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Davies B, Forman J, McIlroy C, Joe H, Safabakhsh S, Liew J, Parker J, Du D, Andrade JG, Bennett MT, Hawkins NM, Chakrabarti S, Yeung J, Deyell MW, Krahn AD, Moss R, Ong K, Laksman Z. Patient experiences of implantable cardiac monitoring in hypertrophic cardiomyopathy: an exploratory study. Eur J Cardiovasc Nurs 2023; 22:780-785. [PMID: 36705579 DOI: 10.1093/eurjcn/zvad017] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
AIMS Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease. Insertable cardiac monitors (ICMs) are increasingly used in this population to provide closer monitoring, with the potential for notification systems. However, little is known regarding the psychological impact this information may have on patients. The Abbott Confirm Rx™ ICM has the capability of connecting to the patient's smartphone to enable active participation in their care, as well as two-way communication between the patient and their care providers. This study aimed to explore individuals' experiences of having a smartphone-enabled ICM to monitor for arrhythmias in HCM. METHODS AND RESULTS Semi-structured interviews were conducted with 10 participants. Utilizing a grounded theory approach, the interview guide was modified based on emerging themes throughout the study. Reflexive thematic analysis was applied to categorize interview data into codes and overacting themes, with each interview independently coded by two study members. Analysis revealed three key themes: (i) psychological impact, (ii) educational needs, and (iii) technology expectations. Participants reported that receiving feedback from ICM transmissions resulted in improved symptom clarity, providing reassurance, and aiding implantable cardioverter defibrillator decision-making. Some participants reported uncertainty regarding when to send manual transmissions. Lastly, participants reported the app interface did not meet expectations with regard to the amount of data available for patients. CONCLUSION Overall, utilizing a smartphone app to facilitate two-way communication of ICM transmissions was well accepted. Future directions include addressing gaps in educational needs and improvements in the patient interface with increased access to data.
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Affiliation(s)
- Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Jacqueline Forman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Cheryl McIlroy
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Heather Joe
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Sina Safabakhsh
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Janet Liew
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Jeremy Parker
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Darson Du
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Jason G Andrade
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Matthew T Bennett
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Nathaniel M Hawkins
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Santabhanu Chakrabarti
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - John Yeung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Marc W Deyell
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Robert Moss
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Kevin Ong
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
| | - Zachary Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Room 220, 1033 Davie St. Vancouver BC, V6E 1M7, Canada
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Lewine EB, Patel Z, Forman J, Manvar A, Hanna I. Thyroid Metastasis to the Colon. ACG Case Rep J 2023; 10:e01204. [PMID: 37954929 PMCID: PMC10635595 DOI: 10.14309/crj.0000000000001204] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Approximately 1% of colorectal cancers can be attributed to metastatic neoplasms originating from other primary sources typically the lung, ovary, breast, prostate, kidney, or skin. Metastasis to the colon from the thyroid however is exceedingly rare. We present a 76-year-old man with a history of papillary thyroid carcinoma WHO presented with colon polyps consistent with carcinoma from his papillary thyroid carcinoma. The findings in this report suggest prompt colorectal cancer screening after thyroid cancer diagnosis and regular screening thereafter.
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Affiliation(s)
- Eliza B. Lewine
- Department of Gastroenterology, New York University Langone Hospital Long Island, Mineola, NY
| | - Zinal Patel
- Department of Gastroenterology, New York University Langone Hospital Long Island, Mineola, NY
| | - Jacqueline Forman
- Department of Gastroenterology, New York University Langone Hospital Long Island, Mineola, NY
| | - Amar Manvar
- Department of Gastroenterology, New York University Langone Hospital Long Island, Mineola, NY
| | - Iman Hanna
- Department of Pathology, New York University Langone Hospital Long Island, Mineola, NY
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3
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Forman J, Murtagh E, Cheung J, Chakrabarti S, Macleod S, MacEwing C, Owens S, Alley H, Bangma K, Villeneuve M, Lauck S. Development of a patient and clinician co-led education program to promote living well with an implantable cardioverter defibrillator: Insights from a pilot project. PEC Innov 2022; 1:100104. [PMID: 37213750 PMCID: PMC10194333 DOI: 10.1016/j.pecinn.2022.100104] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 05/23/2023]
Abstract
Objective To evaluate a pilot education program designed to improve patients' experience of living well with an implantable cardioverter-defibrillator (ICD). Methods Patient Partners with previously implanted ICD and clinicians collaboratively performed monthly education sessions for potential and recent ICD recipients. Curriculum development was informed by current evidence of ICD patients' unique educational needs; delivery format transitioned to a virtual platform following the onset of COVID-19. Participants' experience was evaluated using a tailored questionnaire to explore preliminary insights. Results 126 participants (median age: 62 years; women: 30%) attended 24 sessions. In-person participants (n = 62, 49.2%) reported sessions as helpful (n = 56, 94%) with regards to format and Patient Partner interactions. Virtual participants 64 (50.8%) completed an electronic survey (n = 27, 45%); reporting sufficient information for most topics with the exception of potential psychological effects of ICD implantation. Patient Partners as collaborative session leaders was perceived to be very helpful (n = 22, 82%) or somewhat helpful (n = 5, 18%). Conclusion This novel educational partnership met the learning needs of patients at the vulnerable time of new cardiac device implantation of both in-person and virtual formats. Innovation The inclusion of Patient Partners in co-led cardiac education informs novel approach to care that may improve patients' experiences of living well with complex technology.
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Affiliation(s)
| | | | | | - Santabhanu Chakrabarti
- St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | - Sandra Lauck
- St. Paul’s Hospital, Vancouver, Canada
- University of British Columbia School of Nursing, Vancouver, Canada
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4
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J Johansen N, Dejgaard TF, Lund A, Moeller HJ, Forman J, Vilsboell T, Andersen HU, Knop FK. Residual inflammatory risk appeared related to weight, atherogenic lipid profile and biomarkers of inflammation, but not to glycaemic control in type 1 diabetes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mortality associated with atherosclerotic cardiovascular disease reduces average life expectancy by more than a decade in type 1 diabetes. Systemic inflammation drives atherosclerosis, and the concept of residual inflammatory risk (defined by high-sensitivity C-reactive protein (hsCRP) ≥2 mg/l) poses a potential, new therapeutic target for lowering residual cardiovascular risk in type 1 diabetes. However, the characteristics of individuals with residual inflammatory risk in type 1 diabetes are unknown.
Purpose
Identify differences in relevant demographics, clinical and paraclinical parameters for individuals with residual inflammatory risk as compared to those without in type 1 diabetes.
Methods
Baseline characteristics as stratified for CRP ≥2 mg/l were analysed in 105 patients with type 1 diabetes participating in a previously published clinical trial. The study population was sampled to represent the broad background population struggling with glycaemic control and with a high cardiovascular risk.
Results
Residual inflammatory risk was seen in 39.1% of the study population. Compared to individuals without residual inflammatory risk, individuals with residual inflammatory risk were more frequently women, had increased body weight, body mass index and dual-energy X-ray absorptiometry (DXA)-assessed fat mass and exhibited elevated levels of low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and total cholesterol as well as triglycerides, interleukin 6 and tumour necrosis factor alpha (Table 1). Glycated haemoglobin, blood pressure and markers of renal function were similar between groups (Table 1).
