352 results on '"Heels-Ansdell D"'
Search Results
2. Patient coping and expectations predict recovery after major orthopaedic trauma
- Author
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Busse, J.W., Heels-Ansdell, D., Makosso-Kallyth, S., Petrisor, B., Jeray, K., Tufescu, T., Laflamme, Y., McKay, P., McCabe, R.E., Le Manach, Y., and Bhandari, M.
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- 2019
- Full Text
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3. Femoroacetabular Impingement Randomised controlled Trial (FIRST) - a multi-centre randomized controlled trial comparing arthroscopic lavage and arthroscopic osteochondroplasty on patient important outcomes and quality of life in the treatment of young adult (18–50 years) femoroacetabular impingement: a statistical analysis plan
- Author
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Simunovic, Nicole, Heels-Ansdell, D., Thabane, L., Ayeni, O. R., and on behalf of the FIRST Investigators
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- 2018
- Full Text
- View/download PDF
4. Factors associated with health-related quality of life, hip function, and health utility after operative management of femoral neck fractures
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Sprague, S., Bhandari, M., Heetveld, M. J., Liew, S., Scott, T., Bzovsky, S., Heels-Ansdell, D., Zhou, Q., Swiontkowski, M., and Schemitsch, E. H.
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- 2018
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5. Wound irrigation does not affect healthrelated quality of life after open fractures: results of a randomized controlled trial
- Author
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Sprague, S., Petrisor, B., Jeray, K., McKay, P., Heels-Ansdell, D., Schemitsch, E., Liew, S., Guyatt, G., Walter, S. D., and Bhandari, M.
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- 2018
- Full Text
- View/download PDF
6. Comparison of Prophylactic Intravenous Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors: A Randomized Clinical Trial
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Ghert, M., Schneider, P., Guyatt, G., Thabane, L., Velez, R., O'Shea, T., Randall, R.L., Turcotte, R., Wilson, D., Wunder, J.S., Baptista, A.M., Cheng, E.Y., Doung, Y.C., Ferguson, P.C., Giglio, V., Hayden, J., Heels-Ansdell, D., Khan, S.A., Kumar, V.S., McKay, P., Miller, B., Sande, M. van de, Zumarraga, J.P., Bhandari, M., and Prophylactic Antibiotic Regimens T
- Subjects
Adult ,Male ,Cancer Research ,Oncology ,Lower Extremity ,Humans ,Surgical Wound Infection ,Bone Neoplasms ,Antibiotic Prophylaxis ,United States ,Anti-Bacterial Agents - Abstract
IMPORTANCE The use of perioperative, prophylactic, intravenous antibiotics is standard practice to reduce the risk of surgical site infection after oncologic resection and complex endoprosthetic reconstruction for lower extremity bone tumors. However, evidence guiding the duration of prophylactic treatment remains limited.OBJECTIVE To assess the effect of a 5-day regimen of postoperative, prophylactic, intravenous antibiotics compared with a 1-day regimen on the rate of surgical site infections within 1 year after surgery.DESIGN, SETTING, AND PARTICIPANTS This randomized clinical superiority trial was performed at 48 clinical sites in 12 countries from January 1, 2013, to October 29, 2019. The trial included patients with a primary bone tumor or a soft tissue sarcoma that had invaded the femur or tibia or oligometastatic bone disease of the femur or tibia with expected survival of at least 1 year who required surgical management by excision and endoprosthetic reconstruction. A total of 611 patients were enrolled, and 7 were exduded for ineligibility.INTERVENTIONS A 1- or 5-day regimen of postoperative prophylactic intravenous cephalosporin (cefazolin or cefuroxime) that began within 8 hours after skin closure and was administered every 8 hours thereafter. Those randomized to the 1-day regimen received identical saline doses every 8 hours for the remaining 4 days; patients, care providers, and outcomes assessors were blinded to treatment regimen.MAIN OUTCOMES AND MEASURES The primary outcome in this superiority trial was a surgical site infection (superficial incisional, deep incisional, or organ space) classified according to the criteria established by the Centers for Disease Control and Prevention within 1year after surgery. Secondary outcomes included antibiotic-related complications, unplanned additional operations, oncologic and functional outcomes, and mortality.RESULTS Of the 604 patients included in the final analysis (mean [SD] age, 41.2 [21.9] years; 361 [59.8%] male; 114 [18.9%] Asian, 43 [7.1%) Black, 34 [5.6%] Hispanic, 15 [2.5%] Indigenous, 384 [63.8%] White. and 12 [2.0%] other), 293 were randomized to a 5-day regimen and 311 to a 1-day regimen. A surgical site infection occurred in 44 patients (15.0%) allocated to the 5-day regimen and in 52 patients (16.7%) allocated to the 1-day regimen (hazard ratio, 0.93; 95% CI, 0.62-1.40; P = .73). Antibiotic-related complications occurred in 15 patients (5.1%) in the 5-day regimen and in 5 patients (1.6%) allocated to the 1-day regimen (hazard ratio, 3.24; 95% CI, 1.17-8.98; P = .02). Other secondary outcomes did not differ significantly between treatment groups.CONCLUSIONS AND RELEVANCE This randomized clinical trial did not confirm the superiority of a 5-day regimen of postoperative intravenous antibiotics over a 1-day regimen in preventing surgical site infections after surgery for lower extremity bone tumors that required an endoprosthesis. The 5-day regimen group had significantly more antibiotic-related complications.
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- 2022
7. Fluid type and the use of renal replacement therapy in sepsis: a systematic review and network meta-analysis
- Author
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Rochwerg, B., Alhazzani, W., Gibson, A, Ribic, C. M., Sindi, A., Heels-Ansdell, D., and Thabane, L.
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Medical research -- Analysis ,Medicine, Experimental -- Analysis ,Infection -- Care and treatment ,Septic shock -- Care and treatment ,Health care industry - Abstract
Fluid resuscitation, along with the early administration of antibiotics, is the cornerstone of treatment for patients with sepsis. However, whether differences in resuscitation fluids impact on the requirements for renal replacement therapy (RRT) remains unclear. To examine this issue, we performed a network meta-analysis (NMA), including direct and indirect comparisons, that addressed the effect of different resuscitation fluids on the use of RRT in patients with sepsis. The data sources MEDLINE, EMBASE, ACPJC, CINAHL and Cochrane Central Register were searched up to March 2014. Eligible studies included randomized trials reported in any language that enrolled adult patients with sepsis or septic shock and addressed the use of RRT associated with alternative resuscitation fluids. The risk of bias for individual studies and the overall certainty of the evidence were assessed. Ten studies (6664 patients) that included a total of nine direct comparisons were assessed. NMA at the four-node level showed that an increased risk of receiving RRT was associated with fluid resuscitation with starch versus crystalloid [odds ratio (OR) 1.39, 95 % credibility interval (CrI) 1.17-1.66, high certainty]. The data suggested no difference between fluid resuscitation with albumin and crystalloid (OR 1.04, 95 % CrI 0.78-1.38, moderate certainty) or starch (OR 0.74, 95 % CrI 0.53-1.04, low certainty). NMA at the six-node level showed a decreased risk of receiving RRT with balanced crystalloid compared to heavy starch (OR 0.50, 95 % CrI 0.34-0.74, moderate certainty) or light starch (OR 0.70, 95 % CrI 0.49-0.99, high certainty). There was no significant difference between balanced crystalloid and saline (OR 0.85, 95 % CrI 0.56-1.30, low certainty) or albumin (OR 0.82, 95 % CrI 0.49-1.37, low certainty). Of note, these trials vary in terms of case mix, fluids evaluated, duration of fluid exposure and risk of bias. Imprecise estimates contributed to low confidence in most estimates of effect. Among the patients with sepsis, fluid resuscitation with crystalloids compared to starch resulted in reduced use of RRT; the same may be true for albumin versus starch., Author(s): B. Rochwerg [sup.1], W. Alhazzani [sup.1] [sup.2], A Gibson [sup.1], C. M. Ribic [sup.1], A. Sindi [sup.3], D. Heels-Ansdell [sup.4], L. Thabane [sup.4], A. Fox-Robichaud [sup.1], L. Mbuagbaw [sup.4], [...]
