Bio

Bio


Dr. Shanil Ebrahim specializes in clinical epidemiology, meta-analytic methods, insurance medicine, disability management, and mental health issues in the workplace. His primary methodological focus is in the evaluation of re-analyses and secondary analyses of randomized trials, addressing the impact of missing participant data in meta-analyses, multilevel regression modeling, and multiple treatment comparison models. His primary focus in insurance medicine is in determining optimal management and evaluating predictors of recovery in patients receiving disability benefits, and systematically evaluating the evidence of independent medical evaluations. For his doctoral work, Dr. Ebrahim developed the first rigorous approach to address missing participant data for continuous outcomes in systematic reviews.

Dr. Ebrahim has authored numerous publications in high impact peer-reviewed journals including JAMA, CMAJ, Journal of Clinical Epidemiology, PLoS ONE, BMJ Open, Chest, Clinical Pharmacology & Therapeutics, and Journal of Public Health Policy. For his academic efforts, Dr. Ebrahim has received numerous scholarships including the Canadian Institutes of Health Research Fellowship and Doctoral, and the MITACS Elevate and Accelerate awards.

Professional Education


  • Doctor of Philosophy, McMaster University, Health Research Methodology (Clinical Epidemiology) (2013)
  • Master of Science, University of Toronto, Medical Science (2009)
  • Master of Science, University of Toronto, Bioethics (2009)
  • Bachelor of Science, York University, Psychology (2007)

Stanford Advisors


Publications

Journal Articles


  • Prevalence, characteristics, and publication of discontinued randomized trials. JAMA : the journal of the American Medical Association Kasenda, B., von Elm, E., You, J., Blümle, A., Tomonaga, Y., Saccilotto, R., Amstutz, A., Bengough, T., Meerpohl, J. J., Stegert, M., Tikkinen, K. A., Neumann, I., Carrasco-Labra, A., Faulhaber, M., Mulla, S. M., Mertz, D., Akl, E. A., Bassler, D., Busse, J. W., Ferreira-González, I., Lamontagne, F., Nordmann, A., Gloy, V., Raatz, H., Moja, L., Rosenthal, R., Ebrahim, S., Schandelmaier, S., Xin, S., Vandvik, P. O., Johnston, B. C., Walter, M. A., Burnand, B., Schwenkglenks, M., Hemkens, L. G., Bucher, H. C., Guyatt, G. H., Briel, M. 2014; 311 (10): 1045-1051

    Abstract

    The discontinuation of randomized clinical trials (RCTs) raises ethical concerns and often wastes scarce research resources. The epidemiology of discontinued RCTs, however, remains unclear.To determine the prevalence, characteristics, and publication history of discontinued RCTs and to investigate factors associated with RCT discontinuation due to poor recruitment and with nonpublication.Retrospective cohort of RCTs based on archived protocols approved by 6 research ethics committees in Switzerland, Germany, and Canada between 2000 and 2003. We recorded trial characteristics and planned recruitment from included protocols. Last follow-up of RCTs was April 27, 2013.Completion status, reported reasons for discontinuation, and publication status of RCTs as determined by correspondence with the research ethics committees, literature searches, and investigator surveys.After a median follow-up of 11.6 years (range, 8.8-12.6 years), 253 of 1017 included RCTs were discontinued (24.9% [95% CI, 22.3%-27.6%]). Only 96 of 253 discontinuations (37.9% [95% CI, 32.0%-44.3%]) were reported to ethics committees. The most frequent reason for discontinuation was poor recruitment (101/1017; 9.9% [95% CI, 8.2%-12.0%]). In multivariable analysis, industry sponsorship vs investigator sponsorship (8.4% vs 26.5%; odds ratio [OR], 0.25 [95% CI, 0.15-0.43]; P < .001) and a larger planned sample size in increments of 100 (-0.7%; OR, 0.96 [95% CI, 0.92-1.00]; P = .04) were associated with lower rates of discontinuation due to poor recruitment. Discontinued trials were more likely to remain unpublished than completed trials (55.1% vs 33.6%; OR, 3.19 [95% CI, 2.29-4.43]; P < .001).In this sample of trials based on RCT protocols from 6 research ethics committees, discontinuation was common, with poor recruitment being the most frequently reported reason. Greater efforts are needed to ensure the reporting of trial discontinuation to research ethics committees and the publication of results of discontinued trials.

    View details for DOI 10.1001/jama.2014.1361

    View details for PubMedID 24618966

  • Ethics and legalities associated with independent medical evaluations. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne Ebrahim, S., Sava, H., Kunz, R., Busse, J. W. 2014

    View details for DOI 10.1503/cmaj.131509

    View details for PubMedID 24491474

  • Addressing continuous data measured with different instruments for participants excluded from trial analysis: a guide for systematic reviewers. Journal of clinical epidemiology Ebrahim, S., Johnston, B. C., Akl, E. A., Mustafa, R. A., Sun, X., Walter, S. D., Heels-Ansdell, D., Alonso-Coello, P., Guyatt, G. H. 2014

    Abstract

    We previously developed an approach to address the impact of missing participant data in meta-analyses of continuous variables in trials that used the same measurement instrument. We extend this approach to meta-analyses including trials that use different instruments to measure the same construct.We reviewed the available literature, conducted an iterative consultative process, and developed an approach involving a complete-case analysis complemented by sensitivity analyses that apply a series of increasingly stringent assumptions about results in patients with missing continuous outcome data.Our approach involves choosing the reference measurement instrument; converting scores from different instruments to the units of the reference instrument; developing four successively more stringent imputation strategies for addressing missing participant data; calculating a pooled mean difference for the complete-case analysis and imputation strategies; calculating the proportion of patients who experienced an important treatment effect; and judging the impact of the imputation strategies on the confidence in the estimate of effect. We applied our approach to an example systematic review of respiratory rehabilitation for chronic obstructive pulmonary disease.Our extended approach provides quantitative guidance for addressing missing participant data in systematic reviews of trials using different instruments to measure the same construct.