Conclusion
In the present cohort of individuals with type 1 diabetes, residual inflammatory risk was seen in 39.1% (similar to what is observed outside of type 1 diabetes) and appeared related to overweight/obesity, an atherogenic lipid profile and circulating biomarkers of inflammation but not to glycaemic control, blood pressure or renal function.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZenecaHerlev Gentofte Hospital
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Affiliation(s)
- N J Johansen
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - T F Dejgaard
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - A Lund
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - H J Moeller
- Aarhus University Hospital , Aarhus , Denmark
| | - J Forman
- University of Copenhagen , Copenhagen , Denmark
| | - T Vilsboell
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - H U Andersen
- Steno Diabetes Center Copenhagen , Copenhagen , Denmark
| | - F K Knop
- Herlev and Gentofte Hospital , Copenhagen , Denmark
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Lewis K, Nair K, Armstrong A, Lauck S, Stacey D, Forman J, Birnie D, Healey J, Krahn A, McGillion M, Schwalm J, Carroll S. FACTORS INFLUENCING PATIENT DECISION AID USE FOR IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR DECISIONS IN THREE CANADIAN ACADEMIC HOSPITALS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.211] [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: 11/02/2022] Open
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Deyell MW, Hoskin K, Forman J, Laksman ZW, Hawkins NM, Bennett MT, Yeung-Lai-Wah JA, Chakrabarti S, Krahn AD, Andrade JG. Same-day discharge for atrial fibrillation ablation: outcomes and impact of ablation modality. Europace 2022; 25:400-407. [PMID: 36164922 PMCID: PMC9935052 DOI: 10.1093/europace/euac170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Same-day discharge is increasingly common after catheter ablation for atrial fibrillation (AF). However, the impact of same-day discharge on healthcare utilization after ablation and whether this differs by ablation modality remains uncertain. We examined the safety, efficacy, and subsequent healthcare utilization of a same-day discharge protocol for AF ablation, including radiofrequency (RF) and cryoballoon ablation, in a contemporary cohort. METHODS AND RESULTS All consecutive patients for whom full healthcare utilization data were available at two centres and who underwent AF ablation from 2018 to 2019 were included. Same-day discharge was the default strategy for all patients. The efficacy and safety outcomes were proportions of same-day discharge and readmission/emergency room (ER) visits, and post-discharge complications, respectively. Of the 421 patients who underwent AF ablation (mean 63.3 ± 10.2 years, 33% female), 90.5% (381/421) achieved same-day discharge with no difference between RF and cryoballoon ablation (89.8 vs. 95.1%, adjusted P = 0.327). Readmission ≤30 days occurred in 4.8%, with ER visits ≤30 days seen in 26.1% with no difference between ablation modalities (P = 0.634). Patients admitted overnight were more likely to present to the ER (40.0 vs. 24.7% with same-day discharge, P = 0.036). The overall post-discharge complication rate was low at 4/421 (1.0%), with no difference between ablation modality (P = 0.324) and admission/same-day discharge (P = 0.485). CONCLUSION Same-day discharge can be achieved in a majority of patients undergoing RF or cryoballoon ablation for AF. Healthcare utilization, particularly ER visits, remains high after AF ablation, regardless of ablation modality or same-day discharge.
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Affiliation(s)
- Marc W Deyell
- Corresponding author. Tel: +1 605 806 8256. E-mail address:
| | - Kurt Hoskin
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Jacqueline Forman
- St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Zachary W Laksman
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Nathaniel M Hawkins
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Matthew T Bennett
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - John A Yeung-Lai-Wah
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Santabhanu Chakrabarti
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Jason G Andrade
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
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7
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Missel M, Hansen MH, Petersson NB, Forman J, Højskov IE, Borregaard B. Transforming the experience of illness into action - Patient and spouses experiences of involvement in a patient and family advisory council. Patient Educ Couns 2021; 104:1481-1486. [PMID: 33257200 DOI: 10.1016/j.pec.2020.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/07/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective was to explore patients' and spouses' perception and attitudes towards participating in a patient and family advisory council. METHODS A qualitative study with interviews conducted within a phenomenological-hermeneutical frame, inspired by Ricoeur were conducted with current and former participants (patients and/or spouses) of a patient and family advisory council in Denmark. RESULTS In total, 16 participants were interviewed (12 former patients/four spouses) with a mean age of 68 (range 49-79) and 44 % women. After the analysis, perceptions and attitudes towards participating in a patient advisory council emerged in four themes; "Payback", "A personal invitation", "A safe and equal atmosphere", and "Sharing, caring, and healing". CONCLUSION Participants of an advisory council express a need for "paying it back" to the health care system. When being part of the advisory council, the participants expressed feeling a genuine engagement and interest from the health-care professionals - leading to a feeling of being equal and taken seriously. The advisory council increased the process of recovery by sharing narratives with peers. PRACTICAL VALUE Experiences of being part of an advisory council lead to an understanding of "why" former patients and spouses participate. This knowledge can help others to recruit members.
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Affiliation(s)
- Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Nadja Buch Petersson
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | - Jacqueline Forman
- Centre for Heart Valve Innovation, St. Pauls Hospital, Vancouver, Canada
| | - Ida Elisabeth Højskov
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark; Department of Cardiology, Odense University Hospital, Denmark; University of Southern Denmark, 5000, Odense C, Denmark.
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Lauck SB, Bains VK, Nordby D, Iacoe E, Forman J, Polderman J, Farina L. Responding to the COVID-19 pandemic: Development of a critical care nursing surge model to meet patient needs and maximise competencies. Aust Crit Care 2021; 35:13-21. [PMID: 34052091 PMCID: PMC8157033 DOI: 10.1016/j.aucc.2021.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/30/2020] [Accepted: 02/15/2021] [Indexed: 11/04/2022] Open
Abstract
Background The current coronavirus disease 2019 (COVID-19) pandemic is creating unprecedented and unchartered demands on critical care units to meet patient needs and adapt the delivery of health services. Critical care nurses play a pivotal role in developing models of care that are effective, flexible, and safe. Objectives We report on the accelerated development of a critical care nursing surge model responsive to escalating needs for intensive care capacity. Methods We conducted an exploratory prospective observational cohort study that included (i) a self-assessment and survey of learning needs of noncritical care nurses identified as candidate groups for redeployment in the intensive care unit and (ii) a pilot implementation of a team nursing model evaluated by individual questionnaires and the conduct of focus groups. We used descriptive statistics and qualitative content analysis to analyse the exploratory findings. Results We surveyed 147 noncritical care nurses; 99 (67.3%) self-assessed at the lowest level of critical care competency, whereas 33 (24.3%) reported feeling able to help care for a critically ill patient under the direction of a critical care nurse. Identified learning needs included appropriate use of personal protective equipment in the intensive care unit (n = 123, 83.7%), use of specialised equipment (n = 103, 85.1%), basic mechanical ventilation, and vasoactive medication. We completed 11 team nursing pilot assignments with dyads of critical care and noncritical care nurses categorised in tiers of competencies. Nurses reported high levels of perceived support and provision of safe care; multiple recommendations were identified to improve the model of care delivery and communication. Conclusions The complexity, acuity, and unpredictability of the COVID-19 pandemic is placing new demands on critical care nurses to modify existing processes for care delivery while ensuring excellent outcomes and professional satisfaction. The study findings provide a road map to support nursing engagement in meeting patient needs.
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Affiliation(s)
- Sandra B Lauck
- Providence Health Care, University of British Columbia, Vancouver, Canada.
| | | | | | - Emma Iacoe
- Providence Health Care, University of British Columbia, Vancouver, Canada.
| | - Jacqueline Forman
- Providence Health Care, University of British Columbia, Vancouver, Canada.