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- 2015
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8. A Machine Learning Algorithm to Identify Patients at Risk of Unplanned Subsequent Surgery After Intramedullary Nailing for Tibial Shaft Fractures
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Bhandari, M., Bulstra, A.E.J., Bzovsky, S., Doornberg, J.N., Goslings, J.C., Hendrickx, L.A.M., Jaarsma, R.L., Jeray, K.J., Kerkhoffs, G.M.M.J., Petrisor, B., Ring, D., Schemitsch, E.H., Swiontkowski, M., Sanders, D., Sprague, S., Tornetta, P., Walter, S.D., Heels-Ansdell, D., Buckingham, L., Leece, P., Viveiros, H., Mignott, T., Ansell, N., Sidorkewicz, N., Agel, J., Bombardier, C., Berlin, J.A., Bosse, M., Browner, B., Gillespie, B., Jones, A., O'Brien, P., Poolman, R., Macleod, M.D., Carey, T., Leitch, K., Bailey, S., Gurr, K., Konito, K., Bartha, C., Low, I., MacBean, L.V., Ramu, M., Reiber, S., Strapp, R., Tieszer, C., Kreder, H.J., Stephen, D.J.G., Axelrod, T.S., Yee, A.J.M., Richards, R.R., Finkelstein, J., Gofton, W., Murnaghan, J., Schatztker, J., Ford, M., Bulmer, B., Conlan, L., Laflamme, G.Y., Berry, G., Beaumont, P., Ranger, P., Laflamme, G.H., Gagnon, S., Malo, M., Fernandes, J., Poirier, M.F., McKee, M.D., Waddell, J.P., Bogoch, E.R., Daniels, T.R., McBroom, R.R., Vicente, M.R., Storey, W., Wild, L.M., McCormack, R., Perey, B., Goetz, T.J., Pate, G., Penner, M.J., Panagiotopoulos, K., Pirani, S., Dommisse, I.G., Loomer, R.L., Stone, T., Moon, K., Zomar, M., Webb, L.X., Teasdall, R.D., Birkedal, J.P., Martin, D.F., Ruch, D.S., Kilgus, D.J., Pollock, D.C., Harris, M.B., Wiesler, E.R., Ward, W.G., Shilt, J.S., Koman, A.L., Poehling, G.G., Kulp, B., Creevy, W.R., Stein, A.B., Bono, C.T., Einhorn, T.A., Brown, T.D., Pacicca, D., Sledge, J.B., Foster, T.E., Voloshin, I., Bolton, J., Carlisle, H., Shaughnessy, L., Obremskey, W.T., LeCroy, C.M., Meinberg, E.G., Messer, T.M., Craig, W.L., Dirschl, D.R., Caudle, R., Harris, T., Elhert, K., Hage, W., Jones, R., Piedrahita, L., Schricker, P.O., Driver, R., Godwin, J., Kregor, P.J., Tennent, G., Truchan, L.M., Sciadini, M., Shuler, F.D., Driver, R.E., Nading, M.A., Neiderstadt, J., Vap, A.R., Vallier, H., Patterson, B.M., Wilber, J.H., Wilber, R.G., Sontich, J.K., Moore, T.A., Brady, D., Cooperman, D.R., Davis, J.A., Cureton, B.A., Mandel, S., Orr, R.D., Sadler, J.T.S., Hussain, T., Rajaratnam, K., Drew, B., Bednar, D.A., Kwok, D.C.H., Pettit, S., Hancock, J., Cole, P.A., Smith, J.J., Brown, G.A., Lange, T.A., Stark, J.G., Levy, B.A., Garaghty, M.J., Salzman, J.G., Schutte, C.A., Tastad, L., Vang, S., Seligson, D., Roberts, C.S., Malkani, A.L., Sanders, L., Dyer, C., Heinsen, J., Smith, L., Madanagopal, S., Frantz-Bush, L., Coupe, K.J., Tucker, J.J., Criswell, A.R., Buckle, R., Rechter, A.J., Sheth, D.S., Urquart, B., Trotscher, T., Anders, M.J., Kowalski, J.M., Fineberg, M.S., Bone, L.B., Phillips, M.J., Rohrbacher, B., Stegemann, P., Mihalko, W.M., Buyea, C., Augustine, S.J., Jackson, W.T., Solis, G., Ero, S.U., Segina, D.N., Berrey, H.B., Agnew, S.G., Fitzpatrick, M., Campbell, L.C., Derting, L., McAdams, J., Ponsen, K.J., Luitse, J., Kloen, P., Joosse, P., Winkelhagen, J., Duivenvoorden, R., Teague, D.C., Davey, J., Sullivan, J.A., Ertl, W.J.J., Puckett, T.A., Pasque, C.B., Tompkins, J.F., Gruel, C.R., Kammerlocher, P., Lehman, T.P., Puffinbarger, W.R., Carl, K.L., Weber, D.W., Jomha, N.M., Goplen, G.R., Masson, E., Beaupre, L.A., Greaves, K.E., Schaump, L.N., Goetz, D.R., Westberry, D.E., Broderick, J.S., Moon, B.S., Tanner, S.L., Powell, J.N., Buckley, R.E., Elves, L., Connolly, S., Abraham, E.P., Steele, T., Ellis, T., Herzberg, A., Crawford, D.E., Hart, R., Hayden, J., Orfaly, R.M., Vigland, T., Vivekaraj, M., Bundy, G.L., Miclau, T., Matityahu, A., Coughlin, R.R., Kandemir, U., McClellan, R.T., Lin, C.H.H., Karges, D., Cramer, K., Watson, J.T., Moed, B., Scott, B., Beck, D.J., Orth, C., Puskas, D., Clark, R., Jones, J., Egol, K.A., Paksima, N., France, M., Wai, E.K., Johnson, G., Wilkinson, R., Gruszczynski, A.T., Vexler, L., Mallee, W.H., Schipper, I.B., and SPRINT Investigators
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prediction model ,intramedullary nailing ,machine learning ,subsequent surgery ,tibia shaft fracture ,Orthopedics and Sports Medicine ,Surgery ,General Medicine - Abstract
Objectives: In the SPRINT trial, 18% of patients with a tibial shaft fracture (TSF) treated with intramedullary nailing (IMN) had one or more unplanned subsequent surgical procedures. It is clinically relevant for surgeon and patient to anticipate unplanned secondary procedures, other than operations that can be readily expected such as reconstructive procedures for soft tissue defects. Therefore, the objective of this study was to develop a machine learning (ML) prediction model using the SPRINT data that can give individual patients and their care team an estimate of their particular probability of an unplanned second surgery. Methods: Patients from the SPRINT trial with unilateral TSFs were randomly divided into a training set (80%) and test set (20%). Five ML algorithms were trained in recognizing patterns associated with subsequent surgery in the training set based on a subset of variables identified by random forest algorithms. Performance of each ML algorithm was evaluated and compared based on (1) area under the ROC curve, (2) calibration slope and intercept, and (3) the Brier score. Results: Total data set comprised 1198 patients, of whom 214 patients (18%) underwent subsequent surgery. Seven variables were used to train ML algorithms: (1) Gustilo-Anderson classification, (2) Tscherne classification, (3) fracture location, (4) fracture gap, (5) polytrauma, (6) injury mechanism, and (7) OTA/AO classification. The best-performing ML algorithm had an area under the ROC curve, calibration slope, calibration intercept, and the Brier score of 0.766, 0.954, -0.002, and 0.120 in the training set and 0.773, 0.922, 0, and 0.119 in the test set, respectively. Conclusions: An ML algorithm was developed to predict the probability of subsequent surgery after IMN for TSFs. This ML algorithm may assist surgeons to inform patients about the probability of subsequent surgery and might help to identify patients who need a different perioperative plan or a more intensive approach.
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- 2021
9. Problems with Use of Composite End Points in Cardiovascular Trials: Systematic Review of Randomised Controlled Trials
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Ferreira-González, I., Busse, J. W., Heels-Ansdell, D., Montori, V. M., Akl, E. A., Bryant, D. M., Alonso, J., Jaeschke, R., Schünemann, H. J., Permanyer-Miralda, G., Domingo-Salvany, A., and Guyatt, G. H.
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- 2007
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10. Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture
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Comeau-Gauthier, M., Zura, R.D., Bzovsky, S., Schemitsch, E.H., Axelrod, D., Avram, V., Manjoo, A., Poolman, R.W., Frihagen, F., Heels-Ansdell, D., Bhandari, M., Sprague, S., and HLTH Investigators
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Male ,Reoperation ,musculoskeletal diseases ,medicine.medical_specialty ,WOMAC ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Osteoarthritis ,Severity of Illness Index ,Article ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Prevalence ,Medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Prospective Studies ,Femoral neck ,Randomized Controlled Trials as Topic ,Hip surgery ,030222 orthopedics ,Hip fracture ,business.industry ,Proportional hazards model ,Ossification, Heterotopic ,General Medicine ,Middle Aged ,medicine.disease ,Arthroplasty ,Surgery ,Femoral Neck Fractures ,medicine.anatomical_structure ,Treatment Outcome ,Quality of Life ,Heterotopic ossification ,Female ,business ,Follow-Up Studies - Abstract
Background: Heterotopic ossification (HO) is a frequent complication following hip surgery. Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we aimed to (1) determine the prevalence of HO following total hip arthroplasty (THA) for femoral neck fracture in patients ≥50 years of age, (2) identify whether HO is associated with an increased risk of revision surgery within 24 months after the fracture, and (3) determine the impact of HO on functional outcomes. Methods: We performed a multivariable Cox regression analysis using revision surgery as the dependent variable and HO as the independent variable. We compared Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between participants with and those without HO at 24 months. Results: Of 1,441 participants in the study, 287 (19.9%) developed HO within 24 months. HO was not associated with subsequent revision surgery. Grade-III HO was associated with statistically significant and clinically relevant deterioration in the total WOMAC score, which was mainly related to the function component of the score, compared with grade I or II. Conclusions: The impact of grade-III HO on the functional outcomes and quality of life after THA for hip fracture is clinically important, and HO prophylaxis for selected high-risk patients may be appropriate. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2021
11. Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis
- Author
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Sallinen, V., Akl, E. A., You, J. J., Agarwal, A., Shoucair, S., Vandvik, P. O., Agoritsas, T., Heels-Ansdell, D., Guyatt, G. H., and Tikkinen, K. A.O.
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- 2016
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12. Physicians declining patient enrollment in a critical care trial: a case study in thromboprophylaxis
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Cook, D., Arabi, Y., Ferguson, N. D., Heels-Ansdell, D., Freitag, A., McDonald, E., and Clarke, F.
