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Acceptance and safety of directly observed versus self-administered isoniazid preventive therapy in aboriginal peoples in British Columbia.

https://arctichealth.org/en/permalink/ahliterature203522
Source
Int J Tuberc Lung Dis. 1998 Dec;2(12):979-83
Publication Type
Article
Date
Dec-1998
Author
G. Heal
R K Elwood
J M FitzGerald
Author Affiliation
BC Centre for Disease Control Society, Ministry of Health and Respiratory Medicine, University of British Columbia, Vancouver, Canada.
Source
Int J Tuberc Lung Dis. 1998 Dec;2(12):979-83
Date
Dec-1998
Language
English
Publication Type
Article
Keywords
Adult
Antitubercular Agents - administration & dosage
British Columbia
Female
Humans
Indians, North American
Isoniazid - administration & dosage
Male
Middle Aged
Patient Acceptance of Health Care
Retrospective Studies
Self Administration
Tuberculosis, Pulmonary - prevention & control
Abstract
To document experience with directly observed chemoprophylaxis (DOPT) compared to self-administered isoniazid (INH) among aboriginal persons in British Columbia.
DOPT was compared to self-administered delivery (SAD) over a 3-year period. All aboriginal persons who received INH chemoprophylaxis in British Columbia between 1992 and 1994 were evaluated. Therapy completion rates and adverse outcomes associated with SAD were compared with DOPT. Treatment allocation was by patient choice.
Of 608 people who received INH prophylaxis, 443 received SAD (mean age 31.6 years) and 165 received DOPT (mean age 23.9 years). Two hundred and seventy (60.9%) SAD compared to 124 (75.2%) in the DOPT group completed 6 months of INH (P = 0.0011). The 12-month completion rates were 162/443 (36.6%) for the SAD group and 84/165 (50.9%) for the DOPT group (P = 0.0014). Adverse reactions requiring discontinuation of medication occurred in 13.5% of the patients on SAD and 9.7% of those receiving DOPT (P = 0.202). The most common reason cited for failure to complete therapy was non-cooperation in both groups. There were three deaths in the SAD group, one of which was due to suicide by self-ingestion of INH.
These data demonstrate that in aboriginal people compliance with preventive therapy can be improved by DOPT. Non random allocation to treatment groups might have influenced our findings, and further prospective randomized trials and cost-effectiveness analyses are required.
PubMed ID
9869112 View in PubMed
Less detail

Acute asthma: emergency department management and prospective evaluation of outcome.

https://arctichealth.org/en/permalink/ahliterature229449
Source
CMAJ. 1990 Mar 15;142(6):591-5
Publication Type
Article
Date
Mar-15-1990
Author
J M Fitzgerald
F E Hargreave
Author Affiliation
Firestone Regional Chest and Allergy Unit, St. Joseph's Hospital, Hamilton, Ont.
Source
CMAJ. 1990 Mar 15;142(6):591-5
Date
Mar-15-1990
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adrenal Cortex Hormones - administration & dosage - therapeutic use
Adrenergic beta-Agonists - administration & dosage - therapeutic use
Adult
Asthma - diagnosis - drug therapy - physiopathology
Emergencies
Emergency Service, Hospital - utilization
Evaluation Studies as Topic
Female
Follow-Up Studies
Forced expiratory volume
Humans
Male
Medical History Taking
Middle Aged
Ontario
Prednisone - therapeutic use
Prognosis
Questionnaires
Recurrence
Retrospective Studies
Spirometry
Abstract
To determine the current management of acute asthma in the emergency department and to evaluate outcome we reviewed the charts of 99 patients aged 15 to 55 years who presented to the emergency department of a tertiary referral, university-affiliated hospital and were subsequently discharged with a diagnosis of acute asthma. Outcome was evaluated prospectively, with a structured questionnaire, by telephone. During the visit pulsus paradoxus was documented in four patients. Spirometry was done in 63 patients; postbronchodilator values ranged from 0.9 to 4.1 L. A total of 92 patients received inhaled bronchodilator therapy, most by wet nebulization. Sixteen patients received anticholinergic agents and three received theophylline. Ingested corticosteroids were given to 27 patients. Of the 71 patients contacted, a mean of 12 days after the visit, 26 (37%) had sought further medical attention, 19 at the emergency department; 9 had required admission. Forty-six patients reported that their condition had improved, but over 60% continued to have cough, sputum production, nocturnal waking and early-morning chest tightness. The results indicate that asthma continues to be undertreated in the emergency department and highlight the importance of routine spirometry in all patients and the need for systemic corticosteroid therapy.
Notes
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Comment In: CMAJ. 1990 Sep 15;143(6):459-602207896
Comment In: CMAJ. 1990 Jun 1;142(11):1183, 1186-72344573
PubMed ID
1968778 View in PubMed
Less detail

