[Recommendations for Primary Health Care for transgender people]. / Recomendaciones para la atención de la salud en Atención Primaria de las personas transgénero.

The WHO defines Primary Health Care as essential health care, based on practical, scientifically founded and socially acceptable methods and technologies, made available to all individuals and families in the community, through their full participation, and at a cost that the community and the country can bear, at each and every stage of their development, in a spirit of self-responsibility and self-determination. With the intention of fulfilling the basic objective of caring for and promoting health in all the groups that make up our current society, the need arises to focus on certain groups in which the actions of Primary Care are currently consensual or poorly protocolised, as is the case with the health care of transgender people.

Atención Farmacéutica Integral a pacientes pediátricos hospitalizados con trastornos siquiátricos / Comprehensive Pharmaceutical Care in pediatric inpatient with psychiatric disorders

Introducción: el incremento de nuevos psicofármacos en la edad pediátrica, requieren la valoración de problemas relacionados con medicamentos, de ahí que resulte necesario el desarrollo de los servicios de Atención Farmacéutica. Objetivo: desarrollar la Atención Farmacéutica Integral para pacientes pediátricos con trastornos psiquiátricos hospitalizados. Métodos: se realizó un estudio prospectivo y de intervención, desde febrero a abril del 2017, en el que participaron pacientes pediátricos con trastornos psiquiátricos. El servicio se desarrolló en tres fases del proceso de cuidado farmacéutico y se empleó un procedimiento normalizado de trabajo. Se determinó el impacto de las intervenciones en la prevención o resolución de los resultados negativos asociados a la medicación, el estado clínico de los pacientes y la satisfacción de los cuidadores. Resultados: predominó el sexo femenino (55%), edades comprendidas entre 15 y 18 años (80%) y nivel de escolaridad medio de los cuidadores (45%). Se identificó falta de adherencia terapéutica antes del ingreso, corroborada con las experiencias subjetivas. Se detectaron 19 resultados negativos asociados a la medicación, predominando los de seguridad (89,4%). Se realizaron 36 intervenciones farmacéuticas, para un 80,5% de aceptación, se previnieron 57,1% y se resolvió el 80 % del total de resultados negativos asociados a la medicación. El 100 % de los pacientes tuvieron una evolución favorable y los cuidadores mostraron satisfacción. Conclusiones: La Atención Farmacéutica Integral permitió identificar factores psicosociales del paciente asociados a la enfermedad y la farmacoterapia y la prevención y resolución de la mayoría de los resultados negativos asociados a la medicación.(AU)

Introduction: the use of new psychoactive drugs and their widespread use in the pediatric age underline the importance of assessing the appearance of drug-related problems, hence the need for the development of Pharmaceutical Care services. Objective:to show the preliminary results of the development of the Comprehensive Pharmaceutical Care service for pediatric inpatients with psychiatric disorders. Methods: in 2020, it was carried out a retrospective study about the preliminary implementation of a service provided to pediatric inpatients with psychiatric disorders, from February 1stto April 28thin 2017. The pharmaceutical care process was developed in three phases, a standard operating procedure and the pharmacotherapeutical profiles of patients were used. The preliminary impact of the interventions on the prevention or resolution of negative results associated with medication, the clinical status of the patients and the satisfaction of the caregivers was determined. Results :twenty patients were included, female sex predominated (55%), ages between 15 and 18 years (80%) and average level of education of caregivers (45%). Lack of therapeutic adherence was identified before admission, corroborated with subjective experiences from patients, 19 negative results associated with medication were detected, predominantly related to safety (89.4%), 36 pharmaceutical interventions were carried out with 80.5% of acceptance, 57.1% were prevented and 80% of the total negative results associated with the medication were resolved. 100% of the patients had a favourable progress and caregivers showed 100 % of satisfaction. Conclusions: the Comprehensive Pharmaceutical Care service allowed to identify psychosocial factors in patients associated to disease and pharmacotherapy and contributed to the...(AU)

First-line therapy, autologous stem-cell transplantation, and post-transplantation maintenance in the management of newly diagnosed mantle cell lymphoma.

