Browsing by Author "Jette, Nathalie"
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Item Open Access ACSC Indicator: testing reliability for hypertension(2017-06-26) Walker, Robin L; Ghali, William A; Chen, Guanmin; Khalsa, Tej K; Mangat, Birinder K; Campbell, Norm R C; Dixon, Elijah; Rabi, Doreen; Jette, Nathalie; Dhanoa, Robyn; Quan, HudeAbstract Background With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. The purpose of this study was to test the inter-physician reliability of judgments of avoidable hospitalizations for one ACSC, uncomplicated hypertension, derived from medical chart review. Methods We applied the Canadian Institute for Health Information’s case definition to obtain a random sample of patients who had an ACSC hospitalization for uncomplicated hypertension in Calgary, Alberta. Medical chart review was conducted by three experienced internal medicine specialists. Implicit methods were used to judge avoidability of hospitalization using a validated 5-point scale. Results There was poor agreement among three physicians raters when judging the avoidability of 82 ACSC hospitalizations for uncomplicated hypertension (κ = 0.092). The κ also remained low when assessing agreement between raters 1 and 3 (κ = 0.092), but the κ was lower (less than chance agreement) for raters 1 and 2 (κ = -0.119) and raters 2 and 3 (κ = -0.008). When the 5-point scale was dichotomized, there was fair agreement among three raters (κ = 0.217). The proportion of ACSC hospitalizations for uncomplicated hypertension that were rated as avoidable was 32.9%, 6.1% and 26.8% for raters 1, 2, and 3, respectively. Conclusions This study found a low proportion of ACSC hospitalization were rated as avoidable, with poor to fair agreement of judgment between physician raters. This suggests that the validity and utility of this health indicator is questionable. It points to a need to abandon the use of ACSC entirely; or alternatively to work on the development of explicit criteria for judging avoidability of hospitalization for ACSC such as hypertension.Item Open Access Depression and Neurological Conditions in Canada(2014-12-03) Fiest, Kirsten; Patten, Scott; Jette, Nathalie; Lavorato, Dina; Williams, JeanneItem Open Access Evolution of Surgery Risk in Crohn's Disease(2016) Frolkis, Alexandra; Kaplan, Gilaad; Jette, Nathalie; deBruyn, JenniferWhile many individuals with Crohn’s disease require surgery for management, the risks of surgery are not well characterized in population-based studies. Advances in medical management may have influenced the risk of surgery over time. However, studies have not adequately evaluated the effect of smoking on temporal trends in surgery risk for Crohn’s disease. A mixed methodology approach was used to: 1) describe the morbidity and mortality associated with surgery in Crohn’s disease; 2) summarize the risk of first and second surgery in Crohn’s disease; 3) evaluate whether the risk of surgery has changed over time; and 4) assess whether smoking has influenced the risk of surgery in Crohn’s disease. In Alberta, postoperative morbidity (25%) and mortality (1.2%) was high for Crohn’s disease. A systematic review and meta-analysis found that the estimated pooled risk of surgery 10 years after the diagnosis of Crohn’s disease was 46.6% (95% Confidence Interval [CI] 37.7%-57.7%); however, the risk of first surgery in Crohn’s disease was significantly decreasing over time (meta-regression p- value<0.01). Another systematic review and meta-analysis identified that 10 years following the first surgery the estimated pooled risk of a second surgery was 35% (95% CI 31.8%-38.6%) and this risk was also decreasing over time (Cochran Q for subgroup comparison p-value<0.01). Finally, a nationally representative cohort showed that from 1996 to 2009 the risk of first surgery decreased significantly and the proportion of incident Crohn’s disease patients who have never smoked significantly increased annually by an estimated 3% (Risk Ratio [RR] 1.03; 95% CI 1.02-1.04). Furthermore, in older adults (>40 years at diagnosis) smoking was associated with twice the risk of surgery compared to those who did not smoke. The results of this dissertation demonstrate that surgery is associated with significant morbidity and mortality. Reassuringly, the risk of surgery is decreasing over time. In part, this decrease may be explained by fewer Crohn’s disease patients who are smokers at diagnosis. Thus, public health initiatives that reduce the prevalence of smoking in the general population may reduce the burden of Crohn’s disease.Item Open Access Global assessment of migraine severity measure: preliminary evidence of construct validity(2019-04-04) Sajobi, Tolulope T; Amoozegar, Farnaz; Wang, Meng; Wiebe, Natalie; Fiest, Kirsten M; Patten, Scott B; Jette, NathalieAbstract Background In persons with migraine, severity of migraine is an