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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Walker K, Stephenson M, Loupis A, Ben-Meir M, Joe K, Stephenson M, Lowthian J, Yip B, Wu E, Hansen K, Rosler R, Buntine P, Hutton J. Displaying emergency patient estimated wait times: A multi-centre, qualitative study of patient, community, paramedic and health administrator perspectives. Emerg Med Australas 2021; 33:425-433. [PMID: 32985795 DOI: 10.1111/1742-6723.13640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/19/2020] [Accepted: 08/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE EDs have the potential ability to predict patient wait times and to display this to patients and other stakeholders. Little is known about whether consumers and stakeholders would want this information and how wait time predictions might be used. The aim of the present study was to gain perspectives from consumers and health services personnel regarding the concept of emergency wait time visibility. METHODS We conducted a qualitative interview and focus group study in 2019. Participants included emergency medicine patients, families, paramedics, well community members, and hospital/paramedic administrators from multiple EDs and organisations in Victoria, Australia. Transcripts were coded and themes presented. RESULTS One focus group and 103 semi-structured interviews were conducted in 2019 including 32 patients, 22 carers/advocates and 21 paramedics in the ED; 20 health service administrators (paramedic and hospital) and 15 community members. Consumers and paramedics face physical and psychological difficulties when wait times are not visible. Consumers believe about a 2-h wait is tolerable, beyond this most begin to consider alternative strategies for seeking care. Consumers want to see triage to doctor times; paramedics want door-to-off stretcher times (for all possible transport destinations); with 47 of 50 consumers and 30 of 31 paramedics potentially using this information. About 28 of 50 consumers would use times to inform facility or provider choice, another 19 of 50 want information once in the waiting room. During prolonged waits, 51 of 52 consumers would continue to seek care. CONCLUSIONS Consumers and paramedics want wait time information visibility. They would use the information in a variety of ways, both pre-hospital and while waiting for care.
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Affiliation(s)
- Katie Walker
- Emergency Department, Cabrini Institute, Melbourne, Victoria, Australia
- Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia
- Department of Health Services, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Melanie Stephenson
- Emergency Department, Cabrini Institute, Melbourne, Victoria, Australia
- Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne Loupis
- Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia
| | - Michael Ben-Meir
- Emergency Department, Cabrini Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Keith Joe
- Emergency Department, Cabrini Institute, Melbourne, Victoria, Australia
- Design Health Collab, Monash Art, Design and Architecture, Monash University, Melbourne, Victoria, Australia
| | - Michael Stephenson
- Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
| | - Judy Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Bolton-Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Beatrice Yip
- Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Elena Wu
- Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kim Hansen
- Emergency Department, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
- Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel Rosler
- Emergency Department, Monash Health, Melbourne, Victoria, Australia
| | - Paul Buntine
- Emergency Department, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jennie Hutton
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Walker K, Wu E, Yip B, Stephenson M, Loupis A. What emergency department wait times do community members want to see displayed? Emerg Med Australas 2020; 33:181-183. [PMID: 33283437 DOI: 10.1111/1742-6723.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Katie Walker
- Emergency Department, Cabrini, Melbourne, Australia.,Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia.,Health Services, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elena Wu
- Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Beatrice Yip
- Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Melanie Stephenson
- Emergency Department, Cabrini, Melbourne, Australia.,Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia.,Emergency Department, Austin Health, Melbourne, Victoria, Australia
| | - Anne Loupis
- Department of Emergency Medicine Research, Cabrini Institute, Melbourne, Victoria, Australia
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Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham‐Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo‐Marulanda A, Chan KKL, Chang GJ, Chew MH, Chong PC, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun A, Corr A, Coscia M, Coyne PE, Creavin B, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Enrique‐Navascues JM, Espin‐Basany E, Evans MD, Fearnhead NS, Flatmark K, Fleming F, Frizelle FA, Gallego MA, Garcia‐Granero E, Garcia‐Sabrido JL, Gentilini L, George ML, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins JT, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HØ, Kroon HM, Kusters M, Lago V, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McArthur DR, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Morton JR, Mullaney TG, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, O’Dwyer ST, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson AC, Poggioli G, Proud D, Quinn M, Quyn A, Radwan RW, van Ramshorst GH, Rasheed S, Rasmussen PC, Regenbogen SE, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Ryan ÉJ, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Hellawell G, Shida D, Simpson A, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Sumrien H, Sutton PA, Swartking T, Taylor C, Tekkis PP, Teras J, Thurairaja R, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Vasquez‐Jimenez W, Verhoef C, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Wheeler JMD, Wild J, Wilson M, de Wilt JHW, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, van Zoggel D, Winter DC. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1258-1262. [PMID: 32294308 DOI: 10.1111/codi.15064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023]
Abstract
AIM At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
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CHEUNG J, De Guzman I, Britos V, Munro C, Yip B, Shanmugalingam R, Wong J. SAT-018 IMPACT OF RENAL FUNCTION AT TIME OF PRE-DIALYSIS EDUCATION ON OUTCOMES IN SOUTH WESTERN SYDNEY LOCAL HEALTH DISTRICT 2013-2017. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Lim T, Karim S, Fernando M, Haydar J, Lightowler R, Yip B, Sriamareswaran R, Tong D, Layland J. PO189 Safe and Early Discharge of Low-Risk STEMI Patients Using Zwolle Risk Score. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kim CA, Ahmed S, Ahmed S, Brunet B, Chalchal H, Deobald R, Doll C, Dupre MP, Gordon V, Lee-Ying RM, Lim H, Liu D, Loree JM, McGhie JP, Mulder K, Park J, Yip B, Wong RP, Zaidi A. Report from the 19th annual Western Canadian Gastrointestinal Cancer Consensus Conference; Winnipeg, Manitoba; 29-30 September 2017. ACTA ACUST UNITED AC 2018; 25:275-284. [PMID: 30111968 DOI: 10.3747/co.25.4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The 19th annual Western Canadian Gastrointestinal Cancer Consensus Conference (wcgccc) was held in Winnipeg, Manitoba, 29-30 September 2017. The wcgccc is an interactive multidisciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer.
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Affiliation(s)
- C A Kim
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - S Ahmed
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
| | - S Ahmed
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - B Brunet
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
| | - H Chalchal
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
| | - R Deobald
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
| | - C Doll
- Alberta-Medical Oncology (Mulder), Cross Cancer Institute, University of Alberta, Edmonton; Medical Oncology (Lee-Ying) and Radiation Oncology (Doll), Tom Baker Cancer Centre, University of Calgary, Calgary
| | - M P Dupre
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - V Gordon
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - R M Lee-Ying
- Alberta-Medical Oncology (Mulder), Cross Cancer Institute, University of Alberta, Edmonton; Medical Oncology (Lee-Ying) and Radiation Oncology (Doll), Tom Baker Cancer Centre, University of Calgary, Calgary
| | - H Lim
- British Columbia-Medical Oncology (Lim, Loree), BC Cancer, University of British Columbia, Vancouver; Medical Oncology (McGhie), BC Cancer, University of British Columbia, Victoria; Radiology (Liu), University of British Columbia, Vancouver
| | - D Liu
- British Columbia-Medical Oncology (Lim, Loree), BC Cancer, University of British Columbia, Vancouver; Medical Oncology (McGhie), BC Cancer, University of British Columbia, Victoria; Radiology (Liu), University of British Columbia, Vancouver
| | - J M Loree
- British Columbia-Medical Oncology (Lim, Loree), BC Cancer, University of British Columbia, Vancouver; Medical Oncology (McGhie), BC Cancer, University of British Columbia, Victoria; Radiology (Liu), University of British Columbia, Vancouver
| | - J P McGhie
- British Columbia-Medical Oncology (Lim, Loree), BC Cancer, University of British Columbia, Vancouver; Medical Oncology (McGhie), BC Cancer, University of British Columbia, Victoria; Radiology (Liu), University of British Columbia, Vancouver
| | - K Mulder
- Alberta-Medical Oncology (Mulder), Cross Cancer Institute, University of Alberta, Edmonton; Medical Oncology (Lee-Ying) and Radiation Oncology (Doll), Tom Baker Cancer Centre, University of Calgary, Calgary
| | - J Park
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - B Yip
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - R P Wong
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - A Zaidi
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
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Premaratne M, Yip B, Sefhore O, Sriamareswaran R, Yeap A, Lefkovits L, Carrillo P, Tong D, Layland J. Diabetes is an Independent Predictor of False Negative Stress Echocardiography. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Cheung CC, Ding E, Sereda P, Yip B, Lourenco L, Barrios R, Montaner J, Hogg RS, Lima V, Moore DM. Reductions in all-cause and cause-specific mortality among HIV-infected individuals receiving antiretroviral therapy in British Columbia, Canada: 2001-2012. HIV Med 2016; 17:694-701. [PMID: 27279453 DOI: 10.1111/hiv.12379] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Since 2006, the British Columbia HIV/AIDS Drug Treatment Program (DTP) has expanded enrolment and dramatically increased its number of participants. We examined the effect this expansion has had on the underlying cause of death in HIV-infected individuals. METHODS We analysed data from participants aged 18 years and older in the DTP to measure 2-year mortality rates and causes of death from 2001 to 2012. We conducted tests of trend for all-cause and cause-specific mortality, and compared demographics and characteristics of individuals. Cox proportional hazard models were used to determine the risk of death. RESULTS A total of 8185 participants received antiretroviral therapy (ART) during the study period. Mortality declined from 3.88 per 100 person-years (PY) in 2001-2002 to 2.15 per 100 PY in 2011-2012 (P = 0.02). There were significant decreases in HIV-related deaths (2.34 to 0.56 per 100 PY; P = 0.02) and deaths attributable to chronic liver disease (0.20 to 0.09 per 100 PY; P = 0.01), cardiovascular disease (0.24 to 0.05 per 100 PY; P = 0.03) and suicides (0.47 to 0 per 100 PY; P = 0.003). Multivariate models, adjusted for age, gender, history of injecting drug use, AIDS diagnoses and baseline CD4 cell counts, demonstrated that initiation of ART in all time periods after 2001-2002 was independently associated with reduced mortality (P < 0.001). CONCLUSIONS We observed declines in HIV-related mortality and certain non-HIV-related causes of death among participants in the BC DTP from 2001 to 2012. These findings suggest that there may be broader benefits to the increasingly liberal HIV treatment guidelines, including reductions in death caused by cardiovascular disease and chronic liver disease.
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Affiliation(s)
- C C Cheung
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - E Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - P Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - B Yip
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - L Lourenco
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - R Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Vancouver Coastal Health, Vancouver, Canada
| | - Jsg Montaner
- Department of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - R S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - V Lima
- Department of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - D M Moore
- Department of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
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Stewart M, Bogusz A, Hunter J, Devanny I, Yip B, Reid D, Robertson C, Dancer SJ. Evaluating use of neutral electrolyzed water for cleaning near-patient surfaces. Infect Control Hosp Epidemiol 2014; 35:1505-10. [PMID: 25419773 DOI: 10.1086/678595] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to monitor the microbiological effect of cleaning near-patient sites over a 48-hour period with a novel disinfectant, electrolyzed water. SETTING One ward dedicated to acute care of the elderly population in a district general hospital in Scotland. METHODS Lockers, left and right cotsides, and overbed tables in 30 bed spaces were screened for aerobic colony count (ACC), methicillin-susceptible Staphylococcus aureus (MSSA), and methicillin-resistant S. aureus (MRSA) before cleaning with electrolyzed water. Sites were rescreened at varying intervals from 1 to 48 hours after cleaning. Microbial growth was quantified as colony-forming units (CFUs) per square centimeter and presence or absence of MSSA and MRSA at each site. The study was repeated 3 times at monthly intervals. RESULTS There was an early and significant reduction in average ACC (360 sampled sites) from a before-cleaning level of 4.3 to 1.65 CFU/cm(2) at 1 hour after disinfectant cleaning ( P < .0001). Average counts then increased to 3.53 CFU/cm(2) at 24 hours and 3.68 CFU/cm(2) at 48 hours. Total MSSA/MRSA (34 isolates) decreased by 71% at 4 hours after cleaning but then increased to 155% (53 isolates) of precleaning levels at 24 hours. CONCLUSIONS Cleaning with electrolyzed water reduced ACC and staphylococci on surfaces beside patients. ACC remained below precleaning levels at 48 hours, but MSSA/MRSA counts exceeded original levels at 24 hours after cleaning. Although disinfectant cleaning quickly reduces bioburden, additional investigation is required to clarify the reasons for rebound contamination of pathogens at near-patient sites.
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Affiliation(s)
- M Stewart
- Care of the Elderly Medicine, Hairmyres Hospital, National Health Service (NHS) Lanarkshire, United Kingdom
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13
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Cui Z, Grafstein E, Yip B, Hogg R, Montaner JSG, Lima VD. Modelling clinical progression and health care utilization of HIV-positive patients in British Columbia prior to death. HIV Med 2014; 15:557-64. [PMID: 24641495 DOI: 10.1111/hiv.12151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The extent to which clinical progression of HIV-positive patients leads to an increase in health care utilization, especially prior to their death, is unknown. Thus, we modelled trends in CD4 cell count and emergency department utilization and the likelihood of an emergency department visit leading to a transfer to an acute care-level facility prior to a patient's death from nonaccidental causes. METHODS Eligible patients initiated highly active antiretroviral therapy (HAART) in British Columbia between August 1996 and June 2006 (n = 457). Patients were followed until their death, which occurred on or before 30 June 2007 (period in which the emergency department visit data were available). Trends were modelled using generalized mixed effects. RESULTS Patients experienced a significantly steep decline in CD4 cell count and a corresponding increase in the number of emergency department visits and transfers to acute-level facilities in the 5 years prior to death. For every 6-month interval prior to death, the CD4 cell count decreased by 13.22 cells/μL, the risk of experiencing an emergency department visit increased by 9%, and among those ever admitted, the odds ratio of being transferred to an acute care-level facility increased by 3%. CONCLUSIONS We showed that patients experienced a steep decline in CD4 cell count, which was associated with an increase in health care utilization prior to their death. These findings highlight the substantial residual avoidable burden that unsuccessfully managed HIV disease poses, even in the HAART era. Further strategies to enhance sustained and successful engagement in care are urgently needed to mitigate high health care utilization.
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Affiliation(s)
- Z Cui
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Statistical Department, University of British Columbia, Vancouver, BC, Canada
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Abstract
Predicting unexpected intensive care unit (ICU) re-admission and mortality after critical illness is difficult. This study assessed the associations between eosinopenia on the day of ICU discharge and outcomes after critical illness. This retrospective cohort study involved a total of 1446 critically ill patients who survived their first ICU admission between January 2009 and March 2010 in a multidisciplinary ICU in Western Australia. Eosinopenia was defined as eosinophil count <0.01×109/l and the date of censor for survival was 31 October 2011. Of the 1446 patients included in the study, 106 patients (7.3%) were re-admitted to the ICU during the same hospitalisation and 178 patients died (12.3%) after ICU discharge. Eosinopenia at ICU discharge occurred in 130 patients (9.7%) and was more common among those who were subsequently re-admitted (18.6 vs 8.6%) or died after ICU discharge (22.5 vs 7.5%). Eosinopenia remained associated with ICU re-admission (odds ratio 2.50, 95% confidence interval 1.38-4.50; P=0.002) and post-ICU mortality (hazard ratio 2.65, 95% confidence interval 1.77-3.98; P=0.001) after adjusting for age, gender, nocturnal discharge, neutrophil count at ICU discharge, elective surgical admission, Sequential Organ Failure Assessment scores, Acute Physiology and Chronic Health Evaluation II predicted mortality and chronic medical diseases. Eosinopenia at ICU discharge explained about 8.4% of the variability and was the third most important factor in explaining the variability in survival after ICU discharge. In summary, eosinopenia at ICU discharge was associated with an increased risk of unexpected ICU re-admission and post-ICU mortality.