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Spangmose AL, Ginström Ernstad E, Malchau S, Forman J, Tiitinen A, Gissler M, Opdahl S, Romundstad LB, Bergh C, Wennerholm UB, Henningsen AA, Pinborg A. Obstetric and perinatal risks in 4601 singletons and 884 twins conceived after fresh blastocyst transfers: a Nordic study from the CoNARTaS group. Hum Reprod 2021; 35:805-815. [PMID: 32294185 DOI: 10.1093/humrep/deaa032] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/13/2019] [Indexed: 01/01/2023] Open
Abstract
STUDY QUESTION Are obstetric and perinatal outcomes in pregnancies after fresh blastocyst transfer (BT) comparable with those born after fresh cleavage stage transfer (CT) and spontaneous conception (SC)? SUMMARY ANSWER Fresh BT is associated with a higher risk of placental and perinatal complications. WHAT IS KNOWN ALREADY BT optimizes the selection of top-quality embryos and increases pregnancy and live birth rates per transfer compared to CT. However, concerns have been raised as extended culture duration may increase obstetric complications and impair perinatal outcomes. Previous studies have shown a higher risk of preterm birth (PTB) among infants born after BT compared with CT. Pregnancies after BT are also prone to a higher risk of same-sex twins after single embryo transfer (SET). STUDY DESIGN, SIZE, DURATION A retrospective register-based cohort study used data from Denmark, Norway and Sweden including three cohorts: 56 557 singletons and 16 315 twins born after fresh IVF/ICSI cycles and 2 808 323 SC singletons in Denmark (birth years 1997-2014), Norway (2010-2015) and Sweden (2002-2015). Of the fresh IVF/ICSI singletons, 4601 were born after BT and 51 956 after CT. The twin cohort consisted of 884 fresh IVF/ICSI children born after BT and 15 431 fresh IVF/ICSI children born after CT. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained from a large Nordic cohort of children born after ART and SC initiated by the Committee of Nordic ART and Safety (CoNARTaS). The CoNARTaS cohort was established by cross-linking National ART-, Medical Birth-, and National Patients Registers using the unique personal identification number, allocated to every citizen in the Nordic countries. Obstetric and perinatal outcomes after BT, CT and SC were compared using logistic regression analysis. For perinatal outcomes, we calculated gestational age based on the date of oocyte pick-up (OPU) and in sensitivity analyses on data from Denmark and Norway, we also calculated gestational age based on the second-trimester ultrasonography (US) scan. Risk of pregnancies with same-sex twins after SET was used as a proxy for risk of monozygotic twins. Adjustments were made for child's sex, birth year, parity (0 or >1), maternal age, body mass index, smoking, educational level, fertilization method (IVF/ICSI), the number of aspirated oocytes, SET and country. Information on educational level and the number of aspirated oocytes was not available for Norway. Children born after frozen embryo transfer were not included. The birth cohorts were restricted according to the year in which BT was introduced in the different countries. MAIN RESULTS AND THE ROLE OF CHANCE A higher risk of placenta previa was found in singleton pregnancies after BT compared with CT (adjusted odds ratio [aOR] 2.11 [95% CI 1.76; 2.52]). Singletons born after BT had a higher risk of PTB (aOR 1.14 [95% CI 1.01; 1.29]) compared with CT singletons, when estimated based on OPU. Furthermore, an altered male/female ratio (aOR 1.13 [95% CI 1.06; 1.21]) with more males following BT compared with CT was seen. Risk of same-sex twins after SET was higher after single BT compared with single CT (aOR 1.94 [95% CI 1.42; 2.60]). LIMITATIONS, REASONS FOR CAUTION Residual confounding cannot be excluded, in particular related to duration and cause of infertility that we could not adjust for due to lack of reliable data. WIDER IMPLICATIONS OF THE FINDINGS Extended embryo culture to the blastocyst stage has the potential to compromise obstetric and perinatal outcomes in fresh cycles. These results are important since an increasing number of IVF/ICSI treatments are performed as BT. STUDY FUNDING/COMPETING INTEREST(S) NORDFORSK (project no: 71450). The Research Fund of Rigshospitalet, Copenhagen University Hospital. ReproUnion Collaborative study, co-financed by the European Union, Interreg V ÖKS. Grants from Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (LUA/ALF 70940), Hjalmar Svensson Research Foundation. The Research Council of Norway through its Centres of Excellence funding scheme, project number 262700. None of the authors has any conflicts of interests to declare regarding this study. TRIAL REGISTRATION NUMBER ISRCTN11780826.
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Affiliation(s)
- A L Spangmose
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - E Ginström Ernstad
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S Malchau
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Tiitinen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Gissler
- Information Services Department, Finnish Institute for Health and Welfare (THL), Helsinki, Finland and Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - S Opdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - L B Romundstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Spiren Fertility Clinic, Trondheim, Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - C Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - U B Wennerholm
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A A Henningsen
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Pinborg
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Lauck SB, Achtem L, Borregaard B, Baumbusch J, Afilalo J, Wood DA, Forman J, Cheung A, Ye J, Webb JG. Can you see frailty? An exploratory study of the use of a patient photograph in the transcatheter aortic valve implantation programme. Eur J Cardiovasc Nurs 2020; 20:252–260. [PMID: 33611409 DOI: 10.1177/1474515120953739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Frailty is an important consideration in the assessment of transcatheter aortic valve implantation patients. The documentation of a patient photograph to augment the objective measurement of frailty has been adopted by some transcatheter aortic valve implantation multidisciplinary (TAVI) programmes. METHODS We used a prospective two-part multimethod study design. In part A, we examined the concordance between the Essential Frailty Toolset (EFT) and the score attributed by healthcare professionals based on visual rating of photographs using kappa estimates and linear regression. In part B, we conducted a content analysis qualitative study to elicit information about how the TAVI multidisciplinary team used photographs to form impressions about frailty. FINDINGS Part A: 94 healthcare professionals (registered nurses/allied health 65%; physicians 35%) rated 40 representative photographs (women 42.5%; mean age 83.4±7.5; mobility aid 40%) between 0 (robust) and 5 (very frail). The estimate of weighted kappa was 0.2575 (95% confidence interval 0.082-0.433), indicating fair agreement between median healthcare professional visual and EFT score, especially when the EFT was 1 or 4. There was significant discordance among raters (kappa estimate 0.110, 95% confidence interval 0.079-0.141). Age, sex and mobility aid did not have a significant effect on score discordance. Part B: 12 members of the TAVI multidisciplinary team (registered nurses 27.5%; physicians 72.5%) were shown a series of six representative patient photographs. The following themes emerged from the data: (a) looking at the outside; (b) thinking about the inside; (c) use but with caution; and (d) a better approach. CONCLUSION A patient photograph offers complementary information to the multimodality assessment of TAVI patients.
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Affiliation(s)
- Sandra B Lauck
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada.,School of Nursing, University of British Columbia, Canada
| | - Leslie Achtem
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark.,Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Denmark
| | | | - Jonathan Afilalo
- Centre for Clinical Epidemiology, Jewish General Hospital, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
| | - Jacqueline Forman
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada.,School of Nursing, University of British Columbia, Canada
| | - Anson Cheung
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
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Lauck S, Wood DA, Sathananthan J, Forman J, Webb JG. Anesthesia for TAVR Patients: Should We Focus on Goals of Care? Structural Heart 2020. [DOI: 10.1080/24748706.2020.1774950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lauck S, Forman J, Borregaard B, Sathananthan J, Achtem L, McCalmont G, Muir D, Hawkey MC, Smith A, Højberg Kirk B, Wood DA, Webb JG. Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes. Eur J Cardiovasc Nurs 2020; 19:537-544. [PMID: 32498556 PMCID: PMC7717283 DOI: 10.1177/1474515120934057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic continues to significantly impact the treatment of people living with aortic stenosis, and access to transcatheter aortic valve implantation. Transcatheter aortic valve implantation (TAVI) programmes require unique coordinated processes that are currently experiencing multiple disruptions and are guided by rapidly evolving protocols. We present a series of recommendations for TAVI programmes to adapt to the new demands, based on recent evidence and the international expertise of nurse leaders and collaborators in this field. Although recommended in most guidelines, the uptake of the role of the TAVI programme nurse is uneven across international regions. COVID-19 is further highlighting why a nurse-led central point of coordination and communication is a vital asset for patients and programmes. We propose an alternative streamlined evaluation pathway to minimize patients' pre-procedure exposure to the hospital environment while ensuring appropriate treatment decision and shared decision-making. The competing demands created by COVID-19 require vigilant wait list management, with risk stratification, telephone surveillance and optimized triage and prioritization. A minimalist approach with close scrutiny of all parts of the procedure has become an imperative to avoid any complications and ensure patients' accelerated recovery. Lastly, we outline a nurse-led protocol of rapid mobilization and reconditioning as an effective strategy to facilitate safe next-day discharge home. As the pandemic abates, TAVI programmes must facilitate access to care without compromising patient safety, enable hospitals to manage the competing demands created by COVID-19 and establish new processes to support patients living with valvular heart disease.
