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CityWide The McMaster GIM Newsletter

Fall 2016 edition

Co-editors: John J. You and Daniel Brandt Vegas

A Message from the General Internal Medicine Division Director: Dr. Akbar Panju

Once again, I would like to congratulate Drs. John You and Daniel Brandt Vegas for putting together an

exciting Fall 2016 issue of CityWide. In addition to the newsworthy items that they put in the issue, they

have also given us the list of publications done by the members of the Division of General Internal

Medicine at McMaster University. This issue also contains a nice summary on Medical Assistance in

Dying in Ontario.

Drs. Daniel Brandt Vegas, Mitch Levine, and Christian Kraeker have nicely put the argument for and

against wearing a “white coat” during hospital rounding. It is true that the white coats have become

almost extinct among physicians in the hospital. I am not sure if this is a good thing or not, and one will

have to make up their own mind about it. I am sure our members have visited other medical centres,

particularly in developing countries, where physicians and all healthcare professionals wear starched

white coats on a regular basis.

The Division of GIM at McMaster is made up of an extremely active group where members are involved

in providing exemplary clinical care, excellent teaching activities for both undergraduate medical

students and postgraduate learners in medicine, and a lot of the members are involved in research

activities as evidenced by the publications noted in this issue.

I hope you enjoy reading the Fall issue of CityWide!

- Akbar Panju

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NEWSWORTHY ITEMS Awards, honours, new appointments

Dr. Akbar Panju appointed as Acting Chair for the Department of Medicine

Dr. Ally Prebtani awarded the inaugural 2016 McMaster University Global Impact Award

Incoming GIM Residents Please join us in welcoming our incoming residents who began their training in July 2016:

PGY-4/5 GIM: Andrew Cheung, Emily Jones, Abubaker Khalifa, Haroon Yousuf

PGY-4 IM: Sunita Narang, Madiha Abuzar, Nabeel Syed Other newsworthy items

Dr. Betty Chui had a baby girl, Christina Tam, in August 2016!

A heartfelt welcome back to Dr. Will Harper who recently returned to his outpatient Endocrinology practice.

Congrats to Drs. Vanessa Ocampo (Core Internal Medicine resident) and Shariq Haider for their case report published in the October 20, 2016 issue of the New England Journal of Medicine, “Cutaneous Lupus—“The Pimple That Never Went Away”

MAID in Ontario

Medical assistance in death (MAID) is now an option throughout Ontario. The MOHLTC, CPSO, and

CMPA are working to develop and implement clear procedures and guidelines to process patient

requests and assist clinicians participating.

Across the city, our hospitals are working to develop an infrastructure and system to assist patients

making these requests, and clinicians willing to help them. At SJHH, the institution has clearly

established a position in which it will not be directly affiliated with the act of MAID, but will still provide

assistance to patients making such requests by addressing their suffering, and supporting referral to

appropriate centres and healthcare providers. At HHS, a group of physicians are working to develop a

system to address patients’ requests and provide clear guidelines on ways to proceed if deemed

appropriate.

As Ontario physicians, members of our group have the option of being involved in the MAID program.

This certainly represents an important change in the practice of healthcare, and one that generates a

wide variety of opinions and perspectives, pushes us to reflect on our values and role as healthcare

providers, and generates much discussion.

Over time we'll see how different stakeholders make use of this option, and whether its merits outweigh

the concerns that have been raised in various forums.

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Upcoming Events

Internal Medicine Gala

December 16, 2016

Please come out and support this event for our colleagues in Uganda! If you would like to donate to the silent auction, please contact Dr. Ally Prebtani, Faculty Chair of the IM Gala, at: prebtani@hhsc.ca

Martha Rocks

Featuring GIM-ers

Tim O’Shea (drums) Juan Guzman (bass)

John You (guitar)

in support of

The Mark Preece Family House

Friday December 2nd at 9:00 pm Corktown Pub

Mark Preece House is a caring place to call home for families of patients in Hamilton area hospitals. It depends on community donations to achieve its mission (www.markpreecehouse.ca).

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GIM RESEARCH SPOTLIGHT Call for Proposals: GIM AFP Research Grants Submissions are invited for this year’s 2016-2017 GIM AFP Research Grants. There is $45,000 available

for this year’s competition, with a maximum budget of $20,000 per project.

Applicants are required to submit an electronic copy (single pdf file) of a complete application package

by email to Gail Laforme (laformeg@hhsc.ca) by Monday, November 28, 2016, 5:00pm EST. Any

questions about the competition can be directed to Dr. John You (jyou@mcmaster.ca).

Other grants

Dr. Christina Katsios, staff physician in General Internal Medicine at Hamilton General Hospital, was

awarded a Royal College Professional Development Grant entitled, “Should this elderly patient be

intubated in the emergency department? Development and validation of a clinical prediction tool for

informed decision making” ($4,000)

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GIM Faculty Research Profile There are several members of our Division who are making a truly international impact with their

research. In this edition of CityWide, we would like to highlight and celebrate the work of Dr. Jim

Douketis, who continues to be a superb role model for clinical research in GIM.

Dr. Jim Douketis: Biosketch

Dr. Douketis is a Professor of Medicine at McMaster University and Staff Physician

in General Internal Medicine at St. Joseph’s Healthcare. His research and clinical

expertise is in perioperative anticoagulation, the clinical course of

thromboembolism and its recurrence, and in general internal medicine.