    View details for DOI 10.1016/j.jclinepi.2013.11.014

    View details for PubMedID 24613497

  • Managing moral hazard in motor vehicle accident insurance claims JOURNAL OF PUBLIC HEALTH POLICY Ebrahim, S., Busse, J. W., Guyatt, G. H., Birch, S. 2013; 34 (2): 320-329

    Abstract

    Motor vehicle accident (MVA) insurance in Canada is based primarily on two different compensation systems: (i) no-fault, in which policyholders are unable to seek recovery for losses caused by other parties (unless they have specified dollar or verbal thresholds) and (ii) tort, in which policyholders may seek general damages. As insurance companies pay for MVA-related health care costs, excess use of health care services may occur as a result of consumers' (accident victims) and/or producers' (health care providers) behavior - often referred to as the moral hazard of insurance. In the United States, moral hazard is greater for low dollar threshold no-fault insurance compared with tort systems. In Canada, high dollar threshold or pure no-fault versus tort systems are associated with faster patient recovery and reduced MVA claims. These findings suggest that high threshold no-fault or pure no-fault compensation systems may be associated with improved outcomes for patients and reduced moral hazard.

    View details for DOI 10.1057/jphp.2013.11

    View details for Web of Science ID 000318585000011

    View details for PubMedID 23639998

  • Addressing Dichotomous Data for Participants Excluded from Trial Analysis: A Guide for Systematic Reviewers PLOS ONE Akl, E. A., Johnston, B. C., Alonso-Coello, P., Neumann, I., Ebrahim, S., Briel, M., Cook, D. J., Guyatt, G. H. 2013; 8 (2)

    Abstract

    Systematic reviewer authors intending to include all randomized participants in their meta-analyses need to make assumptions about the outcomes of participants with missing data.The objective of this paper is to provide systematic reviewer authors with a relatively simple guidance for addressing dichotomous data for participants excluded from analyses of randomized trials.This guide is based on a review of the Cochrane handbook and published methodological research. The guide deals with participants excluded from the analysis who were considered 'non-adherent to the protocol' but for whom data are available, and participants with missing data.Systematic reviewer authors should include data from 'non-adherent' participants excluded from the primary study authors' analysis but for whom data are available. For missing, unavailable participant data, authors may conduct a complete case analysis (excluding those with missing data) as the primary analysis. Alternatively, they may conduct a primary analysis that makes plausible assumptions about the outcomes of participants with missing data. When the primary analysis suggests important benefit, sensitivity meta-analyses using relatively extreme assumptions that may vary in plausibility can inform the extent to which risk of bias impacts the confidence in the results of the primary analysis. The more plausible assumptions draw on the outcome event rates within the trial or in all trials included in the meta-analysis. The proposed guide does not take into account the uncertainty associated with assumed events.This guide proposes methods for handling participants excluded from analyses of randomized trials. These methods can help in establishing the extent to which risk of bias impacts meta-analysis results.

    View details for DOI 10.1371/journal.pone.0057132

    View details for Web of Science ID 000316849500067

    View details for PubMedID 23451162

  • Addressing continuous data for participants excluded from trial analysis: a guide for systematic reviewers J Clin Epidemiol Ebrahim, S., Akl, E. A., Mustafa, R. A., Sun, X., Walter, S. D., et al 2013; Jun 15
  • Association of Psychotherapy with Disability Benefit Claim Closure among Patients Disabled Due to Depression. PloS one Ebrahim, S., Guyatt, G. H., Walter, S. D., Heels-Ansdell, D., Bellman, M., Hanna, S. E., Patelis-Siotis, I., Busse, J. W. 2013; 8 (6)

    Abstract

    Depression is the most frequent reason for receiving disability benefits in North America, and treatment with psychotherapy is often funded by private insurers. No studies have explored the association between the provision of psychotherapy for depression and time to claim closure.Using administrative data from a Canadian disability insurer, we evaluated the association between the provision of psychotherapy and short-term disability (STD) and long-term disability (LTD) claim closure by performing Cox proportional hazards regression.We analyzed 10,508 STD and 10,338 LTD claims for depression. In our adjusted analyses, receipt of psychotherapy was associated with longer time to STD closure (HR [99% CI]?=?0.81 [0.68 to 0.97]) and faster LTD claim closure (1.42 [1.33 to 1.52]). In both STD and LTD, older age (0.90 [0.88 to 0.92] and 0.83 [0.80 to 0.85]), per decade), a primary diagnosis of recurrent depression versus non-recurrent major depression (0.78 [0.69 to 0.87] and 0.80 [0.72 to 0.89]), a psychological secondary diagnosis (0.90 [0.84 to 0.97] and 0.66 [0.61 to 0.71]), or a non-psychological secondary diagnosis (0.81 [0.73 to 0.90] and 0.77 [0.71 to 0.83]) versus no secondary diagnosis, and an administrative services only policy ([0.94 [0.88 to 1.00] and 0.87 [0.75 to 0.996]) or refund policy (0.86 [0.80 to 0.92] and 0.73 [0.68 to 0.78]) compared to non-refund policy claims were independently associated with longer time to STD claim closure.We found, paradoxically, that receipt of psychotherapy was independently associated with longer time to STD claim closure and faster LTD claim closure in patients with depression. We also found multiple factors that were predictive of time to both STD and LTD claim closure. Our study has limitations, and well-designed prospective studies are needed to establish the effect of psychotherapy on disabling depression.

    View details for DOI 10.1371/journal.pone.0067162

    View details for PubMedID 23840614

  • Effectiveness of Cognitive Behavioral Therapy for Depression in Patients Receiving Disability Benefits: A Systematic Review and Individual Patient Data Meta-Analysis PLOS ONE Ebrahim, S., Montoya, L., Wanda Truong, W., Hsu, S., el Din, M. K., Carrasco-Labra, A., Busse, J. W., Walter, S. D., Heels-Ansdell, D., Couban, R., Patelis-Siotis, I., Bellman, M., de Graaf, L. E., Dozois, D. J., Bieling, P. J., Guyatt, G. H. 2012; 7 (11)

    Abstract

    To systematically summarize the randomized trial evidence regarding the relative effectiveness of cognitive behavioural therapy (CBT) in patients with depression in receipt of disability benefits in comparison to those not receiving disability benefits.All relevant RCTs from a database of randomized controlled and comparative studies examining the effects of psychotherapy for adult depression (http://www.evidencebasedpsychotherapies.org), electronic databases (MEDLINE, EMBASE, PSYCINFO, AMED, CINAHL and CENTRAL) to June 2011, and bibliographies of all relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTION: Adult patients with major depression, randomly assigned to CBT versus minimal/no treatment or care-as-usual.Three teams of reviewers, independently and in duplicate, completed title and abstract screening, full text review and data extraction. We performed an individual patient data meta-analysis to summarize data.Of 92 eligible trials, 70 provided author contact information; of these 56 (80%) were successfully contacted to establish if they captured receipt of benefits as a baseline characteristic; 8 recorded benefit status, and 3 enrolled some patients in receipt of benefits, of which 2 provided individual patient data. Including both patients receiving and not receiving disability benefits, 2 trials (227 patients) suggested a possible reduction in depression with CBT, as measured by the Beck Depression Inventory, mean difference [MD] (95% confidence interval [CI])?=?-2.61 (-5.28, 0.07), p?=?0.06; minimally important difference of 5. The effect appeared larger, though not significantly, in those in receipt of benefits (34 patients) versus not receiving benefits (193 patients); MD (95% CI)?=?-4.46 (-12.21, 3.30), p?=?0.26.Our data does not support the hypothesis that CBT has smaller effects in depressed patients receiving disability benefits versus other patients. Given that the confidence interval is wide, a decreased effect is still possible, though if the difference exists, it is likely to be small.

