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1.
CMAJ Open ; 9(2): E711-E717, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34162663

RESUMO

BACKGROUND: In Canada, decisions regarding osteoporosis pharmacotherapy are based on estimated 10-year risk of osteoporotic fracture. We aimed to determine how frequently 2 common approaches (Canadian Association of Radiologists and Osteoporosis Canada [CAROC] tool and Fracture Risk Assessment Tool [FRAX]) produced different estimates and to seek possible explanations for differences. METHODS: We conducted a cross-sectional chart review at a tertiary osteoporosis centre (Dr. David Hanley Osteoporosis Centre in Calgary). Included patients were women referred for consideration of osteoporosis pharmacotherapy who attended a consultation between 2016 and 2019 and whose charts contained 10-year osteoporotic fracture risk estimates using both the CAROC tool (based on bone mineral density [BMD] results) and FRAX (based on BMD results and clinically assessed fracture risk factors). Risk estimates provided on BMD reports (calculated with CAROC) and generated through osteoporosis clinic consultation (calculated with FRAX, including BMD) were categorized as low (< 10.0%), moderate (10.0%-19.9%) or high (≥ 20.0%). Estimates were considered discordant when they placed the patient in different risk categories. RESULTS: Of 190 patients evaluated, 99 (52.1%) had discordant risk estimates. Although a similar proportion were considered high risk by BMD reports using the CAROC tool (17.9%) and clinic charts using FRAX (19.5%), the 2 methods identified different patients as being high risk. Around the crucial high-risk (20.0%) treatment threshold, discordance was present in 37 patients (19.5%, 95% confidence interval [CI] 14.5%-25.7%); discordance around the moderate-risk (10.0%) threshold was present in 69 (36.3%, 95% CI 29.5%-43.2%) patients. Disagreement regarding fracture history between BMD reports and clinic charts was observed in 19.8% of patients. INTERPRETATION: Fracture risk estimates on BMD reports (using the CAROC tool) and those calculated in the clinical setting (using FRAX) frequently result in different risk classification. Osteoporosis treatment decisions may differ in up to half of patients depending on which estimate is used, highlighting the need for a consistent and accurate assessment process for fracture risk.


Assuntos
Osteoporose , Fraturas por Osteoporose , Sistemas de Informação em Radiologia/estatística & dados numéricos , Medição de Risco , Alberta/epidemiologia , Densidade Óssea , Tomada de Decisão Clínica , Estudos Transversais , Tratamento Farmacológico/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Medição de Risco/métodos , Medição de Risco/normas , Medição de Risco/estatística & dados numéricos
3.
J Pediatr ; 208: 251-257.e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30732999

RESUMO

OBJECTIVE: To determine the lifetime prevalence of allergies in childhood nephrotic syndrome, the seasonality of presentation and relapses, and the impact of allergies on subsequent relapses. STUDY DESIGN: In a longitudinal cohort of children with nephrotic syndrome (ages 1-18 years), assessment for allergic diseases was conducted using the validated and modified version of the International Study of Asthma and Allergies in Childhood questionnaire at enrollment. Outcomes included frequently relapsing nephrotic syndrome, relapse rates, and the relapse-free duration after initial steroid therapy. RESULTS: Among 277 participants, the majority were male (65%) with a median age of 3.7 years (IQR 2.8-5.8) at presentation. A total of 64% reported lifetime allergies with 20% having asthma, 33% wheezing, 27% eczema, and 24% rhinitis. Over 3.3 years of follow-up, presence of asthma and allergies was not associated with frequently relapsing nephrotic syndrome (OR 1.20; 95% CI 0.60, 2.40), higher relapse rates (relative risk 0.95; 95% CI 0.71, 1.27), or risk of first relapse (hazard ratio 1.10; 95% CI 0.83, 1.47) compared with those with no history of allergic diseases. There was also no seasonal variation evident at initial presentation or frequency of relapses. CONCLUSIONS: Two-thirds of children with nephrotic syndrome at presentation have allergic symptoms and asthma; however, neither are associated with an increased frequency of relapses.