Over his career, he has given more than 300 invited presentations, and currently

holds several high profile editorial and executive posts, including Lead Editor of

the American College of Chest Physicians Guidelines of Perioperative

Management of Antithrombotic Therapy, Associate Editor of the Journal of

Thrombosis and Hemostasis, President of Thrombosis Canada

(www.thrombosiscanada.ca), and Chair of the Guidance and Guidelines Committee of the International

Society on Thrombosis and Haemostasis.

Dr. Douketis is principal investigator on a CIHR-funded ($2.8 million) and Heart and Stroke Foundation-

funded ($240,000) study involving over 3,000 patients who are receiving a direct oral anticoagulant

(DOAC) and require elective surgery to determine best practices regarding optimal interruption and

resumption in the perioperative period.

In just the past 3 years, Dr. Douketis has published 53 peer-reviewed journal articles (15 as first author),

including 3 first author papers in the New England Journal Medicine on bridging anticoagulation in

patients with atrial fibrillation.

While doing all of the above, Dr. Douketis still finds time to continue his musical pursuits, performing as

an accomplished cellist.

Congratulations Jim on all of your accomplishments – the Division is very proud to have you as one of

our own!!

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Emerging Research Opportunities at McMaster

On June 20, 2016 the Institute for Clinical Evaluative Sciences (ICES) (www.ices.on.ca), opened a satellite

site at McMaster University in a 2,300 square foot facility on the 4th floor of the MUMC building on the

main campus.

ICES McMaster is a health services research facility that provides researchers and trainees with access to

over 80 health-related database holdings that can be linked for a comprehensive overview of health

care delivery and outcomes in Ontario. Some databases include the entire Ontario population eligible

for universal health coverage – 13 million people annually. The breadth and scope of ICES data is a

resource for population-based evidence to inform health policy, planning and evaluation.

ICES database holdings include: physician billings (i.e. OHIP claims), hospital and emergency department

visits, prescription drug claims (age 65+), special registries and collections, population-based surveys and

more.

There are several ways our GIM faculty can access ICES data. If you are interested in learning more,

please contact Dr. John You (jyou@mcmaster.ca). Dr. You is an Adjunct Scientist at ICES and has a role as

faculty mentor to build research capacity at the newly launched ICES McMaster satellite site.

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“White Coating”

Standing at a busy nursing station in a teaching hospital, you may struggle to tell apart the staff

physician, from the medical student, from the RN, from the RPN, from the pharmacist. Although in some

instances there are very telling signs (an older person being followed by a posse of younger people is

sure to be the attending, a woman wearing bright colored scrubs filling out a vital signs flowsheet is

almost certainly a bedside nurse), we’ve all been in the awkward position of having to ask someone

what their role is, or even worse, being corrected after mistakenly addressing them for issues unrelated

to their profession (asking the physiotherapist whether the patient as had a bowel movement or

received a certain treatment ordered, or realizing that the person you were just discussing the case with

is in fact a pharmacy student who politely nodded in agreement while not understanding most of what

you said).

In the specific case of medical doctors, what physical feature identifies us best? The white coat has

traditionally been an important part of our professional identity. In the late 1800’s, physicians started

wearing long white coats as both a symbol of cleanliness and sterility, as well as a transition of the

profession towards science and empiricism. In the last decade the use of a white coat has become

increasingly less of a standard. Some studies have suggested an increase in bacterial dissemination

among hospital patients due to the whitecoat or other garments that become contaminated and are

subsequently in contact with many patients as physicians make rounds. The term “whitecoat

hypertension” and the studies supporting its existence, although not specific to the whitecoat, also

suggest that wearing a whitecoat may have negative effects towards patient care. It seems, from an

unstructured, observational perspective, that younger generations use the whitecoat less and less. This

may also be driven from the idea of breaking barriers that separate physicians and patients, humanizing

doctors, helping build trust and empathy. However, in this regard, several survey studies have shown

patients largely prefer physicians wearing whitecoats or scrubs, than those dressed casually or even in

business attire. Furthermore, there is an emerging concept called “enclothed cognition” which, through

social psychology experiments, suggests individuals perform better at tasks depending on what they’re

wearing. A specific study had non-physicians solve math problems. They compared three groups, one

wearing whitecoats described as doctor’s coats, another wearing whitecoats described as painter’s

coats, and a final group not wearing whitecoats. They found the group with the doctor’s white coats

performed considerably better than those not wearing whitecoats. The group wearing painter’s coats

performed worse than those not wearing whitecoats.

There seem to be reasons to support wearing whitecoats, as well as reasons not to do so. In keeping

with this, members of our GIM division appear divided on this issue, as can be seen in any of the

Hamilton Hospitals. We thought we would ask division members why they do or don’t wear whitecoats,

and include pro and con positions in this and future editions of the newsletter. We hope you find

reading these answers both thought provoking and fun. Enjoy!

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Yes to White Coats

by Mitch Levine

I am one of the few relics that still wears a white coat in the hospital on the General Internal Medicine

service. So I would like to dispel some myths and explain why I continue to hold onto a fashion style of a

previous century. First, I do not do it to create white coat hypertension and therefore get to treat one of

the few conditions where there are so many therapeutic options that even a clinical pharmacologist

won’t get bored. Also, I do not do it because I am 5 feet 6 inches and have short man syndrome and

need a prop to address self-esteem issues (at least that is what my therapist says). The most important

part of the white coat is the pockets! I get to put my stethoscope, patient lists, notes and pens into

those deep pockets and know that when I leave a ward they are coming with me. If I am not wearing the

coat there is a better than 50% chance my stethoscope will remain on a desk top somewhere and I will

discover that it is missing two or three wards later and then spend the next 25 minutes retracing all my

steps. So unless I pin my stethoscope to my clothes like my mother did with my winter mittens when I

was five years old, I suspect I will continue to wear the white coat and buck the fashion trends of the 21st

century.

