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Wilfong JM, Badley EM, Perruccio AV. Old Before Their Time? The Impact of Osteoarthritis on Younger Adults. Arthritis Care Res (Hoboken) 2024. [PMID: 38751094 DOI: 10.1002/acr.25374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/27/2024] [Accepted: 05/06/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Osteoarthritis (OA) is frequently perceived as a disease of the elderly and an inevitable result of aging. Because OA studies often are restricted to older adults, there is limited information on OA in younger adults. This study describes the burden of OA across a wide age range and compares younger and older adults. METHODS Descriptive analysis of the Survey on Living with Chronic Diseases in Canada - Arthritis Component, a nationally representative survey of Canadians ≥20 years who reported an arthritis diagnosis in the Canadian Community Health Survey, a general health population survey. Analyses were restricted to those reporting OA and no other kind of arthritis (n = 1,749). RESULTS In the representative group with OA, 55.4% were younger than 65 years. The mean age at diagnosis was 50 years, with 30.4% reporting being diagnosed before age 45 years. Younger adults reported similar symptom severity as their older counterparts with OA regarding the mean number of affected joint sites, severity of pain and fatigue, and activity limitations. In the youngest age group, those with OA were significantly more likely to report fair or poor overall and mental health and life dissatisfaction compared with their general counterparts; the same was not the case in the oldest age group. CONCLUSION OA is not uncommon among younger and middle-aged adults, and they experience OA impacts comparable with those for older adults. These findings suggest that younger adults with OA will live many years with symptoms and disability and highlight a need for effective OA management across ages.
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Affiliation(s)
- Jessica M Wilfong
- Schroeder Arthritis Institute, Krembil Research Institute, and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Epidemiology Unit, and University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Epidemiology Unit, and University of Toronto, Toronto, Ontario, Canada
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Kania-Richmond A, Beaupre LA, Jessiman-Perreault G, Tribo D, Martyn J, Hart DA, Robert J, Slomp M, Jones CA. 'I do hope more people can benefit from it.': The qualitative experience of individuals living with osteoarthritis who participated in the GLA:D™ program in Alberta, Canada. PLoS One 2024; 19:e0298618. [PMID: 38381756 PMCID: PMC10881017 DOI: 10.1371/journal.pone.0298618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION The Good Life with osteoArthritis: Denmark (GLA:DTM) is an evidence-based program designed for individuals with symptomatic hip and knee osteoarthritis (OA). This program has reported improvement in pain, quality of life and self-efficacy, as well as delays in joint replacement surgery for adults with moderate to severe hip or knee OA. Evaluations of GLA:DTM implementation in several countries have focused on effectiveness, training, and feasibility of the program primarily from the provider perspective. Our objective was to examine how the GLA:DTM program was perceived and experienced by individuals with hip and knee OA to inform on-going program refinement and implementation. METHODS Thirty semi-structured telephone interviews were conducted with participants who completed the GLA:DTM program in Alberta. An interpretive description approach was used to frame the study and thematic analysis was used to code the data and identify emergent themes and sub-themes associated with participants' experience and perception of the GLA:DTM program. RESULTS Most participants had a positive experience of the GLA:DTM program and particularly enjoyed the group format, although some participants felt the group format prevented one-on-one support from providers. Three emergent themes related to acceptability were identified: accessible, adaptable, and supportive. Participants found the program to be accessible in terms of location, cost, and scheduling. They also felt the program was adaptable and allowed for individual attention and translatability into other settings. Finally, most participants found the group format to be motivating and fostered connections between participants. CONCLUSION The GLA:DTM program was perceived as acceptable by most participants, yet the group format may not be useful for all individuals living with OA. Recommended improvements included adapting screening to identify those suited for the group format, providing program access earlier in the disease progression trajectory, modifying educational content based on participants' knowledge of OA and finally, providing refresher sessions after program completion.
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Affiliation(s)
- Ania Kania-Richmond
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lauren A. Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Geneviève Jessiman-Perreault
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Danika Tribo
- Rockyview General Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Jason Martyn
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - David A. Hart
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill Robert
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Mel Slomp
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - C. Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Kania-Richmond A, Jones CA, Martyn J, Hastings S, Ellis K, Jessiman-Perreault G, Hart DA, Robert J, Slomp M, Beaupre LA. Implementing a guideline-based education and exercise program for people with knee and hip osteoarthritis-Practical experiences of providers and clinic leaders: A qualitative study. Musculoskeletal Care 2023; 21:1213-1226. [PMID: 37548530 DOI: 10.1002/msc.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The Good Life with osteoArthritis: Denmark (GLA:DTM ) program is an evidence-based education and exercise program designed for individuals with symptomatic hip and knee osteoarthritis. Launched in Denmark, it has been implemented across Europe, Australia, and North America. The authors assessed the feasibility of GLADTM implementation in Canada (Alberta) by applying the RE-AIM framework. An evaluation objective was to identify factors impacting the implementation of the program in both publicly funded and private rehabilitation settings, based on the experience of the initial cohort of providers and clinic leaders who set up and delivered the program. METHODS Semi-structured telephone interviews were conducted with GLA:DTM -trained providers, managers, or directors of clinics across Alberta. Braun and Clarke's thematic approach was used to code the data and identify emergent categories and themes. Those relevant to the implementation were identified and by consensus, categorized as facilitators of and challenges to the implementation process. RESULTS Eighteen GLA:DTM -trained providers and three clinic leaders from a range of clinical settings completed an interview. Seven common themes emerged in relation to implementation across the study settings. Three themes reflect facilitators of implementation (program acceptability by providers, multi-level support mechanisms, and program flexibility) and four implementation challenges (direct and indirect costs, lack of external referrals, program access issues, and lack of suitable space). The initial implementation of the program was exploratory with limited focus on long-term sustainability. CONCLUSIONS The GLA:DTM program is a translatable program that can be implemented with relative ease in both public and private rehabilitation settings; however, costs, space constraints, and having an adequate referral base were noted challenges. Further work is warranted to explore equitable access across public and private settings and program sustainability.
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Affiliation(s)
- Ania Kania-Richmond
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Martyn
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Staci Hastings
- School of Public Health, University of Alberta, Calgary, Alberta, Canada
| | - Kira Ellis
- Rehab Advice Line, Alberta Health Services, Edmonton, Alberta, Canada
| | | | - David A Hart
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill Robert
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Mel Slomp
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Jones CA, Jessiman-Perreault G, Kania-Richmond A(A, Metcalfe A, Hart DA, Beaupre LA. The effect of geographic location and payor type on provincial-wide delivery of the GLA:D program for hip and knee osteoarthritis in Alberta, Canada. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100398. [PMID: 37649533 PMCID: PMC10463251 DOI: 10.1016/j.ocarto.2023.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
Objective The Good Life with osteoArthritis: Denmark (GLA:D™) program for knee and hip osteoarthritis has been shown to be effective, but evaluations have yet to explore whether effectiveness differs by program context. The present study explores whether there are differences in effectiveness of the GLA:D™ program for treatment of hip and knee osteoarthritis across program location (i.e., rural, urban, metro) and program payor (i.e., public, private) within Alberta, Canada. Design The study population was adults with hip or knee osteoarthritis attending the 8-week GLA:D™ supervised exercise and education programme in Alberta between Sep 2017-Mar 2020. Outcomes of interest were joint-related pain and quality of life (HOOS/KOOS), health quality of life (EQ-5D-5L), and performance-based functional (30-s chair stand test; 40-m walk test) measures. Minimally clinically important changes were calculated for each outcome and ANOVA and chi-square tests were used to determine statistical significance by program location or payor. Results Of the 1321 eligible participants, 974 (73.7%) completed the baseline questionnaire, about 50% of participants participated in a metro area and 60% paid privately for the program. There were no statistically significant differences in improvements of joint-related pain, joint-related quality of life, health-related quality of life, or performance-based functional measures by program location or program payor, except for participants who received the program in a publicly covered primary care clinic who experienced significantly larger improvements in joint-related pain. Conclusion The implementation of the GLA:D™ program for the treatment of knee and hip osteoarthritis in Alberta is effective across a range of contexts.
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Affiliation(s)
- C. Allyson Jones
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Ania (Anna) Kania-Richmond
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A. Hart
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lauren A. Beaupre
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - the Bone and Joint Health SCN
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Young JJ, Perruccio AV, Veillette CJH, McGlasson RA, Zywiel MG. The GLA:D® Canada program for knee and hip osteoarthritis: A comprehensive profile of program participants from 2017 to 2022. PLoS One 2023; 18:e0289645. [PMID: 37535587 PMCID: PMC10399832 DOI: 10.1371/journal.pone.0289645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The Good Life with osteoArthritis in Denmark (GLA:D®) program was implemented in Canada in 2017 with the aim of making treatment guideline-recommended care available to the 4 million Canadians with knee and hip osteoarthritis (OA). This report describes the GLA:D® Canada program, registry and data collection procedures, and summarizes the sociodemographic and clinical profile of participants with knee and hip OA to inform the scientific research community of the availability of these data for future investigations and collaborations. METHODS The GLA:D® program consists of three standardized components: a training course for health care providers, a group-based patient education and exercise therapy program, and a participant data registry. Patients seeking care for knee or hip OA symptoms and enrolling in GLA:D® are given the option to provide data to the GLA:D® Canada registry. Participants agreeing to provide data complete a pre-program survey and are followed up after 3-, and 12-months. Data collected on the pre-program and follow-up surveys include sociodemographic factors, clinical characteristics, health status measures, and objective physical function tests. These variables were selected to capture information across relevant health constructs and for future research investigations. RESULTS At 2022 year-end, a total of 15,193 (11,228 knee; 3,965 hip) participants were included in the GLA:D® Canada registry with 7,527 (knee; 67.0%) and 2,798 (hip; 70.6%) providing pre-program data. Participants were 66 years of age on average, predominately female, and overweight or obese. Typically, participants had knee or hip problems for multiple years prior to initiating GLA:D®, multiple symptomatic knee and hip joints, and at least one medical comorbidity. Before starting the program, the average pain intensity was 5 out of 10, with approximately 2 out of 3 participants using pain medication and 1 in 3 participants reporting a desire to have joint surgery. Likewise, 9 out 10 participants report having previously been given a diagnosis of OA, with 9 out 10 also reporting having had a radiograph, of which approximately 87% reported the radiograph showed signs of OA. CONCLUSION We have described the GLA:D® Canada program, registry and data collection procedures, and provided a detailed summary to date of the profiles of participants with knee and hip OA. These individual participant data have the potential to be linked with local health administrative data registries and comparatively assessed with other international GLA:D® registries. Researchers are invited to make use of these rich datasets and participate in collaborative endeavours to tackle questions of Canadian and global importance for a large and growing clinical population of individuals with hip and knee OA.
