Effect of preoperative long-term opioid therapy on patient outcomes after total knee arthroplasty: an analysis of multicentre population-based administrative data.

Background: Up to 40% of patients are receiving opioids at the time of total knee arthroplasty (TKA) in the United States despite evidence suggesting opioids are ineffective for pain associated with arthritis and have substantial risks. Our primary objective was to determine whether preoperative opioid users had worse knee pain and physical function outcomes 12 months after TKA than patients who were opioid-naive preoperatively; our secondary objective was to determine the prevalence of opioid use before and after TKA in Alberta, Canada. Methods: In this retrospective analysis of population-based data, we identified adult patients who underwent TKA between 2013 and 2015 in Alberta. We used multivariable linear regression to examine the association between preoperative opioid use and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function scores 12 months after TKA, adjusting for potentially confounding variables. Results: Of the 1907 patients, 592 (31.0%) had at least 1 opioid dispensed before TKA, and 124 (6.5%) were classified as long-term opioid users. Long-term opioid users had worse adjusted WOMAC pain and physical function scores 12 months after TKA than patients who were opioid-naive preoperatively (pain score ß = 7.7, 95% confidence interval [CI] 4.0 to 11.6; physical function score ß = 7.8, 95% CI 4.0 to 11.6; p < 0.001 for both). The majority (89 ([71.8%]) of patients who were long-term opioid users preoperatively were dispensed opioids 180-360 days after TKA, compared to 158 (12.0%) patients who were opioid-naive preoperatively. Conclusion: A substantial number of patients were dispensed opioids before and after TKA, and patients who received opioids preoperatively had worse adjusted pain and functional outcome scores 12 months after TKA than patients who were opioidnaive preoperatively. These results suggest that patients prescribed opioids preoperatively should be counselled judiciously regarding expected outcomes after TKA.

Contexte: Jusqu'à 40 % des patients se font prescrire des opioïdes lors d'une chirurgie pour prothèse totale du genou (PTG) aux États-Unis, et ce, malgré des données selon lesquelles les opioïdes sont inefficaces pour la douleur associée à l'arthrite et comportent des risques substantiels. Notre objectif principal était de déterminer si les patients qui utilisaient déjà des opioïdes en période préopératoire obtenaient des résultats plus négatifs aux plans de la douleur et du fonctionnement 12 mois après leur PTG, comparativement aux patients qui ne prenaient pas d'opioïdes avant leur intervention; notre objectif secondaire était de mesurer la prévalence du recours aux opioïdes avant et après la PTG en Alberta, au Canada. Méthodes: Dans cette analyse rétrospective menée sur des données de population, nous avons identifié les patients adultes soumis à une PTG entre 2013 et 2015 en Alberta. Nous avons utilisé un modèle de régression linéaire multivarié pour examiner le lien entre l'utilisation d'opioïdes en période préopératoire et les scores de douleur et de fonctionnement à l'échelle WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) 12 mois après la PTG, en tenant compte de potentielles variables de confusion. Résultats: Sur les 1907 patients, 592 (31,0 %) ont reçu au moins 1 opioïde avant leur PTG, et 124 (6,5 %) en étaient considérés des utilisateurs de longue date. Les utilisateurs d'opioïdes de longue date présentaient de moins bons scores WOMAC ajustés pour les domaines de douleur et de fonctionnement 12 mois après la PTG, comparativement aux patients qui n'en prenaient pas avant l'intervention (score de douleur ß = 7,7, intervalle de confiance [IC] de 95 % 4,0 à 11,6; score de fonctionnement ß = 7,8, IC de 95 % 4,0 à 11,6; p < 0,001 pour les 2 domaines). La majorité (89 [71,8 %]) des patients utilisateurs d'opioïdes de longue date avant l'intervention se sont fait servir des opioïdes 180­360 jours après la PTG, comparativement à 158 patients (12,0 %) qui n'en prenaient pas avant l'intervention. Conclusion: Un nombre substantiel de patients ont reçu des opioïdes avant et après la PTG, et ceux qui en prenaient avant l'intervention présentaient des scores de douleur et de fonctionnement ajustés plus défavorables 12 mois après la PTG, comparativement aux patients qui n'en prenaient pas avant l'intervention. Selon ces résultats, il faut adresser des conseils judicieux aux patients qui sont déjà sous opioïdes en période préopératoire et les informer des résultats possibles de la PTG.

