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... Investigators Finlay McAlister, MD, M.Sc. Justin Ezekowitz, MD Natasha Wiebe, M.Math Brian Rowe, MD, M.Sc. Carol Spooner, M.Sc Ellen Crumley, MLIS Lisa Hartling, M.Sc. Padma Kaul, Ph.D. Graham Nichol, MD Dr. Terry Klassen, MD, M.Sc.... more
... Investigators Finlay McAlister, MD, M.Sc. Justin Ezekowitz, MD Natasha Wiebe, M.Math Brian Rowe, MD, M.Sc. Carol Spooner, M.Sc Ellen Crumley, MLIS Lisa Hartling, M.Sc. Padma Kaul, Ph.D. Graham Nichol, MD Dr. Terry Klassen, MD, M.Sc. AHRQ Publication No. ...
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ABSTRACT Chronic fatigue is increasingly common. Conventional medical care is limited in treating chronic fatigue, leading some patients to use traditional Chinese medicine therapies, including herbal medicine. To assess the effectiveness... more
ABSTRACT Chronic fatigue is increasingly common. Conventional medical care is limited in treating chronic fatigue, leading some patients to use traditional Chinese medicine therapies, including herbal medicine. To assess the effectiveness of traditional Chinese medicine herbal products in treating idiopathic chronic fatigue and chronic fatigue syndrome. The following databases were searched for terms related to traditional Chinese medicine, chronic fatigue, and clinical trials: CCDAN Controlled Trials Register (July 2009), MEDLINE (1966-2008), EMBASE (1980-2008), AMED (1985-2008), CINAHL (1982-2008), PSYCHINFO (1985-2008), CENTRAL (Issue 2 2008), the Chalmers Research Group PedCAM Database (2004), VIP Information (1989-2008), CNKI (1976-2008), OCLC Proceedings First (1992-2008), Conference Papers Index (1982-2008), and Dissertation Abstracts (1980-2008). Reference lists of included studies and review articles were examined and experts in the field were contacted for knowledge of additional studies. Selection criteria included published or unpublished randomized controlled trials (RCTs) of participants diagnosed with idiopathic chronic fatigue or chronic fatigue syndrome comparing traditional Chinese medicinal herbs with placebo, conventional standard of care (SOC), or no treatment/wait lists. The outcome of interest was fatigue. 13 databases were searched for RCTs investigating TCM herbal products for the treatment of chronic fatigue. Over 2400 references were located. Studies were screened and assessed for inclusion criteria by two authors. No studies that met all inclusion criteria were identified. Although studies examining the use of TCM herbal products for chronic fatigue were located, methodologic limitations resulted in the exclusion of all studies. Of note, many of the studies labelled as RCTs and conducted in China did not utilize rigorous randomization procedures. Improvements in methodology in future studies is required for meaningful synthesis of data.
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Acyclovir has the potential to shorten the course of illness which may result in reduced costs and morbidity. 1) To examine the evidence evaluating the efficacy of acyclovir in alleviating symptoms and shortening the duration of illness.... more
Acyclovir has the potential to shorten the course of illness which may result in reduced costs and morbidity. 1) To examine the evidence evaluating the efficacy of acyclovir in alleviating symptoms and shortening the duration of illness. 2) To examine complications of chickenpox and adverse effects associated with acyclovir as reported in the relevant trials. We searched the Cochrane Controlled Trials Register (2002, Issue 2), MEDLINE (January 1966 to October 2001), EMBASE (1988 to September 2001). The reference lists of all relevant articles were reviewed. The primary author of relevant studies and the pharmaceutical company that manufactures acyclovir were contacted. Randomized controlled trials that evaluated otherwise healthy children 0-18 years of age with chickenpox. Two reviewers independently reviewed the studies for eligibility. Two reviewers independently assessed methodological quality of the relevant studies using the Jadad scale and allocation concealment. Differences were resolved by consensus. Data were extracted by one reviewer using a structured form and checked by a second. Continuous data were converted to the weighted mean difference (WMD). Weighted mean differences were not combined into an overall estimate due to the varied age groups between studies. There were too few studies to consider statistical heterogeneity between studies (i.e., differences in reported effects), to perform subgroup or sensitivity analyses, or to assess for publication bias. Three studies were included. Study quality was three (n=2) and four (n=1) on the Jadad scale. Acyclovir was associated with a reduction in the number of days with fever, from -1.0 (95% CI -1.5,-0.5) to -1.3 (95% CI -2.0,-0.6). Results were inconsistent with respect to the number of days to no new lesions, the maximum number of lesions and the number of days to the relief of itching. There were no clinically important differences between acyclovir and placebo with respect to complications associated with chickenpox or adverse effects associated with the drug. Acyclovir appears to be effective in reducing the number of days with fever among otherwise healthy children with chickenpox. The results were inconsistent with respect to the number of days to no new lesions, relief of itchiness and maximum number of lesions. The clinical importance of acyclovir treatment in otherwise healthy children remains controversial.
