Gordon H Guyatt

Universitätsspital Basel, Bâle, Basel-City, Switzerland

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Publications (1000)7205.26 Total impact

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    ABSTRACT: Although previous evidence suggests advantages of nifedipine over terbutaline as tocolytic agents, in some jurisdictions, terbutaline is approved for use and nifedipine is not. In women in preterm labour, we compared the impact of terbutaline versus nifedipine on inhibition of uterine contractions, preterm birth, neonatal sepsis, intracranial haemorrhage or necrotizing enterocolitis, death or admission to a neonatal intensive care unit and maternal adverse reactions. We randomized 32 women to nifedipine and 34 to terbutaline. We found no difference between groups in tocolysis or preterm birth. No serious maternal adverse effects or serious neonatal adverse outcomes occurred in either group. Less serious maternal adverse effects less common with terbutaline included flushing (2.94% versus 43.7%) and headache (5.9% versus 31.2%). The administration of terbutaline increased tremor (76.4% versus 0%), nausea (58.8% versus 9.4%) and dizziness (29.4% versus 6.25%). The total number of side effects, and the proportion of women experiencing one or more side effects, proved greater with terbutaline.In this study, terbutaline and nifedipine performed similarly in their tocolytic effects. Each drug has specific side effects, though overall, nifedipine was associated with fewer adverse effects.This article is protected by copyright. All rights reserved.
    Basic & Clinical Pharmacology & Toxicology 08/2014; · 2.18 Impact Factor
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    ABSTRACT: Background: The safety of biological agents used to treat psoriasis remains uncertain. Objective: The authors determined the frequency and severity of adverse effects associated with use of biologic agents for psoriasis through patient-registered lawsuits to the government of Sao Paulo, Brazil. Methods: Sources of information included legal records, dispensing pharmacy data and interviews with patients. Research staff conducted telephone interviews with patients who used biologic drugs during 2004 - 2011, inquiring about medication-related adverse drug reactions (ADRs) and serious adverse events (SAEs). Results: Of the 218 patients identified, 15 proved ineligible or refused participation. 203 patients were interviewed, with 111 (54.7%) taking infliximab, 43 (21.2%) efalizumab, 35 (17.2%) etanercept and 14 (6.9%) adalimumab. Of 84 (41.4%) patients who experienced one or more ADR related to biological agents, 57 (67.9%) experienced one or more SAE. The only risk factor associated with ADRs was comorbidity odds ratio = 6.54 (95% confident interval [CI] 3.20 - 13.32), p < 0.0001. Conclusion: Biologic agents were associated with high rates of ADRs and SAEs. The data suggests that for patients taking a biologic agent to treat psoriasis and who have one or more comorbidities, warnings of possible adverse events and enhanced surveillance are warranted.
    Expert Opinion on Drug Safety 07/2014; · 2.62 Impact Factor
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    ABSTRACT: Fluid resuscitation is the cornerstone of sepsis treatment. However, whether balanced or unbalanced crystalloids or natural or synthetic colloids confer a survival advantage is unclear.
    Annals of internal medicine 07/2014; · 13.98 Impact Factor
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    ABSTRACT: OBJECTIVE: To investigate the planning of subgroup analyses in protocols of randomised controlled trials and the agreement with corresponding full journal publications. DESIGN: Cohort of protocols of randomised controlled trial and subsequent full journal publications. SETTING: Six research ethics committees in Switzerland, Germany, and Canada. DATA SOURCES: 894 protocols of randomised controlled trial involving patients approved by participating research ethics committees between 2000 and 2003 and 515 subsequent full journal publications. RESULTS: Of 894 protocols of randomised controlled trials, 252 (28.2%) included one or more planned subgroup analyses. Of those, 17 (6.7%) provided a clear hypothesis for at least one subgroup analysis, 10 (4.0%) anticipated the direction of a subgroup effect, and 87 (34.5%) planned a statistical test for interaction. Industry sponsored trials more often planned subgroup analyses compared with investigator sponsored trials (195/551 (35.4%) v 57/343 (16.6%), P<0.001). Of 515 identified journal publications, 246 (47.8%) reported at least one subgroup analysis. In 81 (32.9%) of the 246 publications reporting subgroup analyses, authors stated that subgroup analyses were prespecified, but this was not supported by 28 (34.6%) corresponding protocols. In 86 publications, authors claimed a subgroup effect, but only 36 (41.9%) corresponding protocols reported a planned subgroup analysis. CONCLUSIONS: Subgroup analyses are insufficiently described in the protocols of randomised controlled trials submitted to research ethics committees, and investigators rarely specify the anticipated direction of subgroup effects. More than one third of statements in publications of randomised controlled trials about subgroup prespecification had no documentation in the corresponding protocols. Definitive judgments regarding credibility of claimed subgroup effects are not possible without access to protocols and analysis plans of randomised controlled trials.