Fatal farm injuries to Canadian children.

Children on Canadian farms are at high risk for fatal injury. Ongoing surveillance of these deaths is required to affirm recurrent patterns of injury, and to determine whether historical approaches to prevention have resulted in declines in the occurrence of these traumatic events. We analyzed epidemiological patterns and trends in the occurrence of fatal pediatric farm injuries over 23 years. Records of deaths were obtained from the Canadian Agricultural Injury Reporting system. To contrast more recent data with injury patterns described historically, cases were compared between two time periods. An intentional consensus process was used to finalize key patterns and their clinical or social importance. 374 fatal farm injuries to children in Canada were identified over the 23 years of study; 253 in period 1 and 121 in period 2. While machinery and non-machinery causes of death varied between the two study periods, mean annual rates of fatal injury (approximately 4 per 100,000 children) remained similar. Notably emergent types of injury in recent years included those caused by all-terrain vehicles, skid steer loaders, and drownings. Observed declines in the numbers of fatal farm injuries are most likely attributable to analogous declines in the number of registered farms in Canada. Our findings call into question the effectiveness of pediatric farm safety initiatives that primarily focus on education. Second, while CAIR fatality data are maintained, surveillance of hospitalized injuries has been disbanded and the fatality records require updating. Only by doing so will such surveillance findings provide comprehensive information to inform prevention.

Determinants of injury among older Saskatchewan farm operators: A prospective cohort study.

SIGNIFICANCE: The agricultural industry differs from other businesses in the composition of its workforce. Often farm owner-operators work beyond what society would expect to be a normal retirement age. Older farmers may be less receptive to behavioral changes designed to improve worksite safety and are at increased risk for experiencing a work-related injury. We had a unique opportunity to evaluate the relative influence of specific occupational conditions and practices reported by older farm operators (age ≥55 years) on the occurrence of injury using a longitudinal approach. MATERIALS AND METHODS: Baseline data were provided by eligible and consenting farm members in the first quarter of 2013. These farms were then followed longitudinally by mail surveys over 24 months to document injury experiences. For each survey, mailed questionnaires were sent to participating farms and completed by a single respondent. Cox proportional hazard models were used to determine which characteristics of the farm work environment were protective. RESULTS: A total of 96 farm injuries were reported by 73 of 566 farm operators. Medium (hazard ratio [HR] = 0.58; confidence interval [CI], 0.35-0.96) or high (HR = 0.53; CI, 0.30-0.94) worksite physical safety and high economic security (HR = 0.41; CI, 0.24-0.71) were protective in reducing injury among older farmers. CONCLUSION: Safety features in the physical environment and economic security are important protective factors for injury among older farmers. This supports injury prevention theory that suggests that engineering controls are superior to changes in work practices or the use of personal protective equipment in reducing injuries among older farmers.

Preoperative opioid use is associated with worse patient outcomes after Total joint arthroplasty: a systematic review and meta-analysis.

BACKGROUND: A significant number of patients use opioids prior to total joint arthroplasty (TJA) in North America and there is growing concern that preoperative opioid use negatively impacts postoperative patient outcomes after surgery. This systematic review and meta-analysis evaluated the current evidence investigating the influence of preoperative opioid use on postoperative patient-reported outcomes (PRO) after total joint arthroplasty. METHODS: A systematic search was performed using Ovid, Embase, Cochrane Library, Scopus, Web of Science Core Collection, CINAHL on February 15th, 2018. Studies reporting baseline and postoperative PRO among those prescribed preoperative opioids and those who were not prior to total knee and hip arthroplasty were included. Standardized mean differences (SMD) in absolute difference and relative change in PRO measures between the two groups was calculated using random effect models. RESULTS: Six studies were included (n = 7356 patients); overall 24% of patients were prescribed preoperative opioids. Patients with preoperative opioid use had worse absolute postoperative PRO scores when compared to those with no preoperative opioid use (standardized mean difference (SMD) -0.53, 95% Confidence interval (CI) -0.75, - 0.32, p < 0.0001). When relative change in PRO score was analyzed, as measured by difference between postoperative and preoperative PRO scores, there was no group differences (SMD -0.26, 95% CI -0.56, 0.05, p = 0.10). CONCLUSION: Patients prescribed preoperative opioids may attain worse overall pain and function benefits after TJA when compared to opioid-naïve patients, but do still benefit from undergoing TJA. These results suggest preoperative opioid users should be judiciously counselled regarding potential postoperative pain and function improvements after TJA.