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Affiliation(s)
- James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christian J H Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rhona A McGlasson
- Bone and Joint Canada, Canadian Orthopaedic Foundation, Toronto, Ontario, Canada
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Haas R, Gorelik A, Busija L, O’Connor D, Pearce C, Mazza D, Buchbinder R. Prevalence and characteristics of musculoskeletal complaints in primary care: an analysis from the population level and analysis reporting (POLAR) database. BMC PRIMARY CARE 2023; 24:40. [PMID: 36739379 PMCID: PMC9898983 DOI: 10.1186/s12875-023-01976-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/06/2023] [Indexed: 02/06/2023]
Abstract
BACKGROUND Electronic health record datasets have been used to determine the prevalence of musculoskeletal complaints in general practice but not to examine the associated characteristics and healthcare utilisation at the primary care level. AIM To describe the prevalence and characteristics of patients presenting to general practitioners with musculoskeletal complaints. DESIGN AND SETTING A five-year analysis within three Primary Health Networks (PHNs) in Victoria, Australia. METHOD We included patients with at least one face-to-face consultation 2014 to 2018 inclusive and a low back (≥ 18 years), and/or neck, shoulder or knee (≥ 45 years) complaint determined by SNOMED codes derived from diagnostic text within the medical record. We determined prevalence, socio-demographic characteristics and diagnostic codes for patients with an eligible diagnosis; and number of consultations within one year of diagnosis. RESULTS 324,793/1,294,021 (25%) presented with at least one musculoskeletal diagnosis, of whom 41% (n = 133,279) fulfilled our inclusion criteria. There were slightly more females (n = 73,428, 55%), two-thirds (n = 88,043) were of working age (18-64 years) and 83,816 (63%) had at least one comorbidity. Over half had a low back diagnosis (n = 76,504, 57%) followed by knee (n = 33,438, 25%), shoulder (n = 26,335, 20%) and neck (n = 14,492, 11%). Most codes included 'pain' and/or 'ache' (low back: 58%, neck: 41%, shoulder: 32%, knee 26%). Median (IQR) all-cause consultations per patient within one year of diagnosis was 7 (4-12). CONCLUSION The burden of MSK complaints at the primary care level is high as evidenced by the prevalence of people with musculoskeletal complaints presenting to a general practitioner, the preponderance of comorbidities and the numerous consultations per year. Identification and evaluation of strategies to reduce this burden are needed.
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Affiliation(s)
- Romi Haas
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia. .,Cabrini Health, Malvern, VIC, 3144, Australia.
| | - Alexandra Gorelik
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia ,Cabrini Health, Malvern, VIC 3144 Australia
| | - Ljoudmila Busija
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia
| | - Denise O’Connor
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia ,Cabrini Health, Malvern, VIC 3144 Australia
| | | | - Danielle Mazza
- grid.1002.30000 0004 1936 7857Department of General Practice, Monash University, Notting Hill, VIC 3168 Australia
| | - Rachelle Buchbinder
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia ,Cabrini Health, Malvern, VIC 3144 Australia
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Boutefnouchet T, Vallières F, Delisle J, Benderdour M, Fernandes JC. Lymphocyte transformation test reveals low prevalence of true metal hypersensitivity among pre-operative total knee arthroplasty patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:4123-4133. [PMID: 35380240 DOI: 10.1007/s00167-022-06951-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to determine the prevalence of metal hypersensitivity, and identify pre-operative factors which could predict susceptibility to hypersensitivity reactions among patients scheduled for primary total knee arthroplasty (TKA). The present study used a testing method consistent with the recognised biological response to metals. METHODS A prospective cross-sectional analysis of 220 patients was conducted. All patients received a testing protocol using lymphocyte transformation test to evaluate reactivity to possible contents of orthopaedic implants. Test response is interpreted as stimulation index (SI) values. A comprehensive questionnaire was used to evaluate prior exposure. Patients were categorised according to SI values and the odds ratios (OR) were calculated as comparative effect measure for each predetermined prior exposure factor. RESULTS The prevalence of metal sensitivity response was 28% (n = 61) among patients with susceptibility to at least one agent (SI = 2 to 4.9), and 3.2% (n = 7) among patients with true hypersensitivity (SI ≥ 5). The population-weighted prevalence, adjusted for sampling weights of symptomatic knee osteoarthritis, was SI ≥ 5 = 4.7% (95% CI 0.4-11.8%) and SI ≥ 2 = 35.2% (95% CI 24.8-48.6%). Stimulation index levels of response to materials were markedly varied with the highest being aluminium. Female sex, smoking history, cutaneous reaction to jewellery, occupational exposure, and dental procedures were among factors shown to increase the odds of having higher reactivity response to tested metals. Nevertheless, patients with well-functioning prior contralateral TKA did not appear at greater risk of having either sensitivity or susceptibility with odds ratio (OR) = 0.2 (95% CI 0.01-3.2), p: NS and OR = 0.6 (95% CI 0.3-1.2), p: NS, respectively. Prior positive patch test was neither predictor of susceptibility to hypersensitivity OR = 1.2 (95% CI 0.6-2.6) p: NS nor predictor of true hypersensitivity OR = 0.7 (95% CI 0.08-6.1), p: NS. CONCLUSION Among patients scheduled for primary TKA with no prior clinical features of metal allergy the prevalence of true hypersensitivity to at least one metal is just over 3%. Patients are likely to encounter a material to which they have pre-existing susceptibility to hypersensitivity. With certain prior exposure factors, there was increased susceptibility to metal hypersensitivity reaction evoking an acquired condition. LEVEL OF EVIDENCE Level II, prospective cross-sectional study.
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Affiliation(s)
- Tarek Boutefnouchet
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada.
- University Hospitals Birmingham NHS Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
| | - Francis Vallières
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada
| | - Josee Delisle
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada
| | - Mohamed Benderdour
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada
| | - Julio C Fernandes
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada
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Gill J, Sayre EC, Guermazi A, Nicolaou S, Cibere J. Association between statins and progression of osteoarthritis features on magnetic resonance imaging in a predominantly pre-radiographic cohort: the Vancouver Longitudinal Study of Early Knee Osteoarthritis (VALSEKO): a cohort study. BMC Musculoskelet Disord 2022; 23:937. [PMID: 36307782 PMCID: PMC9615180 DOI: 10.1186/s12891-022-05900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To evaluate the effect of statin use on osteoarthritis (OA) incidence/progression using magnetic resonance imaging (MRI) in a population-based cohort with predominantly pre-radiographic knee OA.
Methods
A cohort aged 40–79 years with knee pain was recruited using random population sampling and followed for 7 years. Baseline exclusions were inflammatory arthritis, recent knee surgery/injury, and inability to undergo MRI. At baseline, current statin use was ascertained. Baseline and follow-up MRIs were read semi-quantitatively for cartilage damage (grade 0–4, 0/1 collapsed, 6 regions), osteophytes (grade 0–3, 8 regions), bone marrow lesions (BML) (grade 0–3, 6 regions) and effusion (grade 0–3). The primary outcome was cartilage damage incidence/progression, while secondary outcomes were incidence/progression of osteophytes, BML, and effusion, each defined as an increase by ≥1 grade at any region. To ensure population representative samples, sample weights were used. Logistic regression was used to assess the association of statin use at baseline with incidence/progression of MRI outcomes. Analyses were adjusted for sex, age, BMI, and multiple comorbidities requiring statin therapy.
Results
Of 255 participants evaluated at baseline, 122 completed the 7-year follow-up. Statin use was not significantly associated with progression of cartilage damage (OR 0.82; 95% CI 0.17, 4.06), osteophytes (OR 3.48; 95% CI 0.40, 30.31), BML (OR 0.61; 95% CI 0.12, 3.02), or effusion (OR 2.38; 95% CI 0.42, 13.63), after adjusting for confounders.
Conclusion
In this population-based cohort of predominantly pre-radiographic knee OA, statins did not affect MRI incidence/progression of cartilage damage, BML, osteophytes or effusion. Therefore, statin use does not appear to affect people with pre-radiographic stages of knee OA.
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Reichardt A, Passmore SR, Toth A, Olin G. Utilization of chiropractic services in patients with osteoarthritis and spine pain at a publicly funded healthcare facility in Canada: A retrospective study. J Back Musculoskelet Rehabil 2022; 35:1075-1084. [PMID: 35253731 DOI: 10.3233/bmr-210192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteoarthritis (OA) is one of the most prevalent and disabling musculoskeletal diseases worldwide. There is preliminary evidence from experimental studies and consensus documents that chiropractic management may alleviate spine and/or extremity OA related pain in the short term. OBJECTIVE This research explores the potential relationship of a pragmatic course of care, including soft tissue therapy, spinal manipulation, and other treatments commonly delivered by chiropractors, to spine and extremity pain in patients with OA. METHODS A retrospective analysis of prospectively collected data from the chiropractic program at a publicly funded healthcare facility was conducted. The primary outcome measures for patients diagnosed with spine and/or extremity OA (n= 76) were numeric pain scores of each spinal and extremity region at baseline and discharge, and a change score was determined. RESULTS Statistically significant improvements that exceed a clinically meaningful difference in pain numeric rating scale scores were demonstrated by point change reductions from baseline to discharge visits. Change scores exceeding a minimally clinically important difference of "2-points" were present in the sacroiliac (-2.91), extremity (-2.84), cervical (-2.73), thoracic (-2.61), and lumbar (-2.59) regions. CONCLUSION Patients diagnosed with OA in a socioeconomically disadvantaged community demonstrated reductions in mean pain scores in both a clinically meaningful and statistically significant manner concurrent with a course of chiropractic care.
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Affiliation(s)
- Amber Reichardt
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | - Steven R Passmore
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada.,Research Department, New York Chiropractic College, Seneca Falls, NY, USA
| | - Audrey Toth
- Chiropractic Program, Mount Carmel Clinic, Winnipeg, MB, Canada
| | - Gerald Olin
- Manitoba Chiropractors Association, Winnipeg, MB, Canada
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10
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Hoteit F, Erhmann Feldman D, Carlesso LC. Factors Associated with Intermittent, Constant, and Mixed Pain in People with Knee Osteoarthritis. Physiother Can 2022; 74:267-275. [PMID: 37325210 PMCID: PMC10262826 DOI: 10.3138/ptc-2020-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 08/26/2023]
Abstract
Purpose: To explore factors associated with intermittent, constant, and mixed pain in people with knee osteoarthritis. Method: We conducted a secondary analysis of a cross-sectional multicentre study with adults ≥ 40 years with knee osteoarthritis. Participants completed questionnaires on personal (e.g., demographics, comorbidities), physical (e.g., physical function), psychological (e.g., depressive symptoms), pain (e.g., qualities), and tests for physical performance and nervous system sensitivity. We qualified patients' pain as intermittent, constant, or mixed using the Modified painDETECT Questionnaire and assessed associations with the variables using multinomial logistic regression. Results: The 279 participants had an average age of 63.8 years (SD 9.6), BMI of 31.5 kg/m2 (SD 8.7), and 58.6% were female. Older age (odds ratio [OR] 0.95; 95% CI: 0.90, 1.00) and higher self-reported physical function (OR 0.94; 95% CI: 0.91, 0.98) were associated with a lower likelihood of mixed pain compared with intermittent pain. Higher pain intensity (OR 1.25; 95% CI: 1.07, 1.47) was related to a 25% higher likelihood of mixed pain compared with intermittent pain. Conclusions: This study provides initial data for associations of personal, pain, and physical function factors with different pain patterns. Awareness of these factors can help clinicians develop targeted strategies for managing patients' pain.