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Affiliation(s)
- Sandra Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - Jacqueline Forman
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - Leslie Achtem
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | | | - Douglas Muir
- James Cook University Hospital, Middlesbrough, UK
| | | | - Amanda Smith
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Canada
| | - Bettina Højberg Kirk
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - David A Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
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Lauck S, Lewis K, Forman J, Smith A, Carroll S. PROMOTING SHARED DECISION-MAKING FOR THE TREATMENT OF HEART VALVE DISEASE IN CANADA: A CALL FOR NURSING LEADERSHIP. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.377] [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: 10/25/2022] Open
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Forman J, Murtagh E, Cheung J, MacLeod S, Lauck S, Chakrabarti S, Owens S, MacEwing C. INCORPORATING PATIENT AND FAMILY-CENTRED CARE IN THE DEVELOPMENT OF AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR PATIENT EDUCATION PROGRAM. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.380] [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: 11/26/2022] Open
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15
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Malchau SS, Henningsen AA, Forman J, Loft A, Nyboe Andersen A, Pinborg A. Cumulative live birth rate prognosis based on the number of aspirated oocytes in previous ART cycles. Hum Reprod 2019; 34:171-180. [PMID: 30541039 DOI: 10.1093/humrep/dey341] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/01/2018] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is the number of aspirated oocytes in the first ART cycle associated with the cumulative live birthrates (CLBR) in subsequent cycles? SUMMARY ANSWER The number of aspirated oocytes in the first cycle was associated with CLBR in subsequent cycles. Previous treatment response predicts outcome in future cycles. WHAT IS KNOWN ALREADY Previous reports have shown a positive association between the number of retrieved oocytes and live birthrate per fresh treatment cycle. This has also been shown for the CLBR in one complete ART-cycle, including possible subsequent frozen-thawed transfers (FER). It has been shown that women with less than five oocytes in the first cycle have poorer outcome within six complete cycles than women with more than 12 oocytes, suggesting that the number of aspirated oocytes in the first cycle may be reproduced in later cycles. However, other studies have shown that an initial low treatment response may be improved with increased gonadotrophin start-dose. STUDY DESIGN, SIZE, DURATION The Danish National IVF-registry includes all ART treatments in public and private clinics since 1994. Treatment-cycles were cross-linked with the Medical Birth Registry, identifying treatment-related births and natural conception births. This national cohort study includes all women starting ART treatments with homologous eggs between 2002 and 2011, N = 30 486. Subjects were followed for up to four fresh ART-cycles including subsequent FER-cycles (=four complete cycles), until the first livebirth, or until December 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS The CLBR within 1-4 complete ART-cycles were calculated as the proportion of women with a livebirth, out of all women initiating ART-treatment, including drop-outs (no livebirth or no continued treatment within follow-up). In women with one year follow-up from last treatment, multivariate logistic regression analysis assessed impact of retrieved oocytes on CLBR, adjusting results for female age and cause of infertility. Hospital admission due to ovarian hyperstimulation syndrome (OHSS) was reported. MAIN RESULTS AND THE ROLE OF CHANCE After one, two and three complete ART-cycles, the CLBRs attributable to ART treatment were 26.4% [95%CI 25.9-26.9], 42.6% [42.0-43.1] and 51.3% [50.7-51.9], respectively. The CLBR attributable to non-ART related conception (natural conception or intrauterine insemination) were 5.3% [5.0-5.6], 8.3% [8.0-8.7] and 10.6% [10.3-11.0], after one, two and three complete cycles. In women without a live birth in the first complete cycle, the number of aspirated oocytes predicted the outcome in the second and third cycle: When compared to women with 0-3 aspirated oocytes in the first cycle, the odds for live birth in the second and third cycle was 1.18 [1.07-1.30] for women with 4-9 aspirated oocytes in the first cycle, 1.41 [1.27-1.57] for women with 10-15 aspirated oocytes and 1.63 [1.42-1.88] for women with more than 15 aspirated oocytes. For women without a livebirth in the first and second cycle, the sum of aspirated oocytes predicted outcome in the third complete cycle. Women with a sum larger than six aspirated oocytes, had marked increased odds ratios for livebirth in the third complete cycle, compared to women with a sum of 0-6 oocytes in the first and second fresh cycle. Incidence of hospital-admission due to OHSS was 1.7% in the first cycle, decreasing to 1.3% and 1.0% in the second and third cycles. LIMITATIONS, REASONS FOR CAUTION Although mandatory, there may be treatment-cycles not registered in the IVF-registry. Missing information in number of aspirated oocytes are most likely random losses of information. There were few observations in women with more than 15 aspirated oocytes and these birthrates should be interpreted cautiously. Information on gonadotrophin dose used for stimulation was not available, nor was information on dose adjustments in subsequent cycles. WIDER IMPLICATIONS OF THE FINDINGS With these results we can counsel couples returning for fertility treatments, providing an age-stratified revised prognosis for chances of live birth and risk of OHSS, reflecting prior failed attempts and previous ovarian response. STUDY FUNDING/COMPETING INTEREST(S) This study was unconditionally funded by Ferring Pharmaceuticals and ReproUnion. The funders had no role in the study design, data collection and interpretation, or decision to submit the work for publication. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER The study was approved by the Danish Data Protection Agency (J.nr. 2012-41-1330).
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Affiliation(s)
- S S Malchau
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 26, Hvidovre, Denmark
| | - A A Henningsen
- Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, KBH Ø, Denmark
| | - J Forman
- University of Copenhagen, Department of Public Health, Section of Biostatistics, Øster Farimagsgade 5, DK-1014 KBH K, Denmark
| | - A Loft
- Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, KBH Ø, Denmark
| | - A Nyboe Andersen
- Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, KBH Ø, Denmark
| | - A Pinborg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 26, Hvidovre, Denmark.,Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, KBH Ø, Denmark
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Forman J, Gwozd T, Deyell M. IMPROVING PATIENTS' EXPERIENCE OF SAME-DAY DISCHARGE AFTER ATRIAL FIBRILLATION ABLATION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.460] [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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Azizi Z, Terricabras M, Alipour P, Mallany P, Motamed M, Nath N, Nath S, Forman J, Morris S, Avoulov A, Pantano A, Khaykin Y, Verma A. RISKS OF CONCOMITANT ATRIAL FIBRILLATION WITH IDIOPATHIC VENTRICULAR TACHYCARDIA. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.112] [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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Forman J, Baumbusch J, Jackson H, Lindenberg J, Shook A, Bashir J. Exploring the patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator. Eur J Cardiovasc Nurs 2018; 17:698-706. [DOI: 10.1177/1474515118777419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The implantable cardioverter defibrillator provides effective treatment for the prevention of sudden cardiac arrest but significant risks associated with transvenous implantation persist. The subcutaneous implantable cardioverter defibrillator has proven to be an alternative and innovative treatment option for select patients to mitigate these risks. Obtaining the patients’ perspectives can provide clinicians with essential information to guide implant selection, procedural decision-making, and support patient management. Conventional implantable cardioverter defibrillator patients have reported shock-related anxiety, fear, insufficient education, and challenges adapting to physical and psychological changes. Little evidence exists to determine whether differences between the subcutaneous implantable cardioverter defibrillator and conventional implantable cardioverter defibrillator allow for the transferability of our current knowledge to the care and management of this population. Aims: The purpose of this study was to explore patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator including the decision-making process, implant, and follow-up care processes. Methods: Using an exploratory qualitative approach, semi-structured interviews were conducted by telephone with 15 participants who underwent subcutaneous implantable cardioverter defibrillator implant. Results: Analysis revealed five main themes: (a) influences on decision-making; (b) unmet education needs; (c) physical impact; (d) psychological impact; and (e) recommendations. Conclusion: As a new technology, little knowledge of the subcutaneous implantable cardioverter defibrillator exists outside of the tertiary implanting sites, therefore developing new strategies to increase learning and dissemination is essential. Although similarities exist in our findings to those of conventional implantable cardioverter defibrillators, there are significant differences in the decision-making process and physical impact which require individualized care planning and development of strategies to provide a patient-centered approach to care.
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Ma W, Smirnov D, Forman J, Schweickart A, Slocum C, Srinivasan S, Libeskind-Hadas R. DTL-RnB: Algorithms and Tools for Summarizing the Space of DTL Reconciliations. IEEE/ACM Trans Comput Biol Bioinform 2018; 15:411-421. [PMID: 26955051 DOI: 10.1109/tcbb.2016.2537319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Phylogenetic tree reconciliation is an important technique for reconstructing the evolutionary histories of species and genes and other dependent entities. Reconciliation is typically performed in a maximum parsimony framework and the number of optimal reconciliations can grow exponentially with the size of the trees, making it difficult to understand the solution space. This paper demonstrates how a small number of reconciliations can be found that collectively contain the most highly supported events in the solution space. While we show that the formal problem is NP-complete, we give a approximation algorithm, experimental results that indicate its effectiveness, and the new DTL-RnB software tool that uses our algorithms to summarize the space of optimal reconciliations (www.cs.hmc.edu/dtlrnb).