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Rationale & Objective People receiving hemodialysis often require urgent care or hospitalizations. It is possible that reductions in a patient’s level of physical activity may serve as an “early warning” of clinical deterioration,... more
Rationale & Objective People receiving hemodialysis often require urgent care or hospitalizations. It is possible that reductions in a patient’s level of physical activity may serve as an “early warning” of clinical deterioration, allowing timely clinical intervention. We explored whether step count could serve as a trigger for deterioration. Study Design Prospective observational cohort feasibility study. Setting & Participants We recruited consenting adult participants from outpatient dialysis clinics in Calgary, AB, between June 28, 2019, and October 10, 2019. Exposure and Outcomes Participants wore a wristband fitness tracker for 4 weeks. Activity data from the trackers were imported weekly into the study database. Demographic, clinical management, functional impairment, and frailty were assessed at baseline. Clinical events (urgent care and emergency department visits and hospitalizations) were monitored during the observation period. Analytical Approach Box and whisker plots and line plots were used to describe each participant’s daily steps. Adjusted rate ratios (and 95 % confidence intervals) were calculated to assess the associations between the number of steps taken each day and potential predictors. Results Data from 46 patients were included; their median age was 64 years (range, 22 to 85), and 63 % were men. The median number of steps taken per day was 3,133 (range, 248-13,753). Fourteen events among 11 patients were reported. Within patients, step count varied considerably; it was not possible to identify a patient-specific normal range for daily step count. There was no association between step count and the occurrence of clinical events, although the number of events was very small. Limitations The number of participants was relatively small, and there were too few events to model to examine whether step count could predict clinical deterioration. Conclusions Within-patient variation in daily step count was too high to generate a normal range for patients. However, patient-specific norms over a longer period (3- or 7-day periods) appear potentially worthy of future study in a larger sample and/or over a longer follow-up.
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... Investigators Finlay McAlister, MD, M.Sc. Justin Ezekowitz, MD Natasha Wiebe, M.Math Brian Rowe, MD, M.Sc. Carol Spooner, M.Sc Ellen Crumley, MLIS Lisa Hartling, M.Sc. Padma Kaul, Ph.D. Graham Nichol, MD Dr. Terry Klassen, MD, M.Sc.... more
... Investigators Finlay McAlister, MD, M.Sc. Justin Ezekowitz, MD Natasha Wiebe, M.Math Brian Rowe, MD, M.Sc. Carol Spooner, M.Sc Ellen Crumley, MLIS Lisa Hartling, M.Sc. Padma Kaul, Ph.D. Graham Nichol, MD Dr. Terry Klassen, MD, M.Sc. AHRQ Publication No. ...
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ABSTRACT Since the initial version of this systematic review in 1997, a number of randomised trials examining the benefit of glucocorticoids have been published, reflecting a continued interest in the use of glucocorticoids to treat... more
ABSTRACT Since the initial version of this systematic review in 1997, a number of randomised trials examining the benefit of glucocorticoids have been published, reflecting a continued interest in the use of glucocorticoids to treat patients with croup. The objective of this review was to provide evidence to guide clinicians in their treatment of patients with croup by determining the effectiveness of glucocorticoids and to identify areas of uncertainty for future research. To determine the effect of glucocorticoids for children with croup. We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (issue 1, 2003), MEDLINE (January 1966 to April 2003) and Excerpta Medica/EMBASE (January 1974 to August 2003). We also contacted authors of identified croup trials published in the last ten years to inquire about additional published or unpublished trials. Randomised controlled trials that examine children with croup and objectively measure the effectiveness of glucocorticoid treatment. Based on review of the title and abstract (when available), two researchers identified studies for potential relevance. The complete text was retrieved and using a priori inclusion criteria, the studies were independently reviewed for relevance by two reviewers. Two observers independently assessed quality. Differences with respect to inclusion status and quality assessment were resolved by consensus. Data were extracted using a structured form by one reviewer and checked for accuracy by a second reviewer. Standard statistical analyses were performed. Thirty-one studies were deemed relevant for inclusion (N = 3736). Glucocorticoid treatment was associated with an improvement in the Westley score at six hours with a weighted mean difference of -1.2 (95% confidence interval -1.6 to -0.8) and at 12 hours -1.9 (-2.4 to -1.3); at 24 hours this improvement was no longer significant (-1.3, -2.7 to 0.2). Fewer return visits and/or (re)admissions occurred in patients treated with glucocorticoids (relative risk 0.50; 0.36 to 0.70). Length of time spent in accident and emergency or hospital (weighted mean difference 12 hours, five to 19 hours) was significantly decreased for patients treated with glucocorticoids. Use of epinephrine decreased for children treated with a glucocorticoid (risk difference 10%; 1 to 20). No other decreases in additional treatments were found in the primary analysis. Publication bias does not impact results importantly. No between-trial significant differences were found between populations with mild and moderate croup. Oral dexamethasone may be superior to intramuscular dexamethasone. Dexamethasone and budesonide are effective in relieving the symptoms of croup as early as six hours after treatment. Fewer return visits and/or (re)admissions are required and the length of time spent in hospital is decreased in inpatients. Dexamethasone is also effective in mild croup populations. Research is required to examine the most beneficial method for disseminating croup practice guidelines and to increase the uptake of evidence to improve outcomes.