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Affiliation(s)
- Fatme Hoteit
- School of Rehabilitation, Physiotherapy Program, Université de Montréal, Montreal, Quebec, Canada
| | - Debbie Erhmann Feldman
- School of Rehabilitation, Physiotherapy Program, and School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Institute of Public Health Research, Université de Montréal, Montreal, Quebec, Canada
| | - Lisa C. Carlesso
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St. Joseph’s Hamilton, Hamilton, Ontario, Canada
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
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11
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Liu X, Seidel JE, McDonald T, Patel AB, Waters N, Bertazzon S, Shahid R, Marshall DA. Rural–Urban Disparities in Realized Spatial Access to General Practitioners, Orthopedic Surgeons, and Physiotherapists among People with Osteoarthritis in Alberta, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137706. [PMID: 35805363 PMCID: PMC9266058 DOI: 10.3390/ijerph19137706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/11/2022] [Accepted: 06/19/2022] [Indexed: 01/27/2023]
Abstract
Rural Canadians have high health care needs due to high prevalence of osteoarthritis (OA) but lack access to care. Examining realized access to three types of providers (general practitioners (GPs), orthopedic surgeons (Ortho), and physiotherapists (PTs)) simultaneously helps identify gaps in access to needed OA care, inform accessibility assessment, and support health care resource allocation. Travel time from a patient’s postal code to the physician’s postal code was calculated using origin–destination network analysis. We applied descriptive statistics to summarize differences in travel time, hotspot analysis to explore geospatial patterns, and distance decay function to examine the travel pattern of health care utilization by urbanicity. The median travel time in Alberta was 11.6 min (IQR = 4.3–25.7) to GPs, 28.9 (IQR = 14.8–65.0) to Ortho, and 33.7 (IQR = 23.1–47.3) to PTs. We observed significant rural–urban disparities in realized access to GPs (2.9 and IQR = 0.0–92.1 in rural remote areas vs. 12.6 and IQR = 6.4–21.0 in metropolitan areas), Ortho (233.3 and IQR = 171.3–363.7 in rural remote areas vs. 21.3 and IQR = 14.0–29.3 in metropolitan areas), and PTs (62.4 and IQR = 0.0–232.1 in rural remote areas vs. 32.1 and IQR = 25.2–39.9 in metropolitan areas). We identified hotspots of realized access to all three types of providers in rural remote areas, where patients with OA tend to travel longer for health care. This study may provide insight on the choice of catchment size and the distance decay pattern of health care utilization for further studies on spatial accessibility.
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Affiliation(s)
- Xiaoxiao Liu
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
| | - Judy E. Seidel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Terrence McDonald
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Alka B. Patel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Nigel Waters
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Department of Civil Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Environmental Science and Policy, College of Science, George Mason University, Fairfax, VA 22030, USA
| | - Stefania Bertazzon
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Rizwan Shahid
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Deborah A. Marshall
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Correspondence: ; Tel.: +1-403-210-6377; Fax: +1-403-210-9574
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12
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Liu X, Seidel JE, McDonald T, Waters N, Patel AB, Shahid R, Bertazzon S, Marshall DA. Rural-Urban Differences in Non-Local Primary Care Utilization among People with Osteoarthritis: The Role of Area-Level Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6392. [PMID: 35681975 PMCID: PMC9180262 DOI: 10.3390/ijerph19116392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/21/2022] [Accepted: 05/22/2022] [Indexed: 12/04/2022]
Abstract
The utilization of non-local primary care physicians (PCP) is a key primary care indicator identified by Alberta Health to support evidence-based healthcare planning. This study aims to identify area-level factors that are significantly associated with non-local PCP utilization and to examine if these associations vary between rural and urban areas. We examined rural-urban differences in the associations between non-local PCP utilization and area-level factors using multivariate linear regression and geographically weighted regression (GWR) models. Global Moran's I and Gi* hot spot analyses were applied to identify spatial autocorrelation and hot spots/cold spots of non-local PCP utilization. We observed significant rural-urban differences in the non-local PCP utilization. Both GWR and multivariate linear regression model identified two significant factors (median travel time and percentage of low-income families) with non-local PCP utilization in both rural and urban areas. Discontinuity of care was significantly associated with non-local PCP in the southwest, while the percentage of people having university degree was significant in the north of Alberta. This research will help identify gaps in the utilization of local primary care and provide evidence for health care planning by targeting policies at associated factors to reduce gaps in OA primary care provision.
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Affiliation(s)
- Xiaoxiao Liu
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
| | - Judy E. Seidel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
| | - Terrence McDonald
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Nigel Waters
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Civil Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Environmental Science and Policy, College of Science, George Mason University, Fairfax, VA 22030, USA
| | - Alka B. Patel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
| | - Rizwan Shahid
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Stefania Bertazzon
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Deborah A. Marshall
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
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13
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Zhang P, Li K, Kamali A, Ziadlou R, Ahmad P, Wang X, Richards RG, Alini M, Basoli V, Li Z, Grad S. Small molecules of herbal origin for osteoarthritis treatment: in vitro and in vivo evidence. Arthritis Res Ther 2022; 24:105. [PMID: 35545776 PMCID: PMC9092710 DOI: 10.1186/s13075-022-02785-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 04/19/2022] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis (OA) is one of the most common musculoskeletal degenerative diseases and contributes to heavy socioeconomic burden. Current pharmacological and conventional non-pharmacological therapies aim at relieving the symptoms like pain and disability rather than modifying the underlying disease. Surgical treatment and ultimately joint replacement arthroplasty are indicated in advanced stages of OA. Since the underlying mechanisms of OA onset and progression have not been fully elucidated yet, the development of novel therapeutics to prevent, halt, or reverse the disease is laborious. Recently, small molecules of herbal origin have been reported to show potent anti-inflammatory, anti-catabolic, and anabolic effects, implying their potential for treatment of OA. Herein, the molecular mechanisms of these small molecules, their effect on physiological or pathological signaling pathways, the advancement of the extraction methods, and their potential clinical translation based on in vitro and in vivo evidence are comprehensively reviewed.
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Affiliation(s)
- Penghui Zhang
- AO Research Institute Davos, Davos, Switzerland.,Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Kaihu Li
- AO Research Institute Davos, Davos, Switzerland.,Department of Orthopaedics, Xiangya Hospital of Central South University, Changsha, China
| | - Amir Kamali
- AO Research Institute Davos, Davos, Switzerland
| | | | - Paras Ahmad
- AO Research Institute Davos, Davos, Switzerland
| | - Xinluan Wang
- Translational Medicine R&D Center, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | | | - Mauro Alini
- AO Research Institute Davos, Davos, Switzerland
| | | | - Zhen Li
- AO Research Institute Davos, Davos, Switzerland.
| | - Sibylle Grad
- AO Research Institute Davos, Davos, Switzerland. .,Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland.
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14
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Evaluation of the prevalence of musculoskeletal conditions in consecutive patients with skin psoriasis: a descriptive cross-sectional study. Rheumatol Int 2022; 42:651-657. [DOI: 10.1007/s00296-022-05099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
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15
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Low Use of Guideline Recommended Cardiorenal Protective Antihyperglycemic Agents in Primary Care: A Cross-Sectional Study of Persons with Type 2 Diabetes. Can J Diabetes 2022; 46:487-494. [DOI: 10.1016/j.jcjd.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/23/2021] [Accepted: 02/03/2022] [Indexed: 11/21/2022]
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16
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Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Physical Therapy vs Glucocorticoid Injection for Knee Osteoarthritis. Am J Phys Med Rehabil 2021; 100:e164-e166. [PMID: 34673708 DOI: 10.1097/phm.0000000000001757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Kopec JA, Heath AJ, Sayre EC, Cibere J, Li LC, Marra CA, Liu RR, Esdaile JM. Prevalence of joint-specific osteoarthritis and joint pain in British Columbia, Canada. Rheumatol Int 2021; 42:1623-1628. [PMID: 34716488 DOI: 10.1007/s00296-021-05031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
The objective is to determine the prevalence of self-reported physician-diagnosed osteoarthritis (OA) and musculoskeletal symptoms (pain, stiffness or discomfort) in specific joints among adults in British Columbia (BC), Canada. We carried out a cross-sectional mixed-mode survey in a random population sample of persons 18 years of age and older. Estimates were weighted to reflect the age and sex distribution of the population of BC. We obtained responses from 2,233 individuals. Overall, 18.4% (95% CI 16.8-20.1) of the adult population reported OA. Of those, more than 40% had OA in multiple sites. Prevalence ranged from 8.8% (95% CI 7.6-10.1) in the knee to 2.7% (2.1-3.5) in the foot. One-year prevalence of symptoms ranged from 49.1% (47.0-51.2) in the lower back to 23.3% (21.5-25.1) in the hip. Females reported more symptoms and OA than males in all joints. The most common site of self-reported physician-diagnosed OA in BC is the knee, but OA in the hands, hips, and feet is also common. Having OA in one joint is a strong predictor of OA in other joints.
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Affiliation(s)
- Jacek A Kopec
- School of Population and Public Health, University of British Columbia, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada. .,Arthritis Research Canada, Vancouver, Canada.
| | | | | | - Jolanda Cibere
- Arthritis Research Canada, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Arthritis Research Canada, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Carlo A Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Ran R Liu
- Department of Medicine, Queens University, Kingston, Canada
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D'Arcy Y, Mantyh P, Yaksh T, Donevan S, Hall J, Sadrarhami M, Viktrup L. Treating osteoarthritis pain: mechanisms of action of acetaminophen, nonsteroidal anti-inflammatory drugs, opioids, and nerve growth factor antibodies. Postgrad Med 2021; 133:879-894. [PMID: 34252357 DOI: 10.1080/00325481.2021.1949199] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Osteoarthritis (OA) is a common difficult-to-treat condition where the goal, in the absence of disease-modifying treatments, is to alleviate symptoms such as pain and loss of function. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids are common pharmacologic treatments for OA. Antibodies directed against nerve growth factor (NGF-Abs) are a new class of agents under clinical investigation for the treatment of OA. This narrative review describes (and uses schematics to visualize) nociceptive signaling, chronification of pain, and the mechanisms of action (MOAs) of these different analgesics in the context of OA-related pain pathophysiology. Further, the varying levels of efficacy and safety of these agents observed in patients with OA is examined, based on an overview of published clinical data and/or treatment guidelines (when available), in the context of differences in their MOAs.
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Affiliation(s)
- Yvonne D'Arcy
- Independent Nurse Practitioner, Ponte Vedra Beach, FL, USA
| | - Patrick Mantyh
- Department of Pharmacology and Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Tony Yaksh
- Department of Anesthesiology and Pharmacology, University of California at San Diego, San Diego, CA, USA
| | | | - Jerry Hall
- Lilly Biomedicines, US/Global Medical Affairs, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Lars Viktrup
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
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19
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Garies S, McBrien K, Quan H, Manca D, Drummond N, Williamson T. A data quality assessment to inform hypertension surveillance using primary care electronic medical record data from Alberta, Canada. BMC Public Health 2021; 21:264. [PMID: 33530975 PMCID: PMC7852125 DOI: 10.1186/s12889-021-10295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hypertension is a common chronic condition affecting nearly a quarter of Canadians. Hypertension surveillance in Canada typically relies on administrative data and/or national surveys. Routinely-captured data from primary care electronic medical records (EMRs) are a complementary source for chronic disease surveillance, with longitudinal patient-level details such as sociodemographics, blood pressure, weight, prescribed medications, and behavioural risk factors. As EMR data are generated from patient care and administrative tasks, assessing data quality is essential before using for secondary purposes. This study evaluated the quality of primary care EMR data from one province in Canada within the context of hypertension surveillance. METHODS We conducted a cross-sectional, descriptive study using primary care EMR data collected by two practice-based research networks in Alberta, Canada. There were 48,377 adults identified with hypertension from 53 clinics as of June 2018. Summary statistics were used to examine the quality of data elements considered relevant for hypertension surveillance. RESULTS Patient year of birth and sex were complete, but other sociodemographic information (ethnicity, occupation, education) was largely incomplete and highly variable. Height, weight, body mass index and blood pressure were complete for most patients (over 90%), but a small proportion of outlying values indicate data inaccuracies were present. Most patients had a relevant laboratory test present (e.g. blood glucose/glycated hemoglobin, lipid profile), though a very small proportion of values were outside a biologically plausible range. Details of prescribed antihypertensive medication, such as start date, strength, dose, frequency, were mostly complete. Nearly 80% of patients had a smoking status recorded, though only 66% had useful information (i.e. categorized as current, past, or never), and less than half had their alcohol use described; information related to amount, frequency or duration was not available. CONCLUSIONS Blood pressure and prescribed medications in primary care EMR data demonstrated good completeness and plausibility, and contribute valuable information for hypertension epidemiology and surveillance. The use of other clinical, laboratory, and sociodemographic variables should be used carefully due to variable completeness and suspected data errors. Additional strategies to improve these data at the point of entry and after data extraction (e.g. statistical methods) are required.