Agricultural injuries among farm and non-farm children and adolescents in Alberta, Canada.

BACKGROUND: Understanding of the specific risk of agricultural injury sustained by different populations of children and adolescents is needed for effective safety intervention. OBJECTIVE: To compare the rates and patterns of agricultural injury incidence (fatal and non-fatal injury) between farm and non-farm children less than 18 years of age in Alberta, Canada. METHODS: A total of 115 378 children (five subgroups: two groups of farm children and three groups of non-farm children) in Alberta were followed from 1999 to 2010 to examine injury incidence using the linkage of three administrative health databases. A recurrent event survival analysis using Cox proportional hazards regression was carried out. RESULTS: A total of 1 849 agricultural injury episodes (1 616 emergency department visits, 225 hospitalizations, and 8 deaths) were identified from 1999 to 2010. The age- and gender-adjusted rate (per 100 000 person years) of agricultural injury was 672.3 for rural-living farm children, 369.4 for urban-living farm children, 180.2 for rural non-First Nations (FN) children, 64.4 for rural FN children, and 23.7 for urban children in descending order. CONCLUSION: Specific strategies for different children's populations to prevent agricultural injuries and to extend agricultural injury controls to non-farming populations are needed.

Differences in incidence of injury between rural and urban children in Canada and the USA: a systematic review.

OBJECTIVE: The goal of the study was to systematically review available evidence regarding differences in injury incidence between rural and urban paediatric populations in Canada and the USA. DATA SOURCE: Eight electronic databases, institutional websites and reference lists of relevant studies including published and unpublished reports. SELECTION CRITERIA: Population-based observational studies or surveys published from 1970 to February 2011 that compared injury incidence or injury-related healthcare outcomes between rural and urban children (<18) living in Canada or the USA. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied selection criteria and assessed methodological quality of studies. Data were extracted by one author and independently verified by the second author. Injury rate ratios for rural and urban children were extracted or calculated. Data were synthesised descriptively due to substantial heterogeneity among studies. RESULTS: A total of 41 studies were included for this review (seven surveys and 34 studies using administrative health databases). Internal validity of included studies was moderate. Rural children were at higher risk of overall injury, motor vehicle crash injury and suicide, whereas urban children in the USA experienced higher rates of firearm-related homicides. Greater rural-urban injury disparities were likely to be found between more extreme rural and urban areas. In particular, children in remote rural areas are at increased risk of severe injuries than urban counterparts. Overall, healthcare costs per child for injury were higher for rural children. CONCLUSION: These findings indicate the need of developing geographic area-specific injury-prevention strategies. Future research is required to investigate rural-urban disparity for less-studied injuries and related health outcomes (eg, disability). Systematic review registration number CRD42011001244 (PROSPERO 2011).

Hockey-related emergency department visits after a change in minor hockey age groups.

OBJECTIVE: To examine ice hockey injury rates presenting to emergency departments (EDs) in 2 separate cohorts of players before and after a policy change for age groups in minor hockey. DESIGN: : Retrospective cross-sectional study. SETTING: Retrospective review of ice hockey injuries presenting to 2 tertiary care and 5 community care EDs in Edmonton, Alberta. PATIENTS: Two cohorts of minor ice hockey players were constructed. The pre-age change cohort consisted of 4215 registered male hockey players. The post-age change cohort consisted of 3811 registered male hockey players. ASSESSMENT OF RISK FACTORS: The risk of fracture, head and neck injury (intracranial and nonintracranial), and all other injuries presenting to EDs were compared between the pre-age change and post-age change cohorts. MAIN OUTCOME MEASURES: Presentation to an ED with an injury occurring in ice hockey between September 1 and April 31 for the years 1997 through 2010. RESULTS: Overall, significantly lower injury rates were observed in the post-age change cohort for players in the Peewee division; however, no significant differences were observed for the rate of fractures, and intracranial or nonintracranial head and neck injuries. There were no statistically significant differences observed between the pre-age change and post-age change cohorts in the Atom or Bantam divisions. CONCLUSIONS: Introducing body checking 1 year earlier than in a previous cohort (11 vs 12 years of age) neither significantly decreased nor increased the rate of serious ice hockey injuries occurring 2 years after the introduction of body checking. Further research is recommended to evaluate the claim that introducing body checking lowers injury rates in older divisions of hockey.

