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Yogaparan T, Burrell A, Talbot-Hamon C, Sadowski CA, Grief C, MacDonald E, Thain J, Ng KA, Khoury L, Moran M, Feldman S, Lustgarten S, Bach TV. The Aging Care 5Ms Competencies: A Modified Delphi Study to Revise Medical Student Competencies for the Care of Older Adults. Acad Med 2024; 99:198-207. [PMID: 37856849 DOI: 10.1097/acm.0000000000005475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE To revise the 2009 Canadian Geriatrics Society (CGS) Core Competencies in the Care of Older Persons for Canadian Medical Students by applying current frameworks and using a modified Delphi process. METHOD The working group chose the Geriatric 5Ms model and CanMEDS framework to develop and structure the competencies. National (i.e., Canadian) Delphi participants were recruited, and 3 Delphi survey rounds were conducted from 2019 to 2021. Each survey round collected quantitative data using a 7-point Likert scale (LS) and qualitative data using free-text comments. The purpose of the first round was to establish the importance of the components of the proposed competencies (categorized into 13 subsections) and identify additional themes. The second round assessed agreement with 31 proposed competencies organized into 7 themes: aging, caring for older adults, mind, mobility, medications, multicomplexity, and matters the most. The third survey-rated agreement levels after further revisions to the competencies were applied. The final 33 competencies were shared with survey participants for feedback and other stakeholders for external validation. RESULTS Mean LSs for the importance of the 13 competency component subsections on the first survey varied from 5.11 to 6.54, with an agreement level of 73%-93%. New themes emerged from the qualitative comments. Mean LSs for the 31 competencies on the second survey ranged from 5.57 to 6.81, with an agreement level of 80%-97%. Mean LSs for the revised competencies on the third survey ranged from 5.83 to 6.65, with an agreement level of 83%-95%. CONCLUSIONS The authors developed the 33 Aging Care 5Ms Competencies for Canadian medical students using a consensus process. The competencies fulfill an important need in medical education, and ultimately, society. The authors strongly believe that the competencies can be woven into existing undergraduate medical curricula through purposeful integration and collaboration, including with other specialties.
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Fehlmann CA, Bezzina K, Mazzola R, Visintini SM, Guo MH, Rubens FD, Wells GA, McGuinty C, Huang A, Khoury L, Boczar KE. Influence of preoperative frailty on quality of life after cardiac surgery: A systematic review and meta-analysis. J Am Geriatr Soc 2023; 71:3278-3286. [PMID: 37289174 DOI: 10.1111/jgs.18454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/04/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Frailty has emerged as an important prognostic marker of increased mortality after cardiac surgery, but its association with quality of life (QoL) and patient-centered outcomes is not fully understood. We sought to evaluate the association between frailty and such outcomes in older patients undergoing cardiac surgery. METHODS This systematic review included studies evaluating the effect of preoperative frailty on QoL outcomes after cardiac surgery amongst patients 65 years and older. The primary outcome was patient's perceived change in QoL following cardiac surgery. Secondary outcomes included residing in a long-term care facility for 1 year, readmission in the year following the intervention, and discharge destination. Screening, inclusion, data extraction, and quality assessment were performed independently by two reviewers. Meta-analyses based on the random-effects model were conducted. The evidential quality of findings was assessed with the GRADE profiler. RESULTS After the identification of 3105 studies, 10 observational studies were included (1580 patients) in the analysis. Two studies reported on the change in QoL following cardiac surgery, which was higher for patients with frailty than for patients without. Preoperative frailty was associated with both hospital readmission (pooled odds ratio [OR] 1.48 [0.80-2.74], low GRADE level) as well as non-home discharge (pooled OR 3.02 [1.57-5.82], moderate GRADE level). CONCLUSION While evidence in this field is limited by heterogeneity of frailty assessment and non-randomized data, we demonstrated that baseline frailty may possibly be associated with improved QoL, but with increased readmission as well as discharge to a non-home destination following cardiac surgery. These patient-centered outcomes are important factors when considering interventional options for older patients. STUDY REGISTRATION OSF registries (https://osf.io/vm2p8).
