Providence Health Care Research Articles

Road to Recovery: protocol for a mixed-methods prospective cohort study evaluating the impact of a new model of substance use care in a Canadian setting

IntroductionThe Road to Recovery (R2R) Initiative is an innovative model of substance use care that seeks to increase treatment capacity by creating approximately 100 new addiction treatment beds to provide...

Supporting Clinical Informatics Competency Development Among the Clinical Informatics Team at Providence Health Care.

Clinical informatics (CI) competencies are crucial for health care organizations to effectively use information communication technologies (ICTs) and deliver quality care. An interdisciplinary CI team can assist organizations with leveraging ICTs, but may also require support. This case study describes a peer-led knowledge translation project designed, delivered and implemented over two years by members of the CI team at Providence Health Care (PHC). The project included CI competencies assessment of CI team members, followed by tailored education for identified knowledge gaps. The Kirkpatrick evaluation model was used to assess three levels of learning among CI team members, including a satisfaction survey, pre-and post-cognitive retention of the education intervention using a validated tool for informatics specialists, and project partner feedback of CI team performance 12 weeks after education completion. This case study provides evidence-informed guidance on 'how to' implement peer-led, practice-based CI training for CI teams.

What is the ideal time to begin tapering opioid agonist treatment? A protocol for a retrospective population-based comparative effectiveness study in British Columbia, Canada

IntroductionOpioid agonist treatment (OAT) tapering involves a gradual reduction in daily medication dose to ultimately reach a state of opioid abstinence. Due to the high risk of relapse and overdose...

Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocol

IntroductionUrine drug tests (UDTs) are commonly used for monitoring opioid agonist treatment (OAT) responses, supporting the clinical decision for take-home doses and monitoring potential diversion. However, there is limited evidence...

Contrast Medium Reduction for CTA with Photon-counting CT: A New Opportunity or More of the Same?

HomeRadiology: Cardiothoracic ImagingVol. 5, No. 1 PreviousNext CommentaryContrast Medium Reduction for CTA with Photon-counting CT: A New Opportunity or More of the Same?James Dundas, Jonathon A. Leipsic James Dundas, Jonathon A. Leipsic Author AffiliationsFrom the Department of Radiology, Providence Health Care, Vancouver, BC, Canada (J.D.); and Department of Radiology, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.A.L.).Address correspondence to J.A.L. (email: [email protected]).James DundasJonathon A. Leipsic Published Online:Jan 26 2023https://doi.org/10.1148/ryct.220306MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In

Effect of alternative income assistance schedules on drug use and drug-related harm: a randomised controlled trial

SummaryBackgroundThe synchronised monthly disbursement of income assistance, whereby all recipients are paid on the same day, has been associated with increases in illicit drug use and serious associated harms. This phenomenon is often referred to as the cheque effect. Because payment variability can affect consumption patterns, this study aimed to assess whether these harms could be mitigated through a structural intervention that varied income assistance payment timing and frequency.MethodsThis randomised, parallel group trial was done in Vancouver, Canada, and enrolled recipients of income assistance whose drug use increased around payment days. The recipients were randomly assigned 1:2:2 to a control group that received monthly synchronised income assistance payments on government payment days, a staggered group in which participants received single desynchronised monthly income assistance payments, or a split and staggered group in which participants received desynchronised income assistance payments split into two instalments per month, 2 weeks apart, for six monthly payment cycles. Desynchronised payments in the intervention groups were made on individual payment days outside the week of the standard government schedules. Randomisation was through a pre-established stratified block procedure. Investigators and statisticians were masked to group allocation, but participants and front-line staff were not. Complete final results are reported after scheduled interim analyses and the resulting early stoppage of recruitment. Under intention-to-treat specifications, generalised linear mixed models were used to analyse the primary outcome, which was escalations in drug use, predefined as a 40% increase in at least one of: use frequency; use quantity; or number of substances used during the 3 days after government payments. Secondary analyses examined analogous drug use outcomes coinciding with individual payments as well as exposure to violence. This trial is registered with ClinicalTrials.gov, NCT02457949.FindingsBetween Oct 27, 2015, and Jan 2, 2019, 45 participants were enrolled to the control group, 72 to the staggered group, and 77 to the split and staggered group. Intention-to-treat analyses showed a significantly reduced likelihood of increased drug use coinciding with government payment days, relative to the control group, in the staggered (adjusted odds ratio 0·38, 95% CI 0·20–0·74; p=0·0044) and split and staggered (0·44, 0·23–0·83; p=0·012) groups. Findings were consistent in the secondary analyses of drug use coinciding with individual payment days (staggered group 0·50, 0·27–0·96, p=0·036; split and staggered group 0·49, 0·26–0·94, p=0·030). However, secondary outcome analyses of exposure to violence showed increased harm in the staggered group compared with the control group (2·71, 1·06–6·91, p=0·037). Additionally, 51 individuals had a severe or life-threatening adverse event and there were six deaths, none of which was directly attributed to study participation.InterpretationComplex results indicate the potential for modified income assistance payment schedules to mitigate escalations in drug use, provided measures to address unintended harms are also undertaken. Additional research is needed to clarify whether desynchronised schedules produce other unanticipated consequences and if additional measures could mitigate these harms.FundingCanadian Institutes of Health Research, Providence Health Care Research Institute, Peter Wall Institute for Advanced Research, Michael Smith Foundation for Health Research.