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Affiliation(s)
- Stephanie Garies
- Department of Family Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada.
| | - Kerry McBrien
- Department of Family Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Donna Manca
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - Neil Drummond
- Department of Family Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
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20
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Widdifield J, Jaakkimainen RL, Gatley JM, Hawker GA, Lix LM, Bernatsky S, Ravi B, Wasserstein D, Yu B, Tu K. Validation of canadian health administrative data algorithms for estimating trends in the incidence and prevalence of osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100115. [DOI: 10.1016/j.ocarto.2020.100115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022] Open
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21
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Lan RH, Yu J, Samuel LT, Pappas MA, Brooks PJ, Kamath AF. How Are We Measuring Cost-Effectiveness in Total Joint Arthroplasty Studies? Systematic Review of the Literature. J Arthroplasty 2020; 35:3364-3374. [PMID: 32680755 DOI: 10.1016/j.arth.2020.06.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As volumes of total hip arthroplasty (THA) and total knee arthroplasty (TKA) continue to rise, it is important to understand their economic impact. No systematic review on cost-effectiveness of THA/TKA has been performed since 2016 despite recent changes in the healthcare environment. The purpose of the study is to provide a contemporary analysis of the cost-effectiveness of total joint arthroplasty and the use of quality-adjusted life years (QALYs). METHODS A systematic review was performed from 2005 to 2020. Online databases (OVID Medline, PubMed, Cost-Effectiveness Analysis Registry, Google Scholar, Elton B. Stephens Co) were queried to identify economic analyses that evaluated the cost-effectiveness of THA/TKA. RESULTS In total, 38 studies met the screening criteria. Study designs were primarily Markov models (68%), cohort studies (16%), and randomized trials (8%). Most studies adopted either a societal perspective (45%) or a health system perspective (39%). Analysis revealed that THA/TKA was strongly cost-effective compared to nonsurgical treatment. THA/TKA procedures that were not delayed were more cost-effective than delayed intervention. The majority of studies used QALYs as the primary quality metric (82%); in all these studies there was a significant improvement in QALYs gained. CONCLUSION Given the high economic impact of arthroplasty, ongoing assessment of cost-effectiveness is needed. Twenty-four percent of studies included in this systematic review were published in the last 4 years of this 15-year study period, highlighting the need for continuous assessment of aggregate data. Future studies should incorporate the cost-effectiveness of THA and TKA with respect to the work-value provided by surgeon providers to support health policy and reimbursement.
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Affiliation(s)
- Roy H Lan
- University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Jessica Yu
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Matthew A Pappas
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH; Center for Value-Based Care Research, Cleveland Clinic Foundation, Cleveland, OH
| | - Peter J Brooks
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH
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Liu X, Shahid R, Patel AB, McDonald T, Bertazzon S, Waters N, Seidel JE, Marshall DA. Geospatial patterns of comorbidity prevalence among people with osteoarthritis in Alberta Canada. BMC Public Health 2020; 20:1551. [PMID: 33059639 PMCID: PMC7559790 DOI: 10.1186/s12889-020-09599-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Knowledge of geospatial pattern in comorbidities prevalence is critical to an understanding of the local health needs among people with osteoarthritis (OA). It provides valuable information for targeting optimal OA treatment and management at the local level. However, there is, at present, limited evidence about the geospatial pattern of comorbidity prevalence in Alberta, Canada. METHODS Five administrative health datasets were linked to identify OA cases and comorbidities using validated case definitions. We explored the geospatial pattern in comorbidity prevalence at two standard geographic areas levels defined by the Alberta Health Services: descriptive analysis at rural-urban continuum level; spatial analysis (global Moran's I, hot spot analysis, cluster and outlier analysis) at the local geographic area (LGA) level. We compared area-level indicators in comorbidities hotspots to those in the rest of Alberta (non-hotspots). RESULTS Among 359,638 OA cases in 2013, approximately 60% of people resided in Metro and Urban areas, compared to 2% in Rural Remote areas. All comorbidity groups exhibited statistically significant spatial autocorrelation (hypertension: Moran's I index 0.24, z score 4.61). Comorbidity hotspots, except depression, were located primarily in Rural and Rural Remote areas. Depression was more prevalent in Metro (Edmonton-Abbottsfield: 194 cases per 1000 population, 95%CI 192-195) and Urban LGAs (Lethbridge-North: 169, 95%CI 168-171) compared to Rural areas (Fox Creek: 65, 95%CI 63-68). Comorbidities hotspots included a higher percentage of First Nations or Inuit people. People with OA living in hotspots had lower socioeconomic status and less access to care compared to non-hotspots. CONCLUSIONS The findings highlight notable rural-urban disparities in comorbidities prevalence among people with OA in Alberta, Canada. Our study provides valuable evidence for policy and decision makers to design programs that ensure patients with OA receive optimal health management tailored to their local needs and a reduction in current OA health disparities.
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Affiliation(s)
- Xiaoxiao Liu
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, HRIC Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Rizwan Shahid
- Department of Geography, University of Calgary, Calgary, Canada
- Applied Research and Evaluation Services, Alberta Health Services, Calgary, Canada
| | - Alka B Patel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, HRIC Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada
- Applied Research and Evaluation Services, Alberta Health Services, Calgary, Canada
| | - Terrence McDonald
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Nigel Waters
- Department of Geography, University of Calgary, Calgary, Canada
| | - Judy E Seidel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, HRIC Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada
- Applied Research and Evaluation Services, Alberta Health Services, Calgary, Canada
| | - Deborah A Marshall
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, HRIC Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada.
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, Canada.
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
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Carr ECJ, Ortiz MM, Patel JN, Barber CEH, Katz S, Robert J, Mosher D, Teare SR, Miller J, Homik J, Dinsmore K, Marshall DA. Models of Arthritis Care: A Systems-level Evaluation of Acceptability as a Dimension of Quality of Care. J Rheumatol 2020; 47:1431-1439. [PMID: 31732557 DOI: 10.3899/jrheum.190501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe a systems-level baseline evaluation of central intake (CI) and triage systems in arthritis care within Alberta, Canada. The specific objectives were to (1) describe a process for systems evaluation for the provision of arthritis care; (2) report the findings of the evaluation for different clinical sites that provide arthritis care; and (3) identify opportunities for improving appropriate and timely access based on the findings of the evaluation. METHODS The study used a convergent mixed methods design. Surveys and semistructured interviews were the main data collection methods. Participants were recruited through 2 rheumatology clinics and 1 hip and knee clinic providing CI and triage, and included patients, referring physicians, specialists, and clinic staff who experienced CI processes. RESULTS A total of 237 surveys were completed by patients (n = 169), referring physicians (n = 50), and specialists (n = 18). Interviews (n = 25) with care providers and patients provided insights to the survey data. Over 95% of referring physicians agreed that the current process of CI was satisfactory. Referring physicians and specialists reported issues with the referral process and perceived support in care for wait-listed patients. Patients reported positive experiences with access and navigation of arthritis care services but expressed concerns around communication and receiving minimal support for self-management of their arthritis before and after receiving specialist care. CONCLUSION This baseline evaluation of CI and triage for arthritis care indicates satisfaction with the service, but areas that require further consideration are referral completion, timely waiting lists, and further supporting patients to self-manage their arthritis.
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Affiliation(s)
- Eloise C J Carr
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada. .,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary.
| | - Mia M Ortiz
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jatin N Patel
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Claire E H Barber
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Steven Katz
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jill Robert
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Dianne Mosher
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Sylvia R Teare
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jean Miller
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Joanne Homik
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Kelly Dinsmore
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Deborah A Marshall
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
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Gorelik N, Gyftopoulos S. Applications of Artificial Intelligence in Musculoskeletal Imaging: From the Request to the Report. Can Assoc Radiol J 2020; 72:45-59. [PMID: 32809857 DOI: 10.1177/0846537120947148] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Artificial intelligence (AI) will transform every step in the imaging value chain, including interpretive and noninterpretive components. Radiologists should familiarize themselves with AI developments to become leaders in their clinical implementation. This article explores the impact of AI through the entire imaging cycle of musculoskeletal radiology, from the placement of the requisition to the generation of the report, with an added Canadian perspective. Noninterpretive tasks which may be assisted by AI include the ordering of appropriate imaging tests, automatic exam protocoling, optimized scheduling, shorter magnetic resonance imaging acquisition time, computed tomography imaging with reduced artifact and radiation dose, and new methods of generation and utilization of radiology reports. Applications of AI for image interpretation consist of the determination of bone age, body composition measurements, screening for osteoporosis, identification of fractures, evaluation of segmental spine pathology, detection and temporal monitoring of osseous metastases, diagnosis of primary bone and soft tissue tumors, and grading of osteoarthritis.
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Affiliation(s)
- Natalia Gorelik
- Department of Diagnostic Radiology, 54473McGill University Health Center, Montreal, Quebec, Canada
| | - Soterios Gyftopoulos
- Department of Radiology, 12297NYU Langone Medical Center/NYU Langone Orthopedic Center, New York, NY, USA.,Department of Orthopedic Surgery, 12297NYU Langone Medical Center/NYU Langone Orthopedic Center, New York, NY, USA
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Black JE, Terry AL, Lizotte DJ. Development and evaluation of an osteoarthritis risk model for integration into primary care health information technology. Int J Med Inform 2020; 141:104160. [PMID: 32593009 DOI: 10.1016/j.ijmedinf.2020.104160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/28/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND We developed and evaluated a prognostic prediction model that estimates osteoarthritis risk for use by patients and practitioners that is designed to be appropriate for integration into primary care health information technology systems. Osteoarthritis, a joint disorder characterized by pain and stiffness, causes significant morbidity among older Canadians. Because our prognostic prediction model for osteoarthritis risk uses data that are readily available in primary care settings, it supports targeting of interventions delivered as part of clinical practice that are aimed at risk reduction. METHODS We used the CPCSSN (Canadian Primary Sentinel Surveillance Network) database, which contains aggregated electronic health information from a cohort of primary care practices, to develop and evaluate a prognostic prediction model to estimate 5-year osteoarthritis risk, addressing contextual challenges of data availability and missingness. We constructed a retrospective cohort of 383,117 eligible primary care patients who were included in the cohort if they had an encounter with their primary care practitioner between 1 January 2009 and 31 December 2010. Patients were excluded if they had a diagnosis of osteoarthritis prior to their first visit in this time period. Incident cases of osteoarthritis were observed. The model was constructed to predict incident osteoarthritis based on age, sex, BMI, previous leg injury, and osteoporosis. Evaluation of the model used internal 10-fold cross-validation; we argue that internal validation is particularly appropriate for a model that is to be integrated into the same context from which the data were derived. RESULTS The resulting prediction model for 5-year risk of osteoarthritis diagnosis demonstrated state-of-the-art discrimination (estimated AUROC 0.84) and good calibration (assessed visually.) The model relies only on information that is readily available in Canadian primary care settings, and hence is appropriate for integration into Canadian primary care health information technology. CONCLUSIONS If the contextual challenges arising when using primary care electronic medical record data are appropriately addressed, highly discriminative models for osteoarthritis risk may be constructed using only data commonly available in primary care. Because the models are constructed from data in the same setting where the model is to be applied, internal validation provides strong evidence that the resulting model will perform well in its intended application.
