, Ma, X, Dong, F, Zick, S, Harris, R, Bae, GE, Kwon, JN, Lee, HY, Nam, JK, Lee, SD, Lee, DH, Han, JY, Yun, YJ, Lee, JH, Park, HL, Park, SH, Bocci, C, Ivaldi, GB, Vietti, I, Meaglia, I, Guffi, M, Ruggiero, R, Gualea, M, Longa, E, Bonucci, M, Croke, S, Rodriguez, LD, Caracuel-Martínez, JC, Fajardo-Rodríguez, MF, Ariza-García, A, la Fuente, FG-D, Arroyo-Morales, M, Estrems, MS, Gómez, VG, Sabater, MV, Ferreri, R, Bernardini, S, Pulcri, R, Cracolici, F, Rinaldi, M, Porciani, C, Fisher, P, Hughes, J, Mendoza, A, MacPherson, H, Filshie, J, Di Francesco, A, Bernardini, A, Messe, M, Primitivo, V, Iasella, PA, Taminato, M, Alcantara, JDC, De Oliveira, KR, Rodrigues, DCDA, Mumme, JRC, Sunakozawa, OKM, Filho, VO, Goldenberg, J, Day, A, Sasagawa, M, Ward, L, Cooley, K, Gunnarsdottir, T, Hjaltadottir, I, Hajimonfarednejad, M, Hannan, N, Hellsing, R, Andermo, S, Arman, M, von Hörsten, I, Torrielo, PV, Vilaró, CLA, Cabrera, FC, Hui, H, Ziea, E, Tsui, D, Hsieh, J, Lam, C, Chan, E, Jensen, MP, Battalio, SL, Chan, J, Edwards, KA, Gertz, KJ, Day, MA, Sherlin, LH, Ehde, DM, Börner, A, Lee, B, Chang, GT, Menassa, A, Motoo, Y, Müller, J, Rabini, S, Vinson, B, Storr, M, Niemeijer, M, Hoekman, J, Ruijssenaaars, W, Njoku, FC, Norheim, AJ, Okumus, F, Oncu-Celik, H, Ee, C, Thuraisingam, S, Pirotta, M, French, S, Xue, C, Teede, H, Kristoffersen, AE, Sirois, F, Stub, T, Engler, J, Joos, S, Güthlin, C, Felenda, J, Beckmann, C, Stintzing, F, Evans, R, Bronfort, G, Keefe, D, Taberko, A, Hanson, L, Haley, A, Ma, H, Jolton, J, Yarosh, L, Keefe, F, Nam, J, Ojala, L, Kreitzer, MJ, Fink, C, Kraft, K, Flower, A, Lewith, G, Harman, K, Stuart, B, Bishop, FL, Frawley, J, Füleki, L, Kiss, E, Vancsik, T, Krenacs, T, Funabashi, M, Pohlman, KA, Mior, S, Thiel, H, Hill, MD, Cassidy, DJ, Westaway, M, Yager, J, Hurwitz, E, Kawchuk, GN, O’Beirne, M, Vohra, S, Gaboury, I, Morin, C, Gaertner, K, Torchetti, L, Frei-Erb, M, Kundi, M, Frass, M, Gallo, E, Maggini, V, Comite, M, Sofi, F, Baccetti, S, Vannacci, A, Di Stefano, M, Monechi, MV, Gori, L, Rossi, E, Firenzuoli, F, Mediati, RD, Ballerini, G, Gardiner, P, Lestoquoy, AS, Negash, L, Stillman, S, Shah, P, Liebschutz, J, Adelstein, P, Farrell-Riley, C, Brackup, I, Penti, B, Saper, R, Sampedro, IG, Carvajal, G, Gleiss, A, Gross, MM, Brendlin, D, Röttger, J, Stritter, W, Seifert, G, Grzanna, N, Stange, R, Guendling, PW, Gu, W, Lu, Y, Wang, J, Zhang, C, Bai, H, He, Y, Zhang, X, Zhang, Z, Wang, D, Meng, F, Hagel, A, Albrecht, H, Vollbracht, C, Dauth, W, Hagel, W, Vitali, F, Ganzleben, I, Schultis, H, Konturek, P, Stein, J, Neurath, M, Raithel, M, Krick, B, Haller, H, Klose, P, Dobos, G, Kümmel, S, Cramer, H, Saha, FJ, Kowoll, A, Ebner, B, Berger, B, Choi, K-E, He, L, Wang, H, He, X, Gu, C, Zhang, Y, Zhao, L, Tong, X, Ho, RST, Chung, VCH, Wu, X, Wong, CHL, Wu, JCY, Wong, SYS, Lau, AYL, Sit, RWS, Wong, W, Holmes, M, Bishop, F, Calman, L, Newell, D, Field, J, Htut, WL, Han, D, Choi, DI, Choi, SJ, Kim, HY, Hwang, JH, Huang, CW, Jang, BH, Chen, FP, Ko, SG, Huang, W, Jin, D, Lian, F, Jang, S, Kim, KH, Lee, EK, Sun, SH, Go, HY, Ko, Y, Park, S, Shin, YC, Janik, H, Greiffenhagen, N, Bolte, J, Jaworski, M, Adamus, M, Dobrzynska, A, Jeitler, M, Jaspers, J, von Scheidt, C, Koch, B, Michalsen, A, Steckhan, N, Kessler, C, Huang, W-J, Pang, B, Lian, F-M, Jong, M, Baars, E, Glockmann, A, Hamre, H, Kainuma, M, Murakami, A, Kubota, T, Kobayashi, D, Sumoto, Y, Furusyo, N, Ando, S-I, Shimazoe, T, Kelber, O, Verjee, S, Gorgus, E, Schrenk, D, Kemper, K, Hill, E, Rao, N, Gascon, G, Mahan, J, Kienle, G, Dietrich, J, Schmoor, C, Huber, R, Kim, WH, Ahmed, M, Meggyeshazi, N, Kovago, C, Klaus, AK, Zerm, R, Pranga, D, Ostermann, T, Reif, M, von Laue, HB, Brinkhaus, B, Kröz, M, Recchia, DR, Klein-Laansma, CT, von Hagens, C, Jansen, JP, van Wietmarschen, H, Jong, MC, Sun, S-H, Go, H-Y, Jeon, C-Y, Song, Y-K, Ko, S-G, Koch, AK, Rabsilber, S, Lauche, R, Langhorst, J, Trifunovic-Koenig, M, Koster, E, Delnoij, D, Kroll, L, Weiss, K, Kubo, A, Hendlish, S, Altschuler, A, Connolly, N, Avins, A, Wardle, J, Lee, D, Sibbritt, D, Adams, J, Park, C, Mishra, G, Lechner, J, Lee, I, Chae, Y, Lee, J, Cho, SH, Choi, Y, Lee, JY, Ryu, HS, Yoon, SS, Oh, HK, Hyun, LK, Kim, JO, Yoon, SW, Lee, J-Y, Shin, S-H, Jang, M, Müller, I, Park, S-HJ, Laird, L, Mitchell, S, Li, X, Wang, Y, Zhen, J, Yu, H, Liu, T, Gu, X, Liu, H, Ma, W, Shang, X, Bai, Y, Liu, W, Rooney, C, Smith, A, Lopes, S, Demarzo, M, do Patrocínio Nunes, M, Lorenz, P, Gründemann, C, Heinrich, M, Garcia-Käufer, M, Grunewald, F, Messerschmidt, S, Herrick, A, Gruber, K, Knödler, M, Steinborn, C, Lu, T, Wang, L, Wu, D, Luberto, CM, Hall, DL, Chad-Friedman, E, Lechner, S, Park, ER, Park, E, Goodman, J, Luer, S, Heri, M, von