In This Issue
- Scientific Director
- Report from the Chair
- Project Update
- ACHORD Seen & Heard
- Recent Literature
- Meet the Staff
- ACHORD Accolades
- Other ACHORD News
ACHORD Seen & Heard
Asadi L and Sligl WI (shared first authorship), Eurich DT, Colmers IN, Tjosvold L, Marrie TJ, Majumdar SR. Macrolide-based regimens and mortality in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2012;55:371-380 (selected as an “Editor’s Choice” article) PMID: 22511553
Asakawa K, Senthilselvan A, Feeney D, Johnson JA, Rolfson D. Trajectories of health-related quality of life differ by age among adults: Results from an eight-year longitudinal study. J Health Econ 2012;31(1)207-18. PMID: 22137148
Colmers IN, Bowker SL, Majumdar SR, Johnson JA. Use of thiazolidinediones and the risk of bladder cancer among people with type 2 diabetes: a meta-analysis. CMAJ. 2012 Sep 4;184(12):E675-83. PMID: 22761478
Edwards JP, Kelly EJ, Lin Y, Lenders T, Ghali WA, Graham AJ. Meta-analytic comparison of randomized and nonrandomized studies of breast cancer surgery. Can J Surg. 2012 Jun;55(3):155-62. Review. PMID: 22449722
Eurich DT, Johnstone JJ, Minhas-Sandhu JK, Marrie TJ, Majumdar SR. Pneumococcal vaccination and risk of acute coronary syndromes in patients with pneumonia: population-based cohort study. Heart 2012;98(14):1072-7. PMID: 22739637
Eurich DT, Majumdar SR, Marrie T. Population-Based Cohort Study of Outpatients with Pneumonia: Rationale, Design and Baseline Characteristics. BMC Infect Dis 2012 Jun 18;12:135. PMID: 22709357
Feasby TE, Quan H, Tubman M, Pi D, Tinmouth A, So L, Ghali WA. Appropriateness of the use of intravenous immune globulin before and after the introduction of a utilization control program. Open Med. 2012;6(1):e28-34. PMID: 22567080
Foulds JL, Vanderloo SE, Marks SD, Johnson JA. Health care costs for initial management of children with new-onset type 1 diabetes mellitus in central & northern Alberta. Can J Diabetes 2012;36:129-133.
Gamble JM, McAlister FA, Johnson JA, Eurich DT. Restrictive drug coverage policies can induce substantial drug exposure misclassification in pharmacoepidemiologic studies. Clin Therapeutics 2012;34(6):1379-1386.e3. PMID: 22554975
Hay J, Maximova K, Durksen A, Carson V, Rinaldi RL, Torrance B, Ball GD, Majumdar SR, Plotnikoff RC, Veugelers P, Boulé NG, Wozny P, McCargar L, Downs S, Lewanczuk R, McGavock J. Physical Activity Intensity and Cardiometabolic Risk in Youth. Arch Pediatr Adolesc Med. 2012 Sep 10:1-8. doi: 10.1001/archpediatrics.2012.1028. [Epub ahead of print] PMID: 22965682
Johnson JA, Carstensen B, Witte D, Bowker SL, Lipscombe L, Renehan A, on behalf of the Diabetes and Cancer Research Consortium. Diabetes and Cancer (1): Evaluating the temporal relationship between type 2 diabetes and cancer incidence. Diabetologia 2012;55(6):1607-1618. PMID: 22476947
Johnson JA, Al Sayah F, Wozniak L, Rees S, Soprovich A, Chik CL, Chue P, Florence P, Jacquier J, Lysak P, Opgenorth A, Katon WJ, Majumdar SR. Controlled trial of a collaborative primary care team model for patients with diabetes and depression: Rationale and design for a comprehensive evaluation. BMC Health Services Research 2012;12:258. PMID: 22897901
Johnson ST, Mundt C, Wozniak L, Soprovich A, Plotnikoff RC, Johnson JA. Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD-PCN): Rationale, design, and evaluation of a pragmatic controlled trial for adults with type 2 diabetes. BMC Health Services Research 2012;12(1):455. PMID: 22712881
