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Carter M, Abutheraa N, Ivers N, Grimshaw J, Chapman S, Rogers P, Simeoni M, Watson M. A systematic review of pharmacist-led audit and feedback interventions to influence prescribing behaviour in general practice settings. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab015.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Audit and Feedback (A&F) involves measuring data about practice, comparing it with clinical guidelines, professional standards or peer performance, and then feeding back the data to individuals/groups of health professionals to encourage change in practice (if required). A 2012 Cochrane review (1) found A&F was effective in changing health professionals’ behaviour and suggested that the person who delivers the A&F intervention influences its effect. Increasingly, pharmacists work in general practice and often have responsibility for medication review and repeat prescriptions. The effectiveness of pharmacist-led A&F in influencing prescribing behaviour is uncertain.
Aim
This secondary analysis from an ongoing update of the original Cochrane review aims to identify and describe pharmacist-led A&F interventions and evaluate their impact on prescribing behaviour in general practice compared with no intervention.
Methods
This sub-review is registered with PROSPERO: CRD42020194355 and complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (2). For the updated Cochrane review, the Cochrane Effective Practice and Organization of Care Group searched MEDLINE (1946 to present), EMBASE, CINAHL and Cochrane Library (March 2019) to identify randomised trials featuring A&F interventions. For this sub-review, authors screened titles and abstracts (May 2020) to identify trials involving pharmacist-led A&F interventions in primary care, extracted data, and assessed risk of bias (RoB) in eligible studies. Review results are summarised descriptively. Heterogeneity will be assessed and a random-effects meta-analysis is planned. Publication bias for selected outcomes and the certainty of the body of evidence will be evaluated and presented. Sub-group analyses will be conducted.
Results
Titles and abstracts of 295 studies identified for inclusion in the Cochrane A&F review update were screened. Eleven studies (all cluster-randomised trials) conducted in 9 countries (Denmark, Italy, Netherlands, Norway, Republic of Ireland, UK, Australia, Malaysia, USA) were identified for inclusion (Figure 1). Six studies had low RoB, two had high risk due to dissimilarities between trial arms at baseline and/or insufficient detail about randomisation, and three studies had unclear RoB. Studies examined the effect of A&F on prescribing for specific conditions (e.g. hypertension), medications (e.g. antibiotics), populations (e.g. patients >70), and prescribing errors (e.g. inappropriate dose). The pharmacist delivering A&F was a colleague of intervention participants in five studies. Pharmacists’ levels of skill and experience varied; seven studies reported details of pharmacist training undertaken for trial purposes. A&F interventions in nine studies demonstrated changes in prescribing, including reductions in errors or inappropriate prescribing according to the study aims and smaller increases in unwanted prescribing compared with the control group. Data analyses are ongoing (results will be available for the conference).
Conclusion
The preliminary results demonstrate the effectiveness of pharmacist-led A&F interventions in different countries and health systems with influencing prescribing practice to align more closely with guidance. Studies measured different prescribing behaviours; meta-analysis is unlikely to include all 11 studies. Further detailed analysis including feedback format/content/frequency and pharmacist skill level/experience, work-base (external/internal to recipients), will examine the impact of specific features on intervention effectiveness.
References
1. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012(6):CD000259.
2. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
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Affiliation(s)
| | | | - N Ivers
- University of Toronto & Women's College Hospital, Toronto, Canada
| | - J Grimshaw
- University of Ottawa & Ottawa Hospital Research Institute, Canada
| | | | | | - M Simeoni
- Women's College Hospital Research Institute, Canada
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Hijazi W, Cao A, Ivers N, Bouck Z, Natarajan M, Schwalm J. IMPROVING LONG-TERM MEDICATION ADHERENCE FOR ELDERLY PATIENTS POST-MI THROUGH LONGER PRESCRIPTIONS AT INITIAL DISCHARGE: A PROCESS EVALUATION OF AN INTERVENTIONAL STUDY. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.033] [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: 10/23/2022] Open
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McIntyre W, Yong JHE, Sandhu R, Gladstone D, Simek K, Liu Y, Quinn F, Tytus R, Zizzo D, Henein S, Ivers N, Healey J. Prevalence of undiagnosed atrial fibrillation in elderly individuals and potential cost-effectiveness of non-invasive ambulatory electrocardiographic screening: The ASSERT-III study. J Electrocardiol 2020; 58:56-60. [DOI: 10.1016/j.jelectrocard.2019.11.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/01/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022]
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Atzema C, Jackevicius C, Chong A, Dorian P, Ivers N, Parkash R, Austin P. PROVISION OF EMERGENCY DEPARTMENT PRESCRIPTIONS FOR ORAL ANTICOAGULATION AND SUBSEQUENT LONG-TERM USE IN PATIENTS WITH ATRIAL FIBRILLATION. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.058] [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: 11/24/2022] Open
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Greiver M, Dahrouge S, O'Brien P, Manca D, Lussier MT, Wang J, Burge F, Grandy M, Singer A, Twohig M, Moineddin R, Kalia S, Aliarzadeh B, Ivers N, Garies S, Turner JP, Farrell B. Improving care for elderly patients living with polypharmacy: protocol for a pragmatic cluster randomized trial in community-based primary care practices in Canada. Implement Sci 2019; 14:55. [PMID: 31171011 PMCID: PMC6551894 DOI: 10.1186/s13012-019-0904-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/13/2019] [Indexed: 01/17/2023] Open
Abstract
Background Elders living with polypharmacy may be taking medications that do not benefit them. Polypharmacy can be associated with elevated risks of poor health, reduced quality of life, high care costs, and persistently complex care needs. While many medications could be problematic, this project targets medications that should be deprescribed for most elders and for which guidelines and evidence-based deprescribing tools are available. These are termed potentially inappropriate prescriptions (PIPs) and are as follows: proton pump inhibitors, benzodiazepines, antipsychotics, and sulfonylureas. Implementation strategies for deprescribing PIPs in complex older patient populations are needed. Methods This will be a pragmatic cluster randomized controlled trial in community-based primary care practices across Canada. Eligible practices provide comprehensive primary care and have at least one physician that consents to participate. Community-dwelling patients aged 65 years and older with ten or more unique medication prescriptions in the past year will be included. The objective is to assess whether the intervention reduces targeted PIPs for these patients compared with usual care. The intervention, Structured Process Informed by Data, Evidence and Research (SPIDER), is a collaboration between quality improvement (QI) and research programs. Primary care teams will form interprofessional Learning Collaboratives and work with QI coaches to review electronic medical record data provided by their regional Practice Based Research Networks (PBRNs), identify areas of improvement, and develop and implement changes. The study will be tested for feasibility in three PBRNs (Toronto, Montreal, and Edmonton) using prospective single-arm mixed methods. Findings will then guide a pragmatic cluster randomized controlled trial in five PBRNs (Calgary, Winnipeg, Ottawa, Montreal, and Halifax). Seven practices per PBRN will be recruited for each arm. The analysis will be by intention to treat. Ten percent of patients who have at least one PIP at baseline will be randomly selected to participate in the assessment of patient experience and self-reported outcomes. Qualitative methods will be used to explore patient and physician experience and evaluate SPIDER’s processes. Conclusion We are testing SPIDER in a primary care population with complex care needs. This could provide a widely applicable model for care improvement. Trial registration Clinicaltrials.gov NCT03689049; registered September 28, 2018 Electronic supplementary material The online version of this article (10.1186/s13012-019-0904-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Greiver
- North York General Hospital, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada. .,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada.