Assuntos
Asma/epidemiologia , Hipersensibilidade/epidemiologia , Síndrome Nefrótica/epidemiologia , Adolescente , Asma/complicações , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hipersensibilidade/complicações , Lactente , Estudos Longitudinais , Masculino , Síndrome Nefrótica/complicações , Prevalência , Recidiva , Estações do Ano , Inquéritos e Questionários
4.
Behav Cogn Psychother ; 47(2): 129-147, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30153878

RESUMO

BACKGROUND: Unwanted intrusive thoughts of intentionally harming one's infant (intrusive harm thoughts) are common distressing experiences among postpartum mothers and fathers. AIM: To understand infant crying as a stimulus for intrusive harm thoughts and associated emotional responses in prepartum and postpartum mothers and fathers in response to infant cry. METHOD: Following completion of self-report measures of negative mood and anger, prepartum (n = 48) and postpartum (n = 44) samples of mother and father pairs completed 10 minutes of listening to audio-recorded infant crying. Post-test questionnaires assessed harm thoughts, negative emotions, urges to comfort and flee, and thoughts of shaking as a soothing or coping strategy. RESULTS: One quarter of prepartum and 44% of postpartum parents reported intrusive infant-related harm thoughts following crying. Mothers and fathers did not differ in the likelihood of reporting harm thoughts, nor in the number of thoughts reported. Women reported more internalizing emotions compared with men. Hostile emotions were stronger among postpartum parents, and parents reporting harm thoughts. All parents reported strong urges to comfort the infant. Urges to flee were stronger among parents who reported harm thoughts. The likelihood of using infant shaking as a soothing or coping strategy was minimally endorsed, albeit more strongly by fathers and parents who also reported harm thoughts. CONCLUSIONS: In response to crying, harm thoughts are common and are associated with hostile emotions, urges to flee, and increased thoughts of using infant shaking. Reassuringly, the number of participants considering infant shaking as a strategy for soothing or for coping with a crying infant was low.


Assuntos
Choro , Emoções , Pai/psicologia , Mães/psicologia , Período Pós-Parto/psicologia , Pensamento , Adaptação Psicológica , Adulto , Afeto , Feminino , Humanos , Lactente , Masculino , Autorrelato , Inquéritos e Questionários
5.
Can J Cardiol ; 34(10): 1362-1364, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30269833

RESUMO

Cardiovascular mortality is the primary cause of death in patients with type 2 diabetes mellitus (T2DM). Recently, clinical trials of the sodium-glucose transport protein 2 (SGLT-2) inhibitors empagliflozin and canagliflozin and of the glucagon-like peptide-1 (GLP-1) agonists liraglutide and semaglutide demonstrated that the agents reduced cardiovascular events. Furthermore, empagliflozin and liraglutide reduced cardiovascular mortality. However, despite the proven cardiac benefits, many but not all provincial formularies have restrictive rules for payment and access for SGLT-2 inhibitors and GLP-1 agonists. These restrictions impede a practitioner's ability to provide optimal care for patients with T2DM and cardiovascular disease. The 2018 Diabetes Canada Guidelines recommend the use of a glucose-lowering agent with proven cardiovascular benefit (ie, empagliflozin, canagliflozin, liraglutide, or semaglutide) as second-line therapy after metformin, for patients with T2DM and cardiovascular disease who fail to achieve the glycemic target of A1C <7% with metformin. We recognize that provinces must allot resources especially when health care budgets are limited and not able to provide all available treatments. However, today we have glucose-lowering agents that reduce mortality in patients at very high cardiovascular risk. Furthermore, for empagliflozin, the cost effectiveness is highly favourable. Consequently, we urge provincial formularies to re-examine the access requirements for SGLT-2 inhibitors and to consider adding GLP-1 agonists use to reflect current evidence and clinical guideline recommendations.


Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/complicações , Medicina Baseada em Evidências , Hipoglicemiantes/uso terapêutico , Guias de Prática Clínica como Assunto , Glicemia/metabolismo , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos
6.
Case Rep Nephrol Dial ; 8(1): 76-81, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29850461

RESUMO

Percutaneous insertion of a peritoneal dialysis (PD) catheter has inherent risks of complications, more so if done "blind" (without fluoroscopy and ultrasound guidance). Despite the perceived disadvantages, there are very few reported cases of mechanical complications after PD catheter insertion. We present an 81-year-old man who underwent percutaneous insertion of dual-cuffed coiled Tenckhoff PD catheter under local anesthesia by a trained nephrologist. The procedure was uneventful, and the patient was discharged 45 min later in a stable state. A day later, he noticed a decline in the urine output. A week later at a scheduled clinic visit, upon unclamping the PD catheter, there was a sudden gush of amber colored fluid. A diagnostic CT scan confirmed the presence of PD catheter entering the abdominal cavity inferior to the umbilicus and the distal end coiled in the urinary bladder. This case illustrates the need for prophylactic Foley catheterization in individuals at high risk for a distended bladder either as a consequence of a mechanical obstruction from an enlarged prostate or due to a neurogenic bladder while undergoing "blind" percutaneous placement.

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