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Affiliation(s)
- Jason E Black
- Graduate Program in Epidemiology & Biostatistics, Western University, 1151 Richmond Street, London, Ontario, N6A 5C1, Canada.
| | - Amanda L Terry
- Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
| | - Daniel J Lizotte
- Department of Computer Science, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Department of Statistical and Actuarial Sciences, 1151 Richmond Street, Western University, London, Ontario, N6A 3K7, Canada.
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Swain S, Sarmanova A, Coupland C, Doherty M, Zhang W. Comorbidities in Osteoarthritis: A Systematic Review and Meta-Analysis of Observational Studies. Arthritis Care Res (Hoboken) 2020; 72:991-1000. [PMID: 31207113 DOI: 10.1002/acr.24008] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/11/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) is a common chronic condition in older individuals, but its association with other chronic conditions is largely unknown. This study aimed to systematically review the literature on comorbidities in individuals with OA compared to those without. METHODS We searched 4 databases for observational studies on comorbidities in individuals with OA. Studies of OA only or in comparison with non-OA controls were included. The risk of bias and study quality were assessed using the Newcastle-Ottawa Scale. The prevalence of comorbidities in the OA group and the prevalence ratio (PR) and 95% confidence interval (95% CI) between OA and non-OA groups were calculated. RESULTS In all, 42 studies from 16 countries (27 case-only and 15 comparative studies) met the inclusion criteria. The mean age of participants varied from 51 to 76 years. The pooled prevalence of any comorbidity was 67% (95% CI 57-74) in individuals with OA versus 56% (95% CI 44-68) in individuals without OA. The pooled PR for any comorbidity was 1.21 (95% CI 1.02-1.45). The PR increased from 0.73 (95% CI 0.43-1.25) for 1 comorbidity to 1.58 (95% CI 1.03-2.42) for 2, and to 1.94 (95% CI 1.45-2.59) for ≥3 comorbidities. The key comorbidities associated with OA were stroke (PR 2.61 [95% CI 2.13-3.21]), peptic ulcer (PR 2.36 [95% CI 1.71-3.27]), and metabolic syndrome (PR 1.94 [95% CI 1.21-3.12]). CONCLUSION Individuals with OA are more likely to have other chronic conditions. The association is dose-dependent in terms of the number of comorbidities, suggesting multimorbidities. Further studies on the causality of this association and clinical implications are needed.
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Affiliation(s)
| | | | - Carol Coupland
- School of Medicine, University of Nottingham, Nottingham, UK
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Mathieson S, Wertheimer G, Maher CG, Christine Lin CW, McLachlan AJ, Buchbinder R, Pearson SA, Underwood M. What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies. J Intern Med 2020; 287:458-474. [PMID: 32100394 DOI: 10.1111/joim.13026] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/09/2019] [Accepted: 01/15/2020] [Indexed: 01/01/2023]
Abstract
Guidelines now discourage opioid analgesics for chronic noncancer pain because the benefits frequently do not outweigh the harms. We aimed to determine the proportion of patients with chronic noncancer pain who are prescribed an opioid, the types prescribed and factors associated with prescribing. Database searches were conducted from inception to 29 October 2018 without language restrictions. We included observational studies of adults with chronic noncancer pain measuring opioid prescribing. Opioids were categorized as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing (e.g. sampling year, geographic region as per World Health Organization). The overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Of the 42 studies (5,059,098 participants) identified, the majority (n = 28) were from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic noncancer pain prescribed opioids was 30.7% (95% CI 28.7% to 32.7%, n = 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95% CI 16.0-21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95% CI 7.2-9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined that opioid prescribing was associated with year of sampling (more prescribing in recent years) (P = 0.014) and not geographic region (P = 0.056). Opioid prescribing for patients with chronic noncancer pain is common and has increased over time.
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Affiliation(s)
- S Mathieson
- From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - G Wertheimer
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - C G Maher
- From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - C-W Christine Lin
- From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - A J McLachlan
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - R Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Vic.,, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - S-A Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - M Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,University Hospitals of Coventry and Warwickshire, Coventry, UK
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28
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Kwon YJ, Koh IH, Chung K, Lee YJ, Kim HS. Association between platelet count and osteoarthritis in women older than 50 years. Ther Adv Musculoskelet Dis 2020; 12:1759720X20912861. [PMID: 32362942 PMCID: PMC7178919 DOI: 10.1177/1759720x20912861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/24/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Osteoarthritis (OA) is a multifactorial disease involving inflammatory
processes. Platelets play important roles in both hemostasis and the
inflammatory response; however, the relationship between platelet count and
OA is unclear. Our aim was to evaluate the association between platelet
count and knee and hip OA in Korean women. Methods: In this cross-sectional designed study, we included a total of 6011 women
aged ⩾50 years from the 2010–2013 Korea National Health and Nutrition
Examination Survey. Knee and hip OA were defined as Kellgren–Lawrence grade
⩾2 and presence of knee or hip pain, respectively. Platelet counts were
divided into quartiles as follows: Q1, 150–212 (103/µl); Q2,
213–246 (103/µl); Q3, 247–283 (103/µl); and Q4,
284–450 (103/µl). Multiple logistic-regression analysis was
conducted to calculate odds ratios and 95% confidence intervals. Receiver
operating characteristic analysis was performed to determine the optimal
platelet count cut-off with which to discriminate participants with knee
and/hip OA versus those without OA. Results: Of the 6011 participants, 1141 (18.1%) had knee or hip OA. The mean age of
participants without OA was 60.6 years, and that of participants with OA was
68.0 years. Compared with the lowest quartile, odds ratios (95% confidence
intervals) for OA were 1.08 (0.84–1.39) for Q2, 0.94 (0.73–1.23) for Q3, and
1.35 (1.08–1.69) for Q4 after adjusting for confounders. The prevalence of
OA was significantly higher with platelet counts ⩾288 × 103/µl,
compared with platelet counts <288 × 103/µl. Conclusion: High platelet counts within the normal range are significantly associated
with knee and hip OA.
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Affiliation(s)
- Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il-Hyun Koh
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwangho Chung
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung-Sik Kim
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do 16995, Republic of Korea
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29
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Gebauer S, Schootman M, Xian H, Xaverius P. Neighborhood built and social environment and meeting physical activity recommendations among mid to older adults with joint pain. Prev Med Rep 2020; 18:101063. [PMID: 32140385 PMCID: PMC7044527 DOI: 10.1016/j.pmedr.2020.101063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 01/30/2020] [Accepted: 02/08/2020] [Indexed: 11/26/2022] Open
Abstract
Arthritis is a leading cause of disability in the United States, with the most efficacious treatments being physical activity (PA). Arthritis patients are less likely to meet PA recommendations and the neighborhood environment may play a role. This study examines the effect of neighborhood walkability and social cohesion on PA among arthritis patients in a sample of US adults. This cross-sectional study used 2015 National Health Interview Survey data. Eligible participants were age ≥45 years, had arthritis, recent leg-joint pain and complete data. Walkability was based on 6 questions regarding amenities and destinations that promote walking. Social cohesion was based on 4 validated questions. Meeting PA was defined as 150 min/week. Chi-squared testing and logistic regression determined associations between neighborhood environment and PA, including interaction between social cohesion and walkability. The final unweighted sample included 3,826 participants with mean age 64.6 years (SE = 0.26), 61.8% female and 78.1% non-Hispanic White. In adjusted, weighted analysis, not, slightly, and moderately-walkable neighborhoods all had lower odds of meeting PA recommendations verses highly-walkable neighborhood (OR = 0.61[95% CI 0.41–0.92], OR = 0.65[95% CI 0.50–0.85], OR = 0.75[95% CI 0.59–0.97], respectively). Social cohesion was independently associated with decreased odds of meeting PA guidelines (p = 0.003). No interaction with walkability was found (p = 0.405). Less than a highly-walkable neighborhood and lower social cohesion were independently associated with decreased odds of meeting PA recommendations among adults with arthritis and recent joint pain. Since walking is one of the most effective treatments for arthritis, clinicians should be sensitive to barriers patients may perceive to walking.
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Affiliation(s)
- Sarah Gebauer
- Saint Louis University-School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, United States.,Saint Louis University College for Public Health and Social Justice, 3545 Lafayette Ave, St. Louis, MO 63103, United States
| | - Mario Schootman
- Saint Louis University College for Public Health and Social Justice, 3545 Lafayette Ave, St. Louis, MO 63103, United States.,SSM Health, Center for Clinical Excellence, Department of Clinical Analytics and Insights, 10101 Woodfield Lane, St. Louis, MO 63132, United States
| | - Hong Xian
- Saint Louis University College for Public Health and Social Justice, 3545 Lafayette Ave, St. Louis, MO 63103, United States
| | - Pamela Xaverius
- Saint Louis University College for Public Health and Social Justice, 3545 Lafayette Ave, St. Louis, MO 63103, United States
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30
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Asthana C, Peterson GM, Shastri MD, Patel RP. A novel and sensitive HILIC-CAD method for glucosamine quantification in plasma and its application to a human pharmacokinetic study. J Pharm Biomed Anal 2020; 178:112954. [PMID: 31704130 DOI: 10.1016/j.jpba.2019.112954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/12/2023]
Abstract
The clinical effect of glucosamine, the most widely used supplement in patients with osteoarthritis, on joint pain and function improvement, is reported to be inconsistent. Inter-patient variability in the pharmacokinetics of glucosamine, especially its oral absorption, could contribute to the inconsistent clinical outcomes. To test this hypothesis, a novel but simple Hydrophilic Interaction Liquid Chromatography coupled with Charged Aerosol Detector method was developed and validated. The sample was prepared by simple protein precipitation and analysed using an amino column and acetonitrile:100 mM ammonium formate with gradient elution. The developed method was linear (12.5-800 ng/mL, r2 = 0.999) and the relative standard deviations for intra- and inter-day accuracy, precision and repeatability were all less than 6%. The sensitivity of the method (lower limit of quantitation; 12.5 ng/mL) allowed the quantification of endogenous and exogenous glucosamine levels in 12 patients with osteoarthritis, taking 1500 mg glucosamine daily. The analysis showed 120-fold variation (81.7% variance) in exogenous glucosamine levels among the patients, indicating that substantial variability in the extent of absorption and/or rate of elimination could be a possible cause for the reported inconsistent clinical outcomes. The newly-developed method was sensitive and can be used to study the pharmacokinetics of glucosamine.