Ammon, K, Landini, I, Lapucci, A, Nobili, S, Mini, E, McDermott, C, Richards, S, Cox, D, Frossell, S, Leydon, G, Eyles, C, Raphael, H, Rogers, R, Selby, M, Adler, C, Allam, J, Bu, X, Zhang, H, Zhang, J, Mikolasek, M, Berg, J, Witt, C, Barth, J, Miskulin, I, Lalic, Z, Miskulin, M, Dumic, A, Sebo, D, Vcev, A, Mohammed, NAA, Im, HB, Mukherjee, A, Kandhare, A, Bodhankar, S, Thakurdesai, P, Munk, N, Evans, E, Froman, A, Kline, M, Bair, MJ, Musial, F, Alræk, T, Hamre, HJ, Björkman, L, Fønnebø, VM, Ni, Q, Tong, X-L, Li, X-L, Liu, W-K, Feng, S, Zhao, X-Y, Zheng, Y-J, Zhao, X-M, Lin, Y-Q, Zhao, T-Y, Phd, HC, Liu, F, Zhao, L-H, Ye, R, Gu, C-J, Peng, W, De Carvalho, D, El-Bayoumi, M, Haig, B, Kelly, K, Wade, DJ, Portalupi, E, Gobo, G, Bellavita, L, Guglielmetti, C, Raak, C, Teuber, M, Molsberger, F, von Rath, U, Reichelt, U, Schwanebeck, U, Zeil, S, Vogelberg, C, Veintimilla, DR, Mery, GT, Villavicencio, MM, Moran, SH, Sachse, C, Gündlin, PW, Sahebkarkhorasani, M, Azizi, H, Schumann, D, Sundberg, T, Leach, MJ, Seca, S, Greten, H, Selliah, S, Shakya, A, Sherbakova, A, Ulrich-Merzenich, G, Abdel-Aziz, H, Sibinga, E, Webb, L, Ellen, J, Skrautvol, K, Nåden, D, Song, R, Grabowska, W, Osypiuk, K, Diaz, GV, Bonato, P, Park, M, Hausdorff, J, Fox, M, Sudarsky, LR, Tarsy, D, Novakowski, J, Macklin, EA, Wayne, PM, Hwang, I, Ahn, S, Lee, M-A, Sohn, MK, Sorokin, O, Heydeck, D, Borchert, A, Hohmann, C-D, Kühn, H, Kirschbaum, C, Stalder, T, Stöckigt, B, Teut, M, Suhr, R, Sulmann, D, Streeter, C, Gerbarg, P, Silveri, M, Brown, R, Jensen, J, Rutert, B, Eggert, A, Längler, A, Holmberg, C, Sun, J, Deng, X, Li, W-Y, Wen, B, Robinson, N, Liu, J-P, Sung, HK, Yang, N, Shin, SM, Jung, H, Kim, YJ, Jung, WS, Park, TY, Suzuki, K, Ito, T, Uchida, S, Kamohara, S, Ono, N, Takamura, M, Yokochi, A, Maruyama, K, Tapia, P, Thabaut, K, Thronicke, A, Steele, M, Matthes, H, Herbstreit, C, Schad, F, Tian, J, Yang, L, Tian, T, Tian, X, Wang, C, Chai, QY, Zhang, L, Xia, R, Huang, N, Fei, Y, Liu, J, Trent, N, Miraglia, M, Dusek, J, Pasalis, E, Khalsa, SB, Trifunovic-König, M, Koch, A, Uebelacker, L, Tremont, G, Gillette, L, Epstein-Lubow, G, Strong, D, Abrantes, A, Tyrka, A, Tran, T, Gaudiano, B, Miller, I, Ullmann, G, Li, Y, Vaidya, S, Marathe, V, Vale, AC, Motta, J, Donadão, F, Valente, AC, Valente, LCC, Ghelman, R, Vesovic, D, Jevdic, D, Jevdic, A, Jevdic, K, Djacic, M, Letic, D, Bozic, D, Markovic, M, Dunjic, S, Ruscuklic, G, Baksa, D, Vrca, K, Vincent, A, Wahner-Roedler, D, Whipple, M, Vogelius, MM, Friesecke, I, Gündling, PW, Mahapatra, S, Hynes, R, Van