DOCSLIB.ORG

Error in Dates of Data Analysis in the Methods: the Research Letter Titled

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Error in Dates of Data Analysis in the Methods: the Research Letter Titled Letters Author Affiliations: Renal Hypertension Center, Division of Nephrology, Table 2. Change in Daytime Systolic Blood Pressure University of Ottawa, Ottawa, Ontario, Canada (Ruzicka, Bugeja, Edwards, Mean (SD), mm Hg McCormick, Hiremath); Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (Leenen); Ottawa Hospital Research With Daytime ABPM Mean Value Institute, Ottawa, Ontario, Canada (Ruzicka, Ramsay, Hiremath); Kidney SBP SBP Research Center, University of Ottawa, Ottawa, Ontario, Canada (Ruzicka, Time Point Overall <135 mm Hg ≥135 mm Hg Bugeja, Edwards, McCormick, Hiremath). Immediately after DOT −9.7 (17.3) −26.1 (19.9) −2.9 (10.4) (n = 48) Accepted for Publication: March 29, 2019. 1 mo After DOT −11.0 (15.8) −21.9 (14.0) −6.3 (14.2) Corresponding Author: Marcel Ruzicka, MD, PhD, FRCPC, Renal Hypertension (n = 46) Center, Division of Nephrology, University of Ottawa, 1967 Riverside, Rm 5-21, Ottawa, Ontario K1H 7W9, Canada ([email protected]). Abbreviations: ABPM, ambulatory blood pressure monitoring; DOT, directly Published Online: June 17, 2019. doi:10.1001/jamainternmed.2019.1455 observed therapy; SBP, systolic blood pressure. Author Contributions: Drs Ruzicka and Hiremath had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Results | A total of 60 consecutive patients (32 men [67%]; mean Concept and design: Ruzicka, Ramsay, McCormick, Hiremath. [SD] age, 62.1 [13.1] years) were enrolled in the study, and af- Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Ruzicka, Leenen, Ramsay, Hiremath. ter exclusion of those who withdrew consent (n = 4), did not Critical revision of the manuscript for important intellectual content: Ruzicka, attend DOT (n = 4), or missed subsequent ABPM (n = 4), 48 par- Ramsay, Bugeja, Edwards, McCormick, Hiremath. ticipants completed this study for the primary outcome and Statistical analysis: Ruzicka, Ramsay, Hiremath. 46 for the secondary outcome. Baseline characteristics are re- Obtained funding: Ruzicka, Ramsay, Hiremath. Administrative, technical, or material support: Ruzicka, Leenen, Ramsay, ported in Table 1. After DOT, daytime systolic BP remained 135 McCormick, Hiremath. mm Hg or greater in 34 of 48 patients (71%) who experienced Supervision: Ruzicka, Ramsay, Bugeja, Edwards, McCormick, Hiremath. a mean (SD) decrease in systolic BP of 3 (10) mm Hg. In con- Conflict of Interest Disclosures: Dr Ruzicka reported receiving grants from trast, in 14 participants (29%), treatment-resistant hyperten- Physicians Services Incorporated and The Ottawa Hospital Academic Medical Organization–Innovation Fund Provincial Oversight Committee during the sion resolved and systolic BP decreased by 26 (20) mm Hg conduct of the study. Dr Hiremath reported receiving grants from the Canadian (Table 2). This proportion was similar at 1 month in 14 of 46 Institutes of Health Research, Physicians Services Incorporated, and The Ottawa patients (30%) who no longer had treatment-resistant hyper- Hospital Academic Medical Organization outside the submitted work. No other tension. disclosures were reported. Funding/Support: This study was funded by a peer-reviewed grant (Dr Ruzicka) provided by The Ottawa Hospital Academic Medical Organization and Discussion | The results suggest that nonadherence to BP- the Innovation Fund Provincial Oversight Committee (Ontario, Canada). lowering drug regimens is high among referred patients with Role of the Funder/Sponsor: The funding sources had no role in the design and apparent treatment-resistant hypertension, even among those conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to who said they were adherent on questioning before DOT, had submit the manuscript for publication. pristine pharmacy filling records, and had accurate pill counts. Additional Contributions: Peter Magner, MD, FRCPC, provided critical review Moreover, this apparent nonadherence occurred despite more of the concept and results of this study (not compensated); Valerie Cronin, RN, than 50% of these patients already having had an adverse vas- was the research coordinator for the study (compensated); and the Hypertension Clinic study staff conducted the direct observed therapy cular event related to uncontrolled hypertension. However, we procedures (compensated). cannot exclude the possibility that the process of being in the 1. Burnier M, Wuerzner G, Struijker-Boudier H, Urquhart J. Measuring, study or receiving treatment from a nurse in a clinic was as- analyzing, and managing drug adherence in resistant hypertension. Hypertension. sociated with lower BP for some patients. Of interest, most of 2013;62(2):218-225. doi:10.1161/HYPERTENSIONAHA.113.00687 those with markedly improved BP after DOT had a sustained 2. Fadl Elmula FE, Hoffmann P, Larstorp AC, et al. Adjusted drug treatment is superior to renal sympathetic denervation in patients with true improvement in BP control seen at 1 month. Limitations of the treatment-resistant hypertension. Hypertension. 