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Affiliation(s)
- Chhavi Asthana
- Pharmacy, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
| | - Gregory M Peterson
- Pharmacy, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
| | - Madhur D Shastri
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia.
| | - Rahul P Patel
- Pharmacy, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
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31
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Alrowaili MG. Magnetic resonance evaluation of knee osteoarthritis among the Saudi Population. Pak J Med Sci 2019; 35:1575-1581. [PMID: 31777496 PMCID: PMC6861498 DOI: 10.12669/pjms.35.6.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Osteoarthritis (OA) is the most prevalent worldwide joint degenerative disorder with high morbidities and disabilities. The current study aimed to investigate the prevalence of knee osteoarthritis (KOA) in Arar by using magnetic resonance imaging (MRI). Methods The prevalence of KOA was studied in Arar through MRI evaluation of randomly chosen sample from patients and their relatives attending the Prince Abdul Aziz Bin Mussad Hospital from October 2015 to November 2016. Results A total of 410 participants were enrolled in the study [328 (80%) male and 82 (20%) females]. After MRI, 163 participants [39.75% (95% CI) = 35.14 - 44.57%)] were diagnosed with KOA. The prevalence of OA was about 25.6% (95% CI = 20.8 - 31.1%) below the age of 40 years, which was found to increase by age in the enrolled volunteers. KOA prevalence was higher in females than males (75.6% and 27.7% respectively). There was a significant association between the age and genders of the participants and the prevalence of OA (p-value < 0.0001 for both variables). There was also a significant association between the age and gender of the participants and the MRI-estimated grading (p-value < 0.0001 and 0.0044 respectively). Conclusion KOA is a common disease among Arar young population, especially females. Its prevalence increases by age with higher grades of severity affecting the elderly.
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Affiliation(s)
- Majed Gorayan Alrowaili
- Dr. Majed Gorayan Alrowaili, Department of Surgery (Orthopedic Division), Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
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32
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Marshall DA, Liu X, Barnabe C, Yee K, Faris PD, Barber C, Mosher D, Noseworthy T, Werle J, Lix L. Existing comorbidities in people with osteoarthritis: a retrospective analysis of a population-based cohort in Alberta, Canada. BMJ Open 2019; 9:e033334. [PMID: 31753902 PMCID: PMC6887009 DOI: 10.1136/bmjopen-2019-033334] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES The purpose of this study is to estimate the prevalence of comorbidities among people with osteoarthritis (OA) using administrative health data. DESIGN Retrospective cohort analysis. SETTING All residents in the province of Alberta, Canada registered with the Alberta Health Care Insurance Plan population registry. PARTICIPANTS 497 362 people with OA as defined by 'having at least one OA-related hospitalization, or at least two OA-related physician visits or two ambulatory care visits within two years'. PRIMARY OUTCOME MEASURES We selected eight comorbidities based on literature review, clinical consultation and the availability of validated case definitions to estimate their frequencies at the time of diagnosis of OA. Sex-stratified age-standardised prevalence rates per 1000 population of eight clinically relevant comorbidities were calculated using direct standardisation with 95% CIs. We applied χ2 tests of independence with a Bonferroni correction to compare the percentage of comorbid conditions in each age group. RESULTS 54.6% (n=2 71 794) of people meeting the OA case definition had at least one of the eight selected comorbidities. Females had a significantly higher rate of comorbidities compared with males (standardised rates ratio=1.26, 95% CI 1.25 to 1.28). Depression, chronic obstructive pulmonary disease (COPD) and hypertension were the most prevalent in both females and males after age-standardisation, with 40% of all cases having any combination of these comorbidities. We observed a significant difference in the percentage of comorbidities among age groups, illustrated by the youngest age group (<45 years) having the highest percentage of cases with depression (24.6%), compared with a frequency of 16.1% in those >65 years. CONCLUSIONS Our findings highlight the high frequency of comorbidity in people with OA, with depression having the highest age-standardised prevalence rate. Comorbidities differentially affect females, and vary by age. These factors should inform healthcare programme and delivery.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Xiaoxiao Liu
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karen Yee
- Research Facilitation, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter D Faris
- Research Facilitation, Alberta Health Services, Calgary, Alberta, Canada
| | - Claire Barber
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Dianne Mosher
- Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Thomas Noseworthy
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Jason Werle
- Department of Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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33
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Power JD, Perruccio AV, Gandhi R, Veillette C, Davey JR, Lewis SJ, Syed K, Mahomed NN, Rampersaud YR. Factors Associated With Opioid Use in Presurgical Knee, Hip, and Spine Osteoarthritis Patients. Arthritis Care Res (Hoboken) 2019; 71:1178-1185. [DOI: 10.1002/acr.23831] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/08/2019] [Indexed: 01/16/2023]
Affiliation(s)
- J. Denise Power
- Arthritis Program and Krembil Research InstituteUniversity Health Network Toronto Ontario Canada
| | - Anthony V. Perruccio
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Rajiv Gandhi
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Christian Veillette
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - J. Roderick Davey
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Stephen J. Lewis
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Khalid Syed
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Nizar N. Mahomed
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Y. Raja Rampersaud
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
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34
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Garies S, Cummings M, Forst B, McBrien K, Soos B, Taylor M, Drummond N, Manca D, Duerksen K, Quan H, Williamson T. Achieving quality primary care data: a description of the Canadian Primary Care Sentinel Surveillance Network data capture, extraction, and processing in Alberta. Int J Popul Data Sci 2019; 4:1132. [PMID: 34095540 PMCID: PMC8142949 DOI: 10.23889/ijpds.v4i2.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Electronic medical record (EMR) databases have become increasingly popular for secondary purposes, such as health research. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is the first and only pan-Canadian primary care EMR data repository, with de-identified health information for almost two million Canadians. Comprehensive and freely available documentation describing the data ‘lifecycle’ is important for assessing potential data quality issues and appropriate interpretation of research findings. Here, we describe the flow and transformation of CPCSSN data in the province of Alberta. Approach In Alberta, the data originate from 54 publicly-funded primary care settings, including one community pediatric clinic, with 318 providers contributing de-identified EMR data for 410,951 patients (as of December 2018). Data extraction methods have been developed for five different EMR systems, and include both backend and automated frontend extractions. The raw EMR data are transformed according to specific rules, including trimming implausible values, converting values and free text to standard terminologies or classification systems, and structuring the data into a common CPCSSN format. Following local data extraction and processing, the data are transferred to a central repository and made available for research and disease surveillance. Conclusion This paper aims to provide important contextual information to future CPCSSN data users.
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Affiliation(s)
- S Garies
- Department of Family Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary Alberta, Canada, T2N 4N1.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - M Cummings
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada, T6G 2T4
| | - B Forst
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada, T6G 2T4
| | - K McBrien
- Department of Family Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary Alberta, Canada, T2N 4N1.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - B Soos
- Department of Family Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary Alberta, Canada, T2N 4N1.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - M Taylor
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada, T6G 2T4
| | - N Drummond
- Department of Family Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary Alberta, Canada, T2N 4N1.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada, T6G 2T4
| | - D Manca
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada, T6G 2T4
| | - K Duerksen
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada, T6G 2T4
| | - H Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - T Williamson
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
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35
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Cleveland R, Alvarez C, Schwartz T, Losina E, Renner J, Jordan J, Callahan L. The impact of painful knee osteoarthritis on mortality: a community-based cohort study with over 24 years of follow-up. Osteoarthritis Cartilage 2019; 27:593-602. [PMID: 30583096 PMCID: PMC7063854 DOI: 10.1016/j.joca.2018.12.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/14/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the impact of knee osteoarthritis (OA) and/or knee pain on excess mortality. METHOD We analyzed data from 4,182 participants in a community-based prospective cohort study of African American and Caucasian men and women aged ≥45 years. Participants completed knee radiographs and questionnaires at baseline and at up to three follow-ups to determine knee OA (rOA), knee pain and covariate status. Mortality was determined through 2015. We used Cox proportional hazards regression with time-varying covariates (TVC) to estimate hazard ratios (HR) and 95% confidence intervals (CI). Additional analyses stratified by sex, race and age were carried out. RESULTS Median follow-up time was 14.6 years during which 1822 deaths occurred. Baseline knee radiographic osteoarthritis (rOA) was 27.7%, 38.8% at first follow-up, 52.6% at second follow-up and 61.9% at the third follow-up. Knee rOA with pain and knee pain alone were both associated with a >15% increase in premature all-cause mortality. In analyses stratified by sex, race and age, associations between knee pain, with or without knee rOA, and all-cause death were found among women, Caucasians, those ≤65 years of age, and those with a body mass index (BMI)≥30, with observed increased risks of death between 21% and 65%. We observed similar, somewhat attenuated, results for cardiovascular disease (CVD) deaths. CONCLUSION In models taking into account variables that change over time, individuals who had knee pain, alone or with knee rOA, had increased mortality. These effects were particularly strong among those obese. Effective interventions to reduce knee pain, particularly those including weight management and prevention of comorbidities, could reduce mortality.