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Abir M, Truchil A, Lam V, Forman J, Koegel P, Lozon M, Levites-Agababa E, Bright A, Brenner J. 167 Evaluating Patient-Centered Interventions to Reduce Pediatric Asthma-Related Acute Care Utilization. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.194] [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: 11/28/2022]
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Forman J, Jackson H, Walter C, Hawkins N, Krahn A, Bashir J. THE SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR EXPERIENCE IN BRITISH COLUMBIA – PROVINCIAL COORDINATION ENABLES DISTRIBUTED PATIENT ACCESS TO NEW TECHNOLOGY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.160] [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: 10/18/2022] Open
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Malchau SS, Henningsen AA, Loft A, Rasmussen S, Forman J, Nyboe Andersen A, Pinborg A. The long-term prognosis for live birth in couples initiating fertility treatments. Hum Reprod 2017; 32:1439-1449. [DOI: 10.1093/humrep/dex096] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/20/2017] [Indexed: 11/12/2022] Open
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Storgaard M, Loft A, Bergh C, Wennerholm UB, Söderström-Anttila V, Romundstad LB, Aittomaki K, Oldereid N, Forman J, Pinborg A. Obstetric and neonatal complications in pregnancies conceived after oocyte donation: a systematic review and meta-analysis. BJOG 2017; 124:561-572. [PMID: 27592694 DOI: 10.1111/1471-0528.14257] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Approximately 50 000 oocyte donation (OD) treatment cycles are now performed annually in Europe and the US. OBJECTIVES To ascertain whether the risk of adverse obstetric and perinatal/neonatal outcomes is higher in pregnancies conceived by OD than in pregnancies conceived by conventional in-vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) or spontaneously. SEARCH STRATEGY A systematic search was performed in the PubMed, Cochrane and Embase databases from 1982-2016. Primary outcomes were hypertensive disorders of pregnancy, pre-eclampsia (PE), gestational diabetes mellitus, postpartum haemorrhage, caesarean section, preterm birth, low birthweight and small for gestational age. SELECTION CRITERIA Inclusion criteria were original studies including at least five OD pregnancies with a control group of pregnancies conceived by conventional IVF/ICSI or spontaneous conception, and case series with >500 cases reporting one or more of the selected complications. Studies not adjusting for plurality were excluded. DATA COLLECTION AND ANALYSIS Thirty-five studies met the inclusion criteria. A random-effects model was used for the meta-analyses. MAIN RESULTS For OD pregnancies versus conventional IVF/ICSI pregnancies the risk of PE was adjusted odds ratio (AOR) 2.11 (95% CI, 1.42-3.15) in singleton and AOR 3.31 (95% CI, 1.61-6.80) in multiple pregnancies. The risks of preterm birth and low birthweight in singletons were AOR 1.75 (95% CI, 1.39-2.20) and 1.53 (95% CI, 1.16-2.01), respectively. CONCLUSIONS OD conceptions are associated with adverse obstetric and neonatal outcomes. To avoid the additional increase in risk from multiplicity, single-embryo transfer should be the choice of option in OD cycles. TWEETABLE ABSTRACT Oocyte donation pregnancies have increased risk of a range of obstetric and neonatal complications.
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Affiliation(s)
- M Storgaard
- Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Copenhagen, Denmark
| | - A Loft
- Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - C Bergh
- Reproductive Medicine, Departments of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - U B Wennerholm
- Departments of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital/East, Gothenburg, Sweden
| | | | - L B Romundstad
- Department of Obstetrics and Gynaecology, IVF Unit, St Olav's University Hospital, Trondheim, Norway
- Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Aittomaki
- Department of Medical Genetics, Helsinki University Central Hospital (HUCH) and University of Helsinki, Helsinki, Finland
| | - N Oldereid
- Section for Reproductive Medicine, Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - J Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Pinborg
- Fertility Clinic, Copenhagen University Hospital, Hvidovre, Denmark
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Spangmose AL, Malchau SS, Schmidt L, Vassard D, Rasmussen S, Loft A, Forman J, Pinborg A. Academic performance in adolescents born after ART-a nationwide registry-based cohort study. Hum Reprod 2017; 32:447-456. [PMID: 28057876 DOI: 10.1093/humrep/dew334] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 11/21/2016] [Accepted: 12/07/2016] [Indexed: 01/19/2023] Open
Abstract
STUDY QUESTION Is academic performance in adolescents aged 15-16 years and conceived after ART, measured as test scores in ninth grade, comparable to that for spontaneously conceived (SC) adolescents? SUMMARY ANSWER ART singletons had a significantly lower mean test score in the adjusted analysis when compared with SC singletons, yet the differences were small and probably not of clinical relevance. WHAT IS KNOWN ALREADY Previous studies have shown similar intelligence quotient (IQ) levels in ART and SC children, but only a few have been on adolescents. Academic performance measured with standardized national tests has not previously been explored in a complete national cohort of adolescents conceived after ART. STUDY DESIGN, SIZE, DURATION A Danish national registry-based cohort including all 4766 ART adolescents (n = 2836 singletons and n = 1930 twins) born in 1995-1998 were compared with two SC control cohorts: a randomly selected singleton population (n = 5660) and all twins (n = 7064) born from 1995 to 1998 in Denmark. Nine children who died during the follow-up period were excluded from the study. PARTICIPANTS/MATERIALS, SETTING, METHODS Mean test scores on a 7-point-marking scale from -3 to 12 were compared, and adjustments were made for relevant reproductive and socio-demographic covariates including occupational and educational level of the parents. MAIN RESULTS AND THE ROLE OF CHANCE The crude mean test score was higher in both ART singletons and ART twins compared with SC adolescents. The crude mean differences were +0.41 (95% CI 0.30-0.53) and +0.45 (95% CI 0.28-0.62) between ART and SC singletons and between ART and SC twins, respectively. However, the adjusted mean overall test score was significantly lower for ART singletons compared with SC singletons (adjusted mean difference -0.15 (95% CI -0.29-(-0.02))). For comparison, the adjusted mean difference was +2.05 (95% CI 1.82-2.28) between the highest and the lowest parental educational level, suggesting that the effect of ART is weak compared with the conventional predictors. The adjusted analyses showed significantly lower mean test scores in mathematics and physics/chemistry for ART singletons compared with SC singletons. Comparing ART twins with SC twins yielded no difference in academic performance in the adjusted analyses. Similar crude and adjusted overall mean test scores were found when comparing ART singletons and ART twins. LIMITATIONS, REASONS FOR CAUTION Missing data on educational test scores occurred in 6.6% of adolescents aged 15-16 years for the birth cohorts 1995-1997, where all of the children according to their age should have passed the ninth grade exam at the time of data retrieval. As sensitivity analyses yielded no significant difference in the adjusted risk of having missing test scores between any of the groups, it is unlikely that this should bias our results. Adjustment for body mass index and smoking during pregnancy was not possible. WIDER IMPLICATIONS OF THE FINDINGS As our results are based on national data, our findings can be applied to other populations. The findings of this paper suggest that a possible small negative effect of parental subfertility or ART treatment is counterbalanced by the higher educational level in the ART parents. STUDY FUNDING/COMPETING INTERESTS The Danish Medical Association in Copenhagen (KMS) funded this study with a scholarship grant. None of the authors had any competing interests. TRIAL REGISTRATION NO STATISTICS DENMARK 704676.