2014;63(5):991-999. doi:10. study include that the patients were highly selected and likely 1161/HYPERTENSIONAHA.114.03246 do not represent most patients with hypertension in the com- 3. Ruzicka M, Hiremath S. Can drugs work in patients who do not take them? munity. The use of DOT as described here was strictly dichoto- the problem of non-adherence in resistant hypertension. Curr Hypertens Rep. mous (adherence vs nonadherence) and thus does not allow 2015;17(9):579. doi:10.1007/s11906-015-0579-4 4. Ruzicka M, McCormick B, Leenen FH, Froeschl M, Hiremath S. Adherence to for precise assessment of the degree of nonadherence (eg, par- blood pressure-lowering drugs and resistant hypertension: should trial of direct tial vs complete), as may be the case with therapeutic drug observation therapy be part of preassessment for renal denervation? Can J Cardiol. monitoring.5,6 Overall, the findings suggest that rigorous meth- 2013;29(12):1741.e1-1741.e3. doi:10.1016/j.cjca.2013.07.678 ods of adherence assessment and intervention such as DOT 5. Brinker S, Pandey A, Ayers C, et al. Therapeutic drug monitoring facilitates should be considered for patients with apparent treatment- blood pressure control in resistant hypertension. J Am Coll Cardiol. 2014;63(8): 834-835. doi:10.1016/j.jacc.2013.10.067 resistant hypertension. 6. Eskås PA, Heimark S, Eek Mariampillai J, Larstorp AC, Fadl Elmula FE, Høieggen A. Adherence to medication and drug monitoring in apparent Marcel Ruzicka, MD, PhD, FRCPC treatment-resistant hypertension. Blood Press. 2016;25(4):199-205. doi:10. Frans H. H. Leenen, MD, PhD, FRCPC 3109/08037051.2015.1121706 Tim Ramsay, PhD Ann Bugeja, MD, FRCPC Prevalence of Inappropriateness of Parenteral Cedric Edwards, MD, FRCPC Vitamin B12 Administration in Ontario, Canada Brendan McCormick, MD, FRCPC Randomized clinical trials demonstrate that treating vitamin Swapnil Hiremath, MD, MPH B12 (cobalamin, or hereinafter B12) deficiency with oral supple- 1434 JAMA Internal Medicine October 2019 Volume 179, Number 10 (Reprinted) jamainternalmedicine.com © 2019 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 Letters mentation substantially increases serum B levels compared 12 Table. Characteristics of Patients Who Received an Intramuscular with intramuscular injections, with no difference in hemato- a Vitamin B12 Prescription logic or neuropsychiatric outcomes.1 Despite this, some pri- Patients, No. (%) mary care physicians still inappropriately administer B12 in- Characteristics (n = 146 850) jections to elderly patients.2 To our knowledge, there is no Age, y published literature characterizing prescribing patterns of in- Mean (SD) 76.5 (8.1) Median (IQR) [range] 76 (14.0) tramuscular B12 using laboratory data to document patient se- [65-110] rum levels. In this study, we assessed the prevalence of inap- Age categorized, y propriate B supplementation using population-based 12 65-69 36 866 (25.1) databases and estimated the associated cost. 70-74 28 196 (19.2) 75-79 28 014 (19.1) Methods | We performed a population-based, retrospective co- 80-84 26 055 (17.7) hort study using health system administrative databases within 85-89 18 384 (12.5) ICES, formerly the Institute for Clinical Evaluative Sciences, in ≥ 90 9335 (6.4) Ontario, Canada. Data sets were linked using unique, encoded Sex identifiers and analyzed at ICES. All persons 65 years or older Male 60 037 (40.9) who received at least 1 intramuscular B12 prescription from Janu- Female 86 813 (59.1) ary 1, 2011, to September 30, 2015 (data on B12 levels were not Location of residence available until January 1, 2010), were included. Data were ana- Rural 12 692 (8.6) lyzed from July 26, 2018, to November 22, 2018. The primary Urban 124 359 (84.7) Neighborhood income quintile outcome was the proportion of inappropriate B12 supplemen- Q1 (lowest) 32 905 (22.4) tation, defined as persons with