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Physicians -- Case studies -- Analysis ,Health care industry - Abstract
Purpose To analyze the frequency, rationale and determinants of attending physicians requesting that their eligible patients not be approached for participation in a thromboprophylaxis trial. Methods Research personnel in 67 centers prospectively documented eligible non-randomized patients due to physicians declining to allow their patients to be approached. Results In 67 centers, 3,764 patients were enrolled, but 1,460 eligible patients had no consent encounter. For 218 (14.9 %) of these, attending physicians requested that their patients not be approached. The most common reasons included a high risk of bleeding (31.2 %) related to fear of heparin bioaccumulation in renal failure, the presence of an epidural catheter, peri-operative status or other factors; specific preferences for thromboprophylaxis (12.4 %); morbid obesity (9.6 %); uncertain prognosis (6.4 %); general discomfort with research (3.7 %) and unclear reasons (17.0 %). Physicians were more likely to decline when approached by less experienced research personnel; considering those with >10 years of experience as the reference category, the odds ratios (OR) for physician refusals to personnel without trial experience was 10.47 [95 % confidence interval (CI) 2.19-50.02] and those with less than 10 years experience was 1.72 (95 % CI 0.61-4.84). Physicians in open rather than closed units were more likely to decline (OR 4.26; 95 % CI 1.27-14.34). Refusals decreased each year of enrollment compared to the pilot phase. Conclusions Tracking, analyzing, interpreting and reporting the rates and reasons for physicians declining to allow their patients to be approached for enrollment provides insights into clinicians' concerns and attitudes to trials. This information can encourage physician communication and education, and potentially enhance efficient recruitment., Author(s): D. Cook [sup.1] [sup.2], Y. Arabi [sup.5], N. D. Ferguson [sup.6] [sup.7] [sup.8], D. Heels-Ansdell [sup.4], A. Freitag [sup.3], E. McDonald [sup.4], F. Clarke [sup.4], S. Keenan [sup.9], G. [...]
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- 2013
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13. 1821P High serum FSH/T ratio as a marker for the development of cardiovascular disease in ADT recipients
- Author
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Pinthus, J.H., Margel, D., Subramony Gayathri, V., Duceppe, E., Yousef, S., Naeim, M., Khajehei, M., Hopmans, S., Popovic, S., Ber, Y., Heels-Ansdell, D., Devereaux, P.J., and Duivenvoorden, W.C.M.
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- 2023
- Full Text
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14. The Effects of the Serious Illness Care Program (SICP) on Health Care Resource Utilization (HRU)
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Muscedere, John, Truelove, Amber Hastings, Stockley, Denise, Fowler, Jennifer, Barrie, Carol, Hafid, A., Guenter, D., Gallagher, E., Howard, M., You, J., Nidumolu, A., Lagrotteria, A., Motehayerarani, A., Virk, N., Sinnarajah, A., Human, T., Ying, I., Wong, H., Cummings, G., Pattullo, A., Wang, J., Lee, J., Moffat, D., Grinman, M., Montgomery, C. L., Rolfson, D. B., Stelfox, H. T., Zuege, D., Zygun, D. A., Hudson, D., Opgenorth, D., Bagshaw, S. M., Laur, C., Bell, J., Valaitis, R., Ray, S., Keller, H., Prevett, C., Fang, H., Shkredova, D., Xie, F., Zoratti, M., Gordon, C., Adachi, J., Phillips, S., Richardson, J., Tang, A., Ma, C., Riehm, L., Kendell, C., Urquhart, R., Burge, F., Kotecha, J., Martin, M., Jorgensen, M., Han, H., Dubé, D., Gutman, G., Sussman, T., DeVries, B., Gahagan, J., Brotman, S., Koo, E., Wegier, P., Embuldeniya, G., Ansari, S., Kobewka, D., O’Connor, E., Wu, P., Steinberg, L., Bell, C., Walton, T., Colstello, J., van Walraven, C., Downar, J., Wu, P. E., Costello, J., Wu, R., Frost, D., Kawaguchi, S., Mahtani, R., Toor, H., Goldman, R., Myers, J., Forster, A., Hladkowicz, E., Taljaard, M., Bryson, G., Beaulé, P. E., Gagné, S., Hamilton, G., Huang, A., Joanisse, J. A., Lavallée, L. T., MacDonald, D., Moloo, H., Thavorn, K., Yang, H., Forster, A. J., McIsaac, D. I., Sypes, E. E., de Grood, C., Parsons Leigh, J., Clement, F. M., Niven, D. J., Bitschy, A. M., Donald, E., Ewing, G., Grande, G., Sawatzky, R., Stajduhar, K. I., Parascandalo, F., Yu-Hin Siu, H., Delleman, B., Langevin, J., Mangin, D., Fang, Q., Price, D., Chan, D., Ting Wang, H., Nguyen, Q. D., Menard, C. A., Morinville, A., Hirdes, J. P., Hebert, P., Singh, J., Swinton, M., Morrison, J. M., Laur, C. V., Ebad, M., Dubin, J. A., Chen, H., Curtis, L.J., Bell, J. J., Gramlich, L. M., Keller, H. H., Dionne, J., Duan, E., Clarke, F., Hand, L., Millen, T., Sandu, G., Hodder, J., Santos, M., Shah, S., Trembley, M., Gomes, B., Leclair, L., Montroy, K., Watpool, I., Porteous, R., Acres, S., Foster, D., Auld, F., Williams, V., Marchand, J., Campisi, J., Alam, N., Lebrassier, M., Thompson, P., Hewer, T., Gilles, D., Hunt, M., Georgescu, I., Boyd, T., Lys, J., Marten, N., Campbell, E., Bentall, T., Kavikondala, K., Willems, S., Panchbhaya, Z., Booth, J., Ruddell, S., Richter, B., Tassy, D., Jesso, R., Marinoff, N., Perez, A., Kaur, N., Campbell, T., Lizotte, P., Lavoie, L., Dionne, M., Saunders, L., Zytaruk, N., Heels-Ansdell, D., Johnstone, J., Cook, D., Quinn, K. L., Campitelli, M. A., Diong, C., Daneman, N., Stall, N., Morris, A. M., Detsky, A. S., Jeffs, L., Maxwell, C. J., Bell, C. M., Bronskill, S. E., Alghamdi, M., Baracos, V., Karvellas, C., Churchill, T., Khadaroo, R. G., Moorhouse, P., Sampalli, T., Bedford, L., Edwards, L., Gibson, R., Mallery, L., Taylor, D., Warner, G., Harnish, A., Law, V., Lawson, B. J., Wood, S., Buckler, M., Fernandes, P., Elliott, J., Stolee, P., Ali, G., Dunichand-Hoedl, A., Salim, S. Y., Mazurak, V. C., Baracos, V. E., Heckman, G. A., Hebert, P. C., Costa, A. P., Arthur, S. A., Jones, A., Salam-White, L., Tanner, D., Negm, A. M., Kennedy, C. C., Ioannidis, G., Gajic-Veljanoski, O., Thabane, L., Adachi, J. D., Marr, S., Lau, A., Atkinson, S., Petruccelli, D., DeBeer, J., Winemaker, M., Avram, V., Williams, D., Armstrong, D., Lumb, B., Panju, A., Papaioannou, A., Boucher, A., Haesebaert, J., Freitas, A., Adekpedjou, R., Landry, M., Bourassa, H., Dawn, S., Croteau, J., Légaré, F., Takaoka, A. M., Clarke, F. J., Shears, M. S., Muscedere, J., Cook, D. J., Lee, A., Bouchard, D. R., Sénéchal, M., Mayo, A., Hrubeniuk, T. J., Keshavarz, M., Robertson, C., Read, E. A., Norris, C M., Meyer, S. R., Zibdawi, M., Marshall, H. D., Moody, E. M., Martin-Misener, R., Hawken, E. R., Boyd, J. G., Im, J., Mak, S., Upshur, R., Steinbreg, L., Kuluski, K., Van Damme, J., Delvin, M-E., Medves, J., Woddhouse, K., Sakamoto, M. L., Durepos, P., Ploeg, J., Akhtar-Danesh, N., Punia, H., Kaasalainen, S., Hewston, P., Kennedy, C., Merom, D., Patterson, C., Sztramko, R., Trainor, L., Grenier, A., Woolhouse, M., Petrella, A.F.M., Heath, M., Hyland, B., Fan, M., Hamilton, M., Reding, R., Trbovich, P., O’Reilly, D. M., O’Donnell, S., Bruning, P., Donovan, J., Anoveros-Barrera, A., Coletta, G., Jakubowski, J., Pritchard, J. M., Werner, G. E., Hoben, M., Estabrooks, C. A., Leaker, H. R., Holroyd-Leduc, J., Fox, L., Smallbone, J., Stinchcombe, A., Wilson, K., Kortes-Miller, K., Rees-Milton, K. J., Hulbert, M., Turner, M. E., Berger, C., Anastassiades, T. P., Hopman, W. M., Adams, M. A., Powley, W. L., Holden, R. M., Grewal, K., Sheets, D., Smith, A. P., Trites, M., Kennedy, M., MacDonald, S., Sivarajah, L., Lamarche, L., Giangregorio, A., Radcliffe, S., Ioannidi, G., Negm, A., Connolly, M. S., Klein, J. M., Huber, J. S., Safaraz, S., Foster, A. J., Simpson, J. A., Brunt, K.R., Elfassy, M. D., Munshi, L., Mehta, N., Martinez Guasch, F., Kamen, C., Burry, L., Soong, C., Mehta, S., McKay, S., Yetman, L., Slayter, J., McCollum, A., McGibbon, C. A., Jarrett, P., Robinson, B., Kolyvas, A., McCloskey, R., Gionet, S., Scheme, E., Harris, B., D’Aoust, T. R., Shao, T., Egan, R., Muscedere, J. G., Milne, B., Fitzpatrick, M., Yingwei Peng, P., Parlow, J., and Johnson, A. P.