Time-to-subsequent head injury from sports and recreation activities.

OBJECTIVE: To provide population-based risk estimates for sustaining subsequent head injuries (HIs), which occur in sports and recreation (SR). DESIGN: Population-based, retrospective, cross-sectional study. SETTING: Retrospective review of data from 2 tertiary care and 3 community care emergency departments (EDs) in Edmonton, Alberta, Canada. PATIENTS: Individuals younger than 36 years presenting to an ED with an SR-related injury between April 1, 1997, and March 31, 2008. There were 9246 subsequent ED records identified for 8958 patients in the main analysis. MAIN OUTCOME MEASURES: Clinically diagnosed HI occurring in SR activities after an index presentation, and the number of days between ED presentations for diagnosed SR-HIs. RESULTS: Individuals with 1 and 2 previous SR-related HIs were 2.62 [95% confidence interval (CI), 2.23-3.07] and 5.94 times, respectively, more likely (95% CI, 3.43-10.29) to sustain a subsequent HI than those without a previous HI. The median time-to first HI was 758 days from an initial injury and decreased to 613 days and 303 days for those at risk of second and third SR-related HIs (P < 0.0001). Individuals aged 7 to 13 years were 4.29 times more likely (95% CI, 2.65-6.92) to sustain an HI when presenting with a subsequent SR injury, compared with those aged 30 to 35 years. CONCLUSIONS: The odds of sustaining a subsequent HI substantially increase with each successive HI. Time between SR-related HIs shortens as the number of HIs increases. Initial HI may be a key marker to institute high-risk injury prevention measures directed at young persons who present to EDs.

Intergenerational transfer of occupational risks on family farms.

BACKGROUND: Cultures of safety in farm work settings are under the authority of a responsible owner-operator, who establishes rules, attitudes, and behaviors for farm work practices. This novel analysis provides new evidence to show that risks that can lead to injury and are commonly practiced on Canadian farms are indeed transferred between generations. METHODS: Baseline data were provided by representatives from eligible and consenting farms (n = 589) in the province of Saskatchewan, Canada, during the first quarter of 2013. Mailed questionnaires were sent to participating farms and completed by a single respondent. Questionnaires included scaled assessments of hazards and safety practices by farm operators, and young workers on each farm. Descriptive and multiple regression analyses were used to examine relationships between farm owner-operator risks and safety practices and those reported for the young workers. FINDINGS: Graphical descriptive analyses showed that as farm owner-operator risks increased, so did those reported for children and young workers. Similarly, as farm owner-operator safe work practices increased, young worker hazards decreased, albeit more modestly. The young worker hazard scale increased by 0.20 (95% CI: 0.10-0.30) points, and decreased by 0.08 (95% CI: -0.016 to -0.000) points for each one-point increase in the owner-operator hazard and safe work practices scales, respectively. CONCLUSIONS: Occupational health and safety risks and protections experienced on farms appear to be transferred between generations. This suggests the need to target farm owner-operators, the responsible authority on the farm, as a focus of primary prevention strategies aimed at injury risks to children and young workers.

Child pedestrian injuries and urban change.