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Affiliation(s)
- B Yip
- Department of Intensive Care Medicine, University of Western Australia, Perth Western Australia, Australia
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Fayez R, AlMuntashery A, Bodie G, Almamar A, Gill R, Raîche I, Mueller C, AlMuntashery A, Fayez R, AlMuntashery A, Moustarah F, Khokhotva M, Anvari M, Kwong J, Elkassem S, Bonrath E, Zevin B, Sockalingam S, Smith C, Smith C, Whitlock K, Gill R, Suri M, Palter V, Wakeam E, Khan R, Martelli V, Malik A, Young P, Daigle C, McCreery G, Seth R, Paskar D, Sudarshan M, Richardson D, Haggar F, Davis V, Rivard J, Agzarian J, Racz J, Winocour J, Zilbert N, Decker C, Neumann K, Gosney J, Wissanji H, Chadi S, Alhabboubi M, Partridge E, Alhabboubi M, Olszewski M, Chan R, Nadler A, Hameed U, Brotherhood H, Menezes A, MacDonald B, Rakovich G, Hilsden R, Merani S, Davis P, Davis P, Cools-Lartigue J, Ojah J, Julien F, Carter D, Pitt D, Banks B, Rudovics A, Ravichandran P, Anantha R, Aad I, Kholdebarin R, Aird L, Wong S, Payne J, Hallet J, Farries L, Raiche I, Botkin C, Morency D, Berger-Richardson D, Isa A, Dupuis I, Schweigert M, Koubi S, Ernjakovic M, Grant K, Cools-Lartigue J, Carrott P, Stafford T, Malthaner R, Sudarshan M, Hanna W, Lee L, Markar S, Razzak R, Bharadwaj S, Ashrafi A, Ouellette D, Fergusson D, Forster A, Boushey R, Porter G, Johnson P, Gomes T, Chan B, Auer R, Moloo H, Mamdani M, Markar S, Al-Omran M, Al-Obaid O, Boushey R, Lim DR, Min BS, Baik SH, Gordon P, Kim NK, Lo A, Pinsk I, Bottoni D, Brown C, Raval M, Cheng H, Wong C, Johnston N, Farrokhyar F, Stephen W, Kelly S, Lindsay L, Forbes S, Knickle C, Bouchard A, Parry N, Leslie K, Ott M, Coughlin S, Gazala S, Gazala S, Donahoe L, Walker K, Li C, Alnasser S, Schweigert M, Schweigert M, Zhuruk A, Hanouf A, Vanounou T, Karanicolas P, Aubin JM, Yeung J, Dumitra S, Simoneau E, Vanounou T, Howe B, Hawel J, Jang JH, Bertens K, Rekman J, Wei A, Dumitra S, Koubi S, Ouellet JF, Wei A, Covelli A, Maniar R, Sun S, Davis V, Brackstone M, Boissonneault R, Kim S, Baliski C, Gazala S, Hameed U, Sudarshan M, Arnaout A, Wedman D, Nostedt M, Hebbard P, Shetty S, Dixon M, Wei A, Dixon M, Kazazian K, Lemke M, Wells B, Musselman R, Zih FSW, Menezes A, Nassif M, Leon-Carlyle M, Wei A, Krotneva S, Bradley N, Trabulsi N, Trabulsi N, Chin-Lenn L, Cheng H, Petrucci A, Sandhu L, Neville A, Lee L, Li C, Yang I, Prabhu KL, Melich G, Knowles S, Richardson D, Borowiec A, Hallet J, Boissonneault R, Kolozsvari N, Hallet J, Tuttle P, VanHouwelingen L, Haggar F, Boulanger-Gobeil C, Chan B, Chan B, Richardson D, Musselman R, Melich G, Phang P, Goldstein L, Wen C, Lebrun A, Chadi S, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Christou N, Court O, Bonrath E, Hagen J, Okrainec A, Sullivan P, Grantcharov T, Sharma A, Karmali S, Birch D, Majumdar S, Wang X, Tuepah R, Klarenbach S, Birch D, Karmali S, Sharma A, Padwal R, Smith C, Haggar F, Moloo H, Poulin E, Martel G, Yelle JD, Mamazza J, Jackson T, Penner T, Pitzul K, Urbach D, Okrainec A, Villeneuve S, Roy M, Fayez R, Demyttenaere S, Christou N, Court O, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Court O, Christou N, Biertho L, Hould FS, Lebel S, Lescelleur O, Marceau S, Marceau P, Biron S, Grantcharov T, Sharma A, Yusuf S, Okrainec A, Pitzul K, Urbach D, Jackson T, Lindsay D, Sullivan P, Smith L, Zevin B, Dedy N, Grantcharov T, Bonrath E, Aggarwal R, Grantcharov T, Cassin S, Crawford S, Pitzul K, Khan A, Hawa R, Jackson T, Okrainec A, Brar B, Mamazza J, Raîche I, Yelle JD, Haggar F, Moloo H, Brar B, Haggar F, Dent R, Mamazza J, Raîche I, Moloo H, Gill R, Ali T, Shi X, Birch D, Karmali S, Whitlock K, Shi X, Sarkhosh K, Birch D, Karmali S, Turner J, Nation P, Wizzard P, Brubaker P, Gisalet D, Wales P, Grantcharov T, Tien H, Spencer F, Brenneman F, Kowal J, Wiseman S, Fraser S, Vedel I, Deban M, Holcroft C, Monette M, Monette J, Bergman S, Bell C, Stukel T, Urbach D, Mueller T, Lucykx V, Lukowski C, Compston C, Churchill T, Khadaroo R, Grantcharov T, Vogt K, Dubois L, Gray D, Ananth A, Tai LH, Lam T, Falls T, Souza C, Bell J, Auer R, Crawford S, Parry N, Leslie K, Alhabboubi M, St-Louis E, Deckelbaum D, Razek T, Feldman L, Khwaja K, Porter G, Johnson P, Boushey R, Moloo H, Raiche I, Mamazza J, Schiller D, Eurich D, Sawyer M, Vergis A, Unger B, Hardy K, Andrew C, Gillman L, Park J, Prodger J, Kelly W, Kelly S, Prodger D, Ewara E, Martin J, Sarma S, Chu M, Schlachta C, Zaric G, Al-Ali K, Briggs K, George R, Murnaghan M, Leung A, Regehr G, Moulton CA, Mahmud S, Metcalfe J, McKay A, Park J, Hochman D, Burkle F, Redmond A, McQueen K, Desrosiers E, Gilbert A, Leslie K, Ott M, Sudarshan M, Jessula S, Alburakan A, Deckelbaum D, Razek T, Iqbal S, Khwaja K, Aikins C, Sudarshan M, Deckelbaum D, Iqbal S, Khwaja K, Razek T, Roberts N, Moulton CA, Murnaghan M, Cil T, Marshall J, Pederson K, Erichsen S, White J, Aarts MA, Okrainec A, Victor J, Pearsall E, McLeod R, Jackson T, Okrainec A, Penner T, Urbach D, Karimuddin A, Hall C, Bawan S, Malik S, Hayashi A, Gill R, McAlister C, Zhang N, DesRosiers E, Mills A, Crozier M, Lee L, Maxwell J, Partridge E, Chad S, Steigerwald S, Mapiour D, Roberts D, MacPherson C, Donahoe L, Mercer D, Hopman W, Latulippe JF, Knowles S, Moffat B, Parry N, Leslie K, Switzer N, Khadaroo R, Tul Y, Widder S, Molinari M, Levy A, Johnson P, Bailey J, Molinari M, Hayden J, Johnson P, Benlolo S, Marcus V, Ferri L, Finley R, Anderson D, Gagné JP, Chan S, Wong S, Li J, Michael A, Choi D, Liu E, Hoogenes J, Dath D, Aubin JM, Mew D, McConnell Y, Classen D, Kanthan S, Croome K, Kovacs M, Lazo-Langner A, Hernandez-Alejandro R, Vogt K, Crawford S, Parry N, Leslie K, Khoshgoo N, Iwasiow B, Keijzer R, Brown C, Isa D, Pace D, Widder S, Tul Y, Primrose M, Hudson D, Khadaroo R, Lauzier F, Mailloux O, Trottier V, ARchambault P, Zarychanski R, Turgeon A, Mailloux O, Hardy P, Muirhead R, Masters J, Haggar F, Poulin HME, Martel G, Mamazza J, Milbrandt C, Keijzer R, Sideris L, Grenier-Vallée P, Latulippe JF, Dubé P, Kurashima Y, Kaneva P, Feldman L, Fried G, Vassiliou M, Kwan AL, Fraser S, Solymosi N, Rauh N, Dubecz A, Renz M, Ofner D, Stein H, Borgaonkar M, Crystal P, Easson A, Escallon J, Reedijk M, Cil T, Leong W, McCready D, Clifton J, Mayo J, Finley R, Noreau-Nguyen M, Mulder D, Ferri L, Markar S, Hong J, Low D, Maslow A, Davignon K, Ng T, Tan L, Aruranian J, Kosa S, Ferri L, Murphy G, Allison F, Moshonov H, Darling G, Waddell T, De Perrot M, Cypel M, Yasufuku K, Keshavjee S, Paul N, Pierre A, Darling G, Pedneault C, Marcus V, Mulder D, Ferri L, Low D, Roa W, Löbenberg R, McEwan S, Bédard E, Louie B, Farivar A, McHugh S, Aye R, Tan-Tam C, De Vera M, Bond R, Ong S, Johal B, Schellenberg D, Po M, Nissar S, Lund C, Ahmadi S, Wakil N, Rakovich G, Beauchamps G, Preston S, Baker C, Low D, Campbell G, Malthaner R, Bethune D, Henteleff H, Johnston M, Buduhan G, Coughlin HE, Roth L, Bhandari M, Malthaner R, Johnson J, Kutsogiannis J, Bédard E, Rammohan K, Stewart K, Bédard E, Buduhan G, Gruchy J, Xu Z, Buduhan G, Ferri L, Mulder D, Ncuti A, Neville A, Kaneva P, Watson D, Vassiliou M, Carli F, Feldman L, Av R, Mayrand S, Franco E, Ferri L, Dubecz A, Renz M, Stadlhuber R, Ofner D, Stein H, Renz M, Dubecz A, Solymosi N, Thumfart L, Ofner D, Stein H, Croome K, Leeper R, Hernandez R, Livingstone S, Sapp J, Woodhall D, Alwayn I, Bergman S, Lam-McCulloch J, Balaa F, Jayaraman S, Quan D, Wei A, Guyatt G, Rekman J, Fairfull-Smith R, Mimeault R, Balaa F, Martel G, Boehnert M, Bazerbachi F, Knaak J, Selzner N, McGilvray I, Rotstein O, Adeyi O, Levy G, Keshavjee S, Grant D, Selzner M, Khalil JA, Jamal M, Chaudhury P, Zogopoulos G, Petrakos P, Tchervenkov J, Barkun J, Jamal M, Hassanain M, Chaudhury P, Wong S, Salman A, Tran T, Metrakos P, Groeschl R, Geller D, Marsh J, Gamblin T, Croome K, Croome K, Quan D, Hernandez R, Kim P, Greig PD, Gallinger S, Moulton CA, Wei A, Fischer S, Cleary S, Vogt K, Hernandez-Alejandro R, Gray D, Aubin J, Fairfull-Smith J, Mimeault R, Balaa F, Martel G, Devitt K, Ramjaun A, Gallingher S, Alabbad S, Constantinos D, Hassanein M, Barkun J, Metrakos P, Paraskevas S, Chaudhury P, Tchervenkov J, Borgaonkar M, Tanyingoh D, Dixon E, Kaplan G, Myers R, Howard T, Sutherland F, Zyromski N, Ball C, Coburn N, Moulton CA, Cleary S, Law C, Greig P, Steven G, Baxter N, Fitch M, Wright F, Hochman D, Wirtzfeld D, McKay A, Yaffe C, Yip B, Silverman R, Park J, McConnell Y, Temple W, Mack L, Schiller D, Bathe O, Sawyer M, Scott L, Vandenberg T, Perera F, Potvin K, Chambers A, Loungnarath R, DeBroux É, Lavertu S, Donath D, Ayoub JP, Tehfé M, Richard C, Cornacchi S, Heller B, Farrokhyar F, Babra M, Lovrics P, Liberto C, Ghosh S, McLean R, Schiller D, Jackson T, Okrainec A, Penner T, Urbach D, Dumitra S, Duplisea J, Wexler S, Seely J, Smylie J, Knight K, Robertson S, Watters J, Zhang T, Arneout A, Hochman D, Wirtzfeld D, McKay A, Yip B, Yaffe C, Silverman R, Park J, Baxter N, Yun L, Rakovitch E, Wright F, Warner E, McCready D, Hodgson N, Quan M, Natarajan B, Govindarajan V, Thomas P, Loggie B, Brar S, Mahar A, Law C, Coburn N, Devitt K, Wiebe M, Bathe O, McLeod R, Baxter N, Gagliardi A, Kennedy E, Urbach D, Brar S, Mahar A, Law C, Coburn N, Zih F, Rosario C, Dennis J, Gingras AC, Swallow C, Ko YJ, Rowsell C, Law C, Saskin R, Quan ML, Xie M, McLaughlin K, Marginean C, Moyana T, Moloo H, Boushey R, Auer R, Razik R, Haase E, Mathieson A, Smith A, Swallow C, Barnes A, Scheer A, Moloo H, Boushey R, Sabri E, Auer R, Reidel K, Trabulsi N, Meterissian S, Tamblyn R, Mayo N, Meguerditchian A, Brown J, Hamm J, Phang P, Raval M, Brown C, Devitt K, Wiebe M, Bathe O, McLeod R, Taylor B, Urbach D, Reidel K, Mayo N, Tamblyn R, Meguerditchian A, Hamm J, Wiseman S, Patakfalvi L, Nassif M, Turcotte R, Nichols A, Meguerditchian A, Riedel K, Winslade N, Grégoire JP, Meterissian S, Abrahamovicz M, Megueerditchian A, Pasieka J, McMillan C, Lipa J, Snell L, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Meterissian S, Tomlinson G, Kennedy E, Wei A, Baxter N, Urbach D, Liberman A, Charlebois P, Stein B, Ncuti A, Vassiliou M, Fried G, Feldman L, Capretti G, Power A, Liberman A, Charlebois P, Stein B, Kaneva P, Carli F, Fried G, Feldman L, Carli F, Charlebois P, Stein B, Liberman A, Kaneva P, Augustin B, Gamsa A, Kim DJ, Vassiliou M, Feldman L, Boushey R, Moloo H, Vu L, Chan S, Phang P, Gown A, Jones S, Wiseman S, Jeong DH, Hur H, Baik SH, Kim NK, Faria J, Min BS, Lumb K, Colquhoun P, Porter G, Johnson P, Baxter N, Schmocker S, Huang H, Victor J, Krzyzanowska MK, Brierley J, McLeod R, Kennedy E, Milot H, Desrosiers E, Lebrun A, Drolet S, Bouchard A, Grégoire R, Vuong T, Loungnarath R, DeBroux E, Liberman A, Charlebois P, Stein B, Richard C, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou M, Fried G, Feldman L, Milot H, Drolet S, Bouchard A, Grégoire R, Powell R, Fowler A, Mathieson A, Martin K, Vogt K, Ott M, Pereira G, Einarsdottir K, Moloo H, Boushey R, Mamazza J, Bouchard A, Gagné J, Grégoire R, Thibault C, Bouchard P, Gomes T, Musselman R, Auer R, Moloo H, Mamdani M, Al-Omran M, Boushey R, AlObeed O, Armstrong J. Canadian Surgery Forum1 Is laparoscopic sleeve gastrectomy a reasonable stand-alone procedure for super morbidly obese patients?2 Postoperative monitoring requirements of patients with obstructive sleep apnea undergoing bariatric surgery3 Role of relaparoscopy in the diagnosis and treatment of bariatric complications in the early postoperative period4 Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding5 Prioritization and willingness to pay for bariatric surgery: the patient perspective6 Ventral hernia at the time of laparoscopic gastric bypass surgery: Should it be repaired?7 Linear stapled gastrojejunostomy with transverse handsewn enterotomy closure significantly reduces strictures for laparoscopic Roux-en-Y bypass8 Laparoscopic biliopancreatic diversion with duodenal switch as second stage for super super morbidly obese patients. Do all patients benefit?9 Sleeve gastrectomy in the super super morbidly obese (BMI > 60 kg/m2): a Canadian experience10 Laparoscopic gastric bypass for the treatment of refractory idiopathic gastroparesis: a report of 2 cases11 Duodeno-ileal switch as a primary bariatric and metabolic surgical option for the severely obese patient with comorbidities: review of a single-institution case series of duodeno-ileal intestinal bypass12 Management of large paraesophageal hernias in morbidly obese patients with laparoscopic sleeve gastrectomy: a case series13 Early results of the Ontario bariatric surgical program: using the bariatric registry14 Improving access to bariatric surgical care: Is universal health care the answer?15 Early and liberal postoperative exploration can reduce morbidity and mortality in patients undergoing bariatric surgery16 Withdrawn17 Identification and assessment of technical errors in laparoscopic Roux-en-Y gastric bypass18 A valid and reliable tool for assessment of surgical skill in laparoscopic Roux-en-Y gastric bypass19 Psychiatric predictors of presurgery drop-out following suitability assessment for bariatric surgery20 Predictors of outcomes following Roux-en-Y gastric bypass surgery at The Ottawa Hospital21 Prophylactic management of cholelithiasis in bariatric patients: Is routine cholecystectomy warranted?22 Early outcomes of Roux-en-Y gastric bypass in a publicly funded obesity program23 Similar incidence of gastrojejunal anastomotic stricture formation with hand-sewn and 21 mm circular stapler techniques during Roux-en-Y gastric bypass24 (CAGS Basic Science Award) Exogenous glucagon-like peptide-1 improves clinical, morphological and histological outcomes of intestinal adaptation in a distal-intestinal resection piglet model of short bowel syndrome25 (CAGS Clinical Research Award) Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial26 Negative-pressure wound therapy (iVAC) on closed, high-risk incisions following abdominal wall reconstruction27 The impact of seed granting on research in the University of British Columbia Department of Surgery28 Quality of surgical care is inadequate for elderly patients29 Recurrence of inguinal hernia in general and hernia specialty hospitals in Ontario, Canada30 Oncostatin M receptor deficiency results in increased mortality in an intestinal ischemia reperfusion model in mice31 Laparoscopic repair of large paraesophageal hernias with anterior gastropexy: a multicentre trial32 Response to preoperative medical therapy predicts success of laparoscopic splenectomy for immune thrombocytopenic purpura33 Perioperative sepsis, but not hemorrhagic shock, promotes the development of cancer metastases in a murine model34 Measuring the impact of implementing an acute care surgery service on the management of acute biliary disease35 Patient flow and efficiency in an acute care surgery service36 The relationship between treatment factors and postoperative complications after radical surgery for rectal cancer37 Risk of ventral hernia after laparoscopic colon surgery38 Urinary metabolomics as a tool for early detection of Barrett’s and esophageal cancer39 Construct validity of individual and summary performance metrics associated with a computer-based laparo-scopic simulator40 Impact of a city-wide health system reorganization on emergency department visits in hospitals in surrounding communities41 Transcatheter aortic valve implantation for the nonoperative management of aortic stenosis: a cost-effectiveness analysis42 Breast cancer: racial differences in age of onset. A potential confounder in Canadian screening recommendations43 Risk taking in surgery: in and out of the comfort zone44 A tumour board in the office: Track those cancer patients!45 Increased patient BMI is not associated with advanced colon cancer stage or grade on presentation: a retrospective chart review46 Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies. Report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict47 Learning the CanMEDS role of professional: a pilot project of supervised discussion groups addressing the hidden curriculum48 Assessing the changing scope of training in Canadian general surgery programs: expected versus actual experience49 Predicting need for surgical management for massive gastrointestinal hemorrhage50 International health care experience: using CanMEDS to evaluate learning outcomes following a surgical mission in Mampong, Ghana51 The open abdomen: risk factors for mortality and rates of closure52 How surgeons think: an exploration of mental practice in surgical preparation53 The surgery wiki: a novel method for delivery of under-graduate surgical education54 Understanding surgical residents’ postoperative practices before implementing an enhanced recovery after surgery (ERAS) guideline at the University of Toronto55 From laparoscopic transabdominal to posterior retroperitoneal adrenalectomy: a paradigm shift in operative approach56 A retrospective audit of outcomes in patients over the age of 80 undergoing acute care abdominal surgery57 Canadian general surgery residents’ perspectives on work-hour regulations58 Timing of surgical intervention and its outcomes in acute appendicitis59 Preparing surgical trainees to deal with adverse events. An outline of learning issues60 Acute care surgical service: surgeon agreement at the time of handover61 Predicting discharge of elderly patients to prehospitalization residence following emergency general surgery62 Morbidity and mortality after emergency abdominal surgery in octo- and nonagenarians63 The impact of acute abdominal illness and urgent admission to hospital on the living situation of elderly patients64 A comparison of laparoscopic versus open subtotal gastrectomy for antral gastric adenocarcinoma: a North American perspective65 Minimally invasive excision of ectopic mediastinal parathyroid adenomas66 Perioperative outcomes of laparoscopic hernia repair in a tertiary care centre: a single institution’s experience67 Evaluation of a student-run, practical and didactic curriculum for preclerkship medical students68 Joseph Lister: Father of Modern Surgery69 Comparisons of melanoma sentinel lymph node biopsy prediction nomograms in a cohort of Canadian patients70 Local experience with myocutaneous flaps after extensive pelvic surgery71 The treatment of noncirrhotic splanchnic vein thrombosis: Is anticoagulation enough?72 Implementation of an acute care surgery service does not affect wait-times for elective cancer surgeries: an institutional experience73 Use of human collagen mesh for closure of a large abdominal wall defect, after colon cancer surgery, a case report74 The role of miR-200b in pulmonary hypoplasia associated with congenital diaphragmatic hernia75 Systematic review and meta-analysis of electrocautery versus scalpel for incising epidermis and dermis76 Accuracy of sentinel lymph node biopsy for early breast cancer in the community setting in St. John’s, New-foundland: results of a retrospective review77 Acute surgical outcomes in the 80 plus population78 The liberal use of platelets transfusions in the acute phase of trauma resuscitation: a systematic review79 Implementation of an acute care surgical on call program in a Canadian community hospital80 Short-term outcomes following paraesophageal hernia repair in the elderly patient81 First experience with single incision surgery: feasibility in the pediatric population and cost evaluation82 The impact of the establishment of an acute care surgery unit on the outcomes of appendectomies and cholecystectomies83 Description and preliminary evaluation of a low-cost simulator for training and evaluation of flexible endoscopic skills84 Tumour lysis syndrome in metastatic colon cancer: a case report85 Acute care surgery service model implementation study at a single institution86 Colonic disasters approached by emergent subtotal and total colectomy: lessons learned from 120 consecutive cases87 Acellular collagen matrix stent to protect bowel anastomoses88 Lessons we learned from preoperative MRI-guided wire localization of breast lesions: the University Health Network (UHN) experience89 Interim cost comparison for the use of platinum micro-coils in the operative localization of small peripheral lung nodules90 Routine barium esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer91 Iron deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair92 A randomized comparison of different ventilation strategies during thoracotomy and lung resection93 The Canadian Lung Volume