    View details for DOI 10.1371/journal.pone.0050202

    View details for Web of Science ID 000312104900033

    View details for PubMedID 23209672

  • Return to Work Coordination Programmes for Work Disability: A Meta-Analysis of Randomised Controlled Trials PLOS ONE Schandelmaier, S., Ebrahim, S., Burkhardt, S. C., de Boer, W. E., Zumbrunn, T., Guyatt, G. H., Busse, J. W., Kunz, R. 2012; 7 (11)

    Abstract

    The dramatic rise in chronically ill patients on permanent disability benefits threatens the sustainability of social security in high-income countries. Social insurance organizations have started to invest in promising, but costly return to work (RTW) coordination programmes. The benefit, however, remains uncertain. We conducted a systematic review to determine the long-term effectiveness of RTW coordination compared to usual practice in patients at risk for long-term disability.Eligible trials enrolled employees on work absence for at least 4 weeks and randomly assigned them to RTW coordination or to usual practice. We searched 5 databases (to April 2, 2012). Two investigators performed standardised eligibility assessment, study appraisal and data extraction independently and in duplicate. The GRADE framework guided our assessment of confidence in the meta-analytic estimates. We identified 9 trials from 7 countries, 8 focusing on musculoskeletal, and 1 on mental complaints. Most trials followed participants for 12 months or less. No trial assessed permanent disability. Moderate quality evidence suggests a benefit of RTW coordination on proportion at work at end of follow-up (risk ratio = 1.08, 95% CI = 1.03 to 1.13; absolute effect = 5 in 100 additional individuals returning to work, 95% CI = 2 to 8), overall function (mean difference [MD] on a 0 to 100 scale = 5.2, 95% CI = 2.4 to 8.0; minimal important difference [MID] = 10), physical function (MD = 5.3, 95% CI = 1.4 to 9.1; MID = 8.4), mental function (MD = 3.1, 95% CI = 0.7 to 5.6; MID = 7.3) and pain (MD = 6.1, 95% CI = 3.1 to 9.2; MID = 10).Moderate quality evidence suggests that RTW coordination results in small relative, but likely important absolute benefits in the likelihood of disabled or sick-listed patients returning to work, and associated small improvements in function and pain. Future research should explore whether the limited effects persist, and whether the programmes are cost effective in the long term.

    View details for DOI 10.1371/journal.pone.0049760

    View details for Web of Science ID 000311333800049

    View details for PubMedID 23185429

  • What is a disease? Perspectives of the public, health professionals and legislators BMJ OPEN Tikkinen, K. A., Leinonen, J. S., Guyatt, G. H., Ebrahim, S., Jarvinen, T. L. 2012; 2 (6)

    Abstract

    To assess the perception of diseases and the willingness to use public-tax revenue for their treatment among relevant stakeholders.A population-based, cross-sectional mailed survey.Finland.3000 laypeople, 1500 doctors, 1500 nurses (randomly identified from the databases of the Finnish Population Register, the Finnish Medical Association and the Finnish Nurses Association) and all 200 parliament members.Respondents' perspectives on a five-point Likert scale on two claims on 60 states of being: '(This state of being) is a disease'; and '(This state of being) should be treated with public tax revenue'.Of the 6200 individuals approached, 3280 (53%) responded. Of the 60 states of being, ?80% of respondents considered 12 to be diseases (Likert scale responses of '4' and '5') and five not to be diseases (Likert scale responses of '1' and '2'). There was considerable variability in most states, and great variability in 10 (?20% of respondents of all groups considered it a disease and ?20% rejected as a disease). Doctors were more inclined to consider states of being as diseases than laypeople; nurses and members were intermediate (p<0.001), but all groups showed large variability. Responses to the two claims were very strongly correlated (r=0.96 (95% CI 0.94 to 0.98); p<0.001).There is large disagreement among the public, health professionals and legislators regarding the classification of states of being as diseases and whether their management should be publicly funded. Understanding attitudinal differences can help to enlighten social discourse on a number of contentious public policy issues.

    View details for DOI 10.1136/bmjopen-2012-001632

    View details for Web of Science ID 000315081400072

    View details for PubMedID 23204142

  • Correction: Association of Psychotherapy with Disability Benefit Claim Closure among Patients Disabled Due to Depression. PloS one Ebrahim, S., Guyatt, G. H., Walter, S. D., Heels-Ansdell, D., Bellman, M., Hanna, S. E., Patelis-Siotis, I., Busse, J. W. 2014; 9 (1)

    Abstract

    [This corrects the article on p. e67162 in vol. 8.].

    View details for DOI 10.1371/annotation/fd8ade2b-e9ed-4f75-8e32-5b327535306c

    View details for PubMedID 24404087

  • Psychotherapy for depression in claimants receiving wage replacement benefits: review of the evidence Journal of Insurance Medicine Ebrahim, S. 2014; 44: 53-57
  • An efficient strategy allowed English-speaking reviewers to identify foreign-language articles eligible for a systematic review. Journal of clinical epidemiology Busse, J. W., Bruno, P., Malik, K., Connell, G., Torrance, D., Ngo, T., Kirmayr, K., Avrahami, D., Riva, J. J., Ebrahim, S., Struijs, P. A., Brunarski, D., Burnie, S. J., Leblanc, F., Coomes, E. A., Steenstra, I. A., Slack, T., Rodine, R., Jim, J., Montori, V. M., Guyatt, G. H. 2014

    Abstract

    To assess English-speaking reviewers' accuracy in determining the eligibility of foreign-language articles for a systematic review.Systematic review of randomized controlled trials of therapy for fibromyalgia. Guided by 10 questions, English-speaking reviewers screened non-English-language articles for eligibility. Teams of two native-language speakers provided reference standard judgments of eligibility.Of 15,466 potentially eligible articles, we retrieved 763 in full text, of which 133 were published in 19 non-English languages; 53 trials published in 11 languages other than English proved eligible. Of the 53 eligible articles, English-language reviewers guided by the 10 questions mistakenly judged 6 as ineligible; of the 80 ineligible articles, 8 were incorrectly judged eligible by English-language reviewers (sensitivity=0.89; specificity=0.90). Use of a simple three-step rule (excluding languages with less than three articles, reviewing titles and abstracts for clear indications of eligibility, and noting the lack of a clearly reported statistical analysis unless the word "random" appears) led to accurate classification of 51 of 53 articles (sensitivity=0.96; specificity=0.70).Our findings show promise for limiting the need for non-English-language review teams in systematic reviews with large numbers of potentially eligible non-English-language articles.