Rooy, K, Looker, S, Ghosh, A, Bauer, B, Cutshall, S, Walach, H, Flores, AB, Ofner, M, Kastner, A, Schwarzl, G, Schwameder, H, Alexander, N, Strutzenberger, G, Wang, S, Shi, J, Hao, Y, Wu, J, Qiu, Z, Wang, Y-H, Lou, C-J, Watts, S, Wayne, P, Vergara-Diaz, G, Gow, B, Miranda, J, Sudarsky, L, Macklin, E, Wode, K, Bergqvist, J, Bernhardsson, B-M, Nordberg, JH, Sharp, L, Henriksson, R, Woo, Y, Hyun, MK, Wu, H, Wang, T-F, Zhao, Y, Wei, Y, Tian, L, Wang, X, Wu, R, Han, M, Caldwell, PHY, Liu, S, Chai, Q, Guo, Z, Liu, Z, Yang, IJ, Lincha, VR, Ahn, SH, Lee, DU, Shin, HM, Sung, H, Kim, Y, Yap, A, Kwan, YH, Tan, CS, Ibrahim, S, Ang, SB, Yayi, A, Yoo, JE, Yoo, HR, Jang, SB, Lee, HL, Youssef, A, Ezzat, S, Motaal, AA, El-Askary, H, Yu, X, Cui, Y, Yun, Y, Ahn, J-H, Jang, B-H, Kim, K-S, Choi, I, Glinz, A, ten Brink, F, Büssing, A, Gutenbrunner, C, Helbrecht, B, Fang, T, Shen, Z, Zhang, R, Wu, F, Li, M, Xuan, X, Shen, X, Ren, K, Berman, B, Zheng, Z, Wan, Y, Ma, X, Dong, F, Zick, S, Harris, R, Bae, GE, Kwon, JN, Lee, HY, Nam, JK, Lee, SD, Lee, DH, Han, JY, Yun, YJ, Lee, JH, Park, HL, Park, SH, Bocci, C, Ivaldi, GB, Vietti, I, Meaglia, I, Guffi, M, Ruggiero, R, Gualea, M, Longa, E, Bonucci, M, Croke, S, Rodriguez, LD, Caracuel-Martínez, JC, Fajardo-Rodríguez, MF, Ariza-García, A, la Fuente, FG-D, Arroyo-Morales, M, Estrems, MS, Gómez, VG, Sabater, MV, Ferreri, R, Bernardini, S, Pulcri, R, Cracolici, F, Rinaldi, M, Porciani, C, Fisher, P, Hughes, J, Mendoza, A, MacPherson, H, Filshie, J, Di Francesco, A, Bernardini, A, Messe, M, Primitivo, V, Iasella, PA, Taminato, M, Alcantara, JDC, De Oliveira, KR, Rodrigues, DCDA, Mumme, JRC, Sunakozawa, OKM, Filho, VO, Goldenberg, J, Day, A, Sasagawa, M, Ward, L, Cooley, K, Gunnarsdottir, T, Hjaltadottir, I, Hajimonfarednejad, M, Hannan, N, Hellsing, R, Andermo, S, Arman, M, von Hörsten, I, Torrielo, PV, Vilaró, CLA, Cabrera, FC, Hui, H, Ziea, E, Tsui, D, Hsieh, J, Lam, C, Chan, E, Jensen, MP, Battalio, SL, Chan, J, Edwards, KA, Gertz, KJ, Day, MA, Sherlin, LH, Ehde, DM, Börner, A, Lee, B, Chang, GT, Menassa, A, Motoo, Y, Müller, J, Rabini, S, Vinson, B, Storr, M, Niemeijer, M, Hoekman, J, Ruijssenaaars, W, Njoku, FC, Norheim, AJ, Okumus, F, and Oncu-Celik, H