Reduction Surgery study: an 8-year follow-up94 A comparison of minimally invasive versus open Ivor-Lewis esophagectomy95 A new paradigm in the follow-up after curative resection for lung cancer: minimal-dose CT scan allows for early detection of asymptomatic cancer activity96 Predictors of lymph node metastasis in early esophageal adenocarcinoma: Is endoscopic resection worth the risk?97 How well can thoracic surgery residents operate? Comparing resident and program director opinions98 The impact of extremes of age on short- and long-term outcomes following surgical resection of esophageal malignancy99 Epidermal growth factor receptor targeted gold nanoparticles for the enhanced radiation treatment of non–small cell lung cancer100 Laparoscopic Heller myotomy results in excellent outcomes in all subtypes of achalasia as defined by the Chicago classification101 Neoadjuvant chemoradiation versus surgery in managing esophageal cancer102 Quality of life postesophagectomy for cancer!103 The implementation, evolution and translocation of standardized clinical pathways can improve perioperative outcomes following surgical treatment of esophageal cancer104 A tissue-mimicking phantom for applications in thoracic surgical simulation105 Sublobar resection compared with lobectomy for early stage non–small cell lung cancer: a single institution study106 Not all reviews are equal: the quality of systematic reviews and meta-analyses in thoracic surgery107 Do postoperative complications affect health-related quality of life after video-assisted thoracoscopic lobectomy for patients with lung cancer? A cohort study108 Thoracoscopic plication for palliation of dyspnea secondary to unilateral diaphragmatic paralysis: A worthwhile venture?109 Thoracic surgery experience in Canadian general surgery residency programs110 Perioperative morbidity and pathologic response rates following neoadjuvant chemotherapy and chemoradiation for locally advanced esophageal carcinoma111 An enhanced recovery pathway reduces length of stay after esophagectomy112 Predictors of dysplastic and neoplastic progression of Barrett’s esophagus113 Recurrent esophageal cancer complicated by tracheoesophageal fistula: management by means of palliative airway stenting114 Pancreaticopleural fistula-induced empyema thoracis: principles and results of surgical management115 Prognostic factors of early postoperative mortality following right extended hepatectomy116 Optimizing steatotic livers for transplantation using a cell-penetrating peptide CPP-fused heme oxygenase117 Video outlining the technical steps for a robot-assisted laparoscopic pancreaticoduodenectomy118 Establishment of a collaborative group to conduct innovative clinical trials in Canada119 Hepatic resection for metastatic malignant melanoma: a systematic review and meta-analysis120 Acellular normothermic ex vivo liver perfusion for donor liver preservation121 Pancreatic cancer and predictors of survival: comparing the CA 19–9/bilirubin ratio with the McGill Brisbane Scoring System122 Staged liver resections for bilobar hepatic colorectal metastases: a single centre experience123 Economic model of observation versus immediate resection of hepatic adenomas124 Resection of colorectal liver metastasis in the elderly125 Acceptable long-term survival in patients undergoing liver resection for metastases from noncolorectal, non-neuroendocrine, nonsarcoma malignancies126 Patient and clinicopathological features and prognosis of CK19+ hepatocellular carcinomas: a case–control study127 The management of blunt hepatic trauma in the age of angioembolization: a single centre experience128 Liver resections for noncolorectal and non-neuroendocrine metastases: an evaluation of oncologic outcomes129 Developing an evidence-based clinical pathway for patients undergoing pancreaticoduodenectomy130 Hepatitis C infection and hepatocellular carcinoma in liver transplant: a 20 year experience131 The effect of medication on the risk of post-ERCP pancreatitis132 Temporal trends in the use of diagnostic imaging for patients with hepato-pancreato-biliary (HPB) conditions: How much ionizing radiation are we really using?196 A phase II study of aggressive metastasectomy for intra-and extrahepatic metastases from colorectal cancer133 Why do women choose mastectomy for breast cancer treatment? A conceptual framework for understanding surgical decision-making in early-stage breast cancer134 Synoptic operative reporting: documentation of quality of care data for rectal cancer surgery135 Learning curve analysis for cytoreductive surgery: a useful application of the cumulative sum (CUSUM) method136 Pancreatic cancer is strongly associated with a unique urinary metabolomic signature137 Concurrent neoadjuvant chemo/radiation in locally advanced breast cancer138 Impact of positron emission tomography on clinical staging of newly diagnosed rectal cancer: a specialized single centre retrospective study139 An evaluation of intraoperative Faxitron microradiography versus conventional specimen radiography for the excision of nonpalpable breast lesions140 Comparison of breast cancer treatment wait-times in the Southern Interior of British Columbia in 2006 and 2010141 Factors affecting lymph nodes harvest in colorectal carcinoma142 Laparoscopic adrenalectomy for metastases143 You have a message! Social networking as a motivator for fundamentals of laparoscopic surgery (FLS) training144 The evaluation and validation of a rapid diagnostic and support clinic for women assessment for breast cancer145 Oncoplastic breast surgery: oncologic benefits and limitations146 A qualitative study on rectal cancer patients’ preferences for location of surgical care147 The effect of surgery on local recurrence in young women with breast cancer148 Elevated IL-6 and IL-8 levels in tumour microenvironment is not associated with increased serum levels in humans with Pseudomyxoma peritonei and peritoneal mesothelioma149 Conversion from laparoscopic to open approach during gastrectomy: a population-based analysis150 A scoping review of surgical process improvement tools (SPITs) in cancer surgery151 Splenectomy during gastric cancer surgery: a population-based study152 Defining the polo-like kinase 4 (Plk4) interactome in cancer cell protrusions153 Neoadjuvant imatinib mesylate for locally advanced gastrointestinal stromal tumours154 Implementing results from ACOSOG Z0011: Practice-changing or practice-affirming?155 Should lymph node retrieval be a surgical quality indicator in colon cancer?156 Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer157 Clinical research in surgical oncology: an analysis of clinicaltrials.gov158 Radiation therapy after breast conserving surgery: When are we missing the mark?159 The accuracy of endorectal ultrasound in staging rectal lesions in patients undergoing transanal endoscopic microsurgery160 Quality improvement in gastrointestinal cancer surgery: expert panel recommendations for priority research areas161 Factors influencing the quality of local management of ductal carcinoma in situ: a cohort study162 Papillary thyroid microcarcinoma: Does size matter?163 Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: systematic review of clinical efficacy and quality assessment of reported trials164 Adherence to antiestrogen therapy in seniors with breast cancer: How well are we doing?165 Parathyroid carcinoma: Challenging the surgical dogma?166 A qualitative assessment of the journey to delayed breast reconstruction195 The role of yoga therapy in breast cancer patients167 Outcomes reported in comparative studies of surgical interventions168 Enhanced recovery pathways decrease length of stay following colorectal surgery, but how quickly do patients actually recover?169 The impact of complications on bed utilization after elective colorectal resection170 Impact of trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study171 Complex fistula-in-ano: Should the plug be abandoned in favour of the LIFT or BioLIFT?172 Prognostic utility of cyclooxygenase-2 expression by colon and rectal cancer173 Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is complex and time-consuming: analysis of learning curves for a novice minimally invasive surgeon174 Intraoperative quality assessment following double stapled circular colorectal anastomosis175 Improving patient outcomes through quality assessment of rectal cancer care176 Are physicians willing to accept a decrease in treatment effectiveness for improved functional outcomes for low rectal cancer?177 Turnbull-Cutait delayed coloanal anastomosis for the treatment of distal rectal cancer: a prospective cohort study178 Preoperative high-dose rate brachytherapy in preparation for sphincter preservation surgery for patients with advanced cancer of the lower rectum179 Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection180 The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review181 Is a vertical rectus abdominus flap (VRAM) necessary? An analysis of perineal wound complications182 Fistula plug versus endorectal anal advancement flap for the treatment of high transsphincteric cryptoglandular anal fistulas: a systematic review and meta-analysis183 Maternal and neonatal outcomes following colorectal cancer surgery184 Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option185 Trends in colon cancer in Ontario: 2002–2009186 Validation of electronically derived short-term outcomes in colorectal surgery187 A population-based assessment of transanal and endoscopic resection for adenocarcinoma of the rectum188 Laparoscopic colorectal surgery in the emergency setting: trends in the province of Ontario from 2002 to 2009189 Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with case series of internal hernia through pelvic mesh which was placed in attempt to prevent perineal hernia190 Effect of rectal cancer treatments on quality of life191 The use of antibacterial sutures as an adjunctive preventative strategy for surgical site infection in Canada: an economic analysis192 Impact of socioeconomic status on colorectal cancer screening and stage at presentation: preliminary results of a population-based study from an urban Canadian centre193 Initial perioperative results of the first transanal endoscopic microsurgery (TEM) program in the province of Quebec194 Use of negative pressure wound therapy decreases perineal wound infections following abdominal perineal resection. Can J Surg 2012; 55:S63-S135. [DOI: 10.1503/cjs.016712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Chiu JC, Shi X, Karmali S, Birch DW, Apriasz I, Alkhamesi NA, Lal A, Schlachta CM, Christou NV, Elkassem S, Lindsay D, Smith L, Sullivan P, Sockalingam S, Hawa R, Wnuk S, Jackson T, Okrainec A, Fayez R, Christou NV, Court O, Mueller C, Okrainec A, Sockalingham S, Jackson T, Mueller C, Swanson T, Daigle C, Okrainec A, Pitzul K, Penner T, Urbach DR, Jackson T, Sandhu L, Maciver A, McCall M, Edgar R, Thiesen A, Bigam D, Churchill T, Shapiro AMJ, Luu S, Regehr G, Murnaghan ML, Gallinger S, Moulton CA, Palter V, Grantcharov T, Dath D, Hoogenes J, Matsumoto E, Szalay D, Fox A, Pitzul K, Bhojani F, Kaplan M, Wei A, McGilvray I, Cleary SP, Okrainec A, Alqahtani A, Parsyan A, Payne R, Tabah R, Anantha R, Vogt K, Crawford S, Parry N, Leslie K, Ochs A, Matthew K, Khadaroo R, Churchill T, Lavoie JM, Zalai C, Vasilevsky CA, Booy J, Takata J, Tomlinson G, Urbach DR, Lim D, Tomlinson C, LaBossiere J, Rommens K, Birch DW, Brenneman F, MacLellan S, Simpson J, Asai K, Elgadi K, Ali S, Sawyer J, Helewa R, Turner D, Wirtzfeld D, Park J, Czaykowski P, Mak G, Hochman D, McKay A, Gill R, Al-Adra D, Shi X, Sample C, Armstrong J, Lester L, Vogt K, Brackstone M, Lee L, Kaneva P, Liberman S, Charlebois P, Stein B, Fried G, Feldman L, Kanji A, Sharon E, Asai K, Jacks L, McCready D, Ghazarian D, Leong WL, Wu R, Okrainec A, Penner T, Ball C, Kirkpatrick A, Vasquez A, Balakrishnan L, Miller G, Awan S, Azadeh NR, Hoogenes J, Dath D, Jain V, Busato GM, Cristea O, Landau J, Moreland R, Johnson M, Ramage D, Browning D, Ullah S, Cristea O, Bodrogi A, Johnson M, McAlister V, Palisoc J, Anderson J, Kiladze R, Ciar J, Bancel I, Pitzul K, Leake PA, Okrainec A, Dalvi A, McLean R, Stephen W, Loeb M, Smith R, Christoffersen E, Forbes S, Kidane B, Vogt K, Vinden C, Ahmadi N, Dubois L, McKenzie M, Baxter N, Brown C, Chaudhury P, Dixon E, Fitzgerald W, Henteleff H, Kirkpatrick A, Latosinsky S, MacLean A, McLeod R, Pearsall E, Aarts MA, Meghji Z, McLeod R, Okrainec A, Tran T, Kaneva P, Fried G, Mayo N, Feldman L, Newman D, Bergman S, Cummings BA, Delisle M, Whitehead V, Chertkow H, Chan T, Cicero M, Perampaladas K, Bandukwala T, Struble J, Moser M, Young P, Groeneveld A, Chan P, Smith S, Khadaroo R, Buczkowski A, Hameed M, Tan-Tam C, Meneghetti A, Simons R, Panton N, Elnahas A, Ghaderi I, Madani A, de Gara C, Schlachta CM, Kalechstein S, Pitzul K, Henao O, Okrainec A, Paskar D, Croome K, Hernandez R, Knapp G, Howatt N, Foster S, Cameron B, Austin J, Mack L, Temple W, Puloski S, Schachar N, Gill T, Doris P, Tecson A, Kolozsvari N, Andalib A, Kaneva P, Cao J, Vassiliou M, Fried G, Feldman L, Kolozsvari N, Kaneva P, Vassiliou M, Fried G, Feldman L, Kolozsvari N, Kaneva P, Brace C, Chartrand G, Vaillancourt M, Cao J, Banaszek D, Vassiliou M, Fried G, Feldman L, Fraser S, Bergman S, Deobald R, Chad J, Di Gregorio C, Johnstone J, Kenyon C, Lees M, Auger-Dufour E, Fried G, Feldman L, Ferri L, Vassiliou M, Alqahtani A, Perlman R, Holcroft C, Gordon PH, Szilagyi A, Iradukunda D, Moser MAJ, Rodych N, Shaw JM, Ahmed N, Chiu M, Kurabi B, Qureshi A, Nathens A, Conn LG, Pandya A, Kitto S, Ma G, Pooni A, Forbes S, Eskicioglu C, Pearsall E, Brenneman F, McLeod R, Rockx MA, McAlister V, Roberts D, Ouellet J, Kirkpatrick A, Lall R, Sutherland F, Ball C, Chackungal S, Knowlton LM, Dahn B, McQueen K, Morrison JA, Lent B, Brown J, Fluit M, Herbert C, Deen S, Deutschmann M, McFadden S, Gelfand G, Bosch D, Grimmer L, Milman S, Ng T, Gill R, Perry T, Abele J, Bedard E, Schiller D, Coughlin S, Stewart TC, Parry N, Gray D, Williamson J, Malthaner R, Bottoni D, Perri M, Trejos AL, Naish M, Patel R, Malthaner R, Ashrafi A, Bond J, Ong S, Yamashita M, Ahmadi S, Abdulmosen M, Miller J, Finley C, Ostrander K, Shargall Y, Lee L, Hanley S, Robineau C, Sirois C, Mulder D, Ferri L, Humphrey R, Inculet R, Fortin D, Arab A, Malthaner R, Ashrafi A, Bond J, Ong S, Yamashita M, Ahmadi S, McGuire A, Reid K, Petsikas D, Hopman W, Basi A, Basi S, Irshad K, Hanna W, Croome KP, Marotta P, McAlister V, Quan D, Wall W, Hernandez-Alejandro R, de Mestral C, Zagorski B, Rotstein O, Gomez D, Haas B, Laupacis A, Sharma S, Bridge J, Nathens A, Bhojani F, Fox A, Pitzul K, Moulton CA, Wei A, Okrainec A, Cleary S, Bertens K, Croome KP, Mujoomdar A, Peck D, Rankin R, Quan D, Kakani N, Hernandez-Alejandro R, Suri R, Marcaccio M, Ruo L, Jamal M, Khalil JA, Simoneau-Beaudry E, Dumitra S, Edwards M, Yousef Y, Jiffry MA, Metrakos P, Tchervenkov J, Doi S, Barkun J, Obayan A, Meiers S, Keith R, Elkassem S, Church N, Mitchell P, Turbide C, Dixon E, Debru E, Shum J, Wall WJ, Maniar R, Hochman D, Wirtzfeld D, Yaffe C, Yip B, McKay A, Silverman R, Park J, Francescutti V, Rivera L, Kane JM, Skitzki JJ, Lovrics P, Hodgson N, O'Brien MA, Thabane L, Cornacchi S, Heller B, Reid S, Sanders K, Kittmer T, Simunovic M, Duhaime S, Fong B, Deria M, Acton C, El-Maadawy M, Lad S, Arnaout A, Omole M, Pemberton J, Lovrics P, Bischof D, Stotland P, Hagen J, Swallow C, Klein L, Van Koughnett JA, Ahmad T, Ainsworth P, Brackstone M, Kanagaratnam S, Groot G, VanderBeek L, Francescutti V, Farrokhyar F, Strang B, Kahnamoui K, MacLellan S, MacKay H, Ringash J, Jacks L, Kassam Z, Khalili I, Conrad T, Okrainec A, Chagpar R, Xing Y, You N, Yi-Ju C, Feig B, Chang G, Cormie J, Gervais MK, Sideris L, Drolet P, Mitchell A, Leblanc G, Dubé P, Merchant S, Knowling M, Cheifetz R, Raval M, Heidary B, Kalikias S, Raval D, Phang T, Brown C, Scheer A, O'Connor A, Chan B, Moloo H, Poulin E, Mamazza J, Auer R, Boushey R, Hardy K, Vergis A, Sullivan P, Musselman R, Gomes T, Chan B, Auer R, Moloo H, Poulin E, Mamazza J, Al-Khayal K, Al-Omran M, Mamdani M, AlObeed O, Boushey R, Martel G, Crawford A, Barkun J, Ramsay C, Fergusson D, Boushey R, Williams L, Crawford A, McLaughlin K, Mackey M, Moloo H, Mamazza J, Poulin E, Friedlich M, Boushey R, Auer R, Bellolio F, Cohen Z, MacRae H, O'Connor B, Huang H, Victor JC, McLeod R, Hardy K, Pitzul K, Kwong J, Vergis A, Urbach D, Okrainec A, Vogt K, Dubois L, Vinden C, Chan B, Scheer A, Menezes A, Moloo H, Poulin E, Boushey R, Mamazza J, Bellolio F, MacRae H, Cohen Z, O'Connor B, Huang H, McLeod R, Godbout-Simard C, Azar J, Psaradellis F, Sampalis J, Morin N, Brown C, Kalikias S, Heidary B, Raval D, Phang PT, Raval M, Archibald A, Hurlbut D, Vanner S, Zalai C, Vasilevsky CA, Simunovic M, Cadeddu M, Forbes S, Kelly S, Stephen W, Grubac V, Marcinow M, Coates A, Aslani N, Phang PT, Raval M, Brown C, Scheer A, Carrier M, Boushey R, Asmis T, Wells P, Jonker D, Auer R, Azer N, Gill R, de Gara C, Birch DW, Karmali S, Roxin G, Drolet S, MacLean A, Buie WD, Heine J, Agzarian J, Forbes S, Stephen W, Kelly S, Churchill P, Corner T, Kelly S, Forbes S, Lindsay L, Stephen W, Scheer A, O'Connor A, Chan B, Moloo H, Poulin E, Mamazza J, Auer R, Boushey R, Denis J, Hochman D, Recsky M, Phang PT, Raval M, Cheung W, Brown C, Alkhamesi N, Schlachta CM, Tiwari T, Brown C, Raval MJ, Phang PT. Canadian Surgery Forum: Abstracts of presentations to the Annual Meetings of the Canadian Association of Bariatric Physicians and Surgeons, Canadian Association of General Surgeons, Canadian Association of Thoracic Surgeons, Canadian Hepato-Pancreato-Biliary Society, Canadian Society of Surgical Oncology, Canadian Society of Colon and Rectal Surgeons, London, Ont. Sept. 15-18, 2011. Can J Surg 2011; 54:S57-S104. [PMID: 35488394 PMCID: PMC3191910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- J C Chiu
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - X Shi
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - I Apriasz
- From the Schulich School of Medicine and Dentistry and the London Health Sciences Centre, London, Ont
| | - N A Alkhamesi
- From the Schulich School of Medicine and Dentistry and the London Health Sciences Centre, London, Ont
| | - A Lal
- From the Schulich School of Medicine and Dentistry and the London Health Sciences Centre, London, Ont
| | - C M Schlachta
- From the Schulich School of Medicine and Dentistry and the London Health Sciences Centre, London, Ont
| | | | - S Elkassem
- From the University of Toronto, Toronto, Ont
| | - D Lindsay
- From the University of Toronto, Toronto, Ont
| | - L Smith
- From the University of Toronto, Toronto, Ont
| | - P Sullivan
- From the University of Toronto, Toronto, Ont
| | - S Sockalingam
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - R Hawa
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - S Wnuk
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - T Jackson
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - R Fayez
- From the McGill University Health Centre, Montréal, Que
| | - N V Christou
- From the McGill University Health Centre, Montréal, Que
| | - O Court
- From the McGill University Health Centre, Montréal, Que
| | - C Mueller
- From the Division of General Surgery and Division of Psychiatry, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the Division of General Surgery and Division of Psychiatry, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - S Sockalingham
- From the Division of General Surgery and Division of Psychiatry, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - T Jackson
- From the Division of General Surgery and Division of Psychiatry, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - C Mueller
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - T Swanson
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - C Daigle
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - K Pitzul
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - T Penner
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - T Jackson
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - L Sandhu
- From the University of Toronto, Toronto, Ont
| | - A Maciver
- From the University of Alberta, Edmonton, Alta
| | - M McCall
- From the University of Alberta, Edmonton, Alta
| | - R Edgar
- From the University of Alberta, Edmonton, Alta
| | - A Thiesen
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - T Churchill