BCG vaccination and the prevalence of latent tuberculosis infection in an aboriginal population.

https://arctichealth.org/en/permalink/ahliterature166082
Source
Int J Tuberc Lung Dis. 2006 Dec;10(12):1347-53
Publication Type
Article
Date
Dec-2006
Author
V J Cook
L. Kuramoto
K. Noertjojo
R K Elwood
J M Fitzgerald
Author Affiliation
Department of Tuberculosis Control, British Columbia Centre for Disease Control (BCCDC), Vancouver, Canada. victoria.cook@bccdc.ca
Source
Int J Tuberc Lung Dis. 2006 Dec;10(12):1347-53
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
BCG Vaccine - therapeutic use
British Columbia - epidemiology
Child
Female
Humans
Male
Middle Aged
Population
Prevalence
Retrospective Studies
Tuberculin Test
Tuberculosis, Pulmonary - epidemiology - prevention & control
Vaccination
Abstract
Estimations of prevalence of latent tuberculous infection (LTBI) are confounded by factors known to influence the results of the tuberculin skin test (TST) such as age, contact history and bacille Calmette-Guerin (BCG) vaccination. Appropriate interpretation of TST results is necessary to ensure LTBI treatment for those at greatest risk.
To document the prevalence of LTBI in Aboriginal people living on a reserve in British Columbia (BC) and to determine the influence of BCG.
A population-based, retrospective descriptive analysis of all epidemiological data collected for the on-reserve Aboriginal programme in BC (1951-1996).
Of 17615 persons who received a TST during the study period, 42% had received BCG. During the study period, an average of 2517 TSTs were completed per year (SD = 1228) among persons with an average age of 26 years (SD = 16). Among all subjects, the average prevalence of LTBI was 25% (95 %CI 24-25). The presence of BCG (OR = 3.1, 95%CI 2.8-3.4) and multiple BCGs (OR = 10.2, 95%CI 7.7-13.6) were both associated with a positive TST. A positive TST was also associated with a shorter duration in years between the most recent BCG and the TST.
The average prevalence of LTBI in a sequential sample of Aboriginal people living on a reserve in BC was estimated at 25%. BCG, especially in multiple doses, increased the likelihood of a positive TST.
PubMed ID
17167951 View in PubMed
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Can age and sex explain the variation in COPD rates across large urban cities? A population study in Canada.