important determinant of several health outcomes (e.g., patient quality of life and health care resource utilization). This study investigated how migraine patients rate the severity of their disease and how these ratings correlate with their socio-demographic, clinical, and psycho-social characteristics. Methods This is a cohort of 263 adult migraine patients consecutively enrolled in the Neurological Disease and Depression Study (NEEDs). We obtained a broad range of clinical and patient-reported measures (e.g., patients’ ratings of migraine severity using the Global Assessment of Migraine Severity (GAMS), and migraine-related disability, as measured by the Migraine Disability Scale (MIDAS)). Depression was measured using the 9-item Patient Health Questionnaire (PHQ-9) and the 14-item Hospital Anxiety and Depression Scale (HADS). Median regression analysis was used to examine the predictors of patient ratings of migraine severity. Results The mean age for the patients was 42.5 years (SD = 13.2). While 209 (79.4%) patients were females, 177 (67.4%) participants reported “moderately severe” to “extremely severe” migraine on the GAMS, and 100 (31.6%) patients had chronic migraine. Patients’ report of severity on the GAMS was strongly correlated with patients’ ratings of MIDAS global severity question, overall MIDAS score, migraine type, PHQ-9 score, and frequency of migraine attacks. Mediation analyses revealed that MIDAS mediated the effect of depression on patient ratings of migraine severity, accounting for about 32% of the total effect of depression. Overall, migraine subtype, frequency of migraine, employment status, depression, and migraine-related disability were statistically significant predictors of patient-ratings of migraine severity. Conclusions This study highlights the impact of clinical and psychosocial determinants of patient-ratings of migraine severity. GAMS is a brief and valid tool that can be used to assess migraine severity in busy clinical settings.Item Open Access Hospitalizations for Uncomplicated Hypertension: An Ambulatory Care Sensitive Condition(2015-12-16) Walker, Robin; Quan, Hude; Ghali, William; Rabi, Doreen; Dixon, Elijah; Jette, NathalieWith high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. ACSC are promising healthcare quality indicators widely used internationally, potentially creating opportunity for health care system quality improvement. The overall aim of this thesis was to explore, assess and evaluate ACSC hospitalization as a healthcare quality indicator for one condition, uncomplicated hypertension. We conducted three studies to achieve the aim. Our first study explored ACSC hospitalization rates for uncomplicated hypertension, taking into account important patient characteristics among hypertensive patients. Using population-based data in four provinces we found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, potentially indicating improvement in community care. We found geographic variations in the rate of hospitalizations, potentially signifying disparity among the provinces and those residing in rural versus urban regions. Our second study examined the association between ACSC hospitalizations for uncomplicated hypertension and previous primary care physician (PCP) utilization. Among this population-based cohort of hypertensive patients we found as the frequency of hypertension-related PCP visits increased the adjusted rate of ACSC hospitalizations also increased, even when stratified by demographic and clinical variables. This suggests that hospitalization for uncomplicated hypertension is not reduced with increasing frequency of PCP visits and may not be an appropriate indicator to measure and evaluate patients’ access to primary care. Our final study tested inter-physician reliability of judgments of avoidable hospitalizations for uncomplicated hypertension derived from medical chart review. We found a low proportion of ACSC hospitalizations were rated as avoidable, with poor agreement between physician raters. These findings point either to a need to abandon the use of the ACSC entirely; or alternatively a need to develop explicit criteria for judging avoidability. This research has provided crucial information for the interpretation of ACSC findings for uncomplicated hypertension. The results indicate that the use of this health quality indicator is questionable and may not provide information that is applicable for interventions to improve quality of primary care. At present, ACSC are most appropriately used as a starting point for assessing potential issues in the community which would then require further, more in-depth analysis.Item Open Access Protocol for the development of an international Core Outcome Set for treatment trials in adults with epilepsy: the EPilepsy outcome Set for Effectiveness Trials Project (EPSET)(2022-11-17) Mitchell, James