    BMJ: British medical journal 07/2014; · 9.72 Impact Factor
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    ABSTRACT: Clinical decisions should be based on the totality of the best evidence and not the results of individual studies. When clinicians apply the results of a systematic review or meta-analysis to patient care, they should start by evaluating the credibility of the methods of the systematic review, ie, the extent to which these methods have likely protected against misleading results. Credibility depends on whether the review addressed a sensible clinical question; included an exhaustive literature search; demonstrated reproducibility of the selection and assessment of studies; and presented results in a useful manner. For reviews that are sufficiently credible, clinicians must decide on the degree of confidence in the estimates that the evidence warrants (quality of evidence). Confidence depends on the risk of bias in the body of evidence; the precision and consistency of the results; whether the results directly apply to the patient of interest; and the likelihood of reporting bias. Shared decision making requires understanding of the estimates of magnitude of beneficial and harmful effects, and confidence in those estimates.
    JAMA The Journal of the American Medical Association 07/2014; 312(2):171-9. · 29.98 Impact Factor
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    ABSTRACT: We explored how readers interpret authors' roles based on authorship order and corresponding author.
    Journal of clinical epidemiology. 06/2014;
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    ABSTRACT: The American College of Chest Physicians Antithrombotic Guidelines ninth iteration placed restrictions on panelists with recommendations on which they disclosed a primary conflict of interest (COI). We aimed to describe panelists' financial and intellectual COI and evaluate to what extent, beyond assessing financial COI, assessing intellectual COI affected COI management.
    Journal of clinical epidemiology. 06/2014;
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    ABSTRACT: Low back pain (LBP) is a common complaint among workers receiving Workers' Compensation wage replacement benefits. We used the administrative data from the Ontario Workplace Safety and Insurance Board (WSIB) to explore the association between baseline characteristics and commonly reimbursed therapies and time to claim closure among workers disabled due to LBP.
    EPICOH 2014-Challenges for Occupational Epidemiology in the 21-st Century, Chicago, USA; 06/2014
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    ABSTRACT: The role of low-intensity pulsed ultrasound (LIPUS) in the management of fractures remains controversial. The purpose of this study was to assess the feasibility of a definitive trial to determine the effect of LIPUS on functional and clinical outcomes in tibial fractures managed operatively.
    Trials. 06/2014; 15(1):206.
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    ABSTRACT: Of workers approved for long-term disability benefits, 31.6% suffer from a primary mental illness. Negative patient recovery expectations are associated with worse outcome in many conditions. Our objectives were: 1) to complete a systematic review to identify measures that assess patient recovery expectations, and 2) using the results from our review, develop an instrument designed to assess recovery expectations in individuals receiving disability benefits secondary to a mental health disorder.
    Occupational and environmental medicine. 06/2014; 71 Suppl 1:A81.
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    ABSTRACT: Symptom exaggeration is a significant issue in patients receiving disability benefits secondary to mental health disorders. Measures designed to detect exaggeration of symptoms are valuable for informing more accurate diagnoses, which can impact claim decision-making, both for disability claim approval and patient management. Our objectives were: 1) to complete a systematic review to identify measures that assess symptom exaggeration in mental health disorders, and 2) using the results from the review, develop an instrument assessing symptom exaggeration in individuals receiving disability benefits secondary to mental health disorders.
    Occupational and environmental medicine. 06/2014; 71 Suppl 1:A80-1.
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    ABSTRACT: Independent medical evaluations (IMEs) are a common and influential form of assessment, often influencing whether patients receive compensation for an injury or illness. To inform the evidence-base underlying IMEs, we conducted a systematic review of all primary literature conducted in North America.
    Occupational and environmental medicine. 06/2014; 71 Suppl 1:A83.
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    ABSTRACT: Prevention of chronic chagasic cardiomyopathy (CCC) by treating infected populations with trypanocidal therapy (TT) remains a challenge. Despite a renewed enthusiasm for TT, uncertainty regarding its efficacy, concerns about its safety and limited availability remain barriers for a wider use of conventional drugs. We have updated a previous version of this review.