Background: In Ontario, no clearly defined standard of care for the management of mantle cell lymphoma (mcl) has been developed, and substantial variability from centre to centre is evident. This guidance document was prompted by the need to harmonize practice in Ontario with respect to first-line, conditioning, and post-transplantation maintenance therapy for patients newly diagnosed with transplantation-eligible mcl. Methods: The medline and embase databases were systematically searched from January 2013 to January 2020 for evidence, and the best available evidence was used to draft recommendations relevant to first-line therapy, autologous stem-cell transplantation, and post-transplantation maintenance in the management of transplantation-eligible newly diagnosed mcl. Final approval of this guidance document was obtained from the Stem Cell Transplant Advisory Committee. Recommendations: These recommendations apply to all cases of transplantation-eligible newly diagnosed mcl:■ Alternating cycles of r-chop (rituximab plus cyclophosphamide-doxorubicin-vincristine-prednisolone) and r-dhap [rituximab plus dexamethasone-high-dose cytarabine-cisplatin] is the recommended first-line treatment for symptomatic patients newly diagnosed with mcl before autologous stem-cell transplantation (asct).■ Rituximab plus hyperfractionated cyclophosphamide-vincristine-doxorubicin-dexamethasone (r-hypercvad), alternating with methotrexate and cytarabine, is not recommended for the treatment of patients with newly diagnosed mcl.■ beam (carmustine-etoposide-cytarabine-melphalan), beac (carmustine-etoposide-cytarabine-cyclophosphamide), and total-body irradiation-based regimens are reasonable conditioning options for patients with mcl who have responded to first-line therapy and who are undergoing asct.■ Maintenance therapy with rituximab is recommended for patients with newly diagnosed mcl who have undergone asct.

Baseline staging imaging for distant metastasis in women with stages I, II, and III breast cancer.

Background: In Ontario, there is no clearly defined standard of care for staging for distant metastasis in women with newly diagnosed and biopsy-confirmed breast cancer whose clinical presentation is suggestive of early-stage disease. This guideline addresses baseline imaging investigations for women with newly diagnosed primary breast cancer who are otherwise asymptomatic for distant metastasis. Methods: The medline and embase databases were systematically searched for evidence from January 2000 to April 2019, and the best available evidence was used to draft recommendations relevant to the use of baseline imaging investigation in women with newly diagnosed primary breast cancer who are otherwise asymptomatic. Final approval of this practice guideline was obtained from both the Staging in Early Stage Breast Cancer Advisory Committee and the Report Approval Panel of the Program in Evidence-Based Care. Recommendations: These recommendations apply to all women with newly diagnosed primary breast cancer (originating in the breast) who have no symptoms of distant metastasis Staging tests using conventional anatomic imaging [chest radiography, liver ultrasonography, chest-abdomen-pelvis computed tomography (ct)] or metabolic imaging modalities [integrated positron-emission tomography (pet)/ct, integrated pet/magnetic resonance imaging (mri), bone scintigraphy] should not be routinely ordered for women newly diagnosed with clinical stage i or stage ii breast cancer who have no symptoms of distant metastasis, regardless of biomarker status. In women newly diagnosed with stage iii breast cancer, baseline staging tests using either anatomic imaging (chest radiography, liver ultrasonography, chest-abdomen-pelvis ct) or metabolic imaging modalities (pet/ct, pet/mri, bone scintigraphy) should be considered regardless of whether the patient is symptomatic for distant metastasis and regardless of biomarker profile.

[Control of cardiovascular risk factors in type 2 diabetes in a specialized diabetic clinic]. / Control de los factores de riesgo cardiovascular en diabetes tipo 2 en una consulta monográfica.