| | - S Dahrouge
- Department of Family Medicine, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario, K1R 6M1, Canada.,Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, K1N 5C8, Canada
| | - P O'Brien
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - D Manca
- Department of Family Medicine, University of Alberta, 8303 - 112 Street NW, 610 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - M T Lussier
- Department of Family Medicine and Emergency Medicine, University of Montreal, 1755 René Laennec, Bureau DS-079, Laval, Québec, H7M3L9, Canada
| | - J Wang
- North York General Hospital, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - F Burge
- Department of Family Medicine, Dalhousie University, 8F, 8525 Abbie J Lane Building, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E2, Canada
| | - M Grandy
- Department of Family Medicine, Dalhousie University, 8F, 8525 Abbie J Lane Building, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E2, Canada
| | - A Singer
- Department of Family Medicine, University of Manitoba, D009 - 780 Bannatyne Ave, Winnipeg, Manitoba, R3T 2N2, Canada
| | - M Twohig
- North York General Hospital, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - R Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - S Kalia
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - B Aliarzadeh
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - N Ivers
- Family Practice Health Centre and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5S 1B2, Canada
| | - S Garies
- Department of family Medicine, Cumming School of Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - J P Turner
- Faculty of Pharmacy, University of Montreal, 2900 Edouard Montpetit Boulevard, Montreal, Quebec, H3T 1J4, Canada.,Centre de Recherche, Institut Universitaire de Geriatrie de Montreal, Montreal, Canada
| | - B Farrell
- Department of Family Medicine, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario, K1R 6M1, Canada.,Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, K1N 5C8, Canada.,School of Pharmacy, University of Waterloo, Waterloo, Canada
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Shepherd S, Schwalm J, Ivers N. THE ASSOCIATION BETWEEN IMMIGRATION AND ETHNICITY ON ADHERENCE TO STATINS AND CARDIAC REHABILITATION POST-MYOCARDIAL INFARCTION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.354] [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: 11/27/2022] Open
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Nguyen E, Lemieux V, Udell J, Hanneman K, Bhatia S, Ivers N, Harvey P. Reducing Over Investigation of Women with Stable Chest Pain at Low/Intermediate Risk for Coronary Artery Disease: The Rationale for the RESOLVE Trial. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.01.041] [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: 10/17/2022] Open
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Bhatia R, Farkouh M, Ivers N, Yin X, Myers D, Nesbitt G, Yared K, Edwards J, Hansen M, Wong B, Johri A, Udell J, Weinerman A, Rakowski H, Weiner R. P5224Improving the Appropriate Use of Transthoracic Echocardiography- The results of the Echo WISELY trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R.S. Bhatia
- Women's College Hospital, Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - M. Farkouh
- University Health Network, Toronto, Canada
| | - N. Ivers
- Women's College Hospital, Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - X.C. Yin
- Women's College Hospital, Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - D. Myers
- St. Michael's Hospital, Toronto, Canada
| | - G. Nesbitt
- Mount Sinai Hospital of the University Health Network, Toronto, Canada
| | - K. Yared
- The Scarborough Hospital, Toronto, Canada
| | | | - M. Hansen
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - B.M. Wong
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - A. Johri
- Queen's University, Kingston, Canada
| | - J. Udell
- Women's College Hospital, Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - A. Weinerman
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - R.B. Weiner
- Brigham and Women's Hospital, Boston, United States of America
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McBrien KA, Manns BJ, Hemmelgarn BR, Weaver R, Edwards AL, Ivers N, Rabi D, Lewanczuk R, Braun T, Naugler C, Campbell D, Saad N, Tonelli M. The association between sociodemographic and clinical characteristics and poor glycaemic control: a longitudinal cohort study. Diabet Med 2016; 33:1499-1507. [PMID: 26526088 DOI: 10.1111/dme.13023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
AIMS People with diabetes and poor glycaemic control are at higher risk of diabetes-related complications and incur higher healthcare costs. An understanding of the sociodemographic and clinical characteristics associated with poor glycaemic control is needed to overcome the barriers to achieving care goals in this population. METHODS We used linked administrative and laboratory data to create a provincial cohort of adults with prevalent diabetes, and a measure of HbA1c that occurred at least 1 year following the date of diagnosis. The primary outcome was poor glycaemic control, defined as at least two consecutive HbA1c measurements ≥ 86 mmol/mol (10%), not including the index measurement, spanning a minimum of 90 days. We used multivariable Cox proportional hazards models to evaluate the association between baseline sociodemographic and clinical factors and poor glycaemic control. RESULTS In this population-based cohort of 169 890 people, younger age was significantly associated with sustained poor glycaemic control, with a hazard ratio (HR) of 3.08, 95% CI (2.79-3.39) for age 18-39 years compared with age ≥ 75 years. Longer duration of diabetes, First Nations status, lower neighbourhood income quintile, history of substance abuse, mood disorder, cardiovascular disease, albuminuria and high LDL cholesterol were also associated with poor glycaemic control. CONCLUSIONS Although our results may be limited by the observational nature of the study, the large geographically defined sample size, longitudinal design and robust definition of poor glycaemic control are important strengths. These findings demonstrate the complexity associated with poor glycaemic control and indicate a need for tailored interventions.