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No White Coat

by Christian Kraeker

Why I choose not to wear the white coat.

1. It is ugly.

2. It does not pair well with plaid shirts and Birkenstocks.

3. I do not believe people that say they wear it for the pockets. What could you possibly need that many

pockets for?

4. It gets dirty so easily and most of the time is more of a light beige coat.

5. It raises people’s blood pressure.

6. (This is the serious one) As a general internist in Hamilton I can make as much money in a few weeks

time as most of the patients I serve will earn in an entire year. This means that I cannot even begin to

understand their lives and circumstances and they mine. I believe that anything that widens the divide

between a physician and patient is detrimental to the therapeutic relationship, and I believe the white

coat contributes to this divide. I understand the cultural relevance of the white coat and all that it

symbolizes. I appreciate the history and “prestige” the white coat as a symbol carries. I appreciate the

“white coat ceremony” where we make medical students feel special just for having entered into this

profession. I also, however, realize that the white coat can make our patients uncomfortable,

occasionally scared and can contribute to an unintentional power differential. For me not wearing this

symbol is a way of attempting to relate to my patients and hopefully them to me.

7. Regardless of your opinion, it is still aesthetically unappealing to the eye (AKA ugly).

8. I will also admit that as I was writing this piece my wife reminded me of that time last week when I sat

next to a patient on his bed and promptly felt that warm wet feeling on my rear that was quickly

identified as this elderly gentleman’s urine. It was at this moment that I wished I had my white coat.

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The Golden

What is this light

That came floating down

From the sky

Falling over the grass

The road

My hand,

Turning them all

into a dusty picture

of melancholy and life past

or soon to be

What is this glow

in her eyes, and her hair

humming of the heart

pulling me down

drawing me closer

making me sad to have lost her

or soon will

What is this color

that takes over leafs

changing over skin

children turned into adults

a daughter into a mother

places disappeared

songs forgotten

ages gone by

What is this color

that takes over life

when we get close

to the end of the day

the end of a dream

end of the year

when we turn to autumn

trees red, yellow, orange, bright

before undressing its branches

and forgetting

it was ever spring

What is this Golden

beautiful light

spreading over the crepuscule

and horizon

announcing

the cold

dark

night

is only one

step

away

DBV

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Publications (April 2016 – September 2016) A narrative review and novel framework for application of team-based learning in graduate medical education. Poeppelman RS, Liebert CA, Brandt Vegas D, Germann CA, Volerman A. J Grad Med Educ. 2016 Oct 1;8(4):510-7.

Assessment of Postresuscitation Volume Status by Bioimpedance Analysis in Patients with Sepsis in the Intensive Care Unit: A Pilot Observational Study. Rochwerg B, Cheung JH, Ribic CM, Lalji F, Clarke FJ, Gantareddy S, Ranganath N, Walele A, McDonald E, Meade MO, Cook DJ, Wilkieson TT, Clase CM, Margetts PJ, Gangji AS. Can Respir J. 2016;2016:8671742. doi: 10.1155/2016/8671742. Epub 2016 Aug 15.

Bridge Therapy Outcomes in Patients With Mechanical Heart Valves. Delate T, Meisinger SM, Witt DM, Jenkins D, Douketis JD, Clark NP. Clin Appl Thromb Hemost. 2016 Sep 21. pii: 1076029616669786. [Epub ahead of print]

4 risk assessment models had good calibration but poor discrimination for VTE in hospitalized medical patients. Liew A, Douketis J. Ann Intern Med. 2016 Sep 20;165(6):JC35. doi: 10.7326/ACPJC-2016-165-6-035. No abstract available.

Perioperative Aspirin for Prevention of Venous Thromboembolism: The PeriOperative ISchemia Evaluation-2 Trial and a Pooled Analysis of the Randomized Trials. Eikelboom JW, Kearon C, Guyatt G, Sessler DI, Yusuf S, Cook D, Douketis J, Patel A, Kurz A, Allard R, Jones PM, Dennis RJ, Painter TW, Bergese SD, Leslie K, Wijeysundera DN, Balasubramanian K, Duceppe E, Miller S, Diedericks J, Devereaux PJ. Anesthesiology. 2016 Sep 14. [Epub ahead of print]

Portal vein thrombosis in patients with cirrhosis: underdiagnosis and undertreatment? Liew A, Douketis J. Intern Emerg Med. 2016 May 23. [Epub ahead of print] No abstract available.

Periprocedural Management of Direct Oral Anticoagulants: Comment on the 2015 American Society of Regional Anesthesia and Pain Medicine Guidelines. Douketis JD, Syed S, Schulman S. Reg Anesth Pain Med. 2016 Mar-Apr;41(2):127-9. doi: 10.1097/AAP.0000000000000360. No abstract available.