    View details for DOI 10.1016/j.jclinepi.2013.07.022

    View details for PubMedID 24613496

  • Systematic review of observational studies assessing bleeding risk in patients with atrial fibrillation not using anticoagulants. PloS one Lopes, L. C., Spencer, F. A., Neumann, I., Ventresca, M., Ebrahim, S., Zhou, Q., Bhatnagar, N., Schulman, S., Eikelboom, J., Guyatt, G. 2014; 9 (2)

    Abstract

    Patients with atrial fibrillation considering use of anticoagulants must balance stroke reduction against bleeding risk. Knowledge of bleeding risk without the use of anticoagulants may help inform this decision.To determine the rate of major bleeding reported in observational studies of atrial fibrillation patients not receiving Vitamin K antagonists (VKA).We searched MEDLINE, EMBASE and CINAHL to October 2011 and examined reference lists of eligible studies and related reviews.All longitudinal cohort studies that included over 100 adult patients with atrial fibrillation not receiving VKA.Teams of two reviewers independently and in duplicate adjudicated eligibility, assessed risk of bias and abstracted study characteristics and outcomes.Twenty-one eligible studies included 96,448 patients. Major bleeding rates varied widely, from 0 to 4.69 events per 100 patient-years. The pooled estimate in 13 studies with 78839 patients was 1.59 with a 99% confidence interval of 1.10 to 2.3 and median 1.42 (interquartile range 0.62-2.70). Pooled estimates for fatal bleeding and non-fatal bleeding from 4 studies that reported these outcomes were, respectively, 0.40 (0.34 to 0.46) and 1.18 (0.30 to 4.56) per 100 patient-years. In 9 randomized controlled trials (RCTs) the median rate of major bleeding in patients not receiving either anticoagulant or antiplatelet therapy was 0.6 (interquartile 0.2 to 0.90), and in 12 RCTs the median rate of major bleeding in patients receiving a single antiplatelet agent was 0.75 (interquartile 0.4 to 1.4).Results suggest that patients with atrial fibrillation not receiving VKA enrolled in observational studies represent a population on average at higher risk of bleeding.

    View details for DOI 10.1371/journal.pone.0088131

    View details for PubMedID 24523876

  • Predictors of Seizure Outcomes in Children with Tuberous Sclerosis Complex and Intractable Epilepsy Undergoing Resective Epilepsy Surgery: An Individual Participant Data Meta-Analysis PLOS ONE Fallah, A., Guyatt, G. H., Snead, O. C., Ebrahim, S., Ibrahim, G. M., Mansouri, A., Reddy, D., Walter, S. D., Kulkarni, A. V., Bhandari, M., Banfield, L., Bhatnagar, N., Liang, S., Teutonico, F., Liao, J., Rutka, J. T. 2013; 8 (2)

    Abstract

    To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery.Electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions.We included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate. We resolved disagreements through discussion.One author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes.To identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable.Of 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). In univariable analyses, absence of generalized seizure semiology (OR = 3.1, 95%CI = 1.2-8.2, p = 0.022), no or mild developmental delay (OR = 7.3, 95%CI = 2.1-24.7, p = 0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR = 3.2, 95%CI = 1.4-7.6, p = 0.008) and EEG/Magnetic resonance imaging concordance (OR = 4.9, 95%CI = 1.8-13.5, p = 0.002) were associated with a good postoperative seizure outcome.Small retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The best available evidence suggests four preoperative factors predictive of good seizure outcomes following resective epilepsy surgery. Large long-term prospective multicenter observational studies are required to further evaluate the risk factors identified in this review.

    View details for DOI 10.1371/journal.pone.0053565

    View details for Web of Science ID 000315153400015

    View details for PubMedID 23405072

  • Parental satisfaction, involvement, and presence after pediatric intensive care unit admission JOURNAL OF CRITICAL CARE Ebrahim, S., Singh, S., Parshuram, C. S. 2013; 28 (1): 40-45

    Abstract

    To describe satisfaction, involvement, presence, and preferences of parents following their child's admission to an intensive care unit (ICU).A survey, administered 1 month after their child's ICU admission, described perceptions of parental satisfaction with their interaction with healthcare providers, their presence during resuscitation, involvement in treatment decision-making, and preferences if events were to be re-enacted.One hundred three parents of 91 patients were enrolled; 64 primary parents (70%) completed the survey at 1 month. The mean (SD) satisfaction rating was 87.6 (±14.8) and involvement rating was 70.2 (±34.4) on a scale from 0 (not satisfied/involved) to 100 (completely satisfied/involved). There were no differences in satisfaction (P = .46), involvement (P = .69) and change in preferences (P = .97) between parents who were present and not present. After adjusting for child's baseline illness, receipt of more ICU therapies was associated with worse parental satisfaction (P = .03). Twenty-four (38%) parents reported that if events were repeated, they would have changed their preferences.Overall, parental satisfaction ratings were high, lower in parents of children receiving more ICU therapies, and not associated with presence during resuscitation. These data contrast the American Heart Association's recommendation and suggestion of benefit from parental presence during periods of intensive therapies.

    View details for DOI 10.1016/j.jcrc.2012.05.011

    View details for Web of Science ID 000312949700008

    View details for PubMedID 22835421

  • Systematic review and network meta-analysis of interventions for fibromyalgia: a protocol. Systematic reviews Busse, J. W., Ebrahim, S., Connell, G., Coomes, E. A., Bruno, P., Malik, K., Torrance, D., Ngo, T., Kirmayr, K., Avrahami, D., Riva, J. J., Struijs, P., Brunarski, D., Burnie, S. J., Leblanc, F., Steenstra, I. A., Mahood, Q., Thorlund, K., Montori, V. M., Sivarajah, V., Alexander, P., Jankowski, M., Lesniak, W., Faulhaber, M., Bala, M. M., Schandelmaier, S., Guyatt, G. H. 2013; 2: 18-?

