IRHO - Publications // OHRI - Publications

Permanent URI for this collectionhttps://hdl.handle.net/10393/22939

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Do Subphenotypes Predict Treatment Responses in Sepsis? A Scoping Review
(2024-09-11) Hanna, Andrew M. R.; Hum, Christine; Mendelson, Asher A.; McIntyre, Lauralyn
Handling of covariates in stepped-wedge cluster randomized trials: Protocol for a methodological review
(2022) Nevins, Pascale; Davis-Plourde, Kendra; Pereira Macedo, Jules; Ouyang, Yongdong; Ryan, Mary; Tong, Guangyu; Wang, Xueqi; Meng, Can; Ortiz-Reyes, Luis; Caille, Agnès; Li, Fan; Taljaard, Monica
Background: Stepped-wedge cluster randomized trials (SW-CRTs), which randomize clusters to times at which they transition from control to intervention arms, are an increasingly popular design for evaluating health system and policy interventions. Reporting of SW-CRTs should ideally be guided by the 2018 CONSORT extension for SW-CRTs. Although substantial methodological development has taken place in recent years, several gaps remain in our knowledge about the best practices for the design, analysis, and reporting of SW-CRTs. Objectives: We are undertaking a methodological systematic review of SW-CRTs published 2016-2022. Our primary objectives are to describe current methods and practices for handling covariates (number of and types of covariates) in the design and analysis of SW-CRTs; examine adherence to CONSORT guidelines around reporting of covariates including balance at baseline; and identify prevalent issues in SW-CRTs and gaps in the methodological literature. Methods: We will identify primary reports of SW-CRTs published in English 2016-2022 from three sources: a previously published review covering 2020 to 2021, an existing database of pragmatic trials published 2014-2019, and an updated search capturing trials up to 2022. A data extraction form will be used to standardize the extraction of information about the trials. Analyses will be primarily descriptive in nature.
Efficacy and safety of mesenchymal stromal cell therapy in pre-clinical animal models of sepsis
(2022) Hum, Christine; Tahir, Usama; Mei, Shirley; Champagne, Josee; Fergusson, Dean; Lalu, Manoj; Stewart, Duncan; Walley, Keith; Marshall, John; Winston, Brent; Dave, Chintan; McIntyre, Lauralyn
Have Canadian Emergency Physician Opioid Prescriptions for Undifferentiated Abdominal Pain Changed Significantly Over Five Years?
(2022) Wei, Mike; Da Silva, Marco; Perry, Jeffrey
Introduction: In North America, data over the last decade have found significant morbidity associated with opioid use and prescribing of opioids to patients. The objective of our study was to assess if there has been a change in opioid prescribing practices by emergency physicians over time for undifferentiated abdominal pain. Method: A medical records review for adult patients presenting at two urban academic tertiary care emergency departments was conducted for two distinct time periods; the years of 2012 and 2017. The first 500 patients per year with a discharge diagnosis of “abdominal pain” or “abdominal pain not yet diagnosed” for each year were identified and their charts were reviewed. Data were collected regarding analgesia received in the emergency department and opioid prescriptions written. Opioids were standardized into morphine equivalent doses to compare quantities of prescribed opioids. Results: 1,000 patients were included in our study. The mean age was 42.0 years and 69.6% of patients were female. Comparing 2012 to 2017, there was a non-significant decrease in opioid prescriptions written for patients discharged from the emergency department from 17.8% to 14.4% (p=0.144). Mean opioid quantities per prescription decreased from 130.4 milligrams of morphine equivalents per prescription to 98.9 milligrams per prescription (P=0.002). There was an increase in foundational analgesia use prior to initiating opioids in the emergency department from 17.6% to 26.8% (p=0.001). There was a significant decrease in opioid use in the emergency department from 40.0% to 32.8% (p=0.018). Conclusion: Opioid prescription rates have not changed significantly over our 5-year study period. However, physicians have reduced the quantity prescribed per prescription and are using less opioid analgesia in the emergency department for abdominal pain of undetermined etiology.