- From the University of Alberta, Edmonton, Alta
| | | | - S Luu
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - G Regehr
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - M L Murnaghan
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - S Gallinger
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - C-A Moulton
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - V Palter
- From St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - T Grantcharov
- From St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - D Dath
- From McMaster University, Hamilton, Ont
| | | | | | - D Szalay
- From McMaster University, Hamilton, Ont
| | - A Fox
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - K Pitzul
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - F Bhojani
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - M Kaplan
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - A Wei
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - I McGilvray
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - S P Cleary
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - A Okrainec
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | | | - A Parsyan
- From McGill University, Montréal, Que
| | - R Payne
- From McGill University, Montréal, Que
| | - R Tabah
- From McGill University, Montréal, Que
| | - R Anantha
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - K Vogt
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - S Crawford
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - N Parry
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - K Leslie
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Ochs
- From the University of Alberta, Edmonton, Alta
| | - K Matthew
- From the University of Alberta, Edmonton, Alta
| | - R Khadaroo
- From the University of Alberta, Edmonton, Alta
| | - T Churchill
- From the University of Alberta, Edmonton, Alta
| | | | - C Zalai
- From McGill University, Montréal, Que
| | | | - J Booy
- From the University Health Network, Toronto, Ont
| | - J Takata
- From the University Health Network, Toronto, Ont
| | - G Tomlinson
- From the University Health Network, Toronto, Ont
| | - D R Urbach
- From the University Health Network, Toronto, Ont
| | - D Lim
- From the University of Alberta, Edmonton, Alta
| | - C Tomlinson
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - J LaBossiere
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - K Rommens
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - F Brenneman
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - S MacLellan
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - J Simpson
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - K Asai
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - K Elgadi
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - S Ali
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - J Sawyer
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - R Helewa
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - D Turner
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - D Wirtzfeld
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - P Czaykowski
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - G Mak
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - D Hochman
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - A McKay
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - R Gill
- From the University of Alberta, Edmonton, Alta
| | - D Al-Adra
- From the University of Alberta, Edmonton, Alta
| | - X Shi
- From the University of Alberta, Edmonton, Alta
| | - C Sample
- From the University of Alberta, Edmonton, Alta
| | - J Armstrong
- From the University of Western Ontario, London, Ont
| | - L Lester
- From the University of Western Ontario, London, Ont
| | - K Vogt
- From the University of Western Ontario, London, Ont
| | - M Brackstone
- From the University of Western Ontario, London, Ont
| | - L Lee
- From the McGill University Health Centre, Montréal, Que
| | - P Kaneva
- From the McGill University Health Centre, Montréal, Que
| | - S Liberman
- From the McGill University Health Centre, Montréal, Que
| | - P Charlebois
- From the McGill University Health Centre, Montréal, Que
| | - B Stein
- From the McGill University Health Centre, Montréal, Que
| | - G Fried
- From the McGill University Health Centre, Montréal, Que
| | - L Feldman
- From the McGill University Health Centre, Montréal, Que
| | - A Kanji
- From the University of Toronto, University Health Network, Toronto, Ont
| | - E Sharon
- From the University of Toronto, University Health Network, Toronto, Ont
| | - K Asai
- From the University of Toronto, University Health Network, Toronto, Ont
| | - L Jacks
- From the University of Toronto, University Health Network, Toronto, Ont
| | - D McCready
- From the University of Toronto, University Health Network, Toronto, Ont
| | - D Ghazarian
- From the University of Toronto, University Health Network, Toronto, Ont
| | - W-L Leong
- From the University of Toronto, University Health Network, Toronto, Ont
| | - R Wu
- From The Ottawa Hospital, Ottawa and Toronto Western Hospital, Toronto, Ont
| | - A Okrainec
- From The Ottawa Hospital, Ottawa and Toronto Western Hospital, Toronto, Ont
| | - T Penner
- From The Ottawa Hospital, Ottawa and Toronto Western Hospital, Toronto, Ont
| | - C Ball
- From the University of Calgary, Calgary, Alta
| | | | - A Vasquez
- From the University of Saskatchewan, Saskatoon, Sask
| | | | - G Miller
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Awan
- From the University of Saskatchewan, Saskatoon, Sask
| | | | | | - D Dath
- From McMaster University, Hamilton, Ont
| | - V Jain
- From the University of Western Ontario, London, Ont
| | - G-M Busato
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - O Cristea
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - J Landau
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - R Moreland
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - M Johnson
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - D Ramage
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - D Browning
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - S Ullah
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - O Cristea
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - A Bodrogi
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - M Johnson
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - V McAlister
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - J Palisoc
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - J Anderson
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - R Kiladze
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - J Ciar
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - I Bancel
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - K Pitzul
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - P-A Leake
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - A Dalvi
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - R McLean
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - W Stephen
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - M Loeb
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - R Smith
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - E Christoffersen
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - S Forbes
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - B Kidane
- From the University of Western Ontario, London, Ont
| | - K Vogt
- From the University of Western Ontario, London, Ont
| | - C Vinden
- From the University of Western Ontario, London, Ont
| | - N Ahmadi
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - L Dubois
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - M McKenzie
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - N Baxter
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - C Brown
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - P Chaudhury
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - E Dixon
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - W Fitzgerald
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - H Henteleff
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - A Kirkpatrick
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - S Latosinsky
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - A MacLean
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - R McLeod
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - E Pearsall
- From the University of Toronto, Toronto, Ont
| | - M-A Aarts
- From the University of Toronto, Toronto, Ont
| | - Z Meghji
- From the University of Toronto, Toronto, Ont
| | - R McLeod
- From the University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University of Toronto, Toronto, Ont
| | - T Tran
- From McGill University, Montréal, Que
| | - P Kaneva
- From McGill University, Montréal, Que
| | - G Fried
- From McGill University, Montréal, Que
| | - N Mayo
- From McGill University, Montréal, Que
| | - L Feldman
- From McGill University, Montréal, Que
| | - D Newman
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - S Bergman
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - B-A Cummings
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - M Delisle
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - V Whitehead
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - H Chertkow
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - T Chan
- From McMaster University, Hamilton, Ont
| | - M Cicero
- From McMaster University, Hamilton, Ont
| | | | | | - J Struble
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - M Moser
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - P Young
- From the University of Alberta, Edmonton, Alta
| | | | - P Chan
- From the University of Alberta, Edmonton, Alta
| | - S Smith
- From the University of Alberta, Edmonton, Alta
| | - R Khadaroo
- From the University of Alberta, Edmonton, Alta
| | - A Buczkowski
- From the University of British Columbia, Vancouver, BC
| | - M Hameed
- From the University of British Columbia, Vancouver, BC
| | - C Tan-Tam
- From the University of British Columbia, Vancouver, BC
| | - A Meneghetti
- From the University of British Columbia, Vancouver, BC
| | - R Simons
- From the University of British Columbia, Vancouver, BC
| | - N Panton
- From the University of British Columbia, Vancouver, BC
| | - A Elnahas
- From McMaster University, Hamilton, Ont
| | - I Ghaderi
- From the University of Western Ontario, London, Ont., and the University of Alberta, Edmonton, Alta
| | - A Madani
- From the University of Western Ontario, London, Ont., and the University of Alberta, Edmonton, Alta
| | - C de Gara
- From the University of Western Ontario, London, Ont., and the University of Alberta, Edmonton, Alta
| | - C M Schlachta
- From the University of Western Ontario, London, Ont., and the University of Alberta, Edmonton, Alta
| | - S Kalechstein
- From McMaster University, Hamilton University Health Network, Hamilton, University of Toronto, Toronto, Ont., and the Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - K Pitzul
- From McMaster University, Hamilton University Health Network, Hamilton, University of Toronto, Toronto, Ont., and the Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - O Henao
- From McMaster University, Hamilton University Health Network, Hamilton, University of Toronto, Toronto, Ont., and the Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - A Okrainec
- From McMaster University, Hamilton University Health Network, Hamilton, University of Toronto, Toronto, Ont., and the Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - D Paskar
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - K Croome
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - R Hernandez
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - G Knapp
- From McMaster University, Hamilton, Ont., and Centro Evangelico de Medicina (CEML) Hospital, Lubango, Angola
| | - N Howatt
- From McMaster University, Hamilton, Ont., and Centro Evangelico de Medicina (CEML) Hospital, Lubango, Angola
| | - S Foster
- From McMaster University, Hamilton, Ont., and Centro Evangelico de Medicina (CEML) Hospital, Lubango, Angola
| | - B Cameron
- From McMaster University, Hamilton, Ont., and Centro Evangelico de Medicina (CEML) Hospital, Lubango, Angola
| | - J Austin
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - L Mack
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - W Temple
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - S Puloski
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - N Schachar
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - T Gill
- From the Surrey Memorial Hospital, New Westminster and Surrey, BC
| | - P Doris
- From the Surrey Memorial Hospital, New Westminster and Surrey, BC
| | - A Tecson
- From the Surrey Memorial Hospital, New Westminster and Surrey, BC
| | - N Kolozsvari
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - A Andalib
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - P Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - J Cao
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - M Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - G Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - L Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - N Kolozsvari
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - P Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - M Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - G Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - L Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - N Kolozsvari
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - P Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - C Brace
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - G Chartrand
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - M Vaillancourt
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - J Cao
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - D Banaszek
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - M Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - G Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - L Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - S Fraser
- From the Jewish General Hospital, Montréal, Que
| | - S Bergman
- From the Jewish General Hospital, Montréal, Que
| | - R Deobald
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - J Chad
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - C Di Gregorio
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - J Johnstone
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - C Kenyon
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - M Lees
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - E Auger-Dufour
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - G Fried
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - L Feldman
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - L Ferri
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - M Vassiliou
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - A Alqahtani
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - R Perlman
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - C Holcroft
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - P H Gordon
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - A Szilagyi
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - D Iradukunda
- From the University of Saskatchewan, Saskatoon, Sask
| | - M A J Moser
- From the University of Saskatchewan, Saskatoon, Sask
| | - N Rodych
- From the University of Saskatchewan, Saskatoon, Sask
| | - J M Shaw
- From the University of Saskatchewan, Saskatoon, Sask
| | - N Ahmed
- From the University of Toronto, Toronto, Ont
| | - M Chiu
- From the University of Toronto, Toronto, Ont
| | - B Kurabi
- From the University of Toronto, Toronto, Ont
| | - A Qureshi
- From the University of Toronto, Toronto, Ont
| | - A Nathens
- From the University of Toronto, Toronto, Ont
| | | | - A Pandya
- From the University of Toronto, Toronto, Ont
| | - S Kitto
- From the University of Toronto, Toronto, Ont
| | - G Ma
- From the University of Toronto, Toronto, Ont
| | - A Pooni
- From the University of Toronto, Toronto, Ont
| | - S Forbes
- From the University of Toronto, Toronto, Ont
| | | | - E Pearsall
- From the University of Toronto, Toronto, Ont
| | - F Brenneman
- From the University of Toronto, Toronto, Ont
| | - R McLeod
- From the University of Toronto, Toronto, Ont
| | - M A Rockx
- From the Alberta Medical Association Locum Services and the University of Western Ontario, London, Ont
| | - V McAlister
- From the Alberta Medical Association Locum Services and the University of Western Ontario, London, Ont
| | - D Roberts
- From the University of Calgary, Calgary, Alta
| | - J Ouellet
- From the University of Calgary, Calgary, Alta
| | | | - R Lall
- From the University of Calgary, Calgary, Alta
| | | | - C Ball
- From the University of Calgary, Calgary, Alta
| | - S Chackungal
- From the University of Western Ontario, London, Ont., the University of British Columbia, Vancouver, BC, the Ministry of Health Liberia, Monrovia, Liberia, and Harvard Humanitarian Initiative, Cambridge, Mass
| | - L M Knowlton
- From the University of Western Ontario, London, Ont., the University of British Columbia, Vancouver, BC, the Ministry of Health Liberia, Monrovia, Liberia, and Harvard Humanitarian Initiative, Cambridge, Mass
| | - B Dahn
- From the University of Western Ontario, London, Ont., the University of British Columbia, Vancouver, BC, the Ministry of Health Liberia, Monrovia, Liberia, and Harvard Humanitarian Initiative, Cambridge, Mass
| | - K McQueen
- From the University of Western Ontario, London, Ont., the University of British Columbia, Vancouver, BC, the Ministry of Health Liberia, Monrovia, Liberia, and Harvard Humanitarian Initiative, Cambridge, Mass
| | - J A Morrison
- From the Chatham Kent Health Alliance, Chatham, Ont
| | - B Lent
- From the University of Western Ontario, London, Ont
| | - J Brown
- From the University of Western Ontario, London, Ont
| | - M Fluit
- From the University of Western Ontario, London, Ont
| | - C Herbert
- From the University of Western Ontario, London, Ont
| | - S Deen
- From the University of Calgary, Calgary, Alta
| | | | - S McFadden
- From the University of Calgary, Calgary, Alta
| | - G Gelfand
- From the University of Calgary, Calgary, Alta
| | - D Bosch
- From the University of Calgary, Calgary, Alta
| | - L Grimmer
- From the Brown University School of Medicine, Providence, RI
| | - S Milman
- From the Brown University School of Medicine, Providence, RI
| | - T Ng
- From the Brown University School of Medicine, Providence, RI
| | - R Gill
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - T Perry
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - J Abele
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - E Bedard
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - D Schiller
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - S Coughlin
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - T Charyk Stewart
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - N Parry
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - D Gray
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - J Williamson
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - R Malthaner
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - D Bottoni
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - M Perri
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - A L Trejos
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - M Naish
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - R Patel
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - R Malthaner
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - A Ashrafi
- From the Surrey Memorial Hospital, Surrey, BC
| | - J Bond
- From the Surrey Memorial Hospital, Surrey, BC
| | - S Ong
- From the Surrey Memorial Hospital, Surrey, BC
| | - M Yamashita
- From the Surrey Memorial Hospital, Surrey, BC
| | - S Ahmadi
- From the Surrey Memorial Hospital, Surrey, BC
| | | | - J Miller
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | | | | | - L Lee
- From the McGill University Health Centre, Montréal, Que
| | - S Hanley
- From the McGill University Health Centre, Montréal, Que
| | - C Robineau
- From the McGill University Health Centre, Montréal, Que
| | - C Sirois