Cardio-Renal-Metabolic Care Models

Cardio-Renal-Metabolic Care Models

Survey of Drug Information Database Preferences among Staff from Selected British Columbia Health Authorities

With the increasing use of electronic point-of-care resources, it is imperative to clearly understand what health professionals consider valuable when selecting a drug information database. A current analysis of the preferences of staff in selected British Columbia health authorities was deemed helpful for determining which electronic drug information database should be purchased. To determine the factors that BC hospital pharmacists, nurses, and other health professionals value in an electronic drug information database and to better understand the general preferences of staff in choosing between the Lexicomp and Micromedex databases. An electronic survey was created for data collection. The survey was open from August 10 to September 15, 2018, and again from November 11 to December 7, 2018. The survey link was sent by e-mail to staff in the following health authorities: Fraser Health, Providence Health Care, Provincial Health Services Authority, and Vancouver Coastal Health. Qualitative and quantitative methods were used to analyze the survey data. A total of 247 responses were received, of which 145 (58.7%) were complete. Completed surveys were received from 77 pharmacists, 52 nurses, and 16 other health professionals. Participants ranked dosing information and ease of use as the most important factors that they considered when choosing a drug information database. There were no significant differences between the Lexicomp and Micromedex resources in terms of usability, quality, and preference. This survey provided insights into what BC health authority staff perceive as important when utilizing a drug information database. Those considering either renewing or initiating a subscription to an online drug information database can use these results to better understand the preferences of health care professionals. Survey respondents ranked dosing information and ease of use as the 2 most important factors in selecting a drug information database. Pharmacists were more particular about using their preferred database than were other health professionals.

Comparative effectiveness of buprenorphine-naloxone versus methadone for treatment of opioid use disorder: a population-based observational study protocol in British Columbia, Canada

IntroductionDespite a recent meta-analysis including 31 randomised controlled trials comparing methadone and buprenorphine for the treatment of opioid use disorder, important knowledge gaps remain regarding the long-term effectiveness of different...

Web Exclusive. Annals On Call - The Good, the Bad, and the Ugly-the Sequel: GLP1 Agonists.