Cerebral Oximetry Monitoring to Maintain Normal Cerebral Oxygen Saturation during High-risk Cardiac Surgery: A Randomized Controlled Feasibility Trial. Deschamps A, Hall R, Grocott H, Mazer CD, Choi PT, Turgeon AF, de Medicis E, Bussières JS, Hudson C, Syed S, Seal D, Herd S, Lambert J, Denault A, Deschamps A, Mutch A, Turgeon A, Denault A, Todd A, Jerath A, Fayad A, Finnegan B, Kent B, Kennedy B, Cuthbertson BH, Kavanagh B, Warriner B, MacAdams C, Lehmann C, Fudorow C, Hudson C, McCartney C, McIsaac D, Dubois D, Campbell D, Mazer D, Neilpovitz D, Rosen D, Cheng D, Drapeau D, Dillane D, Tran D, Mckeen D, Wijeysundera D, Jacobsohn E, Couture E, de Medicis E, Alam F, Abdallah F, Ralley FE, Chung F, Lellouche F, Dobson G, Germain G, Djaiani G, Gilron I, Hare G, Bryson G, Clarke H, McDonald H, Roman-Smith H, Grocott H, Yang H, Douketis J, Paul J, Beaubien J, Bussières J, Pridham J, Armstrong JN, Parlow J, Murkin J, Gamble J, Duttchen K, Karkouti K, Turner K, Baghirzada L, Szabo L, Lalu M, Wasowicz M, Bautista M, Jacka M, Murphy M, Schmidt M, Verret M, Perrault MA, Beaudet N, Buckley N, Choi P, MacDougall P, Jones P, Drolet P, Beaulieu P, Taneja R, Martin R, Hall R, George R, Chun R, McMullen S,

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Beattie S, Sampson S, Choi S, Kowalski S, McCluskey S, Syed S, Boet S, Ramsay T, Saha T, Mutter T, Chowdhury T, Uppal V, Mckay W; Canadian Perioperative Anesthesia Clinical Trials Group. Anesthesiology. 2016 Apr;124(4):826-36. doi: 10.1097/ALN.0000000000001029. Patient values and preferences on transcatheter or surgical aortic valve replacement therapy for aortic stenosis: a systematic review. Lytvyn L, Guyatt GH, Manja V, Siemieniuk RA, Zhang Y, Agoritsas T, Vandvik PO. BMJ Open. 2016 Sep 29;6(9):e014327. doi: 10.1136/bmjopen-2016-014327.

Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis. Siemieniuk RA, Agoritsas T, Manja V, Devji T, Chang Y, Bala MM, Thabane L, Guyatt GH. BMJ. 2016 Sep 28;354:i5130. doi: 10.1136/bmj.i5130.

Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies. Foroutan F, Guyatt GH, O'Brien K, Bain E, Stein M, Bhagra S, Sit D, Kamran R, Chang Y, Devji T, Mir H, Manja V, Schofield T, Siemieniuk RA, Agoritsas T, Bagur R, Otto CM, Vandvik PO. BMJ. 2016 Sep 28;354:i5065. doi: 10.1136/bmj.i5065.

Introduction to BMJ Rapid Recommendations. Siemieniuk RA, Agoritsas T, Macdonald H, Guyatt GH, Brandt L, Vandvik PO. BMJ. 2016 Sep 28;354:i5191. doi: 10.1136/bmj.i5191. No abstract available.

Transcatheter or surgical aortic valve replacement for patients with severe, symptomatic, aortic stenosis at low to intermediate surgical risk: a clinical practice guideline. Vandvik PO, Otto CM, Siemieniuk RA, Bagur R, Guyatt GH, Lytvyn L, Whitlock R, Vartdal T, Brieger D, Aertgeerts B, Price S, Foroutan F, Shapiro M, Mertz R, Spencer FA. BMJ. 2016 Sep 28;354:i5085. doi: 10.1136/bmj.i5085. No abstract available.

Review: In severe aortic stenosis, TAVI and conventional surgery do not differ for ≤ 30-day or ≤ 1-year mortality. Vandvik PO, Guyatt G. Ann Intern Med. 2016 Sep 20;165(6):JC31. doi: 10.7326/ACPJC-2016-165-6-031. No abstract available.

Perioperative Aspirin for Prevention of Venous Thromboembolism: The PeriOperative ISchemia Evaluation-2 Trial and a Pooled Analysis of the Randomized Trials. Eikelboom JW, Kearon C, Guyatt G, Sessler DI, Yusuf S, Cook D, Douketis J, Patel A, Kurz A, Allard R, Jones PM, Dennis RJ, Painter TW, Bergese SD, Leslie K, Wijeysundera DN, Balasubramanian K, Duceppe E, Miller S, Diedericks J, Devereaux PJ. Anesthesiology. 2016 Sep 14. [Epub ahead of print]

Multivariable fractional polynomial interaction to investigate continuous effect modifiers in a meta-analysis on higher versus lower PEEP for patients with ARDS. Kasenda B, Sauerbrei W, Royston P, Mercat A, Slutsky AS, Cook D, Guyatt GH, Brochard L, Richard JC, Stewart TE, Meade M, Briel M. BMJ Open. 2016 Sep 8;6(9):e011148. doi: 10.1136/bmjopen-2016-011148.

Association between progression-free survival and health-related quality of life in oncology: a systematic review protocol. Kovic B, Guyatt G, Brundage M, Thabane L, Bhatnagar N, Xie F. BMJ Open. 2016 Sep 2;6(9):e012909. doi: 10.1136/bmjopen-2016-012909.