BACKGROUND: Achieving an adequate control of glycaemic and cardiovascular risk factors (CVRFs) is essential in patients with type 2 diabetes mellitus (T2DM). However, several studies have shown that the percentage of patients achieving these goals is scarce. We evaluated the degree of control of CVRFs target goals in T2DM patients who regularly attend a specialized diabetic clinic. METHODS: We studied T2DM patients who attended the specialized Diabetic Unit at the Department of Endocrinology of Clínica Universitaria de Navarra with a minimum follow-up of one year. Clinical characteristics, chronic complications and treatments were collected and patients were classified into groups according to the fulfilment of target glycated haemoglobin (HbA1c), LDL cholesterol and blood pressure (BP) levels, predefined according to the presence of different comorbidities and the duration of T2DM. RESULTS: We analysed 137 patients (75% men) with T2DM, with an average age of 67 years and a 12.7 year duration of diabetes. During follow-up, 83.9% of the patients were within the individualized HbA1c target, 76.6% considering BP and 67.2% in terms of LDL-cholesterol. In addition, 68% had concomitantly the three main variables within the target. CONCLUSIONS: In our population of T2DM, HbA1c, LDL cholesterol and BP targets were achieved in a substantial proportion of patients (67-91%). Perhaps the intense and individualized care offered through a specialized diabetes unit may explain these results.

Control de los factores de riesgo cardiovascular en diabetes tipo 2 en una consulta monográfica / Control of cardiovascular risk factors in type 2 diabetesin a specialized diabetic clinic

Fundamento: Un adecuado control de la glucemia y de los factores de riesgo cardiovascular (FRCV) es fundamental en los pacientes con diabetes mellitus tipo 2 (DM2). Sin embargo, diversos estudios han demostrado que el porcentaje de pacientes que alcanzan dichos objetivos es escaso. Hemos evaluado el grado de control de FRCV en pacientes DM2 que acuden con regularidad a una consulta monográfica de diabetes. Pacientes y métodos: Se han estudiado los pacientes con DM2 que acudían a revisión al departamento de Endocrinología de la Clínica Universidad de Navarra con un seguimiento mínimo de un año. Se presentan las características clínicas, complicaciones crónicas y tratamiento médico, así como la clasificación en grupos según el cumplimiento de los objetivos de hemoglobina glicada (HbA1c), perfil lipídico (LDL-colesterol) y presión arterial (PA) individualizados según comorbilidades y años de evolución de la DM2. Resultados: Se han analizado 137 pacientes (75% hombres) con DM2, 67 años de edad media y 12,7 años de evolución. Durante el seguimiento, se encontraron dentro del rango objetivo individualizado de HbA1c el 83,9% de los pacientes, el 67,2% en cuanto a LDL-colesterol y el 76,6% considerando PA. Además, el 68% presentaron las tres variables principales dentro del objetivo. Conclusiones: En nuestra población de DM2 la consecución de objetivos de HbA1c, LDL-colesterol y PA se alcanza en una importante proporción de pacientes (67-91%). Posiblemente la intensa e individualizada atención ofrecida a través de una unidad de diabetes especializada pueda explicar estos resultados (AU)

Background: Achieving an adequate control of glycaemic and cardiovascular risk factors (CVRFs) is essential in patients with type 2 diabetes mellitus (T2DM). However, several studies have shown that the percentage of patients achieving these goals is scarce. We evaluated the degree of control of CVRFs target goals in T2DM patients who regularly attend a specialized diabetic clinic. Methods: We studied T2DM patients who attended the specialized Diabetic Unit at the Department of Endocrinology of Clínica Universidad de Navarra with a minimum follow-up of one year. Clinical characteristics, chronic complications and treatments were collected and patients were classified into groups according to the fulfilment of target glycated haemoglobin (HbA1c), LDL cholesterol and blood pressure (BP) levels, predefined according to the presence of different comorbidities and the duration of T2DM. Results: We analysed 137 patients (75% men) with T2DM, with an average age of 67 years and a 12.7 year duration of diabetes. During follow-up, 83.9% of the patients were within the individualized HbA1c target, 76.6% considering BP and 67.2% in terms of LDL-cholesterol. In addition, 68% had concomitantly the three main variables within the target. Conclusions: In our population of T2DM, HbA1c, LDL colesterol and BP targets were achieved in a substantial proportion of patients (67-91%). Perhaps the intense and individualized care offered through a specialized diabetes unit may explain these results (AU)

Follow-up care for survivors of lymphoma who have received curative-intent treatment.