    Cochrane database of systematic reviews (Online) 05/2014; 5:CD003463. · 5.70 Impact Factor
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    ABSTRACT: Background Exploration of values and preferences in the context of anticoagulation therapy for atrial fibrillation (AF) remains limited. To better characterize the distribution of patient and physician values and preferences relevant to decisions regarding anticoagulation in patients with AF, we conducted interviews with patients at risk of developing AF and physicians who manage patients with AF.Methods We interviewed 96 outpatients and 96 physicians in a multicenter study and elicited the maximal increased risk of bleeding (threshold risk) that respondents would tolerate with warfarin vs. aspirin to achieve a reduction in three strokes in 100 patients over a 2-year period. We used the probabilistic version of the threshold technique.ResultsThe median threshold risk for both patients and physicians was 10 additional bleeds (10 P = 0.7). In both groups, we observed large variability in the threshold number of bleeds, with wider variability in patients than clinicians [patient range: 0–100, physician range: 0–50]. We observed one cluster of patients and physicians who would tolerate <10 bleeds and another cluster of patients, but not physicians, who would accept more than 35.Conclusions Our findings suggest wide variability in patient and physician values and preferences regarding the trade-off between strokes and bleeds. Results suggest that in individual decision making, physician and patient values and preferences will often be discordant; this mandates tailoring treatment to the individual patient's preferences.
    Health expectations: an international journal of public participation in health care and health policy 05/2014; · 1.80 Impact Factor
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    ABSTRACT: Digitalis glycosides have been in clinical use for the treatment of heart failure (HF) for longer than 200 years. In recent years, several trials have been conducted to address concerns about their efficacy and toxicity. To examine the effectiveness of digitalis glycosides in treating HF in patients with normal sinus rhythm. To examine the effects of digitalis in patients taking diuretics and angiotensin-converting enzyme inhibitors; in patients with varying severity and duration of disease; in patients with prior exposure to digitalis versus no prior exposure; and in patients with "HF due to systolic dysfunction" versus "HF with preserved ejection fraction." Searches on the following databases were updated in May 2013: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Dissertation Abstracts. Annual meeting abstracts of the American Heart Association, the American College of Cardiology, and the European Society of Cardiology were searched from 1996 to March 2013. In addition, reference lists provided by the pharmaceutical industry (GlaxoSmithKline and Covis Pharma) were searched. Included were randomized placebo-controlled trials of 20 or more adult participants of either sex with symptomatic HF who were studied for seven weeks or longer. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of HF such as acute ischemic heart disease or myocarditis was present. Articles selected from the searches described above were evaluated in a joint effort of the review authors. The staff of the Cochrane Heart Group ran searches on the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. No new studies were identified in the updated searches. Thirteen studies (7896 participants) are included, and major endpoints of mortality, hospitalization, and clinical status, based respectively on 8, 4, and 12 of these selected studies, were recorded and analyzed. The data show no evidence of a difference in mortality between treatment and control groups, whereas digitalis therapy is associated with lower rates of both hospitalization and clinical deterioration. The largest study, in which most participants were taking angiotensin-converting enzyme inhibitors, showed a significant rise in "other cardiac" deaths, possibly due to arrhythmias. However collectively, these findings were based on studies done before beta-blockers, as well as angiotensin receptor blockers and aldosterone antagonists, became widely used to treat HF. The literature indicates that digitalis may have a useful role in the treatment of patients with HF who are in normal sinus rhythm. New trials are needed to elucidate the importance of the dosage of digitalis and its usefulness in the era of beta-blockers and other agents shown to be effective in treating HF.
    Cochrane database of systematic reviews (Online) 04/2014; 4:CD002901. · 5.70 Impact Factor
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    ABSTRACT: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability.
