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The Evidence Speaks (May 2017)

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We’re proud to introduce our Evidence Speaks series, 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.

Salcido DD, Schmicker RH, Buick JE, Cheskes S, Grunau B, Kudenchuk P, Leroux B, Zellner S, Zive D, Aufderheide TP, Koller AC, Herren H, Nuttall J, Sundermann ML, Menegazzi JJ, Resuscitation Outcomes Consortium Investigators. Compression-to-ventilation ratio and incidence of rearrest—A secondary analysis of the ROC CCC trial. Resuscitation. 2017;115:68-74.

When a person has a cardiac arrest outside of the hospital, emergency medical personnel perform cardiopulmonary resuscitation (CPR) with the goal of return to spontaneous circulation, or ROSC. After ROSC, one of the biggest risks to a patient’s survival is a second cardiac arrest (rearrest), before they arrive at the hospital. A recent study investigated two CPR approaches: one used continuous chest compression and one used 2 ventilations for every 30 chest compressions. The study found that the compression-to-ventilation ratio has no impact on survival or function following ROSC. However, this trial did not include rearrest as a study outcome; this led CHÉOS’ Dr. Brian Grunau, along with other the researchers from the original study, to perform a secondary analysis of the trial. After analyzing over 14,000 cases from 10 sites across the U.S. and Canada, the researchers found that of 4713 patients that had ROSC before arriving at the hospital, 43% had a rearrest. Rearrest was associated with worse neurological outcomes and a lower rate of survival, but was not affected by compression-to-ventilation ratio during CPR.

Sayre EC, Guermazi A, Esdaile JM, Kopec JA, Singer J, Thorne A, Nicolaou S, Cibere J. Associations between MRI features versus knee pain severity and progression: Data from the Vancouver Longitudinal Study of Early Knee Osteoarthritis. PLoS ONE. 2017;12(5):e0176833.

The Vancouver Longitudinal Study of Early Knee Osteoarthritis is a CIHR-funded study that includes CHÉOS’ Dr. Joel Singer and researchers from Arthritis Research Canada, University of Calgary, UBC, and others. The aim of the study is to understand and describe the natural course of early knee osteoarthritis with a long-term follow-up period. Investigators followed 122 participants, aged 40-79 with chronic knee pain, for a mean of 7.5 years following baseline, with a “middle visit” at 3.3 years. Several measurements were taken using MRI including cartilage health, meniscal characteristics, and anatomical abnormalities. Self-reported measurements were also recorded, among other variables. The only MRI variable that consistently predicted pain progression was the presence of osteophytes (bone spurs). Meniscal damage and cartilage defects were shown to play a secondary role in pain progression. This study clearly demonstrates the importance of bone in the development of early knee osteoarthritis.

Tu AW, Watts AW, Chanoine JP, Panagiotopoulos C, Geller J, Brant R, Barr SI, Masse L. Does parental and adolescent participation in an e-health lifestyle modification intervention improves weight outcomes? BMC Public Health. 2017;17(1):352.

CHÉOS Scientist Dr. Josie Geller, with a team of researchers from UBC, recently published a study that looked at the effectiveness of web-based interventions to treat or prevent childhood obesity. Specifically, the researchers wanted to examine whether adherence to an electronic intervention could predict changes in body mass index (BMI) and waist circumference (WC). The team also analyzed whether parental participation in the intervention affected these outcomes. One-hundred seventy-six parent-adolescent pairs were recruited; adolescents were between the ages of 11 and 16 years and categorized as overweight or obese according to World Health Organization criteria. The 8-month web-based intervention (MySteps) consisted of weekly logins to a website that encouraged healthy eating, physical activity, and reduced screen time. Parents logged into a separate website to receive complementary information and challenges designed to foster support for their child’s weekly challenges. The research team found that children who had greater participation in the intervention had better BMI outcomes. Parental participation, however, did not affect outcomes in their children. This research showed that e-health interventions can be effective in improving weight outcomes in adolescents but that other strategies are needed to promote effective parental engagement related to these interventions.

Wright AJ, Rose C, Toews M, Paquet M, Corsilli D, Le Cailhier JF, Gill JS. An exception to the rule or a rule for the exception? The potential of using HIV-positive donors in Canada. Transplantation. 2017;101(4):671-4.

Recent evidence has suggested that organ transplantation between people living with HIV is safe and this finding has prompted legislation in the U.S. to allow such transplants for kidneys and livers. CHÉOS Scientists Drs. Caren Rose and John Gill, together with researchers from UBC, Alberta, and Quebec, published a review of the potential for equivalent legislation in Canada. After analyzing a total of 335,793 in-hospital deaths during the study period (2005-2009), 29 potential HIV-positive donors were found. The risk of the organ recipient acquiring a unique strain of HIV that leads to more rapid disease progression is the most salient medical consideration in HIV-positive donation. Although Canadian law currently does not prohibit donation from HIV-positive donors, several specific criteria must be met: a “safe” organ is not readily available, the physician performing the transplant gives authorization, and the patient provides informed consent. The proposed approach to HIV-positive organ donation requires that donors are virally suppressed (have a viral load that is undetectable by current standards). The researchers estimated that, if the same criterion was used in Canada, there would be only 3 to 5 potential donors per year. The researchers concluded that due to the low number of eligible donors and the potential risk to recipients, further understanding of the risks as well as the willingness of recipients is needed before organ donation services are expanded to people living with HIV.

Health research in the heart of Vancouver