Cara Tannenbaum's research while affiliated with Faculté de Médecine et de Pharmacie de Fès and other places

Publications (183)

Article
Objective To describe interventions that target patient, provider, and system barriers to sedative-hypnotic (SH) deprescribing in the community and suggest strategies for healthcare teams. Data Sources Ovid MEDLINE ALL and EMBASE Classic + EMBASE (March 10, 2021). Study Selection and Data Extraction English-language studies in primary care settin...
Chapter
Historically, consideration of sex and gender has been neglected in health research and largely ignored in knowledge translation and implementation science. These omissions have led to a dearth of sex- and gender-specific content in public health, which misses crucial opportunities to develop and deliver more personalised and effective policy and p...
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To improve the outcomes of research and medicine, government-based international research funding agencies have implemented various types of policies and mechanisms with respect to sex as a biological variable and gender as a sociocultural factor. After the 1990s, the US National Institutes of Health (NIH), the Canadian Institute for Health Researc...
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Background Over the past decade, the Canadian Institutes of Health Research (CIHR) has implemented multicomponent interventions to increase the uptake of sex and gender in grant applications. Interventions included mandatory reporting on applicant forms, development of resources for applicants and evaluators, and grant review requirements. Here, we...
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With more time being spent on caregiving responsibilities during the COVID-19 pandemic, female scientists’ productivity dropped. When female scientists conduct research, identity factors are better incorporated in research content. In order to mitigate damage to the research enterprise, funding agencies can play a role by putting in place gender eq...
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Aims: Our goal was to identify which women participating in an educational workshop on incontinence were most likely to benefit from it. Methods: We included women aged 65 or older, living in the community, and not treated for incontinence despite reporting urinary leakage at least twice a week. The workshop's aims were to change beliefs about a...
Article
Background: Long-term opioid use is a known risk factor for opioid-related harms. We aimed to identify risk factors for and predictors of long-term use of prescription opioids in the community-dwelling population of adults without a diagnosis of cancer, to inform practice change at the point of care. Methods: Using Quebec administrative claims d...
Preprint
The COVID-19 pandemic has exposed and exacerbated gender biases in science, technology, engineering, mathematics, and medicine. Accumulating evidence suggests that female scientists’ productivity dropped during the initial lockdown period. With more time being spent on caregiving responsibilities, women may be struggling to collaborate on grant app...
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Sex and gender considerations are understood as essential components of knowledge translation in the design, implementation and reporting of interventions. Integrating sex and gender ensures more relevant evidence for translating into the real world. Canada offers specific funding opportunities for knowledge translation projects that integrate sex...
Article
Background Sedative use in older adults increases the risk of falls, fractures and hospitalisations. The “Developing Pharmacist-led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly” (D-PRESCRIBE), pragmatic randomized clinical trial demonstrated that community-based, pharmacist-led educa...
Article
A male bias in mortality has emerged in the COVID-19 pandemic, which is consistent with the pathogenesis of other viral infections. Biological sex differences may manifest themselves in susceptibility to infection, early pathogenesis, innate viral control, adaptive immune responses or the balance of inflammation and tissue repair in the resolution...
Article
Objectives: Older adults are often prescribed potentially inappropriate medications associated with adverse health outcomes and increased health services utilization. Developing Pharmacist-led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly (D-PRESCRIBE), a pragmatic randomized clinica...
Article
The goal of sex and gender analysis is to promote rigorous, reproducible and responsible science. Incorporating sex and gender analysis into experimental design has enabled advancements across many disciplines, such as improved treatment of heart disease and insights into the societal impact of algorithmic bias. Here we discuss the potential for se...
Article
Background: Long-term benzodiazepine (BZD) use among seniors is mostly inappropriate and associated with adverse health outcomes. To prevent these consequences, withdrawal is crucial, yet knowledge is limited about what predicts BZD discontinuation. Until now, most studies have focused on sociodemographic and BZD intake factors as predictors while...
