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3. Recommendation Reversals in Gastroenterology Clinical Practice Guidelines

Author

Gholami, Reza, Khan, Rishad, Ramkissoon, Anushka, Alabdulqader, Abdulrahman, Gimpaya, Nikko, Bansal, Rishi, Scaffidi, Michael A, Prasad, Vinay, Detsky, Allan S, Baker, Jeffrey P, and Grover, Samir C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical practice guidelines, Evidence-based medicine, Quality of care, Clinical sciences
Abstract

BackgroundRecommendations in clinical practice guidelines (CPGs) may be reversed when evidence emerges to show they are futile or unsafe. In this study, we identified and characterized recommendation reversals in gastroenterology CPGs.MethodsWe searched CPGs published by 20 gastroenterology societies from January 1990 to December 2019. We included guidelines which had at least two iterations of the same topic. We defined reversals as when (a) the more recent iteration of a CPG recommends against a specific practice that was previously recommend in an earlier iteration of a CPG from the same body, and (b) the recommendation in the previous iteration of the CPG is not replaced by a new diagnostic or therapeutic recommendation in the more recent iteration of the CPG. The primary outcome was the number of recommendation reversals. Secondary outcomes included the strength of recommendations and quality of evidence cited for reversals.ResultsTwenty societies published 1022 CPGs from 1990 to 2019. Our sample for analysis included 129 unique CPGs. There were 11 recommendation reversals from 10 guidelines. New evidence was presented for 10 recommendation reversals. Meta-analyses were cited for two reversals, and randomized controlled trials (RCTs) for seven reversals. Recommendations were stronger after the reversal for three cases, weaker in two cases, and of similar strength in three cases. We were unable to compare recommendation strengths for three reversals.ConclusionRecommendation reversals in gastroenterology CPGs are uncommon but highlight low value or harmful practices.

Published
2022

5. Association Between Anesthesiologist Sex and Patients’ Postoperative Outcomes: A Population-based Cohort Study

Author

Jerath, Angela, Satkunasivam, Raj, Kaneshwaran, Kirusanthy, Aminoltejari, Khatereh, Chang, Ashton, MacDonell, D. Su-Yin, Kealey, Alayne, Ladowski, Stephanie, Sarmah, Anita, Flexman, Alana M., Lorello, Gianni R., Nabecker, Sabine, Coburn, Natalie, Conn, Lesley G., Klaassen, Zachary, Ranganathan, Sanjana, Riveros, Carlos, McCartney, Colin J.L., Detsky, Allan S., and Wallis, Christopher J.D.

Published
2024
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6. Superstition in Surgery: A Population-Based Cohort Study to Assess the Association Between Surgery on Friday the 13th and Postoperative Outcomes

Author

Ranganathan, Sanjana, Riveros, Carlos, Geng, Michael, Chang, Courtney, Tsugawa, Yusuke, Ravi, Bheeshma, Melchiode, Zachary, Hu, Siqi, Kobashi, Kathleen, Miles, Brian J., Klaassen, Zachary, Nathens, Avery, Coburn, Natalie, Detsky, Allan S., Jerath, Angela, Wallis, Christopher J. D., and Satkunasivam, Raj

Published
2024
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8. The association between physician trust and prostate-specific antigen screening: Implications for shared decision-making

Author

Klaassen, Zachary, Wallis, Christopher JD, Goldberg, Hanan, Chandrasekar, Thenappan, Fleshner, Neil E, Finelli, Antonio, Kulkarni, Girish S, Detsky, Allan S, and Satkunasivam, Raj

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Cancer, Clinical Research, Prostate Cancer, Aging, Urologic Diseases, Urology & Nephrology, Clinical sciences, Oncology and carcinogenesis
Abstract

IntroductionShared decision-making is widely recommended when men are considering prostate cancer screening with prostate-specific antigen (PSA). The role of patients' trust in cancer information from their physician in such decisions is unknown.MethodsWe identified male respondents ≥18 years of age from the Health Information National Trends Survey, a population-based survey of people living in the U.S. (2011-014). We assessed the association between degree of trust in cancer information from respondent's physician with patient-reported receipt of PSA-screening and patient-reported discussion of PSA screening with their physician.ResultsAmong 5069 eligible respondents, 3606 (71.1%) men reported trusting cancer information from their physician "a lot," 1186 (23.4%) "somewhat," 219 (4.3%) "a little," and 58 (1.1%) "not at all." A total of 2655 (52.4%) men reported receiving PSA screening. The degree of trust an individual had in his physician for cancer information was strongly associated with his likelihood of having received PSA screening (ptrend

Published
2018

11. Association of virtual end-of-life care with healthcare outcomes before and during the COVID-19 pandemic: A population-based study

