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The association between proton pump inhibitor (PPI) use and dementia remains controversial. This cohort study re‐examines this issue, addressing shortcomings identified in previous publications using a population‐based and a high‐dimension propensity‐score matched cohort to follow patients for up to 22 years. Cox regression models using baseline characteristics, a lag period, and time‐varying variables were used to examine the risk of dementia by cumulative PPI exposure. High‐dose PPI users (> 180 days of use) had significantly higher risk of dementia in crude Cox models. After adjustment for medical diagnoses and prescription drug use, these associations disappeared. Among high‐dose users starting PPI therapy between 46 and 55 years old, the unadjusted hazard ratio (HR) was 1.55 (95% confidence interval (CI) 1.14, 2.10); the adjusted hazard ratio (aHR) was 1.10 (95% CI 0.80, 1.51). For high‐dose users starting therapy between 56 and 65 years, HR = 1.22 (95% CI1.03, 1.44); aHR = 0.99 (95% CI 0.83, 1.17). High‐dose users between the ages of 66 and 75 years had no association with the risk of dementia. The use of lag models or time‐varying parameters similarly found some association with dementia in crude, but not multivariable Cox models. Although high‐dose PPI users were more likely to develop dementia, they were more likely to be diagnosed with dementia risk factors, such as diabetes and cardiovascular disease, which are risk factors for dementia. Controlling for these conditions using multivariable models or a propensity‐score matched cohort eliminated this association. [ABSTRACT FROM AUTHOR]

Aims: There are conflicting signals in the literature about comparative safety and effectiveness of direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF). Methods: We conducted multicentre matched cohort studies with secondary meta‐analysis to assess safety and effectiveness of dabigatran, rivaroxaban and apixaban across 9 administrative healthcare databases. We included adults with NVAF initiating anticoagulation therapy (dabigatran, rivaroxaban or apixaban), and constructed 3 cohorts to compare DOACs pairwise. The primary outcome was pooled hazard ratio (pHR) of ischaemic stroke or systemic thromboembolism. Secondary outcomes included pHR of major bleeding, and a composite of stroke, major bleeding, or all‐cause mortality. We used proportional hazard Cox regressions models, and pooled estimates were obtained with random effect meta‐analyses. Results: The cohorts included 73 414 new users of dabigatran, 92 881 of rivaroxaban, and 61 284 of apixaban. After matching, the pHRs (95% confidence intervals) comparing rivaroxaban initiation to dabigatran were: 1.11 (0.93, 1.32) for ischaemic stroke or systemic thromboembolism, 1.26 (1.09, 1.46) for major bleeding, and 1.17 (1.05, 1.30) for the composite endpoint. For apixaban vs dabigatran, they were: 0.91 (0.74, 1.12) for ischaemic stroke or systemic thromboembolism, 0.89 (0.75, 1.05) for major bleeding, and 0.94 (0.78 to 1.14) for the composite endpoint. For apixaban vs rivaroxaban, they were: 0.85 (0.74, 0.99) for ischaemic stroke or systemic thromboembolism, 0.61 (0.53, 0.70) for major bleeding, and 0.82 (0.76, 0.88) for the composite endpoint. Conclusion: We found that apixaban use is associated with lower risks of stroke and bleeding compared with rivaroxaban, and similar risks compared with dabigatran. [ABSTRACT FROM AUTHOR]

Current literature demonstrates the positive impact of pharmacists prescribing medication on patient outcomes and pharmacist perceptions of the practice. The aim of this study was to understand the factors affecting prescribing practices among Manitoba pharmacists and identify whether additional training methods would be beneficial for a practice behavior change. A web-based survey was developed and participation was solicited from pharmacists in Manitoba. Descriptive statistics were calculated to summarize the frequency of demographic characteristics. Chi-square tests were used to explore possible correlations between variables of interest and thematic analysis of qualitative data was completed. A total of 162 participants completed the survey. The response rate was 12.3%. Of those who had met the requirements to prescribe, none were doing so on a daily basis and 23.5% had not assessed or prescribed since being certified. Respondents identified the top barriers for providing this service as a lack of sufficient revenue and a lack of time. Qualitative analysis of responses identified additional barriers including a limiting scope and inadequate tools. Approximately half (54.4%) of respondents expressed that additional training would be of value. The themes identified from the survey data suggest that practice-based education would help pharmacists apply skills. In addition, expansion of prescribing authority and strategies addressing remuneration issues may help overcome barriers to pharmacists prescribing within Manitoba. [ABSTRACT FROM AUTHOR]