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Affiliation(s)
- R.J. Cleveland
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA,Address correspondence and reprint requests to: R.J. Cleveland, Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Building, Campus Box #7280, Chapel Hill, NC 27599-7280, USA. Tel: 1 (919) 966-4533; Fax: 1 (919) 966-1739. (R.J. Cleveland)
| | - C. Alvarez
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - T.A. Schwartz
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA,School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - E. Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - J.B. Renner
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - J.M. Jordan
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - L.F. Callahan
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA,Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, USA,Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
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36
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Postler A, Ramos AL, Goronzy J, Günther KP, Lange T, Schmitt J, Zink A, Hoffmann F. Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data. Clin Interv Aging 2018; 13:2339-2349. [PMID: 30532524 PMCID: PMC6241868 DOI: 10.2147/cia.s174741] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Osteoarthritis (OA) is highly prevalent throughout the world, especially in the elderly population, and is strongly associated with patients’ frailty. However, little is known about the prevalence and treatment of OA in elderly patients in routine clinical care in Germany. Materials and methods As a part of Linking Patient-Reported Outcomes with CLAIms Data for Health Services Research in Rheumatology (PROCLAIR), a cross-sectional study using claims data from a large Germany statutory health insurance (BARMER) was conducted. We included people aged 60 years or older and assessed the prevalence of OA of the hip or knee, defined as having outpatient diagnoses (ICD: M16 or M17) in at least two quarters of 2014. The use of conservative treatment, including analgesics and physical therapy, and total joint replacement was studied. Analyses were stratified by age, sex, comorbidities, and level of care dependency defined by social law. Results A total of 595,754 patients (mean age: 74.9 years; 69.8% female) were diagnosed with OA (21.8%), with the highest prevalence in those between 80 and 89 years (31.0%) and in females compared to males (23.9% vs 18.3%). Prevalence decreased with increasing level of care dependency from 30.5% in patients with a low level (0/1) to 18.7% in the highest level of care dependency. A total of 63.4% of the patients with OA received analgesics, with higher use with increasing age. Physical therapy was prescribed to 43.1% of the patients, but use decreased with age. In all, 5.3% of the patients received total joint replacement in 2014. Conclusion The lower frequency of coded OA with increasing level of care dependency may reflect underdiagnosis, and patients with many other medical problems seem to be at risk for inadequate recognition and treatment of their OA.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany,
| | - Andres Luque Ramos
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Jens Goronzy
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany,
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany,
| | - Toni Lange
- Center for Evidence Based Healthcare, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence Based Healthcare, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
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Structured Education and Neuromuscular Exercise Program for Hip and/or Knee Osteoarthritis: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2018; 18:1-110. [PMID: 30443280 PMCID: PMC6235070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Osteoarthritis is a chronic disorder and the most common form of arthritis. The joints most commonly affected are the hip and knee. The progression of osteoarthritis results in the breakdown of tissues and cartilage and the loss of joint function, causing symptoms such as pain, stiffness, reduced physical function, and limited movement. Although there is no cure for osteoarthritis, treatment options are available to manage symptoms and optimize quality of life. Clinical guidelines recommend education, exercise, and weight loss (when necessary) as the first line of treatment. METHODS We conducted a health technology assessment, which included an evaluation of the effectiveness, safety, and cost-effectiveness of a structured education and neuromuscular exercise program for the management of hip and/or knee osteoarthritis. We also assessed the budget impact of publicly funding such a program, and we spoke with people with osteoarthritis to gain an understanding of their preferences and values. We performed a systematic review of the clinical and economic literature published between January 1, 2008, and October 4, 2017. We also performed a grey literature search of health technology assessment websites. We assessed the risk of bias of each study, and we assessed the quality of the body of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. To evaluate the cost-effectiveness of a structured education and neuromuscular exercise program for adults with knee osteoarthritis, we conducted a cost-utility analysis from the perspective of the Ontario Ministry of Health and Long-Term Care. We also estimated the budget impact of publicly funding such a program in Ontario over the next 5 years. To contextualize the potential value of this type of program as a treatment option, we spoke with people with hip and/or knee osteoarthritis. RESULTS Ten studies met our inclusion criteria for the clinical evidence review. Compared with usual care, a structured education and neuromuscular exercise program showed statistically significant short-term improvements in pain (GRADE low) and physical function (GRADE moderate), as well as statistically significant long-term improvements in performing activities of daily living (GRADE moderate) and in quality of life (GRADE moderate). The short-term improvements in pain and physical function appeared to be sustained into the medium term. Compared with patient education, a structured education and neuromuscular exercise program showed statistically significant short-term improvements in pain (GRADE low) and physical function (GRADE low) and sustained long-term improvement in physical function.Our primary economic evaluation showed that, compared with usual care, a group-based structured education and neuromuscular exercise program consisting of two educational sessions and 24 exercise sessions for the management of knee osteoarthritis was associated with an incremental cost of $719 (95% confidence interval [CI]: $410-$1,118) and an incremental quality-adjusted survival of 0.03 quality-adjusted life-years (QALYs) (95% CI: -0.006 to 0.06), resulting in an incremental cost-effectiveness ratio (ICER) of $23,967 per QALY gained. The budget impact of publicly funding a group-based structured education and neuromuscular exercise program consisting of two educational sessions and 24 exercise sessions would range from $21.4 million to $91.6 million per year over the next 5 years. The budget impact of publicly funding a program consisting of two educational sessions and 12 exercise sessions would range from $12.4 million to $53.2 million per year over the next 5 years.People with hip and/or knee osteoarthritis with whom we spoke reported on the negative impact of osteoarthritis on their physical functioning and quality of life. Those with experience of a structured education and neuromuscular exercise program reported favourably on the program, stating they felt that participation in the program had strengthened their muscles and reduced the negative impact of their symptoms. The cost of such programs was reported as a barrier to access. CONCLUSIONS There is moderate-quality evidence that, compared with usual care, a structured education and neuromuscular exercise program improves physical function, quality of life, and the ability to perform activities of daily living. There is low-quality evidence that, compared with usual care, this type of program improves pain. Low-quality evidence suggests that, compared with patient education, a structured education and neuromuscular exercise program improves pain and physical function.A group-based structured education and neuromuscular exercise program may be cost-effective for the nonsurgical management of knee osteoarthritis. Publicly funding a group-based structured education and neuromuscular exercise program for hip and/or knee osteoarthritis in Ontario would lead to additional costs to the health system of $21.4 million to $91.6 million per year over the next 5 years. If the program could be delivered with a smaller number of 12 exercise sessions, the budget impact would be reduced to between $12.4 million and $53.2 million over the next 5 years.Structured education and neuromuscular exercise programs are perceived favourably by people with hip and/or knee osteoarthritis. However, the cost of such programs may be a barrier to access.
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Wang Y, Wei J, Zeng C, Yang T, Li H, Cui Y, Xie D, Xu B, Liu Z, Li J, Jiang S, Lei G. Association between serum magnesium concentration and metabolic syndrome, diabetes, hypertension and hyperuricaemia in knee osteoarthritis: a cross-sectional study in Hunan Province, China. BMJ Open 2018; 8:e019159. [PMID: 30206073 PMCID: PMC6144480 DOI: 10.1136/bmjopen-2017-019159] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To examine the associations between serum magnesium (Mg) concentration with the prevalence of metabolic syndrome (MetS), diabetes mellitus (DM), hypertension (HP) and hyperuricaemia (HU) in patients with radiographic knee osteoarthritis (OA). METHODS The present study was conducted at the Health Management Center of Xiangya Hospital. Radiographic OA was evaluated for patients aged over 40 years with basic characteristics and blood biochemical assessment. Serum Mg concentration was measured using the chemiluminescence method. MetS, DM, HP and HU were diagnosed based on standard protocols. The associations between serum Mg concentration with MetS, DM, HP and HU were evaluated by conducting multivariable adjusted logistic regression. RESULTS A total of 962 patients with radiographic knee OA were included. Compared with the lowest quintile, the multivariable adjusted ORs and related 95% CIs of DM were 0.40 (95% CI 0.23 to 0.70, p=0.001), 0.33 (95% CI 0.18 to 0.60, p<0.001), 0.27 (95% CI 0.14 to 0.52, p<0.001) and 0.22 (95% CI 0.11 to 0.44, p<0.001) in the second, third, fourth and highest quintiles of serum Mg, respectively (p for trend <0.001); the multivariable adjusted ORs of HU were 0.33 (95% CI 0.19 to 0.59, p<0.001), 0.52 (95% CI 0.30 to 0.91, p=0.022) and 0.39 (95% CI 0.22 to 0.70, p=0.001) in the third, fourth and highest quintiles of serum Mg, respectively (p for trend <0.001); and the multivariable adjusted ORs of MetS were 0.59 (95% CI 0.36 to 0.94, p=0.027) in the second and 0.56 (95% CI 0.34 to 0.93, p=0.024) in the highest quintiles of serum Mg. However, the inverse association between serum Mg and the prevalence of MetS was non-linear (p for trend=0.067). There was no significant association between serum Mg and HP in patients with OA. CONCLUSIONS The serum Mg concentration was inversely associated with the prevalence of MetS, DM and HU in patients with radiographic knee OA. LEVEL OF EVIDENCE Level III, cross-sectional study.
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Affiliation(s)
- Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tuo Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Cui
- International Medical Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bei Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhichen Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiatian Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shide Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Efficacy of commonly prescribed analgesics in the management of osteoarthritis: a systematic review and meta-analysis. Rheumatol Int 2018; 38:1985-1997. [DOI: 10.1007/s00296-018-4132-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/12/2018] [Indexed: 12/11/2022]
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Wong J, Abrahamowicz M, Buckeridge DL, Tamblyn R. Assessing the accuracy of using diagnostic codes from administrative data to infer antidepressant treatment indications: a validation study. Pharmacoepidemiol Drug Saf 2018; 27:1101-1111. [PMID: 29687504 PMCID: PMC6220980 DOI: 10.1002/pds.4436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/24/2018] [Accepted: 03/12/2018] [Indexed: 11/07/2022]
Abstract
PURPOSE To assess the accuracy of using diagnostic codes from administrative data to infer treatment indications for antidepressants prescribed in primary care. METHODS Validation study of administrative diagnostic codes for 13 plausible indications for antidepressants compared with physician-documented treatment indications from an indication-based electronic prescribing system in Quebec, Canada. The analysis included all antidepressant prescriptions written by primary care physicians between January 1, 2003 and December 31, 2012 using the electronic prescribing system. Patient prescribed antidepressants were linked to physician claims and hospitalization data to obtain all diagnoses recorded in the past year. RESULTS Diagnostic codes had poor sensitivity for all treatment indications, ranging from a high of only 31.2% (95% CI, 26.8%-35.9%) for anxiety/stress disorders to as low as 1.3% (95% CI, 0.0%-5.2%) for sexual dysfunction. Sensitivity was notably worse among older patients and patients with more chronic comorbidities. Physician claims data were a better source of diagnostic codes for antidepressant treatment indications than hospitalization data. CONCLUSIONS Administrative diagnostic codes are poor proxies for antidepressant treatment indications. Future work should determine whether the use of other variables in administrative data besides diagnostic codes can improve the ability to predict antidepressant treatment indications.
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Affiliation(s)
- Jenna Wong
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
| | - David L. Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
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Gómez-Gaete C, Ferreira F, Bustos P, Mennickent S, Castillo D, Chávez C, Novoa P, Godoy R. Optimization of rhein-loaded polymeric nanoparticles using a factorial design and evaluation of the cytotoxic and anti-inflammatory effects. Drug Dev Ind Pharm 2018; 44:1285-1294. [PMID: 29482400 DOI: 10.1080/03639045.2018.1445263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of the work was to develop rhein loaded polymeric nanoparticles (R-PNPs). Nanoparticles were prepared by three methods, solvent emulsion-evaporation, double emulsion, and nanoprecipitation, by means of experimental design. Additionally, the effects of the best formulation on in vitro cytotoxicity and inflammation were evaluated. The solvent emulsion-evaporation method presented the highest encapsulation efficiency of the three techniques (38.41%), as well as had a mean diameter of 189.33 nm and a polydispersity index of less than 0.1. Despite efforts to optimize the encapsulation of rhein, the drug release from nanoparticles was close to 50% during the first 5 min, followed by a continuous release within 60 min. It was observed that macrophages exposed to the highest concentration of R-PNPs showed cell viability about 80% and at the lowest nanoparticle concentrations was closed to 100%. IL-1β in cell culture supernatants was decreased in the presence of R-PNPs and TNFα concentrations were lower than the sensitivity of the assay. ROS production was only inhibited with R-PNPs at concentrations of 2.5 and 5 μM. In conclusion, the solvent emulsion-evaporation was the best method evaluated to obtain nanoparticles with the desired specifications. It was possible to assess R-PNPs with low cytotoxicity and anti-inflammatory properties showed by the inhibition of IL-1β production and a low decrease in ROS production.