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Abstracts - Published
- 2019
15. Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients A Randomized Clinical Trial
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Johnstone, J, Meade, M, Lauzier, F, Marshall, J, Duan, E, Dionne, J, Arabi, YM, Heels-Ansdell, D, Thabane, L, Lamarche, D, Surette, M, Zytaruk, N, Mehta, S, Dodek, P, McIntyre, L, English, S, Rochwerg, B, Karachi, T, Henderson, W, Wood, G, Ovakim, D, Herridge, M, Granton, J, Wilcox, ME, Goffi, A, Stelfox, HT, Niven, D, Muscedere, J, Lamontagne, F, D'Aragon, F, St-Arnaud, C, Ball, I, Nagpal, D, Girard, M, Aslanian, P, Charbonney, E, Williamson, D, Sligl, W, Friedrich, J, Adhikari, NK, Marquis, F, Archambault, P, Khwaja, K, Kristof, A, Kutsogiannis, J, Zarychanski, R, Paunovic, B, Reeve, B, Lellouche, F, Hosek, P, Tsang, J, Binnie, A, Trop, S, Loubani, O, Hall, R, Cirone, R, Reynolds, S, Lysecki, P, Golan, E, Cartin-Ceba, R, Taylor, R, Cook, D, Mancebo J., and Gramish, Jawaher A.
- Abstract
Question Does the probiotic Lactobacillus rhamnosus GG prevent ventilator-associated pneumonia (VAP) among critically ill patients? Findings In this randomized trial involving 2650 patients, no significant difference in VAP incidence was found among patients treated with probiotics compared with placebo (21.9% vs 21.3%, respectively; hazard ratio 1.03; 95% CI 0.87-1.22). Meaning These findings do not support the use of Lactobacillus rhamnosus GG for prevention of ventilator-associated pneumonia in critically ill patients requiring mechanical ventilation. Importance Growing interest in microbial dysbiosis during critical illness has raised questions about the therapeutic potential of microbiome modification with probiotics. Prior randomized trials in this population suggest that probiotics reduce infection, particularly ventilator-associated pneumonia (VAP), although probiotic-associated infections have also been reported. Objective To evaluate the effect of Lactobacillus rhamnosus GG on preventing VAP, additional infections, and other clinically important outcomes in the intensive care unit (ICU). Design, Setting, and Participants Randomized placebo-controlled trial in 44 ICUs in Canada, the United States, and Saudi Arabia enrolling adults predicted to require mechanical ventilation for at least 72 hours. A total of 2653 patients were enrolled from October 2013 to March 2019 (final follow-up, October 2020). Interventions Enteral L rhamnosus GG (1 x 10(10) colony-forming units) (n = 1321) or placebo (n = 1332) twice daily in the ICU. Main Outcomes and Measures The primary outcome was VAP determined by duplicate blinded central adjudication. Secondary outcomes were other ICU-acquired infections including Clostridioides difficile infection, diarrhea, antimicrobial use, ICU and hospital length of stay, and mortality. Results Among 2653 randomized patients (mean age, 59.8 years [SD], 16.5 years), 2650 (99.9%) completed the trial (mean age, 59.8 years [SD], 16.5 years; 1063 women [40.1%.] with a mean Acute Physiology and Chronic Health Evaluation II score of 22.0 (SD, 7.8) and received the study product for a median of 9 days (IQR, 5-15 days). VAP developed among 289 of 1318 patients (21.9%) receiving probiotics vs 284 of 1332 controls (21.3%; hazard ratio [HR], 1.03 (95% CI, 0.87-1.22; P = .73, absolute difference, 0.6%, 95% CI, -2.5% to 3.7%). None of the 20 prespecified secondary outcomes, including other ICU-acquired infections, diarrhea, antimicrobial use, mortality, or length of stay showed a significant difference. Fifteen patients (1.1%) receiving probiotics vs 1 (0.1%) in the control group experienced the adverse event of L rhamnosus in a sterile site or the sole or predominant organism in a nonsterile site (odds ratio, 14.02; 95% CI, 1.79-109.58; P < .001). Conclusions and Relevance Among critically ill patients requiring mechanical ventilation, administration of the probiotic L rhamnosus GG compared with placebo, resulted in no significant difference in the development of ventilator-associated pneumonia. These findings do not support the use of L rhamnosus GG in critically ill patients. This clinical trial assessed whether Lactobacillus rhamnosus GG compared with placebo reduces ventilator-associated pneumonia and other clinically important outcomes for a broad range of critically ill patients.
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- 2021
16. Effects of higher--versus lower-protein diets on health outcomes: a systematic review and meta-analysis
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Santesso, N., Akl, E.A., Bianchi, M., Mente, A., Mustafa, R., Heels-Ansdell, D., and Schunemann, H.J.
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Reducing diets -- Research ,High-protein diet -- Research ,Food/cooking/nutrition ,Health - Abstract
BACKGROUND/OBJECTIVES: Numerous randomised controlled trials (RCTs) published in first tier medical journals have evaluated the health effects of diets high in protein. We conducted a rigorous systematic review of RCTs comparing higher- and lower-protein diets. METHODS: We searched several electronic databases up to July 2011 for studies focusing on patient-important outcomes (for example, cardiovascular disease) and secondary outcomes such as risk factors for chronic disease (for example, adiposity). RESULTS: We identified 111 articles reporting on 74 trials. Pooled effect sizes using standardised mean differences (SMDs) were small to moderate and favoured higher-protein diets for weight loss (SMD -0.36, 95% confidence interval (CI) -0.56 to -0.17), body mass index (-0.37, CI -0.56 to 0.19), waist circumference (-0.43, CI -0.69 to -0.16), blood pressure (systolic: -0.21, CI -0.32 to -0.09 and diastolic: -0.18, CI -0.29 to -0.06), high-density lipoproteins (HDL 0.25, CI 0.07 to 0.44), fasting insulin (-0.20, CI -0.39 to -0.01) and triglycerides (-0.51, CI -0.78 to -0.24). Sensitivity analysis of studies with lower risk of bias abolished the effect on HDL and fasting insulin, and reduced the effect on triglycerides. We observed nonsignificant effects on total cholesterol, low-density lipoproteins, C- reactive protein, HbA1c, fasting blood glucose, and surrogates for bone and kidney health. Adverse gastrointestinal events were more common with high-protein diets. Multivariable meta-regression analysis showed no significant dose response with higher protein intake. CONCLUSIONS: Higher-protein diets probably improve adiposity, blood pressure and triglyceride levels, but these effects are small and need to be weighed against the potential for harms. European Journal of Clinical Nutrition (2012) 66, 780-788; doi: 10.1038/ejcn.2012.37; published online 18 April 2012 Keywords: protein diet; GRADE; systematic review; weight loss; meta-analysis; randomised trial, INTRODUCTION International dietary guidelines recommend healthy diets with higher energy intake from carbohydrates, a lower energy intake from fat and a still lower energy intake from protein. (1-3) However, there [...]
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- 2012
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17. What factors increase revision surgery risk when treating displaced femoral neck fractures with arthroplasty
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Blankstein, M., Schemitsch, E.H., Bzovsky, S., Poolman, R.W., Frihagen, F., Axelrod, D., Heels-Ansdell, D., Bhandari, M., Sprague, S., Schottel, P.C., and HEALTH Investigators
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Reoperation ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Population ,Femoral Neck Fractures ,law.invention ,03 medical and health sciences ,Femoral head ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Humans ,Orthopedics and Sports Medicine ,education ,Aged ,Femoral neck ,030222 orthopedics ,education.field_of_study ,Hip fracture ,femoral neck fracture ,business.industry ,Bone Cements ,revision surgery ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,Arthroplasty ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Female ,Hemiarthroplasty ,business ,Body mass index - Abstract
Objectives HEALTH was a randomized controlled trial comparing total hip arthroplasty with hemiarthroplasty in low-energy displaced femoral neck fracture patients aged ≥50 years with unplanned revision surgery within 24 months of the initial procedure being the primary outcome. No significant short-term differences between treatment arms were observed. The primary objective of this secondary HEALTH trial analysis was to determine if any patient and surgical factors were associated with increased risk of revision surgery within 24 months after hip fracture. Methods We analyzed 9 potential factors chosen a priori that could be associated with revision surgery. The factors included age, body mass index, major comorbidities, independent ambulation, type of surgical approach, length of operation, use of femoral cement, femoral head size, and degree of femoral stem offset. Our statistical analysis was a multivariable Cox regression using reoperation within 24 months of index surgery as the dependent variable. Results Of the 1441 patients included in this analysis, 8.1% (117/1441) experienced reoperation within 24 months. None of the studied factors were found to be predictors of revision surgery (P > 0.05). Conclusion Both total and partial hip replacements are successful procedures in low-energy displaced femoral neck fracture patients. We were unable to identify any patient or surgeon-controlled factors that significantly increased the need for revision surgery in our elderly and predominately female patient population. One should not generalize our findings to an active physiologically younger femoral neck fracture population. Level of evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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- 2020
18. Predictors of long-term pain after hip arthroplasty in patients with femoral neck fractures
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Noori, A., Sprague, S., Bzovsky, S., Schemitsch, E.H., Poolman, R.W., Frihagen, F., Axelrod, D., Heels-Ansdell, D., Bhandari, M., Busse, J.W., and HEALTH Investigators
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medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Osteoarthritis ,Femoral Neck Fractures ,law.invention ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,pain ,hip arthroplasty ,hemiarthroplasty ,Aged ,Ontario ,030222 orthopedics ,Hip fracture ,femoral neck fracture ,business.industry ,Absolute risk reduction ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,Arthroplasty ,Confidence interval ,Treatment Outcome ,predictors ,Female ,Surgery ,business ,Cohort study - Abstract
Objectives To identify factors associated with the development of prolonged pain after hip fracture surgery. Design Secondary analysis of a randomized controlled trial. Setting Eighty hospitals in 10 countries. Patients/participants One thousand four hundred forty-one hip fracture patients in the HEALTH trial. Interventions Total hip arthroplasty or hemiarthroplasty. Main outcome measures Moderate-to-severe pain (at least 2 activities on the Western Ontario and McMaster Universities Osteoarthritis questionnaire pain subscale with scores ≥2) at 12 and 24 months after hip arthroplasty. Results Of 840 and 726 patients with complete baseline data and outcomes at 1-year and 2-year follow-up, 96 (11.4%) and 80 (11.0%) reported moderate-to-severe pain, respectively. An increased risk of pain at both 1 and 2 years after surgery was associated with reporting moderate-to-severe hip pain before fracture [absolute risk increase (ARI) 15.3%, 95% confidence interval (CI) 6.44%-24.35%; ARI 12.5%, 95% CI 2.85%-22.12%, respectively] and prefracture opioid use (ARI 15.6%, 95% CI 5.41%-25.89%; ARI 21.1%; 95% CI 8.23%-34.02%, respectively). Female sex was associated with an increased risk of persistent pain at 1 year (ARI 6.2%, 95% CI 3.53%-8.84%). A greater risk of persistent pain at 2 years was associated with younger age (≤79-year-old; ARI 6.3%; 95% CI 2.67%-9.91%) and higher prefacture functional status (ARI 10.7%; 95% CI 3.80%-17.64%). Conclusions Among hip fracture patients undergoing arthroplasty, approximately one in 10 will experience moderate-to-severe pain up to 2 years after surgery. Younger age, female sex, higher functioning prefracture, living with hip pain prefracture, and use of prescription opioids were predictive of persistent pain. Level of evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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- 2020
19. What predicts health-related quality of life for patients with displaced femoral neck fractures managed with arthroplasty?