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Background: Opioid use has risen to epidemic proportions across Canada, with increasing evidence of harms including accidental overdose and death. Policy-makers have called for effective approaches to promote opioid reduction. One promising method from deprescribing randomized trials is to empower patients through direct-to-patient education. The...
Article
BACKGROUND: The ability of questionnaires such as the Patients’ Attitudes Towards Deprescribing (PATD) or the Beliefs about Medicines Questionnaire (Specific section) (BMQ-Specific) to successfully identify patients who will deprescribe remains unknown. OBJECTIVE: To determine if screening questionnaires assessing patients’ attitudes and beliefs to...
Article
Sedative-hypnotic medications are frequently prescribed for hospitalized patients with insomnia, but they can result in preventable harm such as delirium, falls, hip fractures, and increased morbidity. Furthermore, sedative-hypnotic initiation while in the hospital carries a risk of chronic use after discharge. Disrupted sleep is a major contributo...
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Policies have been put in place internationally to reduce the overuse of certain medications that have a high risk of harm, such as sedative-hypnotic drugs for insomnia or opioids for chronic non-cancer pain. We explore and compare the outcomes of policies aimed at deprescribing sedative-hypnotic medication in community-dwelling older adults. Presc...
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Background: The long-term effectiveness of group continence promotion delivered via community organisations on female urinary incontinence, falls and healthy life expectancy remains unknown. Methods: A pragmatic cluster randomised trial was conducted among 909 women aged 65-98 years with urinary incontinence, recruited from 377 community organis...
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Background Clinical practice guideline (CPG) developers have yet to endorse a consistent and systematic approach for considering sex‐specific cardiovascular information in CPGs. This article describes an initiative led by the Canadian Cardiovascular Society to determine the feasibility and outcomes of a structured process for considering sex in a C...
Article
In Reply We deliberately designed the D-PRESCRIBE study as a pragmatic clinical trial to mirror real-life conditions and test the effectiveness, rather than the efficacy, of the pharmacist-led educational intervention for patients and primary care clinicians.¹ The more similar the participants and conditions in a trial are to real life, the more re...
Data
Table S1. PICO Questions for CPG Data S1. CPG Reference List
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Objectives: This study sought to summarize all available evidence on sex differences in adverse drug reactions (ADRs) to heart failure (HF) medication. Background: Women are more likely to experience ADRs than men, and these reactions may negatively affect women's immediate and long-term health. HF in particular is associated with increased ADR...
Article
Introduction and hypothesis Many women consider urinary incontinence (UI) a normal part of ageing. This belief may contribute to delays in treatment seeking. This study examined the relationship among holding that belief, UI type and severity, impact on quality of life, management and healthcare seeking in a sample of older community-dwelling Canad...
Article
Background Across countries and disciplines, studies show male researchers receive more research funding than their female peers. Because most studies have been observational, it is unclear whether imbalances stem from evaluations of female research investigators or of their proposed research. In 2014, the Canadian Institutes of Health Research cre...
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Background: To describe the effectiveness of online learning to augment academic capacity to consider sex and gender in the conduct of basic science, clinical research, and population health studies. Method: The analysis compares pre- and post-test scores from 1441 individuals who completed the Canadian Institutes of Health Research Institute of...
Article
Importance High rates of inappropriate prescribing persist among older adults in many outpatient settings, increasing the risk of adverse drug events and drug-related hospitalizations. Objective To compare the effectiveness of a consumer-targeted, pharmacist-led educational intervention vs usual care on discontinuation of inappropriate medication...
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New knowledge about male–female differences in pathophysiology, diagnosis, and treatment is shifting the practice of medicine from a one-size-fits all approach to a more individualized process that considers sex-specific interventions at the point of care. In this article, we review how clinical practice guideline committees can incorporate a struc...
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Background Little is known about the initiation, style and content of patient and healthcare provider communication around deprescribing. We report the findings from a content analysis of audio-recorded discussions of proton pump inhibitor (PPI) and benzodiazepine deprescribing in primary care. Methods Participants were healthcare providers ( n =...