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Affiliation(s)
- Carolina Gómez-Gaete
- a Department of Pharmacy, Faculty of Pharmacy , University of Concepción , Concepción , Chile
| | - Felipe Ferreira
- a Department of Pharmacy, Faculty of Pharmacy , University of Concepción , Concepción , Chile
| | - Paulina Bustos
- b Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy , University of Concepción , Concepción , Chile
| | - Sigrid Mennickent
- a Department of Pharmacy, Faculty of Pharmacy , University of Concepción , Concepción , Chile
| | - Daniela Castillo
- b Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy , University of Concepción , Concepción , Chile
| | - Catalina Chávez
- a Department of Pharmacy, Faculty of Pharmacy , University of Concepción , Concepción , Chile
| | - Pedro Novoa
- a Department of Pharmacy, Faculty of Pharmacy , University of Concepción , Concepción , Chile
| | - Ricardo Godoy
- a Department of Pharmacy, Faculty of Pharmacy , University of Concepción , Concepción , Chile
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Cram P, Landon BE, Matelski J, Ling V, Stukel TA, Paterson JM, Gandhi R, Hawker GA, Ravi B. Utilization and Short-Term Outcomes of Primary Total Hip and Knee Arthroplasty in the United States and Canada: An Analysis of New York and Ontario Administrative Data. Arthritis Rheumatol 2018; 70:547-554. [PMID: 29287312 DOI: 10.1002/art.40407] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/20/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are common and effective surgical procedures. This study sought to compare utilization and short-term outcomes of primary TKA and THA in adjacent regions of Canada and the United States. METHODS The study was designed as a retrospective cohort study of patients who underwent primary TKA or THA, comparing administrative data from New York and Ontario in 2012-2013. Demographic features of the TKA and THA patients, per capita utilization rates, and short-term outcomes were compared between the jurisdictions. RESULTS A higher percentage of New York hospitals performed TKA compared to Ontario hospitals (75.7% versus 42.1%; P < 0.001), and the mean annual procedural volume for TKAs was lower in New York hospitals (mean 179 versus 327 in Ontario hospitals; P < 0.001). After direct standardization, utilization was significantly lower in New York compared to Ontario, both for TKA (16.1 TKAs versus 21.4 TKAs per 10,000 population per year; P < 0.001) and for THA (10.5 THAs versus 11.5 THAs per 10,000 population per year; P < 0.001). For those who underwent TKA, the length of stay in Ontario hospitals was significantly longer (mean 3.7 days versus 3.4 days in New York hospitals; P < 0.001). A smaller percentage of New York patients were discharged directly home (46.2% versus 90.9% of Ontario patients; P < 0.001), but 30-day and 90-day readmission rates were higher in New York compared to Ontario (30-day rates, 4.6% versus 3.9% [P < 0.001]; 90-day rates, 8.4% versus 6.7% [P < 0.001]). For the THA cohorts, the results with regard to length of stay, discharge disposition, and readmission rates were similar to those for TKA. CONCLUSION Ontario has higher utilization of total joint arthroplasty than New York but has a smaller percentage of hospitals performing these procedures. Patients are more likely to be discharged home and less likely to be readmitted in Ontario. Our results suggest areas where each jurisdiction could improve.
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Affiliation(s)
- Peter Cram
- University of Toronto, Sinai Health System and University Health Network, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - John Matelski
- Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Vicki Ling
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Therese A Stukel
- Institute for Clinical Evaluative Sciences and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada, and Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | | | - Gillian A Hawker
- University of Toronto and Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- University of Toronto and Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Abstract
For the most part aged over 50, people affected with osteoarthritis frequently present associated comorbidities. Debilitating and detrimental in terms of quality of life and fitness to work, osteoarthritis is becoming a public health issue which must be considered in terms of prevention, management and research.
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Affiliation(s)
- Karine Louati
- Service de rhumatologie, Hôpital Saint-Antoine, AP-HP, 184 rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Garies S, Birtwhistle R, Drummond N, Queenan J, Williamson T. Data Resource Profile: National electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Int J Epidemiol 2017; 46:1091-1092f. [DOI: 10.1093/ije/dyw248] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/14/2022] Open
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Birtwhistle R, Queenan JA. Update from CPCSSN. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:851. [PMID: 27737985 PMCID: PMC5063776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Richard Birtwhistle
- Professor in the Centre for Studies in Primary Care, Department of Family Medicine at Queen's University in Kingston, Ont
| | - John A Queenan
- Epidemiologist for the Canadian Primary Care Sentinel Surveillance Network, Department of Family Medicine at Queen's University in Kingston, Ont
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Birtwhistle R, Queenan JA. Mise à jour sur le RCSSSP. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e640-e641. [PMID: 27738000 PMCID: PMC5063791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Richard Birtwhistle
- Professeur au Centre des études en soins primaires, Département de médecine familiale de l'Université Queen's à Kingston, en Ontario
| | - John A Queenan
- épidémiologiste pour le Réseau canadien de surveillance sentinelle en soins primaires, Département de médecine familiale de l'Université Queen's à Kingston, en Ontario
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Risk factors and burden of osteoarthritis. Ann Phys Rehabil Med 2016; 59:134-138. [DOI: 10.1016/j.rehab.2016.01.006] [Citation(s) in RCA: 320] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 01/04/2023]
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Drummond N, Birtwhistle R, Williamson T, Khan S, Garies S, Molnar F. Prevalence and management of dementia in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network. CMAJ Open 2016; 4:E177-84. [PMID: 27398361 PMCID: PMC4933596 DOI: 10.9778/cmajo.20150050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The proportion of Canadians living with Alzheimer disease and related dementias is projected to rise, with an increased burden on the primary health care system in particular. Our objective was to describe the prevalence and management of dementia in a community-dwelling sample using electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices. METHODS We used CPCSSN data as of Dec. 31, 2012, for patients 65 years and older with at least 1 clinical encounter in the previous 2 years. A validated case definition for dementia was used to calculate the national and provincial prevalence rates, to examine variations in prevalence according to age, sex, body mass index, rural or urban residence, and select comorbid conditions, and to describe patterns in the pharmacologic management of dementia over time at the provincial level. RESULTS The age-standardized prevalence of dementia among community-dwelling patients 65 years and older was 7.3%. Prevalence estimates increased with age; they also varied between provinces, and upward trends were observed. Dementia was found to be associated with comorbid diabetes, depression, epilepsy and parkinsonism. Most of the patients with dementia did not have a prescription for a dementia-related medication recorded in their EMR between 2008 and 2012 inclusive. Those who had a prescription were most often prescribed donepezil by their primary care provider. INTERPRETATION Overall prevalence estimates for dementia based on EMR data in this sample managed in primary care were generally in line with previous estimates based on administrative data, survey results or clinical sources.
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Affiliation(s)
- Neil Drummond
- Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont
| | - Richard Birtwhistle
- Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont
| | - Tyler Williamson
- Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont
| | - Shahriar Khan
- Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont
| | - Stephanie Garies
- Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont
| | - Frank Molnar
- Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.; Family Medicine and Public Health Services (Birtwhistle), Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Medicine (Khan), Queen's University, Kingston, Ont.; Departments of Family Medicine and Community Health Sciences (Garies), University of Calgary, Calgary, Alta.; Division of Geriatric Medicine (Molnar), University of Ottawa and The Ottawa Hospital, Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ont
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Examining the prevalence and patterns of multimorbidity in Canadian primary healthcare: a methodologic protocol using a national electronic medical record database. JOURNAL OF COMORBIDITY 2015; 5:150-161. [PMID: 29090163 PMCID: PMC5636032 DOI: 10.15256/joc.2015.5.61] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/27/2015] [Indexed: 11/21/2022]
Abstract
In many developed countries, the burden of disease has shifted from acute to long-term or chronic diseases – producing new and broader challenges for patients, healthcare providers, and healthcare systems. Multimorbidity, the coexistence of two or more chronic diseases within an individual, is recognized as a significant public health and research priority. This protocol aims to examine the prevalence, characteristics, and changing burden of multimorbidity among adult primary healthcare (PHC) patients using electronic medical record (EMR) data. The objectives are two-fold: (1) to measure the point prevalence and clusters of multimorbidity among adult PHC patients; and (2) to examine the natural history and changing burden of multimorbidity over time among adult PHC patients. Data will be derived from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The CPCSSN database contains longitudinal, point-of-care data from EMRs across Canada. To identify adult patients with multimorbidity, a list of 20 chronic disease categories (and corresponding ICD-9 codes) will be used. A computational cluster analysis will be conducted using a customized computer program written in JAVA. A Cox proportional hazards analysis will be used to model time-to-event data, while simultaneously adjusting for provider- and patient-level predictors. All analyses will be conducted using STATA SE 13.1. This research is the first of its kind using a pan-Canadian EMR database, which will provide an opportunity to contribute to the international evidence base. Future work should systematically compare international research using similar robust methodologies to determine international and geographical variations in the epidemiology of multimorbidity.
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Webster F, Bhattacharyya O, Davis A, Glazier R, Katz J, Krueger P, Upshur R, Yee A, Wilson L. An institutional ethnography of chronic pain management in family medicine (COPE) study protocol. BMC Health Serv Res 2015; 15:494. [PMID: 26541288 PMCID: PMC4634802 DOI: 10.1186/s12913-015-1078-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 09/18/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patients with chronic conditions and multiple comorbidities represent a growing challenge for health care globally. Improved coordination of care is considered essential for providing more effective and cost-efficient care for these patients with complex needs. Osteoarthritis is one of the most common and debilitating chronic conditions, is the most frequent cause of chronic pain yet osteoarthritis care is often poorly-coordinated. Primary care is usually the first contact for patients requiring relief from chronic pain. Our previous work suggests discordance between the policy goals of improving patient care and the experience of osteoarthritis patients. We plan to investigate the empirical context of the primary care setting by focusing on primary physicians' conceptualizations and performance of their work in treating complex patients with chronic pain. This will allow for an exploration of how primary health care is - or could be - integrated with other services that play an important role in health care delivery. METHODS Our study is an Institutional Ethnography of pain management in family medicine, to be carried out in three phases over 3 years from 2014/15 to 2018. Over the first year we will undertake approximately 80 key informant interviews with primary care physicians, other health care providers, policymakers and clinical experts. In the second year we will focus on mobilizing our networks from year one to assist in the collection of key texts which shape the current context of care. These texts will be analyzed by the research team. In the final year of the study we will focus on synthesizing our findings in order to map the social relations informing care. As is standard and optimal in qualitative research, analysis will be concurrent with data collection. DISCUSSION Our study will allow us to identify how the work of coordinating care across multiple settings is accomplished, in practice as well as discursively and textually. Ultimately, we will identify links between everyday experience of care for patients with chronic pain, and broader discourses related to health care system inefficiencies, integration and patient-centred care. An expected outcome of this study will be the development of new, or augmentation of existing, models of care, that are based in the local realities of primary care practice.
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Affiliation(s)
- Fiona Webster
- Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Onil Bhattacharyya
- Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada
- Women's College Research Institute, 790 Bay St, 7th Floor, Toronto, ON, M5G 1N8, Canada
| | - Aileen Davis
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Departments of Physical Therapy and Rehabilitation Science Institute, University of Toronto, 399 Bathurst Street, MP11-322, Toronto, ON, M5T 2S8, Canada
| | - Rick Glazier
- Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada
- ICES Central, Primary Care & Population Health Research Program, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Joel Katz
- Department of Psychology, York University, 4700 Keele St., BSB 232, Toronto, ON, M3J 1P3, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth St., 3EB-317, Toronto, ON, M5G 2C4, Canada
| | - Paul Krueger
- Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada
| | - Ross Upshur
- Dalla Lana Faculty of Public Health, 155 College Street, Toronto, ON, M5G 1L4, Canada
| | - Albert Yee
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room MG 371B, Toronto, ON, M4N 3M5, Canada
| | - Lynn Wilson
- Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada
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