OBJECTIVE: This evidence summary set out to assess the available evidence about the follow-up of asymptomatic survivors of lymphoma who have received curative-intent treatment. METHODS: The medline and embase databases and the Cochrane Database of Systematic Reviews were searched for evidence published between 2000 and August 2015 relating to lymphoma survivorship follow-up. The evidence summary was developed by a Working Group at the request of the Cancer Care Ontario Survivorship and Cancer Imaging programs because of the absence of evidence-based practice documents in Ontario for the follow-up and surveillance of asymptomatic patients with lymphoma in complete remission. RESULTS: Eleven retrospective studies met the inclusion criteria. The proportion of relapses initially detected by clinical manifestations ranged from 13% to 78%; for relapses initially detected by imaging, the proportion ranged from 8% to 46%. Median time for relapse detection ranged from 8.6 to 19 months for patients initially suspected because of imaging and from 8.6 to 33 months for those initially suspected because of clinical manifestations. Only one study reported significantly earlier relapse detection for patients initially suspected because of clinical manifestations (mean: 4.5 months vs. 6.0 months, p = 0.042). No benefit in terms of overall survival was observed for patients depending on whether their relapse was initially detected because of clinical manifestations or surveillance imaging. SUMMARY: Findings in the present study support the importance of improving awareness on the part of survivors and clinicians about the symptoms that might be associated with recurrence. The evidence does not support routine imaging for improving outcomes in this patient population.

Transversus abdominal plane block as a sole anesthetic technique for abdominal wall hematoma drainage / Bloqueo del plano transverso abdominal como única técnica anestésica para el drenaje de un hematoma abdominal

Transversus abdominal plane (TAP) block is a known and useful technique, widely used for postoperative pain management of abdominal wall incisions. During the past years, and following the expansion of ultrasound guided techniques, its use has even gained more adepts. It is usually used as an adjuvant technique, primarily in order to control postoperative pain and reduce opioids consumption. We report the case of an 82 years old patient admitted for drainage of a postoperative abdominal wall hematoma after correction of a McBurney incisional hernia. The corrective surgery had gone on without incident, under general anesthesia with laryngeal mask. Two weeks later, the patient came back to our emergency department with a clear hematoma of the abdominal wall. Surgery was decided. A sole local anesthetic technique was achieved, using a TAP block. The block was performed under ultrasound guidance, using a subcostal approach. The surgery went on without complications. Therefore, TAP block offers a hemodynamic stability, appropriate intra-operative anesthesia and post-surgical analgesia of the abdominal wall (AU)

El bloqueo del plano transverso abdominal (TAP) es una técnica conocida y de demostrada utilidad, ampliamente usada en el contexto del manejo del dolor postoperatorio tras una incisión abdominal. Durante los últimos años, y gracias a la expansión de la ecografía en el ámbito de la anestesia, ha aumentado aún más la frecuencia de su utilización. Es frecuentemente usado como técnica adyuvante para el control del dolor postoperatorio y con el fin de disminuir el consumo de opioides u otros analgésicos. Presentamos el caso de una paciente de 82 años de edad intervenida para drenar un hematoma de pared abdominal tras la corrección de una hernia de McBurney. La herniorrafia había transcurrido sin incidencias, bajo anestesia general con mascarilla laríngea. Dos semanas después, la paciente acude a Urgencias con un hematoma franco en la pared abdominal. Se decidió realizarle un drenaje urgente. Dicho drenaje se realizó utilizando únicamente un TAP block ecoguiado. La cirugía cursó sin incidencias. Consideramos, por ello, que el TAP block ofrece una opción efectiva y hemodinámicamente estable para la anestesia de la pared abdominal, y para el posterior control del dolor postoperatorio (AU)

Plerixafor for autologous stem-cell mobilization and transplantation for patients in Ontario.

