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The Evidence Speaks

The Evidence Speaks (March 2018)

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The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators.

In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Black A, Strain K, Wallsworth C, Charlton SG, Chang W, McNamee K, Hamilton C. What constitutes meaningful engagement for patients and families as partners on research teams? J Health Serv Res Policy. 2018 Mar 4 epub ahead of print.

The involvement of patients and their family members in the research process is a recent and ongoing phenomenon that reflects a shift in how key stakeholders can impact research and how it is performed. Meaningful patient involvement, however, lacks validated methodology. A 2016 report from the BC SUPPORT Unit showed that researchers require direction and support in effective engagement of patients and their caregivers. CHÉOS Research Associate Aggie Black, with researchers from PHC, UBC, and Arthritis Research Canada, recently published a report on the perspectives of caregivers and patients who have been involved in research teams. Using interviews and focus groups, the researchers spoke with nineteen participants across three provinces. Four broad categories of factors emerged: research environment, expectations, support, and value. Participants noted that the research environment should be a positive, respectful, team atmosphere. By way of acknowledging the value participants bring to research, clearly defined roles, responsibilities, and expectations were found to be important. Support for patients and caregivers, in the form of training and preparation, was also important to study participants. Finally, valuing and engaging patient partners on how they want to be involved was an important theme. The information gathered in this study is a valuable contribution to the meaningful engagement of patients and caregivers in research.

Tsao NW, Sayre EC, Hanley G, Sadatsafavi M, Lynd LD, Marra CA, De Vera MA. Risk of preterm delivery and small-for-gestational-age births in women with autoimmune disease using biologics before or during pregnancy: a population-based cohort study. Ann Rheum Dis. 2018 Mar 1 epub ahead of print.

Women with autoimmune diseases, such as rheumatoid arthritis or psoriasis, may experience increased risk of adverse outcomes and poor neonatal health. Biologics, a type of medication used to treat autoimmune diseases, modulate the immune system. It is unknown whether these drugs impact infant morbidity and mortality within the context of immunological changes that accompany pregnancy. A group of researchers that included CHÉOS Scientist Dr. Larry Lynd, analyzed data from Population Data BC to compare the birth outcomes between women who were exposed to biologics within three months before and/or during pregnancy and those who were not. The researchers specifically looked at the rates of preterm delivery and small-for-gestational-age (SGA) births. During the study period, there were 6218 eligible women with an autoimmune disease (8607 pregnancies); 109 of these were exposed to biologics (130 pregnancies). After using matching methodology to account for baseline characteristics, the group found no association between the use of biologics before or during pregnancy and preterm delivery (18% biologic exposed vs. 16% unexposed) or SGA (9% exposed vs. 10% unexposed). These findings suggest that biologics may be an appropriate and safe treatment for women with autoimmune disease who are at a higher risk of adverse pregnancy-related outcomes.

Scheuermeyer FX, DeWitt C, Christenson J, Grunau B, Kestler A, Grafstein E, Buxton J, Barbic D, Milanovic S, Torkjari R, Sahota I, Innes G. Safety of a brief emergency department observation protocol for patients with presumed fentanyl overdose. Ann Emerg Med. 2018 Mar 9 epub ahead of print.

Emergency physicians from UBC and St. Paul’s Hospital, including two CHÉOS Scientists, Drs. Brian Grunau and Eric Grafstein, have published an analysis of a protocol for patients with suspected fentanyl overdose. Due to the spike in fentanyl-related opioid overdoses and the variation in their presentation in the emergency department (ED), a protocol for the monitoring and safe discharge of these patients was needed. The physicians modified a monitoring protocol previously used for heroin overdoses as a strategy to deal with fentanyl overdoses. Between September 1 and December 31 of 2017, there were 1009 eligible ED visits for suspected fentanyl overdose in 827 patients. Because naloxone is typically administered prior to arrival at the ED, many patients can be safely discharged within hours of their most recent naloxone dose. Of the encounters at the ED, one patient was hospitalized, one died after discharge, sixteen were given naloxone in the ED, and median length of stay was 2.9 hours. The data gathered in this study provide a detailed summary of fentanyl overdoses at St. Paul’s and a protocol for identifying low-risk patients which will be of service to physicians and public health officials for resource allocation.

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