- From the McGill University Health Centre, Montréal, Que
| | - D Mulder
- From the McGill University Health Centre, Montréal, Que
| | - L Ferri
- From the McGill University Health Centre, Montréal, Que
| | - R Humphrey
- From the University of Western Ontario, Woodstock, and London, Ont
| | - R Inculet
- From the University of Western Ontario, Woodstock, and London, Ont
| | - D Fortin
- From the University of Western Ontario, Woodstock, and London, Ont
| | - A Arab
- From the University of Western Ontario, Woodstock, and London, Ont
| | - R Malthaner
- From the University of Western Ontario, Woodstock, and London, Ont
| | - A Ashrafi
- From the Surrey Memorial Hospital, Surrey, BC
| | - J Bond
- From the Surrey Memorial Hospital, Surrey, BC
| | - S Ong
- From the Surrey Memorial Hospital, Surrey, BC
| | - M Yamashita
- From the Surrey Memorial Hospital, Surrey, BC
| | - S Ahmadi
- From the Surrey Memorial Hospital, Surrey, BC
| | - A McGuire
- From Queen's University, Ottawa and Kingston, Ont
| | - K Reid
- From Queen's University, Ottawa and Kingston, Ont
| | - D Petsikas
- From Queen's University, Ottawa and Kingston, Ont
| | - W Hopman
- From Queen's University, Ottawa and Kingston, Ont
| | - A Basi
- From the University of Western Ontario, London, and the William Osler Health Centre, Brampton, Ont
| | - S Basi
- From the University of Western Ontario, London, and the William Osler Health Centre, Brampton, Ont
| | - K Irshad
- From the University of Western Ontario, London, and the William Osler Health Centre, Brampton, Ont
| | - W Hanna
- From the Toronto General Hospital, Toronto, Ont
| | - K P Croome
- From the University of Western Ontario, London, Ont
| | - P Marotta
- From the University of Western Ontario, London, Ont
| | - V McAlister
- From the University of Western Ontario, London, Ont
| | - D Quan
- From the University of Western Ontario, London, Ont
| | - W Wall
- From the University of Western Ontario, London, Ont
| | | | - C de Mestral
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - B Zagorski
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - O Rotstein
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - D Gomez
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - B Haas
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - A Laupacis
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - S Sharma
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - J Bridge
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - A Nathens
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - F Bhojani
- From the University of Toronto, Toronto, Ont
| | - A Fox
- From the University of Toronto, Toronto, Ont
| | - K Pitzul
- From the University of Toronto, Toronto, Ont
| | - C-A Moulton
- From the University of Toronto, Toronto, Ont
| | - A Wei
- From the University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University of Toronto, Toronto, Ont
| | - S Cleary
- From the University of Toronto, Toronto, Ont
| | - K Bertens
- From the University of Western Ontario, London, Ont
| | - K P Croome
- From the University of Western Ontario, London, Ont
| | - A Mujoomdar
- From the University of Western Ontario, London, Ont
| | - D Peck
- From the University of Western Ontario, London, Ont
| | - R Rankin
- From the University of Western Ontario, London, Ont
| | - D Quan
- From the University of Western Ontario, London, Ont
| | - N Kakani
- From the University of Western Ontario, London, Ont
| | | | - R Suri
- From McMaster University, Hamilton, Ont
| | | | - L Ruo
- From McMaster University, Hamilton, Ont
| | - M Jamal
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - J Abou Khalil
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - E Simoneau-Beaudry
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - S Dumitra
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - M Edwards
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - Y Yousef
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - M Al Jiffry
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - P Metrakos
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - J Tchervenkov
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - S Doi
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - J Barkun
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - A Obayan
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask., and the Regina General Hospital, Regina, Sask
| | - S Meiers
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask., and the Regina General Hospital, Regina, Sask
| | - R Keith
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask., and the Regina General Hospital, Regina, Sask
| | - S Elkassem
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - N Church
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - P Mitchell
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - C Turbide
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - E Dixon
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - E Debru
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - J Shum
- From the University of Western Ontario, London, Ont
| | - W J Wall
- From the University of Western Ontario, London, Ont
| | - R Maniar
- From the University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the University of Manitoba, Winnipeg, Man
| | - D Wirtzfeld
- From the University of Manitoba, Winnipeg, Man
| | - C Yaffe
- From the University of Manitoba, Winnipeg, Man
| | - B Yip
- From the University of Manitoba, Winnipeg, Man
| | - A McKay
- From the University of Manitoba, Winnipeg, Man
| | - R Silverman
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - V Francescutti
- From the Roswell Park Cancer Institute, Buffalo, New York, NY
| | - L Rivera
- From the Roswell Park Cancer Institute, Buffalo, New York, NY
| | - J M Kane
- From the Roswell Park Cancer Institute, Buffalo, New York, NY
| | - J J Skitzki
- From the Roswell Park Cancer Institute, Buffalo, New York, NY
| | - P Lovrics
- From McMaster University, Hamilton, Ont
| | - N Hodgson
- From McMaster University, Hamilton, Ont
| | | | - L Thabane
- From McMaster University, Hamilton, Ont
| | | | - B Heller
- From McMaster University, Hamilton, Ont
| | - S Reid
- From McMaster University, Hamilton, Ont
| | - K Sanders
- From McMaster University, Hamilton, Ont
| | - T Kittmer
- From McMaster University, Hamilton, Ont
| | | | - S Duhaime
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - B Fong
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - M Deria
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - C Acton
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - M El-Maadawy
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - S Lad
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - A Arnaout
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - M Omole
- From McMaster University, Hamilton, Ont
| | | | - P Lovrics
- From McMaster University, Hamilton, Ont
| | - D Bischof
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - P Stotland
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - J Hagen
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - C Swallow
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - L Klein
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - J A Van Koughnett
- From the Division of General Surgery, University of Western Ontario, and the London Regional Cancer Program, London, Ont
| | - T Ahmad
- From the Division of General Surgery, University of Western Ontario, and the London Regional Cancer Program, London, Ont
| | - P Ainsworth
- From the Division of General Surgery, University of Western Ontario, and the London Regional Cancer Program, London, Ont
| | - M Brackstone
- From the Division of General Surgery, University of Western Ontario, and the London Regional Cancer Program, London, Ont
| | | | - G Groot
- From the University of Saskatchewan, Saskatoon, Sask
| | | | | | | | - B Strang
- From McMaster University, Hamilton, Ont
| | | | - S MacLellan
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - H MacKay
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - J Ringash
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - L Jacks
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - Z Kassam
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - I Khalili
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - T Conrad
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - A Okrainec
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - R Chagpar
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - Y Xing
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - N You
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - C Yi-Ju
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - B Feig
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - G Chang
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - J Cormie
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - M-K Gervais
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - L Sideris
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - P Drolet
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - A Mitchell
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - G Leblanc
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - P Dubé
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - S Merchant
- From the University of British Columbia, General Surgery, and the BC Cancer Agency, Vancouver, BC
| | - M Knowling
- From the University of British Columbia, General Surgery, and the BC Cancer Agency, Vancouver, BC
| | - R Cheifetz
- From the University of British Columbia, General Surgery, and the BC Cancer Agency, Vancouver, BC
| | - M Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - B Heidary
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - S Kalikias
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - D Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - T Phang
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C Brown
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - A Scheer
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A O'Connor
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Chan
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man., and the University of Toronto, Toronto, Ont
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man., and the University of Toronto, Toronto, Ont
| | - P Sullivan
- From the University of Manitoba, Winnipeg, Man., and the University of Toronto, Toronto, Ont
| | - R Musselman
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - T Gomes
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - B Chan
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - R Auer
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - E Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - K Al-Khayal
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - M Al-Omran
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - M Mamdani
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - O AlObeed
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - R Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - G Martel
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - A Crawford
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - J Barkun
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - C Ramsay
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - D Fergusson
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - R Boushey
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - L Williams
- From the University of Ottawa, Ottawa, Ont
| | - A Crawford
- From the University of Ottawa, Ottawa, Ont
| | | | - M Mackey
- From the University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the University of Ottawa, Ottawa, Ont
| | - E Poulin
- From the University of Ottawa, Ottawa, Ont
| | | | - R Boushey
- From the University of Ottawa, Ottawa, Ont
| | - R Auer
- From the University of Ottawa, Ottawa, Ont
| | - F Bellolio
- From the University of Toronto, Toronto, Ont
| | - Z Cohen
- From the University of Toronto, Toronto, Ont
| | - H MacRae
- From the University of Toronto, Toronto, Ont
| | - B O'Connor
- From the University of Toronto, Toronto, Ont
| | - H Huang
- From the University of Toronto, Toronto, Ont
| | - J C Victor
- From the University of Toronto, Toronto, Ont
| | - R McLeod
- From the University of Toronto, Toronto, Ont
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - K Pitzul
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - J Kwong
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - D Urbach
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - A Okrainec
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - K Vogt
- From the London Health Sciences Centre, London, Ont
| | - L Dubois
- From the London Health Sciences Centre, London, Ont
| | - C Vinden
- From the London Health Sciences Centre, London, Ont
| | - B Chan
- From the University of Ottawa, Ottawa, Ont
| | - A Scheer
- From the University of Ottawa, Ottawa, Ont
| | - A Menezes
- From the University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the University of Ottawa, Ottawa, Ont
| | - E Poulin
- From the University of Ottawa, Ottawa, Ont
| | - R Boushey
- From the University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the University of Ottawa, Ottawa, Ont
| | - F Bellolio
- From the University of Toronto, Toronto, Ont
| | - H MacRae
- From the University of Toronto, Toronto, Ont
| | - Z Cohen
- From the University of Toronto, Toronto, Ont
| | - B O'Connor
- From the University of Toronto, Toronto, Ont
| | - H Huang
- From the University of Toronto, Toronto, Ont
| | - R McLeod
- From the University of Toronto, Toronto, Ont
| | - C Godbout-Simard
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - J Azar
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - F Psaradellis
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - J Sampalis
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - N Morin
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - C Brown
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - S Kalikias
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - B Heidary
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - D Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - A Archibald
- From the Department of Pathology and the Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ont
| | - D Hurlbut
- From the Department of Pathology and the Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ont
| | - S Vanner
- From the Department of Pathology and the Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ont
| | - C Zalai
- From McGill University, Montréal, Que
| | | | - M Simunovic
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - S Forbes
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - S Kelly
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - W Stephen
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - V Grubac
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - M Marcinow
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - A Coates
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - N Aslani
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - P T Phang
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - M Raval
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - C Brown
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - A Scheer
- From The Ottawa Hospital, Ottawa, Ont
| | - M Carrier
- From The Ottawa Hospital, Ottawa, Ont
| | - R Boushey
- From The Ottawa Hospital, Ottawa, Ont
| | - T Asmis
- From The Ottawa Hospital, Ottawa, Ont
| | - P Wells
- From The Ottawa Hospital, Ottawa, Ont
| | - D Jonker
- From The Ottawa Hospital, Ottawa, Ont
| | - R Auer
- From The Ottawa Hospital, Ottawa, Ont
| | - N Azer
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - R Gill
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - C de Gara
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - G Roxin
- From the University of Calgary, Calgary, Alta
| | - S Drolet
- From the University of Calgary, Calgary, Alta
| | - A MacLean
- From the University of Calgary, Calgary, Alta
| | - W D Buie
- From the University of Calgary, Calgary, Alta
| | - J Heine
- From the University of Calgary, Calgary, Alta
| | - J Agzarian
- From McMaster University Hamilton, Ont., and the Harvard School of Public Health, Boston, Mass
| | - S Forbes
- From McMaster University Hamilton, Ont., and the Harvard School of Public Health, Boston, Mass
| | - W Stephen
- From McMaster University Hamilton, Ont., and the Harvard School of Public Health, Boston, Mass
| | - S Kelly
- From McMaster University Hamilton, Ont., and the Harvard School of Public Health, Boston, Mass
| | - P Churchill
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - T Corner
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - S Kelly
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - S Forbes
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - L Lindsay
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - W Stephen
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - A Scheer
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - A O'Connor
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - B Chan
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E Poulin
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R Auer
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R Boushey
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Denis
- From the Winnipeg Regional Health Authority, University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the Winnipeg Regional Health Authority, University of Manitoba, Winnipeg, Man
| | - M Recsky
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - M Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - W Cheung
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - C Brown
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - N Alkhamesi
- From Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - C M Schlachta
- From Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - T Tiwari
- From the Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - C Brown
- From the Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, Vancouver, BC
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17
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Moore DM, Zhang W, Yip B, Genebat M, Lima VD, Montaner JSG, Hogg RS. Non-medically supervised treatment interruptions among participants in a universally accessible antiretroviral therapy programme. HIV Med 2009; 11:299-307. [PMID: 20002777 DOI: 10.1111/j.1468-1293.2009.00779.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined clinical outcomes, patient characteristics and trends over time of non-medically supervised treatment interruptions (TIs) from a free-of-charge antiretroviral therapy (ART) programme in British Columbia (BC), Canada. METHODS Data from ART-naïve individuals > or =18 years old who initiated triple combination highly active antiretroviral therapy (HAART) between January 2000 and June 2006 were analysed. Participants having > or =3 month gap in HAART coverage were defined as having a TI. Cox proportional hazards modelling was used to examine factors associated with TIs and to examine factors associated with resumption of treatment. RESULTS A total of 1707 participants were study eligible and 643 (37.7%) experienced TIs. TIs within 1 year of ART initiation decreased from 29% of individuals in 2000 to 19% in 2006 (P<0.001). TIs were independently associated with a history of injection drug use (IDU) (P=0.02), higher baseline CD4 cell counts (P<0.001), hepatitis C co-infection (P<0.001) and the use of nelfinavir (NFV) (P=0.04) or zidovudine (ZDV)/lamivudine (3TC) (P=0.009) in the primary HAART regimen. Male gender (P<0.001), older age (P<0.001), AIDS at baseline (P=0.008) and having a physician who had prescribed HAART to fewer patients (P=0.03) were protective against TIs. Four hundred and eighty-eight (71.9%) participants eventually restarted ART with male patients and those who developed an AIDS-defining illness prior to their TI more likely to restart therapy. Higher CD4 cell counts at the time of TI and unknown hepatitis C status were associated with a reduced likelihood of restarting ART. CONCLUSION Treatment interruptions were associated with younger, less ill, female and IDU participants. Most participants with interruptions eventually restarted therapy. Interruptions occurred less frequently in recent years.