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Axelrod, D., Comeau-Gauthier, M., Bzovsky, S., Schemitsch, E.H., Poolman, R.W., Frihagen, F., Guerra-Farfan, E., Heels-Ansdell, D., Bhandari, M., Sprague, S., and HEALTH Investigators
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medicine.medical_specialty ,WOMAC ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Population ,Osteoarthritis ,Femoral Neck Fractures ,femoral neck fractures ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,education ,Femoral neck ,030222 orthopedics ,education.field_of_study ,function ,business.industry ,Repeated measures design ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,Arthroplasty ,health-related quality of life ,Treatment Outcome ,medicine.anatomical_structure ,Quality of Life ,Surgery ,Hemiarthroplasty ,business - Abstract
BACKGROUND: Total hip arthroplasty (THA) has been argued to improve health-related quality of life (HRQoL) and function in femoral neck fracture patients compared with hemiarthroplasty (HA). The HEALTH trial showed no clinically important functional advantages of THA over HA. The current analysis explores factors associated with HRQoL and function in this population. METHODS: Using repeated measures regression, we estimated the association between HRQoL and function [Short Form-12 (SF-12) physical component score (PCS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score] and 23 variables. RESULTS: THA as compared to monopolar HA, but not bipolar HA, was more likely to improve PCS scores (adjusted mean difference [AMD] 1.88 points, P = 0.02), whereas higher American Society of Anesthesiologists score (AMD -2.64, P < 0.01), preoperative use of an aid (AMD -2.66, P < 0.01), and partial weight-bearing status postoperatively (AMD -1.38, P = 0.04) demonstrated less improvement of PCS scores over time. THA improved WOMAC function scores over time compared with monopolar HA (but not bipolar HA) (AMD -2.40, P < 0.01), whereas higher American Society of Anesthesiologists classification (AMD 1.99, P = 0.01) and preoperative use of an aid (AMD 5.39, P < 0.01) were associated with lower WOMAC function scores. Preoperative treatment for depression was associated with lower functional scores (AMD 7.73, P < 0.01). CONCLUSION: Patients receiving THA are likely to receive small and clinically unimportant improvements in health utility and function compared with those receiving monopolar HA and little improvement compared with those receiving bipolar HA. Patient-specific characteristics seem to play a larger role in predicting functional improvement among femoral neck fracture patients. LEVEL OF EVIDENCE: Prognostic Level II.
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- 2020
20. Arthroplasty versus internal fixation for the treatment of undisplaced femoral neck fractures
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Afaq, S., OʼHara, N.N., Schemitsch, E.H., Bzovsky, S., Sprague, S., Poolman, R.W., Frihagen, F., Heels-Ansdell, D., Bhandari, M., Tan, E.C.T.H., Kampen, A. van, Biert, J., Edwards, M.J.R., Frolke, J.P.M., Poelhekke, L.M.S.J., Waal Malefijt, M.C. de, Schreurs, B.W., Swiontkowski, M., and Slobogean, G.P.
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Male ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Femoral Neck Fractures ,law.invention ,03 medical and health sciences ,Fracture Fixation, Internal ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Risk of mortality ,internal fixation ,Internal fixation ,Humans ,Orthopedics and Sports Medicine ,undisplaced femoral neck fracture ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Mortality rate ,030208 emergency & critical care medicine ,Retrospective cohort study ,General Medicine ,Odds ratio ,Middle Aged ,Arthroplasty ,Surgery ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10] ,Treatment Outcome ,Quality of Life ,arthroplasty ,Female ,Hemiarthroplasty ,business - Abstract
Contains fulltext : 228684.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs). DESIGN: Retrospective cohort study. SETTING: Secondary data analysis of 2 multinational randomized controlled trials. PARTICIPANTS: Patients aged 50 years or older with a FNF. INTERVENTION: Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF. MAIN OUTCOME MEASUREMENT: The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life. RESULTS: The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44-0.72, P < 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32-0.55, P < 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6-3.8, P < 0.01). CONCLUSIONS: Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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- 2020
21. Factors Associated With Mortality After Surgical Management of Femoral Neck Fractures
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Bzovsky, S., Comeau-Gauthier, M., Schemitsch, E.H., Swiontkowski, M., Heels-Ansdell, D., Frihagen, F., Tan, E.C.T.H., Kampen, A. van, Biert, J., Edwards, M.J.R., Frölke, J.P., Poelhekke, L.M.S.J., Waal Malefijt, M.C. de, Bhandari, M., and Sprague, S.
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medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Femoral Neck Fractures ,03 medical and health sciences ,Fracture Fixation, Internal ,0302 clinical medicine ,Risk Factors ,Risk of mortality ,Medicine ,Internal fixation ,Humans ,Orthopedics and Sports Medicine ,Femoral neck ,Aged ,Retrospective Studies ,030222 orthopedics ,Hip fracture ,business.industry ,Hip Fractures ,Mortality rate ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,Arthroplasty ,Surgery ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,medicine.anatomical_structure ,Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10] ,business ,Kidney disease - Abstract
Contains fulltext : 228698.pdf (Publisher’s version ) (Closed access) BACKGROUND: Hip fractures are recognized as one of the most devastating injuries impacting older adults because of the complications that follow. Mortality rates postsurgery can range from 14% to 58% within one year of fracture. We aimed to identify factors associated with increased risk of mortality within 24 months of a femoral neck fracture in patients aged ≥50 years enrolled in the FAITH and HEALTH trials. METHODS: Two multivariable Cox proportional hazards regressions were used to investigate potential prognostic factors that may be associated with mortality within 90 days and 24 months of hip fracture. RESULTS: Ninety-one (4.1%) and 304 (13.5%) of 2247 participants died within 90 days and 24 months of suffering a femoral neck fracture, respectively. Older age (P < 0.001), lower body mass index (P = 0.002), American Society of Anesthesiologists (ASA) class III/IV/V (P = 0.004), use of an ambulatory aid before femoral neck fracture (P < 0.001), and kidney disease (P < 0.001) were associated with a higher risk of mortality within 24 months of femoral neck fracture. Older age (P = 0.03), lower body mass index (P = 0.02), use of an ambulatory aid before femoral neck fracture (P < 0.001), and having a comorbidity (P = 0.04) were associated with a higher risk of mortality within 90 days of femoral neck fracture. CONCLUSIONS: Our analysis found that factors that are indicative of a poorer health status were associated with a higher risk of mortality within 24 months of femoral neck fracture. We did not find a difference in treatment methods (internal fixation vs. joint arthroplasty) on the risk of mortality. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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- 2020
22. High-sensitivity troponin I predicts major cardiovascular events after noncardiac surgery
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Borges, F.K, primary, Duceppe, E, additional, Heels-Ansdell, D, additional, Ofori, S.N, additional, Marcucci, M, additional, Kavsak, P.A, additional, Pettit, S, additional, Spence, J, additional, Belley-Cote, E, additional, Lemanach, Y, additional, McGillion, M, additional, Whitlock, R, additional, Lamy, A, additional, and Devereaux, P.J, additional
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- 2020
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23. Reply to higher- versus lower-protein diets
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Santesso, N, Akl, E, Mente, A, Heels-Ansdell, D, and Schünemann, H J
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- 2012
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24. The Association between Frailty and Short-Term Outcomes in an Intensive Care Unit Rehabilitation Trial: An Exploratory Analysis
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Takaoka, A., primary, Heels-Ansdell, D., additional, Cook, D.J, additional, and Kho, M.E., additional
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- 2020
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25. Association between complications and death within 30 days after noncardiac surgery
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Spence, J., LeManach, Y., Chan, M.T.V., Wang, C.Y., Sigamani, A., Xavier, D., Pearse, R., Alonso-Coello, P., Garutti, I., Srinathan, S.K., Duceppe, E., Walsh, M., Borges, F.K., Málaga Rodríguez, Germán Javier, Abraham, V., Faruqui, A., Berwanger, O., Biccard, B.M., Villar, J.C., Sessler, D.I., Kurz, A., Chow, C.K., Polanczyk, C.A., Szczeklik, W., Ackland, G., Garg, A.X., Jacka, M., Guyatt, G.H., Sapsford, R.J., Williams, C., Cortes, O.L., Coriat, P., Patel, A., Tiboni, M., Belley-Côté, E.P., Yang, S., Heels-Ansdell, D., McGillion, M., Schünemann, H.J., Parlow, S., Patel, M., Pettit, S., Yusuf, S., Devereaux, P.J., and VISION Investigators
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Male ,surgical mortality ,patient monitoring ,Kaplan-Meier Estimate ,mortality rate ,noncardiac surgery ,sepsis ,Postoperative Complications ,Prospective Studies ,Prospective cohort study ,risk reduction ,Mortality rate ,adult ,Hazard ratio ,General Medicine ,Middle Aged ,cohort analysis ,aged ,female ,Surgical Procedures, Operative ,multicenter study (topic) ,Female ,Cohort study ,prospective study ,early diagnosis ,medicine.medical_specialty ,Postoperative Hemorrhage ,surgical technique ,Article ,Sepsis ,male ,Internal medicine ,medicine ,operative blood loss ,Humans ,controlled study ,human ,outcome assessment ,Aged ,Proportional hazards model ,business.industry ,disease association ,heart muscle injury ,Perioperative ,medicine.disease ,major clinical study ,Confidence interval ,purl.org/pe-repo/ocde/ford#3.02.00 [https] ,hospital discharge ,peroperative complication ,hospital admission ,early intervention ,Commentary ,mortality risk ,business - Abstract
BACKGROUND: Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications. METHODS: We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model. RESULTS: We included 40 004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2–3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9–2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6–6.8; AF 12.0%). INTERPRETATION: Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality. Study registration:ClinicalTrials.gov, no. NCT00512109.
