127 results on '"Strumpf E"'
Search Results
2. Factors associated with multiple barriers to access to primary care: an international analysis
- Author
-
Corscadden, L., Levesque, J. F., Lewis, V., Strumpf, E., Breton, M., and Russell, G.
- Published
- 2018
- Full Text
- View/download PDF
3. Maternal and neonatal outcomes after implementation of a hospital policy to limit low-risk planned caesarean deliveries before 39 weeks of gestation: an interrupted time-series analysis
- Author
-
Hutcheon, J A, Strumpf, E C, Harper, S, and Giesbrecht, E
- Published
- 2015
- Full Text
- View/download PDF
4. Using inter-institutional practice variation to understand the risks and benefits of routine labour induction at 41+0 weeks
- Author
-
Hutcheon, J A, Harper, S, Strumpf, E C, Lee, L, and Marquette, G
- Published
- 2015
- Full Text
- View/download PDF
5. Physician Market
- Author
-
Léger, P.T., primary and Strumpf, E., additional
- Published
- 2014
- Full Text
- View/download PDF
6. Factors associated with multiple barriers to access to primary care: an international analysis.
- Author
-
Corscadden, L, Levesque, JF, Lewis, V, Strumpf, E, Breton, M, Russell, G, Corscadden, L, Levesque, JF, Lewis, V, Strumpf, E, Breton, M, and Russell, G
- Abstract
BACKGROUND: Disparities in access to primary care (PC) have been demonstrated within and between health systems. However, few studies have assessed the factors associated with multiple barriers to access occurring along the care-seeking process in different healthcare systems. METHODS: In this secondary analysis of the 2016 Commonwealth Fund International Health Policy Survey of Adults, access was represented through participant responses to questions relating to access barriers either before or after reaching the PC practice in 11 countries (Australia, Canada, France, Germany, Norway, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and United States). The number of respondents in each country ranged from 1000 to 7000 and the response rates ranged from 11% to 47%. We used multivariable logistic regression models within each of eleven countries to identify disparities in response to the access barriers by age, sex, immigrant status, income and the presence of chronic conditions. RESULTS: Overall, one in five adults (21%) experienced multiple barriers before reaching PC practices. After reaching care, an average of 16% of adults had two or more barriers. There was a sixfold difference between nations in the experience of these barriers to access. Vulnerable groups experiencing multiple barriers were relatively consistent across countries. People with lower income were more likely to experience multiple barriers, particularly before reaching primary care practices. Respondents with mental health problems and those born outside the country displayed substantial vulnerability in terms of barriers after reaching care. CONCLUSION: A greater understanding of the multiple barriers to access to PC across the stages of the care-seeking process may help to inform planning and performance monitoring of disparities in access. Variation across countries may reveal organisational and system drivers of access, and inform efforts to improve access to PC for vul
- Published
- 2018
7. Application of an immersed boundary method with analytical interface approximation to a bubble chain in liquid metal
- Author
-
Krull, B., Schwarz, S., Fröhlich, J., Strumpf, E., Shevchenko, N., Roshchupkina, O., and Eckert, S.
- Subjects
Physics::Fluid Dynamics ,bubbly flow ,immersed boundary method ,liquid metal ,bubble deformation ,bubble chain - Abstract
Bubble-laden liquid metal flows are an important topic in metallurgy, where bubbles are used for stirring, to remove inclusions, to control chemical reactions, etc. The bubbles encountered in this flows are generally too large to remain spherical, but deform. Deformation can enhance separation of the wake behind the bubble noticeably increasing drag [1]. Furthermore, deformable bubbles lead to an increase of turbulent kinetic energy while having almost no impact on the mean flow, which is a significant difference to flows with spherical bubbles. Furthermore, the near-wall behavior of spherical and non-spherical bubbles differs [2,3]. The deformation of a stationary rising single bubble is well-understood [4]. However, for unsteady flows containing larger numbers of interacting bubbles the deformation and its impact on the flow is not known and therefore investigated in this work.
- Published
- 2017
8. A163 DIRECT ACTING ANTIVIRAL UPTAKE DISPARITIES IN HIV-HEPATITIS C CO-INFECTED POPULATIONS IN CANADA
- Author
-
Saeed, S, primary, Strumpf, E, additional, Walmsley, S, additional, Cooper, C, additional, Conway, B, additional, Laferriere, V, additional, Pick, N, additional, Wong, A, additional, and Klein, M B, additional
- Published
- 2018
- Full Text
- View/download PDF
9. The impact of team-based primary care on health care services utilization and costs: Quebec's family medicine groups
- Author
-
Strumpf, E. (Erin), Ammi, M. (Mehdi), Diop, M. (Mamadou), Fiset-Laniel, J. (Julie), Tousignant, P. (Pierre), Strumpf, E. (Erin), Ammi, M. (Mehdi), Diop, M. (Mamadou), Fiset-Laniel, J. (Julie), and Tousignant, P. (Pierre)
- Abstract
We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec's Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside
- Published
- 2017
- Full Text
- View/download PDF
10. Experimental study on rise velocities of single bubbles in liquid metal under the influence of strong horizontal magnetic fields in a flat vessel
- Author
-
Strumpf, E. and Strumpf, E.
- Abstract
The ascent of single argon bubbles with equivalent diameters (deq) between 3.43 and 6.28 mm is investigated at room temperature in a flat, cubic vessel by means of Ultrasound Doppler Velocimetry (UDV). GaInSn is used as a working liquid and magnetic flux intensities up to B ≈ 0.918 T are applied. A decelerating effect on the rise velocity is observed at lower, an accelerating effect at medium and a reduction at higher field strengths. Maximum velocities are achieved when N/CD ≈ 1, bubble paths are substantially rectilinear at N/CD > 2. The mean ascent velocities are compared with literature and data of this work as well of other publications is provided in tables.
- Published
- 2017
11. Measurements of the diameter of rising gas bubbles by means of the ultrasound transit time technique
- Author
-
Richter, T., Keplinger, O., Strumpf, E., Wondrak, T., Eckert, K., Eckert, S., Odenbach, S., Richter, T., Keplinger, O., Strumpf, E., Wondrak, T., Eckert, K., Eckert, S., and Odenbach, S.
- Abstract
This study presents ultrasound transit time technique (UTTT) measurements of single Ar bubbles rising in Galinstan under an applied magnetic field. Two setups were used to analyze the bubble rise, which led to differently oriented zig-zag trajectories. UTTT is able to visualize the bubble trajectory and to measure the variations of the apparent bubble diameters associated with the zig-zag trajectory. Due to the straightening of the bubble trajectories with increasing magnetic field, an increase of the apparent bubble diameter was detected.
- Published
- 2017
12. Combined experimental and numerical analysis of a bubbly liquid metal flow
- Author
-
Krull, B., Strumpf, E., Keplinger, O., Shevchenko, N., Fröhlich, J., Eckert, S., Gerbeth, G., Krull, B., Strumpf, E., Keplinger, O., Shevchenko, N., Fröhlich, J., Eckert, S., and Gerbeth, G.
- Abstract
The paper proposes a combined experimental and numerical procedure for the investigation of bubbly liquid-metal flows. It describes the application to a model configuration consisting of a recirculating GaInSn flow driven by an argon bubble chain. The experimental methods involve X-ray measurements to detect the bubbles and UDV measurements to gain velocity information about the liquid metal. The chosen numerical method is an immersed boundary method extended to deformable bubbles. The model configuration includes typical phenomena occurring in industrial applications and allows insight into the physics of bubbly liquid-metal flows. It constitutes an attractive test case for assessing further experimental and numerical methods.
- Published
- 2017
13. Investigation of single bubbles and bubble chains in liquid metal under the influence of magnetic fields
- Author
-
Strumpf, E. and Eckert, S.
- Subjects
Physics::Fluid Dynamics ,liquid metal ,single bubble ,ultrasound ,magnetic field ,bubble chain - Abstract
Two-phase flows play an important role in industrial applications, such as the continuous casting of steel. Here, inert gas is injected into the beginning of the submerged entry nozzle to avoid nozzle clogging as well as to catch impurities within the melt and to transport them to the free surface, away from the solidification front. Furthermore electromagnetic brakes are used with the aim to dampen the highly turbulent flow and to reduce high velocities in the liquid metal. Although a vast number of simulations and experiments of bubbly flows in water exist, such investigations in liquid metal still lack quantity. However, liquid metal experiments are unavoidable for a correct modelling of such special cases, like the influence of magnetic fields on the flow or the two-phase flow behavior. In the present study the ascents of single bubbles and of bubble chains in a liquid metal are investigated. For this purpose a benchmark experiment is set up, a cuboid vessel of the dimensions 144 x 144 x 12 mm³, which is filled with eutectic alloy GaInSn. A transversal magnetic field up to 1.1 T is imposed to this vessel. Ultrasound Doppler Velocimetry (UDV) is used to map the flow in the continuous phase of bubble chain regimes as well as the ascent velocity of single bubbles.