Ladhani NN, Majumdar SR, Johnson JA, Tsuyuki RT, Lewanczuk RZ, Spooner R, Simpson SH. Adding pharmacists to primary care teams reduces predicted long-term risk of cardiovascular events in Type 2 diabetic patients without established cardiovascular disease: results from a randomized trial. Diabet Med 2012 Apr 9. doi: 10:1111/j.1464-549102012.03673.x (Epub ahead of print) PMID: 22486226
Luo N, Fu AZ, Johnson JA. Preference-based SF-6D index scores derived from the SF-36 and SF-12 have different discriminative power in the general US population. Med Care 2012;50(7):627-632. PMID: 22456112
Macintyre EJ, Majumdar SR, Gamble JM, Minhas-Sandhu JK, Marrie TJ, Eurich DT. Stress Hyperglycemia and Newly Diagnosed Diabetes in 2124 Patients Hospitalized with Pneumonia. Am J Med. 2012 Aug 2. [Epub ahead of print] PMID: 22863217
Martin BJ, Hauer T, Arena R, Austford LD, Galbraith PD, Lewin AM, Knudtson ML, Ghali WA, Stone JA, Aggarwal SG. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients. Circulation. 2012 Aug 7;126(6):677-87. PMID: 22777176
McBrien K, Rabi DM, Campbell N, Barnieh L, Clement F, Hemmelgarn BR, Tonelli M, Leiter LA, Klarenbach SW, Manns BJ. Intensive and Standard Blood Pressure Targets in Patients With Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis. Arch Intern Med. 2012 Aug 6:1-8. doi: 10.1001/archinternmed.2012.3147. [Epub ahead of print] PMID: 22868819
McMurtry MS, Southern DA, Lewin AM, Galbraith PD, Kaul P, Ghali WA, Knudtson ML, Graham MM. Recent Temporal Trends and Geographic Distribution of Cardiac Procedures in Alberta. Can J Cardiol. 2012 Aug 14. [Epub ahead of print] PMID: 22902156
Myint PK, Kwok CS, Majumdar SR, Eurich DT, Clark AB, Yealy DM, España PP, Man SY, Huang DT, Angus DC, Capelastegui A, Rainer TH, Marrie TJ, Fine MJ, Loke YK. The International Community-acquired Pneumonia (CAP) Collaboration Cohort (ICCC) study: Rationale, Design and Description of Study Cohorts and Patients. BMJ Open 2012;2(3). PMID: 22614174
Oster RT, Johnson JA, Balko SU, Svenson LW, Toth EL. Increasing rates of diabetes amongst status Aboriginal youth in Alberta, Canada. Int J Circumpolar Health. 2012;71(0):1-7. PMID: 22584517
Renehan AG, Yeh HC, Johnson JA, Wild SH, Gale EAM, Moller H, on behalf of the Diabetes and Cancer Research Consortium. Diabetes and Cancer (2): Evaluating the impact of diabetes on mortality in patients with cancer. Diabetologia 2012;55(6):1619-1632. PMID: 22476948
Soon IS, Molodecky NA, Rabi DM, Ghali WA, Barkema HW, Kaplan GG. The relationship between urban environment and the inflammatory bowel diseases: a systematic review and meta-analysis. BMC Gastroenterol. 2012 May 24;12(1):51. PMID: 22624994
Vanderloo S, Johnson JA, Reimer K, McCrea P, Nuernberger K, Kreuger H, Aydede SK, Collet JP, Amed S. Validation of Classification Algorithms for Childhood Diabetes Identified From Administrative Data. Pediatric Diabetes 2012;13(3):229-234. PMID: 21771232
Congratulations to the following students/trainees/faculty on their latest accomplishments:
Ahmed Abdelmoneim on receiving an ADI Studentship.
Jongnam Hwang on receiving an ADI Studentship.
Isabelle Colmers on successfully defending her Masters on June 26, 2012.
Darren Lau on successfully defending his PhD on August 13, 2012.
Robin Lau on winning the Brian Dufton Memorial Manuscript Award from the Canadian Journal of Diabetes. Robin will be presented this award at the Canadian Diabetes Association Meeting in Vancouver October, 2012.
Jeff Johnson on being awarded a Centennial Professorship from the University of Alberta.
