Sunnybrook Health Sciences Centre

About: Sunnybrook Health Sciences Centre is a healthcare organization based out in Toronto, Ontario, Canada. It is known for research contribution in the topics: Population & Breast cancer. The organization has 7689 authors who have published 15236 publications receiving 523019 citations. The organization is also known as: Sunnybrook.

Performance Measures Provide Assessments of Pain and Function in People With Advanced Osteoarthritis of the Hip or Knee

Abstract: Background and Purpose. Pain and physical function are core outcome measures for people with osteoarthritis, and self-report questionnaires have been the preferred assessment method. There is evidence suggesting that self-reports of physical function represent what people experience when performing activities rather than their ability to perform activities. The purpose of this study was to examine the factorial validity of performance-specific assessments of pain and function. Subjects. The sample consisted of 177 participants who had osteoarthritis of the hip (n=81) or knee (n=96) and who were awaiting total joint arthroplasty. Methods. Through a cross-sectional design, participants performed 4 performance activities (self-paced walk test, stair test, Timed “Up & Go” Test, and Six-Minute Walk Test). Outcomes were time or distance (function) and pain ratings obtained immediately after each activity. The authors conceptualized 2 correlated factors, with pain items loading uniquely on 1 factor and functional items loading on the second factor, and uncorrelated error terms. Confirmatory factor analysis was applied. Results. Initial analysis yielded results consistent with the conceptualized model in this study with the exception of a nonzero correlation between the stair pain and function error terms. Dropping the stair test provided results consistent with the conceptualized model. Discussion and Conclusion. Given the limitations of self-report alone as a method of obtaining reasonably distinct assessments of pain and function, the extent to which performance-specific assessments could accomplish this goal was examined in this study. It was found that collectively the walk test, Timed “Up & Go” Test, and Six-Minute Walk Test yielded 2 factors consistent with the health concepts of pain and function. The authors believe that the application of these tests may provide clinicians and clinical researchers with more distinct impressions of pain and function that complement information from self-report measures.

The burden of obesity among adults with bipolar disorder in the United States

Abstract: The prevalence of overweight and obesity (henceforth obesity) continues to rise in the United States (1). Adults with bipolar disorder (BD) comprise a group for whom obesity may be a particularly concerning condition because the leading cause of mortality in BD is premature cardiovascular disease (CVD) (2), and CVD among adults with BD is evident up to 14 years before adults without BD (3). Treatment with medications associated with weight gain is a leading explanation for the increased prevalence of obesity in BD (4, 5), however increased prevalence of obesity has also been reported among medication-naive patients with BD (6). Other explanations have been invoked for the association between obesity and BD, including excessive carbohydrate consumption, low rate and intensity of exercise, reduced fat oxidation, substance misuse, and maladaptive efforts at self-modulation of mood by over-eating (4, 5, 7–11). Taken together, these findings indicate that adults with BD are at increased risk of obesity due to a multitude of factors. In addition to concerns regarding the medical consequences of obesity among adults with BD, there is substantial evidence demonstrating that obesity is associated with a number of proxies for the burden of BD including increased number of manic and depressive episodes, increased depressive symptom severity, treatment-resistance, suicidality, and treatment use (12–19). Due to the association of obesity with increased BD severity, the morbidity of obesity may be greater among individuals with, as compared to without, BD. However, to date, only clinical studies have examined for correlates of obesity among subjects with BD. Previous representative epidemiologic studies have examined the prevalence of BD based on obesity (rather than the converse), have not examined BD separately from other mood disorders, or have not examined broadly for correlates of obesity among persons with BD (20–24). This study seeks to extend our understanding of obesity in BD by examining the relative prevalence of obesity among persons with BD, and by examining for correlates of obesity in BD which may inform prevention and treatment strategies. We set out to examine the following hypotheses: (i) subjects with BD will have significantly greater prevalence of obesity compared to subjects without BD; and (ii) among subjects with BD, obesity will be associated with increased illness burden as determined by presence of past-year episodes, lifetime number of episodes, duration of longest episode, history of suicide attempts, mixed manic episodes, comorbid conditions, and rates of treatment utilization. We also set out to examine in exploratory fashion the prevalence of obesity among subjects with BD versus those with major depressive disorder (MDD), which has also been associated with increased prevalence of obesity (25, 26). Finally, because of previous contradictory reports among adults and youth with BD (23, 27), we examined whether comorbid substance use disorders (SUD) are associated with obesity among adults with BD.