    Abstract

    Fibromyalgia is associated with substantial socioeconomic loss and, despite considerable research including numerous randomized controlled trials (RCTs) and systematic reviews, there exists uncertainty regarding what treatments are effective. No review has evaluated all interventional studies for fibromyalgia, which limits attempts to make inferences regarding the relative effectiveness of treatments.We will conduct a network meta-analysis of all RCTs evaluating therapies for fibromyalgia to determine which therapies show evidence of effectiveness, and the relative effectiveness of these treatments. We will acquire eligible studies through a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, PsychINFO, PapersFirst, ProceedingsFirst, and the Cochrane Central Registry of Controlled Trials. Eligible studies will randomly allocate patients presenting with fibromyalgia or a related condition to an intervention or a control. Teams of reviewers will, independently and in duplicate, screen titles and abstracts and complete full text reviews to determine eligibility, and subsequently perform data abstraction and assess risk of bias of eligible trials. We will conduct meta-analyses to establish the effect of all reported therapies on patient-important outcomes when possible. To assess relative effects of treatments, we will construct a random effects model within the Bayesian framework using Markov chain Monte Carlo methods.Our review will be the first to evaluate all treatments for fibromyalgia, provide relative effectiveness of treatments, and prioritize patient-important outcomes with a focus on functional gains. Our review will facilitate evidence-based management of patients with fibromyalgia, identify key areas for future research, and provide a framework for conducting large systematic reviews involving indirect comparisons.

    View details for DOI 10.1186/2046-4053-2-18

    View details for PubMedID 23497523

  • A methodological survey of the analysis, reporting and interpretation of Absolute Risk ReductiOn in systematic revieWs (ARROW): a study protocol. Systematic reviews Alonso-Coello, P., Carrasco-Labra, A., Brignardello-Petersen, R., Neumann, I., Akl, E. A., Sun, X., Johnston, B. C., Briel, M., Busse, J. W., Glujovsky, D., Granados, C. E., Iorio, A., Irfan, A., García, L. M., Mustafa, R. A., Ramirez-Morera, A., Solà, I., Tikkinen, K. A., Ebrahim, S., Vandvik, P. O., Zhang, Y., Selva, A., Sanabria, A. J., Zazueta, O. E., Vernooij, R. W., Schünemann, H. J., Guyatt, G. H. 2013; 2: 113-?

    Abstract

    Clinicians, providers and guideline panels use absolute effects to weigh the advantages and downsides of treatment alternatives. Relative measures have the potential to mislead readers. However, little is known about the reporting of absolute measures in systematic reviews. The objectives of our study are to determine the proportion of systematic reviews that report absolute measures of effect for the most important outcomes, and ascertain how they are analyzed, reported and interpreted.We will conduct a methodological survey of systematic reviews published in 2010. We will conduct a 1:1 stratified random sampling of Cochrane vs. non-Cochrane systematic reviews. We will calculate the proportion of systematic reviews reporting at least one absolute estimate of effect for the most patient-important outcome for the comparison of interest. We will conduct multivariable logistic regression analyses with the reporting of an absolute estimate of effect as the dependent variable and pre-specified study characteristics as the independent variables. For systematic reviews reporting an absolute estimate of effect, we will document the methods used for the analysis, reporting and interpretation of the absolute estimate.Our methodological survey will inform current practices regarding reporting of absolute estimates in systematic reviews. Our findings may influence recommendations on reporting, conduct and interpretation of absolute estimates. Our results are likely to be of interest to systematic review authors, funding agencies, clinicians, guideline developers and journal editors.

    View details for DOI 10.1186/2046-4053-2-113

    View details for PubMedID 24330779

  • Opioids for chronic non-cancer pain: a protocol for a systematic review of randomized controlled trials. Systematic reviews Busse, J. W., Schandelmaier, S., Kamaleldin, M., Hsu, S., Riva, J. J., Vandvik, P. O., Tsoi, L., Lam, T., Ebrahim, S., Johnston, B., Oliveri, L., Montoya, L., Kunz, R., Malandrino, A., Bhatnagar, N., Mulla, S. M., Lopes, L. C., Soobiah, C., Wong, A., Buckley, N., Sessler, D., Guyatt, G. H. 2013; 2: 66-?

    Abstract

    Opioids are prescribed frequently and increasingly for the management of chronic non-cancer pain (CNCP). Current systematic reviews have a number of limitations, leaving uncertainty with regard to the benefits and harms associated with opioid therapy for CNCP. We propose to conduct a systematic review and meta-analysis to summarize the evidence for using opioids in the treatment of CNCP and the risk of associated adverse events.Eligible trials will include those that randomly allocate patients with CNCP to treatment with any opioid or any non-opioid control group. We will use the guidelines published by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to inform the outcomes that we collect and present. We will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to evaluate confidence in the evidence on an outcome-by-outcome basis. Teams of reviewers will independently and in duplicate assess trial eligibility, abstract data, and assess risk of bias among eligible trials. To ensure interpretability of our results, we will present risk differences and measures of relative effect for all outcomes reported and these will be based on anchor-based minimally important clinical differences, when available. We will conduct a priori defined subgroup analyses consistent with current best practices.Our review will evaluate both the effectiveness and the adverse events associated with opioid use for CNCP, evaluate confidence in the evidence using the GRADE approach, and prioritize patient-important outcomes with a focus on functional gains guided by IMMPACT recommendations. Our results will facilitate evidence-based management of patients with CNCP and identify key areas for future research.Our protocol is registered on PROSPERO (CRD42012003023), http://www.crd.york.ac.uk/PROSPERO.

