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2.  Non-Hodgkin's lymphoma in systemic lupus erythematosus 
Annals of the Rheumatic Diseases  2005;64(10):1507-1509.
Objectives: To describe demographic factors, subtypes, and survival of patients with SLE who develop NHL.
Methods: A multi-site cohort of 9547 subjects with definite SLE was assembled. Subjects at each centre were linked to regional tumour registries to determine cancer cases occurring after SLE diagnosis. For the NHL cases ascertained, descriptive statistics were calculated, and NHL subtype frequency and median survival time of patients determined.
Results: 42 cases of NHL occurred in the patients with SLE during the 76 948 patient-years of observation. The median age of patients at NHL diagnosis was 57 years. Thirty six (86%) of the 42 patients developing NHL were women, reflecting the female predominance of the cohort. In the patients, aggressive histological subtypes appeared to predominate, with the most commonly identified NHL subtype being diffuse large B cell (11 out of 21 cases for which histological subtype was available). Twenty two of the patients had died a median of 1.2 years after lymphoma diagnosis.
Conclusions: These data suggest aggressive disease in patients with SLE who develop NHL. Continuing work should provide further insight into the patterns of presentation, prognosis, and aetiology of NHL in SLE.
PMCID: PMC1755239  PMID: 16162903
3.  Feasibility of Data Exchange with a Patient-centered Health Record 
A patient-centered health record is a personal health record that is patient-owned, patient-managed, and that represents the health information important to patients in the ways they prefer to represent it. The Patient-centered Health Record (PcHR) was developed to address these needs. Integration with traditional electronic health records adds significant value, and we used a national showcase to demonstrate the feasibility of exchanging health information through document level interoperability with commercial enterprise clinical systems.
PMCID: PMC1560649  PMID: 16779410
4.  An evidence-based approach to prescribing NSAIDs in musculoskeletal disease: a Canadian consensus. Canadian NSAID Consensus Participants. 
OBJECTIVE. To make recommendations for the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) in primary care practice, particularly for patients at high risk for NSAID-induced complications. OPTIONS. The use of misoprostol to prevent gastrointestinal ulceration and other unwanted NSAIDs effects was considered. The role of cyclooxygenase-2 (COX-2) versus COX-1 inhibiting agents was also examined. OUTCOMES. Reduction of complications associated with long-term use of NSAIDs. EVIDENCE. Evidence was gathered in late 1995 from published research studies and reviews. Position papers were prepared by faculty and advisory board members and discussed at the Canadian NSAID Consensus Symposium in Cambridge, Ont., Jan. 26 and 27, 1996. VALUES. Recommendations were based on randomized, placebo-controlled clinical trials (level I evidence) and case-control studies (level II evidence) involving NSAID use when such evidence was available. When the scientific literature was incomplete or inconsistent in a particular area, recommendations reflect the consensus of the participants at the symposium (level III evidence). Physicians were recruited from across Canada for their expertise in rheumatology, gastroenterology, epidemiology, gerontology, family practice, and clinical and basic scientific research. BENEFITS, HARMS AND COSTS. Although a reduction in complications due to inappropriate NSAID use should reduce costs of additional investigations, admissions to hospital and time lost from work, definitive cost analysis studies are not yet available. RECOMMENDATIONS. Currently, no NSAID is available that lacks potential for serious toxicity; therefore, long-term use of NSAIDs should be avoided whenever possible, particularly in high-risk patients (e.g., those who are elderly, suffer from hypertension, congestive heart failure, renal or hepatic impairment or volume depletion, take certain concomitant medications or have a history of peptic ulcer disease) (level I evidence). If NSAIDs are to be used in patients with gastric or nephrotoxic risk factors, the lowest effective dose of NSAID should be used (level III evidence); NSAIDs that are weak COX-1 inhibitors may be preferred (level II evidence). In addition, concomitant administration of misoprostol is recommended in patients at increased risk for upper gastrointestinal complications (level I evidence). However, the clinical judgement of the practising clinician must always be part of any therapeutic decision. VALIDATION. These recommendations are based on the consensus of Canadian experts in rheumatology, gastroenterology and epidemiology, and have been subjected to external peer review.