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Affiliation(s)
- A L Spangmose
- Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - S S Malchau
- Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - L Schmidt
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - D Vassard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S Rasmussen
- Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - A Loft
- Fertility Clinic Section 4071, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Pinborg
- Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark
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Finkelstein S, Forman J, Fernandez E, Chen C, Lieberfarb M, Salenius S, Dosoretz D, Dosoretz A, Shafman T, Mantz C. Multicenter Assessment of Stereotactic Body Radiation Therapy (SBRT) Boost in Intermediate-Risk Prostate Cancer: Biochemical Failure and Toxicity. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1331] [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: 10/20/2022]
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Martinez A, Olivera G, Ghilezan M, Forman J, Kestin L, Finkelstein S, Mo X, Key S, Mantz C, Fernandez E, Dosoretz D, Galmarini D. Adaptive Dose Recalculation for Prostate Cancer in the Era of Online IGRT IMRT: How Close Is the Planned Radiation Dose to the Delivered Dose? Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1147] [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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Moniz M, Chang T, Davis M, Forman J, Landgraff J, Dalton V. Policy ahead of clinical practice: a qualitative study of implementation experiences in states with Medicaid coverage of immediate postpartum long-acting reversible contraceptive methods. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.097] [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: 10/23/2022]
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Malyon AC, Forman J, McFritz ZB. P-24 Documentation and discussion of advance care planning in an acute hospital: A review of the medical records of patients approaching the end of life. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.154] [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: 11/03/2022]
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Forman J, Marshak J, Tseng YA, Friedel DM, Grendell J. Image of the month: Gastric metastasis of renal clear cell carcinoma. Am J Gastroenterol 2015; 110:15. [PMID: 25713859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Forman J, Flavelle S, Van Breemen O, Hahn E, McIlroy C, Carleton J. EVALUATING THE INTEGRATION OF REMOTE MONITORING FOR CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE FOLLOW-UP. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Forman J, Hahn E, Flavelle S, McIlroy C, Carleton J, Van Breemen O. MRI IN PATIENTS WITH CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICES: INTEGRATING A NURSING PROCESS WITHIN THE DEVELOPMENT OF AN INTERDISCIPLINARY GUIDELINE. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.646] [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: 11/28/2022] Open
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Lauck S, Garland E, Achtem L, Forman J, Baumbusch J, Boone R, Cheung A, Ye J, Wood DA, Webb JG. Integrating a palliative approach in a transcatheter heart valve program: bridging innovations in the management of severe aortic stenosis and best end-of-life practice. Eur J Cardiovasc Nurs 2014; 13:177-84. [PMID: 24477655 DOI: 10.1177/1474515114520770] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Severe aortic stenosis (AS) is the most prevalent structural heart disease and affects primarily older adults in their last decade of life. If the risk for surgery is high, transcatheter aortic valve implantation (TAVI) is the treatment of choice for many patients with suitable anatomy who are likely to derive significant benefit from this innovative and minimally invasive approach. In a large transcatheter heart valve (THV) centre that offers TAVI as one of the treatment options, of 565 consecutive referrals for the assessment of eligibility for TAVI over 18 months, 78 (14%) were deemed unsuitable candidates for TAVI or higher risk surgery by the interdisciplinary Heart Team because of their advanced disease, excessive frailty or comorbid burden. Concerns were raised for patients for whom TAVI is not an option. The integration of a palliative approach in a THV program offers opportunities to adopt best end-of-life practices while promoting innovative approaches for treatment. An integrated palliative approach to care focuses on meeting a patient's full range of physical, psychosocial and spiritual needs at all stages of a life-limiting illness, and is well suited for the severe AS and TAVI population. A series of interventions that reflect best practices and current evidence were adopted in collaboration with the Palliative Care Team and are currently under evaluation in a large TAVI centre. Changes include the introduction of a palliative approach in patient assessment and education, the measurement of symptoms, improved clarity about responsibility for communication and follow-up, and triggering referrals to palliative care services.
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Pinborg A, Henningsen AA, Loft A, Malchau SS, Forman J, Andersen AN. Large baby syndrome in singletons born after frozen embryo transfer (FET): is it due to maternal factors or the cryotechnique? Hum Reprod 2014; 29:618-27. [PMID: 24413766 DOI: 10.1093/humrep/det440] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [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: 11/13/2022] Open
Abstract
STUDY QUESTION Are singletons born after frozen embryo transfer (FET) at increased risk of being born large for gestational age (LGA) and if so, is this caused by intrinsic maternal factors or related to the freezing/thawing procedures? SUMMARY ANSWER Singletons after FET have an increased risk of being born LGA. This cannot solely be explained by intrinsic maternal factors as it was also observed in sibling pairs, where the sibling conceived after FET had an increased risk of LGA compared with the sibling born after Fresh embryo transfer. WHAT IS KNOWN ALREADY FET singletons have a higher mean birthweight than singletons born after transfer of fresh embryos, and FET singletons may be at an increased risk of being born LGA. STUDY DESIGN, SIZE, DURATION The national register-based controlled cohort study involves two populations of FET singletons. The first population (A: total FET cohort) consisted of all FET singletons (n = 896) compared with singletons born after Fresh embryo transfer (Fresh) (n = 9480) and also with that born after natural conception (NC; n = 4510) in Denmark from 1997 to 2006. The second population (B: Sibling FET cohort) included all sibling pairs, where one singleton was born after FET and the consecutive sibling born after Fresh embryo transfer or vice versa from 1994 to 2008 (n = 666). The sibling cohort included n = 550 children with the sibling combination first child Fresh/second child FET and n = 116 children with the combination first child FET/second child Fresh. PARTICIPANTS/MATERIALS, SETTING, METHODS Main outcome measures were LGA defined as birthweight of >2 SD from the population mean (z-score >2) according to Marsáls curves. Macrosomia was defined as birthweight of >4500 g. Crude and adjusted odds ratios (AORs) of LGA and macrosomia were calculated for FET versus Fresh and versus NC singletons in the total FET cohort. Similarly, AOR was calculated for FET versus Fresh in the sibling cohort. Adjustments were made for maternal age, parity, child sex, year of birth and birth order in the sibling analyses. Meta-analyses were performed by pooling our data with the previously published cohort studies on LGA and macrosomia. MAIN RESULTS AND THE ROLE OF CHANCE The AORs of LGA (z-score >2) and macrosomia in FET singletons versus singletons conceived after Fresh embryo transfer were 1.34 [95% confidence interval (95% CI) 0.98-1.80] and 1.91 (95% CI 1.40-2.62), respectively. The corresponding risks for FET versus NC singletons were 1.41 (95% CI 1.01-1.98) for LGA and 1.67 (95% CI 1.18-2.37) for macrosomia. The increased risk of LGA and macrosomia in FET singletons was confirmed in the sibling cohort also after adjustment for birth order. Hence, the increased risk of LGA in FET singletons cannot solely be explained by being the second born or by intrinsic maternal factors, but may also partly be related to freezing/thawing procedures per se. In the meta-analysis, the summary effects of LGA and macrosomia in FET versus singletons conceived after Fresh embryo transfer were AOR 1.54 (95% CI 1.31-1.81) and AOR 1.64 (95% CI 1.26-2.12), respectively. The corresponding figures for FET versus NC singletons were for LGA AOR 1.32 (95% CI 1.07-1.61) and macrosomia AOR 1.41 (95% CI 1.11-1.80), respectively. LIMITATIONS, REASONS FOR CAUTION Adjustment for body mass index as a possible confounder was not possible. The size of the FET/Fresh sibling cohort was limited; however, the complete sibling cohort was sufficiently powered to explore the risk of LGA. A bias is very unlikely as data coding was based on national registers. WIDER IMPLICATIONS OF THE FINDINGS Our findings are consistent with the previous Nordic studies and thus can be generalized to the Nordic countries. The causes for LGA in FET singletons should be further explored. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this project. None of the authors have any conflict of interest to declare.
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Affiliation(s)
- A Pinborg
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Kettegaard Allé 30, Hvidovre DK-2650, Denmark
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Abstract
Abstract
Background: Triple negative breast cancers (TNBC) are enriched for increased phosphorylated EGFR expression and decreased expression of PTEN. We found that combined treatment of metformin and erlotinib induces cell death in a subset of TNBC cell lines with evidence of combined enhanced reduction of EGFR, AKT, S6 and 4EBP1 phosphorylation. Analysis of TNBC cell line alterations led to the hypothesis that loss of PTEN sensitized cells to the drug combination, which was confirmed using isogenic cell line models with and without PTEN expression. The inhibitory effects of combined erlotinib and metformin were confirmed in mouse xenografts of PTEN null TNBC breast cancer cell lines. These data provided a rationale for clinical translation and testing in advanced TNBC patients.
Trial Design: Single institution expanded Phase I design in patients with advanced TNBC. Erlotinib dosing will start and remain at 150 mg. Due to frequent GI upset in patients starting metformin, the dose of metformin will be titrated up to the assigned dose level over 2 weeks. The first metformin dose level will be 850 mg twice daily and will be escalated to its maximum FDA approved dose of 850 mg three times daily. Dose escalation will follow the standard 3 + 3 design. Dose limiting toxicities will be determined during the first 5 weeks of therapy. One metformin dose de-escalation level to 500 mg twice daily is allowed. Cycles will be defined as three weeks of treatment, and response assessments will be performed after every three cycles.
Main Eligibility Criteria:
1. Pathologic diagnosis of TNBC.
2. Measurable or non-measurable disease.
3. At least one prior treatment for metastatic disease.
4. ECOG PS = 0-2.
5. Prior metformin or EGFR targeted therapy.
6. Fasting blood glucose level < 126 mg/dl.
7. Normal renal function.
8. Available archived tumor tissue.
Specific Aims: The primary endpoints are defining the maximum tolerated dose (MTD) of metformin in combination with 150 mg erlotinib, and for the extended phase, determining the potential for clinical benefit by treating 14 patients at the MTD with the goal of rejecting the null hypothesis that the regimen is futile. Clinical benefit is defined as either partial response or lack of progression after 18 weeks of therapy (stable disease). Secondary endpoints include: 1) progression free survival, and 2) pharmacodynamic assessment of the phosphorylation status of AMPK and EGFR from pre- and on-treatment skin biopsies. The exploratory endpoint will be assessment of the status of EGFR, PTEN, LKB1, and 4EBP1 from available patient tumor samples to correlate against treatment response.