    View details for DOI 10.1186/2046-4053-2-66

    View details for PubMedID 23965223

  • Comparison of utility scores from the Visual Analog Scale and Health Utilities Index 3 in children following pediatric intensive care unit admission. Journal of child health care : for professionals working with children in the hospital and community Ebrahim, S., Parshuram, C. 2013

    Abstract

    Indirect and direct health-related quality of life (HRQoL) measures are intended to assess the same underlying constructs. There is evidence that the two types of assessments can show important differences. We assessed the agreement between the utilities of direct and indirect HRQoL measurements in children following pediatric intensive care unit (PICU) admission. We collected Health Utilities Index 3 (HUI-3) and Visual Analog Scale (VAS) ratings of children who were urgently admitted to the PICU of a university-affiliated pediatric hospital at ICU admission (baseline) and one month post-ICU admission. The mean (SD) VAS converted standard gamble and HUI-3 utilities were 0.82 (±0.19) and 0.70 (±0.39), respectively, at baseline (n = 51), and 0.81 (±0.15) and 0.58 (±0.39) at one month (n = 36). The VAS utilities were significantly greater than the HUI-3 utilities (p = 0.009). At baseline, the intraclass coefficient (95% confidence interval) was 0.49 (0.25-0.68), representing moderate agreement, and at one month, was 0.18 (-0.87 to 0.45), representing negligible agreement. There were significant differences between indirect and direct measures, and inconsistent agreement between utilities derived from the two measures. These data illustrate the potential impact of HRQoL assessment techniques on economic analyses used to inform health policy decision-making for pediatric critical care.

    View details for DOI 10.1177/1367493513496909

    View details for PubMedID 23939724

  • Systematic Review of Observational Studies Assessing Bleeding Risk in Patients with Atrial Fibrillation taking Vitamin K Antagonist Clin Pharmacol Ther Lopes, L. C., Spencer, F., Neumann, I., Ventresca, M., Ebrahim, S. 2013; May 13
  • Addressing the impact of missing participant data for continuous outcomes in systematic reviews EBHC Newsl Ebrahim, S., Akl, E. A., Mustafa, R. A., Sun, X., Walter, S. D. 2013; Apr
  • Adaptive Behavior, Functional Outcomes, and Quality of Life Outcomes of Children Requiring Urgent ICU Admission PEDIATRIC CRITICAL CARE MEDICINE Ebrahim, S., Singh, S., Hutchison, J. S., Kulkarni, A. V., Sananes, R., Bowman, K. W., Parshuram, C. S. 2013; 14 (1): 10-18

    Abstract

    To describe the adaptive behavior and functional outcomes, and health-related quality of life of children who were urgently admitted to the ICU.Prospective observational study.Critical Care Medicine program at a University-affiliated pediatric institution.Urgently admitted patients, aged 1 month to 18 yrs.None.We evaluated children's adaptive behavior functioning with the Vineland Adaptive Behavior Scale-2, functional outcomes with the pediatric cerebral performance category and pediatric overall performance category, and health-related quality of life with the Pediatric Quality of Life Inventory 4 and Visual Analogue Scale. We enrolled 91 children and 65 (71%) completed the 1-month assessment. Patients had a mean (SD) Vineland Adaptive Behavior Scale-2 rating of 83.2 (± 24.8), considered to be moderate-low adaptive behavior functioning. From baseline to 1 month, pediatric cerebral performance category ratings did not significantly change (p = 0.59) and pediatric overall performance category ratings significantly improved (p = 0.03). Visual Analogue Scale ratings significantly worsened from baseline to 1 wk (p < 0.0001) and significantly improved from 1 wk to 1 month (p=0.002). At 1 month, patients had a mean (SD) Pediatric Quality of Life Inventory 4 rating of 52.8 (± 27.9) of 100, a poor quality of life rating. Circulatory admissions, worse pediatric cerebral performance category score at baseline, worse transcutaneous oxygen saturation, and longer cardiac compression duration were independently associated with worse adaptive behavior functioning. Neurological admissions, worse pediatric cerebral performance category score at baseline, longer ICU stay, and longer duration of extracorporeal membrane oxygenation were independently associated with worse functional outcome. Worse pediatric cerebral performance category score at baseline, longer ICU stay, and longer duration of extracorporeal membrane oxygenation were independently associated with worse health-related quality of life.Children surviving PICU have significant adaptive behavior functioning and functional morbidity and reduced health-related quality of life. Although neurologic morbidity following ICU was associated with baseline state, we found that resuscitation intensity and illness severity factors were independently associated with the development of acquired brain injury and reduced quality of life.

    View details for DOI 10.1097/PCC.0b013e31825b64b3

    View details for Web of Science ID 000313352200008

    View details for PubMedID 23132399

  • Correcting and interpreting the effect of cognitive therapy versus exposure in anxiety disorders BMC PSYCHIATRY Ebrahim, S., Bance, S. 2012; 12

    Abstract

    Dr. Ougrin's evaluation of cognitive therapy versus exposure in anxiety disorders reported a standardised mean difference [SMD] (95% confidence interval [CI]) of 0.52 (0.37, 0.74) for short-term outcomes and 0.46 (0.29, 0.73) for long-term outcomes in social phobia, and 0.88 (0.69, 1.11) for short-term outcomes and 1.05 (0.80, 1.37) for long-term outcomes in posttraumatic stress disorder (PTSD). These were incorrectly meta-analysed. Upon re-analysis, we found that the correct SMD (95% CI) was -0.66 (-1.19, -0.14) for short-term outcomes and mean difference (95% CI) of -29.66 (-46.13, -13.19) on the Social Phobia subscale from the Social Phobia Anxiety Inventory for long-term outcomes in Social Phobia. For PTSD, the SMD (95% CI) for short-term outcomes was -0.13 (-0.36, 0.11) and 0.05 (-0.22, 0.32) for long-term outcomes. However, correcting the errors did not change the interpretation of the findings considerably.

    View details for DOI 10.1186/1471-244X-12-202

    View details for Web of Science ID 000314302000001

    View details for PubMedID 23164260

  • Re: McAfee PC, Reah C, Gilder K, et al. A meta-analysis of comparative outcomes following cervical arthroplasty or anterior cervical fusion: results from four prospective multi-center randomized clinical trials and up to 1226 patients. Spine (Phila Pa 1976) 2012;37:943-52 SPINE Fallah, A., Ebrahim, S. 2012; 37 (19): 1720-1720

    View details for DOI 10.1097/BRS.0b013e3182656400

    View details for Web of Science ID 000308352300024

    View details for PubMedID 22735621

  • Anterior Cervical Discectomy with Arthroplasty versus Arthrodesis for Single-Level Cervical Spondylosis: A Systematic Review and Meta-Analysis PLOS ONE Fallah, A., Akl, E. A., Ebrahim, S., Ibrahim, G. M., Mansouri, A., Foote, C. J., Zhang, Y., Fehlings, M. G. 2012; 7 (8)

    Abstract

    To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) for patient-important outcomes for single-level cervical spondylosis.Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS), archives of spine meetings and bibliographies of relevant articles.We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD), reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate.We used random-effects model to pool data using mean difference (MD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome.Of 2804 citations, 9 articles reporting on 9 trials (1778 participants) were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004) and improvement in the Neck pain visual analogue scale (VAS) (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID) = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia.There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single level cervical spondylosis is an option although its benefits and indication over ACDF remain in question.