- Published
- 2016
14. X-ray radioscopy as a powerful tool for visualization of liquid metal bubbly flows
- Author
-
Roshchupkina, O., Shevchenko, N., Strumpf, E., Hoppe, D., and Eckert, S.
- Subjects
Physics::Fluid Dynamics ,X-ray radiography ,water ,GaInSn ,two-phase flows - Abstract
Many technical applications in metallurgy and the quality of continuous casting rely on liquid metal two-phase flows. Injection of the Argon gas became an integral part of continuous casting since it prevents clogging of the casting nozzle and also separates alumina particles from the melt. On the other hand, injection of gas has many side effects as for example induction of highly turbulent complex two-phase flows. There exist many numerical simulations and water models, but due to large differences in physical properties between water and liquid metals water models and experiments cannot be fully extended to liquid metals. Therefore, direct investigation and understanding of liquid metal two-phase flows became critical. In the present work we demonstrate that X-ray radiography can be used as a powerful tool for the visualization of liquid metal two-phase flows. Here we present an experimental study of ascending bubble chains over a wide range of gas flow rates in GaInSn alloy at room temperature. We report on differences in bubble release frequency, shape, size, velocity etc. and additionally compare with experiments in water. The efficiency of the corresponding measurement technique is primarily validated in water experiments. * The research is supported by the German Helmholtz Association in form of the Helmholtz-Alliance “LIMTECH”.
- Published
- 2016
15. Combined experimental and numerical analysis of a bubbly liquid metal flow
- Author
-
Krull, B, primary, Strumpf, E, additional, Keplinger, O, additional, Shevchenko, N, additional, Fröhlich, J, additional, Eckert, S, additional, and Gerbeth, G, additional
- Published
- 2017
- Full Text
- View/download PDF
16. Measurements of the diameter of rising gas bubbles by means of the ultrasound transit time technique
- Author
-
Richter, T., primary, Keplinger, O., additional, Strumpf, E., additional, Wondrak, T., additional, Eckert, K., additional, Eckert, S., additional, and Odenbach, S., additional
- Published
- 2017
- Full Text
- View/download PDF
17. Ultrasound Doppler measurements in liquid metal two-phase flows
- Author
-
Vogt, T., Zhang, C., Strumpf, E., Eckert, S., and Gerbeth, G.
- Subjects
Physics::Fluid Dynamics - Abstract
Because of the ability to work in opaque fluids and to deliver complete velocity profiles in real time the Ultrasound Doppler Velocimetry (UDV) can be considered as an attractive technique to obtain velocity data from liquid metal flows. This paper presents several examples for UDV measurements in liquid metal two-phase flows. The measuring technique shows the capability to detect both the bubble and the liquid velocity simultaneously. The probability density function of the recorded velocity data was examined to the signals arising from the liquid and the gaseous phase. Multiple reflections of the ultrasonic beam occurring between the gas bubbles at higher gas flow rates may complicate a precise discrimination between both phase velocities. An iterative threshold method was applied to obtain accurate velocity profiles by identifying and excluding artifacts in the signal. Nevertheless, the signal quality deteriorates significantly with increasing gas flow rate. Bubble-driven flows play a prominent role in many industrial facilities and processes. In metallurgical applications gas bubbles are injected into furnaces, ladles or similar melt containing transfer vessels in order to homogenize the melt and their physical and chemical properties. On the other hand, uncontrolled entrainment of cover gas into the liquid metal in the casting process causes a worsening of the mechanical properties of the casting products. In the field of nuclear engineering, gas entrainment into the coolant is one of the essential safety issues in the design of innovative liquid metal-cooled fast reactors. Model experiments using low-melting metal alloys can be considered as an effective tool to gain a better understanding of the complex character of liquid metal two-phase flows. In this paper, we present exemplary measurements performed at various experimental configurations concerning the behaviour of single bubbles and bubble plumes under the influence of AC and DC magnetic fields and a visualization of gas entrainment at the free surface of a liquid metal.
- Published
- 2015
18. Liquid metal two-phase flows
- Author
-
Strumpf, E., Roshchupkina, O., Shevchenko, N., Eckert, S., and Gerbeth, G.
- Subjects
Physics::Fluid Dynamics ,two phase flow ,X-ray ,liquid metal ,bubble ,magnetic field ,UDV - Abstract
The ascents of single Argon bubbles and bubble chains are investigated by means of Ultrasound Doppler Vecolimetry and X-ray radiography. A cuboid benchmark experiment of dimensions 144 x 144 x 12 mm³ is used and filled with eutectic alloy GaInSn. Furthermore the effects on the bubble behaviour and flow structure is investigated by superimposing a strong magnetic transversal DC field up to 1.1 T.
- Published
- 2015
19. Investigation of single bubbles and bubble chains in liquid metal under the influence of magnetic fields
- Author
-
Strumpf, E., Roshchupkina, O., Shevchenko, N., and Eckert, S.
- Subjects
Physics::Fluid Dynamics ,X-ray ,liquid metal ,bubble ,magnetic field ,UDV ,two-phase flows - Abstract
In the present study the ascents of single bubbles and of bubble chains in a liquid metal are investigated. For this purpose a benchmark experiment is set up, a cuboid vessel of the dimensions 144 x 144 x 12 mm³, which is filled with eutectic alloy GaInSn. A transversal magnetic field up to 1.1 T is imposed to this vessel. Ultrasound Doppler Velocimetry (UDV) is used to map the flow in the continuous phase of bubble chain regimes as well as the ascent velocity of single bubbles. X-ray radioscopy is applied to obtain detailed information within the disperse phase of bubble chains, such as bubble diameter, shape, trajectory etc.
- Published
- 2015
20. Visualization of liquid metal bubbly flows using the X-ray radioscopy
- Author
-
Roshchupkina, O., Shevchenko, N., Strumpf, E., Timmel, K., and Eckert, S.
- Subjects
X-ray radioscopy ,continuous casting ,two-phase flows - Abstract
The quality of continuous cast steel is significantly affected by the flow pattern in the mould and submerged entry nozzle (SEN). The flow in continuous casting machines is often a two-phase one because argon is injected to avoid clogging inside the casting nozzle. Moreover, the argon bubbles are supposed to drag alumina particles and transport them towards the slag layer at the free surface. On the other hand, the gas injection leads to highly turbulent and complex two-phase flows, which are difficult to predict by numerical simulations. The injected bubbles have a distinct influence on the flow pattern and may trigger instabilities in the mold, for instance, observations made on real casters showed correlations between gas pressure variations in the SEN and mould meniscus perturbations. Despite of the considerable number of previous studies mainly performed as numerical simulations and water models the understanding of liquid metal two phase flows remains fragmentary. Many open questions require further investigations, as concerns the formation process of gas bubbles, their distribution and flow regime in the SEN, the size of bubbles entering the mould, the flotation of the gas in the mould, the gas entrapment in the solidifying strand, etc. This situation motivated us to construct a specific model experiment where liquid metal two-phase flows can be investigated under flow conditions which are similar to those in the real continuous casting process. We present an experimental study in a mockup of the continuous casting process. The two-phase flows in the mould and the SEN were visualized by means of X-ray radioscopy. The argon gas is injected through the tip of the stopper rod into the liquid metal flow. The system operates continuously with the low melting, eutectic alloy GaInSn under isothermal conditions. Experimental results will be presented and discussed accompanied by statistical analysis.
- Published
- 2015
21. Ultraschall zur Bestimmung von Partikelbewegungen in flüssigem Metall
- Author
-
Hoppe, D., Strumpf, E., Hoppe, D., and Strumpf, E.
- Abstract
In flüssigem Metall schwebende Partikel können Echos von Ultraschall verursachen. Aus solchen Echos wird versucht, die entlang der Schallausbreitung vorkommenden Partikelbewegungen zu rekonstruieren. Konkret sind damit die Positionen gemeint, welche die Partikel vertikal oberhalb des Schallwandlers als Funktionen der Zeit einnehmen. Anhand solcher Funktionen soll dann auf Strömungsvorgänge im flüssigen Metall geschlossen werden.
- Published
- 2016
22. LIMTECH A5: Liquid metal two-phase flows
- Author
-
Strumpf, E., Eckert, S., Richter, T., and Gerbeth, G.