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- 2019
26. Meta-analysis of flavonoids for the treatment of haemorrhoids
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Alonso-Coello, P., Zhou, Q., Martinez-Zapata, M. J., Mills, E., Heels-Ansdell, D., Johanson, J. F., and Guyatt, G.
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- 2006
27. Validation of a symptom diary for patients with gastro-oesophageal reflux disease
- Author
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PUHAN, M. A., GUYATT, G. H., ARMSTRONG, D., WIKLUND, I., FALLONE, C. A., HEELS-ANSDELL, D., DEGLʼINNOCENTI, A., VAN ZANTEN, S. J. O. VELDHUYZEN, TANSER, L., BARKUN, A. N., CHIBA, N., AUSTIN, P., EL-DIKA, S., and SCHÜNEMANN, H. J.
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- 2006
28. Do physicians correctly assess patient symptom severity in gastro-oesophageal reflux disease?
- Author
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FALLONE, C. A., GUYATT, G. H., ARMSTRONG, D., WIKLUND, I., DEGLʼINNOCENTI, A., HEELS-ANSDELL, D., BARKUN, A. N., CHIBA, N., VAN ZANTEN, S. J. O. V., EL-DIKA, S., AUSTIN, P., TANSER, L., and SCHÜNEMANN, H. J.
- Published
- 2004
29. In medical-surgical ICU patients, major bleeding is common but independent of heparin prophylaxis
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Lauzier, F, Arnold, D, Rabbat, C, Heels-Ansdell, D, Dodek, P, Ashley, B, Albert, M, Khwaja, K, Ostermann, M, Skrobik, Y, Fowler, R, McIntyre, L, Nates, J, Karachi, T, Lopes, R, Zytaruk, N, Crowther, M, and Cook, D
- Published
- 2012
- Full Text
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30. Consequences of suspected heparin-induced thrombocytopenia in the ICU
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Ostermann, M, McIntyre, L, Lauzier, F, Alhashemi, J, Qushmaq, I, Langevin, S, Dodek, P, Albert, M, Khwaja, K, Kutsiogiannis, J, Burry, L, Granton, J, Friedrich, J, Ferguson, N, Marshall, J, Finfer, S, Heels-Ansdell, D, Zytaruk, N, Cook, D, Sheppard, J, Warkentin, T, and Crowther, M
- Published
- 2012
- Full Text
- View/download PDF
31. Antiembolic stockings and pneumatic compression devices in a medical-surgical thromboprophylaxis trial
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Zytaruk, N, Heels-Ansdell, D, Vallance, S, Marshall, J, Skrobik, Y, Cooper, DJ, Finfer, S, Seppelt, I, Ostermann, M, Qushmaq, I, Alsultan, M, Arabi, Y, Alhashemi, J, Al-Hazmi, M, Alzem, A, Shaikh, N, Mandourah, Y, and Cook, DJ
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- 2011
- Full Text
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32. Upper extremity thromboses in medical-surgical critically ill patients
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Zytaruk, N, Lamontagne, F, McIntyre, L, Dodek, P, Vlahakis, N, Lewis, B, Schiff, D, Moody, A, Ostermann, M, Padayachee, S, Heels-Ansdell, D, Vallance, S, Davies, A, Cooper, JD, and Cook, DJ
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- 2011
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33. Are large clinical trials in orthopaedic trauma justified?
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Sprague, S, Tornetta, P, Slobogean, GP, O'Hara, NN, McKay, P, Petrisor, B, Jeray, KJ, Schemitsch, EH, Sanders, D, Bhandari, M, Guyatt, GH, Walter, S, Anglen, J, Bosse, M, Liew, S, Sancheti, P, Tai, K, Heels-Ansdell, D, Buckingham, L, Duraikannan, A, Tanner, SL, Snider, RG, Altman, D, Gandhi, R, Bischoff, M, Della Rocca, GJ, Ristevski, B, Rajaratnam, K, Williams, D, Denkers, M, Bednar, D, Sadler, J, Kwok, D, Drew, B, Wong, I, Madden, K, Hall, JA, McKee, MD, Ahn, H, Whelan, D, Waddell, J, Daniels, T, Bogoch, E, Nauth, A, Vicente, MR, Hidy, JT, Lawendy, AR, Gurr, K, Carey, T, Bailey, C, MacLeod, M, Bartley, D, Tieszer, C, Coles, C, Leighton, R, Richardson, CG, Biddulph, M, Gross, M, Dunbar, M, Amirault, JD, Alexander, D, Coady, C, Glazebrook, M, Johnston, D, Oxner, W, Trenholm, JA, Reardon, G, Trask, K, MacDonald, S, Papp, S, Gofton, W, Liew, A, Kingwell, S, O'Neill, J, Johnson, G, Wai, E, Foxall, J, Broekhuyse, HM, O'Brien, PJ, Blachut, PA, Lefaivre, KA, Johal, R, Leduc, S, Laflamme, GY, Beaumont, P, Malo, M, Benoit, B, Rouleau, D, Ranger, P, Fournier, J, Tardif, K, and Reindl, R
- Subjects
Reoperation ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Sports medicine ,medicine.medical_treatment ,Pilot Projects ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Epidemiology ,Medicine and Health Sciences ,Medicine ,Humans ,Multicenter Studies as Topic ,Orthopedics and Sports Medicine ,Orthopedic Procedures ,030212 general & internal medicine ,Therapeutic Irrigation ,Saline ,Orthopaedic trial ,Randomized Controlled Trials as Topic ,FLOW trial ,business.industry ,Sample size ,Confidence interval ,3. Good health ,Clinical trial ,Sample size determination ,Relative risk ,Orthopedic surgery ,Large trials ,lcsh:RC925-935 ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
The objective of this analysis is to evaluate the necessity of large clinical trials using FLOW trial data. The FLOW pilot study and definitive trial were factorial trials evaluating the effect of different irrigation solutions and pressures on re-operation. To explore treatment effects over time, we analyzed data from the pilot and definitive trial in increments of 250 patients until the final sample size of 2447 patients was reached. At each increment we calculated the relative risk (RR) and associated 95% confidence interval (CI) for the treatment effect, and compared the results that would have been reported at the smaller enrolments with those seen in the final, adequately powered study. The pilot study analysis of 89 patients and initial incremental enrolments in the FLOW definitive trial favored low pressure compared to high pressure (RR: 1.50, 95% CI: 0.75–3.04; RR: 1.39, 95% CI: 0.60–3.23, respectively), which is in contradiction to the final enrolment, which found no difference between high and low pressure (RR: 1.04, 95% CI: 0.81–1.33). In the soap versus saline comparison, the FLOW pilot study suggested that re-operation rate was similar in both the soap and saline groups (RR: 0.98, 95% CI: 0.50–1.92), whereas the FLOW definitive trial found that the re-operation rate was higher in the soap treatment arm (RR: 1.28, 95% CI: 1.04–1.57). Our findings suggest that studies with smaller sample sizes would have led to erroneous conclusions in the management of open fracture wounds. NCT01069315 (FLOW Pilot Study) Date of Registration: February 17, 2010, NCT00788398 (FLOW Definitive Trial) Date of Registration: November 10, 2008.