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Affiliation(s)
- Christophe A Fehlmann
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Kathryn Bezzina
- Care of the Elderly Program, Élisabeth Bruyère Hospital, Ottawa, Ontario, Canada
| | - Rosetta Mazzola
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sarah M Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ming Hao Guo
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Fraser D Rubens
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Allen Huang
- Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lara Khoury
- Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kevin Emery Boczar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Whitney K, Peck V, Huang AR, Park J, Menard P, MacDonald J, Spilg E, Khoury L. Changing the channel: a qualitative analysis of an innovative video intervention to explore resident attitudes towards interprofessional collaboration on a Geriatric Medicine Unit. Can Med Educ J 2023; 14:51-60. [PMID: 37304634 PMCID: PMC10254114 DOI: 10.36834/cmej.71529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Medical learners develop a more positive attitude toward Interprofessional Collaboration (IPC) following Interprofessional Education (IPE) programs. However, IPE is not standardized, and the most effective teaching tool is unclear. The purpose of our study was to develop an IPE teaching tool for medical residents during an inpatient geriatric medicine rotation at an academic hospital, evaluate and explore the impact of the program on resident attitudes towards teamwork, and identify barriers and facilitators to interprofessional collaboration. Methods An innovative video was developed which simulated a common IPC scenario. Near the start of the rotation, learners watched the video then participated in a facilitated discussion around principles of IPE, using the Canadian Interprofessional Health Collaborative (CIHC) framework, which highlights interprofessional communication, patient-centered care, role clarification, team functioning, collaborative leadership, and interprofessional conflict resolution. At the end of their four-week rotation, focus groups were conducted to explore resident attitudes towards IPE. The Theoretical Domain Framework (TDF) was used for qualitative analysis. Results Data from 23 participants in five focus groups were analyzed using the TDF framework. Residents were able to identify barriers and facilitators to IPC in five TDF domains: environmental context and resources, social/professional role and identity, knowledge, social influences, and skills. Their observations correlated with the CIHC framework. Conclusion The use of a scripted video and facilitated group discussion gave insights into residents' attitudes, perceived barriers, and facilitators towards IPC on a geriatric medicine unit. Future research could explore the use of this video intervention in other hospital services where team-based care is important.
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Affiliation(s)
- Krista Whitney
- University of Ottawa, Ontario, Canada
- The Ottawa Hosptial, Ontario, Canada
| | | | - Allen R Huang
- The Ottawa Hosptial, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ontario, Canada
| | - Junghyun Park
- University of Ottawa, Ontario, Canada
- The Ottawa Hosptial, Ontario, Canada
| | - Prudy Menard
- University of Ottawa, Ontario, Canada
- The Ottawa Hosptial, Ontario, Canada
| | - Jason MacDonald
- University of Ottawa, Ontario, Canada
- The Ottawa Hosptial, Ontario, Canada
| | - Edward Spilg
- The Ottawa Hosptial, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ontario, Canada
| | - Lara Khoury
- The Ottawa Hosptial, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ontario, Canada
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Abstract
There has been little published literature examining the unique communication challenges older adults pose for health care providers. Using an explanatory mixed-methods design, this study explored patients’ and their family/caregivers’ experiences communicating with health care providers on a Canadian tertiary care, inpatient Geriatric unit between March and September 2018. In part 1, the modified patient–health care provider communication scale was used and responses scored using a 5-point scale. In part 2, one-on-one telephone interviews were conducted and responses transcribed, coded, and thematically analyzed. Thirteen patients and 7 family/caregivers completed part 1. Both groups scored items pertaining to adequacy of information sharing and involvement in decision-making in the lowest 25th percentile. Two patients and 4 family/caregivers participated in telephone interviews in part 2. Interview transcript analysis resulted in key themes that fit into the “How, When, and What” framework outlining the aspects of communication most important to the participants. Patients and family/caregivers identified strategic use of written information and predischarge family meetings as potentially valuable tools to improve communication and shared decision-making.