BACKGROUND: High-dose chemotherapy with autologous stem-cell transplantation (asct) is an accepted part of standard therapy for patients with hematologic malignancies. Usually, stem-cell mobilization uses granulocyte colony-stimulating factor (g-csf); however, some patients are not able to be mobilized with chemotherapy and g-csf, and such patients could be at higher risk of failing mobilization. Plerixafor is a novel mobilization agent that is absorbed quickly after subcutaneous injection and, at the recommended dose of 0.24 mg/kg, provides a sustained increase in circulating CD34+ cells for 10-18 hours. The main purpose of the present report was to evaluate the most current evidence on the efficacy of plerixafor in enhancing hematopoietic stem-cell mobilization and collection before asct for patients in Ontario so as to make recommendations for clinical practice and to assist Cancer Care Ontario in decision-making with respect to this intervention. METHODS: The medline and embase databases were systematically searched for evidence from January 1996 to March 2015, and the best available evidence was used to draft recommendations relevant to the efficacy of plerixafor in enhancing hematopoietic stem-cell mobilization and collection before asct. Final approval of this practice guideline report was obtained from both the Stem Cell Transplant Steering Committee and the Report Approval Panel of the Program in Evidence-Based Care. RECOMMENDATIONS: These recommendations apply to adult patients considered for asct: ■ Adding plerixafor to g-csf is an option for initial mobilization in patients with non-Hodgkin lymphoma or multiple myeloma who are eligible for asct when chemotherapy cannot be used and only g-csf mobilization is available.■ For patients with a low peripheral blood CD34+ cell count (for example, <10/µL) at the time of anticipated stem-cell harvesting, or with an inadequate first-day apheresis collection, it is recommended that plerixafor be added to the mobilization regimen to maximize stem-cell collection and to prevent the need for remobilization.■ It is recommended that patients who have failed a previous mobilization attempt undergo remobilization with g-csf and plerixafor, with or without chemotherapy.

[Assessment of the impact of pain on work productivity: validation of the Spanish WPAI:Pain questionnaire]. / Valoración de la repercusión del dolor sobre la productividad laboral: validación del cuestionario WPAI:Pain.

BACKGROUND: Health measuring instruments are essential in daily clinical practice. However, a validation process is needed in order to certify the validity and reliability of it. The aim of our study is to validate a questionnaire to assess the consequences of pain in work productivity. METHODS: Based on the Work Productivity and Activity Impairment Questionnaire ­ General Health we have created a modified version called WPAI:Pain in order to be able to measure the consequences of pain in work productivity. The study was conducted following the usual guidelines of test validation, omitting face validity as WPAI:Pain is a modification of an existing questionnaire. Validity and reliability were calculated. RESULTS: A total of 577 questionnaires were obtained in 2 spanish university hospitals. The questionnaire's discriminating power was verified by Mann-Whitney test. Reliability tests were realized, Cronbach's alpha was 0.896 and Guttman split-half was 0.921. Stability was evaluated with a test-retest which was significant. Construct validity was established by Pearson correlation comparing the results of the questionnaire with the pain visual analog scale, which was statistically significant for all values. CONCLUSIONS: The WPAI:Pain questionnaire is a valid instrument for measuring the consequences of pain in work productivity.It is currently the only one validated in Spanish.Major studies are needed in order to establish its universal validity.