- Published
- 2018
34. Reducing Unnecessary Blood Tests in the Critically Ill (RUBIC): A Multi-Center Prospective Audit
- Author
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Khalifa, A., primary, Dodek, P.M., additional, Hillis, C., additional, Garland, A., additional, Duan, E., additional, Belley-Cote, E., additional, Kavsak, P., additional, Karachi, T.A., additional, Siegal, D., additional, Millen, T., additional, Heels-Ansdell, D., additional, Rahman, O., additional, Born, K., additional, English, S.W., additional, McCredie, V.A., additional, Charbonney, E., additional, Mbuagbaw, L., additional, Scales, D.C., additional, Bagshaw, S.M., additional, Amaral, A., additional, Meade, M.O., additional, Cook, D.J., additional, and Rochwerg, B., additional
- Published
- 2019
- Full Text
- View/download PDF
35. Wound irrigation does not affect health-related quality of life after open fractures: results of a randomized controlled trial
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Sprague, S., primary, Petrisor, B., additional, Jeray, K., additional, McKay, P., additional, Heels-Ansdell, D., additional, Schemitsch, E., additional, Liew, S., additional, Guyatt, G., additional, Walter, S. D., additional, and Bhandari, M., additional
- Published
- 2018
- Full Text
- View/download PDF
36. Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis
- Author
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Bassler, D, Briel, M, Montori, V, Lane, M, Glasziou, P, Zhou, Q, Heels-Ansdell, D, Walter, S, Guyatt, G, Flynn, D, Elamin, M, Murad, M, Abu Elnour, N, Lampropulos, J, Sood, A, Mullan, R, Erwin, P, Bankhead, C, Perera, R, Ruiz Culebro, C, You, J, Mulla, S, Kaur, J, Nerenberg, K, and Schünemann, H
- Abstract
CONTEXT: Theory and simulation suggest that randomized controlled trials (RCTs) stopped early for benefit (truncated RCTs) systematically overestimate treatment effects for the outcome that precipitated early stopping. OBJECTIVE: To compare the treatment effect from truncated RCTs with that from meta-analyses of RCTs addressing the same question but not stopped early (nontruncated RCTs) and to explore factors associated with overestimates of effect. DATA SOURCES: Search of MEDLINE, EMBASE, Current Contents, and full-text journal content databases to identify truncated RCTs up to January 2007; search of MEDLINE, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects to identify systematic reviews from which individual RCTs were extracted up to January 2008. STUDY SELECTION: Selected studies were RCTs reported as having stopped early for benefit and matching nontruncated RCTs from systematic reviews. Independent reviewers with medical content expertise, working blinded to trial results, judged the eligibility of the nontruncated RCTs based on their similarity to the truncated RCTs. DATA EXTRACTION: Reviewers with methodological expertise conducted data extraction independently. RESULTS: The analysis included 91 truncated RCTs asking 63 different questions and 424 matching nontruncated RCTs. The pooled ratio of relative risks in truncated RCTs vs matching nontruncated RCTs was 0.71 (95% confidence interval, 0.65-0.77). This difference was independent of the presence of a statistical stopping rule and the methodological quality of the studies as assessed by allocation concealment and blinding. Large differences in treatment effect size between truncated and nontruncated RCTs (ratio of relative risks
- Published
- 2016
37. Addressing continuous data measured with different instruments for participants excluded from trial analysis: a guide for systematic reviewers
- Author
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Ebrahim, S, Johnston, BC, Akl, EA, Mustafa, RA, Sun, X, Walter, SD, Heels-Ansdell, D, Alonso-Coello, P, and Guyatt, GH
- Subjects
Missing participant data ,Continuous outcomes ,Meta-analysis ,Systematic reviews ,Lost to follow-up ,Risk of bias - Abstract
Background: We previously developed an approach to address the impact of missing participant data in meta-analyses of continuous variables in trials that used the same measurement instrument. We extend this approach to meta-analyses including trials that use different instruments to measure the same construct. Methods: We reviewed the available literature, conducted an iterative consultative process, and developed an approach involving a complete-case analysis complemented by sensitivity analyses that apply a series of increasingly stringent assumptions about results in patients with missing continuous outcome data. Results: Our approach involves choosing the reference measurement instrument; converting scores from different instruments to the units of the reference instrument; developing four successively more stringent imputation strategies for addressing missing participant data; calculating a pooled mean difference for the complete-case analysis and imputation strategies; calculating the proportion of patients who experienced an important treatment effect; and judging the impact of the imputation strategies on the confidence in the estimate of effect. We applied our approach to an example systematic review of respiratory rehabilitation for chronic obstructive pulmonary disease. Conclusions: Our extended approach provides quantitative guidance for addressing missing participant data in systematic reviews of trials using different instruments to measure the same construct. (C) 2014 Elsevier Inc. All rights reserved.
- Published
- 2014
38. Covert stroke after non-cardiac surgery: a prospective cohort study
- Author
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Mrkobrada, M., primary, Hill, M.D., additional, Chan, M.T.V., additional, Sigamani, A., additional, Cowan, D., additional, Kurz, A., additional, Sessler, D.I., additional, Jacka, M., additional, Graham, M., additional, Dasgupta, M., additional, Dunlop, V., additional, Emery, D.J., additional, Gulka, I., additional, Guyatt, G., additional, Heels-Ansdell, D., additional, Murkin, J., additional, Pettit, S., additional, Sahlas, D.J., additional, Sharma, M., additional, Srinathan, S., additional, St John, P., additional, Tsai, S., additional, Gelb, A.W., additional, O’Donnell, M., additional, Siu, D., additional, Chiu, P.W.Y., additional, Sharath, V., additional, George, A., additional, and Devereaux, P.J., additional
- Published
- 2016
- Full Text
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39. Resident reflections on end-of-life education: a mixed-methods study of the 3 Wishes Project
- Author
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Centofanti, J, primary, Swinton, M, additional, Dionne, J, additional, Barefah, A, additional, Boyle, A, additional, Woods, A, additional, Shears, M, additional, Heels-Ansdell, D, additional, and Cook, D, additional
- Published
- 2016
- Full Text
- View/download PDF
40. Addressing continuous data for participants excluded from trial analysis: a guide for systematic reviewers
- Author
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Ebrahim, S, Akl, EA, Mustafa, RA, Sun, X, Walter, SD, Heels-Ansdell, D, Alonso-Coello, P, Johnston, BC, and Guyatt, GH
- Subjects
Missing participant data ,Continuous outcomes ,Meta-analysis ,Systematic reviews ,Lost to follow-up ,Risk of bias - Abstract
Background: No methods directly address the impact of missing participant data for continuous outcomes in systematic reviews on risk of bias. Methods: We conducted a consultative, iterative process to develop a framework for handling missing participant data for continuous outcomes. We considered sources reflecting real observed outcomes in participants followed-up in individual trials included in the systematic review, and developed a range of plausible strategies. We applied our approach to two systematic reviews. Results: We used five sources of data for imputing the means for participants with missing data. To impute standard deviation (SD), we used the median SD from the control arms of all included trials. Using these sources, we developed four progressively more stringent imputation strategies. In the first example review, effect estimates diminished and lost significance as strategies became more stringent, suggesting rating down confidence in estimates of effect for risk of bias. In the second, effect estimates maintained statistical significance using even the most stringent strategy, suggesting missing data does not undermine confidence in results. Conclusions: Our approach provides a useful, reasonable, and relatively simple, quantitative guidance for judging the impact of risk of bias as a result of missing participant data in systematic reviews of continuous outcomes. (C) 2013 Elsevier Inc. All rights reserved.
- Published
- 2013
41. Prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurement after noncardiac surgery: a systematic review and meta-analysis
- Author
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Levy, M, Heels-Ansdell, D, Hiralal, R, Bhandari, M, Guyatt, G, Yusuf, S, Cook, D, Villar, JC, McQueen, M, McFalls, E, Filipovic, M, Schunemann, H, Sear, J, Foex, P, Lim, W, Landesberg, G, Godet, G, Poldermans, D, Bursi, F, Kertai, MD, Bhatnagar, N, Devereaux, PJ, Anesthesiology, and Cardiology
- Subjects
Cardiovascular Diseases ,Surgical Procedures, Operative ,Creatine Kinase, MB Form ,Humans ,Prognosis ,Biomarkers ,Troponin - Abstract
Background: There is uncertainty regarding the prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurements after noncardiac surgery. Methods: The current study undertook a systematic review and meta-analysis. The study used six search strategies and included noncardiac surgery studies that provided data from a multivariable analysis assessing whether a postoperative troponin or creatine kinase muscle and brain isoenzyme measurement was an independent predictor of mortality or a major cardiovascular event. Independent investigators determined study eligibility and abstracted data in duplicate. Results: Fourteen studies, enrolling 3,318 patients and 459 deaths, demonstrated that an increased troponin measurement after surgery was an independent predictor of mortality (odds ratio [OR] 3.4, 95% confidence interval [CI] 2.2-5.2), but there was substantial heterogeneity (I(2) = 56%). The independent prognostic capabilities of an increased troponin value after surgery in the 10 studies that assessed intermediate-term (
- Published
- 2011
42. The influence of study characteristics on reporting of subgroup analyses in randomised controlled trials: systematic review
- Author
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Sun, X, Briel, M, Busse, JW, You, JJ, Akl, EA, Mejza, F, Bala, MM, Bassler, D, Mertz, D, Diaz-Granados, N, Vandvik, PO, Malaga, G, Srinathan, SK, Dahm, P, Johnston, BC, Alonso-Coello, P, Hassouneh, B, Truong, J, Dattani, ND, Walter, SD, Heels-Ansdell, D, Bhatnagar, N, Altman, DG, and Guyatt, GH
- Abstract
Objective To investigate the impact of industry funding on reporting of subgroup analyses in randomised controlled trials. Design Systematic review. Data sources Medline. Study selection Randomised controlled trials published in 118 core clinical journals (defined by the National Library of Medicine) in 2007. 1140 study reports in a 1: 1 ratio by high (five general medicine journals with largest number of total citations in 2007) versus lower impact journals, were randomly sampled. Two reviewers, independently and in duplicate, used standardised, piloted forms to screen study reports for eligibility and to extract data. They also used explicit criteria to determine whether a randomised controlled trial reported subgroup analyses. Logistic regression was used to examine the association of prespecified study characteristics with reporting versus not reporting of subgroup analyses. Results 469 randomised controlled trials were included, of which 207 (44%) reported subgroup analyses. High impact journals (adjusted odds ratio 2.64, 95% confidence interval 1.62 to 4.33), non-surgical (versus surgical) trials (2.10, 1.26 to 3.50), and larger sample size (3.38, 1.64 to 6.99) were associated with more frequent reporting of subgroup analyses. The strength of association between trial funding and reporting of subgroups differed in trials with and without statistically significant primary outcomes (interaction P=0.02). In trials without statistically significant results for the primary outcome, industry funded trials were more likely to report subgroup analyses (2.29, 1.30 to 4.72) than non-industry funded trials. This was not true for trials with a statistically significant primary outcome (0.79, 0.46 to 1.36). Industry funded trials were associated with less frequent prespecification of subgroup hypotheses (31.3% v 38.0%, adjusted odds ratio 0.49, 0.26 to 0.94), and less use of the interaction test for analyses of subgroup effects (41.4% v 49.1%, 0.52, 0.28 to 0.97) than non-industry funded trials. Conclusion Industry funded randomised controlled trials, in the absence of statistically significant primary outcomes, are more likely to report subgroup analyses than non-industry funded trials. Industry funded trials less frequently prespecify subgroup hypotheses and less frequently test for interaction than non-industry funded trials. Subgroup analyses from industry funded trials with negative results for the primary outcome should be viewed with caution.