either a normal serum B12 level Q2 32 230 (22.0) (≥ 221 pmol/L), or without a documented B12 level in the 12 Q3 29 828 (20.3) months prior to their first intramuscular B12 prescription. Vita- Q4 27 679 (18.9) min B12 supplementation was considered appropriate when per- Q5 (highest) 23 573 (16.1) sons had at least 1 documented level of marginal B12 deficiency Comorbidities (≤ 221 pmol/L) in the year prior to receiving their first B injec- 12 Crohn disease, ulcerative colitis, and malabsorption 9309 (6.3) tion. Annual cost of inappropriate, once-monthly injections was Pernicious anemia 40 908 (27.9) estimated in Canadian dollars using the amount paid for a phy- ADG comorbidity classification scheme sician visit ($33.70), intramuscular injection ($3.89), and pre- Low scores (0-5) 24 135 (16.4) scription cost ($6.74). Sunnybrook Health Sciences Centre’s re- Moderate scores (6-9) 51 920 (35.4) search ethics board approved this study and waived patient High scores (≥ 10) 70 795 (48.2) written informed consent for deidentified data.
Load more

Recommended publications
  • 2019 Abstract Book
    2019 NATIONAL MEETING / ÉDITION 2019 DU CONGRÈS ANNUEL: TAKING ACTION LE SURDIAGNOSTIC : PASSEZ À L’ACTION ABSTRACT BOOK CAHIER DES RÉSUMÉS Dear National Meeting Attendees, We are excited to be hosting the National Meeting in Montreal, Quebec and for the first time featuring both English and French sessions. I would like to thank our co-host, the Quebec Medical Association and our partner, the Canadian Medical Association for their contributions to this year’s event. The 2019 National Meeting includes a special celebration marking the fifth anniversary of the Choosing Wisely Canada campaign. I am thrilled to celebrate this important milestone with the Choosing Wisely Canada community and recognize our collective efforts in reducing unnecessary tests and treatments. In the past five years, Choosing Wisely Canada has evolved from a conversation between clinicians and patients to the national voice for reducing unnecessary tests and treatments in health care. There has been unparalleled engagement and dedication from clinicians, administrators, researchers and systems leaders. There are close to 350 quality improvement projects related to the campaign taking root across the country and 12 active provincial and territorial campaigns to help accelerate the pace of change locally. As Chair of Choosing Wisely Canada, I am proud of the sizable impact our community has had in Canada and the momentum the campaign has gained. This year’s theme Taking Action is reflective of our next chapter of the campaign. The abstracts featured in this book are a testament to the breadth of projects taking place from coast-to-coast and showcase the energy of our community in putting campaign recommendations into practice.
    [Show full text]
  • Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources: Update 2005/06 to 2017/18
    Response to an Ontario Ministry of Health and Long-Term Care Applied Health Research Question Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources: Update 2005/06 to 2017/18 Prepared By Sue Schultz, Rick Glazier, Erin Graves, Michael Schull and Rinku Sutradhar Submission Date May 3, 2019 Submitted To Negotiations Branch Negotiations and Accountability Management Division Ontario Ministry of Health and Long-Term Care ICES Project No. 2018 0866 010 004 Corresponding Authors Dr. Michael Schull ICES 2075 Bayview Avenue, G-Wing Toronto, ON M4N 3M5 Tel: 416-480-4055, ext. 4297 [email protected] Sue Schultz, Senior Epidemiologist [email protected] Note: This file replaces the 2017 update which contained results to 2015/16. Acknowledgement This study was supported by ICES (formerly the Institute for Clinical Evaluative Sciences), which is funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions are those of the authors and are independent from the funding source. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. © ICES. All rights reserved. Payments to Ontario Physicians from Ministry of Health and Long-Term Care Sources: Update 2005/06 to 2017/18 Study Population All active Ontario physicians. Time Frame The study reports physician payments for Ontario and by specialty for the years 2005/06 to 2017/18. Although previous reports have included payment estimates for 2000/01 to 2004/05 as well, the data for these years are known to be incomplete. The decision was made to exclude these early years to ensure comparable data across all years with respect to trends over time.