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Affiliation(s)
- Shirley Chien-Chieh Huang
- Department of Medicine, Division of Geriatric Medicine, University of Ottawa, The Ottawa Hospital, and the Ottawa Hospital Research Institute, Ontario, Canada
| | - Alden Morgan
- Faculty of Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada
| | | | - Lara Khoury
- Department of Medicine, Division of Geriatric Medicine, University of Ottawa, The Ottawa Hospital, and the Ottawa Hospital Research Institute, Ontario, Canada
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Lampron J, Khoury L, Moors J, Nemnom MJ, Figueira S, Podinic I, Eagles D. Impact of a geriatric consultation service on outcomes in older trauma patients: a before-after study. Eur J Trauma Emerg Surg 2021; 48:2859-2865. [PMID: 34146122 DOI: 10.1007/s00068-021-01724-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Early geriatric involvement is recommended for older trauma patients. We wished to determine the impact of geriatric consultation on mortality, hospital length of stay and discharge disposition in older patients who were admitted to our Level 1 trauma unit. METHODS We completed a health records review of trauma unit patients, age ≥ 75 years old with Injury Severity Score (ISS) ≥ 12, before (11/2015-10/2017) and after (11/2017-10/2019) implementation of a geriatric trauma consultation initiative. Primary outcomes were mortality, hospital length of stay and discharge destination. Secondary objectives were adherence to the geriatric trauma consult process and identification of geriatric-specific issues. A multivariable analysis controlling for age, gender, multi-morbidity and ISS was undertaken. RESULTS 157 patients pre-implementation and 172 post-implementation with mean age 83.8 years and 53.8% females were included. Geriatric consultation had no impact on in-hospital mortality [OR 0.70 (95% CI 0.31-1.58)] or length of stay [ß 0.68 (95%CI - 1.35-2.72)]. Patients who received a geriatric consultation were more likely to be discharged home (OR 2.01 (95% CI 1.24-3.24). The adherence to consultation process was 99.4%. Mobility, pain and cognitive impairment were the most common geriatric concerns, identified in 76.6, 61.1 and 50.0% of older trauma patients, respectively. CONCLUSION Older trauma patients that receive geriatric trauma consultation are more likely to be discharged home. Collaboration between trauma and geriatric specialists is beneficial and may lead to meaningful improvements in outcomes for older trauma patients.
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Affiliation(s)
- Jacinthe Lampron
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lara Khoury
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Joy Moors
- Department of Geriatrics, The Ottawa Hospital, Ottawa, ON, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sonshire Figueira
- Ottawa Regional Trauma Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Irina Podinic
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Debra Eagles
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Civic Campus, 1053 Carling Ave, Ottawa, ON, F658aK1Y 4E9, Canada.
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Erber R, Hartmann A, Fasching P, Stöhr R, Beckmann M, Zentgraf M, Ruebner M, Huebner H, Fischer J, Guerini Rocco E, Viale G, Cayre A, Penault-Llorca F, Caniego Casa T, Palacios Calvo J, Jank P, Denkert C, Khoury L, Mairinger T, Ferrazzi F. 28P Europe-side external quality assessment (EQA) of RNA based testing of ER, PR, HER2 and Ki67 in invasive breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pontes F, Rego I, Domingues I, Pinto L, Garcia R, Teixeira M, Khoury L, Serra T, Mariano M, Sousa G. Survival outcomes and prognostic factors in recurrent and/or metastatic head and neck cancer patients treated with chemotherapy plus cetuximab as first-line therapy in a real-world setting. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz428.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pontes F, Rego I, Domingues I, Pinto L, Garcia R, Teixeira M, Serra T, Khoury L, Mariano M, Sousa G. Survival outcomes and survival predictors in recurrent and metastatic head and neck squamous cell cancer (R/M-HNSCC) patients treated with chemotherapy (CT) plus cetuximab as first-line therapy in a real-world study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz428.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kopp B, Khoury L, Audebert M. Validation of the γH2AX biomarker for genotoxicity assessment: a review. Arch Toxicol 2019; 93:2103-2114. [DOI: 10.1007/s00204-019-02511-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
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10
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Theumer M, Henneb Y, Khoury L, Snini S, Tadrist S, Canlet C, Puel O, Oswald I, Audebert M. Genotoxicity of aflatoxins and their precursors in human cells. Toxicol Lett 2018; 287:100-107. [DOI: 10.1016/j.toxlet.2018.02.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 10/18/2022]
