A retrospective cohort study of liver toxicity in hepatitis B and C HIV co-infected patients in the HIV Ontario Observational Database

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Jejunal atresia, periodic fevers and psoriatic arthropathy in Baraitser-Winter malformation syndrome.

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Attending Nurse Practitioners in Long-Term Care Homes Evaluation

Introduction In 2014, the Ontario Ministry of Health and Long-Term Care (MOHLTC) announced funding for 75 nurse practitioners (NPs) over three years in long-term care (LTC) homes. This evaluation was approved by ICES’ Applied Health Research Question (AHRQ) team, a portfolio which answers questions from stakeholders having impact on healthcare policy. Objectives and Approach The purpose of this project is to evaluate the impact of the first thirty NPs hired. Changes will be evaluated using key outcome measures of resident care (e.g., early hospital discharge, emergency room bed days) identified through a literature review conducted by the MOHLTC. LTC home residents were identified using all individuals with claims in OHIP during the 2016-17 fiscal year with a location of a LTC home. LTC homes with a hired NP were considered to be cases and all other LTC homes were considered to be controls. Results For part one of this evaluation, case and control LTC homes were stratified by bed size, Case Mix Index, rurality and Local Health Integration Network. Hospitalization records and emergency visits (from Discharge Abstract Database and National Ambulatory Care Reporting System) were determined for LTCH residents 6 months before and after the NP hire date of October 1, 2016. Overall, the rate of hospital admissions (per 100 residents) increased by 3.44% (8.51% to 11.94%) following the NP hire date; whereas, the rate of hospital admissions increased by 2.29% (6.55% to 8.83%) among controls. Following the NP hire date, the rate of emergency department visits also increased by 3.15% among cases (16.62% to 19.77%) in comparison to a 2.31% increase among controls (12.55% to 14.86%). Conclusion/Implications The findings from this evaluation will inform further implementation strategies of the NP program and guide decision-making of future funding opportunities. In summary, the results will inform policies to strengthen care of LTC homes and improve the quality of care of residents

Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis

AbstractContextTo date, there is no Level 1 evidence comparing the efficacy of radical prostatectomy and radiotherapy for patients with clinically-localized prostate cancer.ObjectiveTo conduct a meta-analysis assessing the overall and prostate cancer-specific mortality among patients treated with radical prostatectomy or radiotherapy for clinically-localized prostate cancer.Evidence acquisitionWe searched Medline, EMBASE, and the Cochrane Library through June 2015 without year or language restriction, supplemented with hand search, using Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Meta-analysis of Observational Studies in Epidemiology guidelines. We used multivariable adjusted hazard ratios (aHRs) to assess each endpoint. Risk of bias was assessed using the Newcastle-Ottawa scale.Evidence synthesisNineteen studies of low to moderate risk of bias were selected and up to 118 830 patients were pooled. Inclusion criteria and follow-up length varied between studies. Most studies assessed patients treated with external beam radiotherapy, although some included those treated with brachytherapy separately or with the external beam radiation therapy group. The risk of overall (10 studies, aHR 1.63, 95% confidence interval 1.54–1.73, p<0.00001; I2=0%) and prostate cancer-specific (15 studies, aHR 2.08, 95% confidence interval 1.76–2.47, p < 0.00001; I2=48%) mortality were higher for patients treated with radiotherapy compared with those treated with surgery. Subgroup analyses by risk group, radiation regimen, time period, and follow-up length did not alter the direction of results.ConclusionsRadiotherapy for prostate cancer is associated with an increased risk of overall and prostate cancer-specific mortality compared with surgery based on observational data with low to moderate risk of bias. These data, combined with the forthcoming randomized data, may aid clinical decision making.Patient summaryWe reviewed available studies assessing mortality after prostate cancer treatment with surgery or radiotherapy. While the studies used have a potential for bias due to their observational design, we demonstrated consistently higher mortality for patients treated with radiotherapy rather than surgery

The effect of sodium nitroprusside on the vegetative development of Aronia melanocarpa [Michx.] Elliot under in vitro conditions