- Subjects
horizontal magnetic field ,UTTT ,liquid metal ,single bubble ,UDV ,two-phase - Abstract
Measurements for rising single bubbles were performed in a cuboid benchmark experiment filled with the liquid metal GaInSn. Data was acquired by two different ultrasound techniques simultaneously, which are Ultrasound Doppler Velocimetry (UDV) and Ultrasound Transit Time Technique (UTTT). The focus was on the influence of a horizontal magnetic field on the bubble behavior.
- Published
- 2014
23. The Impact of Parental and Medical Leave Policies on Socioeconomic and Health Outcomes in OECD Countries: A Systematic Review of the Empirical Literature.
- Author
-
NANDI, A. R. I. J. I. T., JAHAGIRDAR, D. E. E. P. A., DIMITRIS, M. I. C. H. E. L. L. E. C., LABRECQUE, J. E. R. E. M. Y. A., STRUMPF, E. R. I. N. C., KAUFMAN, J. A. Y. S., VINCENT, I. L. O. N. A., ATABAY, E. F. E., HARPER, S. A. M., EARLE, A. L. I. S. O. N., and HEYMANN, S. J. O. D. Y.
- Subjects
CINAHL database ,ECONOMICS ,PSYCHOLOGY information storage & retrieval systems ,LEAVE of absence ,EVALUATION of medical care ,MEDLINE ,PARENTAL leave ,RESEARCH funding ,SYSTEMATIC reviews ,SOCIOECONOMIC factors ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Policy Points: Historically, reforms that have increased the duration of job‐protected paid parental leave have improved women's economic outcomes. By targeting the period around childbirth, access to paid parental leave also appears to reduce rates of infant mortality, with breastfeeding representing one potential mechanism. The provision of more generous paid leave entitlements in countries that offer unpaid or short durations of paid leave could help families strike a balance between the competing demands of earning income and attending to personal and family well‐being. Context: Policies legislating paid leave from work for new parents, and to attend to individual and family illness, are common across Organisation for Economic Co‐operation and Development (OECD) countries. However, there exists no comprehensive review of their potential impacts on economic, social, and health outcomes. Methods: We conducted a systematic review of the peer‐reviewed literature on paid leave and socioeconomic and health outcomes. We reviewed 5,538 abstracts and selected 85 published papers on the impact of parental leave policies, 22 papers on the impact of medical leave policies, and 2 papers that evaluated both types of policies. We synthesized the main findings through a narrative description; a meta‐analysis was precluded by heterogeneity in policy attributes, policy changes, outcomes, and study designs. Findings: We were able to draw several conclusions about the impact of parental leave policies. First, extensions in the duration of paid parental leave to between 6 and 12 months were accompanied by attendant increases in leave‐taking and longer durations of leave. Second, there was little evidence that extending the duration of paid leave had negative employment or economic consequences. Third, unpaid leave does not appear to confer the same benefits as paid leave. Fourth, from a population health perspective, increases in paid parental leave were consistently associated with better infant and child health, particularly in terms of lower mortality rates. Fifth, paid paternal leave policies of adequate length and generosity have induced fathers to take additional time off from work following the birth of a child. How medical leave policies for personal or family illness influence health has not been widely studied. Conclusions: There is substantial quasi‐experimental evidence to support expansions in the duration of job‐protected paid parental leave as an instrument for supporting women's labor force participation, safeguarding women's incomes and earnings, and improving child survival. This has implications, in particular, for countries that offer shorter durations of job‐protected paid leave or lack a national paid leave entitlement altogether. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
24. A feasibility study of a telephone-supported self-care intervention for depression among adults with a comorbid chronic physical illness in primary care
- Author
-
Mccusker, J., Cole, M., Yaffe, M., Sussman, T., Kim Lavoie, Strumpf, E., Sewitch, M., Sahin, D., and Raad, M.
- Subjects
Article - Abstract
Objective We assessed the feasibility and acceptability to patients of a telephone-supported self-care intervention for depression among adults aged 40 years or over with one of six targeted chronic physical illnesses and comorbid depressive symptoms in family practice settings. Methods An open, uncontrolled trial (feasibility study) was conducted among patients treated in Montreal family practices. Eligible patients were aged 40 years or over, had one or more of the targeted chronic physical illnesses for at least 6 months (arthritis, hypertension, diabetes, heart disease, asthma and chronic obstructive pulmonary disease) and were evaluated as having at least mild depressive symptoms (a score of ≥ 5 on the 9-item Patient Health Questionnaire, PHQ-9). Participants received a package of six self-care tools (information booklet, video, Internet programme, action plan, workbook and mood-monitoring tool) with telephone support by a lay coach for up to 6 months. Results In total, 63 eligible patients provided written consent and completed the baseline interview; 57 (90%) and 55 (87%) patients completed 2-month and 6-month follow-up interviews, respectively. The mean number of telephone calls made by coaches to participants was 10.5 (SD 4.0), and the average length of these calls was 10.6 minutes. At the 6-month follow-up, 83.6% of the participants reported that one or more of the tools were helpful. Clinically significant improvements were seen in depressive symptoms (as assessed by the PHQ-9) at 6 months, with an effect size of 0.88 (95% CI, 0.55, 1.14). Conclusion A telephone-supported self-care intervention for depression was feasible, was acceptable to patients, and was associated with a significant 6-month improvement in depressive symptoms. A randomised trial of this intervention is justified.
- Published
- 2012
25. Cervical dilation at time of caesarean delivery in nulliparous women: a population-based cohort study.
- Author
-
Riddell, CA, Kaufman, JS, Strumpf, EC, Abenhaim, HA, Hutcheon, JA, Riddell, C A, Kaufman, J S, Strumpf, E C, Abenhaim, H A, and Hutcheon, J A
- Subjects
CESAREAN section ,DELIVERY (Obstetrics) ,LABOR (Obstetrics) ,OXYTOCIN ,LABOR complications (Obstetrics) ,CERVIX uteri physiology ,OXYTOCICS ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL protocols ,PATHOLOGICAL physiology ,RESEARCH ,EVALUATION research ,RETROSPECTIVE studies ,PARITY (Obstetrics) ,DYSTOCIA ,THERAPEUTICS - Abstract
Objectives: Our objective was to describe contemporary practice patterns in the timing of caesarean delivery in relation to cervical dilation, overall and by indication for caesarean. Our secondary objective was to examine how commonly caesarean delivery was performed for labour dystocia at dilations below 4 cm or without the use of oxytocin, overall and between hospitals.Design: Retrospective, population-based cohort study.Setting: Ontario, Alberta, and British Columbia, Canada, 2008-2012.Population: Nulliparous women in labour who delivered term singletons in cephalic position.Methods: Histograms were used to examine the distribution of cervical dilation at time of caesarean delivery, overall and by indication for caesarean. Funnel plots were used to illustrate variation in hospital-level rates of caesarean deliveries for labour dystocia that were performed early (<4 cm dilation) or without the use of oxytocin.Main Outcome Measures: Cervical dilation (in centimetres) at time of caesarean delivery.Results: The population-based cohort comprised 392 025 women, of whom 18.8% had a caesarean delivery. Of first-stage caesareans for labour dystocia in women who entered labour spontaneously, 13.6% (95% CI 12.9, 14.2) had dilations <4 cm [hospital-level inter-quartile range (IQR): 6.2% to 20.0%] and 29.5% (95% CI 28.6, 30.4) did not receive oxytocin to treat their dystocia (hospital-level IQR: 22.1-54.6%).Conclusions: The proportion of caesareans done before 4 cm dilation or without oxytocin varies substantially across hospitals and suggests the need for institutions to review their practices and ensure that management of labour practice guidelines are followed.Tweetable Abstract: Many caesareans for labour dystocia are performed early during labour (<4 cm dilation) or without oxytocin. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
26. The Canadian Society for Epidemiology and Biostatistics 2013 National Student Conference
- Author
-
Skrastins, E., primary, Cunningham, M., additional, Jindal, P., additional, Fitzpatrick, R., additional, Oneko, O., additional, Carpenter, J., additional, Booth, C., additional, Yeates, K., additional, Aronson, K., additional, Smith, L., additional, Kaufman, J., additional, Strumpf, E., additional, Levesque, L., additional, van Gaalen, R., additional, Zhongjie, L., additional, Shengjie, L., additional, Honglong, Z., additional, Biyun, C., additional, Lidong, G., additional, Hongjie, Y., additional, Weizhong, Y., additional, Buckeridge, D., additional, Peterson, W., additional, Deonandan, R., additional, Arole, S., additional, Premkumar, R., additional, Kamble, R., additional, Hobbins, M., additional, Miller, C., additional, Small, W., additional, Thielman, J., additional, Moher, D., additional, McDowell, I., additional, Kristjansson, E., additional, Poirier, A., additional, Dodds, L., additional, Johnson, M., additional, Dummer, T., additional, Rainham, D., additional, Braund, R., additional, Billard, M., additional, Pfister, T., additional, Wang, Q., additional, Kopciuk, K. A., additional, Doyle-Baker, P., additional, McLaren, L., additional, Matthews, C. E., additional, Courneya, K. S., additional, Friedenreich, C. M., additional, Chalifoux, M., additional, Brehaut, J. C., additional, Kohen, D., additional, Carroll, K., additional, Hutton, B., additional, and Fergusson, D., additional
- Published
- 2013
- Full Text
- View/download PDF
27. Les nouveaux modèles de soins intégrés atteignent-ils leur objectif de prévention ? Le cas québécois des groupes de médecine de famille (GMF)
- Author
-
Fiset-Laniel, J., primary, Borgès Da Silva, R., additional, Provost, S., additional, Strumpf, E., additional, and Tousignant, P., additional
- Published
- 2013
- Full Text
- View/download PDF
28. Innovative and Diverse Strategies Toward Primary Health Care Reform: Lessons Learned from the Canadian Experience
- Author
-
Strumpf, E., primary, Levesque, J.-F., additional, Coyle, N., additional, Hutchison, B., additional, Barnes, M., additional, and Wedel, R. J., additional
- Published
- 2012
- Full Text
- View/download PDF
29. Are United States and Canadian cancer screening rates consistent with guideline information regarding the age of screening initiation?