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Affiliation(s)
- K A McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - B J Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - B R Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - R Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - A L Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Toronto, Canada
| | - N Ivers
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - D Rabi
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - R Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Provincial Primary Health Care, Alberta Health Services, Calgary, Canada
| | - T Braun
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
| | - C Naugler
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Laboratory Services, Calgary, Canada
| | - D Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - N Saad
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - M Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Leblanc K, Bhatia R, Dorian P, Ivers N, Valentinis A, Beard-Ashley L, Grinman M, Morra D, Ha A, Meshkat N. TRANSITIONING EMERGENCY ATRIAL FIBRILLATION MANAGEMENT (TEAM) MODEL IMPROVES QUALITY OF LIFE AND HELPS PATIENTS AVOID ED VISITS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.512] [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: 10/22/2022] Open
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Montazeri N, Anderson C, Rao-Melacini P, Ivers N, Natarajan M, Schwalm J. LONGER LENGTH OF INITIAL PRESCRIPTION POST-STEMI IS ASSOCIATED WITH HIGHER MEDICATION ADHERENCE: A POST-HOC SUB-STUDY OF THE DERLA-STEMI TRIAL. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.111] [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: 11/27/2022] Open
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Widdifield J, Young J, Bombardier C, Jaakkimainen R, Butt D, Ivers N, Bernatsky S, Paterson J, Thorne J, Ahluwalia V, Tomlinson G, Tu K. FRI0194 Identifying Patients with Rheumatoid Arthritis in Primary Care Electronic Medical Records. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ivers N, Schwalm J, Kingsbury K, Guo H, Tu J, Grimshaw J, Natarajan M. 341 Long-Term Statin Adherence in Secondary Prevention: A Provincial Retrospective Cohort Study. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.337] [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: 11/27/2022] Open
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Valentinis A, Ivers N, Bhatia R, Leblanc K, Grinman M, Meshkat N, Ha A, Morra D. 615 Comparison of the 2010 and 2012 Canadian Cardiovascular Society Atrial Fibrillation Guidelines in a Large Urban Family Practice. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.553] [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: 11/25/2022] Open
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Norton JH, Tranter WP, Campbell RS, Ivers N, Martin P. A farming systems study of abortion in dairy cattle on the Atherton Tableland. 4. Pasture composition and plasma progesterone concentrations of pregnant cows in affected herds. Aust Vet J 1989; 66:170-4. [PMID: 2549929 DOI: 10.1111/j.1751-0813.1989.tb09794.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To provide more evidence for an apparent association between immature, high protein pasture diets and abortion in dairy cows on the Atherton Tableland in tropical north Queensland, pastures and cows on 4 farms were sampled on 5 occasions during a 7-month period. Pasture samples were analysed for dry matter (DM), protein, nitrate and fibre content. Plasma progesterone concentrations were determined in 18 to 20 pregnant cows. Fifty-four pasture samples (38 grass and 16 legume) were analysed and the distribution for 3 DM ranges was: 10% to 14.9% - 20 samples, 15% to 19.9% - 27 samples and 20% to 24.9% - 7 samples, while the distribution for 4 protein ranges was: 15% to 19% - 5 samples, 20% to 24% - 20 samples, 25% to 29% - 21 samples and 30% to 34% - 8 samples. Both pasture protein and DM content fluctuated with time. Pasture nitrate was low and insignificant while fibre (cell wall) levels appeared to be satisfactory for ruminant nutrition. Significant differences occurred between the mean plasma progesterone levels on 3 of the 4 farms. Raised levels in pregnant cows suggested the possibility of increased progesterone production in response to a previous low progesterone crisis or, alternatively, a decreased metabolic clearance rate of progesterone in pregnant cows on a declining plane of nutrition towards the end of the summer wet season. Progesterone data were not available from cows which previously aborted.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J H Norton
- Queensland Department of Primary Industries, Oonoonba Veterinary Laboratory, Townsville
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