    [Show full text]
  • Health System Use by Frail Ontario Seniors an In-Depth Examination of Four Vulnerable Cohorts
    Health System Use by Frail Ontario Seniors An in-depth examination of four vulnerable cohorts November 2011 Health System Use by Frail Ontario Seniors An in-depth examination of four vulnerable cohorts Editors Susan E. Bronskill, PhD Ximena Camacho, MMath Andrea Gruneir, PhD Minnie M. Ho, MHSc November 2011 Health System Use by Frail Ontario Seniors ICES II PUBLICATION INFORMATION Canadian Cataloguing in Publication Data How to Cite This Publication Published by the Institute for Clinical Evaluative Health System Use by Frail Ontario Seniors: An The production of Health System Use by Frail Ontario Sciences (ICES) In-Depth Examination of Four Vulnerable Cohorts. Seniors was a collaborative venture. Accordingly, to give credit to individual authors, please cite individual © 2011 Institute for Clinical Evaluative Sciences ISBN: 978-1-926850-21-4 (Online) chapters and title, in addition to editors and book title. All rights reserved. No part of this publication may be Institute for Clinical Evaluative Sciences (ICES) Bronskill SE, Corbett L, Gruneir A, Stevenson, reproduced, stored in a retrieval system or transmitted G1 06, 2075 Bayview Avenue JE. Introduction. In: Bronskill SE, Camacho X, Gruneir A, in any format or by any means, electronic, mechanical, Toronto, ON M4N 3M5 Ho MM, editors. Health System Use by Frail Ontario photocopying, recording or otherwise, without the Telephone: 416-480-4055 Seniors: An In-Depth Examination of Four Vulnerable proper written permission of the publisher. www.ices.on.ca Cohorts. Toronto, ON: Institute for Clinical Evaluative The opinions, results and conclusions included in this Sciences; 2011. report are those of the authors and are independent from the funding sources.
    [Show full text]
  • Long-Term MI Outcomes at Hospitals with Or Without On-Site Revascularization
    ORIGINAL CONTRIBUTION Long-term MI Outcomes at Hospitals With or Without On-site Revascularization David A. Alter, MD, PhD Context Many studies have found that patients with acute myocardial infarction (AMI) C. David Naylor, MD, DPhil who are admitted to hospitals with on-site revascularization facilities have higher rates Peter C. Austin, PhD of invasive cardiac procedures and better outcomes than patients in hospitals without such facilities. Whether such differences are due to invasive procedure rates alone or Jack V. Tu, MD, PhD to other patient, physician, and hospital characteristics is unknown. Objective To determine whether invasive procedural rate variations alone account ARK TWAIN REPUTEDLY for outcome differences in patients with AMI admitted to hospitals with or without said: “To a man with a on-site revascularization facilities. hammer, every nail looks Design Retrospective, observational cohort study using linked population-based ad- like it needs driving.” ministrative data from a universal health insurance system. MThis aphorism is reflected in the oft- Setting One hundred ninety acute care hospitals in Ontario, 9 of which offered in- replicated finding that, when patients vasive procedures. with acute myocardial infarction (AMI) Patients A total of 25697 patients hospitalized with AMI between April 1, 1992, are admitted to hospitals with on-site re- and December 31, 1993, of whom 2832 (11%) were in invasive hospitals. vascularization facilities, they undergo Main Outcome Measures Mortality, recurrent cardiac hospitalizations,
    [Show full text]
  • Association of Mirabegron with the Risk of Arrhythmia in Adult Patients 66 Years Or Older—A Population-Based Cohort Study
    Letters preceding persons’ first intramuscular B12 injection, 25.5% Corresponding Author: William K. Silverstein, MD, Core Internal Medicine, Faculty of Medicine, University of Toronto, Department of Medicine, University (n = 37 487) had a normal B12 level, whereas 38.2% (n = 56 128) Health Network, 200 Elizabeth St, Eaton Building 14-217, Toronto, Ontario M5G did not have a B12 level documented. Findings were similar over 2C4, Canada ([email protected]). a 24-month look-back period (data not shown). Only 43.1% Author Contributions: Drs Cheung, Croxford, and Dharma had full access to all (n = 24 175) of the 56 128 people without a B12 level docu- of the data in the study