https://arctichealth.org/en/permalink/ahliterature129337
Source
Int J Tuberc Lung Dis. 2011 Dec;15(12):1691-8
Publication Type
Article
Date
Dec-2011
Author
W C Tan
J. Bourbeau
J M FitzGerald
R. Cowie
K. Chapman
P. Hernandez
S A Buist
D D Sin
Author Affiliation
University of British Columbia James Hogg Research Laboratories, Providence Heart and Lung Institute, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. wan.tan@hli.ubc.ca
Source
Int J Tuberc Lung Dis. 2011 Dec;15(12):1691-8
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Canada - epidemiology
Female
Humans
Male
Middle Aged
Population Surveillance - methods
Prevalence
Pulmonary Disease, Chronic Obstructive - epidemiology - etiology - physiopathology
Questionnaires
Risk factors
Severity of Illness Index
Sex Distribution
Smoking - epidemiology
Spirometry
Urban Population - statistics & numerical data
Abstract
To measure the prevalence of chronic obstructive pulmonary disease (COPD) and determine the effect of age and sex on the variation in prevalence across major cities within the same country and health care system.
We used the Burden of Obstructive Lung Disease (BOLD) methodology to estimate the prevalence of COPD in adults aged = 40 years in different Canadian cities. The study used interviewer-administered questionnaires on respiratory, smoking and occupational history, medication use and comorbidities. Post-bronchodilator spirometry was used to classify subjects. We determined the prevalence and severity of COPD with and without adjustments for age and sex distribution across different cities.
The study population was 3042. Overall, 16.7% (95%CI 14.8-18.7) of study subjects met the criteria for Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity Stage 1 or higher. The prevalence according to the criteria for the lower limits of normal of the ratio forced expiratory volume in 1 second/forced vital capacity was 11.6% (95%CI 9.9-13.3). COPD prevalence varied by severity across site (P = 0.0025). After age-sex adjustment, the variation disappeared (P> 0.16).
Age and sex differences account for most of the heterogeneity in COPD estimates across large cities within the same country. Adjustments for age and sex are essential in comparing COPD rates across the country.
Notes
Comment In: Int J Tuberc Lung Dis. 2012 May;16(5):709-10; author reply 71022507944
PubMed ID
22118181 View in PubMed
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Comparison of males and females presenting with acute asthma to the emergency department.

https://arctichealth.org/en/permalink/ahliterature211206
Source
Respir Med. 1996 Sep;90(8):485-9
Publication Type
Article
Date
Sep-1996
Author
N. Awadh
S. Chu
A. Grunfeld
K. Simpson
J M FitzGerald
Author Affiliation
Department of Medicine, University of British Columbia, Vancouver, Canada.
Source
Respir Med. 1996 Sep;90(8):485-9
Date
Sep-1996
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Asthma - epidemiology - physiopathology
Canada
Emergency Service, Hospital
Female
Humans
Lung - physiopathology
Male
Middle Aged
Patient Acceptance of Health Care
Retrospective Studies
Sex Distribution
Spirometry
Abstract
To determine the female:male ratio and compare the severity of asthma between female and male patients presenting with acute asthma to the authors' emergency department (ED).
Patients aged 15-50 years presenting with acute asthma.
Emergency department of a university-affiliated hospital.
Retrospective analysis of asthma surveillance data and medical records of all asthma-related visits to ED over 6 months (January 1992-June 1992).
One hundred and thirty-seven patients aged 15-50 years made 196 consecutive visits to the authors' ED over 6 months. The ratio of female:male patients was 1.9 and the ratio of the number of visits made by female vs. male patients was 2.6. Initial peak expiratory flow rate (PEFR) and forced expiratory volume in 1 s (FEV1) were recorded in 94% and 49% of the visits, respectively. There was no statistically significant difference between the male and female patients in heart rate, respiratory rate or percentage of patients admitted to hospital. The mean (SD) initial FEV1 as a percentage of predicted was significantly higher in females compared to males (49% +/- 20% vs. 33% +/- 15%; P
PubMed ID
8869443 View in PubMed
Less detail

A cost-effectiveness analysis of the routine use of isoniazid prophylaxis in patients with a positive Mantoux skin test.