Background: Abnormal microbiota composition induced by prenatal exposure to antibiotics has been proposed as a potential contributor to the development of attention-deficit/hyperactivity disorder (ADHD). We examined the association between prenatal antibiotic exposure and risk of ADHD., Methods: We conducted a population-based retrospective cohort study of children born in Manitoba, Canada, between 1998 and 2017 and their mothers. We defined exposure as the mother having filled 1 or more antibiotic prescriptions during pregnancy. The outcome was diagnosis of ADHD in the offspring, as identified in administrative databases. We estimated hazard ratios (HRs) using Cox proportional hazards regression in the overall cohort, in a separate cohort matched on high-dimensional propensity scores and in a sibling cohort., Results: In the overall cohort, consisting of 187 605 children, prenatal antibiotic dispensation was associated with increased risk of ADHD (HR 1.22, 95% confidence interval [CI] 1.18-1.26). Similar results were observed in the matched cohort of 129 674 children (HR 1.20, 95% CI 1.15-1.24) but not in the sibling cohort (HR 1.06, 95% CI 0.99-1.13). Two negative-control analyses indicated a positive association with ADHD despite the lack of a reasonable biological mechanism, which suggested that the observed association between prenatal antibiotic dispensation and risk of ADHD was likely due to confounding., Interpretation: In our study, prenatal antibiotic exposure was not associated with increased risk of ADHD in children. Although the risk was higher in the overall and matched cohorts, it was likely overestimated because of unmeasured confounding. Future studies are warranted to examine other factors affecting microbiota composition in association with risk of ADHD., Competing Interests: Competing interests: Salaheddin Mahmud has received unrestricted research grants from Merck, GlaxoSmithKline, Sanofi Pasteur, Pfizer and Roche-Assurex for unrelated studies, and has also received fees as an advisory board member for Sanofi Pasteur. Silvia Alessi-Severini has received unrestricted research grants from Merck and Pfizer for unrelated studies. No other competing interests were declared., (© 2020 Joule Inc. or its licensors.)

Current literature demonstrates the positive impact of pharmacists prescribing medication on patient outcomes and pharmacist perceptions of the practice. The aim of this study was to understand the factors affecting prescribing practices among Manitoba pharmacists and identify whether additional training methods would be beneficial for a practice behavior change. A web-based survey was developed and participation was solicited from pharmacists in Manitoba. Descriptive statistics were calculated to summarize the frequency of demographic characteristics. Chi-square tests were used to explore possible correlations between variables of interest and thematic analysis of qualitative data was completed. A total of 162 participants completed the survey. The response rate was 12.3%. Of those who had met the requirements to prescribe, none were doing so on a daily basis and 23.5% had not assessed or prescribed since being certified. Respondents identified the top barriers for providing this service as a lack of sufficient revenue and a lack of time. Qualitative analysis of responses identified additional barriers including a limiting scope and inadequate tools. Approximately half (54.4%) of respondents expressed that additional training would be of value. The themes identified from the survey data suggest that practice-based education would help pharmacists apply skills. In addition, expansion of prescribing authority and strategies addressing remuneration issues may help overcome barriers to pharmacists prescribing within Manitoba.

Objectives: Pharmacists in Canadian provinces are at different stages of applying prescribing legislation into practice. The purpose of this environmental scan was to examine differences in legislation, remuneration, professional uptake, continuing education requirements and continuing education resources relating to pharmacist prescribing for ambulatory ailments, with a focus on continuing education., Methods: Data were collected between May and December 2016 using websites and communication with provincial professional regulatory bodies, advocacy bodies, drug coverage programs and other organizations that offer continuing education for pharmacists., Results: Training requirements to prescribe for ambulatory ailments vary provincially, including no training requirements, online tutorials and a comprehensive application process. Government-funded remuneration for prescribing services is absent in most provinces. Pharmacist uptake of the training required to obtain prescribing authority ranges from 30% to 100% of pharmacists. Continuing education programs on the topic of prescribing across the country include online courses, in-person courses, webinars, panel discussions and preparation courses., Conclusion: Many aspects of pharmacist prescribing for ambulatory ailments, including the style and content of continuing education resources, vary from province to province. Further research on this topic would help to determine the effect of these differences on the success of incorporating pharmacist prescribing into practice., Competing Interests: Declaration of Conflicting Interests:D. Dunford contributed to the CPhA Continuing Education: Assessing and Prescribing for Minor Ailments: Urticaria Module. D. Dunford, S. Ng and B. Shearer were involved in providing the continuing education program Assessment and Prescribing for Ambulatory Ailments Workshop offered in Manitoba.