CMAJ open
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Hypothermia can result from exposure to cold or as a consequence of underlying physiologic vulnerabilities. Who, where, when and how British Columbians (and Canadians) die of hypothermia have received little research attention. The objective of this study was to describe the epidemiology of mortality due to hypothermia among residents of British Columbia. ⋯ Our results showed that older people are at higher risk of hypothermia-related death. Among residents of British Columbia who died of hypothermia, the most frequent additional causes of death were alcohol and nonalcohol psychoactive substances. However, further assessment of both the occurrence and determinants of mortality due to hypothermia are needed to inform measures to reduce its impact.
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The use of prasugrel or ticagrelor as part of dual antiplatelet therapy with acetylsalicylic acid after acute coronary syndrome (ACS) improves clinical outcomes relative to clopidogrel. The relative cost-effectiveness of these agents are unknown. We conducted an economic analysis evaluating 12 months of treatment with clopidogrel, prasugrel or ticagrelor after ACS. ⋯ Ticagrelor was the most cost-effective agent when used as part of dual antiplatelet therapy after ACS. This conclusion was robust to wide variations in model parameters.
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Characteristics of patients receiving long-term opioid therapy (≥ 6 months) for chronic noncancer pain are poorly understood. We conducted a cross-sectional survey of this patient population to explore demographic variables, pain relief, functional improvement, adverse effects and impressions of an educational pamphlet on long-term opioid therapy. ⋯ Most outpatients receiving long-term opioid therapy for chronic noncancer pain at a tertiary care chronic pain clinic reported at least moderate pain relief and functional improvement; however, adverse effects were common and few patients were engaged in competitive employment.
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Regional variation in the use of surgery implies that there is uncertainty regarding appropriate use. The objectives of this study were to identify which surgical procedures are most commonly performed in the province of Ontario and measure the extent of variation in the use of surgical procedures across Ontario counties. ⋯ Colonoscopy was the most commonly performed procedure in Ontario, and cataract extraction was the most common surgical procedure. Procedures with the highest measures of variation between counties tended to be those that occurred less commonly in Ontario, and common procedures were associated with less regional variation.
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Postoperative antibiotic prophylaxis is currently the standard of care for patients undergoing total hip and knee arthroplasty. We evaluated the evidence for this practice in the reduction of surgical-site infections. ⋯ The available evidence did not show efficacy of postoperative antibiotic prophylaxis for the prevention of surgical-site infections in patients undergoing total hip or knee arthroplasty. Multicentred RCTs are likely to have an important impact on the confidence in the effect estimate and to change the estimate itself.