Published
2017

14. Partnership for fragility bone fracture care provision and prevention program (P4Bones): study protocol for a secondary fracture prevention pragmatic controlled trial

Author

Gaboury, I., Corriveau, H., Boire, G., Cabana, F., Beaulieu, M.C., Dagenais, P., Gosselin, S., Bogoch, E., Rochette, M., Filiatrault, J., Laforest, S., Jean, S., Fansi, A., Theriault, D., and Burnand, B.

Abstract

BACKGROUND: Fractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs.Methods/design: This pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers.The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants' perceptions of care integration, expectations and satisfaction with the program; and participants' compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated fragility fracture prevention program.This integrated program will facilitate knowledge translation and dissemination via the following: involvement of various collaborators during the development and set-up of the integrated program; distribution of pamphlets about osteoporosis and fall prevention strategies to primary care physicians in the intervention group and patients in the control group; participation in evaluation activities; and eventual dissemination of study results.Study/trial registration: Clinical Trial.Gov NCT01745068Study ID number: CIHR grant # 267395.

Published
2013

15. Which children with otitis media acuta benefit from treatment with antibiotics? An individual patient data meta-analysis

Author

Rovers, M, Glasziou, P, Appelman, C, Burke, P, McCormick, D, Damoiseaux, R, Gaboury, I, Little, P, and Hoes, A

Subjects
otorhinolaryngologic diseases
Abstract

Background: At present it is not known which subgroups of children with otitis media acuta (AOM) derive benefit from antibiotics and which do not. Methods: In an individual patient data meta-analysis on six randomised trials, including 1643 children aged 6 months to 12 years with AOM, we performed subgroup analyses to identify children who might benefit more than others from treatment with antibiotics. The primary outcome was a prolonged course of AOM, which was defined as having either residual pain or fever at 3-7 days. Results: In children younger than 2 years of age with bilateral AOM, 55% in the control group and 30% in the antibiotics group still had pain and/or fever at 3-7 days: a rate difference (RD) of -25% (95% CI -36 - -14%, NNT 4). In children aged 2 years or older with unilateral AOM these percentages were 26% and 19% (RD -7%, 95% CI -14-0%, NNT 15). For age alone no differences were found. In children with and without otorrhoea the RD and NNT were -36% (95% CI -53 - -19%) and 3, and -14% (95% CI -23% - -5%) and 8. Discussion: Antibiotics appear to be more beneficial in children younger than 2 years of age with bilateral AOM, and in children with AOM and otorrhoea. For most other children with mild disease an observational policy seems justified. The Dutch AOM guideline has been changed to match these findings.

Published
2006

16. Does the CONSORT checklist improve the quality of reports of randomised controlled trials? A systematic review

Author

Plint, A. C., David Moher, Morrison, A., Schulz, K., Altman, D. G., Hill, C., and Gaboury, I.

Abstract

OBJECTIVE: To determine whether the adoption of the CONSORT checklist is associated with improvement in the quality of reporting of randomised controlled trials (RCTs). DATA SOURCES: MEDLINE, EMBASE, Cochrane CENTRAL, and reference lists of included studies and of experts were searched to identify eligible studies published between 1996 and 2005. STUDY SELECTION: Studies were eligible if they (a) compared CONSORT-adopting and non-adopting journals after the publication of CONSORT, (b) compared CONSORT adopters before and after publication of CONSORT, or (c) a combination of (a) and (b). Outcomes examined included reports for any of the 22 items on the CONSORT checklist or overall trial quality. DATA SYNTHESIS: 1128 studies were retrieved, of which 248 were considered possibly relevant. Eight studies were included in the review. CONSORT adopters had significantly better reporting of the method of sequence generation (risk ratio [RR], 1.67; 95% CI, 1.19-2.33), allocation concealment (RR, 1.66; 95% CI, 1.37-2.00) and overall number of CONSORT items than non-adopters (standardised mean difference, 0.83; 95% CI, 0.46-1.19). CONSORT adoption had less effect on reporting of participant flow (RR, 1.14; 95% CI, 0.89-1.46) and blinding of participants (RR, 1.09; 95% CI, 0.84-1.43) or data analysts (RR, 5.44; 95% CI, 0.73-36.87). In studies examining CONSORT-adopting journals before and after the publication of CONSORT, description of the method of sequence generation (RR, 2.78; 95% CI, 1.78-4.33), participant flow (RR, 8.06; 95% CI, 4.10-15.83), and total CONSORT items (standardised mean difference, 3.67 items; 95% CI, 2.09-5.25) were improved after adoption of CONSORT by the journal. CONCLUSIONS: Journal adoption of CONSORT is associated with improved reporting of RCTs.

Published
2006

23. Association of mitral annular calcification and aortic valve morphology: a substudy of the aortic stenosis progression observation measuring effects of rosuvastatin (ASTRONOMER) study

Author

Jassal, D. S., primary, Tam, J. W., additional, Bhagirath, K. M., additional, Gaboury, I., additional, Sochowski, R. A., additional, Dumesnil, J. G., additional, Giannoccaro, P. J., additional, Jue, J., additional, Pandey, A. S., additional, Joyner, C. D., additional, Teo, K. K., additional, and Chan, K. L., additional

Published
2008
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35. A prospective multicenter study of adrenal function in critically ill children.