Web Exclusives4 February 2020Annals On Call - The Good, the Bad, and the Ugly—the Sequel: GLP1 AgonistsFREERobert M. Centor, MD and Katherine R. Tuttle, MDRobert M. Centor, MDHuntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)Search for more papers by this author and Katherine R. Tuttle, MDProvidence Health Care and University of Washington School of Medicine, Spokane, Washington (K.R.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/A19-0023 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this episode of Annals On Call, Dr. Centor discusses the role of glucagon-like peptide-1 receptor agonists in the treatment of patients with type 2 diabetes with Dr. Tuttle of Providence Health Care and University of Washington School of Medicine.Annals articles discussed include...In the Clinic. Type 2 Diabetes: https://annals.org/aim/fullarticle/2754207/type-2-diabetesBenefits and Harms of Once-Weekly Glucagon-like Peptide-1 Receptor Agonist Treatments. A Systematic Review and Network Meta-analysis: https://annals.org/aim/fullarticle/2474362/benefits-harms-once-weekly-glucagon-like-peptide-1-receptor-agonistAbout Annals On CallAnnals On Call focuses on a clinically influential article published in Annals of Internal Medicine. Dr. Robert Centor shares his own perspective on the material and interviews topic area experts to discuss, debate, and share diverse insights about patient care and health care delivery.For more information on Annals On Call and for more episodes, visit go.annals.org/OnCall. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)Providence Health Care and University of Washington School of Medicine, Spokane, Washington (K.R.T.)Disclosures: Dr. Centor has disclosed the following: Honoraria: Medscape. Dr. Tuttle has disclosed the following: Honoraria: Eli Lilly and Company, AstraZeneca, Bayer. Consultantship: Eli Lilly and Company, AstraZeneca, Boehringer Ingelheim, Gilead, Goldfinch Bio, Novo Nordisk.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose. Previousarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBenefits and Harms of Once-Weekly Glucagon-like Peptide-1 Receptor Agonist Treatments Francesco Zaccardi , Zin Zin Htike , David R. Webb , Kamlesh Khunti , and Melanie J. Davies Type 2 Diabetes Sandeep Vijan Metrics 4 February 2020Volume 172, Issue 3Page: OC1KeywordsDiagnostic techniquesDisclosureHealth careNetwork analysisPatientsSystematic reviewsType 2 diabetes ePublished: 4 February 2020 Issue Published: 4 February 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.Loading ...

MicroRNA Modification of Coxsackievirus B3 Decreases Its Cardiotoxicity, While Retaining Oncolytic Potency Against Lung Cancer

Background: We recently discovered that coxsackievirus B3 (CVB3) is a potent oncolytic virus against KRAS-mutant (KRASmut) lung adenocarcinoma. Nevertheless, the evident cardiotoxicity restricts the use of wild-type (WT)-CVB3 for lung cancer therapy. The current study aims to genetically engineer the CVB3 genome to decrease its toxicity towards normal tissues and to extend our previous research to determine the safety and oncolytic efficacy of the modified CVB3 in treating TP53-and/or RB1-mutant small cell lung cancer (TP53mut/RB1mut SCLC). Methods: A microRNA-modified CVB3 (miR-CVB3) was generated via inserting multiple copies of tumor-suppressive miR-145 and miR-143 target sequences into the 5' untranslated region of the viral genome. The safety and effectiveness of the miR-CVB3 were then examined in cultured cells and using a TP53mut/RB1mut SCLC cell-derived xenograft model. Findings: In vitro experiments revealed that miR-CVB3 retained the ability to infect and lyse KRASmut lung adenocarcinoma and TP53mut/RB1mut SCLC cells, but with a markedly reduced cytotoxicity towards cardiomyocytes. In vivo study demonstrated that a single dose of miR-CVB3 via systemic administration resulted in a significant tumor regression. Most strikingly, mice treated with miR-CVB3 all survived the time-course of the experiment with greatly attenuated cardiotoxicities and decreased viral titers as compared to WT-CVB3-treated mice. Interpretation: We generated a recombinant CVB3 that was powerful in destroying both KRASmut lung adenocarcinoma and TP53mut/RB1mut SCLC, with a negligible toxicity towards normal tissues. Fundings: This work was supported by the BC Lung Association, Providence Health Care Research Institute and Vancouver Coastal Health Research Institute Innovation and Translational Research Award. Declaration of Interest: WWGJ is the Chief Scientific Officer at Virogin Biotech Ltd. HL (H Liu) and CSN are partially sponsored by Virogin Biotech Ltd. through MITACS Accelerate Program. No conflicts of interest were disclosed by others. Ethical Approval: The protocol was approved by the University Animal Care Committee (A18-0275).

Addiction and Heroin-Assisted Treatment: Legal Discourse and Drug Reform

This article analyzes the arguments put forth over a 3-day period at an injunction hearing, Providence Health Care Society v. Canada, held March 13–15, 2014 in Vancouver, British Columbia. The plaintiffs sought broad interlocutory relief from the Court for the provision of prescription heroin if requested by their physicians. This article fills an identified gap in scholarship by analyzing the civil Charter challenge, including the notice of civil claim, injunction court transcripts, judgment, and individual plaintiffs’ affidavits. We draw from Canada’s unique history of drug prohibition and critical drug research to contextualize our analysis and findings. We argue that the lives of people using criminalized drugs, such as heroin, are affected by legal realms that produce ideas about heroin, addiction, and criminality that ultimately impact public health policies and treatment initiatives.