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Azad N, Lemay G, Li J, Benzaquen M, Khoury L. Perspectives from Geriatric In-patients with Heart Failure, and their Caregivers, on Gaps in Care Quality. Can Geriatr J 2016; 19:195-201. [PMID: 28050224 PMCID: PMC5178862 DOI: 10.5770/cgj.19.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Evidence indicates that care experiences for complex HF patients could be improved by simple organizational and process changes, rather than complex clinical mechanisms. This survey identifies care gaps and recommends simple changes. Methods The study utilized both quantitative and qualitative methods at The Ottawa Hospital, Geriatric Medical Unit (GMU) during a three-month period. Results Nineteen patients (average age 85, 12 female) surveyed. Twelve participants lived alone. Fourteen lived in own home. Four patients had formal home-care services. Fifteen relied on family. Gaps were identified in in-patient practice, discharge plan, and discharge summary implementation feedback. Only five participants had seen a cardiologist or a specialist. Half of the patients did not know if they were on a special Heart-Failure (HF) diet. Participants did not recall receiving information on life expectancy but were comfortable discussing EoL care and dying. HF-specific management recommendations were mentioned in only 37% of discharge summaries to primary care providers (PCPs). Conclusion The results provide the starting point for a quality assurance and process re-engineering program in GMU. Organization change is needed to develop and integrate a cardiogeriatric clinical framework to allow the cardiologist, geriatrician, and PCP to actively work as a team with the patient/caregiver to develop the optimal care plan pre- and post-discharge.
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Affiliation(s)
- Nahid Azad
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Division of Geriatrics, The Ottawa Hospital, Ottawa, ON, Canada
| | - G Lemay
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - J Li
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - M Benzaquen
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - L Khoury
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Abstract
This article examines problems that may arise when addressing liability resulting from the genetic modification of microbes, animals, and plants. More specifically, it evaluates how uncertainties relating to the outcomes of these biotechnological innovations affect—or may affect—the courts' application of the reasonable foreseeability requirement and, hence, liability under the tort of negligence. The article also examines how concern expressed by society about injuries feared to result from these genetically modified products could have an impact on the way the courts assess reasonable foreseeability in this area.
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Gagnon MP, Payne-Gagnon J, Breton E, Fortin JP, Khoury L, Dolovich L, Price D, Wiljer D, Bartlett G, Archer N. Adoption of Electronic Personal Health Records in Canada: Perceptions of Stakeholders. Int J Health Policy Manag 2016; 5:425-433. [PMID: 27694670 PMCID: PMC4930348 DOI: 10.15171/ijhpm.2016.36] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/02/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Healthcare stakeholders have a great interest in the adoption and use of electronic personal health records (ePHRs) because of the potential benefits associated with them. Little is known, however, about the level of adoption of ePHRs in Canada and there is limited evidence concerning their benefits and implications for the healthcare system. This study aimed to describe the current situation of ePHRs in Canada and explore stakeholder perceptions regarding barriers and facilitators to their adoption. METHODS Using a qualitative descriptive study design, we conducted semi-structured phone interviews between October 2013 and February 2014 with 35 individuals from seven Canadian provinces. The participants represented six stakeholder groups (patients, ePHR administrators, healthcare professionals, organizations interested in health technology development, government agencies, and researchers). A detailed summary of each interview was created and thematic analysis was conducted. RESULTS We observed that there was no consensual definition of ePHR in Canada. Factors that could influence ePHR adoption were related to knowledge (confusion with other electronic medical records [EMRs] and lack of awareness), system design (usability and relevance), user capacities and attitudes (patient health literacy, education and interest, support for professionals), environmental factors (government commitment, targeted populations) and legal and ethical issues (information control and custody, confidentiality, privacy and security). CONCLUSION ePHRs are slowly entering the Canadian healthcare landscape but provinces do not seem well-prepared for the implementation of this type of record. Guidance is needed on critical issues regarding ePHRs, such as ePHR definition, data ownership, access to information and interoperability with other electronic health records (EHRs). Better guidance on these issues would provide a greater awareness of ePHRs and inform stakeholders including clinicians, decision-makers, patients and the public. In turn, it may facilitate their adoption in the country.