Valoración de la repercusión del dolor sobre la productividad laboral: validación del cuestionario WPAI: pain / Assessment of the impact of pain on work productivity: validation of the Spanish WPAI: pain questionnaire

Fundamento: Los instrumentos de medida de salud son esenciales en la actividad clínica diaria. Sin embargo, es necesario un proceso de validación para poder certificar la validez y fiabilidad de los mismos. En la actualidad no existe ninguno que permita evaluar la repercusión del dolor en la productividad laboral de los pacientes. El objetivo de nuestro estudio es validar un cuestionario para evaluar las consecuencias del dolor en dicha productividad. Método: En base al Work Productivity and Activity Impairment Questionnaire - General Health hemos creado una versión modificada denominada WPAI:Pain con el fin obtener un cuestionario que pudiera medir las consecuencias del dolor en la productividad laboral. El estudio se realizó siguiendo las pautas habituales de validación de pruebas, omitiéndose las fases de redacción y validez de contenido ya que se modificaba un cuestionario existente. Resultados: Se obtuvieron 577 cuestionarios en dos hospitales universitarios españoles. Se comprobó la capacidad discriminante del cuestionario mediante prueba de U de Mann-Whitney. Se realizaron los test de fiabilidad obteniéndose un alfa de Cronbach de 0,896 con un test de dos mitades de Guttman de 0,921. Se comprobó la estabilidad con un test-retest estadísticamente significativo. La validez de constructo se estableció mediante correlación de Pearson comparando los resultados del cuestionario con el dolor en escala visual analógica, que resultó estadísticamente significativa para todos los valores. Conclusiones: El cuestionario WPAI:Pain es un instrumento de medida válido para determinar las consecuencias del dolor en la productividad laboral de los pacientes, siendo el único validado en español. Sin embargo, se requieren estudios de mayor envergadura para poder confirmar una validez universal (AU)

Background: Health measuring instruments are essential in daily clinical practice. However, a validation process is needed in order to certify the validity and reliability of it. The aim of our study is to validate a questionnaire to assess the consequences of pain in work productivity. Methods: Based on the Work Productivity and Activity Impairment Questionnaire - General Health we have created a modified version called WPAI:Pain in order to be able to measure the consequences of pain in work productivity. The study was conducted following the usual guidelines of test validation, omitting face validity as WPAI:Pain is a modification of an existing questionnaire. Validity and reliability were calculated. Results: A total of 577 questionnaires were obtained in 2 spanish university hospitals. The questionnaire's discriminating power was verified by Mann-Whitney test. Reliability tests were realized, Cronbach's alpha was 0.896 and Guttman split-half was 0.921. Stability was evaluated with a test-retest which was significant. Construct validity was established by Pearson correlation comparing the results of the questionnaire with the pain visual analog scale, which was statistically significant for all values. Conclusions: The WPAI:Pain questionnaire is a valid instrument for measuring the consequences of pain in work productivity. It is currently the only one validated in Spanish. Major studies are needed in order to establish its universal validity (AU)

Transversus abdominal plane block as a sole anesthetic technique for abdominal wall hematoma drainage.

Transversus abdominal plane (TAP) block is a known and useful technique, widely used for postoperative pain management of abdominal wall incisions. During the past years, and following the expansion of ultrasound guided techniques, its use has even gained more adepts. It is usually used as an adjuvant technique, primarily in order to control postoperative pain and reduce opioids consumption. We report the case of an 82 years old patient admitted for drainage of a postoperative abdominal wall hematoma after correction of a McBurney incisional hernia. The corrective surgery had gone on without incident, under general anesthesia with laryngeal mask. Two weeks later, the patient came back to our emergency department with a clear hematoma of the abdominal wall. Surgery was decided. A sole local anesthetic technique was achieved, using a TAP block. The block was performed under ultrasound guidance, using a subcostal approach. The surgery went on without complications. Therefore, TAP block offers a hemodynamic stability, appropriate intra-operative anesthesia and post-surgical analgesia of the abdominal wall.

The organization of colposcopy services in Ontario: recommended framework.