Isabelle Colmers for receiving the Junior Best Award for a Mini Oral Presenation at the ADI Research Day and to Danny Huang for receiving a Junior Honorable Mention in the same category.
Jeff Johnson for being named the Scientific Director of the Obesity, Diabetes and Nutrition Scientific Clinical Network for Alberta Health Services.
Other ACHORD News
Danielle St. Laurent, our new ABCD Data Administrative Assistant and ACHORD Receptionist.
Serena Humphries, our newest Research Associate.
Darren Lau on his marriage to Emily Chan in June. The wedding took place in Edmonton.
Allison and Curtis Soprovich on the addition of Hannah Lynn to their family in September.
10th Annual ACHORD Retreat
March 7-8, 2013
The Banff Centre
Banff, Alberta, Canada
Scientific Director of Obesity, Diabetes and Nutrition Strategic Clinical Network for Alberta Health Services
Dr. Jeff Johnson was recently appointed as Scientific Director (SD) for the Obesity, Diabetes and Nutrition Strategic Clinical Network (SCN) with Alberta Health Services (AHS). In this new position, Jeff will maintain his faculty position at the University of Alberta, providing scientific leadership to the SCN for 40% of his time. Jeff will work closely with Dr. Alun Edwards, Senior Medical Lead, and Bretta Maloff, Vice-President of this SCN, and also with Dr. Cy Frank, Vice-President of Research Strategy for AHS.
Strategic Clinical Networks are being created to improve quality and sustainability of health and health care in Alberta by using evidence-based research to put the health care dollars in the areas that will make the biggest impact. Each SCN is being encouraged to develop a provincial “research and knowledge translation team”. These teams will be developed in partnership with AHS and Universities in Alberta. The teams are intended to perform and translate the world-class research done in Alberta into common practice.
The Scientific Director is the most senior provincial research leader of the SCN. The SD will develop, implement and assess the impact of research and knowledge translation in their given area. The SD will also develop a health research agenda addressing the needs of the SCN’s population, focusing on generating and applying research evidence to achieve the SCN’s priorities. The SD will also work to integrate academic and community resources relevant to their SCN. Most importantly, the SD will enable the success of individual researchers and research groups in the SCN mandate area to create an effective research network in the province.
There were six SCNs in operation as of June 2012, including:
• Obesity, Diabetes and Nutrition
• Seniors’ Health
• Bone and Joint Health
• Cardiovascular and Stroke
• Cancer Care
• Addiction and Mental Health
It is anticipated that another six SCNs will be launched in 2013.
We are very happy that Jeff will be the founding Scientific Director of the Obesity, Diabetes and Nutrition SCN; we know with him at the helm this portfolio will have a strong foundation in which to build in the future. All the best in the new position Jeff!
Report from the Chair
Hello All! Hope everyone has had a great summer; it is hard to believe we are changing seasons again. Here is a quick update on what we have been doing since our last newsletter.
First, I am very excited to be taking up a new leadership role for the Obesity, Diabetes and Nutrition SCN. It seemed to me to be a very natural progression for me, and for what we have done in building up ACHORD. I am looking forward to working with the SCN team, and the broad research and community resources we can draw on in Alberta to improve health and the health care system as it relates to obesity, diabetes and nutrition.
ACHORD members and trainees have been busy presenting their research at many different meetings over the past few months. Research has been presented at CAHSPR in Montreal in May, the ADA meeting in Philadelphia in June, the CPHA meeting in Edmonton in June, and the 28th International Conference on Pharmacoepidemiology and Therapeutic Risk Management in Barcelona in August. In October, a number of ACHORD members will be attending the EASD Annual Meeting in Berlin, where I will be participating in a symposium on diabetes and cancer, and the CDA Annual Meeting in Vancouver, where I am part of a panel discussion, to talk about the economics surrounding self-monitoring of blood glucose for type 2 diabetes.
I am also preparing for a workshop in October in Canmore, organized by the Health Quality Council of Alberta, AHS, and the Institute of Health Economics. At this invitational workshop, we will discuss the use of the EQ-5D in Alberta, as a patient reported outcome measure for clinical care, in population health, and in economic evaluations. A number of international speakers, who are colleagues of mine from the EuroQol Group, will share similar experiences in different jurisdictions. This workshop is another example of the ongoing engagement we have had with both HQCA and AHS.