Article
Many seniors remain unaware that certain medications may be harmful, despite high rates of polypharmacy and inappropriate medication use among community-dwelling older adults. Patient education is an effective method for reducing the use of inappropriate medications. Increasing public awareness and engagement is essential for promoting shared decis...
Article
Background Missing data in health-related quality-of-life outcomes are an ongoing problem. The 12-item short form health survey (SF-12) scores are no exception. Data imputation is complicated, because missingness may be partially predicted by the missing data themselves. Objectives To compare the performance of a Bayesian method for imputing SF-12...
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One in four community-dwelling older adults is prescribed an inappropriate medication. Educational interventions aimed at patients to reduce inappropriate medications may cause patients to question their prescriber’s judgment. The objective of this study was to determine whether a patient-focused deprescribing intervention compromised trust between...
Preprint
Background Previous research shows that men often receive more research funding than women, but does not provide empirical evidence as to why this occurs. In 2014, the Canadian Institutes of Health Research (CIHR) created a natural experiment by dividing all investigator-initiated funding into two new grant programs: one with and one without an exp...
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Objectives: To distribute the EMPOWER patient education brochure and use hospitalization as an opportunity to reduce inappropriate sedatives. Design: Participants were sequentially recruited until we achieved 30-day follow-up telephone and pharmacy records for 50 individuals. The proportion meeting the primary outcome was compared with that of a...
Article
Context: Interprofessional communication is an effective mechanism for reducing inappropriate prescriptions among older adults. Physicians' views about which elements are essential for pharmacists to include in an evidence-based pharmaceutical opinion for deprescribing remain unknown. Objective: To develop a prototype for an evidence-based pharm...
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Background: The number of e-mental health apps is increasing rapidly. Studies have shown that the use of some apps is beneficial, whereas others are ineffective or do not meet users' privacy expectations. Individuals and organizations that curate, recommend, host, use, or pay for apps have an interest in categorizing apps according to the consensu...
Data
Table S1. Prevalence of inappropriate medication use per province (unweighted) Table S2. Provincial variation in respondent awareness and behaviours towards medication harms and deprescribing (unweighted) Table S3. Information seeking behaviours
Article
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Objectives: To determine older adults' awareness of the concept of medication-induced harm and their familiarity with the term "deprescribing." Secondary objectives were to ascertain determinants of self-initiated deprescribing conversations and to identify how older adults seek information on medication harms. Design: Cross-sectional population...
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Integrating sex and gender in health research is essential to produce the best possible evidence to inform health care. Comprehensive integration of sex and gender requires considering these variables from the very beginning of the research process, starting at the proposal stage. To promote excellence in sex and gender integration, we have develop...
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Decision-making regarding the initiation and cessation of medications in older adults is primarily the responsibility of clinicians, however, this can be impacted by appropriate health policy. This study investigated policies across Canadian jurisdictions designed to discourage the use of inappropriate medications, and encourage deprescribing. A na...
Article
In Canada 66% of people aged ≥65 years take five or more medications per day, and 1-in-3 consumes a Beers List inappropriate prescription. The Canadian Deprescribing Network was launched in 2016 to mobilize older adults, clinicians, health care organizations and policy-makers to reduce inappropriate prescriptions by 50% over the next 3–5 years. The...
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Women and men, female and male animals and cells are biologically different, and acknowledgement of this fact is critical to advancing medicine. However, incorporating concepts of sex-specific analysis in basic research is largely neglected, introducing bias into translational findings, clinical concepts and drug development. Research funding agenc...
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Background and objectives Successful mechanisms for engaging patients in the deprescribing process remain unknown but may include: (1) triggering motivation to deprescribe by increasing patients’ knowledge and concern about medications; (2) building capacity to taper by augmenting self-efficacy and (3) creating opportunities to discuss and receive...