    New England Journal of Medicine 04/2014; N Engl J Med. 2014 Apr 17;370(16):1504-13. doi: 10.1056/NEJMoa1401106. Epub 2014 Mar 31.. · 51.66 Impact Factor
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    ABSTRACT: Adaptation of guidelines for use at the national or local level can facilitate their implementation. We developed and evaluated an adaptation process in adherence with standards for trustworthy guidelines and the GRADE methodology aiming for efficiency and transparency. This is the first in a series of four articles describing our adaptation of the 9th iteration of the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis for a Norwegian setting. Informed by the ADAPTE framework, we developed a 5-step adaptation process customized to guidelines developed with GRADE: 1) planning, 2) initial assessment of the recommendations, 3) modification, 4) publication, and 5) evaluation. We developed a taxonomy for describing how and why recommendations from the parent guideline were modified. We applied a mixed-methods, case-study design for evaluation of the process. We published the adapted guideline November 2013 in a novel multilayered format. The taxonomy for adaptation facilitated transparency of the modification process for both the guideline developers and end-users. We excluded 30 and modified 131 of the 333 original recommendations according to the taxonomy and developed 8 new recommendations. Unforeseen obstacles related to acquiring a licensing agreement and procuring a publisher resulted in a 9-month delay. We propose modifications of the adaptation process to overcome these obstacles in the future. This case study demonstrates the feasibility of our novel adaptation process. Replication is needed to further validate the usefulness of the process in increasing the organizational and methodological efficiency of guideline adaptation.
    Chest 04/2014; · 5.85 Impact Factor
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    ABSTRACT: The Antithrombotic Therapy and the Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-based Guidelines (AT9) represent trustworthy international guidelines for antithrombotic treatment and thromboprophylaxis. Here, we describe major changes to the format and content resulting from applying new strategies for guideline adaptation and dissemination. A Norwegian guideline panel of 46 experts completed a structured and systematic adaptation process, updating the recommendations based on new evidence, and rewrote the recommendations in an electronic multilayered presentation format. We published the adapted guideline using a web-based authoring and publication platform (MAGICapp at www.magicapp.org/public). We applied a novel presentation format to 333 recommendations from 11 of the 15 management chapters in AT9, condensed and restructured into 249 recommendations in a multilayered format. We added additional relevant information, such as 29 best practice statements about new oral anticoagulants and practical information sections for 121 recommendations. Common reasons for modifications included feasibility of the recommendations in a national context, disagreement with applied baseline risk estimates and re-evaluating the balance between the benefits and harms of interventions in relation to assumed typical patient preferences and values. The adapted guideline was published and disseminated online in November 2013. New strategies for adapting, updating and disseminating trustworthy guidelines proved feasible and will provide Norwegian health care professionals and patients with up to date guidance tailored to national circumstances.
    Chest 04/2014; · 5.85 Impact Factor
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    ABSTRACT: Abstract OBJECTIVE: To investigate the risk of pancreatitis associated with the use of incretin-based treatments in patients with type 2 diabetes mellitus. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. ELIGIBILITY CRITERIA: Randomised and non-randomised controlled clinical trials, prospective or retrospective cohort studies, and case-control studies of treatment with glucagon-like peptide-1 (GLP-1) receptor agonists or dipeptidyl peptidase-4 (DPP-4) inhibitors in adults with type 2 diabetes mellitus compared with placebo, lifestyle modification, or active anti-diabetic drugs. DATA COLLECTION AND ANALYSIS: Pairs of trained reviewers independently screened for eligible studies, assessed risk of bias, and extracted data. A modified Cochrane tool for randomised controlled trials and a modified version of the Newcastle-Ottawa scale for observational studies were used to assess bias. We pooled data from randomised controlled trials using Peto odds ratios, and conducted four prespecified subgroup analyses and a post hoc subgroup analysis. Because of variation in outcome measures and forms of data, we describe the results of observational studies without a pooled analysis. RESULTS: 60 studies (n=353 639), consisting of 55 randomised controlled trials (n=33 350) and five observational studies (three retrospective cohort studies, and two case-control studies; n=320 289) were included. Pooled estimates of 55 randomised controlled trials (at low or moderate risk of bias involving 37 pancreatitis events, raw event rate 0.11%) did not suggest an increased risk of pancreatitis with incretins versus control (odds ratio 1.11, 95% confidence interval 0.57 to 2.17). Estimates by type of incretin suggested similar results (1.05 (0.37 to 2.94) for GLP-1 agonists v control; 1.06 (0.46 to 2.45) for DPP-4 inhibitors v control). Analyses according to the type of control, mode, duration of treatment, and individual incretin agents suggested no differential effect by subgroups, and sensitivity analyses by alternative statistical modelling and effect measures did not show important differences in effect estimates. Three retrospective cohort studies (moderate to high risk of bias, involving 1466 pancreatitis events, raw event rate 0.47%) also did not suggest an increased risk of pancreatitis associated with either exenatide (adjusted odds ratios 0.93 (0.63 to 1.36) in one study and 0.9 (0.6 to 1.5) in another) or sitagliptin (adjusted hazard ratio 1.0, 0.7 to 1.3); a case-control study at moderate risk of bias (1003 cases, 4012 controls) also suggested no significant association (adjusted odds ratio 0.98, 0.69 to 1.38). Another case-control study (1269 cases, 1269 controls) at moderate risk of bias, however, suggested that the use of either exenatide or sitagliptin was associated with significantly increased odds of acute pancreatitis (use within two years v no use, adjusted odds ratio 2.07, 1.36 to 3.13). CONCLUSIONS: The available evidence suggests that the incidence of pancreatitis among patients using incretins is low and that the drugs do not increase the risk of pancreatitis. Current evidence, however, is not definitive, and more carefully designed and conducted observational studies are warranted to definitively establish the extent, if any, of increased risk.