The Alberta’s Caring for Diabetes (ABCD) project is surging ahead. Two quality-improvement interventions for people with type 2 diabetes supported by our partner PCNs are wrapping up this fall. Data analysis and evaluation activities are ongoing. The ABCD Advisory Committee and Implementation & Evaluation Steering Committee meetings are planned for November, where our attention is shifting from implementation of the interventions to findings and knowledge translation strategies. The ABCD Cohort study is well underway, and I’m happy to announce that approximately 1500 people with type 2 diabetes around the province have joined the study to date. We look forward to following this cohort for the next several years.
We have also seen some personnel changes in the ACHORD offices in Edmonton. Dr. Logan McLeod recently relocated to Wilfrid Laurier University in Waterloo, and JM Gamble started in a faculty position at Memorial University in St. John’s Newfoundland, but I am happy that both Logan and JM will continue ongoing collaborations. Isabelle Colmers (MSc) and Darren Lau (PhD) defended their thesis during the summer and are both in med school at U of A. I am very happy to welcome Serena Humphries as a full time Research Associate, who will be helping me with a number of projects and managing our ever-growing research program.
That’s a quick summary for now. Our next newsletter in December will update you with our ongoing activities in ACHORD!
Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD-PCN).
About the Study
The Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD-PCN)1 will serve to establish effectiveness of a theory-guided self-management program for those with type 2 diabetes in a community-based, primary care setting. The program is based on a pilot study2 that showed reductions in blood pressure, body weight and resting heart rate among overweight and obese adults with type 2 diabetes.
Patients from Primary Care Networks located in St. Albert Sturgeon, Leduc Beaumont Devon, Camrose, and Fort Saskatchewan, Alberta will be assigned to either a control group where they will receive usual care or the HEALD group.
For those who enter the HEALD program, they will participate in two phases each lasting 12-weeks. In the first phase, a certified Exercise Specialist trained in delivering the HEALD program will lead two, one-hour group sessions at a local recreational facility in each of the communities where the PCNs are located. The initial sessions are intended to help patients set individual pedometer-based total daily step goals. Patients are then encouraged to try to meet their daily step goals for a period of 12-weeks. After the initial 12-weeks, patients will attend two group sessions where they learn how to increase their walking speed with a pedometer and also learn about the glycemic index and how to incorporate this dietary concept into their diet. All sessions are provided free of charge and includes a day pass to the community recreation facility.
Physical activity is the primary study outcome of interest. A food frequency questionnaire will be used to determine dietary intake. Behavioural, clinical and psychosocial variables were measured at 3-month intervals over the 6-month study period. Information on the cost of the program in the primary care context, as well as subsequent health care utilization, through linkage with administrative data in the Alberta Diabetes Surveillance System (ADSS) (www.albertadiabetes.ca). Such information will be used to estimate the cost-effectiveness of the program, using previously developed diabetes economic forecasting model for Alberta. The RE-AIM approach will be used to evaluate the implementation of HEALD-PCN.
With only one group to have their 6-month follow-up data collection in Fort Saskatchewan, the total sample size will be 200 (103 in the intervention and 97 controls). The retention was ~85% after 3 months. Class participation across the sites has averaged approximately 80%. We are collecting data through participant interviews among 10% of the sample from the intervention group. Baseline data will be ready for analysis within the coming months.
Primary Care Networks, an emerging model of primary care in Alberta, presents an ideal environment for enhanced access to care with specific roles and responsibilities for various aspects of care and education assigned to the most relevant health professionals (i.e., Exercise Specialists). Ultimately, this study will serve as a platform and framework upon which an emerging model of care can incorporate effective and efficient chronic disease prevention and self-management in the primary care setting. Perhaps most importantly, this study will help to answer questions around program sustainability.