Association of physician sex and gender with patient outcomes in acute care: A systematic review and meta-analysis.
(2022) Etherington, Cole; Burns, Joesph; Boet, Sylvain; Kennedy, Catherine
This is an updated systematic review protocol
Breast density and risk of interval cancers: The effect of annual versus biennial screening mammography policies in Canada
(2021) Seely, Jean Morag; Peddle, Susan Elizabeth; Yang, Huiming; Chiarelli, Anna M.; McCallum, Megan; Narasimhan, Gopinath; Zakaria, Dianne; Earle, Craig C.; Fung, Sharon; Bryant, Heather; Nicholson, Erika; Politis, Chris; Berg, Wendie
Regular screening mammography reduces breast cancer mortality. However, in women with dense breasts, the performance of screening mammography is reduced, which is reflected in higher interval cancer rates (ICR). In Canada, population-based screening mammography programs generally screen women biennially; however, some provinces and territories offer annual mammography for women with dense breast tissue routinely and/or on recommendation of the radiologist. This study compared the ICRs in those breast screening programs with a policy of annual vs. those with biennial screening for women with dense breasts. Among 148,575 women with dense breasts screened between 2008 to 2010, there were 288 invasive interval breast cancers; screening programs with policies offering annual screening for women with dense breasts had fewer interval cancers 63/70,814 (ICR 0.89/1000, 95% CI: 0.67-1.11) compared with those with policies of usual biennial screening 225/77,761 (ICR 1.45 /1000 (annualized), 95% CI: 1.19-1.72) i.e. 63% higher (p = 0.0016). In screening programs where radiologists' screening recommendations were able to be analyzed, a total of 76,103 women were screened, with 87 interval cancers; the ICR was lower for recommended annual (65/69,650, ICR 0.93/1000, 95% CI: 0.71, 1.16) versus recommended biennial screening (22/6,453, ICR 1.70/1000 (annualized), 95%CI: 0.70, 2.71)(p = 0.0605). Screening program policies of annual as compared with biennial screening in women with dense breasts had the greatest impact on reducing interval cancer rates. We review our results in the context of current dense breast notification in Canada.
Association of physician sex and gender with patient outcomes in acute care: A systematic review and meta-analysis.
(2020) Etherington, Nicole; Burns, Joseph; Boet, Sylvain; Kennedy, Catherine
Influence of prolonged treatment with omalizumab on the development of solid epithelial cancer in patients with atopic asthma and chronic idiopathic urticaria: A systematic review and meta‐analysis
(2019) Johnston, Amy; Smith, Christine; Zheng, Carine; Aaron, Shawn D; Kelly, Shannon E; Skidmore, Becky; Wells, George A.
We investigated whether prolonged treatment with omalizumab influences development or progression of solid epithelial cancer in patients with atopic asthma or chronic idiopathic urticaria.
Efficacy and safety of novel GZ667161 glucosylceramide synthase inhibitor to modulate CNS glucocerebrosidase activity and synucleinopathies in pre-clinical and clinical studies investigating Parkinson’s disease: a systematic review
(2019) Grigor, Emma; Montroy, Joshua; Lalu, Manoj; Mestre, Tiago; Schlossmacher, Michael; Fergusson, Dean
Background: Parkinson’s disease (PD) is a disorder caused by neurodegeneration of select neuronal clusters in the central nervous system (CNS), which leads to a progressive movement disorder and associated cognitive decline over the ensuing decades. Glucosylceramide synthase (GCS) inhibitors are an exciting new treatment option for patients with PD. Here, we provide a first review that may help to inform the design of future in vivo pre-clinical trials using the CGS inhibitor, GZ667161. Methods: A comprehensive search strategy was developed with the help of an information specialist to identify studies of GZ667161 in animals or humans with parkinson's disease. Article screening, data extraction, and risk of bias assessment was done in duplicate by two independent reviewers. Results: The systematic search of the literature yielded 4 citations for possible inclusion. Following de-duplication and screening, a total of one pre-clinical study was determined to meet our full eligibility criteria for inclusion. There were no clinical studies of GZ667161 identified. The one included study saw significant reductions in glucoceramide levels in GZ667161 mice compared to controls (p<0.01). Adverse events were not reported. Conclusions: The review of the study suggests that GZ667161 may be able to reduce the levels of GlcCer in the CNS of mouse models for Parkinson disease. However, these results should be interpreted with caution, as only one study was included in the review, and it was found to be at a high risk of bias across multiple domains.