Epidemiologic features of a large hepatitis C cohort evaluated in a major health system in the western United States

Introduction and aimReal-world epidemiologic data to guide hepatitis C virus (HCV)-related public health initiatives are lacking. The aim of this study was to describe the prevalence and epidemiological characteristics of a large cohort of patients with an HCV diagnosis evaluated in one of the largest health systems in the United States. Materials and methodsDe-identified demographic and clinical data were extracted from the electronic health record for patients actively followed within the Providence Health & Services health care system. Rates of HCV prevalence and co-morbid illnesses among HCV-infected patients were determined. ResultsAmong 2,735,511 active patients, 23,492 (0.86%) were found to have evidence of HCV infection, the majority of which were Caucasian (78.2%) and born between the years 1945 and 1965 (68.3%). In comparison to Caucasians, higher rates of HCV infection were found among Native Americans (2.5% vs. 0.95%, p<0.001). Compared to HCV-negative patients, a greater proportion of HCV-positive patients had diabetes mellitus (18.7 vs. 8.9%, p<0.0001), chronic kidney disease (4.4 vs. 1.8%, p<0.0001), end-stage renal disease necessitating hemodialysis (2.6 vs. 0.6%, p<0.0001), and HIV co-infection (2.4 vs. 0.2, p<0.0001). Nearly two-thirds (62.1%) of HCV patients had government-sponsored insurance, and 93.0% of treated patients resided in urban settings. ConclusionThe prevalence of HCV infection in this large health care system serving the Pacific Northwest, Alaska, and California was lower than prior population-based estimates and may reflect real-world prevalence rates among patients not selected for risk-based screening. Native Americans are disproportionately affected by HCV and may warrant targeted screening.

Diabetes Increases Risk of Sepsis, But Not Mortality, Inflammatory or Lipid Responses