Statistical Methods: If one patient meets the primary endpoint, among the 14 patients treated at the MTD, then the regimen will be considered worthy of further investigation.
Target Accrual: 17-20 patients. Four patients accrued as of June 2013. Accrual completion expected June 2015.
Contact: Matthew Maurer, Columbia University Medical Center, mm2058@columbia.edu.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT1-4-03.
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Affiliation(s)
- M Maurer
- Columbia University, New York, NY
| | | | - J Forman
- Columbia University, New York, NY
| | | | - K Crew
- Columbia University, New York, NY
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Fisk M, Gale N, Mohan D, Marchong MN, Forman J, Lomas DA, Cockcroft JR, Bolton CE, MacNee W, Fuld J, Calverley CM, McEniery CM, Tal-Singer R, Wilkinson IB, Polkey MI. P129 Skeletal muscle weakness, not arterial stiffness, differs according to GOLD group in COPD: Abstract P129 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.279] [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: 11/04/2022]
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Forman J, Baumbusch J, Currie L, Lauck S. Exploring Changes in Functional Status While Waiting for Transcatheter Aortic Valve Implantation. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.721] [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: 11/30/2022] Open
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Wennerholm UB, Henningsen AKA, Romundstad LB, Bergh C, Pinborg A, Skjaerven R, Forman J, Gissler M, Nygren KG, Tiitinen A. Perinatal outcomes of children born after frozen-thawed embryo transfer: a Nordic cohort study from the CoNARTaS group. Hum Reprod 2013; 28:2545-53. [DOI: 10.1093/humrep/det272] [Citation(s) in RCA: 254] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Stora C, Devouche E, Delaroche L, Patrat C, Matheron S, Damond F, Yazbeck C, Longuet P, Llabador MA, Luton D, Epelboin S, Lemmen J, Rasmussen S, Ziebe S, El Khattabi L, Hafhouf E, Royere D, Pouly JL, De Mouzon J, Levy R, Hagman A, Loft A, Wennerholm UB, Pinborg A, Bergh C, Aittomaki K, Nygren KG, Romundstad LB, Hazekamp J, Soderstrom-Anttila V, Mukaida T, Goto T, Tajima T, Oka C, Takahashi K, Carrasco B, Boada M, Rodriguez I, Coroleu B, Barri PN, Veiga A, Wennerholm UB, Henningsen AKA, Romundstad LB, Bergh C, Pinborg A, Skjaerven R, Forman J, Gissler M, Nygren KG, Tiitinen A. Session 60: Perinatal outcome after ART. Hum Reprod 2013. [DOI: 10.1093/humrep/det193] [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: 11/12/2022] Open
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Pinkerton MH, Forman J, Bury SJ, Brown J, Horn P, O'Driscoll RL. Diet and trophic niche of Antarctic silverfish Pleuragramma antarcticum in the Ross Sea, Antarctica. J Fish Biol 2013; 82:141-164. [PMID: 23331143 DOI: 10.1111/j.1095-8649.2012.03476.x] [Citation(s) in RCA: 9] [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: 06/01/2023]
Abstract
The diet of Antarctic silverfish Pleuragramma antarcticum was evaluated by examining stomach contents of specimens collected in the Ross Sea (71°-77° S; 165°-180° E) in January to March 2008. Pleuragramma antarcticum (50-236 mm standard length, L(S)) and prey items were analysed for stable-isotopic composition of carbon and nitrogen. According to index of relative importance (I(RI) ), which incorporates frequency of occurrence, mass and number of prey items, the most important prey items were copepods (81%I(RI) over all specimens), predominantly Metridia gerlachei and Paraeuchaeta sp., with krill and fishes having low I(RI) (2·2 and 5·6%I(RI) overall). According to mass of prey (M) in stomachs, however, fishes (P. antarcticum and myctophids) and krill dominated overall diet (48 and 22%M, respectively), with copepods being a relatively minor constituent of overall diet by mass (9·9%M). Piscivory by P. antarcticum occurred mainly in the extreme south-west of the region and near the continental slope. Krill identified to species level in P. antarcticum stomachs were predominantly Euphausia superba (14·1%M) with some Euphausia crystallophorias (4·8%M). Both DistLM modelling (PRIMER-permanova+) on stomach contents (by I(RI)) and stepwise generalized linear modelling on stable isotopes showed that L(S) and location were significant predictors of P. antarcticum diet. Postlarval P. antarcticum (50-89 mm L(S)) consumed exclusively copepods. Juvenile P. antarcticum (90-151 mm L(S)) consumed predominantly krill and copepods by mass (46 and 30%M, respectively). Small adult P. antarcticum (152-178 mm L(S)) consumed krill, fishes and copepods (37, 36 and 15%M, respectively). Large adult P. antarcticum (179-236 mm L(S)) consumed predominantly fishes and krill (55 and 17%M, respectively), especially in the north (near the Ross Sea slope) and in the SW Ross Sea. Amphipods were occasionally important prey items for P. antarcticum (western Ross Sea, 39%M). General concordance between stomach contents and trophic level of P. antarcticum and prey based on δ(15) N was demonstrated. Pleuragramma antarcticum trophic level was estimated as 3·7 (postlarval fish) and 4·1 (fish aged 3+ years).
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Affiliation(s)
- M H Pinkerton
- National Institute of Water and Atmospheric Research Ltd, Private Bag 14901, Wellington 6241, New Zealand.
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Achtem L, Lauck S, Forman J, Baumbusch J. N029 Making the Decision to Undergo Transcatheter Aortic Valve Implantation Eligibility Assessment: An Exploratory Study of Factors Influencing Patients Motivation. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.775] [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] Open
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Maurer M, Kalinsky K, Crew K, Jayasena R, Forman J, Lau YK, Shaw J, Parsons R, Hershman D. OT3-01-13: Phase One Trial of Combined Temsirolimus, Erlotinib, and Cisplatin in Advanced Solid Tumors. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot3-01-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A large subset of triple negative breast cancers (TNBC) are driven in part by a combination of activated growth factor signaling and downstream constitutive activation of the PI3K pathway. One therapeutic strategy is to target each driver simultaneously, requiring an understanding of drug interactions and combined toxicities. There is a strong correlation between loss of PTEN and both expression of EGFR and mutation of p53 in a subset of TNBC. Single agent trials targeting EGFR in breast cancer have been a disappointment likely, in part, due to constitutive downstream activation of PI3K, AKT and mTOR signaling, mainly through loss of PTEN expression. Preclinical studies have demonstrated 1) that resistance to EGFR-targeted therapy in the setting of an activated PI3K pathway can be overcome with rapamycin (which inhibits the TORC1 mTOR complex), and 2) that a subset of TNBC cells with p53 mutations are particularly sensitive to the DNA damaging agent cisplatin due to their high expression of p63 and p73. We have hypothesized that targeting the EGFR, PTEN and DNA damage pathways simultaneously with the rapalog temsirolimus, the EGFR inhibitor erlotinib, and cisplatin will provide therapeutic benefit in a definable subset of TNBC patients.
Design: Single institution phase one dose escalation trial of combined temsirolimus, erlotinib, and cisplatin in advanced solid tumor patients. Cisplatin and temsirolimus are given on day 1 and day 8 of 21 day cycles and erlotinib is taken daily without interruption. Patients are dose escalated using a standard 3+3 design. Cisplatin is given at a fixed dose of 30 mg/m2. Erlotinib was started at 100 mg and will be escalated to 150 mg. Temsirolimus was started at 15 mg, and after erlotinib escalation, will be escalated to 25 mg. The objectives of the study are: 1) characterize toxicity of the regimen and establish combined maximal tolerated dosing, 2) measure drug target inhibition by assessing EGFR, AKT, and mTOR activation in serial assessments of peripheral blood mononuclear cells and skin biopsies, 3) measure the pharmacokinetics of all three drugs in combination, and 4) exploratory assessment of molecular measures of PTEN, EGFR, and p53 status, and markers of activated downstream pathways in patient's archived pathology specimens to assess feasibility of identifying candidate biomarkers in future trials involving patients with TNBC. Eligibility criteria include one prior treatment for advanced disease, ECOG PS=0-1, measurable or non-measurable disease, available archived tumor sample, non-smoking, normal renal function, and lack of concurrent use of strong CYP3A4 inhibitors or inducers. Because of significant rash encountered in prior combination trials of EGFR and TORC1 inhibitors, a prophylactic oral doxycycline strategy supported by randomized trials is being employed. Current accrual is 6 out of a possible 18 patients.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT3-01-13.