BACKGROUND: The health impacts of rapid changes in urban environments due to economic growth and/or retraction are not widely known. This study looks at the effects of urban change on the risk of child pedestrian injury in Edmonton, Alberta, a city that has experienced large economic and population growth following the expansion of the oil and gas industry in Canada. METHODS: A longitudinal ecological study design was used to model the relationships between several built and social environmental variables and the risk of child pedestrian injury and severe child pedestrian injury between 1996 and 2007. RESULTS: The incidence of child pedestrian injury was stable, but the incidence of severe injury increased over the study period. Areas with higher proportions of families on low incomes had higher injury incidence. While new residential development is associated with a lower incidence of injury in most areas, in poor areas, new residential development is associated with a higher incidence, even after controlling for urban planning features and traffic intensity. CONCLUSION: While suburban areas have a lower incidence of child pedestrian injury, residential development in poorer areas is associated with a higher child pedestrian injury risk. Child pedestrians may be less able to adapt to changes in the urban environment due to rapid growth and increasing income, and as a result, may be at greater risk of injury.

What we are not talking about: an evaluation of prevention messaging in print media reporting on agricultural injuries and fatalities.

BACKGROUND: Agricultural injury and fatality pose a significant burden on farmers, families, health care systems, and economies. One way of increasing knowledge of this problem and promoting prevention is the use of printed mass media such as newspapers. METHODS: We conducted a scan of all media reports contained in the Canadian Agricultural Safety Association (CASA) archives for the period January, 2007 to September, 2009, inclusive, for injury and fatality and analyzed newspaper articles for prevention messages. RESULTS: Of the 409 articles in the database, 392 met the inclusion criteria. Ninety-three of the articles (24%) contained a prevention message, and 39 (10%) of these were considered to be strong. Urban papers were two times more likely to have a safety message (OR = 2.03) while adult-related events were less likely to have a safety message included (OR = 0.49). CONCLUSION: Print media reporting of agricultural injury and fatality represents a missed opportunity to provide a prevention message. More can be done to improve linkages between news media outlets and injury prevention specialists to improve prevention content in newsprint.

Presentations of infants to emergency departments in Alberta, Canada, for bronchiolitis: a large population-based study.

OBJECTIVES: Bronchiolitis is the most common lower respiratory tract disease among infants and results in 35 admissions per 1000 infants in Canada. We describe the epidemiology of bronchiolitis presentations to emergency departments (EDs) made by infants (aged ≤2 years) in Alberta, Canada. METHODS: Provincial administrative databases were used to obtain all ED encounters for bronchiolitis during April 1999 to March 2005. Information included demographics, ED visit timing, and subsequent visits to non-ED settings. Data analysis included summaries and standardized rates. RESULTS: There were 26,742 ED visits for bronchiolitis made by 18,155 infants. Most (74.9%) had only 1 bronchiolitis-related ED visit; males (60.6% of ED visits, 59.8% of infants) more commonly presented than females. The standardized rates increased from 23.2 to 46.7 per 1000 in 1999/2000 to 2000/2001 and decreased gradually to 38.8 per 1000 in 2004/2005. Of the total visits, 22.6% required hospitalization. In a discharged subset, 10.4% had a repeat ED visit within 7 days. Most infants (63.3%) had yet to have a non-ED follow-up visit by 1 week; median time to the first follow-up was 18 days. CONCLUSIONS: Bronchiolitis is a common presenting problem in Alberta EDs, and further study of these trends is required to understand variation in presentations. The important findings include different trends in rates for the first 3 years before a gradual decrease, disparities based on age, sex, and socioeconomic/cultural status, and the low rate of early follow-up. Targeted interventions could be implemented to reduce bronchiolitis-related hospitalizations.

Seasonality patterns in croup presentations to emergency departments in Alberta, Canada: a time series analysis.

INTRODUCTION: Croup is a common pediatric respiratory illness presenting to the emergency department (ED) in the fall and winter months. Most cases are caused by parainfluenza viruses. We examine the monthly patterns of young children who made croup-related visits to EDs in Alberta, Canada. METHODS: Emergency department visits were identified in provincial administrative databases to obtain all ED encounters for croup made by young children (aged ≤2 years) during 6 years (April 1, 1999, to March 30, 2005). Time series models (seasonal autoregressive integrated moving average) were developed to capture temporal and seasonal trends and predict future presentations. RESULTS: Overall, 27,355 croup-related ED visits were made during the study period. More males (62%) than females presented, and most (43%) were younger than 1 year. Differences were observed in the number of visits made in odd and even years. Peak visits occurred in November for odd years and in February for other years. Strong seasonal patterns at 12 months were detected and included in the modeling. CONCLUSIONS: We observed the presence of a clear biennial pattern of croup ED visits. The seasonal autoregressive moving average models and predictions offer insights into the epidemiology of croup-related visits to EDs and may be helpful in planning both research and resource needs.