PMCID: PMC1487875  PMID: 8673987
5.  Radiological progression in rheumatoid arthritis: how many patients are required in a treatment trial to test disease modification? 
Annals of the Rheumatic Diseases  1993;52(5):332-337.
OBJECTIVE--To determine whether the number of patients required in a therapeutic trial that uses progression of radiological abnormalities as the outcome measure would be similar for multiple centres. METHODS--The progression of radiological damage to the fingers and wrists of patients with rheumatoid arthritis in five centres, three in North America and two in Europe, was examined. The reproducibility of repeated readings by the same and multiple observers was examined. The number of patients required in a two group trial was calculated for several combinations of power and significance. RESULTS--Scoring progression of radiological abnormalities in sequential films taken between 0.5 and 2.1 years was found to be highly reproducible. When the scores of a single reader were used the rate of change of radiological scores was similar in all centres. Based on the mean progression rate for all centres it was estimated that 153 patients in each group would be required to assure 90% power for detecting a 50% slowing of radiological progression at a significance of 0.05. Review of the experience in three trials showed a large variability in the radiological progression rates. CONCLUSION--The progression of scores for radiological damage in rheumatoid arthritis is relatively uniform in North America and Europe and thus the number of patients required in a trial would be similar. Experience in three trials showed that patient selection is of paramount importance in setting up a successful study.
PMCID: PMC1005045  PMID: 8323380
6.  Concurrent onset of adult onset Still's disease and insulin dependent diabetes mellitus. 
Annals of the Rheumatic Diseases  1990;49(7):547-548.
Within two weeks after symptoms of an upper respiratory tract infection a 32 year old man developed Still's disease and insulin dependent diabetes mellitus, both of which have persisted for 24 months. Investigations failed to confirm acute infection but did show isolated persistent increase of serum antibodies to rubella virus. The simultaneous onset of these two diseases suggests a shared cause, possible associated with rubella infection.
PMCID: PMC1004148  PMID: 2383082
7.  Polymyositis with plasma cell infiltrate in essential mixed cryoglobulinaemia. 
A patient with essential cryoglobulinaemia who presented with polymyositis is described. Muscle biopsy showed intense plasma cell infiltration of muscle. Plasmapheresis produced a rapid resolution of the cutaneous manifestations of the disease, but little improvement in muscle strength. Oral steroids resulted in moderate improvement in muscle strength. There have been no previously reported cases of polymyositis in association with essential cryoglobulinaemia.
PMCID: PMC1014872  PMID: 8459252
8.  The Impact of Continuing Education on the Quality of Patient Care 
Canadian Family Physician  1983;29:810-818.
We randomly allocated family physicians meeting explicit entry criteria to experimental and control groups to determine whether CME affects the quality of patient care. The experimental group received educational packages, the control group did not. These educational packages were closely matched with explicit criteria used in the indicator condition—our method of measuring the quality of care. The indicator conditions were divided into elective, mandatory and hidden categories. We compared over 4,500 patient encounters, before and after the educational maneuver, with explicit clinical criteria in the indicator condition. These episodes of care were then classified according to quality of care. Though knowledge increased from the educational packages, overall quality of care improved very little. If the topics were elective, quality of care improved equally in both the experimental and control groups. When the topics were mandatory, quality of care provided by the experimental group improved (P < 0.05). Topics covered by the hidden indicator conditions showed no spillover effect.
PMCID: PMC2154144  PMID: 21283460
9.  Medical Management of the Heart Victim 
Canadian Family Physician  1969;15(11):60-63.
PMCID: PMC2281556  PMID: 20468448

Results 1-10 (10)