OBJECTIVE: The purpose of this guideline is to help ensure the provision of high-quality colposcopy practices in the province of Ontario, including those conducted as diagnostic procedures in follow-up to an abnormal cervical screening test. METHODS: This document updates the recommendations published in the 2008 colposcopy guideline from Cancer Care Ontario, The Optimum Organization for the Delivery of Colposcopy Service in Ontario. A systematic review of guidelines was conducted to evaluate the existing evidence and recommendations concerning these key aspects of colposcopy: □ Training, qualification, accreditation, and maintenance of competence□ Practice setting requirements□ Operational practice□ Quality indicators and outcomes. RESULTS: This guideline provides recommendations on training and maintenance of competence for colposcopists in the practice settings in which colposcopic evaluation and treatments are conducted. It also provides recommendations on operational issues and quality indicators for colposcopy. CONCLUSIONS: This updated guideline is intended to support quality improvement for colposcopy for all indications, including the follow-up of an abnormal cervical screening test and work-up for lower genital tract lesions that are not clearly malignant. The recommendations contained in this document are intended for clinicians and institutions performing colposcopy in Ontario, and for policymakers and program planners involved in the delivery of colposcopy services.

Extracorporeal photopheresis in the management of graft-versus-host disease.

QUESTION: Is there a benefit associated with the use of extracorporeal photopheresis (ecp) compared with other treatment options for patients who have received allogeneic stem-cell transplantation (sct) and are experiencing graft-versus-host disease (gvhd), if response rate, survival, or improvement in symptoms are the outcomes of interest? PERSPECTIVES: After allogeneic sct, gvhd is a common complication historically categorized as either acute (agvhd: onset ≤100 days post-transplantation) or chronic (cgvhd: >100 days post-transplantation). Graft-versus-host disease occurs when the donor's immune cells recognize the host patient's tissues and organs as foreign and attack them, causing a multitude of problems, often in liver, gastrointestinal system, and skin. Photopheresis is one therapy that has emerged since the early 2000s for the management of steroid-refractory gvhd because of its steroid-sparing ability, low associated toxicity, and efficacy in some clinical settings. The present recommendation report summarizes the available data about photopheresis for the treatment of gvhd and provides recommendations on its use. METHODOLOGY: The medline (Ovid) database was systematically searched for January 1995 to August 2013, and the best available evidence was used to draft recommendations relevant to adult and pediatric patients in Ontario who have received allogeneic sct and are experiencing gvhd. Draft recommendations were first reviewed by clinical and methodology experts before undergoing internal review. Final approval of this practice guideline report was obtained from both the Stem Cell Transplant Steering Committee and the Report Approval Panel of the Program in Evidence-Based Care. RECOMMENDATIONS: These recommendations apply to adult and pediatric patients who have received an allogeneic sct and are experiencing gvhd: ecp is an acceptable therapy for the treatment of steroid-dependent or refractory agvhd in adult and pediatric patients.ecp is an effective therapy for the treatment of steroid-dependent or refractory cgvhd in adult and pediatric patients. QUALIFYING STATEMENT: In Ontario, ecp is currently a covered therapy for patients with steroid-refractory gvhd who meet certain eligibility criteria.

Verotoxigenic Escherichia coli: costs of illness in Canada, including long-term health outcomes.

The main objective of this study was to provide cost estimates of human Escherichia coli O157 infection to facilitate future assessment of the benefits and costs of alternative preventive strategies to reduce illness. We investigated the costs of illness to Canadians from primary human infection by verotoxigenic E. coli O157 (also called Shiga toxin-producing E. coli O157) using data from the National Notifiable Diseases Registry. We used relative risk information from peer-reviewed publications to estimate the burden of illness and associated costs for eight long-term health outcomes. National estimates of the number of cases (mean and 5th and 95th percentiles), associated costs, and a rank correlation test to identify which outcomes were associated with the highest per capita costs were calculated. An estimated 22,344 cases of primary infections occur in Canada annually, costing $26.7 million. There are 37,867 additional on-going long-term health outcomes costing $377.2 million each year. Our analysis indicated that the annual cost for primary and long-term illness is $403.9 million. The analysis supports evaluation of alternative control and prevention measures and the development and implementation of policy and practices aimed at safe food production.