Background: Diabetes may increase sepsis risk, but it is unknown whether and how diabetes alters sepsis mortality. Our hypotheses were: (1) diabetes increases risk of sepsis and mortality; during sepsis (2) diabetes alters the inflammatory response; (3) hyperglycemia is associated with altered lipid levels. Methods: We studied four cohorts (Population-based, multi-center, and single center cohorts; 2000-2016) with minimum 28-day follow-up: UK Biobank Cohort 1 (n =484,857; diabetics n = 25,430; non-diabetics n = 459,407), Single Centre Cohort 2 (n = 727; diabetics = 37; non-diabetics n = 690), Inflammation Mechanism Cohort 3 (n = 779; diabetics n = 165; non-diabetics n = 614), Lipid Mechanism Cohort 4 (n = 200; diabetics n = 49; non-diabetics n = 151). Twenty eight-day mortality and days-alive-and-free (DAF) of vasopressors, ventilation and renal replacement therapy (RRT) of diabetics and non-diabetics were compared. Hierarchical clustering was done on 39 cytokines and glucose association with HDL and triglyceride levels was evaluated early in sepsis. Findings: Diabetics increased sepsis admission risk (n = 478/25,430 [1.89%] vs. n = 3,179/459,407 [0.70%], odds ratio (OR)[95% CI]: 2.75 [2.50 to 3.03], p<1E-15) but not mortality in UK Biobank Cohort 1 (15.8% vs. 13.7%; OR [95% CI]: 1.18 [0.91 - 1.54]], p=0.21), Single Centre Cohort 2 (24.3% vs. 19.3%, OR 1.35 [ 95% CI]: 0.63-2.92] p=0.452), Inflammation Mechanism Cohort 3 (38.8% vs. 36.9%, OR 1.09 [95%CI: 0.76, 1.55] p=0.651); or Lipid Mechanism Cohort 4 ((90-day) 17% vs. 14%, OR 1.59 [0.70-3.65], p=0.28), or in DAF vasopressors, ventilation and RRT (Cohort 3). Diabetics and non-diabetics had similar cytokine levels, hierarchical clustering and principal components analyses. There was no association of hyperglycemia with HDL or triglycerides levels. Interpretation: Despite increased risk of sepsis, diabetic patients did not have increased 28-day mortality perhaps because inflammatory and lipid responses of diabetics and non-diabetics were similar. Funding Statement: Support for VASST: Canadian Institutes of Health Research, Grant number: MCT 44152, Trial Registration: ISRCTN94845869. John Boyd is a recipient of a Providence Health Care Research Scholarship. Liam Brunham is supported by a Canada Research Chair in Precision Cardiovascular Disease Prevention and is a Michael Smith Foundation for Health Research Scholar. Keith Walley is supported by CIHR FDN 154311. Joe Hsu is supported by a grant from the National Institutes of Health, National Heart Lung and Blood Institute (1K08HL122528-01A1). Support for current study: Department of Anesthesia and Department of Medicine, Division of Pulmonary and Critical Care, Stanford University; James A. Russell (overhead funds UBC/PHC); Canadian Institutes of Health Research (CIHR)(SONRIS). Declaration of Interests: Dr. Russell reports patents owned by the University of British Columbia (UBC) that are related to the use of PCSK9 inhibitor(s) in sepsis and related to the use of vasopressin in septic shock. Dr. Russell is an inventor on these patents. Dr. Russell was a founder, Director and shareholder in Cyon Therapeutics Inc. Dr. Russell is a shareholder in Molecular You Corp. Dr. Russell reports receiving consulting fees in the last 3 years from: 1. Asahi Kesai Pharmaceuticals of America (AKPA)(developing recombinant thrombomodulin in sepsis). 2. SIB Therapeutics LLC (developing a sepsis drug). 3. Ferring Pharmaceuticals (manufactures vasopressin and developing selepressin). No longer actively consulting for the following: 4. La Jolla Pharmaceuticals (developing angiotensin II; Dr. Russell chaired the DSMB of a trial of angiotensin II from 2015 - 2017) - no longer actively consulting. 5. Cubist Pharmaceuticals (now owned by Merck; formerly was Trius Pharmaceuticals; developing antibiotics) – no longer actively consulting. 6. Grifols (sells albumin) - no longer actively consulting. 7. CytoVale Inc. (developing a sepsis diagnostic) - no longer actively consulting. 8. PAR Pharma (sells prepared bags of vasopressin) - no longer actively consulting. Dr. Russell reports having received an investigator-initiated grant from Grifols (entitled “Is HBP a mechanism of albumin’s efficacy in human septic shock?”) that was provided to and administered by UBC. Ethics Approval Statement: UK Biobank Cohort 1 was approved by the UK Biobank (ID: 42857) and by the Clinical Research Ethics Board of the University of British Columbia. Single Centre Cohort 2 was approved by the Institutional Review Board of St. Paul’s Hospital and the University of British Columbia. The Inflammation Mechanism Cohort 3 was approved by each participating hospital. Lipid Mechanism Cohort 4 was approved by the Institutional Review Board of St. Paul’s Hospital and the University of British Columbia. For each study written informed consent was obtained from patients, next of kin or surrogate decision maker.

PSEN1 and NUP98 as Diagnostic Biomarkers for Human Myocarditis

BackgroundMyocarditis, inflammation of the myocardium not associated with ischemia, is a spectrum of conditions causing considerable morbidity and mortality. The etiologies known to drive such inflammation are diverse and include autoimmunity and drug hypersensitivity, but are most commonly attributed to cardiotropic viral infections. Clinical symptoms are also variable, ranging from life threatening acute illness to chronic disease, while others never come to clinical attention. Moreover, these factors make the frequency of myocarditis difficult to ascertain, however, an estimated 9% of adult autopsies show myocarditis on histologic examination. Given the tools presently available, clinical, etiologic and hitstologic variability make diagnosis, and therefore treatment, exceedingly difficult. The current gold standard of diagnosis is inflammation shown on endomyocardial biopsy with (“active”) or without (“borderline”) myocyte damage. However, under these criteria, myocarditis diagnostic sensitivity is estimated as low as 30%. To improve upon this, we examined several markers implicated in the pathogenesis of viral myocarditis in animal models as possible adjunct diagnostic biomarkers in human myocarditis. PSEN1, a cellular protease implicated in heart failure and NUP98, a nuclear pore protein with inducible cardioprotective and antiviral gene transcription capabilities, have emerged as promising candidates.DesignTwo groups were examined for PSEN1 and NUP98 immunohistochemical (IHC) staining: a development set of 50 cases (18 lymphocytic active or healing myocarditis, 4 eosinophilic myocarditis, 4 idiopathic dilated cardiomyopathy, 3 hypertrophic cardiomyopathy, 4 sarcoidosis, 3 transplant rejection, 1 toxoplasmosis, 4 arrhythmogenic right ventricular cardiomyopathy (ARVC), 4 coronary artery disease (CAD) and 5 normal controls) and a validation set of all (62) cardiac biopsies performed at SPH from January 2015–June 2016, irrespective of diagnosis. Staining intensity was assessed by computer aided image analysis. Statistical analysis was performed using Mann Whitney U test and receiver operating characteristic (ROC) curves. All protocols were approved by the UBC/PHCRI Research Ethics Board.ResultsPSEN1 distinguished myocarditis from all other diagnoses in the development set (p=0.0001). NUP98 could distinguish inflammatory myocarditides as well as viral from non‐viral from most other diagnoses in the development set (p=0.001). ROC values comparing myocarditis to all other cardiomyopathies was 0.85 for PSEN1 and 0.80 for NUP98. These findings appear hold true in preliminary analyses of the validation set.ConclusionPSEN1 and NUP98 appear to be valuable biomarkers, particularly in combination, for improving sensitivity of endomyocardial biopsy for diagnosing myocarditis, and may provide greater ability to deduce etiologic information from such biopsies. Moreover, PSEN1 and NUP98 are detectable even in regions even without inflammation and in tissue long after initial insult. These insights will aid in personalization of treatment and significantly improve clinical outcomes.Support or Funding InformationThis research is funded by the Providence Health Care Research Institute and through donations made to the St. Paul's Hospital Foundation.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial.