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Affiliation(s)
- Marie-Pierre Gagnon
- Faculty of Nursing Science, Université Laval, Quebec City, QC, Canada
- Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Centre de recherche sur les soins et les services de première ligne, Centre intégré de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Julie Payne-Gagnon
- Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Erik Breton
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Jean-Paul Fortin
- Centre de recherche sur les soins et les services de première ligne, Centre intégré de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Lara Khoury
- Faculty of Law, McGill University, Montreal, QC, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - David Price
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Norman Archer
- DeGroote School of Business, McMaster University, Hamilton, ON, Canada
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Khoury L, Couture-Ménard ME, Redko O. The role of private law in the control of risks associated with tobacco smoking: the Canadian experience. Am J Law Med 2013; 39:442-470. [PMID: 23815038 DOI: 10.1177/009885881303900211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Can private law litigation serve as a tool for advancing public health objectives? With this contentious and oft-asked question in mind, we tackle Canada's recent tobacco litigation. This Article first presents critical commentary regarding various lawsuits waged against Canadian cigarette manufacturers by citizens acting as individuals or as parties to class action lawsuits. We then turn to analyze how Canada's provincial governments rely on targeted legislation to facilitate private law recourses for recouping the healthcare costs of treating tobacco-related diseases. We address challenges to the constitutionality of this type of legislation, as well as attempts by manufacturers to transfer responsibility to the federal government.Canadian litigation in this field is nothing like that of the United States with regards to both the volume and variety of its individual and class action litigation claims. This is also true with regard to the stage of advancement of governmental claims in Canada. Nevertheless, particularities of the Canadian context may provide interesting contrast with the situation in the United States.
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El-Badawi K, Hinojosa M, Khoury L, Stamos M. QS271. Volume Outcome Relationship for Laparoscopic Colectomy - Not So Simple. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khoury L. Factual causation and healthcare-associated infections. Health Law J 2009; 17:195-227. [PMID: 20608319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Rabay-Chacar H, Rizkallah E, Hakimeh NI, Khoury L, Merhej MT. Neurological complications associated with Mycoplasma pneumoniae infection. A case report. J Med Liban 2000; 48:108-11. [PMID: 11028161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Mycoplasma pneumoniae (MP) is a frequent cause of respiratory tract infection. Extra-pulmonary manifestations may be neurological with variable expression, encephalitis being the most frequent. Meningitis, myelitis or polyradiculoneuritis are also reported. The pathophysiology of neurological manifestations remains poorly understood. Although not isolated from cerebral tissue, MP was reportedly detected in cerebro-spinal fluid (CSF) on several occasions. We report the case of a five-year-old girl who presented with fever, then pneumonia, and later developed spastic quadriparesis. MP was identified as the causative agent, evidenced by the presence of specific antibodies in both serum and CSF. The identification of a central nervous syndrome associated with confirmed MP infection extends the list of similar cases documented in individuals younger than 17 years of age.
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Affiliation(s)
- H Rabay-Chacar
- Pediatrics Department, St George Hospital (SGH), Beirut, Liban.
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Chacar H, Rizkallah E, Khoury L, Hakimeh N. Complications neurologiques liees au mycoplasma pneumoniae: A propos d'un cas. Arch Pediatr 1999. [DOI: 10.1016/s0929-693x(99)81643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Despite the severity of ankle syndesmosis injuries, it has been argued that they are relatively poorly detected. This study investigated the interrater reliability of four orthopaedic tests for ankle syndesmosis injury and assessed their ability to predict the extended recovery times that have been reported as a consequence of this injury. Nine physiotherapists, working in random pairings, examined 53 subjects, all receiving treatment for ankle injury at two private clinics. Each subject was tested by two physiotherapists who independently performed the palpation test, external rotation test, squeeze test, and dorsiflexion-compression test. Kappa coefficient testing indicated that the external rotation test had the best interrater reliability (kappa = 0.75). The squeeze test was found to have moderate reliability (kappa = 0.50), and the palpation and dorsiflexion-compression tests both had only fair reliability (kappa = 0.36). The degree of pair-wise association between the results of the four tests was low (phi < or = 0.30 for all test combinations), suggesting that if all four tests were performed on the same subject, it was not likely that they would achieve similar results. Follow-up interviews were conducted to determine the time taken for subjects to walk 10 m without pain and, for sports injuries, the time taken to return to training and then to competition. For each test, Mann-Whitney U values showed no significant difference between the recovery times of subjects with positive or negative test results, although subjects with recovery times markedly longer than normal were detected by three of the four tests. When an either/or combination of the external rotation and dorsiflexion-compression tests was considered, subjects with a positive test result took significantly longer to return to playing sports.