https://arctichealth.org/en/permalink/ahliterature228336
Source
Am Rev Respir Dis. 1990 Oct;142(4):848-53
Publication Type
Article
Date
Oct-1990
Author
J M Fitzgerald
A. Gafni
Author Affiliation
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Source
Am Rev Respir Dis. 1990 Oct;142(4):848-53
Date
Oct-1990
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Child
Cost-Benefit Analysis
Humans
Isoniazid - adverse effects - therapeutic use
Middle Aged
Tuberculin Test
Tuberculosis, Pulmonary - diagnosis - economics - prevention & control
Abstract
The role of isoniazid prophylaxis in low-risk patients with positive Mantoux skin tests has recently been questioned. In general, recent research has focused on the risk/benefit ratio. We, therefore, decided to extend these data and apply a cost-effectiveness analysis of the routine use of isoniazid prophylaxis from a societal perspective. Costs per case prevented were calculated for a 20-, 50-, and 70-yr-old low-risk patient who had a positive Mantoux test with base, high, and low costings. Rates were also calculated based on the use of direct costs alone and direct and indirect costs combined. Costs varied from Canadian $8,586.00 in a 20-yr-old patient to $40,102.00 in a 70-yr-old patient per case prevented based on direct costs with costs ranging from $3,236.00 to $11,320.00 with both direct and indirect costs included. These costs could be considered reasonable from a societal perspective but do not address the issue of any increased life expectancy resulting from chemoprophylaxis.
PubMed ID
2121080 View in PubMed
Less detail

Cost-effectiveness of a new interferon-based blood assay, QuantiFERON-TB Gold, in screening tuberculosis contacts.

https://arctichealth.org/en/permalink/ahliterature154157
Source
Int J Tuberc Lung Dis. 2008 Dec;12(12):1414-24
Publication Type
Article
Date
Dec-2008
Author
F. Marra
C A Marra
M. Sadatsafavi
O. Morán-Mendoza
V. Cook
R K Elwood
M. Morshed
R C Brunham
J M Fitzgerald
Author Affiliation
University of British Columbia, Vancouver, British Columbia, Canada. carlo.marra@ubc.ca
Source
Int J Tuberc Lung Dis. 2008 Dec;12(12):1414-24
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
BCG Vaccine
Canada
Clinical Laboratory Techniques - economics
Contact Tracing
Cost-Benefit Analysis
Humans
Interferon-gamma - blood
Markov Chains
Middle Aged
Sensitivity and specificity
Tuberculin Test - economics
Tuberculosis - diagnosis
Vaccination
Abstract
Recent approval of interferon-gamma release assays that are more specific for Mycobacterium tuberculosis has given new options for the diagnosis of latent tuberculosis infection (LTBI).
To assess the cost-effectiveness of Quanti-FERON-TB Gold (QFT-G) vs. the tuberculin skin test (TST) in diagnosing LTBI in contacts of active TB cases using a decision analytic Markov model.
Three screening strategies--TST alone, QFT-G alone and sequential screening of TST then QFT-G--were evaluated. The model was further stratified according to ethnicity and bacille Calmette-Guérin (BCG) vaccination status. Data sources included published studies and empirical data. Results were reported in terms of the incremental net monetary benefit (INMB) of each strategy compared with the baseline strategy of TST-based screening in all contacts.
The most economically attractive strategy was to administer QFT-G in BCG-vaccinated contacts, and to reserve TST for all others (INMB CA$3.70/contact). The least cost-effective strategy was QFT-G for all contacts, which resulted in an INMB of CA$-11.50 per contact. Assuming a higher prevalence of recent infection, faster conversion of QFT-G, a higher rate of TB reactivation, reduction in utility or greater adherence to preventive treatment resulted in QFT-G becoming cost-effective in more subgroups.
Selected use of QFT-G appears to be cost-effective if used in a targeted fashion.
PubMed ID
19017451 View in PubMed
Less detail

Cost-effectiveness of continuous positive airway pressure therapy in patients with obstructive sleep apnea-hypopnea in British Columbia.