CKD is characterized by remarkably high hospitalization and readmission rates. Our study aim was to test a medication therapy management intervention to reduce subsequent acute care utilization. The CKD Medication Intervention Trial was a single-blind (investigators), randomized clinical trial conducted at Providence Health Care in Spokane, Washington. Patients with CKD stages 3-5 not treated by dialysis who were hospitalized for acute illness were recruited. The intervention was designed to improve posthospitalization care by medication therapy management. A pharmacist delivered the intervention as a single home visit within 7 days of discharge. The intervention included these fundamental elements: comprehensive medication review, medication action plan, and a personal medication list. The primary outcome was a composite of acute care utilization (hospital readmissions and emergency department and urgent care visits) for 90 days after hospitalization. Baseline characteristics of participants (n=141) included the following: age, 69±11 (mean±SD) years old; women, 48% (67 of 141); diabetes, 56% (79 of 141); hypertension, 83% (117 of 141); eGFR, 41±14 ml/min per 1.73 m2 (serum creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation); and urine albumin-to-creatinine ratio median, 43 mg/g (interquartile range, 8-528) creatinine. The most common primary diagnoses for hospitalization were the following: cardiovascular events, 36% (51 of 141); infections, 18% (26 of 141); and kidney diseases, 12% (17 of 141). The primary outcome occurred in 32 of 72 (44%) of the medication intervention group and 28 of 69 (41%) of those in usual care (log rank P=0.72). For only hospital readmission, the rate was 19 of 72 (26%) in the medication intervention group and 18 of 69 (26%) in the usual care group (log rank P=0.95). There was no between-group difference in achievement of guideline-based goals for use of renin-angiotensin system inhibition or for BP, hemoglobin, phosphorus, or parathyroid hormone. Acute care utilization after hospitalization was not reduced by a pharmacist-led medication therapy management intervention at the transition from hospital to home.

Childhood sexual abuse among men who have sex with men in urban north China: a cross-sectional survey