W.; Noble, Adam; Baker, Gus; Batchelor, Rachel; Brigo, Francesco; Christensen, Jakob; French, Jacqueline; Gil-Nagel, Antonio; Guekht, Alla; Jette, Nathalie; Kälviäinen, Reetta; Leach, John P.; Maguire, Melissa; O’Brien, Terence; Rosenow, Felix; Ryvlin, Philippe; Tittensor, Phil; Tripathi, Manjari; Trinka, Eugen; Wiebe, Samuel; Williamson, Paula R.; Marson, TonyAbstract Background A Core Outcome Set (COS) is a standardised list of outcomes that should be reported as a minimum in all clinical trials. In epilepsy, the choice of outcomes varies widely among existing studies, particularly in clinical trials. This diminishes opportunities for informed decision-making, contributes to research waste and is a barrier to integrating findings in systematic reviews and meta-analyses. Furthermore, the outcomes currently being measured may not reflect what is important to people with epilepsy. Therefore, we aim to develop a COS specific to clinical effectiveness research for adults with epilepsy using Delphi consensus methodology. Methods The EPSET Study will comprise of three phases and follow the core methodological principles as outlined by the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Phase 1 will include two focused literature reviews to identify candidate outcomes from the qualitative literature and current outcome measurement practice in phase III and phase IV clinical trials. Phase 2 aims to achieve international consensus to define which outcomes should be measured as a minimum in future trials, using a Delphi process including an online consensus meeting involving key stakeholders. Phase 3 will involve dissemination of the ratified COS to facilitate uptake in future trials and the planning of further research to identify the most appropriate measurement instruments to use to capture the COS in research practice. Discussion Harmonising outcome measurement across future clinical trials should ensure that the outcomes measured are relevant to patients and health services, and allow for more meaningful results to be obtained. Core Outcome Set registration COMET Initiative as study 118 .Item Open Access Second-Generation Antipsychotics and Metabolic Side Effects in the Canadian Population(2016) Hirsch, Lauren Elizabeth; Pringsheim, Tamara; Patten, Scott; Jette, Nathalie; Bresee, LaurenThe use of second-generation antipsychotic (SGA) has increased substantially in Canada over the last decade. Though an association has been found between SGAs and metabolic dysfunction in randomized controlled trials (RCTs), this information might not be generalizable to all SGA users. Furthermore, SGA use has been inadequately characterized in the population. This thesis aimed to quantify trends in SGA use and the effect of SGAs on indicators of metabolic dysfunction in the Canadian population through two studies: i) a systematic review the literature on population-based studies of SGA use and their associated metabolic harms, and ii) a cross-sectional analysis of SGA use using the Canadian Health Measures Survey (CHMS). The results of this thesis showed SGA use has tripled in Canada between 2007 and 2013 and confirmed the presence of metabolic dysfunction and poor health in SGA users in the general household population.Item Open Access Systematic review and assessment of validated case definitions for depression in administrative data(BMC, 2014) Fiest, Kirsten M.; Jette, Nathalie; Quan, Hude; St Germaine-Smith, Christine; Metcalfe, Amy; Patten, Scott B.; Beck, Cynthia A.Background: Administrative data are increasingly used to conduct research on depression and inform health services and health policy. Depression surveillance using administrative data is an alternative to surveys, which can be more resource-intensive. The objectives of this study were to: (1) systematically review the literature on validated case definitions to identify depression using International Classification of Disease and Related Health Problems (ICD) codes in administrative data and (2) identify individuals with and without depression in administrative data and develop an enhanced case definition to identify persons with depression in ICD-coded hospital data. Methods: (1) Systematic review: We identified validation studies using ICD codes to indicate depression in administrative data up to January 2013. (2) Validation: All depression case definitions from the literature and an additional three ICD-9-CM and three ICD-10 enhanced definitions were tested in an inpatient database. The diagnostic accuracy of all case definitions was calculated [sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV)]. Results: (1) Systematic review: Of 2,014 abstracts identified, 36 underwent full-text review and three met eligibility criteria. These depression studies used ICD-9 and ICD-10 case definitions. (2) Validation: 4,008 randomly selected medical charts were reviewed to assess the performance