Author

Menon K, Ward RE, Lawson ML, Gaboury I, Hutchison JS, Hébert PC, Canadian Critical Care Trials Group, Menon, Kusum, Ward, Roxanne E, Lawson, Margaret L, Gaboury, Isabelle, Hutchison, James S, and Hébert, Paul C

Abstract

Rationale: Adrenal insufficiency is a clinical condition associated with fluid- and catecholamine-resistant hypotension.Objectives: The objectives of this study were to determine the prevalence of adrenal insufficiency, risk factors and potential mechanisms for its development, and its association with clinically important outcomes in critically ill children.Methods: A prospective, cohort study was conducted from 2005 to 2008 in seven tertiary-care, pediatric intensive care units in Canada on patients up to 17 years of age with existing vascular access. Adrenocorticotropic hormone stimulation tests (1 microg) were performed and adrenocorticotropic hormone levels measured in all participants.Measurements and Main Results: A total of 381 patients had adrenal testing on admission. The prevalence of adrenal insufficiency was 30.2% (95% confidence interval, 25.9-35.1). Patients with adrenal insufficiency had higher baseline cortisol levels (28.6 microg/dl vs. 16.7 microg/dl, P < 0.001) and were significantly older (11.5 yr vs. 2.3 yr, P < 0.001) than those without adrenal insufficiency. Adrenal insufficiency was associated with an increased need for catecholamines (P < 0.001) and more fluid boluses (P = 0.026). The sensitivity and specificity of the low-dose adrenocorticotropic hormone stimulation test were 100% and 84%, respectively.Conclusions: Adrenal insufficiency occurs in many disease conditions in critically ill children and is associated with an increased use of catecholamines and fluid boluses. It is likely multifactorial in etiology and is associated with high baseline cortisol levels. Further research is necessary to determine which of these critically ill children are truly cortisol deficient before any treatment recommendations can be made. [ABSTRACT FROM AUTHOR]

Published
2010
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36. 'I never hear what happens, even if they die': A survey of emergency physicians about outcome feedback.

Author

Lavoie CF, Plint AC, Clifford TJ, and Gaboury I

Abstract

Objective: Emergency physicians (EPs) rarely find out what happens to patients after the patients leave their care, a process we call 'outcome feedback.' Some suggest this hinders the practice of emergency medicine (EM); however, evidence is lacking. We sought to evaluate EPs' perception of the current and potential role of outcome feedback in EM. Methods: We surveyed practising French- and Englishspeaking EPs from emergency departments within 100 km of Ottawa, Ont., in the provinces of Ontario and Quebec. The main outcomes included the prevalence, role and effect of outcome feedback. Results: Of the 297 physicians surveyed, 231 (77.8%) re - spond ed. The sample contained good representation of language groups, practice settings, sexes and age groups. All participants indicated that knowing outcomes is 'essential' (62.6%) or 'beneficial' (37.4%) to gaining experience in EM. Participants reported currently receiving passive outcome feedback in 10.0% of all cases, and seeking out (active) outcome feedback in 7.5% of all cases. The great majority of participants (97.3%) stated that they would like to re ceive more outcome feedback and believed that this would improve diagnostic accuracy (97.3%), clinical efficiency (85.5%), treatment outcomes (95.6%) and job satisfaction (95.1%). When asked to indicate 'any possible nega tive effects that might arise from increased outcome feedback,' 62.1% indicated none. However, 17.9% hypothesized negative emotional effects and 11.5% suggested increased time requirements. Conclusion: The overwhelming majority of EPs receive very little outcome feedback. Most would like more outcome feedback and believe it would improve the practice of EM. [ABSTRACT FROM AUTHOR]

Published
2009
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37. Vasopressin in pediatric vasodilatory shock: a multicenter randomized controlled trial.

Author

Choong K, Bohn D, Fraser DD, Gaboury I, Hutchison JS, Joffe AR, Litalien C, Menon K, McNamara P, Ward RE, and Canadian Critical Care Trials Group

Abstract

RATIONALE: Vasopressin has been proposed as a potent vasoactive agent in the treatment of vasodilatory shock in adults and children. The objective of this trial was to evaluate the efficacy and safety of vasopressin as an adjunctive agent in pediatric vasodilatory shock. METHODS: In this multicenter, double-blind trial, children with vasodilatory shock were randomized to receive low-dose vasopressin (0.0005-0.002 U/kg/min) or placebo in addition to open-label vasoactive agents. Vasoactive infusions were titrated to clinical endpoints of adequate perfusion. The primary outcome was time to vasoactive-free hemodynamic stability. Secondary outcomes included mortality, organ-failure-free days, length of critical care unit stay, and adverse events. MEASUREMENTS AND MAIN RESULTS: Sixty-five of 69 children (94%) who were randomized received the study drug (33 vasopressin, 32 placebo) and were included in the analysis. There was no significant difference in the primary outcome between the vasopressin and placebo groups (49.7 vs. 47.1 hours; P = 0.85). There were 10 deaths (30%) in the vasopressin group and five (15.6%) in the placebo group (relative risk, 1.94; 95% confidence interval, 0.75-5.05; P = 0.24). There were no significant differences with respect to organ failure-free days (22 vs. 25.5 days; P = 0.11), ventilator-free days (16.5 23 days; P = 0.15), length of stay (8 vs. 8.5 days; P = 0.93), or adverse event rate ratios (12.0%; 95% confidence interval, -2.6 to 26.7; P = 0.15). CONCLUSIONS: Low-dose vasopressin did not demonstrate any beneficial effects in this pediatric trial. Although not statistically significant, there was a concerning trend toward increased mortality. Clinical trial registered with www.controlled-trials.com (ISRCTN11597444). [ABSTRACT FROM AUTHOR]