Identifying priorities in methodological research using ICD-9-CM and ICD-10 administrative data: report from an international consortium

Abstract: Background Health administrative data are frequently used for health services and population health research. Comparative research using these data has been facilitated by the use of a standard system for coding diagnoses, the International Classification of Diseases (ICD). Research using the data must deal with data quality and validity limitations which arise because the data are not created for research purposes. This paper presents a list of high-priority methodological areas for researchers using health administrative data.

Timing of androgen-deprivation therapy in patients with prostate cancer with a rising PSA (TROG 03.06 and VCOG PR 01-03 [TOAD]): a randomised, multicentre, non-blinded, phase 3 trial

Abstract: Summary Background Androgen-deprivation therapy is offered to men with prostate cancer who have a rising prostate-specific antigen after curative therapy (PSA relapse) or who are considered not suitable for curative treatment; however, the optimal timing for its introduction is uncertain. We aimed to assess whether immediate androgen-deprivation therapy improves overall survival compared with delayed therapy. Methods In this randomised, multicentre, phase 3, non-blinded trial, we recruited men through 29 oncology centres in Australia, New Zealand, and Canada. Men with prostate cancer were eligible if they had a PSA relapse after previous attempted curative therapy (radiotherapy or surgery, with or without postoperative radiotherapy) or if they were not considered suitable for curative treatment (because of age, comorbidity, or locally advanced disease). We used a database-embedded, dynamically balanced, randomisation algorithm, coordinated by the Cancer Council Victoria, to randomly assign participants (1:1) to immediate androgen-deprivation therapy (immediate therapy arm) or to delayed androgen-deprivation therapy (delayed therapy arm) with a recommended interval of at least 2 years unless clinically contraindicated. Randomisation for participants with PSA relapse was stratified by type of previous therapy, relapse-free interval, and PSA doubling time; randomisation for those with non-curative disease was stratified by metastatic status; and randomisation in both groups was stratified by planned treatment schedule (continuous or intermittent) and treatment centre. Clinicians could prescribe any form and schedule of androgen-deprivation therapy and group assignment was not masked. The primary outcome was overall survival in the intention-to-treat population. The trial closed to accrual in 2012 after review by the independent data monitoring committee, but data collection continued for 18 months until Feb 26, 2014. It is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12606000301561) and ClinicalTrials.gov (NCT00110162). Findings Between Sept 3, 2004, and July 13, 2012, we recruited 293 men (261 with PSA relapse and 32 with non-curable disease). We randomly assigned 142 men to the immediate therapy arm and 151 to the delayed therapy arm. Median follow-up was 5 years (IQR 3·3–6·2) from the date of randomisation. 16 (11%) men died in the immediate therapy arm and 30 (20%) died in the delayed therapy arm. 5-year overall survival was 86·4% (95% CI 78·5–91·5) in the delayed therapy arm versus 91·2% (84·2–95·2) in the immediate therapy arm (log-rank p=0·047). After Cox regression, the unadjusted HR for overall survival for immediate versus delayed arm assignment was 0·55 (95% CI 0·30–1·00; p=0·050). 23 patients had grade 3 treatment-related adverse events. 105 (36%) men had adverse events requiring hospital admission; none of these events were attributable to treatment or differed between treatment-timing groups. The most common serious adverse events were cardiovascular, which occurred in nine (6%) patients in the delayed therapy arm and 13 (9%) in the immediate therapy arm. Interpretation Immediate receipt of androgen-deprivation therapy significantly improved overall survival compared with delayed intervention in men with PSA-relapsed or non-curable prostate cancer. The results provide benchmark evidence of survival rates and morbidity to discuss with men when considering their treatment options. Funding Australian National Health and Medical Research Council and Cancer Councils, The Royal Australian and New Zealand College of Radiologists, Mayne Pharma Australia.