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Individualization of drug therapy requires that the right drug be administered at the correct dose to patients who are likely to achieve the highest benefit and lowest risk. Female sex and age comprise two important risk factors for altered drug exposure and response. This review summarizes the current state of science for considering age and sex-r...
Article
Background The Internet and eHealth technologies represent new opportunities for managing health. Age, sex, socioeconomic status, and current technology use are some of the known factors that influence individuals’ uptake of eHealth; however, relatively little is known about facilitators and barriers to eHealth uptake specific to older adults, part...
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An Ecological Approach to Reducing Potentially Inappropriate Medication Use: Canadian Deprescribing Network—Erratum - Cara Tannenbaum, Barbara Farrell, James Shaw, Steve Morgan, Johanna Trimble, Janet C. Currie, Justin Turner, Paula Rochon, James Silvius
Article
In Reply Biomedical research questions should be driven by substantive knowledge about biologic mechanisms, pathophysiology, and the risks of disease and treatment. There is strong indication that sex and gender matter for the majority of health conditions.¹ Unfortunately, scientific discoveries remain hampered by systematic underinvestigation and...
Article
Background: The importance of sex and gender in the diagnosis and management of health conditions is well established, but the extent to which this evidence is integrated into clinical practice guidelines remains unknown. We aimed to determine the proportion of Canadian clinical practice guidelines that integrate evidence on sex and gender consider...
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Background Evidence-based mailed educational brochures about the harms of sedative-hypnotic use lead to discontinuation of chronic benzodiazepine use in older adults. It remains unknown whether patients with mild cognitive impairment (MCI) are able to understand the information in the EMPOWER brochures, and whether they achieve similar rates of ben...
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RÉSUMÉ La polypharmacie est en croissance au Canada, ainsi que les effets indésirables des médicaments et les coûts associés à la drogue. Une partie de la solution peut être la déprescription—le processus planifié et contrôlé de la réduction des doses ou la cessation des médicaments qui peuvent nutrient ou qui n’offrent plus d’avantage. La déprescr...
Data
Detailed description of the gender-blinding intervention and additional data. (PDF)
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Objective To review the literature on strategies implemented or identified to prevent or reduce gender bias in peer review of research grants. Methods Studies of any type of qualitative or quantitative design examining interventions to reduce or prevent gender bias during the peer review of health-related research grants were included. Electronic...
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Translating policy into action is a complex task, with much debate surrounding the process whereby US and Canadian health funding agencies intend to integrate sex and gender science as an integral component of methodological rigor and reporting in health research. Effective January 25, 2016, the US National Institutes of Health implemented a policy...
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Background There has been a recent swell in activity by health research funding organizations and science journal editors to increase uptake of sex and gender considerations in study design, conduct and reporting in order to ensure that research results apply to everyone. However, examination of the implementation research literature reveals that a...
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Efforts to integrate gender medicine into medical school curricula have focused largely on the work of individual champions. Online sex and gender materials for undergraduate courses have also been developed and disseminated. Success has been sporadic, with varying uptake across schools within and between countries. International trends in medical...
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Background The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. Methods An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained a...
Conference Paper
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Hypothesis / aims of study This study aims to explore the nature and mechanisms of behavioural changes made by community living older women following attendance at a bladder health and continence promotion workshop to support self-management and reduce severity of lower urinary tract symptoms (LUTS). Significant improvements in continence status we...
Article
Genre, travail et vieillissement - Volume 35 Issue 3 - Cara Tannenbaum, Patrice Voss, Hani El-Gabalawy, Yves Joanette
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Gender, Work, and Aging - Volume 35 Issue 3 - Cara Tannenbaum, Patrice Voss, Hani El-Gabalawy, Yves Joanette
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Background: Many medications pose greater health risks when prescribed for older adults, compared with available pharmacologic and nonpharmacologic alternatives. We sought to quantify the frequency and cost of potentially inappropriate prescribing for older women and men in Canada. Methods: Using data for 2013 from the National Prescription Drug...