of new and previously published depression-related ICD case definitions. All newly tested case definitions resulted in Sp >99%, PPV >89% and NPV >91%. Sensitivities were low (28-35%), but higher than for case definitions identified in the literature (1.1-29.6%). Conclusions: Validating ICD-coded data for depression is important due to variation in coding practices across jurisdictions. The most suitable case definitions for detecting depression in administrative data vary depending on the context. For surveillance purposes, the most inclusive ICD-9 & ICD-10 case definitions resulted in PPVs of 89.7% and 89.5%, respectively. In cases where diagnostic certainty is required, the least inclusive ICD-9 and -10 case definitions are recommended, resulting in PPVs of 92.0% and 91.1%. All proposed case definitions resulted in suboptimal levels of sensitivity (ranging from 28.9%-35.6%). The addition of outpatient data (such as pharmacy records) for depression surveillance is recommended and should result in improved measures of validity.Item Open Access Systematic Reviews and Meta-Analyses of the Incidence and Prevalence of Dementia and Its Commoner Neurodegenerative Causes(CAMBRIDGE UNIV PRESS, 2016) Jette, Nathalie; Maxwell, Colleen J.; Fiest, Kirsten M.; Hogan, David B.Item Open Access The Prevalence and Incidence of Dementia Due to Alzheimer's Disease: a Systematic Review and Meta-Analysis(CAMBRIDGE UNIV PRESS, 2016) Fiest, Kirsten M.; Roberts, Jodie I.; Maxwell, Colleen J.; Hogan, David B.; Smith, Eric E.; Frolkis, Alexandra; Cohen, Adrienne; Kirk, Andrew; Pearson, Dawn; Pringsheim, Tamara; Venegas-Torres, Andres; Jette, NathalieBackground: Updated information on the epidemiology of dementia due to Alzheimer's disease (AD) is needed to ensure that adequate resources are available to meet current and future healthcare needs. We conducted a systematic review and meta-analysis of the incidence and prevalence of AD. Methods: The MEDLINE and EMBASE databases were searched from 1985 to 2012, as well as the reference lists of selected articles. Included articles had to provide an original population-based estimate for the incidence and/or prevalence of AD. Two individuals independently performed abstract and full-text reviews, data extraction and quality assessments. Random-effects models were employed to generate pooled estimates stratified by age, sex, diagnostic criteria, location (i.e., continent) and time (i.e., when the study was done). Results: Of 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 119 studies met the inclusion criteria. In community settings, the overall point prevalence of dementia due to AD among individuals 60 + was 40.2 per 1000 persons (CI95%: 29.1-55.6), and pooled annual period prevalence was 30.4 per 1000 persons (CI95%: 15.6-59.1). In community settings, the overall pooled annual incidence proportion of dementia due to AD among individuals 60 + was 34.1 per 1000 persons (CI95%: 16.4-70.9), and the incidence rate was 15.8 per 1000 person-years (CI95%: 12.9-19.4). Estimates varied significantly with age, diagnostic criteria used and location (i.e., continent). Conclusions: The burden of AD dementia is substantial. Significant gaps in our understanding of its epidemiology were identified, even in a high-income country such as Canada. Future studies should assess the impact of using such newer clinical diagnostic criteria for AD dementia such as those of the National Institute on Aging-Alzheimer's Association and/or incorporate validated biomarkers to confirm the presence of Alzheimer pathology to produce more precise estimates of the global burden of AD.Item Open Access The Prevalence and Incidence of Dementia: a Systematic Review and Meta-analysis(CAMBRIDGE UNIV PRESS, 2016) Fiest, Kirsten M.; Jette, Nathalie; Roberts, Jodie I.; Maxwell, Colleen J.; Smith, Eric E.; Black, Sandra E.; Blaikie, Laura; Cohen, Adrienne; Day, Lundy; Holroyd-Leduc, Jayna; Kirk, Andrew; Pearson, Dawn; Pringsheim, Tamara; Venegas-Torres, Andres; Hogan, David B.Introduction: Dementia is a common neurological condition affecting many older individuals that leads to a loss of independence, diminished quality of life, premature mortality, caregiver burden and high levels of healthcare utilization and cost. This is an updated systematic review and meta-analysis of the worldwide prevalence and incidence of dementia. Methods: The MEDLINE and EMBASE databases were searched for relevant studies published between 2000 (1985 for Canadian papers) and July of 2012. Papers selected for full-text review were included in the systematic review if they provided an original population-based estimate for the incidence and/or prevalence of dementia. The reference lists of included articles were also searched for additional studies. Two individuals independently performed abstract and full-text review, data extraction, and quality assessment of the