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Canadian Primary Care Physicians' Attitudes Toward Understanding Clinical Practice Guidelines for Diabetes Screening. Alexander PE, Li SA, Tonelli M, Guyatt G. Can J Diabetes. 2016 Aug 30. pii: S1499-2671(16)30102-2. doi: 10.1016/j.jcjd.2016.05.018. [Epub ahead of pr int]

Authors seldom report the most patient-important outcomes and absolute effect measures in systematic review abstracts. Agarwal A, Johnston BC, Vernooij RW, Carrasco-Labra A, Brignardello-Petersen R, Neumann I, Akl EA, Sun X, Briel M, Busse JW, Ebrahim S, Granados CE, Iorio A, Irfan A, Martínez García L, Mustafa RA, Ramirez-Morera A, Selva A, Solà I, Sanabrai AJ, Tikkinen KA, Vandvik PO, Zhang Y, Zazueta OE, Zhou Q, Schunemann HJ, Guyatt GH, Alonso-Coello P. J Clin Epidemiol. 2016 Aug 21. pii: S0895-4356(16)30358-4. doi: 10.1016/j.jclinepi.2016.08.004. [Epub ahead of print] Review.

A randomized clinical trial to compare the effectiveness of rotator cuff repair with or without augmentation using porcine small intestine submucosa for patients with moderate to large rotator cuff tears: a pilot study. Bryant D, Holtby R, Willits K, Litchfield R, Drosdowech D, Spouge A, White D, Guyatt G. J Shoulder Elbow Surg. 2016 Oct;25(10):1623-33. doi: 10.1016/j.jse.2016.06.006. Epub 2016 Aug 18.

Aspects of patient reported outcomes in rare diseases: a discussion paper. Rüther A, Elstein D, Wong-Rieger D, Guyatt G. Int J Technol Assess Health Care. 2016 Jan;32(3):126-30. doi: 10.1017/S0266462316000271. Epub 2016 Aug 15.

Reporting of financial and non-financial conflicts of interest by authors of systematic reviews: a methodological survey. Hakoum MB, Anouti S, Al-Gibbawi M, Abou-Jaoude EA, Hasbani DJ, Lopes LC, Agarwal A, Guyatt G, Akl EA. BMJ Open. 2016 Aug 10;6(8):e011997. doi: 10.1136/bmjopen-2016-011997.

Women's values and preferences and health state valuations for thromboprophylaxis during pregnancy: A cross-sectional interview. Bates SM, Alonso-Coello P, Tikkinen KA, Ebrahim S, Lopes LC, McDonald SD, Zhou Q, Akl EA, Neumann I, Jacobsen AF, Zhang Y, Santamaría A, Annichino-Bizzacchi JM, Sandset PM, Bitar W, Eckman MH, Guyatt GH. Thromb Res. 2016 Apr;140:22-9.

Guideline conflict of interest management and methodology heavily impacts on the strength of recommendations: comparison between two iterations of the American College of Chest Physicians Antithrombotic Guidelines. Agoritsas T, Neumann I, Mendoza C, Guyatt GH. J Clin Epidemiol. 2016 Jul 26. pii: S0895-4356(16)30232-3. doi: 10.1016/j.jclinepi.2016.07.007. [Epub ahead of print] No abstract available.

Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group. Guyatt GH, Alonso-Coello P, Schünemann HJ, Djulbegovic B, Nothacker M, Lange S, Murad MH, Akl EA. J Clin Epidemiol. 2016 Jul 22. pii: S0895-4356(16)30231-1. doi: 10.1016/j.jclinepi.2016.07.006. [Epub ahead of print] No abstract available.

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When and how to update systematic reviews: consensus and checklist. Garner P, Hopewell S, Chandler J, MacLehose H, Schünemann HJ, Akl EA, Beyene J, Chang S, Churchill R, Dearness K, Guyatt G, Lefebvre C, Liles B, Marshall R, Martínez García L, Mavergames C, Nasser M, Qaseem A, Sampson M, Soares-Weiser K, Takwoingi Y, Thabane L, Trivella M, Tugwell P, Welsh E, Wilson EC; Panel for updating guidance for systematic reviews (PUGs). BMJ. 2016 Jul 20;354:i3507. doi: 10.1136/bmj.i3507. No abstract available.

Arthroscopic surgery for knee pain. Järvinen TL, Guyatt GH. BMJ. 2016 Jul 20;354:i3934. doi: 10.1136/bmj.i3934. No abstract available.

Limited responsiveness related to the minimal important difference of patient-reported outcomes in rare diseases. Johnston BC, Miller PA, Agarwal A, Mulla S, Khokhar R, De Oliveira K, Hitchcock CL, Sadeghirad B, Mohiuddin M, Sekercioglu N, Seweryn M, Koperny M, Bala MM, Adams-Webber T, Granados A, Hamed A, Crawford MW, van der Ploeg AT, Guyatt GH. J Clin Epidemiol. 2016 Jul 2. pii: S0895-4356(16)30187-1. doi: 10.1016/j.jclinepi.2016.06.010. [Epub ahead of print] Review.

GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. Alonso-Coello P, Oxman AD, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, Treweek S, Mustafa RA, Vandvik PO, Meerpohl J, Guyatt GH, Schünemann HJ; GRADE Working Group. BMJ. 2016 Jun 30;353:i2089. doi: 10.1136/bmj.i2089. No abstract available.

GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. Alonso-Coello P, Schünemann HJ, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, Treweek S, Mustafa RA, Rada G, Rosenbaum S, Morelli A, Guyatt GH, Oxman AD; GRADE Working Group. BMJ. 2016 Jun 28;353:i2016. doi: 10.1136/bmj.i2016. No abstract available.

Comparative Effectiveness of Phosphate Binders in Patients with Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis. Sekercioglu N, Thabane L, Díaz Martínez JP, Nesrallah G, Longo CJ, Busse JW, Akhtar-Danesh N, Agarwal A, Al-Khalifah R, Iorio A, Guyatt GH. PLoS One. 2016 Jun 8;11(6):e0156891. doi: 10.1371/journal.pone.0156891. eCollection 2016.

Aspiration thrombectomy prior to percutaneous coronary intervention in ST-elevation myocardial infarction: a systematic review and meta-analysis. El Dib R, Spencer FA, Suzumura EA, Goma H, Kwong J, Guyatt GH, Vandvik PO. BMC Cardiovasc Disord. 2016 Jun 2;16:121. doi: 10.1186/s12872-016-0285-4. Erratum in: BMC Cardiovasc Disord. 2016;16(1):182.

Glucagon-like peptide-1 receptor agonists and heart failure in type 2 diabetes: systematic review and meta-analysis of randomized and observational studies. Li L, Li S, Liu J, Deng K, Busse JW, Vandvik PO, Wong E, Sohani ZN, Bala MM, Rios LP, Malaga G, Ebrahim S, Shen J, Zhang L, Zhao P, Chen Q, Wang Y, Guyatt GH, Sun X. BMC Cardiovasc Disord. 2016 May 11;16:91. doi: 10.1186/s12872-016-0260-0.

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Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials. Alshamsi F, Belley-Cote E, Cook D, Almenawer SA, Alqahtani Z, Perri D, Thabane L, Al-Omari A, Lewis K, Guyatt G, Alhazzani W. Crit Care. 2016 May 4;20(1):120. doi: 10.1186/s13054-016-1305-6.

Cinacalcet versus standard treatment for chronic kidney disease: a systematic review and meta-analysis. Sekercioglu N, Busse JW, Sekercioglu MF, Agarwal A, Shaikh S, Lopes LC, Mustafa RA, Guyatt GH, Thabane L. Ren Fail. 2016 Jul;38(6):857-74. doi: 10.3109/0886022X.2016.1172468. Epub 2016 May 2.

Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia. Siemieniuk RA, Alonso-Coello P, Guyatt GH. Ann Intern Med. 2016 May 3;164(9):636-7. doi: 10.7326/L15-0583. No abstract available.

Use of heparins in patients with cancer: individual participant data meta-analysis of randomised trials study protocol. Schünemann HJ, Ventresca M, Crowther M, Briel M, Zhou Q, Garcia D, Lyman G, Noble S, Macbeth F, Griffiths G, DiNisio M, Iorio A, Beyene J, Mbuagbaw L, Neumann I, Van Es N, Brouwers M, Brozek J, Guyatt G, Levine M, Moll S, Santesso N, Streiff M, Baldeh T, Florez I, Gurunlu Alma O, Solh Z, Ageno W, Marcucci M, Bozas G, Zulian G, Maraveyas A, Lebeau B, Buller H, Evans J, McBane R, Bleker S, Pelzer U, Akl EA; IPDMA heparin use in cancer patients research group. BMJ Open. 2016 Apr 29;6(4):e010569. doi: 10.1136/bmjopen-2015-010569.

International law's effects on health and its social determinants: protocol for a systematic review, meta-analysis, and meta-regression analysis. Hoffman SJ, Hughsam M, Randhawa H, Sritharan L, Guyatt G, Lavis JN, Røttingen JA. Syst Rev. 2016 Apr 16;5:64. doi: 10.1186/s13643-016-0238-0.

N of 1 randomized trials: a commentary. Guyatt G. J Clin Epidemiol. 2016 Aug;76:4-5. doi: 10.1016/j.jclinepi.2015.09.020. Epub 2016 Apr 5. No abstract available.

Guideline of guidelines: thromboprophylaxis for urological surgery. Violette PD, Cartwright R, Briel M, Tikkinen KA, Guyatt GH. BJU Int. 2016 Sep;118(3):351-8. doi: 10.1111/bju.13496. Epub 2016 Apr 29.

How to Use a Randomized Clinical Trial Addressing a Surgical Procedure: Users' Guide to the Medical Literature. Evaniew N, Carrasco-Labra A, Devereaux PJ, Tikkinen KA, Fei Y, Bhandari M, Guyatt G. JAMA Surg. 2016 Jul 1;151(7):657-62. doi: 10.1001/jamasurg.2016.0072.

Recommendations for kidney disease guideline updating: a report by the KDIGO Methods Committee. Uhlig K, Berns JS, Carville S, Chan W, Cheung M, Guyatt GH, Hart A, Lewis SZ, Tonelli M, Webster AC, Wilt TJ, Kasiske BL. Kidney Int. 2016 Apr;89(4):753-60. doi: 10.1016/j.kint.2015.11.030.

User Experiences of the McMaster Optimal Aging Portal's Evidence Summaries and Blog Posts: Usability Study. M Barbara A, Dobbins M, Haynes RB, Iorio A, Lavis JN, Levinson AJ. JMIR Hum Factors. 2016 Aug 19;3(2):e22. doi: 10.2196/humanfactors.6208.