Farm work exposure of older male farmers in Saskatchewan.

BACKGROUND: The average age of farmers in North America is increasing each year. Research has determined that age and health status are both related to increased risk of injury. The purpose of this research was to determine the association of health and medication factors with exposure to farm work in older male farmers. METHODS: As part of a cohort study to study determinants of injury on Saskatchewan farms, 5,502 farm people associated with 2,386 Saskatchewan farms were surveyed by mail questionnaire during the winter of 2007. The primary dependent variable was average hours per week of farm work. Independent variables included illnesses, age, and medication use. RESULTS: The mean number of hours worked per week by farmers aged 55 years and older was 48. There was a significant relationship between age and hours worked with each year of age accounting for about 0.85 hr less work per week. Medication use was related to a reduction in weekly work hours during the busy fall season but was not related to work exposure averaged over the whole year. In multivariable linear regression analysis, the main contributing variables to farm work exposure were: retired status (-), working off farm (-), and age (-). CONCLUSION: The amount of hours older farmers work on the farm is considerable compared to any other occupational category. While there is a declining trend in the amount of work, a 75-year-old farmer still works, on average, about 34 hr per week. Some farmers do appear to self-limit during busy times of the year if they are taking medication.

Health, medication use, and agricultural injury: A review.

BACKGROUND: Agricultural work in the United States and Canada continues to be one of the most dangerous vocations. Surveillance evidence suggests that older farmers (>60 years of age) are at greater risk of serious injury than their younger counterparts. The purpose of this article was to outline illnesses and medications that may contribute to older farmers' increased risk of agricultural injury and to determine a minimum set of health-related covariates that could be used in farm injury studies. METHODS: A review of English language literature in Medline, CINAHL, and NIOSH databases was conducted examining disease and medication factors related to farm injury. RESULTS: Health- and disease-related factors most commonly reported as significantly contributing to agricultural injury included previous injury, hearing problems, depression, arthritis, and sleep deprivation. The use of "any medication" was identified as a significant risk factor for injury in a number of studies. The use of sleep medication was significantly related to injury in two studies. CONCLUSIONS: Based on the findings, it is recommended that at a minimum, researchers collect information on the prevalence of previous injury, hearing problems, depression, arthritis/muscular-skeletal problems and sleep disturbance as these have been identified as significant risk factors in a number of studies. In addition, where subjects that identify any of these afflictions, further information should be sought on any medications used in their treatment which can add data on disease severity. More research and surveillance activities need to be focused on the older farm worker. This population is critical to the maintenance of the agricultural base in North America and health and safety research initiatives need to address this. By integrating research from the fields of gerontology, occupational health and safety, and injury prevention, innovative interventions could be constructed to assist the aging farmer in the continuation of safe farming.

Do catheter washouts extend patency time in long-term indwelling urethral catheters? A randomized controlled trial of acidic washout solution, normal saline washout, or standard care.

PURPOSE: Blockage of long-term indwelling catheters with mineral deposit is an ongoing management issue, but evidence on optimal management is lacking. Our purpose was to examine whether catheter washouts prevent or reduce catheter blockage. DESIGN: A multisite randomized controlled trial. SUBJECTS AND SETTING: Adults with long-term indwelling catheters that required changing every 3 weeks or less, living in the community, and requiring supportive or continuing care were recruited. Participants were randomly assigned to 1 of 3 groups: control (usual care, no washout), saline washout, or commercially available acidic washout solution (Contisol Maelor Pharmaceuticals Ltd, Wrexham, UK). METHODS: At baseline visit, the catheter was changed and participants were followed weekly for 8 weeks, with checks for catheter patency and urine pH. Participants randomized to saline or commercial solution had a weekly washout with the appropriate solution. Endpoints were 8 weeks (completion data), 3 or more catheter changes in the 8-week period, or symptomatic urinary tract infection (UTI) requiring antibiotics. The study hypothesis was that catheter life would be extended by 25% in the commercial solution group. It was not possible to blind participants or research nurses to washout versus no intervention, but participants in the saline and washout solution groups were blinded to solution type. RESULTS: One hundred twelve potential participants were screened; 73 were enrolled, randomized, and included in the final analysis. Of these, 53 completed the full 8 weeks of data collection; 16 terminated early because of 3 catheter changes or self-reported 'UTI'. Other reasons for termination were hematuria, latex sensitivity, deceased/severe illness, or personal choice. Analysis of variance was used to analyze mean differences on demographic variables and mean number of weeks in study. Kaplan-Meier survival curve analysis showed no statistical difference between the groups in time to first catheter change. CONCLUSION: At this time, the evidence is insufficient to state whether catheter washout with saline or Contisol is more effective than usual care with no washout in preventing blocking. No increased risk of UTI was associated with washout regimes.