    View details for DOI 10.1371/journal.pone.0043407

    View details for Web of Science ID 000308063700097

    View details for PubMedID 22912869

  • The effectiveness of splint therapy in patients with temporomandibular disorders A systematic review and meta-analysis JOURNAL OF THE AMERICAN DENTAL ASSOCIATION Ebrahim, S., Montoya, L., Busse, J. W., Carrasco-Labra, A., Guyatt, G. H. 2012; 143 (8): 847-857

    Abstract

    The authors conducted a systematic review of all published randomized controlled trials in which investigators compared the effectiveness of splint therapy with that of minimal or no treatment in patients with temporomandibular disorders (TMDs).The authors searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for studies published from inception of each database through August 2011. In eligible studies, investigators enrolled adult patients with TMDs and assigned them randomly to splint therapy or a control group receiving minimal or no treatment.Of 1,567 potentially eligible studies, 11 proved eligible and were included. Moderate-quality evidence suggests that splint therapy reduced pain in the temporomandibular joint (TMJ) area (standardized response mean = -0.93, 95 percent confidence interval [CI], -1.33 to -0.53; risk difference for having continued pain = -0.35, 95 percent CI, -0.21 to -0.46; mean change on the 100-millimeter visual analog scale = -11.5 mm, 95 percent CI, -16.5 mm to -6.6 mm). Low to very low quality of evidence showed no significant differences between the splint therapy and control groups in terms of quality of life or depression. None of the trial reports described effect on function.Although overall results are promising for the reduction of pain, establishing the role of splints for patients with TMDs will require large trials with stronger safeguards against bias.

    View details for Web of Science ID 000307626700011

    View details for PubMedID 22855899

  • Evaluating patient values and preferences for thromboprophylaxis decision making during pregnancy: a study protocol BMC PREGNANCY AND CHILDBIRTH Alonso-Coello, P., Ebrahim, S., Guyatt, G. H., Tikkinen, K. A., Eckman, M. H., Neumann, I., McDonald, S. D., Akl, E. A., Bates, S. M. 2012; 12

    Abstract

    Pregnant women with prior venous thromboembolism (VTE) are at risk of recurrence. Low molecular weight heparin (LWMH) reduces the risk of pregnancy-related VTE. LMWH prophylaxis is, however, inconvenient, uncomfortable, costly, medicalizes pregnancy, and may be associated with increased risks of obstetrical bleeding. Further, there is uncertainty in the estimates of both the baseline risk of pregnancy-related recurrent VTE and the effects of antepartum LMWH prophylaxis. The values and treatment preferences of pregnant women, crucial when making recommendations for prophylaxis, are currently unknown. The objective of this study is to address this gap in knowledge.We will perform a multi-center cross-sectional interview study in Canada, USA, Norway and Finland. The study population will consist of 100 women with a history of lower extremity deep vein thrombosis (DVT) or pulmonary embolism (PE), and who are either pregnant, planning pregnancy, or may in the future consider pregnancy (women between 18 and 45 years). We will exclude individuals who are on full dose anticoagulation or thromboprophylaxis, who have undergone surgical sterilization, or whose partners have undergone vasectomy. We will determine each participant's willingness to receive LMWH prophylaxis during pregnancy through direct choice exercises based on real life and hypothetical scenarios, preference-elicitation using a visual analog scale ("feeling thermometer"), and a probability trade-off exercise. The primary outcome will be the minimum reduction (threshold) in VTE risk at which women change from declining to accepting LMWH prophylaxis. We will explore possible determinants of this choice, including educational attainment, the characteristics of the women's prior VTE, and prior experience with LMWH. We will determine the utilities that women place on the burden of LMWH prophylaxis, pregnancy-related DVT, pregnancy-related PE and pregnancy-related hemorrhage. We will generate a "personalized decision analysis" using participants' utilities and their personalized risk of recurrent VTE as inputs to a decision analytic model. We will compare the personalized decision analysis to the participant's stated choice.The preferences of pregnant women at risk of VTE with respect to the use of antithrombotic therapy remain unexplored. This research will provide explicit, quantitative expressions of women's valuations of health states related to recurrent VTE and its prevention with LMWH. This information will be crucial for both guideline developers and for clinicians.

    View details for DOI 10.1186/1471-2393-12-40

    View details for Web of Science ID 000311212600001

    View details for PubMedID 22646475

  • METHODOLOGICAL LIMITATIONS OF A SYSTEMATIC REVIEW EVALUATING INFERIOR OR DOUBLE JOINT SPACES INJECTION VERSUS SUPERIOR JOINT SPACE INJECTION FOR TEMPOROMANDIBULAR DISORDERS JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY Ebrahim, S. 2012; 70 (3): 504-505

    View details for DOI 10.1016/j.joms.2011.11.030

    View details for Web of Science ID 000301505300018

    View details for PubMedID 22374054

  • Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest MacLean, S., Mulla, S., Akl, E. A., Jankowski, M., Vandvik, P. O., Ebrahim, S., McLeod, S., Bhatnagar, N., Guyatt, G. H. 2012; 141 (2): e1S-23S

    Abstract

    Development of clinical practice guidelines involves making trade-offs between desirable and undesirable consequences of alternative management strategies. Although the relative value of health states to patients should provide the basis for these trade-offs, few guidelines have systematically summarized the relevant evidence. We conducted a systematic review relating to values and preferences of patients considering antithrombotic therapy.We included studies examining patient preferences for alternative approaches to antithrombotic prophylaxis and studies that examined, in the context of antithrombotic prophylaxis or treatment, how patients value alternative health states and experiences with treatment. We conducted a systematic search and compiled structured summaries of the results. Steps in the process that involved judgment were conducted in duplicate.We identified 48 eligible studies. Sixteen dealt with atrial fibrillation, five with VTE, four with stroke or myocardial infarction prophylaxis, six with thrombolysis in acute stroke or myocardial infarction, and 17 with burden of antithrombotic treatment.Patient values and preferences regarding thromboprophylaxis treatment appear to be highly variable. Participant responses may depend on their prior experience with the treatments or health outcomes considered as well as on the methods used for preference elicitation. It should be standard for clinical practice guidelines to conduct systematic reviews of patient values and preferences in the specific content area.