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EBHC pyramid 5.0 for accessing preappraised evidence and guidance. Alper BS, Haynes RB. Evid Based Med. 2016 Aug;21(4):123-5. doi: 10.1136/ebmed-2016-110447. Epub 2016 Jun 20. No abstract available.

Effectiveness and content analysis of interventions to enhance medication adherence in hypertension: a systematic review and meta-analysis protocol. Morrissey EC, Durand H, Nieuwlaat R, Navarro T, Haynes RB, Walsh JC, Molloy GJ. Syst Rev. 2016 Jun 7;5:96. doi: 10.1186/s13643-016-0278-5.

The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website. Barbara AM, Dobbins M, Haynes RB, Iorio A, Lavis JN, Raina P, Levinson AJ. JMIR Hum Factors. 2016 May 11;3(1):e14. doi: 10.2196/humanfactors.4800.

Dissemination of Clinical Practice Guidelines: A Content Analysis of Patient Versions. Santesso N, Morgano GP, Jack SM, Haynes RB, Hill S, Treweek S, Schünemann HJ; DECIDE Workpackage 3 Group. Med Decis Making. 2016 Aug;36(6):692-702. doi: 10.1177/0272989X16644427. Epub 2016 Apr 18.

Hyponatremia due to an interaction between hydromorphone and desmopressin in a patient with central diabetes insipidus. Mazzetti G, Steen O, Patel A, McInnes N. CJGIM. 2016;11(2):32-37.

Toward Fairness in Data Sharing. International Consortium of Investigators for Fairness in Trial Data Sharing, Devereaux PJ, Guyatt G, Gerstein H, Connolly S, Yusuf S.

N Engl J Med. 2016 Aug 4;375(5):405-7. doi: 10.1056/NEJMp1605654. One-Year Outcomes in Caregivers of Critically Ill Patients. Cameron JI, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, Friedrich JO, Mehta S, Lamontagne F, Levasseur M, Ferguson ND, Adhikari NK, Rudkowski JC, Meggison H, Skrobik Y, Flannery J, Bayley M, Batt J, dos Santos C, Abbey SE, Tan A, Lo V, Mathur S, Parotto M, Morris D, Flockhart L, Fan E, Lee CM, Wilcox ME, Ayas N, Choong K, Fowler R, Scales DC, Sinuff T, Cuthbertson BH, Rose L, Robles P, Burns S, Cypel M, Singer L, Chaparro C, Chow CW, Keshavjee S, Brochard L, Hébert P, Slutsky AS, Marshall JC, Cook D, Herridge MS; RECOVER Program Investigators (Phase 1: towards RECOVER); Canadian Critical Care Trials Group. N Engl J Med. 2016 May 12;374(19):1831-41. doi: 10.1056/NEJMoa1511160.

CYCLE pilot: a protocol for a pilot randomised study of early cycle ergometry versus routine physiotherapy in mechanically ventilated patients. Kho ME, Molloy AJ, Clarke F, Herridge MS, Koo KK, Rudkowski J, Seely AJ, Pellizzari JR, Tarride JE, Mourtzakis M, Karachi T, Cook DJ; Canadian Critical Care Trials Group. BMJ Open. 2016 Apr 8;6(4):e011659. doi: 10.1136/bmjopen-2016-011659.

A very low number of national adaptations of the World Health Organization guidelines for HIV and tuberculosis reported their processes. Godah MW, Abdul Khalek RA, Kilzar L, Zeid H, Nahlawi A, Lopes LC, Darzi AJ, Schünemann HJ, Akl EA. J Clin Epidemiol. 2016 Aug 24. pii: S0895-4356(16)30363-8. doi: 10.1016/j.jclinepi.2016.07.017. [Epub ahead of print]

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Quality Indicators but Not Admission Volumes of Neonatal Intensive Care Units Are Effective in Reducing Mortality Rates of Preterm Infants. Rochow N, Landau-Crangle E, Lee S, Schünemann H, Fusch C. PLoS One. 2016 Aug 10;11(8):e0161030. doi: 10.1371/journal.pone.0161030. eCollection 2016.

The effect of a monetary incentive for administrative assistants on the survey response rate: a randomized controlled trial. Agarwal A, Raad D, Kairouz V, Fudyma J, Curtis AB, Schünemann HJ, Akl EA. BMC Med Res Methodol. 2016 Aug 5;16:94. doi: 10.1186/s12874-016-0201-8.

The skills and experience of GRADE methodologists can be assessed with a simple tool. Norris SL, Meerpohl JJ, Akl EA, Schünemann HJ, Gartlehner G, Chen Y, Whittington C; Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. J Clin Epidemiol. 2016 Jul 14. pii: S0895-4356(16)30193-7. doi: 10.1016/j.jclinepi.2016.07.001. [Epub ahead of print]

The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels. Neumann I, Brignardello-Petersen R, Wiercioch W, Carrasco-Labra A, Cuello C, Akl E, Mustafa RA, Al-Hazzani W, Etxeandia-Ikobaltzeta I, Rojas MX, Falavigna M, Santesso N, Brozek J, Iorio A, Alonso-Coello P, Schünemann HJ. Implement Sci. 2016 Jul 15;11:93. doi: 10.1186/s13012-016-0462-y.