https://arctichealth.org/en/permalink/ahliterature157530
Source
Can Respir J. 2008 Apr;15(3):159-65
Publication Type
Article
Date
Apr-2008
Author
M C Y Tan
N T Ayas
A. Mulgrew
L. Cortes
J M FitzGerald
J A Fleetham
M. Schulzer
C F Ryan
R. Ghaeli
P. Cooper
C A Marra
Author Affiliation
Vancouver Coastal Health Research Institute, Vancouver, Canada.
Source
Can Respir J. 2008 Apr;15(3):159-65
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - economics - prevention & control - statistics & numerical data
British Columbia
Continuous Positive Airway Pressure - economics
Cost of Illness
Cost-Benefit Analysis
Humans
Markov Chains
Quality of Life
Quality-Adjusted Life Years
Sleep Apnea, Obstructive - economics - therapy
Abstract
Obstructive sleep apnea-hypopnea (OSAH) is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs). Continuous positive airway pressure (CPAP), which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.
To assess the cost-effectiveness of CPAP therapy versus no treatment for OSAH patients who are drivers.
A Markov decision analytical model with a five-year time horizon was used. The study population consisted of male and female patients, between 30 and 59 years of age, who were newly diagnosed with moderate to severe OSAH. The model evaluated the cost-effectiveness of CPAP therapy in reducing rates of MVCs and improving quality of life. Utility values were obtained from previously published studies. Rates of MVCs under the CPAP and no CPAP scenarios were calculated from Insurance Corporation of British Columbia data and a systematic review of published studies. MVCs, equipment and physician costs were obtained from the British Columbia Medical Association, published cost-of-illness studies and the price lists of established vendors of CPAP equipment in British Columbia. Findings were examined from the perspectives of a third-party payer and society.
From the third-party payer perspective, CPAP therapy was more effective but more costly than no CPAP (incremental cost-effectiveness ratio [ICER] of $3,626 per quality-adjusted life year). From the societal perspective, the ICER was similar ($2,979 per quality-adjusted life year). The ICER was most dependent on preference elicitation method used to obtain utility values, varying almost sixfold under alternative assumptions from the base-case analysis.
After considering costs and impact on quality of life, as well as the risk of MVCs in individuals with OSAH, CPAP therapy for OSAH patients is a highly efficient use of health care resources. Provincial governments who do not provide funding for CPAP therapy should reconsider.
Notes
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PubMed ID
18437259 View in PubMed
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The cost of moderate and severe COPD exacerbations to the Canadian healthcare system.

https://arctichealth.org/en/permalink/ahliterature159759
Source
Respir Med. 2008 Mar;102(3):413-21
Publication Type
Article
Date
Mar-2008
Author
N. Mittmann
L. Kuramoto
S J Seung
J M Haddon
C. Bradley-Kennedy
J M Fitzgerald
Author Affiliation
Health Outcomes and PharmacoEconomic (HOPE) Research Centre, Division of Clinical Pharmacology, Sunnybrook Research Institute, Department of Pharmacology, University of Toronto, Ontario, Canada. nicole.mittmann@sunnybrook.ca
Source
Respir Med. 2008 Mar;102(3):413-21
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care - economics
Canada - epidemiology
Cost of Illness
Female
Health Care Costs - statistics & numerical data
Hospitalization - economics
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive - economics - epidemiology
Abstract
The cost of exacerbations in chronic obstructive pulmonary disease (COPD) has not been well studied. The aim of this study was to identify and quantify the (average) cost of moderate and severe exacerbations (ME and SE, respectively) from a Canadian perspective.
Resources used during ME and SE were identified in a year long prospective, observational study (Resource Utilization Study In COPD (RUSIC)). The units of analysis were ME and SE. Unit costs (2006$CAN), based on provincial, hospital and published sources, were applied to resources. The overall cost per ME and SE were calculated. The population burden of exacerbations was also calculated.
Among study participants (N=609, aged 68.6+/-9.4 years, 58.3% male) there were 790 exacerbations: 639 (80.9%) MEs and 151 (19.1%) SEs. Of the 790 exacerbations, 618 (78.2%), 245 (31.0%) and 151 (19.1%) included a visit to an outpatient clinic, emergency department (ED) or hospital, respectively. For ME, 85.9% and 13.1% involved visits to GPs and respirologists, respectively. Pharmacologic treatment changes in the outpatient setting involved antibiotics (63.1%) and corticosteroids (34.7%). The overall mean costs for outpatient and ED services for MEs were $126 (N=574) and $515 (N=105), respectively. The average overall cost of a ME was $641. For SEs, the average hospital stay was 10.0 days. The overall mean costs of outpatient, ED and hospitalization services for SE were $114 (N=44), $774 (N=140) and $8669 (N=151), respectively. The average overall cost of a SE was $9557.
The economic burden associated with MEs and especially SEs, in Canada, is considerable and likely has a substantial impact on healthcare costs. The overall burden of exacerbations has been estimated in the range of $646 million to $736 million per annum.
PubMed ID
18086519 View in PubMed
Less detail