- Author
-
Kadiyala, S., primary and Strumpf, E. C., additional
- Published
- 2011
- Full Text
- View/download PDF
30. Resource implications of the latent tuberculosis cascade of care: a time and motion study in five countries
- Author
-
Alsdurf, H., Oxlade, O., Adjobimey, M., Ahmad Khan, F., Bastos, M., Bedingfield, N., Benedetti, A., Boafo, D., Buu, T. N, Chiang, L., Cook, V., Fisher, D., Fox, G. J, Fregonese, F., Hadisoemarto, P., Johnston, J. C, Kassa, F., Long, R., Moayedi Nia, S., Nguyen, T. A, Obeng, J., Paulsen, C., Romanowski, K., Ruslami, R., Schwartzman, K., Sohn, H., Strumpf, E., Trajman, A., Valiquette, C., Yaha, L., and Menzies, D.
- Subjects
3. Good health - Abstract
Background: The End TB Strategy calls for global scale-up of preventive treatment for latent tuberculosis infection (LTBI), but little information is available about the associated human resource requirements. Our study aimed to quantify the healthcare worker (HCW) time needed to perform the tasks associated with each step along the LTBI cascade of care for household contacts of TB patients. Methods: We conducted a time and motion (TAM) study between January 2018 and March 2019, in which consenting HCWs were observed throughout a typical workday. The precise time spent was recorded in pre-specified categories of work activities for each step along the cascade. A linear mixed model was fit to estimate the time at each step. Results: A total of 173 HCWs in Benin, Canada, Ghana, Indonesia, and Vietnam participated. The greatest amount of time was spent for the medical evaluation (median: 11 min; IQR: 6–16), while the least time was spent on reading a tuberculin skin test (TST) (median: 4 min; IQR: 2–9). The greatest variability was seen in the time spent for each medical evaluation, while TST placement and reading showed the least variability. The total time required to complete all steps along the LTBI cascade, from identification of household contacts (HHC) through to treatment initiation ranged from 1.8 h per index TB patient in Vietnam to 5.2 h in Ghana. Conclusions: Our findings suggest that the time requirements are very modest to perform each step in the latent TB cascade of care, but to achieve full identification and management of all household contacts will require additional human resources in many settings.
31. Sensor-based modeling of radial fans
- Author
-
Holzinger, F., Michael Kommenda, Strumpf, E., Langer, J., Zenisek, J., and Affenzeller, M.
32. Using Interinstitutional Practice Variation to Understand the Risks and Benefits of Routine Labor Induction at 41+0 Weeks.
- Author
-
Hutcheon, J. A., Harper, S., Strumpf, E. C., Lee, L., and Marquette, G.
- Published
- 2016
- Full Text
- View/download PDF
33. Adherence to cancer screening guidelines across Canadian provinces: an observational study
- Author
-
Chai Zhijin, Strumpf Erin C, and Kadiyala Srikanth
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Cancer screening guidelines reflect the costs and benefits of population-based screening based on evidence from clinical trials. While most of the existing literature on compliance with cancer screening guidelines only measures raw screening rates in the target age groups, we used a novel approach to estimate degree of guideline compliance across Canadian provinces for breast, colorectal and prostate cancer screening. Measuring compliance as the change in age-specific screening rates at the guideline-recommended initiation age (50), we generally found screening patterns across Canadian provinces that were not consistent with guideline compliance. Methods We calculated age-cancer-specific screening rates for ages 40-60 using the Canadian Community Health Survey (2003 and 2005), a cross-sectional, nationally representative survey of health status, health care utilization and health determinants in the Canadian population. We estimated the degree of compliance using logistic regression to measure the change in adjusted screening rates at the guideline-recommended initiation age for each province in the sample. Results For breast cancer, after adjusting for age trends and other covariates, being above age 50 in Quebec increased the probability of being screened by 19 percentage points, from an average screening rate of 24% among 40-49 year olds. None of the other regions exhibited a statistically significant change in screening rates at age 50. Additional analyses indicated that these patterns reflect asymptomatic screening and that Quebec's breast cancer screening program enhanced the degree of guideline compliance in that province. Colorectal cancer screening practice was consistent with guidelines only in Saskatchewan, as screening rates increased at age 50 by 12 percentage points, from an average rate of 6% among 40-49 year olds. For prostate cancer, the regions examined here are not compliant with Canadian guidelines since screening rates were quite high, and there was not a discrete increase at any particular age. Conclusions Screening practice for breast, colorectal and prostate cancer was generally not consistent with Canadian clinical guidelines. Quebec (breast) and Saskatchewan (colorectal) were exceptions to this, and the impact of Quebec's breast cancer screening program suggests a role for policy in improving screening guideline compliance.
- Published
- 2010
- Full Text
- View/download PDF
34. Development of a Canadian Guidance for Reporting Real-world Evidence for Regulatory and Health-Technology Assessment (HTA) Decision Making.
- Author
-
Tadrous M, Aves T, Fahim C, Riad J, Mittmann N, Prieto-Alhambra D, Rivera DR, Chan K, Lix LM, Kent S, Dawoud D, Guertin JR, McDonald T, Round J, Klarenbach S, Stanojevic S, De Vera MA, Strumpf E, Platt RW, Husein F, Lambert L, and Hayes KN
- Abstract
Real-world evidence (RWE) can complement and fill knowledge gaps from randomized controlled trials to assist in health-technology assessment (HTA) for regulatory decision-making. However, the generation of RWE is an intricate process with many sequential decision points, and different methods and approaches may impact the quality and reliability of evidence. Standardization and transparency in reporting these decisions is imperative to appraise RWE and incorporate it into HTA decision-making. A partnership between Canadian health system stakeholders, namely Health Canada and Canada's Drug Agency (formerly the Canadian Agency for Drugs and Technologies in Health (CADTH)), was established to develop a guidance for standardization of reporting of RWE for regulatory and HTA decision-making in Canada. In this article, we describe the methods to develop the Guidance for Reporting Real-World Evidence document and checklist for reporting RWE for regulatory and HTA decision-making in Canada. This guidance can be adapted for other jurisdictions and will have future extensions to incorporate emerging issues with RWE and HTA decision-making., (Copyright © 2024. Published by Elsevier Inc.)