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Affiliation(s)
- D M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
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18
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Druyts EF, Yip B, Lima VD, Burke TA, Lesovski D, Fernandes KA, McInnes CW, Rustad CA, Montaner JSG, Hogg RS. Health care services utilization stratified by virological and immunological markers of HIV: evidence from a universal health care setting. HIV Med 2009; 10:88-93. [PMID: 19200171 DOI: 10.1111/j.1468-1293.2008.00656.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E F Druyts
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada
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19
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Mir PS, Dugan MER, He ML, Entz T, Yip B. Effects of dietary sunflower seeds and tylosin phosphate on production variables, carcass characteristics, fatty acid composition, and liver abscess incidence in crossbred steers1,2. J Anim Sci 2008; 86:3125-36. [DOI: 10.2527/jas.2008-0875] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Tam LWY, Hogg RS, Yip B, Montaner JSG, Harrigan PR, Brumme CJ. Performance of a World Health Organization first-line regimen (stavudine/lamivudine/nevirapine) in antiretroviral-naïve individuals in a Western setting. HIV Med 2007; 8:267-70. [PMID: 17561871 DOI: 10.1111/j.1468-1293.2007.00463.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In 2003, the World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) introduced the '3 by 5 Initiative' to treat 3 million individuals by the end of 2005. This study evaluates the time to treatment termination, viral load suppression, and detection of drug resistance among antiretroviral-naïve individuals initiating stavudine/lamivudine/nevirapine (d4T/3TC/NVP) in British Columbia, Canada, to provide a context for future programme planning. METHODS Primary outcome was time to treatment termination. Secondary outcome was time to viral suppression. Accumulation of drug resistance mutations was followed systematically in the first 145 individuals over 30 months. Cox proportional hazard regression identified factors associated with termination and suppression. RESULTS 312 antiretroviral-naïve individuals initiated d4T/3TC/NVP between August 1996 and September 2003. Median follow-up time was 26.5 months (interquartile range [IQR] 6.8-46.5). At a median of 12.4 months (IQR 4.3-33.3), 132 (42.3%) patients switched treatment, 53 (17.0%) stopped therapy and 26 (8.3%) died. Of 308 subjects with baseline viral load >500 copies/mL, 223 (72.4%) suppressed to <or=500 copies/mL at a median of 2.0 months. Among 145 (46.5%) individuals followed longitudinally, resistance mutations to NNRTI, 3TC, or other NRTI were detected in 11 (7.6%), six (4.1%) and four (2.8%) individuals after 12 months of therapy; and in 23 (15.9%), 17 (12.0%), and six (4.1%) individuals after 30 months. CONCLUSIONS The population requiring second-line treatment was 30% at 12 months and 40% at 24 months; 20% had detectable drug resistance mutations by 30 months. While these results are from a Western setting, they illustrate the need to consider second- and third-line approaches as antiretroviral treatment scale-up continues in the developing world.
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Affiliation(s)
- L W Y Tam
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
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21
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Wood E, Hogg RS, Yip B, Moore D, Harrigan PR, Montaner JSG. Superior virological response to boosted protease inhibitor-based highly active antiretroviral therapy in an observational treatment programme. HIV Med 2007; 8:80-5. [PMID: 17352763 DOI: 10.1111/j.1468-1293.2007.00430.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of boosted protease inhibitor (PI)-based antiretroviral therapy has become increasingly recommended in international HIV treatment consensus guidelines based on the results of randomized clinical trials. However, the impact of this new treatment strategy has not yet been evaluated in community-treated cohorts. METHODS We evaluated baseline characteristics and plasma HIV RNA responses to unboosted and boosted PI-based highly active antiretroviral therapy (HAART) among antiretroviral-naïve HIV-infected patients in British Columbia, Canada who initiated HAART between August 1997 and September 2003 and who were followed until September 2004. We evaluated time to HIV-1 RNA suppression (<500 HIV-1 RNA copies/mL) and HIV-1 RNA rebound (>or=500 copies/mL), while stratifying patients into those that received boosted and unboosted PI-based HAART as the initial regimen, using Kaplan-Meier methods and Cox proportional hazards regression. RESULTS During the study period, 682 patients initiated therapy with unboosted PI and 320 individuals initiated HAART with a boosted PI. Those who initiated therapy with a boosted PI were more likely to have a CD4 cell count <200 cells/muL and to have a plasma HIV RNA>100 000 copies/mL, and to have AIDS at baseline (all P<0.001). However, when we examined virological response rates, those who initiated HAART with a boosted PI achieved more rapid virological suppression [relative hazard 1.26, 95% confidence interval (CI) 1.06-1.51, P=0.010]. CONCLUSIONS Patients prescribed boosted PIs achieved superior virological response rates despite baseline factors that have been associated with inferior virological responses to HAART. Despite the inherent limitations of observational studies which require this study be interpreted with caution, these findings support the use of boosted PIs for initial HAART therapy.
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Affiliation(s)
- E Wood
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
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22
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Normén L, Yip B, Montaner J, Harris M, Frohlich J, Bondy G, Hogg RS. Use of metabolic drugs and fish oil in HIV-positive patients with metabolic complications and associations with dyslipidaemia and treatment targets. HIV Med 2007; 8:346-56. [PMID: 17661842 DOI: 10.1111/j.1468-1293.2007.00449.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) with protease inhibitors (PI) is successful in suppressing viral replication, but may lead to a range of metabolic abnormalities associated with cardiovascular disease (CVD). OBJECTIVES The first objective of the study was to compare baseline demographic and clinical characteristics between PI users and non-PI users referred to a specialized metabolic clinic during 1999-2003. The second objective was to assess the associations of prescription drugs and fish oil with dyslipidaemia and to determine whether or not patients achieved treatment targets during 6 months of treatment. METHODS A retrospective analysis was performed using two sets of charts based on standardized forms with entries for personal data, drug treatment and clinical history. Anonymous linkage with the British Columbia HIV/AIDS Drug Treatment Program and the hospital laboratory was performed to gather information about HAART prescriptions and blood work. RESULTS In total, 237 patients were included in the study. There were few differences in any demographic or clinical factors between PI users and non-PI users. Compared with controls not taking lipid-lowering drugs or fish oil (n=48), statins appeared to be the only agent that was significantly associated with a reduced total cholesterol concentration (-15.6%; P=0.009). Fibrate treatment was associated with the largest reduction of triglyceride concentration (-37.4%; P=0.012), closely followed by fish oil (n=18;-32%; P=0.027). Six-month treatment success rates ranged between 17 and 43% of patients for total cholesterol (<5.2 mmol/L) and between 15 and 44% of patients for triglycerides (<2.3 mmol/L). CONCLUSIONS Despite the apparent lowering of blood lipids with drug and fish oil treatments, a majority of patients in these treatment groups (56.5-83.3%) still had elevated concentrations after 6 months.
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Affiliation(s)
- L Normén
- Canadian HIV Trials Network, Pacific Region, St Paul's Hospital, and Healthy Heart Program, St Paul's Hospital, Vancouver, British Columbia, Canada.
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Moore DM, Hogg RS, Yip B, Wood E, Harris M, Montaner JSG. Regimen-dependent variations in adherence to therapy and virological suppression in patients initiating protease inhibitor-based highly active antiretroviral therapy. HIV Med 2007; 7:311-6. [PMID: 16945076 DOI: 10.1111/j.1468-1293.2006.00381.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine differences among four protease inhibitor (PI)-based drug regimens in adherence to therapy and rate of achievement of virological suppression in a cohort of antiretroviral-naive patients initiating highly active antiretroviral therapy (HAART). METHODS Participants were antiretroviral-naive and were first dispensed combination therapy containing two nucleosides and a ritonavir (RTV)-boosted PI, or unboosted nelfinavir, between 1 January 2000 and 30 September 2003. Logistic regression analysis was used to examine associations between the prescribed PI and other baseline factors associated with being >90% adherent to therapy and then to determine the associations of prescribed drug regimen, adherence to therapy and baseline variables with the odds of achieving two consecutive viral loads of <500 HIV-1 RNA copies/mL. RESULTS A total of 385 subjects were available for analysis. Lopinavir (LPV)/RTV was prescribed for 168 patients (42% of total); 86 (22%) received indinavir (IDV)/RTV; 91 (24%) received nelfinavir (NFV) and 40 (10%) received saquinavir (SQV)/RTV. SQV/RTV-based HAART was associated with reduced adherence to therapy [odds ratio (OR)=0.40; 95% confidence interval (CI) 0.19-0.83]. In multivariate models, IDV/RTV (OR=0.45; 95% CI 0.22-0.92), SQV/RTV (OR=0.18; 95% CI 0.07-0.43) and NFV were associated with reduced odds of achieving virological suppression within 1 year in comparison to LPV/RTV-based therapy. For patients receiving NFV, adjusting for adherence (OR=0.73; 95% CI 0.36-1.47) rendered this association nonsignificant. CONCLUSION Patients prescribed IDV/RTV, NFV or SQV/RTV were less likely to achieve virological suppression on their first regimen compared with patients prescribed LPV/RTV. Reduced adherence to these therapies only partly explained these observed differences.
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Affiliation(s)
- D M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
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Moore DM, Hogg RS, Yip B, Craib K, Wood E, Montaner JSG. CD4 percentage is an independent predictor of survival in patients starting antiretroviral therapy with absolute CD4 cell counts between 200 and 350 cells/microL. HIV Med 2007; 7:383-8. [PMID: 16903983 DOI: 10.1111/j.1468-1293.2006.00397.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prognostic value of baseline CD4 percentage in terms of patient survival in comparison to absolute CD4 cell counts for HIV-positive patients initiating highly active antiretroviral therapy (HAART). METHODS A population-based cohort study of 1,623 antiretroviral therapy-naïve HIV-positive individuals who initiated HAART between 1 August 1996 and 30 June 2002 was conducted. Cumulative mortality rates were estimated using Kaplan-Meier methods. Cox proportional hazards regression was used to model the effect of baseline CD4 strata and CD4 percentage strata and other prognostic variables on survival. A subgroup analysis was conducted on 417 AIDS-free subjects with baseline CD4 counts between 200 and 350 cells/microL. RESULTS In multivariate models, low CD4 percentages were associated with increased risk of death [CD4%<5, relative hazard (RH)=4.46; CD4% 5-14, RH=2.43; P<0.01 for both] when compared with those subjects with an initial CD4 fraction of 15% or greater, but had less predictive value than absolute CD4 counts. In subgroup analyses where absolute CD4 strata were not associated with mortality, a baseline CD4 fraction below 15% [RH=2.71; 95% confidence interval (CI) 1.20-6.10], poor adherence to therapy and baseline viral load >100,000 HIV-1 RNA copies/mL were associated with an increased risk of death. CONCLUSION CD4 percentages below 15% are independent predictors of mortality in AIDS-free patients starting HAART, including those with CD4 counts between 200 and 350 cells/microL. CD4 percentage should be considered for inclusion in guidelines used to determine when to start therapy.
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Affiliation(s)
- D M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
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Mir PS, Bittman S, Hunt D, Entz T, Yip B. Lipid content and fatty acid composition of grasses sampled on different dates through the early part of the growing season. Can J Anim Sci 2006. [DOI: 10.4141/a05-050] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In order to explore the value of herbage for the production of ruminant products with a high content of conjugated linoleic acid (CLA), a study was undertaken to determine the content of fatty acids that can be hydrogenated [hydrogenatable fatty acids (HFA)] in herbage of three cool-season forage grasses, orchardgrass (OG), perennial ryegrass (PRG) and tall fescue (TF). Dry matter (DM) yield, lipid content (ether extract) and fatty acid concentration (weight percent of detected fatty acids) on five sampling dates in the spring of 2004 were determined. HFA is the available substrate for the production and deposition of fatty acid bioconversion products in ruminants that consume the grass. Fatty acid content of the grasses was estimated as the product of fatty acids concentration (weight percent) and lipid content (ether extract), while HFA was estimated as the sum of the content of C18:1, C18:2 and C18:3. The DM yield of the three species of grasses increased (P < 0.05) between Mar. 29 and Apr. 28, after which the increase was observed for TF followed by PRG. However, the lipid content decreased in all the grasses over the 140 d of sampling. Although concentration of the saturated fatty acids and C18:1 and C18:2 increased over the sampling period, the content did not alter substantially. In OG samples, C18:2 concentrations were higher (P < 0.05) than those in PRG or TF in all samples. The concentration and content of C18:3 was highest (P < 0.05) in all the forages, but declined progressively. Results indicate that the availability of HFA is greatest in OG and PRG, especially in the early samples, but DM yields are low; however, later in the season TF produces more DM but with substantially reduced lipid and HFA content. Key words: Orchard grass, perennial ryegrass, tall fescue, hydrogenatable fatty acids, conjugated linoleic acid, ruminants
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Abstract
In biometrical genetic analyses of binary traits, the use of family data overcomes some limitations of twin studies, particularly in terms of sample size and types of genetic or environmental factors that can be estimated. However, because of computational problems, recent methods in the application of generalized linear mixed models for family data structure have limited the ability to handle large data sets with general covariates. In this paper, we investigate the use of the hierarchical likelihood approach to the analysis of binary traits from family data. In a simulation study, the method is shown to be highly accurate for the estimation of both the variance components and fixed regression parameters, even for small family sizes. For illustration, we analyze a real data set of familial aggregation of preeclampsia, a pregnancy-induced hypertension. When possible, the analysis is compared with the exact maximum likelihood approach.