Author

Lapp, John M., primary, Stukel, Thérèse A., additional, Chung, Hannah, additional, Bell, Chaim M., additional, Bhatia, R. Sacha, additional, Detsky, Allan S., additional, Downar, James, additional, Isenberg, Sarina R., additional, Lee, Douglas S., additional, Stall, Nathan, additional, Tanuseputro, Peter, additional, and Quinn, Kieran L., additional

Published
2024
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15. Association Between Surgeon and Anesthesiologist Sex Discordance and Postoperative Outcomes: A Population-based Cohort Study

Author

Wallis, Christopher J. D., Jerath, Angela, Kaneshwaran, Kirusanthy, Hallet, Julie, Coburn, Natalie, Wright, Frances C., Conn, Lesley Gotlib, Bischof, Danielle, Covelli, Andrea, Klaassen, Zachary, Zlotta, Alexandre R., Kulkarni, Girish S., Luckenbaugh, Amy N., Armstrong, Kathleen, Lim, Kelvin, Bass, Barbara, Detsky, Allan S., and Satkunasivam, Raj

Published
2022
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17. Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures

Author

Wallis, Christopher J. D., primary, Jerath, Angela, additional, Aminoltejari, Khatereh, additional, Kaneshwaran, Kirusanthy, additional, Salles, Arghavan, additional, Buntin, Melinda Beeuwkes, additional, Coburn, Natalie G., additional, Wright, Frances C., additional, Gotlib Conn, Lesley, additional, Heybati, Kiyan, additional, Luckenbaugh, Amy N., additional, Ranganathan, Sanjana, additional, Riveros, Carlos, additional, McCartney, Colin, additional, Armstrong, Kathleen A., additional, Bass, Barbara L., additional, Detsky, Allan S., additional, and Satkunasivam, Raj, additional

Published
2023
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19. Association between patient-surgeon gender concordance and mortality after surgery in the United States: retrospective observational study

Author

Wallis, Christopher JD, primary, Jerath, Angela, additional, Ikesu, Ryo, additional, Satkunasivam, Raj, additional, Dimick, Justin B, additional, Orav, E John, additional, Maggard-Gibbons, Melinda, additional, Li, Ruixin, additional, Salles, Arghavan, additional, Klaassen, Zachary, additional, Coburn, Natalie, additional, Bass, Barbara L, additional, Detsky, Allan S, additional, and Tsugawa, Yusuke, additional

Published
2023
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23. Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures.

Author

Wallis, Christopher J. D., Jerath, Angela, Aminoltejari, Khatereh, Kaneshwaran, Kirusanthy, Salles, Arghavan, Buntin, Melinda Beeuwkes, Coburn, Natalie G., Wright, Frances C., Gotlib Conn, Lesley, Heybati, Kiyan, Luckenbaugh, Amy N., Ranganathan, Sanjana, Riveros, Carlos, McCartney, Colin, Armstrong, Kathleen A., Bass, Barbara L., Detsky, Allan S., and Satkunasivam, Raj

Published
2024
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25. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries

Author

Wallis, Christopher J. D., primary, Jerath, Angela, additional, Aminoltejari, Khatereh, additional, Kaneshwaran, Kirusanthy, additional, Salles, Arghavan, additional, Coburn, Natalie, additional, Wright, Frances C., additional, Gotlib Conn, Lesley, additional, Klaassen, Zachary, additional, Luckenbaugh, Amy N., additional, Ranganathan, Sanjana, additional, Riveros, Carlos, additional, McCartney, Colin, additional, Armstrong, Kathleen, additional, Bass, Barbara, additional, Detsky, Allan S., additional, and Satkunasivam, Raj, additional

Published
2023
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27. The risk of death within 5 years of first hospital admission in older adults

Author

Quinn, Kieran L., Stall, Nathan M., Yao, Zhan, Stukel, Therese A., Cram, Peter, Detsky, Allan S., and Bell, Chaim M.

Subjects
Ontario. Ministry of Health and Long-Term Care, Hospital admission and discharge, Health counseling, Health
Abstract