- Published
- 2024
- Full Text
- View/download PDF
35. Antenatal corticosteroids and newborn respiratory outcomes in twins: A regression discontinuity study.
- Author
-
Socha PM, Harper S, Strumpf E, Murphy KE, and Hutcheon JA
- Subjects
- Humans, Female, Pregnancy, Infant, Newborn, British Columbia epidemiology, Premature Birth epidemiology, Premature Birth prevention & control, Hospital Mortality, Twins, Registries, Gestational Age, Adult, Infant, Premature, Respiratory Distress Syndrome, Newborn prevention & control, Respiratory Distress Syndrome, Newborn epidemiology, Pregnancy, Twin, Prenatal Care, Adrenal Cortex Hormones therapeutic use, Adrenal Cortex Hormones adverse effects
- Abstract
Objective: To estimate the effect of antenatal corticosteroids on newborn respiratory morbidity in twins., Design: Regression discontinuity applied to population-based birth registry data., Setting: British Columbia, Canada, 2008-2018., Population: Twin pregnancies admitted for birth between 31
+0 and 36+6 weeks of gestation., Methods: During our study period, Canadian clinical practice guidelines recommended antenatal corticosteroid administration for imminent preterm birth up to 33+6 weeks. We used a logistic model to compare the predicted risks of our outcomes among pregnancies admitted for birth immediately before this clinical cut-point (higher probability of exposure to antenatal corticosteroids) versus immediately after it (lower probability)., Main Outcome Measures: Our primary outcome was a composite of newborn respiratory distress or in-hospital death. Our secondary outcome was a composite of newborn respiratory intervention or in-hospital death., Results: Among 2524 pregnancies (5035 liveborn twins), 47% of admissions before 34+0 weeks of gestation were exposed to antenatal corticosteroids but only 4.2% of admissions after this cut-point were exposed. The risk of newborn respiratory distress or in-hospital mortality increased abruptly at 34+0 weeks, corresponding to a protective effect of treatment (risk ratio [RR] 0.69, 95% CI 0.53-0.90; risk difference [RD] -12 cases per 100 births, 95% CI -20 to -4.1). There was no clear evidence for or against an effect on newborn respiratory intervention or in-hospital death (RR 0.89, 95% CI 0.70-1.13; RD -4.2 per 100, 95% CI -13 to +4.2)., Conclusions: Our findings provide evidence for the effectiveness of antenatal corticosteroids in preventing adverse newborn respiratory outcomes in twins., (© 2024 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)- Published
- 2024
- Full Text
- View/download PDF
36. Human resource implications of expanding latent tuberculosis patient care activities.
- Author
-
Alsdurf H, Benedetti A, Buu TN, Adjobimey M, Cook VJ, Fisher D, Fox G, Fregonese F, Hadisoemarto P, Johnston J, Long R, Obeng J, Oxlade O, Ruslami R, Schwartzman K, Strumpf E, and Menzies D
- Abstract
Introduction: The World Health Organization (WHO) declared increasing services for latent tuberculosis infection (LTBI) a priority to eliminate tuberculosis (TB) by 2035. Yet, there is little information about thehuman resource needs required to implement LTBI treatment scale-up. Our study aimed to estimate the change in healthcare workers (HCW) time spent on different patient care activities, following an intervention to strengthen LTBI services., Methods: We conducted a time and motion (TAM) study, observing HCW throughout a typical workday before and after the intervention (Evaluation and Strengthening phases, respectively) at 24 health facilities in five countries. The precise time spent on pre-specified categories of work activities was recorded. Time spent on direct patient care was subcategorized as relating to one of three conditions: LTBI, active or suspected TB, and non-TB (i.e., patients with any other medical condition). A linear mixed model (LMM) was fit to estimate the change in HCW time following the intervention., Results: A total of 140 and 143 HCW participated in the TAMs during the Evaluation and Strengthening phases, respectively. Results from intervention facilities showed an increase of 9% (95% CI: 3%, 15%) in the proportion of HCW time spent on LTBI-related services, but with a corresponding change of -11% (95% CI: -21%, -1%) on active TB services. There was no change in the proportion of time spent on LTBI care in control facilities; this remained low in both phases of the study., Discussion: Our findings suggest that additional HCW personnel will be required for expansion of LTBI services to ensure that this expansion does not reduce the time available for care of active TB patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Alsdurf, Benedetti, Buu, Adjobimey, Cook, Fisher, Fox, Fregonese, Hadisoemarto, Johnston, Long, Obeng, Oxlade, Ruslami, Schwartzman, Strumpf and Menzies.)
- Published
- 2024
- Full Text
- View/download PDF
37. The impact of team-based primary care on medication-related outcomes in older adults: A comparative analysis of two Canadian provinces.
- Author
-
Rudoler D, Austin N, Allin S, Bjerre LM, Dolovich L, Glazier RH, Grudniewicz A, Laporte A, Martin E, Schultz S, Sirois C, and Strumpf E
- Abstract
Objective: To evaluate if access to team-based primary care is related to medication management outcomes for older adults., Methods: We completed two retrospective cohort studies using administrative health data for older adults (66+) in Ontario (n = 428,852) and Québec (n = 310,198) who were rostered with a family physician (FP) between the 2001/02 and 2017/18 fiscal years. We generated matched comparison groups of older adults rostered to an FP practicing in a team-based model, and older adults rostered to an FP in a non-team model. We compared the following outcomes between these groups: any adverse drug reactions (ADRs), any potentially inappropriate prescription (PIP), and polypharmacy. Average treatment effects of access to team-based care were estimated using a difference-in-differences estimator., Results: The risk of an ADR was 22 % higher (RR = 1.22, 95 % CI = 1.18, 1.26) for older adults rostered to a team-based FP in Québec and 6 % lower (RR = 0.943, 95 % CI = 0.907, 0.978) in Ontario. However, absolute risk differences were less than 0.5 %. Differences in the risk of polypharmacy were small in Québec (RR = 1.005, 95 % CI = 1.001, 1.009) and Ontario (RR = 1.004, 95 % CI = 1.001, 1.007) and had absolute risk differences of less than 1 % in both provinces. Effects on PIP were not statistically or clinically significant in adjusted models., Interpretation: We did not find evidence that access to team-based primary care in Ontario or Québec meaningfully improved medication management outcomes for older adults., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors have no conflict of interest to declare. The Quebec component of this work was completed through a traineeship at Institut national d’excellence en santé et services sociaux (INESSS). We thank INESSS for their guidance and support throughout the analytical process. The Ontario component of this study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by the Ontario Ministry of Health and the Canadian Institute for Health Information. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. We thank IQVIA Solutions Canada Inc. for use of their Drug Information File. Parts of this material are based on data and/or information from the Canadian Drug Product Database and Data Extract, compiled and provided by Health Canada, and used by ICES with the permission of the Minister of Health Canada, 2017. This work was supported by the Canadian Institutes of Health Information (CIHR) (PJT156326)., (© 2023 The Authors.)
- Published
- 2023
- Full Text
- View/download PDF
38. Inequalities in survival and care across social determinants of health in a cohort of advanced lung cancer patients in Quebec (Canada): A high-resolution population-level analysis.
- Author
-
Qureshi S, Boily G, Boulanger J, Pagé É, and Strumpf E
- Subjects
- Humans, Gefitinib therapeutic use, Erlotinib Hydrochloride adverse effects, Quebec epidemiology, Social Determinants of Health, Protein Kinase Inhibitors adverse effects, ErbB Receptors genetics, Canada epidemiology, Mutation, Carcinoma, Non-Small-Cell Lung pathology, Lung Neoplasms drug therapy, Lung Neoplasms epidemiology
- Abstract
Background: Advanced lung cancer patients exposed to breakthrough therapies like EGFR tyrosine kinase inhibitors (EGFR-TKI) may experience social inequalities in survival, partly from differences in care. This study examined survival by neighborhood-level socioeconomic and sociodemographic status, and geographical location of advanced lung cancer patients who received gefitinib, an EGFR-TKI, as first-line palliative treatment. Differences in the use and delay of EGFR-TKI treatment were also examined., Methods: Lung cancer patients receiving gefitinib from 2001 to 2019 were identified from Quebec's health administrative databases. Accounting for age and sex, estimates were obtained for the median survival time from treatment to death, the probability of receiving osimertinib as a second EGFR-TKI, and the median time from biopsy to receiving first-line gefitinib., Results: Among 457 patients who received first-line treatment with gefitinib, those living in the most materially deprived areas had the shortest median survival time (ratio, high vs. low deprivation: 0.69; 95% CI: 0.47-1.04). The probability of receiving osimertinib as a second EGFR-TKI was highest for patients from immigrant-dense areas (ratio, high vs. lowdensity: 1.95; 95% CI: 1.26-3.36) or from Montreal (ratio, other urban areas vs. Montreal: 0.39; 95% CI: 0.16-0.71). The median wait time for gefitinib was 1.27 times longer in regions with health centers peripheral to large centers in Quebec or Montreal in comparison to regions with university-affiliated centers (95% CI: 1.09-1.54; n = 353)., Conclusion: This study shows that real-world variations in survival and treatment exist among advanced lung cancer patients in the era of breakthrough therapies and that future research on inequalities should also focus on this population., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
- Published
- 2023
- Full Text
- View/download PDF
39. Team-based primary care reforms and older adults: a descriptive assessment of sociodemographic trends and prescribing endpoints in two Canadian provinces.