Physician sex, gender, processes of care, and clinical outcomes in perioperative cardiothoracic care: a systematic review protocol
(2018) Etherington, Nicole; Boet, Sylvain; Deng, Mimi; Johnston, Amy; Mansour, Fadi; Said, Hussein; Zheng, Katina; Sun, Louise
A protocol for a systematic review that aims to summarize the nature and extent of available evidence on the role of anesthesiologists’ and surgeons’ sex/gender in relation to processes of care and/or clinical outcomes within the context of perioperative cardiothoracic care.
Signal Detection Report: Light therapy for non-seasonal depression
(2017) Pratt, Misty; Ahmadzai, Nadera; Hutton, Brian; Wieland, Susan; Skidmore, Becky; Moher, David
Previous research evaluating a cohort of published systematic reviews demonstrated that 7% of reviews were out of date by the time of publication, while as many as 23% went out of date within two years of being completed. The utility of systematic review-based evidence depends on their remaining up-todate. As such, the Cochrane Complementary Medicine Field and the Knowledge Synthesis group at the Ottawa Hospital Research Institute (OHRI) have determined a set of existing reviews of interest for which signal detection work using the Ottawa Method’s qualitative/quantitative signal detection approach has been performed. The Ottawa method involves identification of qualitative and quantitative signals/triggers indicating the need of updating of a systematic review. The Ottawa method has been used to assess the need for updating systematic reviews in the past. A graphical overview of our approach and application of the Ottawa signal detection method is provided in Appendix A, Figure 1 of this report. This work assessed potential triggers signifying the need for updating of six past Cochrane Complementary Medicine reviews. The conclusion as to whether or not each of the reviews is in need of updating was made based on the identification of qualitative and quantitative signals.
Guidelines for management of patients with abnormal coagulation requiring an invasive procedure: A scoping review protocol
(2019) Baker, Laura; Shaw, Joseph; Khair, Simonne; Bryson, Gregory; Fergusson, Dean; Kelly, Erin; LeGal, Gregoire; Martel, Guillaume; Tinmouth, Allan; Saidenberg, Elianna
Introduction: Patients with coagulation abnormalities requiring invasive procedures are commonly encountered. Such abnormalities may arise as a consequence of congenital or acquired deficiencies of platelets or coagulation factors or the use of anti-platelet or anti-coagulant medications. The availability and quality of guidelines pertaining to specific procedures and patient populations and their quality has yet to be surveyed. Objective: The purpose of this review is to evaluate and summarize existing guidelines for the management of patients with abnormal coagulation undergoing invasive procedures. Methods & Analysis: A scoping review will be conducted to identify guidelines pertaining to patients with abnormalities of hemostasis undergoing invasive procedures. EMBASE and Medline will be systematically searched from January 1998 to present. The following guideline-specific databases will also be searched: National Institute for Health and Care Excellence (NICE) (UK), the Canadian Medical Association Infobase (Canada), the G-I-N International Guideline Library, the New Zealand Guidelines (NZG) Group, The World Health Organization and the Scottish Intercollegiate Guidelines Network (SIGN). Title and abstract screening will be performed in duplicate by two reviewers. Full manuscript review and data abstraction will be performed independently in duplicate. References of included articles will also be scanned for potentially relevant publications. The following data will be extracted from eligible guidelines: specified patient population, planned procedure and recommended peri-procedural management of coagulation abnormality (timing and details of medication cessation and initiation, administration of blood products, anticoagulant reversing agents or pro-hemostatic agents). The Appraisal of Guidelines for Research & Evaluation (AGREE) II tool will be used to evaluate the methodological quality of identified guidelines. Results will be presented through (1) a descriptive summary of studies and (2) a summary of available guidelines and their associated