    BMJ: British medical journal 04/2014; 348. · 9.72 Impact Factor

Publication Stats

50k Citations
7,205.26 Total Impact Points

Institutions

  • 2008–2014
    • Universitätsspital Basel
      • Institute for Clinical Epidemiology and Biostatistics (CEB)
      Bâle, Basel-City, Switzerland
    • The University of Manchester
      Manchester, England, United Kingdom
    • All India Institute of Medical Sciences
      • Department of Neurology
      New Delhi, NCT, India
    • University of Auckland
      • Faculty of Medical and Health Sciences
      Auckland, Auckland, New Zealand
  • 2013
    • University of Sorocaba
      Sorocaba, São Paulo, Brazil
    • Vanderbilt University
      • Vanderbilt Center for Evidence-based Medicine
      Nashville, MI, United States
    • Sichuan University
      Hua-yang, Sichuan, China
    • University of Manitoba
      • Department of Surgery
      Winnipeg, Manitoba, Canada
    • University Health Network
      • Toronto General Hospital
      Toronto, Ontario, Canada
    • University College Cork
      • Centre for Gerontology and Rehabilitation
      Cork, M, Ireland
  • 2006–2013
    • University of Ottawa
      • • Faculty of Health Sciences
      • • Department of Medicine
      Ottawa, Ontario, Canada
    • Jagiellonian University
      • II Department of Internal Medicine
      Kraków, Lesser Poland Voivodeship, Poland
    • New York Presbyterian Hospital
      New York City, New York, United States
    • Nagoya City University
      • Department of Psychiatry and Cognitive-Behavioral Medicine
      Nagoya, Aichi, Japan
  • 2002–2013
    • Mayo Foundation for Medical Education and Research
      • Department of Medicine
      Rochester, Michigan, United States
    • Queen's University
      • Department of Medicine
      Kingston, Ontario, Canada
    • St. Michael's Hospital
      • Department of Surgery
      Toronto, Ontario, Canada
  • 1984–2013
    • McMaster University
      • • Department of Clinical Epidemiology and Biostatistics
      • • Department of Surgery
      • • Faculty of Health Sciences
      • • Department of Medicine
      Hamilton, Ontario, Canada
  • 2012
    • Stanford University
      • Stanford Stroke Center
      Stanford, CA, United States
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
    • Norwegian Knowledge Centre for the Health Services
      Kristiania (historical), Oslo County, Norway
    • Kaiser Permanente
      • Center for Health Research (Oregon, Hawaii, and Georgia)
      Oakland, CA, United States
    • Toronto Western Hospital
      Toronto, Ontario, Canada
    • University of Santiago, Chile
      CiudadSantiago, Santiago, Chile
  • 2009–2012
    • Institute for Work and Health
      Toronto, Ontario, Canada
    • London School of Hygiene and Tropical Medicine
      Londinium, England, United Kingdom
    • University of Newcastle
      • Centre for Clinical Epidemiology and Biostatistics
      Newcastle, New South Wales, Australia
  • 2006–2012
    • The University of Western Ontario
      • • Department of Surgery
      • • School of Physical Therapy
      London, Ontario, Canada
  • 2002–2012
    • University at Buffalo, The State University of New York
      • • Department of Medicine
      • • Department of Sociology
      • • School of Medicine and Biomedical Sciences
      Buffalo, NY, United States
  • 2001–2012
    • Mayo Clinic - Rochester
      • Department of Hospital Internal Medicine
      Rochester, Minnesota, United States
    • Indiana University-Purdue University Indianapolis
      Indianapolis, Indiana, United States
  • 2011
    • Universitätsklinikum Freiburg
      • Institute of Medical Biometry and Statistics
      Freiburg an der Elbe, Lower Saxony, Germany
    • Oregon Health and Science University