- Author
-
Austin N, Rudoler D, Allin S, Dolovich L, Glazier RH, Grudniewicz A, Martin E, Sirois C, and Strumpf E
- Subjects
- Humans, Aged, Quebec epidemiology, Ontario, Primary Health Care, Inappropriate Prescribing, Drug-Related Side Effects and Adverse Reactions epidemiology, Drug-Related Side Effects and Adverse Reactions prevention & control
- Abstract
Background: Team-based primary care reforms aim to improve care coordination by involving multiple interdisciplinary health professionals in patient care. Team-based primary care may support improved medication management for older adults with polypharmacy and multiple points of contact with the healthcare system. However, little is known about this association. This study compares sociodemographic and prescribing trends among older adults in team-based vs. traditional primary care models in Ontario and Quebec., Methods: We constructed two provincial cohorts using population-level health administrative data from 2006-2018. Our primary exposure was enrollment in a team-based model of care. Key endpoints included adverse drug events (ADEs), potentially inappropriate prescriptions (PIPs), and polypharmacy. We plotted prescribing trends across the observation period (stratified by model of care) in each province. We used standardized mean differences to compare characteristics of older adults and providers, as well as prescribing endpoints., Results: Formal patient/physician enrollment increased in both provinces since the time of policy implementation; team-based enrollment among older adults was higher in Quebec (47%) than Ontario (33%) by the end of our observation period. The distribution of sociodemographic characteristics was reasonably comparable between team-based and non-team-based patients in both provinces, aside from a persistently higher share of rural patients in team-based care. Most PIPs assessed either declined or remained relatively steady over time, regardless of model of care and province. Several PIPs were more common among team-based patients than non-team-based patients, particularly in Quebec. We did not detect notable trends in ADEs or polypharmacy in either province., Conclusions: Our findings offer encouraging evidence that many PIPs are declining over time in this population, regardless of patients' enrollment in team-based care. Rates of decline appear similar across models of care, suggesting these models may not meaningfully influence prescribing endpoints. Additional efforts are needed to understand the impact of team-based care among older adults and improve primary care prescribing practices., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
40. Cost modelling incorporating procalcitonin for the risk stratification of febrile infants ≤60 days old.
- Author
-
Dionisopoulos Z, Strumpf E, Anderson G, Guigui A, and Burstein B
- Abstract
Objectives: Procalcitonin testing is recommended to discriminate febrile young infants at risk of serious bacterial infections (SBI). However, this test is not available in many clinical settings, limited largely by cost. This study sought to evaluate contemporary real-world costs associated with the usual care of febrile young infants, and estimate impact on clinical trajectory and costs when incorporating procalcitonin testing., Methods: We assessed hospital-level door-to-discharge costs of all well-appearing febrile infants aged ≤60 days, evaluated at a tertiary paediatric hospital between April/2016 and March/2019. Emergency Department and inpatient expense data for usual care were obtained from the institutional general ledger, validated by the provincial Ministry of Health. These costs were then incorporated into a probabilistic model of risk stratification for an equivalent simulated cohort, with the addition of procalcitonin., Results: During the 3-year study period, 1168 index visits were included for analysis. Real-world median costs-per-infant were the following: $3266 (IQR $2468 to $4317, n=93) for hospitalized infants with SBIs; $2476 (IQR $1974 to $3236, n=530) for hospitalized infants without SBIs; $323 (IQR $286 to $393, n=538) for discharged infants without SBIs; and, $3879 (IQR $3263 to $5297, n=7) for discharged infants subsequently hospitalized for missed SBIs. Overall median cost-per-infant of usual care was $1555 (IQR $1244 to $2025), compared to a modelled cost of $1389 (IQR $1118 to $1797) with the addition of procalcitonin (10.7% overall cost savings; $1,816,733 versus $1,622,483). Under pessimistic and optimistic model assumptions, savings were 5.9% and 14.9%, respectively., Conclusions: Usual care of febrile young infants is variable and resource intensive. Increased access to procalcitonin testing could improve risk stratification at lower overall costs., Competing Interests: All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2022
- Full Text
- View/download PDF
41. Advanced Lung Cancer Patients' Use of EGFR Tyrosine Kinase Inhibitors and Overall Survival: Real-World Evidence from Quebec, Canada.
- Author
-
Qureshi S, Boily G, Boulanger J, Golo KT, Guédon AC, Lehuédé C, Roussafi F, Truchon C, and Strumpf E
- Subjects
- Humans, Afatinib therapeutic use, Gefitinib therapeutic use, Quebec, Erlotinib Hydrochloride therapeutic use, ErbB Receptors genetics, Protein Kinase Inhibitors therapeutic use, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung genetics, Carcinoma, Non-Small-Cell Lung pathology, Lung Neoplasms drug therapy, Lung Neoplasms genetics, Lung Neoplasms pathology
- Abstract
EGFR tyrosine kinase inhibitors (EGFR-TKIs) are breakthrough palliative treatments for advanced lung cancer patients with tumors harboring mutations in the EGFR gene. Using healthcare administrative data, three cohorts were created to describe the use of three EGFR-TKIs that are publicly funded in Quebec for specific indications (i.e., 1st-line gefitinib, 1st-line afatinib, and post-EGFR-TKI osimertinib). The main objective was to compare overall survival (OS) among patients receiving these treatments to those in previous experimental and real-world studies. The patients who received EGFR-TKIs for indications of interest between 1 April 2001, and 31 March 2019 (or 31 March 2020, for post-EGFR-TKI osimertinib) were included to estimate the Kaplan-Meier-based median OS for each cohort. An extensive literature search was conducted to include comparable studies. For the gefitinib 1st-line (n = 457), the afatinib 1st-line (n = 80), and the post-EGFR-TKI osimertinib (n = 119) cohorts, we found a median OS (in months) of 18.9 (95%CI: 16.3-21.9), 26.6 (95%CI: 13.7-NE) and 19.9 (95%CI: 17.4-NE), respectively. Out of the 20 studies that we retained from the literature review and where comparisons were feasible, 17 (85%) had similar OS results, which further confirms the value of these breakthrough therapies in real-world clinical practice.
- Published
- 2022
- Full Text
- View/download PDF
42. Mapping Canadian Data Assets to Generate Real-World Evidence: Lessons Learned from Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration's RWE Data Working Group.
- Author
-
Dai WF, de Oliveira C, Blommaert S, Pataky RE, Tran D, Aurangzeb Z, Kendell C, Folkins C, Somayaji C, Dowden J, Cheung W, Strumpf E, Beca JM, McClure C, Urquhart R, McDonald JT, Alvi R, Turner D, Peacock S, Denburg A, Mercer RE, Muñoz C, Parmar A, Tadrous M, Takhar P, Chan KKW, and On Behalf Of The CanREValue Collaboration
- Subjects
- Canada, Humans, Antineoplastic Agents therapeutic use, Neoplasms drug therapy
- Abstract
Canadian provinces routinely collect patient-level data for administrative purposes. These real-world data (RWD) can be used to generate real-world evidence (RWE) to inform clinical care and healthcare policy. The CanREValue Collaboration is developing a framework for the use of RWE in cancer drug funding decisions. A Data Working Group (WG) was established to identify data assets across Canada for generating RWE of oncology drugs. The mapping exercise was conducted using an iterative scan with informant surveys and teleconference. Data experts from ten provinces convened for a total of three teleconferences and two in-person meetings from March 2018 to September 2019. Following each meeting, surveys were developed and shared with the data experts which focused on identifying databases and data elements, as well as a feasibility assessment of conducting RWE studies using existing data elements and resources. Survey responses were compiled into an interim data report, which was used for public stakeholder consultation. The feedback from the public consultation was used to update the interim data report. We found that databases required to conduct real-world studies are often held by multiple different data custodians. Ninety-seven databases were identified across Canada. Provinces held on average 9 distinct databases (range: 8-11). An Essential RWD Table was compiled that contains data elements that are necessary, at a minimal, to conduct an RWE study. An Expanded RWD Table that contains a more comprehensive list of potentially relevant data elements was also compiled and the availabilities of these data elements were mapped. While most provinces have data on patient demographics (e.g., age, sex) and cancer-related variables (e.g., morphology, topography), the availability and linkability of data on cancer treatment, clinical characteristics (e.g., morphology and topography), and drug costs vary among provinces. Based on current resources, data availability, and access processes, data experts in most provinces noted that more than 12 months would be required to complete an RWE study. The CanREValue Collaboration's Data WG identified key data holdings, access considerations, as well as gaps in oncology treatment-specific data. This data catalogue can be used to facilitate future oncology-specific RWE analyses across Canada.
- Published
- 2022
- Full Text
- View/download PDF
43. Patient characteristics associated with enrolment under voluntary programs implemented within fee-for-service systems in British Columbia and Quebec: a cross-sectional study.