Published
2009
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39. The appropriateness of referrals to a pediatric emergency department via a telephone health line.

Author

Al-Abdullah T, Plint AC, Shaw A, Correll R, Gaboury I, Pitters C, Bottaglia A, and Clifford T

Abstract

OBJECTIVE: We compared the appropriateness of visits to a pediatric emergency department (ED) by provincial telephone health line-referral, by self- or parent-referral, and by physician-referral. METHODS: A cohort of patients younger than 18 years of age who presented to a pediatric ED during any of four 1-week study periods were prospectively enrolled. The cohort consisted of all patients who were referred to the ED by a provincial telephone health line or by a physician. For each patient referred by the health line, the next patient who was self- or parent-referred was also enrolled. The primary outcome was visit appropriateness, which was determined using previously published explicit criteria. Secondary outcomes included the treating physician's view of appropriateness, disposition (hospital admission or discharge), treatment, investigations and the length of stay in the ED. RESULTS: Of the 578 patients who were enrolled, 129 were referred from the health line, 102 were either self- or parent-referred, and 347 were physician-referred. Groups were similar at baseline for sex, but health line-referred patients were significantly younger. Using explicitly set criteria, there was no significant difference in visit appropriateness among the health line-referrals (66%), the self- or parent-referrals (77%) and the physician-referrals (73%) (p = 0.11). However, when the examining physician determined visit appropriateness, physician-referred patients (80%) were deemed appropriate significantly more often than those referred by the health line (56%, p < 0.001) or by self- or parent-referral (63%, p = 0.002). There was no significant difference between these latter 2 referral routes (p = 0.50). In keeping with their greater acuity, physician-referred patients were significantly more likely to have investigations, receive some treatment, be admitted to hospital and have longer lengths of stay. Patients who were self- or parent-referred, and those who were health line-referred were similar to each other in these outcomes. CONCLUSION: There was no significant difference in visit appropriateness based on the route of referral when we used set criteria; however, there was when we used treating physician opinion, triage category and resource use. [ABSTRACT FROM AUTHOR]

Published
2009
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41. Prevalence of metabolic markers of insulin resistance in offspring of gestational diabetes pregnancies.

Author

Keely EJ, Malcolm JC, Hadjiyannakis S, Gaboury I, Lough G, and Lawson ML

Abstract

In utero hyperglycemia has been associated with insulin resistance (IR) in children; however, there are limited data in low-risk populations. The purpose of this study was to describe the prevalence of metabolic markers of IR in a primarily Caucasian cohort of gestational diabetes mellitus (GDM) offspring aged 7-11 yr (mean 9.1) and to correlate offspring with maternal indexes. Sixty-eight children were recruited through a follow-up study of women who participated in a randomized controlled trial of minimal intervention vs. tight glycemic control for GDM. All participants had a fasting plasma glucose (FPG), insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-chol), triglyceride (TG) level, and a 2-h oral glucose tolerance test. We calculated homeostasis model assessment (HOMA) and recorded body mass index and waist circumference (WC). Criteria for metabolic syndrome for children included: FPG > 6.0 mmol/L, HDL-chol < 1.03 mmol/L, TG > 1.24 mmol/L, WC > 90% for age and gender, and 2-h glucose > 7.8 mmol/L. Among these children, 45 (66%), 17 (25%), 5 (7%), and 1 (1.5%) had zero, one, two, or three metabolic markers of IR, respectively. Hypertriglyceridemia (21%) was most prevalent, with no child having an elevated FPG. WC (p = 0.018) and TG (p = 0.005) were strong predictors of IR in the offspring after adjustment for age, gender, birthweight, family history, and maternal IR. Maternal and offspring HDL-chol, TG, WC, and HOMA but not fasting or 2-h glucose levels were significantly correlated. We conclude that metabolic markers of IR in children exposed to GDM may be present in the absence of abnormal fasting or 2-h glucose values. Screening strategies that focus on glucose levels may need to be reconsidered to institute early intervention with lifestyle changes for children at risk. [ABSTRACT FROM AUTHOR]