papers. Random-effects models and/or meta-regression were used to generate pooled estimates by age, sex, setting (i.e., community, institution, both), diagnostic criteria utilized, location (i.e., continent) and year of data collection. Results: Of 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 160 studies met the inclusion criteria. Among individuals 60 and over residing in the community, the pooled point and annual period prevalence estimates of dementia were 48.62 (CI95%: 41.98-56.32) and 69.07 (CI95%: 52.36-91.11) per 1000 persons, respectively. The respective pooled incidence rate (same age and setting) was 17.18 (CI95%: 13.90-21.23) per 1000 person-years, while the annual incidence proportion was 52.85 (CI95%: 33.08-84.42) per 1,000 persons. Increasing participant age was associated with a higher dementia prevalence and incidence. Annual period prevalence was higher in North America than in South America, Europe and Asia (in order of decreasing period prevalence) and higher in institutional compared to community and combined settings. Sex, diagnostic criteria (except for incidence proportion) and year of data collection were not associated with statistically significant different estimates of prevalence or incidence, though estimates were consistently higher for females than males. Conclusions: Dementia is a common neurological condition in older individuals. Significant gaps in knowledge about its epidemiology were identified, particularly with regard to the incidence of dementia in low- and middle-income countries. Accurate estimates of prevalence and incidence of dementia are needed to plan for the health and social services that will be required to deal with an aging population.Item Open Access The Prevalence and Incidence of Frontotemporal Dementia: a Systematic Review(CAMBRIDGE UNIV PRESS, 2016) Hogan, David B.; Jette, Nathalie; Fiest, Kirsten M.; Roberts, Jodie I.; Pearson, Dawn; Smith, Eric E.; Pamela Roach; Kirk, Andrew; Pringsheim, Tamara; Maxwell, Colleen J.Background Population-based prevalence and incidence studies are essential for understanding the burden of frontotemporal dementia (FTD). Methods The MEDLINE and EMBASE databases were searched to identify population-based publications from 1985 to 2012, addressing the incidence and/or prevalence of FTD. References of included articles and prior systematic reviews were searched for additional studies. Two reviewers screened all abstracts and full-text reviews, abstracted data and performed quality assessments. Results Twenty-six studies were included. Methodological limitations led to wide ranges in the estimates for prevalence (point prevalence 0.01-4.6 per 1000 persons; period prevalence 0.16-31.04 per 1000 persons) and incidence (0.0-0.3 per 1000 person-years). FTD accounted for an average of 2.7% (range 0-9.1%) of all dementia cases among prevalence studies that included subjects 65 and older compared to 10.2% (range 2.8-15.7%) in studies restricted to those aged less than 65. The cumulative numbers of male (373 [52.5%]) and female (338 [47.5%]) cases from studies reporting this information were nearly equal (p=0.18). The behavioural variant FTD (bvFTD) was almost four times as common as the primary progressive aphasias. Conclusions Population-based estimates for the epidemiology of FTD varied widely in the included studies. Refinements in the diagnostic process, possibly by the use of validated biomarkers or limiting case ascertainment to specialty services, are needed to obtain more precise estimates of the prevalence and incidence of FTD.Item Open Access Understanding the Barriers to Guideline Use for Depression & Anxiety in Patients with Parkinson's Disease and Dementia.(2016) Goodarzi, Zahra; Holroyd-Leduc, Jayna M.; Hanson, Heather; Jette, Nathalie; Patten, Scott; Pringsheim, TamaraBackground: Depression or anxiety are under-diagnosed and under-treated in those with dementia or Parkinson’s disease (PD). Objectives: The objectives of this thesis were to first understand what high quality guideline recommendations exist for depression or anxiety in dementia or PD. Secondly to explore the barriers and facilitators to implementing these guidelines. Methods: A systematic review of guidelines was completed, following the PRISMA statement and using the AGREE II tool to assess quality. In focus groups with stakeholders, we assessed the barriers and facilitators to guideline use and implementation. Results: Guideline quality scores were lowest for stakeholder involvement, applicability, and editorial independence. Major barriers to use included a lack of evidence, lack of applicability to the practice population, impractical or out of date recommendations. Conclusions: There are guideline recommendations for depression or anxiety in dementia and PD. However, practitioners have difficulty with implementation due to a lack of evidence and applicability.