and take responsibility for the integrity of the data and mented in the year preceding their first B12 prescription had the accuracy of the data analysis. Drs Lin and Cheung contributed equally as ever had one measured. This was performed a mean (SD) 1033.5 co–senior authors to this study. Study concept and design: Silverstein, Lin, Dharma, Cheung. (488.1) days prior to their first prescription (range, 366-2801 Acquisition, analysis, or interpretation of data: Lin, Dharma, Croxford, days). Only 35.3% (n = 8539) of these 24 175 persons had mar- Earle, Cheung. Drafting of the manuscript: Silverstein, Cheung. ginally deficient B12 levels. The estimated annual cost of in- Critical revision of the manuscript for important intellectual content: Lin, appropriate B prescribing was $45.6 million, assuming a 64% 12 Dharma, Croxford, Earle, Cheung. inappropriate prescription rate. Finally, only 1.7% (n = 2498) Statistical analysis: Dharma, Croxford, Cheung.
    [Show full text]
  • Arthritis and Related Conditions in Ontario-ICES Research Atlas (2Nd
    Arthritis and related conditions in Ontario ICES Research Atlas September 2004 Arthritis and Related Conditions in Ontario ICES Research Atlas 2nd Edition September 2004 Authors EM Badley, DPhil NM Kasman, MSc E Boyle, MSc H Kreder, MD, MPH, FRCS(C) L Corrigan, BHScPT, MSc C MacKay, BScPT, MHSc D DeBoer, MMath N Mahomed, MD, ScD RH Glazier, MD, MPH MM Mamdani, PharmD, MA, MPH J Guan, MSc AV Perruccio, MHSc G Hawker, MSc, MD, FRCPC JD Power, MHSc SB Jaglal, PhD D Shipton, PhD J Williams, PhD Institute for Clinical Evaluative Sciences Toronto Arthritis and Related Conditions in Ontario Published by the Institute for Clinical Evaluative Sciences (ICES) © 2004 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the proper written permission of the publisher. Canadian cataloguing in publication data Arthritis and Related Conditions in Ontario: ICES Research Atlas. Includes bibliographical references. ISBN 0-9730491-8-9 i. Badley, Elizabeth M. 1946 ii. Glazier, Richard H. 1956 How to cite the publication: The production of Arthritis and Related Conditions in Ontario: ICES Research Atlas was a collaborative venture. Accordingly, to give credit to individual authors, please cite individual chapters using chapter authors and title, in addition to editors and book title. For example, for Chapter 2: Perruccio AV, Badley EM, Guan J. Burden of disease. In: Badley EM, Glazier RH, editors. Arthritis and related conditions in Ontario: ICES research atlas. 2nd ed. Toronto: Institute for Clinical Evaluative Sciences; 2004.
    [Show full text]
  • Research with Impact
    Research with Impact A selection of recent projects that illustrate the combination of clinical insight and scientific rigour that drives ICES research. Helping to inform Supporting Patients First Contributing to policy Driving the development Advancing Ontario’s Canada’s opioid response by mapping access to changes for the prevention of new cardiovascular mental health strategy primary care of concussions risk prediction models with system-wide with big data benchmarking and analysis Institute for Clinical Evaluative Sciences 9 Tara Gomes David Juurlink Helping to inform Canada’s opioid response The inappropriate use of prescription opioids has ICES research also helped to inform the Canadian The work of ICES and ODPRN emerged as a significant public health and safety issue Medical Association’s 2015 policy statement on harms has helped to drive rapid, in Ontario and across Canada. Work conducted at associated with opioids and other psychoactive targeted regional responses ICES contributed to the speed with which Ontario has prescription drugs, which recommended the launch to the opioid crisis. modelled for other provinces the collection of timely of a comprehensive national strategy. ICES senior and robust data and analysis for an evidence-informed scientist David Juurlink presented at the House of response to the opioid crisis. Commons Standing Committee on Health during the strategy formulation in October 2016, and delivered ICES scientist Tara Gomes is principal investigator of a keynote address at Canada’s national Opioid ICES research helped to the Ontario Drug Policy Research Network (ODPRN), Conference the following month. inform Ontario’s Strategy to in which ICES is a partner.