1. Johnson ST, Mundt C, Soprovich A, Wozniak L, Plotnikoff RC, Johnson JA. Healthy eating and active living for diabetes in primary care networks (HEALD-PCN): rationale, design, and evaluation of a pragmatic controlled trial for adults with type 2 diabetes. BMC Public Health, 19 12(1): 455, 2012
2. Johnson ST, Bell GJ, McCargar LJ, Welsh RS, Bell RC. Improved cardiovascular health following a progressive walking and dietary intervention for type 2 diabetes. Diabetes, Obesity & Metabolism, 11(9): 836, 2009
Recent Literature from the ACHORD Journal Club
(Paper discussed Monday, July 9, 2012; Commentary by Ahmed Abdelmoneium)
ORIGIN Trial Investigators, Gerstein HC, Bosch J, Dagenais GR, Díaz R, Jung H, Maggioni AP, Pogue J, Probstfield J, Ramachandran A, Riddle MC, Rydén LE, Yusuf S. (2012) Basal Insulin and Cardiovascular and Other Outcomes in Dysglycemia. N Engl J Med. 2012 Jul 26;367(4):319-28. PMID: 22686416
What was the study about?
Prior evidence suggests that early provision of sufficient basal insulin targeting normal fasting plasma glucose levels may safely reduce incident cardiovascular outcomes. The Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial was conducted to investigate whether targeting normal fasting blood glucose with insulin glargine will reduce incidence of cardiovascular events and new diabetes in people at risk of it. The study also investigated the effect of exogenous insulin on cancer incidence.
The ORIGIN trial was a large multi-center, open-label, randomized controlled trial, which involved assigning 12,537 people with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes to receive insulin glargine or standard care for a.
What were the results of the study?
During a median follow-up time of 6.2 years, the incidence rates of cardiovascular endpoints were similar in the insulin-glargine and standard-care groups (2.94 vs. 2.85 per 100 person-years, respectively; HR, 1.04; 95%CI, 0.94-1.11). Among glargine users, the incidence of new cases of diabetes was 30% compared to 35% among people on standard-care (OR, 0.80; 95% CI, 0.64-1.00). There was no significant difference in cancers risk (HR, 1.00; 95% CI, 0.88-1.13) between the two groups. However, insulin-galrgine users had a higher incidence of severe hypoglycemia (1.00 vs. 0.31 per 100 person-years).
What did this study find?
The authors concluded that early use of basal insulin to target fasting plasma glucose levels had a neutral effect on cardiovascular outcomes and cancers and slowed the progression of dysglycaemia.
These results do not support epidemiological evidence linking insulin with incident cancers. However, it is unlikely that findings from this study would change the current practice of managing early dysglycemia.
Meet the Staff
Serena graduated with an Honours Bachelor of Arts degree in Geography and Anthropology from McMaster University in 1998. She completed a Master’s of Science in Health Research Methodologies at McMaster in 2002. Serena is currently a PhD Candidate in Health Policy and Management in the University of Alberta’s School of Public Health and will be defending her thesis in the fall of 2012. Serena’s dissertation research explored how program policy and management decisions are made and translated into actions in health care organizations. Prior to returning to university to pursue her PhD, Serena worked in both the private and public sectors in the areas of health research and health service delivery innovation. Serena brings experience in health research, policy and program management to her role as Research Associate with ACHORD.
Serena is an active volunteer in her community, dedicating her spare time to helping with local youth and arts programs.
ACHORD Seen and Heard (cont)
Davis VW, Schiller DE, Eurich DT, Sawyer MB. The metabolic signature of pancreatic cancer in urine. American Society of Clinical Oncology 2012 Gastrointestinal Cancers Symposium. The Moscone West Building, San Francisco, CA. January 19-21, 2012 (J Clin Oncol 30. 2012 suppl 4;A36).
Davis VW, Schiller DE, Eurich DT, Sawyer MB. The metabolic signature of esophageal cancer. American Society of Clinical Oncology 2012 Gastrointestinal Cancers Symposium. The Moscone West Building, San Francisco, CA. January 19-21, 2012 (J Clin Oncol 30. 2012 suppl 4;A21).
Davis VW, Schiller DE, Eurich DT, Sawyer MB. The urinary metabolomic signature of Barrett’s esophagus. American Society of Clinical Oncology 2012 Gastrointestinal Cancers Symposium. The Moscone West Building, San Francisco, CA. January 19-21, 2012 (J Clin Oncol 30. 2012 suppl 4;A37).