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Affiliation(s)
- A Alonso
- SportsFizz Physiotherapy and Sports Injury Centre, Bankstown, New South Wales, Australia
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Poláková H, Khoury L, Cierna M. [The fragile X chromosome syndrome: DNA analysis in families with familial occurrence of mental retardation]. BRATISL MED J 1997; 98:150-6. [PMID: 9264820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The fragile X syndrome, the most common form of inherited mental retardation, is characterized by unique genetic mechanisms, which include amplification of a CGG repeat and abnormal DNA methylation. Direct DNA analysis of fragile X mutations has already shown its clear superiority for postnatal and prenatal diagnosis of the disorder and for carrier detection. In this, paper the authors report on the results of DNA analysis in families with familial mental retardation. They present the various alternatives (probe/enzymes combinations) for Southern blot based diagnosis and protocols which gave optimal results for detection of patients segregating for fragile X syndrome. Totally, 36 members from 10 families were analyzed by Southern blotting, including 18 mentally affected patients. No CGG expansion was detected in 9 clinically affected patients of 5 families. Expansion of the CGG repeats was found in 9 clinically and cytogenetically affected males, in 5 unaffected carriers of premutation, and in 1 carrier of full mutation in the remaining 5 families. Carriers represented mothers of the patients. These results correlated with cytogenetic and clinical expression of fragile X syndrome. The application of the method for diagnosis of the disease is discussed. (Tab. 2, Fig. 3, Ref. 21.)
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Affiliation(s)
- H Poláková
- Laboratórium genetiky Ustavu molekulárnej fyziológie a genetiky Slovenskej akadémic vicd v Bratislave, Slovakia
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21
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Affiliation(s)
- L Khoury
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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22
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Abstract
The Child and Adolescent Psychiatry Service of the William S. Hall Psychiatric Institute, Columbia, South Carolina, routinely administers the MMPI to the parents of children and adolescents in outpatient psychiatric treatment. The MMPI data obtained from parents during the (1970-74) and (1975-79) periods (N = 342) have been analyzed from two perspectives. MMPI critical item endorsement and MMPI clinical scale changes have been evaluated statistically through a comparison of parents in the two time periods. Both the increase in clinical scale elevations and shift in critical item endorsement suggest a parent population in which mothers are suffering considerably more psychological distress or psychopathology than fathers during the last 5 years. The findings indicate the need for cross-clinic replications of the present investigation in order to establish the reliability of the current findings.
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23
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Abstract
Sinus node (SN) and atrioventricular node (AVN) function were evaluated in 49 patients with secundum type atrial septal defect (ASD). Automaticity and conduction system function were assessed by intracardiac recording of the AH and HV intervals at rest, corrected SN recovery time, sinoatrial conduction time, AVN refractory period and the ability of the AVN to conduct rapidly paced atrial beats to the ventricles. Electrophysiologic abnormalities were found in 41% of the 34 patients who were studied before surgery. However, no preoperative abnormalities were present in children younger than 2.5 years. If only children older than 2.5 years were analyzed, the incidence of conduction abnormalities was similar for the patients studied before operation (62%) and those studied after operation (71%). The size and ejection fractions of the right and left ventricles, the magnitude of shunt flow and the size of the ASD did not differ between the patients with and those without electrophysiologic abnormalities. AVN dysfunction was present in 40% of the patients who were studied after surgical repair. While this frequency was more than twice the preoperative incidence of AVN dysfunction, it was not statistically significant. The data suggest that patient age is the major factor that influences the presence of conduction system dysfunction in patients with ASD.
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