quality. A multidisciplinary group of experts has been involved in the development of this protocol and will be involved throughout the conduct of this study. Ethics & Dissemination: This study aims to investigate and summarize previously published guidelines and therefore does not require ethics approval. This review will allow for appreciation of available literature on the topic, helping to identify gaps and inform future research. Additionally, it will serve as a valuable resource to health care providers managing patients with coagulation abnormalities requiring invasive procedures. We intend to report the findings of this scoping review in a peer-reviewed journal and at a scientific conference. Registration: Submitted to University of Ottawa Library Depository Keywords:
Defining critical and non-critical moments in the Operating Room: Protocol for a modified Delphi study
(2017) Boet, Sylvain; Etherington, Nicole; Cairns, Martin; Kenna, Julie; Posner, Glenn; Jung, James; Grantcharov, Teodor
Background: Many advances in perioperative patient safety have been inspired by the aviation industry. One key protocol from aviation that has yet to be formally established in the operating room (OR) is the ‘sterile cockpit’ rule, which prohibits all non-essential behavior and actions during critical phases of a flight. It has been suggested that the application of a sterile cockpit rule to healthcare could have similar benefits for patient safety;1,2 yet, it remains unclear as to which phases of the surgical process are the most critical. Methods: After ethical approval, we will use a modified Delphi method to identify the critical moments of the surgical process according to OR team members across institutions, professions and specialties. Providers will be asked to identify the critical moments of surgery relevant to their professional perspective. At least 140 participants will be recruited, with iterative web-based surveys administered. Analysis and consensus will take place after each round. The stopping criterion will be either consensus on 80% of the survey items or no change in the mean score for any individual item between two consecutive rounds among each profession. Significance: Defining critical moments during surgery will allow future research to determine the relative importance of behavior and actions at each stage. This can potentially enhance the effectiveness of future interventions by enabling the most important moments to be targeted. As a result, interventions to reduce medical errors linked to poor surgical patient outcomes may be greatly enhanced.
Development of a collaborative research framework: the example of a study conducted by and with a First Nations, Inuit and Métis womens's community and their research partners
(2016) Jull, Janet; Giles, Audrey; Boyer, Yvonne; Minwaashin Lodge- The Aboriginal Women's Support Centre; Stacey, Dawn
The lack of research that effectively addresses inequity within Canadian society is an indicator of the failure of mainstream research approaches and practices to engage with all populations. This paper describes the development of a collaborative framework defined by a First Nations, Inuit and Métis women’s community members and its research partners as ethical, useful and relevant. There were two essential phases in negotiating a collaborative framework for a community- research partnership and the steps in a community-based participatory approach described: 1) establish guiding features of a collaborative framework by forming an advisory group, developing ethical guidance, agreeing upon underlying theoretical concepts for the research study; and 2) engage in research actions that support co-creation of knowledge throughout study processes. The case study example used to illustrate the collaborative framework was conducted by and with a First Nations, Inuit and Métis women’s community and research partners to culturally adapt a health decision-making strategy. A community-based participatory research approach fostered engagement among community and research participants and directed community-research collaboration. The collaborative framework structured ongoing negotiations within the community-research partnership to ensure that ethical obligations to research participants and the broader community were met and goals of the study achieved.