    View details for DOI 10.1378/chest.11-2290

    View details for PubMedID 22315262

  • Managing issues of justice in medico-legal disputes involving the deaf population MUMJ Ebrahim, S., Campbell, M. 2012; 9 (1): 43-44
  • Sikh Perspectives towards Death and End-of-Life Care JOURNAL OF PALLIATIVE CARE Ebrahim, S., Bance, S., Bowman, K. W. 2011; 27 (2): 170-174

    View details for Web of Science ID 000293483900014

    View details for PubMedID 21805953

  • Surgical Activity of First-Year Canadian Neurosurgical Residents CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES Fallah, A., Ebrahim, S., Haji, F., Gillis, C., Girgis, F., Howe, K., Ibrahim, G. M., Radic, J., Shahideh, M., Wallace, M. C. 2010; 37 (6): 855-860

    Abstract

    Surgical activity is probably the most important component of surgical training. During the first year of surgical residency, there is an early opportunity for the development of surgical skills, before disparities between the skill sets of residents increase in future years. It is likely that surgical skill is related to operative volumes. There are no published guidelines that quantify the number of surgical cases required to achieve surgical competency. The aim of this study was to describe the current trends in surgical activity in a recent cohort of first-year Canadian neurosurgical trainees.This study utilized retrospective database review and survey methodology to describe the current state of surgical training for first-year neurosurgical trainees. A committee of five residents designed this survey in an effort to capture factors that may influence the operative activity of trainees.Nine out of a cohort of 20 first-year Canadian neurosurgical trainees that began training in July of 2008 participated in the study. The median number of cases completed by a resident during the initial three month neurosurgical rotation was 66, within which the trainee was identified as the primary surgeon in 12 cases. Intracranial hemorrhage and cerebrospinal fluid diversion procedures were the most common operations to have the trainee as primary surgeon.Based on this pilot study, it appears that the operative activity of Canadian first-year residents is at least equivalent to the residents of other studied training systems with respect to volume and diversity of surgical activity.

    View details for Web of Science ID 000284674100025

    View details for PubMedID 21059551

  • Case Series: tumefactive demyelinating lesions: a diagnostic challenge. Canadian journal of surgery. Journal canadien de chirurgie Fallah, A., Banglawala, S., Ebrahim, S., Paulseth, J. E., Jha, N. K. 2010; 53 (1): 69-70

    View details for PubMedID 20100418

  • Admission and Acute Complication Rate for Outpatient Lumbar Microdiscectomy CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES Fallah, A., Massicotte, E. M., Fehlings, M. G., Lewis, S. J., Rampersaud, Y. R., Ebrahim, S., Bernstein, M. 2010; 37 (1): 49-53

    Abstract

    Specialization is generally independently associated with improved outcomes for most types of surgery. This is the first study comparing the immediate success of outpatient lumbar microdiscectomy with respect to acute complication and conversion to inpatient rate. Long-term pain relief is not examined in this study.Two separate prospective databases (one belonging to a neurosurgeon and brain tumor specialist, not specializing in spine (NS) and one belonging to four spine surgeons (SS)) were retrospectively reviewed. All acute complications as well as admission data of patients scheduled for outpatient lumbar microdiscectomy were extracted.In total, 269 patients were in the NS group and 137 patients were in the SS group. The NS group averaged 24 cases per year while the SS group averaged 50 cases per year. Chi-square tests revealed no difference in acute complication rate [NS (6.7%), SS (7.3%)] (p > 0.5) and admission rate [NS (4.1%), SS (5.8%)] (p = 0.4) while the SS group had a significantly higher proportion of patients undergoing repeat microdiscectomy [NS (4.1%), SS (37.2%)] (p < 0.0001). Excluding revision operations, there was no statistically significant difference in acute complication [NS (5.4%), SS (1.2%)] (p = 0.09) and conversion to inpatient [NS (4.3%), SS (4.6%)] (p > 0.5) rate. The combined acute complication and conversion to inpatient rate was 6.9% and 4.7% respectively.Based on this limited study, outpatient lumbar microdiscectomy can be apparently performed safely with similar immediate complication rates by both non-spine specialized neurosurgeons and spine surgeons, even though the trend favored the latter group for both outcome measures.

    View details for Web of Science ID 000274039200009

    View details for PubMedID 20169773

  • Focus on autonomy neglects the essential role of personal interconnectedness. Re: Autonomy at the end of life: life prolonging treatment in nursing homes – relatives’ role in the decision-making process J Med Ethics Ebrahim, S. 2010
  • Issue of hair shaving in Sikh patients undergoing a neurosurgical procedure CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES Ebrahim, S., Bance, S., Fallah, A. 2009; 36 (6): 793-794

    View details for Web of Science ID 000271838500027

    View details for PubMedID 19967808

  • Do subspecialized neurosurgeons experience higher complication rates for nonsubspecialty emergent surgery? SURGICAL NEUROLOGY Fallah, A., Ebrahim, S., Englesakis, M., Bernstein, M. 2009; 72 (1): 98-99

    View details for DOI 10.1016/j.surneu.2009.01.008

    View details for Web of Science ID 000267775800017

    View details for PubMedID 19329162

  • Pin-site epidural hematoma in an adult case of chronic hydrocephalus with associated thinning of the cranium BRITISH JOURNAL OF NEUROSURGERY Jha, N. K., Ebrahim, S., Fallah, A., Cenic, A., De Villiers, R. A. 2009; 23 (2): 211-212

    Abstract

    We report a case of a 22-year-old man presenting with a fourth ventricular tumour and associated chronic obstructive hydrocephalus likely leading to thinning of the cranium. Intraoperatively, he developed an epidural hematoma secondary to a fracture of the temporal bone by application of the three-point skull fixator. This is the second reported adult case of an iatrogenic epidural hematoma secondary to pin-site complications. We advocate the careful placement of the pins and suggest the tightening force be catered individually especially in pediatric patients or patients with chronic hydrocephalus.

    View details for DOI 10.1080/02688690802434830

    View details for Web of Science ID 000264530900020

    View details for PubMedID 19306183

Books and Book Chapters


  • Understanding and respecting cultural differences in end-of-life care End-of-Life Communication in the ICU Bowman, K. W., Ebrahim, S. Ottawa, Canada: CRI Critical Care Education Network. 2008

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