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Affiliation(s)
- M Noh
- Department of Statistics, Seoul National University, South Korea
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Abstract
Adherence to highly active antiretroviral therapy (HAART) is necessary to achieve long-term effectiveness. The impact of HIV/AIDS-specific pharmacy services on patient adherence and HIV viral suppression is currently not well described. This study aimed to compare the impact of differing levels of HIV-pharmacy care on adherence and time to HIV viral suppression among participants on HAART enrolled in a population-based HIV/AIDS drug treatment programme in British Columbia. We performed a retrospective observational study of 788 treatment-naïve patients who started HAART between August 1997 and July 2000 and were followed until 31 March 2002. The degree of outpatient pharmacy care was defined according to pharmacy dispensing site for the participants' first prescription of HAART: highest at the AIDS-tertiary care hospital outpatient pharmacies, intermediate at HIV/AIDS drug treatment programme funded off-site pharmacies and lowest at family physician's offices. Cox-proportional hazard models examined the independent effect of pharmacy dispensing site on time to two consecutive HIV viral suppressions controlling for other prognostic factors including physicians' experience, age, gender, injection drug use, use of therapy containing NNRTI versus PI, adherence >90%, AIDS diagnosis at baseline, baseline CD4 cell count and HIV viral load. The median time on antiretrovirals was 28 months (IQR=14-38). There were 489 (62.1%) participants who obtained their medications from the AIDS-tertiary care outpatient pharmacies; 98 (12.4%) from off-site pharmacies and 201 (25.5%) from their physicians' offices. The proportion of patients exhibiting >90% adherence to treatment was observed to be higher among patients receiving their HAART at the AIDS-tertiary care pharmacies compared to off-site pharmacies and to physicians' offices (70.4, 59.2 and 55.7%, respectively; p=0.0001). After adjusting for other prognostic factors, subjects who were first dispensed medications from the AIDS-tertiary care pharmacy were 1.42 times (CI: 1.10-1.84) more likely to achieve HIV viral suppression than those getting their medications from off-site pharmacies and physicians' offices. Providing regular outpatient pharmacy care is independently associated with improved HIV viral load response through enhanced adherence to HAART. Standardization of pharmacy practices for dispensing HAART may improve outcomes for patients who receive their HIV medications from other non-tertiary care pharmacy sites.
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Affiliation(s)
- E Castillo
- Department of Health Care and Epideiology, University of British Columbia, Vancouver, Canada
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Jahnke N, Seminari E, Hogg RS, Yip B, O'Shaughnessy MV, Montaner JS. Antiretroviral effect of two different dose regimens of ritonavir and saquinavir on HIV-infected adults in a population-based setting. Antivir Ther 2003; 4:151-6. [PMID: 12731754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To characterize the antiviral effect and tolerability of higher dose (HD, 600 mg two times daily) and lower dose (LD, 400 mg two times daily) combination regimens of ritonavir and saquinavir in British Columbia (BC), Canada. DESIGN Intent-to-treat analysis with suppression of plasma viral load to levels below 500 copies/ml as the main outcome measure. PATIENTS Adult human immunodeficiency virus (HIV)-positive individuals in the province of British Columbia prescribed ritonavir and saquinavir in combination between 1 September 1996 and 30 June 1997, with a minimum of two plasma viral loads, one at baseline and one after the initiation of therapy. RESULTS A total of 84 participants [27 HD (32%) and 57 LD (68%)] were prescribed ritonavir and saquinavir. There was no difference at baseline in the two groups with respect to age (P=0.466), CD4 cell count (P=0.373) and baseline plasma viral load (P=0.656). However, LD were more likely to have had prior protease experience than HD participants (65 versus 40%, P=0.037). The median follow-up time was 9 months. A total of 44 (52%) subjects demonstrated a decrease in plasma viral load to levels <500 copies/ml. After adjusting for length of follow-up, baseline CD4 cell count and prior AIDS diagnosis, HD participants were as likely to be suppressed to <500 copies/ml as LD individuals (P=0.760). HD participants did report more adverse effects (P=0.042) than LD subjects. CONCLUSION Our results provide confirmatory evidence that lower doses of ritonavir and saquinavir in combination are better tolerated and as effective as the standard doses of these drugs. This response, however, is seriously compromised by prior exposure to protease inhibitors.
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Affiliation(s)
- N Jahnke
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada
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Martin BJ, Yip B, Hearty M, Marletta S, Hill R. Outcome, functional recovery and unmet needs following acute stroke. Experience of patient follow up at 6 to 9 months in a newly established stroke service. Scott Med J 2002; 47:136-7. [PMID: 12616970 DOI: 10.1177/003693300204700605] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess outcome at six months post stroke and the unmet needs and adherence to the secondary prevention advice among survivors living at home. SETTING Stroke Rehabilitation Unit (SRU), Hairmyres Hospital and patients homes. SUBJECTS Survivors living at home who had been managed in the SRU. RESULTS Of 572 consecutive patients with confirmed acute stroke, 301 were managed in the SRU and 179 of these were reviewed at home between 6 and 9 months post acute stroke incident. One hundred and thirty seven (76%) survivors at home were living with a carer. Sixty-eight (38%) had had no personal contact with their General Practitioner since discharge from hospital, although 83 (46%) had attended or were attending day hospital. Thirty-two individuals (18%) had resumed smoking. One hundred and forty nine survivors (83%) still required assistance with daily living tasks. One hundred and fifteen patients (64%) required medication advice. One hundred and forty one (79%) had health concerns. Eight subjects had returned to paid employment. Issues raised by survivors included a feeling of being abandoned by the healthcare system, poor access to professional psychological support and a fear of further stroke. CONCLUSION There is a need for continuing patient education, improved support for stroke survivors and more active involvement of Primary Care Services in the care of stroke patients following hospital discharge.
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Affiliation(s)
- B J Martin
- Stroke Service, Hairmyres Hospital, East Kilbride
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Hogg RS, Yip B, Chan KJ, Wood E, Craib KJ, O'Shaughnessy MV, Montaner JS. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA 2001; 286:2568-77. [PMID: 11722271 DOI: 10.1001/jama.286.20.2568] [Citation(s) in RCA: 502] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Current recommendations for initiation of antiretroviral therapy in patients infected with human immunodeficiency virus type 1 (HIV) are based on CD4 T-lymphocyte cell counts and plasma HIV RNA levels. The relative prognostic value of each marker following initiation of therapy has not been fully characterized. OBJECTIVE To describe rates of disease progression to death and AIDS or death among patients starting triple-drug antiretroviral therapy, stratified by baseline CD4 cell count and HIV RNA levels. DESIGN, SETTING, AND PARTICIPANTS Population-based analysis of 1219 antiretroviral therapy-naive HIV-positive men and women aged 18 years or older in British Columbia who initiated triple-drug therapy between August 1, 1996, and September 30, 1999. MAIN OUTCOME MEASURE Cumulative mortality rates from the initiation of triple-drug antiretroviral therapy to September 30, 2000, determined using various CD4 cell and plasma HIV RNA thresholds. RESULTS As of September 30, 2000, 82 patients had died of AIDS-related causes, for a crude AIDS-related mortality rate of 6.7%. The product limit estimate (SE) of the cumulative mortality rate at 12 months was 2.9% (0.5%). In univariate analyses, a prior diagnosis of acquired immunodeficiency syndrome (AIDS), CD4 cell count, use of protease inhibitors, and HIV RNA level were associated with mortality. There was no difference in mortality by age or sex. Only CD4 cell count remained statistically significant in the multivariate analysis. After controlling for AIDS, protease inhibitor use, and plasma HIV RNA level at baseline, patients with CD4 cell counts of less than 50/microL were 6.67 (95% confidence interval [CI], 3.61-12.34) times and those with counts of 50/microL to 199/microL were 3.41 (95% CI, 1.93-6.03) times more likely to die than those with counts of at least 200/microL. CONCLUSION Our data demonstrate uniformly low rates of disease progression to death and AIDS or death among patients starting antiretroviral therapy with CD4 cell counts of at least 200/microL. In our study, disease progression to death and AIDS or death was clustered among patients starting therapy with CD4 cell counts less than 200/microL.
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Affiliation(s)
- R S Hogg
- Director, AIDS Research Programme, St Paul's Hospital/University of British Columbia, 667-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
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Chan V, Yip B, Lam YH, Tse HY, Wong HS, Chan TK. Quantitative polymerase chain reaction for the rapid prenatal diagnosis of homozygous alpha-thalassaemia (Hb Barts hydrops fetalis). Br J Haematol 2001; 115:341-6. [PMID: 11703333 DOI: 10.1046/j.1365-2141.2001.03112.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A quantitative polymerase chain reaction (Q-PCR) method based on the TaqMan technology has been devised for the prenatal diagnosis of homozygous alpha*-thalassaemia (south-east Asian type deletion). Primers and TaqMan probes were designed to specifically amplify an alpha*-thal chromosomal fragment or a normal alpha-chromosomal fragment. Variations in input target DNA in individual sample wells were normalized by the simultaneous amplification of a beta-actin gene fragment and results expressed as a ratio to that of beta-actin. There was no overlap of the data between the homozygous alpha*-thal, alpha*-thal and normal subjects. Up to 5% maternal DNA (alpha*-thal) contamination did not affect the specificity of the result. In 31 prenatal diagnoses, the result using Q-PCR compared favourably with the gold standard of Southern hybridization of alpha-genes.
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Affiliation(s)
- V Chan
- University Department of Medicine, Queen Mary Hospital, Hong Kong, China.
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Low-Beer S, Chan K, Wood E, Yip B, Montaner JS, O'Shaughnessy MV, Hogg RS. Health related quality of life among persons with HIV after the use of protease inhibitors. Qual Life Res 2001; 9:941-9. [PMID: 11284213 DOI: 10.1023/a:1008985728271] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study was conducted to determine the effect of the use of HIV protease inhibitors on the quality of life among persons infected with HIV. METHODS Subjects were participants in the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program who had completed two annual participant surveys, one prior to initiating therapy with a protease inhibitor and one after. Quality of life was measured using the Medical Outcomes Study Short Form Health Survey (MOS-SF). Statistical analyses were conducted using parametric and multivariate methods. RESULTS Our analysis was based on 179 HIV-positive individuals. Compared to quality of life at baseline, we found no statistically significant changes in the health perception, pain, physical, role and social functioning MOS-SF subscale scores at follow-up. The measure of mental health was the only component to decline significantly over time. Subanalyses found significant increases in the measures of health perception (p = 0.004), physical (p = 0.037), role (p < 0.001) and social functioning (p = 0.053) for individuals with a low baseline quality of life. For those with a higher quality of life before starting a protease inhibitor containing regimen we observed a significant decline in the subscales of mental health (p = 0.001), physical (p = 0.007), role (p = 0.021) and social functioning (p = 0.003) over the study period. CONCLUSIONS Our findings indicate that despite strict dosage requirements and adverse side effects associated with protease inhibitor use patients are on the whole maintaining their quality of life after starting on a protease inhibitor containing regimen. Continued follow-up of this cohort will be required to determine the long term implications of these observations.
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Affiliation(s)
- S Low-Beer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Palepu A, Yip B, Miller C, Strathdee SA, O'Shaughnessy MV, Montaner JS, Hogg RS. Factors associated with the response to antiretroviral therapy among HIV-infected patients with and without a history of injection drug use. AIDS 2001; 15:423-4. [PMID: 11273228 DOI: 10.1097/00002030-200102160-00021] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Palepu
- Centre for Health Evaluation and Outcome Sciences, and Department of Medicine, University of British Columbia, Canada
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Montaner JS, Harrigan PR, Jahnke N, Raboud J, Castillo E, Hogg RS, Yip B, Harris M, Montessori V, O'Shaughnessy MV. Multiple drug rescue therapy for HIV-infected individuals with prior virologic failure to multiple regimens. AIDS 2001; 15:61-9. [PMID: 11192869 DOI: 10.1097/00002030-200101050-00010] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To characterize the antiviral response and tolerability of a multi-drug rescue therapy (MDRT) among heavily pretreated patients. METHODS Observational study conducted in a single, university-based tertiary referral clinic. Patients (n = 106) who failed several prior regimens started MDRT including at least five antiretroviral (ARV) drugs between August 1997 and June 1998. The most common starting regimen included three nucleoside reverse transcriptase inhibitors and two protease inhibitors, which was prescribed to 45 (42.5%) patients. Virologic response was defined as plasma viral load < 400 copies/ml on at least two consecutive visits. RESULTS Median prior ARV exposure was seven drugs over a median time of 43 months. Fifty-nine percent of the patients were phenotypically (VIRCO Antivirogram) resistant at baseline to seven or more ARV. Median plasma viral load change following initiation of MDRT was -1.04 log10 copies/ml over a median of 15 months. Using intention-to-treat analysis 40% of patients had plasma viral load values < 400 copies/ml between weeks 47 and 57 of follow-up. Twenty-six patients (25%) experienced severe laboratory abnormalities or subjective adverse drug effects and six of these participants discontinued therapy. CONCLUSION MDRT induced a substantial antiviral response in this heavily pretreated group of patients despite extensive phenotypic resistance at baseline. Adverse effects were frequent but generally manageable. Our data suggest that relying exclusively on historical, clinical and laboratory evidence may not be sufficient to rule out a possible antiviral response when multiple drug regimens are used in this heavily pretreated patient population.
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Affiliation(s)
- J S Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada
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Chan V, Yam I, Yip B, Au P, Shing MK, Li CK, Chan TK. Single nucleotide polymorphisms of the factor IX gene for linkage analysis in the southern Chinese population. Br J Haematol 2000; 111:540-3. [PMID: 11122097 DOI: 10.1046/j.1365-2141.2000.02384.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Carrier detection and prenatal testing for haemophilia B in Oriental populations have been hampered by the lack of informative markers within the factor IX (FIX) gene. We detected a T/C nucleotide variation at nucleotide 32770 in the poly-A region of the FIX gene in the mother of a haemophilia B child. Analysis of 139 unrelated alleles revealed a heterozygosity rate of 0.193, thus offering an additional marker for linkage analysis. Together with two other polymorphic sites (5' MseI and 3' HhaI) found in Chinese and Thai populations, these polymorphisms were useful in 66% of the families studied.
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Affiliation(s)
- V Chan
- University Department of Medicine, Queen Mary Hospital, and Department of Paediatrics, Prince of Wales Hospital, Hong Kong.
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Chan V, Yam I, Yip B, Au P, Shing MK, Li CK, Chan TK. Single nucleotide polymorphisms of the factor IX gene for linkage analysis in the southern Chinese population. Br J Haematol 2000. [DOI: 10.1111/j.1365-2141.2000.02384.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anis AH, Guh D, Hogg RS, Wang XH, Yip B, Craib KJ, O'Shaughnessy MV, Schechter MT, Montaner JS. The cost effectiveness of antiretroviral regimens for the treatment of HIV/AIDS. Pharmacoeconomics 2000; 18:393-404. [PMID: 15344307 DOI: 10.2165/00019053-200018040-00007] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To estimate survival, the number of life-years gained and cost effectiveness of antiretroviral therapy (ART) regimens, denoted as ERA-I [zidovudine + (didanosine or zalcitabine)]; ERA-II [stavudine + (didanosine or zalcitabine) or lamivudine + (zidovudine or didanosine or zalcitabine or stavudine)]; and ERA-III [2 nucleoside reverse transcriptase inhibitors + (1 protease inhibitor or 1 non-nucleoside reverse transcriptase inhibitor)]. DESIGN Modelling of drug cost, cost of opportunistic diseases and survival of HIV positive men and women in the province of British Columbia who were first prescribed any ART between October 1992 and June 1996. A 'reference cohort' was modelled upon individuals in a longitudinal cohort of homosexual men followed since 1982. PERSPECTIVE AND SETTING: Third-party payer perspective in British Columbia, Canada. PATIENTS All HIV-positive men and women aged > or =18 years with CD4+ counts < or =350 cells/microL who were enrolled in the province-wide drug treatment programme. MAIN OUTCOME MEASURES Annual costs, survival and cost-effectiveness ratios of successive ART regimens. RESULTS Total costs [1997 Canadian dollars ($Can)] at 12 months under ERA-I, -II and -III were $Can4897, $Can6620 and $Can 11 914, respectively. Survival at 12 months under ERA-I, -II and -III was 89.6%, 91.0% and 97.6%, respectively. The annual incremental cost (estimated by the total incremental cost at 12 months) between ERA-II and ERA-I was $Can1723. The incremental cost-effectiveness ratios between ERA-III and ERA-I, and between ERA-III and ERA-II were $Can58 806 and $Can46 971 per life-year gained, respectively. CONCLUSION We found the cost effectiveness of ERA-III ART regimens well within the range of currently funded therapies for the treatment of other chronic diseases.
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Affiliation(s)
- A H Anis
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Wood E, Yip B, Hogg RS, Sherlock CH, Jahnke N, Harrigan RP, O'Shaughnessy MV, Montaner JS. Full suppression of viral load is needed to achieve an optimal CD4 cell count response among patients on triple drug antiretroviral therapy. AIDS 2000; 14:1955-60. [PMID: 10997400 DOI: 10.1097/00002030-200009080-00011] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize the relationship between plasma viral load (pVL) suppression and triple drug antiretroviral therapy, and the accompanying changes in CD4 cell counts. METHOD Retrospective study of 465 participants in a HIV/AIDS Treatment Program who initiated triple drug therapy between August 1996 and May 1998. Participants were divided into three groups according to their pVL response: (i) non-responders (NR; n = 112) exhibited pVL persistently > 500 copies/ml over the study period; (ii) partial responders (PR; n = 100) achieved a pVL < 100 copies/ml at least once and subsequently rebounded to > 500 copies/ml; and (iii) full responders (FR; n = 253) achieved a pVL < 500 copies/ml and sustained this level for the remainder of the study period. For each group, the accompanying changes in absolute and fractional CD4 cell counts were evaluated. RESULTS The median net change in pVL per person from baseline to the end of the observation period was -0.37, -2.27, and -2.56 log10 copies/ml for NR, PR and FR, respectively. During weeks 68-83, the median CD4 cell count (x 10(6) cells/l) was 150 [interquartile range (IQR) 90-370], 380 (IQR 300-480) and 525 (IQR 305-705) for NR, PR and FR, respectively. Median changes in CD4 cells (x 10(6) cells/l) were -20 (IQR -90 to 40), 150 (IQR 30-250) and 240 (IQR 110-365) for NR, PR, and FR, respectively. The net percentage change in CD4 cells per person was 0% (IQR -34-31), 54% (IQR 6-160), and 83% (IQR 39-173) for NR, PR, and FR, respectively. By weeks 68-83, the median fractional CD4 cells was 0.16 (IQR 0.07-0.22), 0.22 (IQR 0.15-0.28), and 0.26 (IQR 0.17-0.34) for NR, PR and FR respectively. CONCLUSIONS An optimal CD4 cell count response appears to be coupled with continued pVL suppression. Our data indicate that maximal suppression of viral replication should remain the primary goal of therapy.