      • Department of Medical Informatics & Clinical Epidemiology
      Los Angeles, CA, United States
  • 2010–2011
    • Université de Sherbrooke
      • Étienne-Le Bel Clinical Research Center
      Sherbrooke, Quebec, Canada
    • Princess Alexandra Hospital (Queensland Health)
      • Department of Internal Medicine and Clinical Epidemiology
      Brisbane, Queensland, Australia
    • Hebrew University of Jerusalem
      Yerushalayim, Jerusalem District, Israel
    • University of Florida
      • Department of Urology
      Gainesville, FL, United States
  • 2008–2011
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
  • 2007–2011
    • West Park Healthcare Centre
      Toronto, Ontario, Canada
    • University Hospital Vall d'Hebron
      • Department of Cardiology
      Barcelona, Catalonia, Spain
    • University of Barcelona
      • Departament de Medicina
      Barcelona, Catalonia, Spain
  • 1998–2011
    • Hospital de la Santa Creu i Sant Pau
      Barcino, Catalonia, Spain
    • The University of Tampa
      Tampa, Florida, United States
    • SickKids
      • Department of Critical Care Medicine
      Toronto, Ontario, Canada
  • 1987–2011
    • University of Toronto
      • • Department of Rehabilitation Science
      • • Department of Medicine
      Toronto, Ontario, Canada
  • 2008–2010
    • Case Western Reserve University
      • • Division of Gastroenterology and Hepatology (MetroHealth Medical Center)
      • • Division of Gastroenterology and Liver Disease
      Cleveland, OH, United States
  • 2008–2009
    • Shaare Zedek Medical Center
      Yerushalayim, Jerusalem District, Israel
  • 2006–2009
    • Istituto Regina Elena - Istituti Fisioterapici Ospitalieri
      Roma, Latium, Italy
  • 2005–2009
    • University of British Columbia - Vancouver
      • Department of Medicine
      Vancouver, British Columbia, Canada
    • Hamilton Health Sciences
      Hamilton, Ontario, Canada
  • 2004–2009
    • London Health Sciences Centre
      • • Department of Surgery
      • • Division of Critical Care
      London, Ontario, Canada
    • University of Oxford
      Oxford, England, United Kingdom
    • Duke University
      • Department of Medicine
      Durham, North Carolina, United States
    • CUNY Graduate Center
      New York City, New York, United States
    • McGill University
      • Division of Gastroenterology
      Montréal, Quebec, Canada
  • 2004–2008
    • L’Institut Régional de Médecine Physique et de Réadaptation
      Nancy, Lorraine, France
    • University of Zurich
      • Horten-Zentrum
      Zürich, ZH, Switzerland
  • 2002–2008
    • St. Paul's Hospital
      Saskatoon, Saskatchewan, Canada
  • 2005–2007
    • The Canadian College of Naturopathic Medicine
      Toronto, Ontario, Canada
    • AstraZeneca
      Tukholma, Stockholm, Sweden
  • 1999–2007
    • The University of Calgary
      • Department of Medicine
      Calgary, Alberta, Canada
    • University of Sydney
      Sydney, New South Wales, Australia
  • 2005–2006
    • Iberoamerican Cochrane Centre
      Barcino, Catalonia, Spain
  • 2001–2004
    • Dalhousie University
      • Department of Medicine
      Halifax, Nova Scotia, Canada
  • 2003
    • Catholic University of the Maule
      Talca, Maule, Chile
  • 1999–2002
    • Institut Universitaire de Cardiologie et de Pneumologie de Québec (Hôpital Laval)
      Québec, Quebec, Canada
  • 2000
    • Mount Sinai Hospital, Toronto
      Toronto, Ontario, Canada
    • Mount Sinai Hospital
      New York City, New York, United States
  • 1998–1999
    • Harvard Medical School
      • Department of Pediatrics
      Boston, MA, United States
  • 1991–1997
    • St. Joseph's Healthcare Hamilton
      Hamilton, Ontario, Canada
  • 1996
    • Institute for Clinical Evaluative Sciences
      Toronto, Ontario, Canada