Published
2008

47. Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disordersMembers of the Canadian STOPP Consortium are listed in Appendix A

Author

Huber, A. M., Gaboury, I., Cabral, D. A., Lang, B., Ni, A., Stephure, D., Taback, S., Dent, P., Ellsworth, J., LeBlanc, C., SaintCyr, C., Scuccimarri, R., Hay, J., Lentle, B., Matzinger, M., Shenouda, N., Moher, D., Rauch, F., Siminoski, K., and Ward, L. M.

Abstract

ObjectiveVertebral fractures are an underrecognized problem in children with inflammatory disorders. We studied spine health among 134 children 87 girls with rheumatic conditions median age 10 years within 30 days of initiating glucocorticoid therapy.MethodsChildren were categorized as follows: juvenile dermatomyositis n 30, juvenile idiopathic arthritis n 28, systemic lupus erythematosus and related conditions n 26, systemic arthritis n 22, systemic vasculitis n 16, and other conditions n 12. Thoracolumbar spine radiograph and dual xray absorptiometry for lumbar spine Lspine areal bone mineral density BMD were performed within 30 days of glucocorticoid initiation. Genant semiquantitative grading was used for vertebral morphometry. Second metacarpal morphometry was carried out on a hand radiograph. Clinical factors including disease and physical activity, calcium and vitamin D intake, cumulative glucocorticoid dose, underlying diagnosis, Lspine BMD Z score, and back pain were analyzed for association with vertebral fracture.ResultsThirteen vertebral fractures were noted in 9 children 7. Of these, 6 patients had a single vertebral fracture and 3 had 2–3 fractures. Fractures were clustered in the midthoracic region 69. Three vertebral fractures 23 were moderate grade 2; the others were mild grade 1. For the entire cohort, mean ± SD Lspine BMD Z score was significantly different from zero −0.55 ± 1.2, P< 0.001 despite a mean height Z score that was similar to the healthy average 0.02 ± 1.0, P 0.825. Back pain was highly associated with increased odds for fracture odds ratio 10.6 95 confidence interval 2.1–53.8, P 0.004.ConclusionIn pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged glucocorticoid exposure.

Published
2010
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48. Antibiotics for acute otitis media: a meta-analysis with individual patient data

Author

Rovers, M.M., Glasziou, P., Appelman, C.L., Burke, P., McCormick, D.P., Damoiseaux, R.A., Gaboury, I., Little, P., and Hoes, A.W.

Abstract

Background: Individual trials to test effectiveness of antibiotics in children with acute otitis media have been too small for valid subgroup analyses. We aimed to identify subgroups of children who would and would not benefit more than others from treatment with antibiotics. Methods: We did a meta-analysis of data from six randomised trials of the effects of antibiotics in children with acute otitis media. Individual patient data from 1643 children aged from 6 months to 12 years were validated and re-analysed. We defined the primary outcome as an extended course of acute otitis media, consisting of pain, fever, or both at 3-7 days. Findings: Significant effect modifications were noted for otorrhoea, and for age and bilateral acute otitis media. In children younger than 2 years of age with bilateral acute otitis media, 55% of controls and 30% on antibiotics still had pain, fever, or both at 3-7 days, with a rate difference between these groups of -25% (95% CI -36% to -14%), resulting in a number-needed-to-treat (NNT) of four children. We identified no significant differences for age alone. In children with otorrhoea the rate difference and NNT, respectively, were -36% (-53% to -19%) and three, whereas in children without otorrhoea the equivalent values were -14% (-23% to -5%) and eight. Interpretation: Antibiotics seem to be most beneficial in children younger than 2 years of age with bilateral acute otitis media, and in children with both acute otitis media and otorrhoea. For most other children with mild disease an observational policy seems justified.

Published
2006
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