- Author
-
Lavergne MR, King C, Peterson S, Simon L, Hudon C, Loignon C, McCracken RK, Brackett A, McGrail K, and Strumpf E
- Subjects
- Adult, Canada epidemiology, Cross-Sectional Studies, Demography, Female, Health Services Needs and Demand, Humans, Income, Male, Reimbursement, Incentive, Chronic Disease economics, Chronic Disease epidemiology, Fee-for-Service Plans organization & administration, Fee-for-Service Plans statistics & numerical data, Health Services Accessibility organization & administration, Health Services Accessibility standards, Socioeconomic Factors, Substance-Related Disorders economics, Substance-Related Disorders epidemiology, Voluntary Programs statistics & numerical data
- Abstract
Background: There is a paucity of information on patient characteristics associated with enrolment under voluntary programs (e.g. incentive payments) implemented within fee-for-service systems. We explored patient characteristics associated with enrolment under these programs in British Columbia and Quebec., Methods: We used linked administrative data and a cross-sectional design to compare people aged 40 years or more enrolled under voluntary programs to those who were eligible but not enrolled. We examined 2 programs in Quebec (enrolment of vulnerable patients with qualifying conditions [implemented in 2003] and enrolment of the general population [2009]) and 3 in BC (Chronic disease incentive [2003], Complex care incentive [2007] and enrolment of the general population [A GP for Me, 2013]). We used logistic regression to estimate the odds of enrolment by neighbourhood income, rural versus urban residence, previous treatment for mental illness, previous treatment for substance use disorder and use of health care services before program implementation, controlling for characteristics linked to program eligibility., Results: In Quebec, we identified 1 569 010 people eligible for the vulnerable enrolment program (of whom 505 869 [32.2%] were enrolled within the first 2 yr of program implementation) and 2 394 923 for the general enrolment program (of whom 352 380 [14.7%] were enrolled within the first 2 yr). In BC, we identified 133 589 people eligible for the Chronic disease incentive, 47 619 for the Complex care incentive and 1 349 428 for A GP for Me; of these, 60 764 (45.5%), 28 273 (59.4%) and 1 066 714 (79.0%), respectively, were enrolled within the first 2 years. The odds of enrolment were higher in higher-income neighbourhoods for programs without enrolment criteria (adjusted odds ratio [OR] comparing highest to lowest quintiles 1.21 [95% confidence interval (CI) 1.20-1.23] in Quebec and 1.67 [95% CI 1.64-1.69] in BC) but were similar across neighbourhood income quintiles for programs with health-related eligibility criteria. The odds of enrolment by urban versus rural location varied by program. People treated for substance use disorders had lower odds of enrolment in all programs (adjusted OR 0.60-0.72). Compared to people eligible but not enrolled, those enrolled had similar or higher numbers of primary care visits and longitudinal continuity of care in the year before enrolment., Interpretation: People living in lower-income neighbourhoods and those treated for substance use disorders were less likely than people in higher-income neighbourhoods and those not treated for such disorders to be enrolled in programs without health-related eligibility criteria. Other strategies are needed to promote equitable access to primary care., Competing Interests: Competing interests: None declared., (© 2022 CMA Impact Inc. or its licensors.)
- Published
- 2022
- Full Text
- View/download PDF
44. Impact of trauma centre accreditation on mortality and complications in a Canadian trauma system: an interrupted time series analysis.
- Author
-
Batomen B, Moore L, Strumpf E, Champion H, and Nandi A
- Subjects
- Canada, Hospital Mortality, Humans, Interrupted Time Series Analysis, Accreditation, Trauma Centers
- Abstract
Background: Periodic external accreditation visits aiming to determine whether trauma centres are fulfilling the criteria for optimal care are part of most trauma systems. However, despite the growing trend towards accreditation of trauma centres, its impact on patient outcomes remains unclear. In addition, a recent systematic review found inconsistent results on the association between accreditation and patient outcomes, mostly due to the lack of robust controls. We aim to address these gaps by assessing the impact of trauma centre accreditation on patient outcomes, specifically in-hospital mortality and complications, using an interrupted time series (ITS) design., Methods: We included all major trauma admissions to five level I and four level II trauma centres in Quebec, Canada between 2008 and 2017. In order to perform ITS, we first obtained monthly and quarterly estimates of the proportions of in-hospital mortality and complications, respectively, for level I and level II centres. Prognostic scores were used to standardise these proportions to account for changes in patient case mix and segmented regressions with autocorrelated errors were used to estimate changes in levels and trends in both outcomes following accreditation., Results: There were 51 035 admissions, including 20 165 for major trauma during the study period. After accounting for changes in patient case mix and secular trend in studied outcomes, we globally did not observe an association between accreditation and patient outcomes. However, associations were heterogeneous across centres. For example, in a level II centre with worsening preaccreditation outcomes, accreditation led to -9.08 (95% CI -13.29 to -4.87) and -9.60 (95% CI -15.77 to -3.43) percentage point reductions in mortality and complications, respectively., Conclusion: Accreditation seemed to be beneficial for centres that were experiencing a decrease in performance preceding accreditation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
- Full Text
- View/download PDF
45. Comparing public policies impacting prescribing and medication management in primary care in two Canadian provinces.
- Author
-
Allin S, Martin E, Rudoler D, Church Carson M, Grudniewicz A, Jopling S, and Strumpf E
- Subjects
- Humans, Ontario, Polypharmacy, Primary Health Care, Public Policy, Medication Review, Medication Therapy Management
- Abstract
The challenges of polypharmacy and inappropriate prescribing are recognized internationally. This study synthesizes and compares the policies related to these issues introduced in Canada's two most populous provinces - Ontario and Quebec - over the first two decades of the 21st century. Drawing on policy documents and consultations with experts, we found that while medication management to address polypharmacy and inappropriate prescribing has not been an explicit and consistent policy target in either province, some policy changes sought to directly or indirectly impact medication management. These changes include the introduction of primary care teams that include pharmacists, the introduction of a medication review performed by pharmacists (in Ontario), increased emphasis on quality improvement with some attention to potentially inappropriate medications (specifically opioids in Ontario), and investments in information technology to improve communication across providers and move toward electronic prescribing to improve medication safety and appropriateness. Despite growing evidence of the problem of polypharmacy and inappropriate prescribing, there has been limited policy attention targeting these problems directly, and policy changes with potential to improve prescribing and medication management may not have been fully realized. Further research to evaluate the impact of these changes on provider behaviours, and on patient outcomes, warrants attention., Competing Interests: Declaration of Competing Interest The authors have no conflicts to declare., (Copyright © 2021. Published by Elsevier B.V.)
- Published
- 2021
- Full Text
- View/download PDF
46. Avoidable Hospitalizations in Persons with Dementia: a Population-Wide Descriptive Study (2000-2015).
- Author
-
Godard-Sebillotte C, Strumpf E, Sourial N, Rochette L, Pelletier E, and Vedel I
- Abstract
Background: Whether avoidable hospitalizations in community-dwelling persons with dementia have decreased during primary care reforms is unknown., Methods: We described the prevalence and trends in avoidable hospitalizations in population-based repeated yearly cohorts of 192,144 community-dwelling persons with incident dementia (Quebec, 2000-2015) in the context of a province-wide primary care reform, using the provincial health administrative database., Results: Trends in both types of Ambulatory Care Sensitive Condition (ACSC) hospitalization (general and older population) and 30-day readmission rates remained constant with average rates per 100 person-years: 20.5 (19.9-21.1), 31.7 (31.0-32.4), 20.6 (20.1-21.2), respectively. Rates of delayed hospital discharge (i.e., alternate level of care (ALC) hospitalizations) decreased from 23.8 (21.1-26.9) to 17.9 (16.1-20.1) (relative change -24.6%)., Conclusions: These figures shed light on the importance of the phenomenon, its lack of improvement for most outcomes over the years, and the need to develop evidence-based policies to prevent avoidable hospitalizations in this vulnerable population., Competing Interests: CONFLICT OF INTEREST DISCLOSURES The authors declare that no conflicts of interest exist., (© 2021 Author(s). Published by the Canadian Geriatrics Society.)
- Published
- 2021
- Full Text
- View/download PDF
47. Development and Validation of an Instrument to Measure Health-Related Out-of-Pocket Costs: The Cost for Patients Questionnaire.