    [Show full text]
  • Research Atlas
    Research Atlas Supply of Physicians’ Services KEY MESSAGES in Ontario ✓ The supply of active physicians increased steadily from 1991/92 to 1997/98 concurrent with the population rate growth. 1,2,3,4 Ben Chan ✓ The geographic maldistribution of doctors in Ontario has increased. Doctors continue to practise in 1Scientist, Institute for Clinical Evaluative Sciences, Toronto, Ontario 2Assistant Professor, Department of Health Administration, University of Toronto urban centres, while underserviced 3Assistant Professor, Department of Family and Community Medicine, University of Toronto areas continue to lose doctors. 4Lecturer, Department of Public Health Sciences, University of Toronto ✓ The comprehensiveness of primary care services has declined. Fewer general practitioners and family physicians are working in hospitals, nursing homes and obstetrics, opting instead to work more exclusively in their offices. ✓ Women physicians have made a Key Terms & Concepts significant entry into many fields of medicine, but have low participation • Physician Supply in some specialty areas. This may • Alternative Funding Plan (AFP) represent either lifestyle choices or • Full-time Equivalent (FTE) continued barriers. The opinions, results and conclusions are those of the author and no endorsement by the Ministry of Health or the Institute for Clinical Evaluative Sciences is intended or should be inferred. Supply of Physicians' Services in Ontario There is no "right" formula for determining the number of doctors needed. As Background the authors of the influential
    [Show full text]
  • Challenges for the FDA: the Future of Drug Safety
    Challenges for the FDA: The Future of Drug Safety, Workshop Summary Leslie Pray and Sally Robinson, Rapporteurs, Forum on Drug Discovery, Development, and Translation ISBN: 0-309-10987-6, 126 pages, 6x9, (2007) This free PDF was downloaded from: http://www.nap.edu/catalog/11969.html Visit the National Academies Press online, the authoritative source for all books from the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council: • Download hundreds of free books in PDF • Read thousands of books online for free • Purchase printed books and PDF files • Explore our innovative research tools – try the Research Dashboard now • Sign up to be notified when new books are published Thank you for downloading this free PDF. If you have comments, questions or want more information about the books published by the National Academies Press, you may contact our customer service department toll-free at 888-624-8373, visit us online, or send an email to [email protected]. This book plus thousands more are available at www.nap.edu. Copyright © National Academy of Sciences. All rights reserved. Unless otherwise indicated, all materials in this PDF file are copyrighted by the National Academy of Sciences. Distribution or copying is strictly prohibited without permission of the National Academies Press <http://www.nap.edu/permissions/>. Permission is granted for this material to be posted on a secure password-protected Web site. The content may not be posted on a public Web site. Challenges for the FDA: The Future of Drug Safety, Workshop Summary http://www.nap.edu/catalog/11969.html Leslie Pray and Sally Robinson, Rapporteurs Forum on Drug Discovery, Development, and Translation Board on Health Sciences Policy THE NATIONAL ACADEMIES PRESS Washington, D.C.