The Influence of Allowable Refill Gaps on Detecting Long-Term Opioid Therapy: An Analysis of Population-Based Administrative Dispensing Data Among Patients with Knee Arthritis Awaiting Total Knee Arthroplasty.

BACKGROUND: It is challenging to detect long-term opioid therapy (LTOT) using administrative data, as refill gaps can disrupt opioid utilization episodes. Previous studies have used various methods to define LTOT and allowable refill gaps with little supporting evidence. OBJECTIVE: To describe the effect of allowable refill gaps on detecting LTOT among a cohort of patients with arthritis awaiting total knee arthroplasty (TKA) using 3 different methods. METHODS: A retrospective analysis of multicenter population-based data between January 1, 2012, and December 31, 2016, identified patients prescribed opioids before TKA in Alberta, Canada. We described 3 methods to detect LTOT based on a (1) fixed number of days between prescriptions; (2) fraction of the preceding prescription length; and (3) combination method that selected whichever refill gap was greatest. We then compared the number of patients classified as long-term opioid users by varying the number of days between prescriptions from 1-90 days (fixed method) or 0.04-3.2 times the duration (fraction method) for each method and refill gap. RESULTS: Of the 14,252 patients included in our cohort, 4,393 patients (31%) had an opioid prescription within 180 days before TKA. Detection of LTOT varied from 4.4% to 14.6% (fixed method), 4.2% to 13.2% (fraction method), and 4.5% to 15.1% (mixed method) as refill gaps varied from minimum to maximum. As refills gaps increased, the dose and duration of opioids in the utilization episode decreased for all 3 methods. CONCLUSIONS: The allowable refill gap between opioid prescriptions can influence the estimated rate of LTOT when using administrative pharmaceutical dispensing data. Definitional parameters should be carefully considered when using administrative data to define consistent opioid use. DISCLOSURES: This work was supported by the Department of Surgery's Clinical Research Grant at the University of Alberta (RES0039945). The authors have no potential conflicts of interest.

The prevalence of cerebral palsy in British Columbia, 1991-1995.

OBJECTIVE: To quantify the prevalence of cerebral palsy (CP) in British Columbia within a four-year birth cohort. METHODS: The study was a population-based record linkage study of a birth cohort of British Columbian children born between April 1, 1991 and March 31, 1995. Cases were identified by the presence of International Classification of Diseases, Version 9 (ICD-9) diagnostic code "343" recorded at three years of age or older or by having the ICD-9 diagnostic code "343" recorded prior to the third birthday with two confirmatory diagnoses within the first three years of life through a record search of the BC Medical Services Plan billing files for the fiscal years 1991 to 1995. RESULTS/CONCLUSION: This research has provided an estimate of the prevalence of CP in the four-year birth cohort 1991 to 1995 in British Columbia. An aggregate prevalence rate of CP was measured as 2.68 per 1000 live births, and a congenital rate was measured at 2.57 for the same population. Birth weight and gestational age demonstrated a significant relationship with the development of CP. This study should lend credence to the establishment of a CP register in British Columbia.

Erratum to "Prevalence of Asthma and Chronic Obstructive Pulmonary Disease in Aboriginal and Non-Aboriginal Populations: A Systematic Review and Meta-Analysis of Epidemiological Studies".

[This corrects the article DOI: 10.1155/2012/825107.].