BackgroundChildhood sexual abuse is associated with HIV vulnerabilities and psychological distress. Research indicates that childhood sexual abuse is also more common among sexual minorities. However, there is limited research into childhood sexual abuse among sexual minorities in China. We describe the prevalence and correlates of penetrative childhood sexual abuse among men who have sex with men (MSM) in urban north China. MethodsData were collected from July 4, 2013, to March 23, 2014, by anonymous, self-administered, structured questionnaires at MSM HIV testing clinics in Beijing and Tianjin, China. Participants were also recruited via peer referral, gay websites, and community-based organisations. Penetrative childhood sexual abuse was defined as being forced to have sex with someone before age 16 years. Logistic regression was used to assess measures of association. Study protocols were reviewed and approved by the National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, and the Providence Health Care Research Institute, University of British Columbia. FindingsOut of 400 respondents, the prevalence of penetrative childhood sexual abuse was 5% (20/400). Median age at experience of penetrative childhood sexual abuse was 13 years (IQR 5 years). 85% (17/20) of perpetrators were older than the survivor (on average older by 7·5 years [SD 5·34]). Median length of relationship between the perpetrator and survivor was 3 months (IQR 24 months). Penetrative childhood sexual abuse was associated with migrant status (crude odds ratio [cOR] 3·65, 95% CI 1·04–12·55) and living with one's wife (4·09, 1·25–13·41). Pre-teen penetrative childhood sexual abuse was associated with Christian religious affiliation (cOR 7·24, 95% CI 1·40–37·30), particularly Catholic religious affiliation (11·71, 1·08–127·16). No significant associations were detected between penetrative childhood sexual abuse and HIV infection, unprotected sex, depression, or anxiety. InterpretationWe found that prevalence of penetrative childhood sexual abuse among urban Chinese MSM in urban North China was lower than in studies among MSM in North America, but higher than studies among Chinese males overall. These findings could help inform interventions to decrease childhood sexual abuse among sexual minority males in China. FundingMinistry of Science and Technology of China (2012ZX10004-904), the US Fulbright Program, and the Liu Institute for Global Issues.

Medication Intervention for Chronic Kidney Disease Patients Transitioning from Hospital to Home: Study Design and Baseline Characteristics

Background: The hospital readmission rate in the population with chronic kidney disease (CKD) is high and strategies to reduce this risk are urgently needed. Methods: The CKD-Medication Intervention Trial (CKD-MIT; www.clinicaltrials.gov; NCTO1459770) is a single-blind (investigators), randomized, clinical trial conducted at Providence Health Care in Spokane, Washington. Study participants are hospitalized patients with CKD stages 3-5 (not treated with kidney replacement therapy) and acute illness. The study intervention is a pharmacist-led, home-based, medication management intervention delivered within 7 days after hospital discharge. The primary outcome is a composite of hospital readmissions and visits to emergency departments and urgent care centers for 90 days following hospital discharge. Secondary outcomes are achievements of guideline-based targets for CKD risk factors and complications. Results: Enrollment began in February 2012 and ended in May 2015. At baseline, the age of participants was 69 ± 11 years (mean ± SD), 50% (77 of 155) were women, 83% (117 of 141) had hypertension and 56% (79 of 141) had diabetes. At baseline, the estimated glomerular filtration rate was 41 ± 14 ml/min/1.73 m² and urine albumin-to-creatinine ratio was 43 mg/g (interquartile range 8-528 mg/g). The most frequent diagnosis category for the index hospital admission was cardiovascular diseases at 34% (53 of 155), but the most common single diagnosis for admission was community-acquired acute kidney injury at 10% (16 of 155). Conclusion: Participants in CKD-MIT are typical of acutely ill hospitalized patients with CKD. A medication management intervention after hospital discharge is under study to reduce post-hospitalization acute care utilization and to improve CKD management.

Practice-based Research Program Promotes Dietitians' Participation in Research.

Barriers to dietitians' participation in research include lack of time, self-perceived competence, confidence, administrative support, and funding. Providence Health Care, a multi-site health care organization in Vancouver, British Columbia implemented the Practice-based Research Challenge (RC), a 1-year research program, to support interdisciplinary teams of nurses and allied health professionals to conduct practice-relevant research projects. Funding, mentoring, and research education were provided to research teams. From 2011 to 2015, 37% of all dietitians in the organization were involved in the RC in 4 cohorts of the 1-year program. An online survey was conducted to understand these dietitians' interest and experience in the RC. The survey results indicated that the major reasons for participating in the program were to increase knowledge, improve patient care, and to work on a project of interest. Respondents thought they gained knowledge, enhanced professional development, and improved patient care. A majority stated they would likely conduct future research. The RC enabled and supported dietitians' participation in research; infrastructure supports for research and enabling a culture of research participation are key contributors to promoting dietitians involvement in research.

Pulse wave velocity measurements in moderate to severe chronic obstructive pulmonary disease: A test–retest reliability study

a Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada b School of Kinesiology, University of British Columbia, Vancouver, Canada c Providence Health Care, University of British Columbia, Vancouver, Canada d Department of Internal Medicine, University of British Columbia, Vancouver, Canada e Department of Physical Therapy, University of Toronto, Vancouver, Canada f Division of Cardiology, University of British Columbia, Vancouver, Canada g Department of Physical Therapy, University of British Columbia, Vancouver, Canada