- Author
-
Laberge M, Coulibaly LP, Berthelot S, Borges da Silva R, Guertin JR, Strumpf E, Poirier A, Zomahoun HTV, and Poder TG
- Subjects
- Female, Humans, Male, Outpatients, Reproducibility of Results, Costs and Cost Analysis statistics & numerical data, Delphi Technique, Health Expenditures, Surveys and Questionnaires statistics & numerical data
- Abstract
Objective: The growth of healthcare spending is a major concern for insurers and governments but also for patients whose health problems may result in costs going beyond direct medical costs. To develop a comprehensive tool to measure direct and indirect costs of a health condition for patients and their families to various outpatient contexts., Methods: We conducted a content and face validation including results of a systematic review to identify the items related to direct and indirect costs for patients or their families and an online Delphi to determine the cost items to retain. We conducted a pilot test-retest with 18 naive participants and analyzed data calculating intraclass correlation and kappa coefficients., Results: An initial list of 34 items was established from the systematic review. Each round of the Delphi panel incorporated feedback from the previous round until a strong consensus was achieved. After 4 rounds of the Delphi to reach consensus on items to be included and wording, the questionnaire had a total of 32 cost items. For the test-retest, kappa coefficients ranged from -0.11 to 1.00 (median = 0.86), and intraclass correlation ranged from -0.02 to 0.99 (median = 0.62)., Conclusions: A rigorous process of content and face development was implemented for the Cost for Patients Questionnaire, and this study allowed to set a list of cost elements to be considered from the patient's perspective. Additional research including a test-retest with a larger sample will be part of a subsequent validation strategy., (Copyright © 2021 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
48. Dementia and Poor Continuity of Primary Care Delay Hospital Discharge in Older Adults: A Population-Based Study From 2001 to 2016.
- Author
-
Aaltonen M, El Adam S, Martin-Matthews A, Sakamoto M, Strumpf E, and McGrail K
- Subjects
- Aged, British Columbia epidemiology, Hospitals, Humans, Retrospective Studies, Dementia epidemiology, Dementia therapy, Patient Discharge
- Abstract
Objectives: Delayed discharge, remaining in acute care longer than medically necessary, reflects less than optimal use of hospital care resources and can have negative implications for patients. We studied (1) the change over time in delayed discharge in people with and without dementia, and (2) the association of delayed discharge with discharge destination and with the continuity of primary care prior to urgent admission., Design: A retrospective population-based study., Setting and Participants: Delayed discharge after urgent admission and length of delayed discharge were studied in all hospital users aged ≥70 years with at least 1 urgent admission in British Columbia, Canada, in years 2001/02, 2005/06, 2010/11, and 2015/16 (N = 276,299)., Methods: Linked administrative data provided by Population Data BC were analyzed using generalized estimating equations (GEE), logistic regression analysis, and negative binomial regression analyses., Results: Delayed discharge increased among people with dementia and decreased among people without dementia, whereas the length of delay decreased among both. Dementia was the strongest predictor of delayed discharge [odds ratio 4.76; 95% confidence interval (CI) 4.59-4.93], whereas waiting for long-term care placement [incidence rate ratio (IRR) 1.56; 95% CI 1.50-1.62] and dementia (IRR 1.50; 95% CI 1.45-1.54) predicted a higher number of days of delay. Continuity and quantity of care with the same physician before urgent admission was associated with a decreased risk of delayed discharge, especially in people with dementia., Conclusions and Implications: This study demonstrates the need for better system integration and patient-centered care especially for people with dementia. Population aging will likely increase the number of patients at risk of delayed discharge. Delayed discharge is associated with both the patient's complex needs and the inability of the system to meet these needs during and after urgent care. Sufficient investments are needed in both primary care and long-term care resources to reduce delayed discharges., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
49. Association of Intravenous Radiocontrast With Kidney Function: A Regression Discontinuity Analysis.
- Author
-
Goulden R, Rowe BH, Abrahamowicz M, Strumpf E, and Tamblyn R
- Subjects
- Acute Kidney Injury physiopathology, Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Kidney physiopathology, Male, Middle Aged, Young Adult, Acute Kidney Injury chemically induced, Contrast Media adverse effects, Glomerular Filtration Rate drug effects, Kidney drug effects
- Abstract
Importance: Radiocontrast has long been thought of as nephrotoxic; however, a number of recent observational studies found no evidence of an association between intravenous contrast and kidney injury. Because these studies are at high risk of confounding and selection bias, alternative study designs are required to enable more robust evaluation of this association., Objective: To determine whether intravenous radiocontrast exposure is associated with clinically significant long-term kidney impairment, using a study design that permits stronger causal interpretation than existing observational research., Design, Setting, and Participants: This cohort study included all emergency department patients aged 18 years or older undergoing D-dimer testing between 2013 and 2018 in the Canadian province of Alberta. A fuzzy regression discontinuity design was used, exploiting the fact that individuals just either side of the eligibility cutoff for computed tomographic pulmonary angiogram (CTPA)-typically 500 ng/mL-have markedly different probabilities of contrast exposure, but should otherwise be similar with respect to potential confounders., Exposures: Intravenous contrast in the form of a CTPA., Main Outcomes and Measures: Estimated glomerular filtration rate (eGFR) up to 6 months following the index emergency department visit., Results: During the study period 156 028 individuals received a D-dimer test. The mean age was 53 years, 68 206 (44%) were men and 87 822 (56%) were women, and the mean baseline eGFR level was 86 mL/min/1.73 m2. Patients just above and below the CTPA eligibility cutoff were similar in terms of measured confounders. There was no evidence for an association of contrast with eGFR up to 6 months later, with a mean change in eGFR of -0.4 mL/min/1.73 m2 (95% CI, -4.9 to 4.0) associated with CTPA exposure. There was similarly no evidence for an association with need for kidney replacement therapy (risk difference [RD], 0.07%; 95% CI, -0.47% to 0.61%), mortality (RD, 0.3%; 95% CI, -2.9% to 3.2%), and acute kidney injury (RD, 4.3%; 95% CI, -2.7% to 12.9%), though the latter analysis was limited by missing data. Subgroup analyses were potentially consistent with harm among patients with diabetes (mean eGFR change -6.4 mL/min/1.73 m2; 95% CI, -15.4 to 0.2), but not among those with other reported risk factors for contrast-induced nephropathy; these analyses, however, were relatively underpowered., Conclusions and Relevance: Using a cohort study design and analysis that permits stronger causal interpretation than existing observational research, we found no evidence for a harmful effect on kidney function of intravenous contrast administered for CTPA in an emergency setting.
- Published
- 2021
- Full Text
- View/download PDF
50. Primary care continuity and potentially avoidable hospitalization in persons with dementia.
- Author
-
Godard-Sebillotte C, Strumpf E, Sourial N, Rochette L, Pelletier E, and Vedel I
- Subjects
- Aged, Aged, 80 and over, Ambulatory Care statistics & numerical data, Databases, Factual, Emergency Service, Hospital statistics & numerical data, Female, Humans, Independent Living psychology, Independent Living statistics & numerical data, Male, Patient Readmission statistics & numerical data, Propensity Score, Quebec, Retrospective Studies, Universal Health Insurance, Continuity of Patient Care statistics & numerical data, Dementia therapy, Health Services Misuse statistics & numerical data, Hospitalization statistics & numerical data, Primary Health Care statistics & numerical data
- Abstract
Background/objective: To measure the association between high primary care continuity and potentially avoidable hospitalization in community-dwelling persons with dementia. Our hypothesis was that high primary care continuity is associated with fewer potentially avoidable hospitalizations., Design: Population-based retrospective cohort (2012-2016), with inverse probability of treatment weighting using the propensity score., Setting: Quebec (Canada) health administrative database, recording most primary, secondary and tertiary care services provided via the public universal health insurance system., Participants: Population-based sample of 22,060 community-dwelling 65 + persons with dementia on March 31st, 2015, with at least two primary care visits in the preceding year (mean age 81 years, 60% female). Participants were followed for 1 year, or until death or long-term care admission., Exposure: High primary care continuity on March 31st, 2015, i.e., having had every primary care visit with the same primary care physician, during the preceding year., Main Outcome Measures: Primary: Potentially avoidable hospitalization in the follow-up period as defined by ambulatory care sensitive conditions (ACSC) hospitalization (general and older population definitions), 30-day hospital readmission; Secondary: Hospitalization and emergency department visit., Results: Among the 22,060 persons, compared with the persons with low primary care continuity, the 14,515 (65.8%) persons with high primary care continuity had a lower risk of ACSC hospitalization (general population definition) (relative risk reduction 0.82, 95% CI 0.72-0.94), ACSC hospitalization (older population definition) (0.87, 0.79-0.95), 30-day hospital readmission (0.81, 0.72-0.92), hospitalization (0.90, 0.86-0.94), and emergency department visit (0.92, 0.90-0.95). The number needed to treat to prevent one event were, respectively, 118 (69-356), 87 (52-252), 97 (60-247), 23 (17-34), and 29 (21-47)., Conclusion: Increasing continuity with a primary care physician might be an avenue to reduce potentially avoidable hospitalizations in community-dwelling persons with dementia on a population-wide level., (© 2021 The American Geriatrics Society.)
- Published
- 2021
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.