Aronia is a berry fruit that has a significant amount of antioxidants. Both sexual and vegetative methods of propagation are available for aronia. Genetic diversity is present in the process of seed propagation. Therefore, clonal propagation techniques such as cuttings, basal shoots, and tissue culture are preferred. Plant tissue culture is a process that offers a high multiplication rate and the ability to produce clean plant material. This study aimed to stimulate the growth of plantlets by introducing several growth-promoting agents into the culture media. Specifically, the effects of a nitric oxide donor SNP (sodium nitroprusside) on the vegetative development of the plants were examined under in vitro conditions. Four distinct concentrations of SNP (0, 100, 200, and 300 µM) were administered to promote vegetative development. The survival rate (%), rooting rate (%), root number (per plantlet), root length (cm), leaf number (per plantlet), shoot length (cm), plant fresh weight (g), and plant dry weight (g) of the plantlets were estimated on the 60th day of growth in the nutrient medium under in vitro conditions. The survival rate was 100% for the applications of SNP at concentrations of 100 µM and 200 µM. The 0 µM treatment had the highest root number, the 100 µM treatment had the longest root, and the 200 µM treatment had the highest values for shoot length. The 0 µM treatment provided the highest values for plant fresh weight, while the 0 and 100 µM applications resulted in the highest plant dry weight values. The study suggested that an increased concentration of SNP causes a toxic effect

Examination of High-Cost Patients in Ontario

Introduction In Ontario, the top 5% of high-cost users account for 66% of health care costs. The heavy use of resources combined with perceived inefficiencies offer an imperative to target strategies to redesign care to better meet patient needs and increase value. Objectives and Approach As part of a request submitted to the Applied Health Research Question (AHRQ) review team, the main objective of this study was to identify drivers of high health care use in Ontario in order to find better ways to improve the efficiency in healthcare delivery. Using data in fiscal year 2012/13, characteristics of the top 5% of high costs users were described, and further stratified by mental health status. Total spending by sector of care were also described. Data were linked including physician, hospital, medication and long term care databases for each patient. Results In the top 5% of high-cost users, there were 729,870 patients who accounted for $20,179,208,348 of total healthcare spending in 2012/13, with the highest percentage of spending observed among older adults aged 61-80 years old. Mental health high-cost patients accounted for 6.1% of these patients, of which 51.5% were female, had a low socio-economic status and an average age of 44 years. These patients had an average of 4.9 (SD=2.3) ICD chapters and used an average of 8.7 (SD=3.8) drugs. Using the health accounts methodology (ICHA), as described by the OECD and WHO, over 90% of healthcare costs among the top 5% of high-cost patients were from inpatient care, day surgery and clinic care, physician care, outpatients drugs and inpatient rehabilitation and complex/continuing care. Conclusion/Implications This study provides a systematic description of the needs in a high cost patient group, and serves as a platform for international comparisons across healthcare systems to better understand gaps and identify targets for intervention. These cross-comparisons offer a tool to evaluate performance of healthcare systems and to prioritize policies

Тромботическая тромбоцитопеническая пурпура - редкая этиопатогенетическая причина инфаркта головного мозга и экстрацеребрального тромбоза

Thrombotic thrombocytopenic purpura is a disease from the group of thrombotic microangiopathies, the early diagnosis of which is a real challenge in clinical practice. The article presents a clinical case that clearly illustrates the multisystem nature of the damage against the background of thrombotic microangiopathy, specific parameters of diagnosis, and emergency therapy Timely initiation of specific treatment significantly increases the chances of survival in this category of patients.Тромботическая тромбоцитопеническая пурпура - это заболевание из группы тромботических микроангиопатий, ранняя диагностика которого является трудной задачей в клинической практике. В статье представлен клинический случай, наглядно иллюстрирующий мультисистемность поражения на фоне тромботической микроангиопатии, особенности диагностики и неотложной терапии. Своевременное начало специфического лечения на порядок увеличивает шансы на выживание