    [Show full text]
  • Quality of Care of International and Canadian Medical Graduates in Acute Myocardial Infarction
    ORIGINAL INVESTIGATION Quality of Care of International and Canadian Medical Graduates in Acute Myocardial Infarction Dennis T. Ko, MD; Peter C. Austin, PhD; Benjamin T. B. Chan, MD, MPA; Jack V. Tu, MD, PhD Background: International medical graduates (IMGs) Results: Of the 127275 admitted AMI patients, 28061 make up a substantial proportion of the physician work- (22.0%) were treated by IMGs and 99214 (78.0%) by Ca- force and play an important role in the care of patients nadian medical graduates. The risk-adjusted mortality rates with acute myocardial infarction (AMI). There are con- of IMG- and Canadian medical graduate–treated patients cerns that IMGs may provide inferior medical care com- were not significantly different at 30 days (13.3% vs 13.4%, pared with locally trained medical graduates, but that has P=.57) and at 1 year (21.8% vs 21.9%, P=.63). Further- not been established. more, AMI patients treated by both groups had similar ad- justed likelihood of receiving secondary prevention medi- Methods: We performed a retrospective cohort study cations at 90 days and cardiac invasive procedures at 1 year. of linked administrative databases containing health care claims of physicians’ service payments, hospital dis- Conclusions: The use of secondary prevention medications charge abstracts, and patients’ vital status. We included and cardiac procedures and the mortality of AMI patients 127275 AMI patients admitted between April 1, 1992, were similar, regardless of the origin of medical education and March 31, 2000, to acute care hospitals in Ontario. of the admitting physician. This information places the care We then compared the risk-adjusted mortality rates and provided by IMGs into perspective and supports the abil- adjusted use of secondary prevention medications and ity of well-selected IMGs in caring for AMI patients.
    [Show full text]
  • Health Data Safe Haven Recommendations for Improving Access to Health Data to Support Communities
    Building Ontario's Next- Generation Smart Cities Through Data Governance Part 1: Health Data Safe Haven Recommendations for improving access to health data to support communities I. ABOUT THE SERIES Building Ontario’s Next-Generation Smart Cities Through Data Governance There are many definitions of a “smart city,” but central to all of them is the implementation of advanced technology for the creation of systems and services to support prosperity and quality of life for people. As cities adopt smart infrastructure, they are beginning to gather useful data. Alone, that data can provide useful insights to help make specific aspects of city life more efficient and more livable. Combined with other data, city data could generate innovative new uses and new value. This emerging opportunity raises important questions on how data might be owned, shared and governed. It’s still early days and cities around the world are still figuring it out, researching and testing new methodologies, and leveraging digital technologies to support them. In such environments, digital research infrastructure is key to the exploration of smart cities data governance. Rapid advancements in data collection, transfer, and analysis technologies have provided the Government of Ontario with the opportunity to explore new infrastructure systems for economic development. These technologies have enhanced the government’s ability to amass volumes of data and interpret them to create data-driven solutions to challenges in infrastructure development and delivery of products and services to the citizens. However, this also raises concerns around privacy, security, individual rights, and privatization of citizen data. In order to balance innovation that leverages this data with individual wellbeing, the Government of Ontario granted Compute Ontario and ORION funding to study smart cities.
    [Show full text]
  • Population Health Digital Research Infrastructure: Building up and out from a Learning Collaborative Network
    Population Health Digital Research Infrastructure: Building Up and Out from a Learning Collaborative Network A White Paper submitted by Health Data Research Network Canada (HDRN Canada) to the New Digital Research Infrastructure Organization (NDRIO) December 9, 2020 Authors: P. Alison Paprica,* Donna Curtis Maillet, Lindsey Dahl, Brent Diverty, Jean-François Ethier, Frank Gavin, Alan Katz, Lisa M. Lix, Don MacDonald, Ted McDonald, Kimberlyn McGrail, Hude Quan, Robyn Rowe, Michael J. Schull, Catherine Street, J. Charles Victor, Jennifer Walker, Juliana Wu, Nicole Yada * The designated contact person for this White Paper is Alison Paprica ([email protected]); other authors are listed in alphabetical order by last name ABOUT HDRN CANADA Incorporated as an independent non-profit research institute in January 2020, Health Data Research Network Canada (HDRN Canada) is a pan-Canadian network of organizations that are working together to facilitate and accelerate multi-jurisdiction research in Canada (see Figure 1).1 The organizations that make up HDRN Canada hold and manage population-wide health and health-related data infrastructure that is used by hundreds of expert analysts and researchers across Canada. Administrative health data, which include longitudinal information about entire populations, are invaluable for high impact health research, particularly when they are linked with social and clinical data. For example, using the population-wide administrative data accessible through HDRN Canada Organizations, researchers can: study diseases of low prevalence, measure the safety and effectiveness of drugs and healthcare interventions, and compare health care system outcomes across provincial and territorial boundaries.2 However, in Canada, each province and territory is responsible for administering its own publicly funded health care program.
    [Show full text]