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Affiliation(s)
- E Wood
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital and the Department of Healthcare and Epidemiology, University of British Columbia, Vancouver, Canada
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Low-Beer S, Chan K, Yip B, Wood E, Montaner JS, O'Shaughnessy MV, Hogg RS. Depressive symptoms decline among persons on HIV protease inhibitors. J Acquir Immune Defic Syndr 2000; 23:295-301. [PMID: 10836751 DOI: 10.1097/00126334-200004010-00003] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To ascertain whether initiation of protease inhibitors was associated with a change in depressive symptoms among persons infected with HIV. METHODS Study subjects included men and women who were enrolled in the HIV/AIDS Drug Treatment Program and who had completed an annual participant survey before and after initiating triple combination therapy with a protease inhibitor. Depressive symptoms were assessed using the Centre for Epidemiologic Studies-Depression scale (CES-D). Statistical analyses to determine the change in CES-D total and subscale scores before and after protease inhibitor use were conducted using parametric and multivariate methods. RESULTS Our analysis was restricted to 453 participants. Of these 234 (52%) were depressed at baseline (CES-D score > or = 16). Compared with nondepressed participants, depressed participants were slightly younger (p = .048), less likely to be employed (p < .001) and more likely to have an annual income less than $10,000 per annum (p < .001). After adjusting for CD4 count, employment status, income, age, and CES-D total or subscale score at baseline, we found a significant improvement in total scale score (p = .001) and depressive mood (p = .002), positive affects (p = .005), and somatic symptoms (p = .011) subscale scores at follow-up. There was no significant change in the interpersonal relations score over the study period. CONCLUSION Our findings indicate that in addition to conferring impressive clinical benefits, protease inhibitor use is associated with a significant improvement in HIV-positive individuals' mental health.
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Affiliation(s)
- S Low-Beer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Weber AE, Yip B, O'Shaughnessy MV, Montaner JS, Hogg RS. Determinants of hospital admission among HIV-positive people in British Columbia. CMAJ 2000; 162:783-6. [PMID: 10750463 PMCID: PMC1231269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND This study was initiated to evaluate the demographic and clinical determinants of admission to hospital among HIV-positive men and women receiving antiretroviral therapy in British Columbia. METHODS The analysis was restricted to participants enrolled in the HIV/AIDS Drug Treatment Program between September 1992 and March 1997 who had completed an annual participant survey, had a viral load determination and had signed a consent form allowing electronic access to their inpatient hospital records. A record linkage was conducted with the BC Ministry of Health to obtain all records of hospital admissions from April 1991 to March 1997. Statistical analyses were carried out using parametric and nonparametric methods and multivariate logistic analyses. RESULTS The study sample comprised 947 participants (859 men, 88 women). Of these, 165 (17%) were admitted to hospital during the study period from May 1, 1996, to Mar. 31, 1997. The median number of admissions was 1 (interquartile range [IQR] 1-2 admissions), and the median length of stay per admission was 3 days (IQR 1-8 days). Admission to hospital was associated with being unemployed (82% of those admitted v. 58% of those not admitted), being an injection drug user (24% v. 17%), reporting a fair or poor health status (46% v. 29%) and having a physician experienced in the management of HIV/AIDS (31% v. 24%). Examination of clinical determinants demonstrated that hospital admission was associated with a previous admission (72% v. 46%), a high viral load (median 74,000 v. 14,000 HIV-1 RNA copies/mL), a low CD4 count (median 0.16 v. 0.27 x 10(9)/L) and an AIDS diagnosis (44% v. 24%). Multivariate logistic regression analysis revealed that being admitted to hospital was independently associated with being unemployed (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.66-4.20), having been previously admitted to hospital (OR 2.30, 95% CI 1.53-3.46), having a high viral load at baseline (OR 1.45, 95% CI 1.16-1.80), being an injection drug user (OR 1.63, 95% CI 1.02-2.62) and having an experienced physician (OR 1.98, 95% CI 1.29-3.03). INTERPRETATION Hospital admission among participants in this study was found to be associated with marginalization and poor health status.
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Affiliation(s)
- A E Weber
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital
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Wood E, Yip B, Gataric N, Montaner JS, O'Shaughnessy MV, Schechter MT, Hogg RS. Determinants of geographic mobility among participants in a population-based HIV/AIDS drug treatment program. Health Place 2000; 6:33-40. [PMID: 10685023 DOI: 10.1016/s1353-8292(99)00028-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study was undertaken to determine the geographic distribution and patterns of migration of persons with HIV in British Columbia. Our analysis was restricted to all HIV-positive men and women aged 18 years and over who had completed a participant survey and were enrolled in the HIV/AIDS Drug Treatment Program between September 1992 and September 1997. Patterns of migration were determined by examining participants whose postal code changed between July 1995 and September 1997. Statistical analysis were carried out using both parametric and non-parametric methodologies. Stepwise logistic regression was used to determine baseline predictors of migration. The final multivariate model revealed that residing in a census subdivision with a population less than 100,000, being heterosexual, acquiring HIV through intravenous drug use, and the absence of AIDS at baseline were all independently associated with moving census subdivisions during the period of observation. In summary, our analyses demonstrate the need for the continued study of the evolving geography and migration patterns of persons with HIV.
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Affiliation(s)
- E Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Cornelisse PG, Montessori V, Yip B, Craib KJ, O'Shaughnessy MV, Montaner JS, Hogg RS. The impact of zidovudine on dementia-free survival in a population of HIV-positive men and women on antiretroviral therapy. Int J STD AIDS 2000; 11:52-6. [PMID: 10667902 DOI: 10.1258/0956462001914788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Our objective was to characterize the effect of zidovudine therapy on AIDS dementia complex (dementia) free survival among HIV-infected men and women in a population-based cohort with free access to antiretroviral therapy in the province of British Columbia. Time to diagnosis of dementia among individuals was examined on the basis of zidovudine duration, CD4+ cell count at first treatment, gender, and transmission group [men having sex with men (MSM), intravenous drug users (IDU), heterosexuals]. We restricted the analysis to subjects with CD4+ cells counts within 12 months prior to treatment start date. Among 641 participants eligible for analysis, median duration of follow-up was 3.6 years, under which 86 (9.3%) events of dementia occurred. Participants were less likely to develop dementia with: increased zidovudine exposure (OR=0.26, 95% CI: 0.14-0.49), at least 260 CD4+ cells/mm3 (median) (OR=0.52, 95% CI: 0.34-0.78), and MSM risk group (OR=0.57, 95% CI: 0.35-0.94). Those infected through heterosexual contact had an increased risk (RR=2.04, 95% CI: 1.02-4.07). Using Cox's proportional hazards model, controlling for CD4+ cell count at treatment start date, independent predictors of dementia-free survival were: duration of zidovudine (OR=0.28, 95% CI: 0.15-0.52) and MSM transmission group (OR=0.61, 95% CI: 0.37-1.00). In this observational treatment cohort, factors associated with dementia-free survival include duration of zidovudine (AZT) therapy and MSM transmission group. It is not clear from these data whether the AZT protective effect is exclusive to this agent or whether other therapies might offer a similar protective effect.
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Affiliation(s)
- P G Cornelisse
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada
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Harrigan PR, Hertogs K, Verbiest W, Pauwels R, Larder B, Kemp S, Bloor S, Yip B, Hogg R, Alexander C, Montaner JS. Baseline HIV drug resistance profile predicts response to ritonavir-saquinavir protease inhibitor therapy in a community setting. AIDS 1999; 13:1863-71. [PMID: 10513644 DOI: 10.1097/00002030-199910010-00008] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether baseline drug resistance assays could help to predict treatment failure with the protease inhibitor combination ritonavir-saquinavir. METHODS Baseline HIV-1 drug resistance was determined for 76 consecutive patients who started treatment with the dual protease inhibitor combination ritonavir-saquinavir between September 1996 and June 1997 either alone or in combination with other antiviral agents. Resistance to 10 different antiviral agents was assessed by both phenotype (Virco Antivirogram) and genotype (Vircogen). RESULTS Resistance inferred from viral genotype was similar to measured phenotypic resistance for both ritonavir and saquinavir (P<0.01). Baseline drug resistance phenotype was predictive of poor virological response to this dual protease inhibitor combination, despite the confounding effects of other antivirals. Patients were at least four times less likely to achieve a 0.5 log10 decrease in plasma HIV RNA viral load if their viral isolates were resistant to ritonavir or saquinavir. Patients classified as resistant to either drug using either method had median decreases in plasma viral load of 0.05 log10 HIV RNA copies/ml or less, compared to >0.8 log10 for those with sensitive virus. Patients resistant to both drugs never achieved plasma viral loads <100000 copies/ml. As little as fourfold increases in baseline resistance appeared to be sufficient to compromise even dual protease inhibitor therapy. CONCLUSION Baseline resistance to ritonavir or saquinavir or both was associated with a poor antiviral response. Our data suggest that the measurement of drug resistance may assist in optimizing antiretroviral therapy in the clinic.
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Affiliation(s)
- P R Harrigan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
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Raboud JM, Rae S, Hogg RS, Yip B, Sherlock CH, Harrigan PR, O'Shaughnessy MV, Montaner JS. Suppression of plasma virus load below the detection limit of a human immunodeficiency virus kit is associated with longer virologic response than suppression below the limit of quantitation. J Infect Dis 1999; 180:1347-50. [PMID: 10479170 DOI: 10.1086/314998] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Suppression of human immunodeficiency virus type 1 plasma virus load (PVL) to <20 copies/mL is associated with a longer virologic response after initiation of antiretroviral therapy. The relationship between duration of virologic response and PVL nadir according to a less sensitive assay was explored. When compared with subjects with a PVL nadir >500 copies/mL, the relative risks of PVL rising above 1000 copies/mL for participants in the INCAS trial and the British Columbia Drug Treatment Program with a PVL nadir below the limit of detection (LOD) were 0.04 (95% confidence interval [CI], 0.02-0.09) and 0.06 (95% CI, 0.03-0.12), respectively. The corresponding relative risks for persons with a detectable but not quantifiable PVL nadir were 0.25 (95% CI, 0.13-0.50) and 0.54 (95% CI, 0.25-1.19). The relative risks of virologic failure associated with a PVL nadir detectable but not quantifiable and a PVL nadir below the LOD were statistically different (P<.0001) in both data sets.
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Affiliation(s)
- J M Raboud
- Data and Methodology Program, Canadian HIV Trials Network, Vancouver, Canada
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Jahnke N, Yip B, Hogg RS, O'Shaughnessy M, Montaner JS. Antiviral effect of AZT versus stavudine in combination with lamivudine and indinavir in the context of a populational study. J Acquir Immune Defic Syndr 1999; 21:347-8. [PMID: 10428115 DOI: 10.1097/00126334-199908010-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hogg RS, Yip B, Kully C, Craib KJ, O'Shaughnessy MV, Schechter MT, Montaner JS. Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. CMAJ 1999; 160:659-65. [PMID: 10102000 PMCID: PMC1230111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The efficacy of triple-drug antiretroviral regimens in the treatment of patients infected with HIV has been established in several randomized clinical trials. However, the effectiveness of these new regimens in patient populations outside clinical trials remain unproven. This study compared mortality and AIDS-free survival among HIV-infected patients in British Columbia who were treated with double- and triple-drug regimens. METHODS The authors used a prospective, population-based cohort design to study a population of HIV-positive men and women 18 years or older for whom antiretroviral therapy was first prescribed between Oct. 1, 1994, and Dec. 31, 1996; all patients were from British Columbia. Rates of progression from the initiation of antiretroviral therapy to death or to diagnosis of primary AIDS were determined for patients who initially received an ERA-II regimen (2 nucleoside analogue reverse transcriptase inhibitors [NRTIs] including lamivudine or stavudine, or both) and for those who initially received an ERA-III regimen (triple-drug regimen consisting of 2 NRTIs and a protease inhibitor [indinavir, ritonavir or saquinavir] or a non-NRTI [nevirapine]). RESULTS A total of 500 men and women (312 receiving an ERA-III regimen and 188 an ERA-III regimen) were eligible. Patients in the ERA-III group survived significantly longer than those in the ERA-II group. As of Dec. 31, 1997, 40 patients had died (35 in the ERA-II group and 5 in the ERA-III group), for a crude mortality rate of 8.0%. The cumulative mortality rates at 12 months were 7.4% (95% confidence interval [CI] 5.9% to 8.9%) for patients in the ERA-II group and 1.6% (95% CI 0.7% to 2.5%) for those in the ERA-III group (log rank p = 0.003). The likelihood of death was more than 3 times higher among patients in the ERA-II group (mortality risk ratio 3.82 [95% CI 1.48% to 9.84], p = 0.006). After adjustment for prophylaxis for Pneumocystis carinii pneumonia or Mycobacterium avium infection, AIDS diagnosis, CD4+ cell count, sex and age at initiation of therapy, the likelihood of death among patients in the ERA-II group was 3.21 times higher (95% CI 1.24 to 8.30, p = 0.016) than in the ERA-III group. Cumulative rates of progression to AIDS or death at 12 months were 9.6% (95% CI 7.7% to 11.5%) in the ERA-II group and 3.3% (95% CI 1.8% to 4.8%) in the ERA-III group (log rank p = 0.006). After adjustment for prognostic variables (prophylaxis for P. carinii pneumonia or M. avium infection, CD4+ cell count, sex and age at initiation of treatment), the likelihood of progression to AIDS or death at 12 months among patients in the ERA-II group was 2.37 times higher (95% CI 1.04 to 5.38, p = 0.040) than in the ERA-III group. INTERPRETATION This population-based cohort study confirms that patients initially treated with a triple-drug antiretroviral regimen comprising 2 NRTIs plus protease inhibitor or a non-NRTI have a lower risk of morbidity and death than patients treated exclusively with 2 NRTIs.
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Forrest DM, Seminari E, Hogg RS, Yip B, Raboud J, Lawson L, Phillips P, Schechter MT, O'Shaughnessy MV, Montaner JS. The incidence and spectrum of AIDS-defining illnesses in persons treated with antiretroviral drugs. Clin Infect Dis 1998; 27:1379-85. [PMID: 9868646 DOI: 10.1086/515030] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The incidence and spectrum of primary AIDS-defining illnesses in human immunodeficiency virus-positive patients receiving antiretroviral drugs may have changed since the introduction of newer antiretroviral agents. We performed a retrospective analysis of patients enrolled in the British Columbia Drug Treatment Program who were ever prescribed antiretroviral drugs between 1 January 1994 and 31 December 1996. Rates were calculated on a 6-month basis. There were 344 AIDS cases diagnosed among 2,533 participants between 1994 and 1996. The incidence of primary AIDS diseases decreased from 1994 to 1996, with a sharp decline in 1995 and 1996. There was no statistically significant change in the incidence of primary AIDS diagnoses relative to one another, and Pneumocystis carinii pneumonia and Kaposi's sarcoma remain the most common AIDS index diagnoses. In patients receiving antiretroviral therapy in the modern era, the incidence of AIDS-defining illnesses has decreased substantially, but the spectrum of AIDS-defining illnesses remains unchanged.
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Affiliation(s)
- D M Forrest
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Rhone SA, Hogg RS, Yip B, Sherlock C, Conway B, Schechter MT, O'Shaughnessy MV, Montaner JS. Do dual nucleoside regimens have a role in an era of plasma viral load-driven antiretroviral therapy? J Infect Dis 1998; 178:662-8. [PMID: 9728533 DOI: 10.1086/515365] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This study was undertaken to characterize predictors of response to double nucleoside combinations among 245 human immunodeficiency virus-infected persons initiating antiretroviral therapy. The median time for receiving antiretroviral therapy in this group was 6 months, and the plasma virus load was 58,000 copies/mL. The most commonly prescribed regimens were zidovudine/lamivudine (154 subjects, 63%) and stavudine/lamivudine (46 subjects, 19%). A total of 96 (39%) subjects had their virus load decrease to < 500 copies/mL after the initiation of therapy. Of the 245 study subjects, 102 (41.6%) had > or = 5 months of follow-up and two or more consecutive virus load determinations performed after the start of antiretroviral therapy. Multivariate analysis demonstrated that baseline virus load was the only significant factor associated with obtaining two or more plasma virus loads of < 500 copies/mL. Overall, these data demonstrate that dual nucleoside therapy (using currently licensed agents) cannot reliably achieve a high level of suppression of plasma virus load.
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Affiliation(s)
- S A Rhone
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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