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Research Interests: Child Welfare, Treatment Outcome, Medicine, Humans, Epinephrine, and 13 morePlacebo, Anesthesia, Infant, Meta Analysis, Randomized Controlled Trial, Odds ratio, Bronchiolitis, Confidence Interval, Acute Disease, Child preschool, Albuterol, Paediatrics and reproductive medicine, and Bronchodilator agents
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Background: Approximately 78% of chronic kidney disease (CKD) cases reside in low- and middle-income countries (LMICs). However, little is known about the care models for CKD in LMICs. Objective: Our objective was to update a prior... more
Background: Approximately 78% of chronic kidney disease (CKD) cases reside in low- and middle-income countries (LMICs). However, little is known about the care models for CKD in LMICs. Objective: Our objective was to update a prior systematic review on CKD care models in LMICs and summarize information on multidisciplinary care and management of CKD complications. Design: We searched MEDLINE, EMBASE, and Global Health databases in September 2020, for papers published between January 1, 2017, and September 14, 2020. We used a combination of search terms, which were different iterations of CKD, care models, and LMICs. The World Bank definition (2019) was used to identify LMICs. Setting: Our review included studies published in LMICs across 4 continents: Africa, Asia, North America (Mexico), and Europe (Ukraine). The study settings included tertiary hospitals (n = 6), multidisciplinary clinics (n = 1), primary health centers (n = 2), referral centers (n = 2), district hospitals (n = 1)...
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Background: People receiving in-center hemodialysis (HD) have prioritized the need for more individualized health information and better communication with nephrologists. The most common setting for patient-nephrologist interactions is... more
Background: People receiving in-center hemodialysis (HD) have prioritized the need for more individualized health information and better communication with nephrologists. The most common setting for patient-nephrologist interactions is during the HD treatment, which is a time pressured setting that lacks privacy. Objective: To facilitate effective communication in the hemodialysis (HD) unit, we evaluated the usability of a web application (web app) from both the patient and physician perspective. The main aim of the web app was to support patients in prioritizing their dialysis concerns outside of the clinical HD encounter. Design: Mixed method, parallel arm, multi-site, pilot randomized controlled trial. Setting: Two outpatient Canadian HD centers. Participants: Adult patients receiving in-center HD and their attending nephrologists. Methods: Patients were randomized to either a web application or an active control (paper form) for logging concerns to be addressed at weekly encount...
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Background: In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women... more
Background: In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods: We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a national guideline dissemination strategy targeting primary care physicians. Women aged 40 to 74 years living in Ontario or Alberta from 30th November 2008 to 30th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results: In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 participant-months - the monthly screening rate/1000 - in Ontario and Alberta, respectively)....
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ABSTRACT A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science in Medical Sciences, Public Health Sciences Thesis (M.Sc.)--University of Alberta,... more
ABSTRACT A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science in Medical Sciences, Public Health Sciences Thesis (M.Sc.)--University of Alberta, 2005. Includes bibliographical references.
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Background: The prevalence of hypertension among people with chronic kidney disease is high with over 60% of people not attaining recommended targets despite multiple medications. Given the health and economic implications of... more
Background: The prevalence of hypertension among people with chronic kidney disease is high with over 60% of people not attaining recommended targets despite multiple medications. Given the health and economic implications of hypertension, additional strategies are needed. Exercise is an effective strategy for reducing blood pressure in the general population; however, it is not known whether exercise would have a comparable benefit in people with moderate to advanced chronic kidney disease and hypertension. Methods: This is a parallel arm trial of adults with hypertension (systolic blood pressure greater than 130 mmHg) and an estimated glomerular filtration rate of 15-45 ml/min 1.73 m2. A total of 160 participants will be randomized, with stratification for estimated glomerular filtration rate, to a 24-week aerobic-based exercise intervention or enhanced usual care. The primary outcome is the difference in 24-hour ambulatory systolic blood pressure after eight weeks of exercise tra...