Protocol for a scoping review of systematic reviews: benefits and harms of medical marijuana
(2018-01-16) Pratt, Misty; Stevens, Adrienne; Thuku, Micere; Hutton, Brian; Wieland, Susan; Shea, Bev; Clemons, Mark; Kanji, Salmaan; Moher, David
Measuring non-technical skills of anesthesiologists in the operating room: A systematic review of assessment tools and their measurement properties
(2017-11-13) Boet, Sylvain; Larrigan, Sarah; Calderon, Leonardo; Liu, Henry; Sullivan, Katrina; Etherington, Nicole
Background and Rationale: Clinical competence in anesthesia requires proficiency in non-technical skills (e.g. communication, leadership, situation awareness). Comprehensive assessment of non-technical skills performance in clinical practice requires robust tool(s) to be identified. It is currently unknown which assessment tools are the most robust for assessing non-technical skills in anesthesia, with inconsistency in the tools and settings used in evaluations of anesthesiologists’ non-technical skills. Objectives: This systematic review will: (1) summarize the tools used to measure the intraoperative non-technical performance of anesthesiologists; and (2) synthesize the psychometric properties of these tools. Search strategy and information sources: Literature searches will be conducted by an experienced librarian collaborating closely with the team of investigators. Medline and Medline in Process (via OVID), PsycINFO, CINAHL, Embase (via OVID), and ERIC will be searched with no date or language restrictions. The Medline search strategy will be peer-reviewed by a second information specialist using the PRESS tool. Adjustments will be made to the search for each database to optimize search results. Reference lists of previously published systematic reviews and of included articles will also be searched for additional relevant references. Eligibility criteria: Inclusion Criteria: Examine the psychometric properties (i.e. validity and reliability) of tools specifically intended to assess the non-technical skills of anesthesiologists (either trainee or graduated); Tools are evaluated within a clinical or simulation intraoperative environment; Study must include a quantitative analysis of psychometric properties or qualitative assessment of forms of validity; Tools must be developed for objective assessment of skills. Exclusion Criteria: Tools that assess anesthesia assistants, nurse anesthetists, and interprofessional teams; Tools that include technical skills items; Studies where psychometric assessment is not the primary outcome; Studies that evaluate anesthesiologists’ performance but not the assessment tool itself; Tools that are developed for subjective (i.e. self-reported) assessment of skills. Study selection: Titles and abstracts will be screened in duplicate for eligibility by two independent reviewers. Full-texts of included studies will then be reviewed. Disagreements at each level of screening will be resolved by consensus discussion or assistance from another reviewer if needed. Data extraction: Data extraction will be conducted by one reviewer using an electronic data collection form for all included articles. Extracted information will them be verified by a second reviewer. The final list of included tools will be reviewed by a group of anesthesiologists to determine accuracy and completeness. The data extraction form will collect general article information (e.g. year and study location), demographics of learners (e.g. trainee status), tool design (e.g. name and number of items), and psychometric outcomes (e.g. properties assessed and validation values). Study quality: Screeners will assess the methodological quality of included studies in duplicate using The COSMIN checklist.22 Disagreements will be resolved through consensus or a third reviewer as required. Synthesis: A narrative summary of the types of reliability and validity, psychometric coefficients, validation context (i.e. simulation or clinical), and level of psychometric evidence for each assessment tool (i.e. minimal, moderate, or extensive) will be completed for each included assessment tool.
Systematic Review Protocol: Outcome Predictors and Care Plans for Women Pregnant Using Assisted Reproductive Technologies
(2017-06-15) Velez, Maria; Gaudet, Laura; Hamel, Candyce; Thuku, Micere; Cobey, Kelly; Pratt, Misty; Skidmore, Becky; Hutton, Brian
Signal Detection Report: Mistletoe Therapy in Oncology
(2017-04) Pratt, Misty; Ahmadzai, Nadera; Hutton, Brian; Wieland, Susan; Skidmore, Becky; Moher, David
Signal Detection Report: Glucosamine Therapy for Treating Osteoarthritis
(2017-07) Pratt, Misty; Ahmadzai, Nadera; Hutton, Brian; Wieland, Susan; Skidmore, Becky; Moher, David
Signal Detection Report: Acupuncture for Shoulder Pain
(2017-07) Ahmadzai, Nadera; Pratt, Misty; Hutton, Brian; Wieland, Susan; Skidmore, Becky; Moher, David

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