BACKGROUND: The risk of death in people after their first admission to hospital or first presentation to the emergency department for any reason is not known. The objective of this study was to estimate the risk of death among older adults who had had no admissions to hospital or emergency department visits in the preceding 5 years. METHODS: We used administrative data from Ontario, Canada, from 2007 to 2017 to measure the 5-year risk of death in community-dwelling adults aged 66 years and older after their first planned or unplanned hospital admission or emergency department visit, and among those who were neither admitted to hospital nor presented to the emergency department. We describe how this risk varied by age. RESULTS: Among 922 074 community-dwelling older adults, 12.7% died (116 940 deaths) over a follow-up of 3 112528 person-years (standardized mortality rate 53.8 per 1000 person-years). After the first unplanned hospital admission, 39.7% died (59234 deaths, standardized mortality rate 127.6 per 1000 person-years). After the first planned hospital admission, 13.0% died (10 775 deaths, standardized mortality rate 44.6 per 1000 person-years). After the first visit to the emergency department, 10.9% died (35 663 deaths, standardized mortality rate 36.2 per 1000 person-years). Among those with neither an emergency department visit nor hospital admission during follow-up, 3.1% died (11268 deaths, standardized mortality rate 29.6 per 1000 person-years). Slightly more than half of all deaths were in those with first unplanned hospital admission (50.7%). INTERPRETATION: Death within 5 years of first unplanned hospital admission for older adults is frequent and common. Knowledge of this risk may influence counselling and patient preferences and may be useful in research and analyses for health system planning., More than 420 million hospital admissions occur every year around the world. (1) Short-term prognosis is favourable; most people survive beyond admission. In North American adults, all-cause 1-year mortality after [...]

Published
2019
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29. Comparison of Medical and Mental Health Sequelae Following Hospitalization for COVID-19, Influenza, and Sepsis

Author

Quinn, Kieran L., primary, Stukel, Thérèse A., additional, Huang, Anjie, additional, Abdel-Qadir, Husam, additional, Altaf, Azmina, additional, Bell, Chaim M., additional, Cheung, Angela M., additional, Detsky, Allan S., additional, Goulding, Susie, additional, Herridge, Margaret, additional, Ivers, Noah, additional, Lapointe-Shaw, Lauren, additional, Lapp, John, additional, McNaughton, Candace D., additional, Raissi, Afsaneh, additional, Rosella, Laura C., additional, Warda, Nahrain, additional, Razak, Fahad, additional, and Verma, Amol A., additional

Published
2023
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42. Looking Back

Author

Glick, Lauren, primary, Fitzpatrick, Laura A., additional, Detsky, Allan S., additional, and Rush, Raphael P., additional

Published
2022
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49. Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes

Author

Wallis, Christopher J. D., primary, Jerath, Angela, additional, Coburn, Natalie, additional, Klaassen, Zachary, additional, Luckenbaugh, Amy N., additional, Magee, Diana E., additional, Hird, Amanda E., additional, Armstrong, Kathleen, additional, Ravi, Bheeshma, additional, Esnaola, Nestor F., additional, Guzman, Jonathan C. A., additional, Bass, Barbara, additional, Detsky, Allan S., additional, and Satkunasivam, Raj, additional

Published
2022
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50. Predicting low testosterone in aging men: a systematic review

Author

Millar, Adam C., Lau, Adrian N.C., Tomlinson, George, Kraguljac, Alan, Simel, David L., Detsky, Allan S., and Lipscombe, Lorraine L.

Subjects
Impotence -- Diagnosis -- Comparative analysis -- Research -- Risk factors, Aged men -- Research -- Health aspects, Hypogonadism -- Research -- Causes of, Testosterone -- Comparative analysis -- Research -- Health aspects, Health
Abstract

Background: Physicians diagnose and treat suspected hypogonadism in older men by extrapolating from the defined clinical entity of hypogonadism found in younger men. We conducted a systematic review to estimate the accuracy of clinical symptoms and signs for predicting low testosterone among aging men. Methods: We searched the MEDLINE and Embase databases (January 1966 to July 2014) for studies that compared clinical features with a measurement of serum testosterone in men. Three of the authors independently reviewed articles for inclusion, assessed quality and extracted data. Results: Among 6053 articles identified, 40 met the inclusion criteria. The prevalence of low testosterone ranged between 2% and 77%. Threshold testosterone levels used for reference standards also varied substantially. The summary likelihood ratio associated with decreased libido was 1.6 (95% confidence interval [CI] 1.31.9), and the likelihood ratio for absence of this finding was 0.72 (95% CI 0.58-0.85). The likelihood ratio associated with the presence of erectile dysfunction was 1.5 (95% CI 1.3-1.8) and with absence of erectile dysfunction was 0.83 (95% CI 0.76-0.91). Of the multiple-item instruments, the ANDROTEST showed both the most favourable positive likelihood ratio (range 1.9-2.2) and the most favourable negative likelihood ratio (range 0.37-0.49). Interpretation: We found weak correlation between signs, symptoms and testosterone levels, uncertainty about what threshold testosterone levels should be considered low for aging men and wide variation in estimated prevalence of the condition. It is therefore difficult to extrapolate the method of diagnosing pathologic hypogonadism in younger men to clinical decisions regarding age-related testosterone decline in aging men., Male hypogonadism is defined as the presence of low serum testosterone and spermatozoa levels, accompanied by clinical signs and symptoms. (1) The Endocrine Society divides the symptoms and signs of [...]

Published
2016
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