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Affiliation(s)
- M Maurer
- 1Columbia University, New York, NY
| | | | - K Crew
- 1Columbia University, New York, NY
| | | | - J Forman
- 1Columbia University, New York, NY
| | - Y-K Lau
- 1Columbia University, New York, NY
| | - J Shaw
- 1Columbia University, New York, NY
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Arregui-Dalmases C, Del Pozo E, Stacey S, Kindig M, Lessley D, Lopez-Valdes F, Forman J, Kent R. Pressure waves in the aorta during isolated abdominal belt loading: the magnitude, phasing, and attenuation. Proc Inst Mech Eng H 2011; 225:688-95. [PMID: 21870376 DOI: 10.1177/0954411911400690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While rupture of the aorta is a leading cause of sudden death following motor vehicle crashes, the specific mechanism that causes this injury is not currently well understood. Aortic ruptures occurring in the field are likely due to a complex combination of contributing factors such as acceleration, compression of the chest, and increased pressure within the aorta. The objective of the current study was to investigate one of these factors in more detail than has been done previously; specifically, to investigate the in situ intra-aortic pressure generated during isolated belt loading to the abdomen. Ten juvenile swine were subjected to dynamic belt loads applied to the abdomen. Intraaortic pressure was measured at multiple locations to assess the magnitude and propagation of the resulting blood pressure wave. The greatest average peak pressure (113.6 +/- 43.5 kPa) was measured in the abdominal aorta. Pressures measured in the thoracic aorta and aortic arch were 70 per cent and 50 per cent, respectively, that measured in the abdominal aorta. No macroscopic aortic trauma was observed. To the authors' knowledge the present study is the first one to document the presence, propagation, and attenuation of a transient pressure wave in the aorta generated by abdominal belt loading. The superiorly moving wave is sufficient to generate hydrostatic and intimal shear stress in the aorta, possibly contributing to the hypothesized mechanisms of traumatic aortic rupture.
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Affiliation(s)
- C Arregui-Dalmases
- European Center for Injury Prevention, Preventive and Public Health Department, University of Navarra, Pamplona, Spain.
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Buschiazzo A, Trajtenberg F, Albanesi D, Botti H, Ruetalo N, Forman J, Nilges M, de Mendoza D, Alzari P. Conformational plasticity of histidine kinases is key for signal transduction. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311091446] [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: 11/10/2022] Open
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Crandall J, Bose D, Forman J, Untaroiu C, Arregui-Dalmases C, Shaw C, Kerrigan J. Human surrogates for injury biomechanics research. Clin Anat 2011; 24:362-71. [DOI: 10.1002/ca.21152] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
The diet of the alfonsino Beryx splendens was determined from examination of stomach contents of 287 specimens of 17 to 48 cm fork length (L(F)) sampled by bottom trawl on the Chatham Rise to the east of New Zealand. Prey items were predominantly crustaceans and mesopelagic fishes. The most important prey species by mass was Sergestes spp. prawns, followed by the myctophid Lampanyctodes hectoris, and then Pasiphaea spp. prawns. Multivariate analyses indicated that small crustaceans (euphausiids and amphipods) were most important in the diet of smaller B. splendens (100-424 g, 17-26.5 cm), with larger prawn species and mesopelagic fishes most important for larger fish (425-2070 g, 27-46 cm). Moon phase and bottom temperature also explained some of the variability in diet, but the moon phase effect was difficult to explain, and the bottom temperature effect may have been confounded, to some extent, with L(F). The results indicated that B. splendens were moderately selective feeders that foraged primarily in the mesopelagic layers. The diet of New Zealand B. splendens is generally similar to those reported from other areas, i.e. dominated by mesopelagic crustaceans and fishes, and with a transition from small crustaceans to fishes with increasing predator size.
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Affiliation(s)
- P L Horn
- National Institute of Water and Atmospheric Research, P.O. Box 14-901, Kilbirnie, Wellington, New Zealand.
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Damschroder LJ, Banaszak-Holl J, Kowalski CP, Forman J, Saint S, Krein SL. The role of the champion in infection prevention: results from a multisite qualitative study. BMJ Qual Saf 2009; 18:434-40. [PMID: 19955453 DOI: 10.1136/qshc.2009.034199] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [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
BACKGROUND Although 20% or more of healthcare-associated infections can be prevented, many hospitals have not implemented practices known to reduce infections. We explored the types and numbers of champions who lead efforts to implement best practices to prevent hospital-acquired infection in US hospitals. METHODS Qualitative analyses were conducted within a multisite, sequential mixed methods study of infection prevention practices in Veteran Affairs and non-Veteran Affairs hospitals in the USA. The first phase included telephone interviews conducted in 2005-2006 with 38 individuals at 14 purposively selected hospitals. The second phase used findings from phase 1 to select six hospitals for site visits and interviews with another 48 individuals in 2006-2007. RESULTS It was possible for a single well-placed champion to implement a new technology, but more than one champion was needed when an improvement required people to change behaviours. Although the behavioural change itself may appear to be an inexpensive and simple solution, implementation was often more complicated than changing technology because behavioural changes required interprofessional coalitions working together. Champions in hospitals with low-quality working relationships across units or professions had a particularly challenging time implementing behavioural change. Merely appointing champions is ineffective; rather, successful champions tended to be intrinsically motivated and enthusiastic about the practices they promoted. Even when broad implementation is stymied, champions can implement change within their own sphere of influence. CONCLUSIONS The types and numbers of champions varied with the type of practice implemented and the effectiveness of champions was affected by the quality of organisational networks.
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Affiliation(s)
- L J Damschroder
- VA Ann Arbor HSR&D Center of Excellence, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
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Damschroder LJ, Banaszak-Holl J, Kowalski CP, Forman J, Saint S, Krein SL. The role of the champion in infection prevention: results from a multisite qualitative study. Qual Saf Health Care 2009. [PMID: 19955453 DOI: 10.1136/qshc.2009.034199.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although 20% or more of healthcare-associated infections can be prevented, many hospitals have not implemented practices known to reduce infections. We explored the types and numbers of champions who lead efforts to implement best practices to prevent hospital-acquired infection in US hospitals. METHODS Qualitative analyses were conducted within a multisite, sequential mixed methods study of infection prevention practices in Veteran Affairs and non-Veteran Affairs hospitals in the USA. The first phase included telephone interviews conducted in 2005-2006 with 38 individuals at 14 purposively selected hospitals. The second phase used findings from phase 1 to select six hospitals for site visits and interviews with another 48 individuals in 2006-2007. RESULTS It was possible for a single well-placed champion to implement a new technology, but more than one champion was needed when an improvement required people to change behaviours. Although the behavioural change itself may appear to be an inexpensive and simple solution, implementation was often more complicated than changing technology because behavioural changes required interprofessional coalitions working together. Champions in hospitals with low-quality working relationships across units or professions had a particularly challenging time implementing behavioural change. Merely appointing champions is ineffective; rather, successful champions tended to be intrinsically motivated and enthusiastic about the practices they promoted. Even when broad implementation is stymied, champions can implement change within their own sphere of influence. CONCLUSIONS The types and numbers of champions varied with the type of practice implemented and the effectiveness of champions was affected by the quality of organisational networks.
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Affiliation(s)
- L J Damschroder
- VA Ann Arbor HSR&D Center of Excellence, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
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Bernard A, Mullineaux D, Auxier J, Bell M, Shapiro R, Forman J, Lock D, Klimkina D, Pienkowski D. QS237. Anthropometric Fit of Youths on All Terrain Vehicles. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.539] [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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Sasson C, McNally B, Krass D, Forman J. 88: Creation of a National Model Protocol on Termination of Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: Identifying Public Policy Concerns for Controversial EMS Issues. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.154] [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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Saint S, Kowalski CP, Kaufman SR, Hofer TP, Kauffman CA, Olmsted RN, Forman J, Banaszak-Holl J, Damschroder L, Krein SL. Preventing Hospital-Acquired Urinary Tract Infection in the United States: A National Study. Clin Infect Dis 2008; 46:243-50. [DOI: 10.1086/524662] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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