- Published
- 2011
43. Stopping Randomized Trials Early for Benefit and Estimation of Treatment Effects Systematic Review and Meta-regression Analysis
- Author
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Bassler, D, Briel, M, Montori, VM, Lane, M, Glasziou, P, Zhou, Q, Heels-Ansdell, D, Walter, SD, Guyatt, GH, Urrutia G., and STOPIT-2 Study Grp
- Abstract
Context Theory and simulation suggest that randomized controlled trials (RCTs) stopped early for benefit (truncated RCTs) systematically overestimate treatment effects for the outcome that precipitated early stopping. Objective To compare the treatment effect from truncated RCTs with that from meta-analyses of RCTs addressing the same question but not stopped early (nontruncated RCTs) and to explore factors associated with overestimates of effect. Data Sources Search of MEDLINE, EMBASE, Current Contents, and full-text journal content databases to identify truncated RCTs up to January 2007; search of MEDLINE, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects to identify systematic reviews from which individual RCTs were extracted up to January 2008. Study Selection Selected studies were RCTs reported as having stopped early for benefit and matching nontruncated RCTs from systematic reviews. Independent reviewers with medical content expertise, working blinded to trial results, judged the eligibility of the nontruncated RCTs based on their similarity to the truncated RCTs. Data Extraction Reviewers with methodological expertise conducted data extraction independently. Results The analysis included 91 truncated RCTs asking 63 different questions and 424 matching nontruncated RCTs. The pooled ratio of relative risks in truncated RCTs vs matching nontruncated RCTs was 0.71 (95% confidence interval, 0.65-0.77). This difference was independent of the presence of a statistical stopping rule and the methodological quality of the studies as assessed by allocation concealment and blinding. Large differences in treatment effect size between truncated and nontruncated RCTs (ratio of relative risks
- Published
- 2010
44. Internal consistency reliability is a poor predictor of responsiveness
- Author
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Puhan, M A, Bryant, D, Guyatt, G H, Heels-Ansdell, D, Schünemann, H J, University of Zurich, and Puhan, M A
- Subjects
610 Medicine & health ,2739 Public Health, Environmental and Occupational Health ,10029 Clinic and Policlinic for Internal Medicine - Published
- 2005
- Full Text
- View/download PDF
45. 594 Incidence and remission of nocturia: A systematic review of longitudinal population-based studies with meta-analysis and meta-regression
- Author
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Pesonen, J.S., primary, Cartwright, R., additional, Mangera, A., additional, Santti, H., additional, Griebling, T.L., additional, Pryalukhin, A.E., additional, Riikonen, J., additional, Tähtinen, R.M., additional, Agarwal, A., additional, Tsui, J.F., additional, Vaughan, C.P., additional, Markland, A.D., additional, Johnson, T.M., additional, Fonsell-Annala, R., additional, Khoo, C., additional, Tammela, T.L.J., additional, Aoki, Y., additional, Auvinen, A., additional, Heels-Ansdell, D., additional, Guyatt, G.H., additional, and Tikkinen, K.A.O., additional
- Published
- 2014
- Full Text
- View/download PDF
46. Prediction Scores Do Not Correlate with Clinically Adjudicated Categories of Pulmonary Embolism in Critically Ill Patients
- Author
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Katsios, CM, primary, Donadini, M, additional, Meade, M, additional, Mehta, S, additional, Hall, R, additional, Granton, J, additional, Kutsiogiannis, J, additional, Dodek, P, additional, Heels-Ansdell, D, additional, McIntyre, L, additional, Vlahakis, N, additional, Muscedere, J, additional, Friedrich, J, additional, Fowler, R, additional, Skrobik, Y, additional, Albert, M, additional, Cox, M, additional, Klinger, J, additional, Nates, J, additional, Bersten, A, additional, Doig, C, additional, Zytaruk, N, additional, Crowther, M, additional, and Cook, DJ, additional
- Published
- 2014
- Full Text
- View/download PDF
47. Does a Perioperative Cardiovascular Service Improve Patient Cardiovascular Outcomes?
- Author
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Cosman, T., primary, Alvarado, K., additional, Dokainish, H., additional, Hastings, D., additional, Joseph, P., additional, Magloire, P., additional, Tandon, V., additional, Salehian, O., additional, Heels-Ansdell, D., additional, and Devereaux, P.J., additional
- Published
- 2013
- Full Text
- View/download PDF
48. Radiographs of hip fractures were digitally altered to mask surgeons to the type of implant without compromising the reliability of quality ratings or making the rating process more difficult
- Author
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Karanicolas PJ, Bhandari M, Walter SD, Heels Ansdell D, Guyatt GH, MORONI , ANTONIO, COAST Musculoskeletal Group, Karanicolas, Pj, Bhandari, M, Walter, Sd, Heels Ansdell, D, Guyatt, Gh, Moroni, Antonio, and COAST Musculoskeletal, Group
- Subjects
Male ,medicine.medical_specialty ,Blinding ,Attitude of Health Personnel ,Epidemiology ,Intraclass correlation ,Radiography ,Bone Screws ,Femoral Neck Fractures ,Fracture Fixation, Internal ,Humans ,Medicine ,Single-Blind Method ,Observer Variation ,Orthodontics ,Hip fracture ,business.industry ,Subtraction ,medicine.disease ,Internal Fixators ,Surgery ,Inter-rater reliability ,Orthopedics ,Research Design ,Orthopedic surgery ,Female ,business - Abstract
Objective To devise and test techniques to blind outcome assessors in trials of hip fracture fixation. Study Design and Setting We developed three techniques (Blackout, Subtraction, and Overlay) to mask radiographs of hip fractures fixated with cancellous screws or dynamic hip screws. Fifty orthopedic trauma surgeons each assessed 32 radiographs blinded with each technique. Results All techniques achieved low rates of correct identification of screw type (14.9% for Blackout, 26.9% for Subtraction, 22.1% for Overlay) and high proportions of "don't know" responses (72.3%, 48.4%, 52.8%, respectively). The interrater reliability of reduction quality in the blinded images (intraclass correlation coefficient [ICC]=0.55–0.57) was similar to the reliability of the unblinded radiographs (ICC=0.60). Surgeons perceived 6.9% of the Overlay images as much more difficult to rate than unblinded radiographs, compared with 9.7% of Subtraction images ( P =0.25) and 28.0% of Blackout images ( P Conclusion Three techniques of blinding radiographs of femoral neck fractures successfully mask surgeons to the type of implant fixated, do not compromise reliability of reduction ratings, and do not make rating most radiographs more difficult. Trialists should explore creative approaches to optimize blinding when designing trials, and should incorporate rigorous approaches to testing blinding success.
- Published
- 2009
49. 056 Addressing Continuous Data For Participants Excluded From Trial Analysis: A Guide
- Author
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Ebrahim, S, primary, Akl, E, additional, Mustafa, R, additional, Sun, X, additional, Walter, S, additional, Heels-Ansdell, D, additional, Alonso-Coello, P, additional, Johnston, B, additional, and Guyatt, G, additional
- Published
- 2013
- Full Text
- View/download PDF
50. Credibility of claims of subgroup effects in randomised controlled trials: systematic review
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Sun, X., primary, Briel, M., additional, Busse, J. W., additional, You, J. J., additional, Akl, E. A., additional, Mejza, F., additional, Bala, M. M., additional, Bassler, D., additional, Mertz, D., additional, Diaz-Granados, N., additional, Vandvik, P. O., additional, Malaga, G., additional, Srinathan, S. K., additional, Dahm, P., additional, Johnston, B. C., additional, Alonso-Coello, P., additional, Hassouneh, B., additional, Walter, S. D., additional, Heels-Ansdell, D., additional, Bhatnagar, N., additional, Altman, D. G., additional, and Guyatt, G. H., additional
- Published
- 2012
- Full Text
- View/download PDF
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