Cryptogenic organizing pneumonia. A report of 25 cases and a review of the literature.

https://arctichealth.org/en/permalink/ahliterature214830
Source
Medicine (Baltimore). 1995 Jul;74(4):201-11
Publication Type
Article
Date
Jul-1995
Author
K. Alasaly
N. Muller
D N Ostrow
P. Champion
J M FitzGerald
Author Affiliation
Department of Respiratory Medicine, Vancouver General Hospital, Canada.
Source
Medicine (Baltimore). 1995 Jul;74(4):201-11
Date
Jul-1995
Language
English
Publication Type
Article
Keywords
Adrenal Cortex Hormones - administration & dosage - therapeutic use
Adult
Aged
Biopsy
Bronchiolitis Obliterans - drug therapy - epidemiology - physiopathology
Canada - epidemiology
Female
Follow-Up Studies
Humans
Incidence
Lung - physiopathology - radiography
Male
Methylprednisolone - administration & dosage - therapeutic use
Middle Aged
Prednisone - administration & dosage - therapeutic use
Prevalence
Respiratory Function Tests
Terminology as Topic
Tomography, X-Ray Computed
Abstract
Cryptogenic organizing pneumonia (COP), also known as bronchiolitis obliterans organizing pneumonia (BOOP), is an uncommon lung disease characterized by the presence of granulation tissue within the alveolar ducts and alveoli. Because of the limited published literature on this topic and limited information on outcome we reviewed our own experience over an 8-year period and also critically evaluated the literature. We reviewed all cases of COP diagnosed from 1985 through 1992 at Vancouver General Hospital: 25 patients (14 male, 11 female) aged 20-77 years (mean, 49 yr, SD +/- 17 yr). Nine patients had myeloproliferative disorder, including 6 who had allogenic bone marrow transplants; 2 patients had connective tissue disease; and 14 patients had no underlying disease (idiopathic). Data retrieved retrospectively from clinical records included demographics, risk factors, symptoms, chest radiographs, computerized tomograms, lung function tests, therapy prescribed, and response to therapy. Symptoms included dyspnea and cough (n = 15) (60%), cough only (n = 10) (40%), and fever (n = 15) (60%). Twenty-two patients were diagnosed by open lung biopsy and 3 by transbronchial biopsy. Lung imaging showed bilateral patchy airspace consolidation or nodular opacities as the main finding in 22 patients. Pulmonary function tests showed a combined restrictive and obstructive pattern. All patients received prednisone therapy except 1 patient whose idiopathic findings resolved completely with minimal treatment. Eight patients died, including 4 of the 9 patients with myeloproliferative disorder--2 from a combination of respiratory failure due to COP and graft-versus-host disease. One of 2 patients with connective tissue disease died, and 3 of 14 patients with idiopathic COP died. COP is an uncommon condition but should be considered in patients with bilateral airspace disease, especially those who fail to respond to antibiotics for presumed pneumonia. Although pulmonary function tests and CT scan findings in conjunction with the clinical features usually suggest the diagnosis, definite confirmation usually requires either open lung biopsy or transbronchial biopsy. Histologic confirmation of the diagnosis is particularly warranted as therapy with corticosteroids is usually needed for a number of months. The prognosis is excellent with idiopathic cases but more guarded especially when COP is associated with lymphoproliferative or connective tissue disease.
PubMed ID
7623655 View in PubMed
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