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Introduction Cardiac rehabilitation (CR) is a proven therapy for reducing cardiovascular death and hospitalization. Whether CR participation is associated with improved outcomes in patients with chronic kidney disease (CKD) is unknown.... more
Introduction Cardiac rehabilitation (CR) is a proven therapy for reducing cardiovascular death and hospitalization. Whether CR participation is associated with improved outcomes in patients with chronic kidney disease (CKD) is unknown. Methods We obtained data on all adult patients in Calgary, Alberta, Canada with angiographically proven coronary artery disease from 1996 to 2016 referred to CR from The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease and TotalCardiology Rehabilitation. An estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 or kidney replacement therapy defined CKD. Predictors of CR use were estimated with multinomial logistic regression. The association between starting versus not starting and completion versus noncompletion of CR and clinical outcomes were estimated using multivariable Cox proportional hazards models. Results Of 23,215 patients referred to CR, 12,084 were eligible for inclusion. Participants with CKD (N = 1322) were older, had more comorbidity, lower exercise capacity on graded treadmill testing, and took longer to be referred and to start CR than those without CKD. CKD predicted not starting CR: odds ratio 0.73 (95% confidence interval [CI] 0.64–0.83). Over a median 1 year follow-up, there were 146 deaths, 40 (0.3%) from CKD and 106 (1.0%) not from CKD. Similar to those without CKD, the risk of death was lower in CR completers (hazard ratio [HR] 0.24 [95% CI 0.06–0.91) and starters (HR 0.56 [95% CI 0.29– 1.10]) with CKD. Conclusion CR participation was associated with comparable benefits in people with moderate CKD as those without who survived to CR. Lower rates of CR attendance in this high-risk population suggest that strategies to increase CR utilization are needed.
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Research Interests: Telemedicine and Medicine
Introduction: Hypertension is a key determinant of both cardiovascular (CV) events and progressive renal dysfunction in people with chronic kidney disease (CKD) Exercise is an effective strategy for blood pressure (BP) reduction in the... more
Introduction: Hypertension is a key determinant of both cardiovascular (CV) events and progressive renal dysfunction in people with chronic kidney disease (CKD) Exercise is an effective strategy for blood pressure (BP) reduction in the general population but in CKD, hypertension is mediated by advanced vascular stiffness and volume expansion, and it is unclear whether exercise will mitigate this The primary aim of this randomized trial was to determine the effect of exercise training compared to usual care on 24-hour ambulatory systolic blood pressure (SBP) in people with CKD at eight weeks Methods: Participants with an eGFR of 15-44 ml/min per 1 73m2 and SBP &gt;120 mmHg were recruited from a single center Canadian renal program Participants were randomized, stratified by eGFR (&lt;30 versus ≥30), to receive thrice weekly, moderate intensity aerobic exercise (50–60% heart rate reserve) supplemented with isometric resistance exercise, targeting 150 minutes per week and delivered over 24-weeks, or usual care For exercise participants, Phase 1 (eight weeks) included an in-center weekly session and home-based sessions, and Phase 2 (16 weeks) included home-based sessions The primary outcome was the difference in 24-h ambulatory SBP after 8 weeks of exercise training compared to control Secondary outcomes included markers of CV risk, arterial stiffness (pulse wave velocity), aerobic capacity as measured by cardiopulmonary exercise testing and physical activity as measured by 7-day accelerometry Outcomes were analyzed using mixed linear regression including fixed effects terms for time point, intervention, baseline eGFR, the outcome variable measured at baseline, and a random effects term for participant Missing values were multiply imputed using chained equations with predictive mean matching Results: 44 people were randomized (30% of target enrolment) prior to stopping due to COVID-19 Of those randomized, 36% were female, mean age was 66, 55% were diabetic, and mean GFR was 29 Eligibility was 25%, primarily due to transportation barrier to attend the in-center sessions Compared with usual care, there was no significant change in 24-ambulatory SBP at eight weeks 2 86 mmHg (95% CI -2 64, 8 35;P=0 31) or 24 weeks There was no significant change in arterial stiffness as measured by pulse wave velocity VO2peak improved by 235 ml/min in the exercise group (95% CI 18, 452;P=0 03) and there was a significant increase in BMI at 8 weeks 2 01 kg/m2 (95% CI 0 13, 3 89;0 04) which was reflected in an increase in kilograms of fat free mass but this was not sustained at 24 weeks The daily mean step count did not differ significantly between groups at 8 weeks, -62 (95% CI -821, 698) or at 24 weeks In Phase 1, 90% of participants initiated at least 70% of the prescribed sessions versus only 48% of participants in Phase 2 Conclusions: Exercise training improved VO2peak and optimized body composition in people with moderate to severe CKD However, the trial was under powered to detect a difference in blood pressure and additional trials are needed To address limitations to trial recruitment resulting from a lack of transportation as well as the pandemic, effective home-based exercise interventions are needed No conflict of interest