Hoang H, Sligl WI, Eurich DT, Malhotra A, Marrie TJ, Majumdar SR. Macrolide use in the treatment of critically ill patients with pneumonia: incidence, correlates, timing, and outcomes. Association of Medical Microbiology and Infectious Diseases of Canada Annual Meeting, Vancouver BC, May 3-5, 2012. Can J Infectious Dis Med Microbiol.
Asadi L, Sligl WI, Eurich DT, Colmers IN, Tjosvold L, Marrie TJ, Majumdar SR. Macrolide-Based Regimens and Mortality in Hospitalized Patients with Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis. Association of Medical Microbiology and Infectious Diseases of Canada Annual Meeting, Vancouver BC, May 3-5, 2012. (Can J Infectious Dis Med Microbiol.
Sligl W, Asadi L, Eurich DT, Malhotra A, Marrie TJ, Majumdar SR. Macrolide use in the Treatment of Critically Ill Patients with Pneumonia: Incidence, Correlates, Timing, and Outcomes. Association of Medical Microbiology Infectious Disease Canada Annual Meeting, Vancouver, BC, May 3-5, 2012. Can J Infectious Dis Med Microbiol.
Gamble JM, Johnson JA, McAlister FA, Majumdar SR, Simpson SH, Eurich DT. Impact of Exposure Misclassification Due to Incomplete Drug Data in Observational Studies of Drug Safety and Effectiveness: a cohort study. Canadian Association for Population Therapeutics (CAPT) Annual Meeting, Montreal, QC May 6-8, 2012. J Popul Ther Clin Pharmacol.
Davis VW, Schiller DE, Eurich DT, Bathe OF, Sawyer MB. Pancreatic Cancer is Strongly Associated with a Unique Urinary Metabolomic Signature. University of Alberta Tom Williams Surgical Research Day, May 11, 2012, Edmonton, AB
Abdelmoneim A, Eurich DT, Gamble JM, Johnson JA, Seubert J, Qiu W, Simpson S. Cardiovascular risk difference between glyburide and gliclazide: a nested case-control study. American Diabetes Association 72st Scientific Sessions, Philadelphia, PA, USA, June 9-12, 2012 [Diabetes 2012;61(Suppl 1):A346 (Abstract 1334-P)] Nominated for a Moderated Poster Session.
Colmers IN, Bowker SL, Richardson K, Marra CA, Majumdar SR, Yasui Y, Johnson JA. Short-term increased risk of bladder cancer after diagnosis of Type 2 diabetes: Evidence of potential surveillance bias. 72nd Annual American Diabetes Association Scientific Sessions, June 8-12, 2012, Philadelphia, PA. Diabetes 2012;61(Suppl 1):1389P.
Gamble JM, Majumdar SR, Johnson JA, McAlister FA, Simpson SH, Eurich DT. Changes in Thiazolidinedione Use and Outcomes Following Removal of a Prior Authorization Policy: Controlled Time-Series Analysis. 72nd Annual American Diabetes Association scientific sessions. June 8-12, 2012, Philadelphia, PA. Diabetes 2012; 61(Suppl 1) A1436.
Nerenberg KA, Johnson JA, Kaul P. Risk of preeclampsia in pregnant women with gestational diabetes in Alberta. (poster) Hypertension in Pregnancy. 2012;3:323-4.
Gamble JM, Johnson JA, Majumdar SR, McAlister FA, Simpson SH, Eurich DT. Drug Exposure Misclassification Because of Prior-Authorization Policies: A Cautionary Tale for Researchers Using Databases Limited to Formulary-Approved Prescriptions. Abstracts of the 28th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, 23-26 August 2012, Barcelona, Spain. Pharmacoepidemiol Drug Saf 2012.
Gamble JM, Johnson JA, McAlister FA, Majumdar SR, Simpson SH, Eurich DT. Impact of Exposure Misclassification Due to Incomplete Drug Data in Observational Studies of Safety and Effectiveness. Abstracts of the 28th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, 23-26 August 2012, Barcelona, Spain. Pharmacoepidemiol Drug Saf 2012.
Kahlon S, Eurich DT, Padwal RS, Malhotra A, Minhas-Sandhu JK, Marrie TJ, Majumdar SR. Obesity and outcomes in patients hospitalized with pneumonia. European Respiratory Society Annual Congress, Vienna, Austria, September 1-5, 2012. Eur Resp J.