World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Vitamin D. Yepes-Nuñez JJ, Fiocchi A, Pawankar R, Cuello-Garcia CA, Zhang Y, Morgano GP, Ahn K, Al-Hammadi S, Agarwal A, Gandhi S, Beyer K, Burks W, Canonica GW, Ebisawa M, Kamenwa R, Lee BW, Li H, Prescott S, Riva JJ, Rosenwasser L, Sampson H, Spigler M, Terracciano L, Vereda A, Waserman S, Schünemann HJ, Brożek JL. World Allergy Organ J. 2016 May 17;9:17. doi: 10.1186/s40413-016-0108-1. eCollection 2016.

MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis. Bousquet J, Schünemann HJ, Hellings PW, Arnavielhe S, Bachert C, Bedbrook A, Bergmann KC, Bosnic-Anticevich S, Brozek J, Calderon M, Canonica GW, Casale TB, Chavannes NH, Cox L, Chrystyn H, Cruz AA, Dahl R, De Carlo G, Demoly P, Devillier P, Dray G, Fletcher M, Fokkens WJ, Fonseca J, Gonzalez-Diaz SN, Grouse L, Keil T, Kuna P, Larenas-Linnemann D, Lodrup Carlsen KC, Meltzer EO, Mullol J, Muraro A, Naclerio RN, Palkonen S, Papadopoulos NG, Passalacqua G, Price D, Ryan D, Samolinski B, Scadding GK, Sheikh A, Spertini F, Valiulis A, Valovirta E, Walker S, Wickman M, Yorgancioglu A, Haahtela T, Zuberbier T; MASK study group*. J Allergy Clin Immunol. 2016 Aug;138(2):367-374.e2. doi: 10.1016/j.jaci.2016.03.025. Epub 2016 Apr 23.

Principles for Disclosure of Interests and Management of Conflicts in Guidelines: Desirable and Undesirable Action and Consequences. Schünemann H. Ann Intern Med. 2016 May 17;164(10):702. doi: 10.7326/L15-0623. No abstract available.

Using GRADE to respond to health questions with different levels of urgency. Thayer KA, Schünemann HJ. Environ Int. 2016 Jul-Aug;92-93:585-9. doi: 10.1016/j.envint.2016.03.027. Epub 2016 Apr 26.

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Interpreting GRADE's levels of certainty or quality of the evidence: GRADE for statisticians, considering review information size or less emphasis on imprecision? Schünemann HJ. J Clin Epidemiol. 2016 Jul;75:6-15. doi: 10.1016/j.jclinepi.2016.03.018. Epub 2016 Apr 6.

Developing GRADE outcome-based recommendations about diagnostic tests: a key role in laboratory medicine policies. Trenti T, Schünemann HJ, Plebani M. Clin Chem Lab Med. 2016 Apr;54(4):535-43. doi: 10.1515/cclm-2015-0867. Barriers and facilitators for goals of care discussions between residents and hospitalised patients. Shah K, Swinton M, You JJ. Postgrad Med J. 2016 Jul 22. pii: postgradmedj-2016-133951. doi: 10.1136/postgradmedj-2016-133951. [Epub ahead of print]

Agreements between Industry and Academia on Publication Rights: A Retrospective Study of Protocols and Publications of Randomized Clinical Trials. Kasenda B, von Elm E, You JJ, Blümle A, Tomonaga Y, Saccilotto R, Amstutz A, Bengough T, Meerpohl JJ, Stegert M, Olu KK, Tikkinen KA, Neumann I, Carrasco-Labra A, Faulhaber M, Mulla SM, Mertz D, Akl EA, Bassler D, Busse JW, Ferreira-González I, Lamontagne F, Nordmann A, Gloy V, Raatz H, Moja L, Ebrahim S, Schandelmaier S, Sun X, Vandvik PO, Johnston BC, Walter MA, Burnand B, Schwenkglenks M, Hemkens LG, Bucher HC, Guyatt GH, Briel M. PLoS Med. 2016 Jun 28;13(6):e1002046. doi: 10.1371/journal.pmed.1002046. eCollection 2016 Jun.

Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study. Howard M, Bonham AJ, Heyland DK, Sudore R, Fassbender K, Robinson CA, McKenzie M, Elston D, You JJ. BMJ Open. 2016 Jun 23;6(6):e010375. doi: 10.1136/bmjopen-2015-010375.

Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis. Chung HO, Oczkowski SJ, Hanvey L, Mbuagbaw L, You JJ. BMC Med Educ. 2016 Apr 29;16:131. doi: 10.1186/s12909-016-0653-x.

Communication Tools for End-of-Life Decision-Making in Ambulatory Care Settings: A Systematic Review and Meta-Analysis. Oczkowski SJ, Chung HO, Hanvey L, Mbuagbaw L, You JJ. PLoS One. 2016 Apr 27;11(4):e0150671. doi: 10.1371/journal.pone.0150671. eCollection 2016.

Communication tools for end-of-life decision-making in the intensive care unit: a systematic review and meta-analysis. Oczkowski SJ, Chung HO, Hanvey L, Mbuagbaw L, You JJ. Crit Care. 2016 Apr 9;20:97. doi: 10.1186/s13054-016-1264-y.

'Talk to me': a mixed methods study on preferred physician behaviours during end-of-life communication from the patient perspective. Abdul-Razzak A, Sherifali D, You J, Simon J, Brazil K. Health Expect. 2016 Aug;19(4):883-96. doi: 10.1111/hex.12384. Epub 2015 Jul 14.