1
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Lofters AK, O'Brien MA, Sutradhar R, Pinto AD, Baxter NN, Donnelly P, Elliott R, Glazier RH, Huizinga J, Kyle R, Manca D, Pietrusiak MA, Rabeneck L, Riordan B, Selby P, Sivayoganathan K, Snider C, Sopcak N, Thorpe K, Tinmouth J, Wall B, Zuo F, Grunfeld E, Paszat L. Correction to: Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial. BMC Public Health 2021; 21:1714. [PMID: 34548061 PMCID: PMC8456665 DOI: 10.1186/s12889-021-11700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada. .,Women's College Hospital Research Institute, Toronto, Canada. .,Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada. .,Ontario Health (Cancer Care Ontario), Toronto, Canada. .,ICES, Toronto, Canada.
| | - M A O'Brien
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - R Sutradhar
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A D Pinto
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - N N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - P Donnelly
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,University of St. Andrews, Scotland, UK
| | - R Elliott
- Durham Region Health Department, Whitby, Canada
| | - R H Glazier
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Huizinga
- Durham Region Health Department, Whitby, Canada
| | - R Kyle
- Durham Region Health Department, Whitby, Canada
| | - D Manca
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | | | - L Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - B Riordan
- Durham Region Health Department, Whitby, Canada
| | - P Selby
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - K Sivayoganathan
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Durham Region Health Department, Whitby, Canada
| | - C Snider
- Durham Region Health Department, Whitby, Canada
| | - N Sopcak
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - K Thorpe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - J Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - B Wall
- Durham Region Health Department, Whitby, Canada
| | - F Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - E Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - L Paszat
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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2
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Lofters AK, O'Brien MA, Sutradhar R, Pinto AD, Baxter NN, Donnelly P, Elliott R, Glazier RH, Huizinga J, Kyle R, Manca DM, Pietrusiak MA, Rabeneck L, Riordan B, Selby P, Sivayoganathan K, Snider C, Sopcak N, Thorpe K, Tinmouth J, Wall B, Zuo F, Grunfeld E, Paszat L. Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial. BMC Public Health 2021; 21:1496. [PMID: 34344340 PMCID: PMC8329623 DOI: 10.1186/s12889-021-11452-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) intervention was designed to integrate the approach to chronic disease prevention and screening in primary care and demonstrated effective in a previous randomized trial. METHODS We tested the effectiveness of the BETTER HEALTH intervention, a public health adaptation of BETTER, at improving participation in chronic disease prevention and screening actions for residents of low-income neighbourhoods in a cluster randomized trial, with ten low-income neighbourhoods in Durham Region Ontario randomized to immediate intervention vs. wait-list. The unit of analysis was the individual, and eligible participants were adults age 40-64 years residing in the neighbourhoods. Public health nurses trained as "prevention practitioners" held one prevention-focused visit with each participant. They provided participants with a tailored prevention prescription and supported them to set health-related goals. The primary outcome was a composite index: the number of evidence-based actions achieved at six months as a proportion of those for which participants were eligible at baseline. RESULTS Of 126 participants (60 in immediate arm; 66 in wait-list arm), 125 were included in analyses (1 participant withdrew consent). In both arms, participants were eligible for a mean of 8.6 actions at baseline. At follow-up, participants in the immediate intervention arm met 64.5% of actions for which they were eligible versus 42.1% in the wait-list arm (rate ratio 1.53 [95% confidence interval 1.22-1.84]). CONCLUSION Public health nurses using the BETTER HEALTH intervention led to a higher proportion of identified evidence-based prevention and screening actions achieved at six months for people living with socioeconomic disadvantage. TRIAL REGISTRATION NCT03052959 , registered February 10, 2017.
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Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada. .,Women's College Hospital Research Institute, Toronto, Canada. .,Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada. .,Ontario Health (Cancer Care Ontario), Toronto, Canada. .,ICES, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.
| | - M A O'Brien
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - R Sutradhar
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A D Pinto
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - N N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - R Elliott
- Durham Region Health Department, Whitby, Canada
| | - R H Glazier
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - J Huizinga
- Durham Region Health Department, Whitby, Canada
| | - R Kyle
- Durham Region Health Department, Whitby, Canada
| | - D M Manca
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | | | - L Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - B Riordan
- Durham Region Health Department, Whitby, Canada
| | - P Selby
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - K Sivayoganathan
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Durham Region Health Department, Whitby, Canada
| | - C Snider
- Durham Region Health Department, Whitby, Canada
| | - N Sopcak
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - K Thorpe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - J Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - B Wall
- Durham Region Health Department, Whitby, Canada
| | - F Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - E Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - L Paszat
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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3
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Meggetto O, Jembere N, Gao J, Walker MJ, Rey M, Rabeneck L, Murphy KJ, Kupets R. The impact of the COVID-19 pandemic on the Ontario Cervical Screening Program, colposcopy and treatment services in Ontario, Canada: a population-based study. BJOG 2021; 128:1503-1510. [PMID: 33982870 PMCID: PMC8209864 DOI: 10.1111/1471-0528.16741] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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] [Accepted: 03/22/2021] [Indexed: 12/02/2022]
Abstract
Objective To describe the immediate impact of the COVID‐19 pandemic on cervical screening, colposcopy and treatment volumes in Ontario, Canada. Design Population‐based retrospective observational study. Setting Ontario, Canada. Population People with a cervix age of 21–69 years who completed at least one cervical screening cytology test, colposcopy or treatment procedure for cervical dysplasia between January 2019 and August 2020. Methods Administrative databases were used to compare cervical screening cytology, colposcopy and treatment procedure volumes before (historical comparator) and during the first 6 months of the COVID‐19 pandemic (March–August 2020). Main outcome measures Changes in cervical screening cytology, colposcopy and treatment volumes; individuals with high‐grade cytology awaiting colposcopy. Results During the first 6 months of the COVID‐19 pandemic, the monthly average number of cervical screening cytology tests, colposcopies and treatments decreased by 63.8% (range: −92.3 to −41.0%), 39.7% (range: −75.1 to −14.3%) and 31.1% (range: −43.5 to −23.6%), respectively, when compared with the corresponding months in 2019. Between March and August 2020, on average 292 (−51.0%) fewer high‐grade cytological abnormalities were detected through screening each month. As of August 2020, 1159 (29.2%) individuals with high‐grade screening cytology were awaiting follow‐up colposcopy. Conclusions The COVID‐19 pandemic has had a substantial impact on key cervical screening and follow‐up services in Ontario. As the pandemic continues, ongoing monitoring of service utilisation to inform system response and recovery is required. Future efforts to understand the impact of COVID‐19‐related disruptions on cervical cancer outcomes will be needed. Tweetable abstract COVID‐19 has had a substantial impact on cervical screening and follow‐up services in Ontario, Canada. COVID‐19 has had a substantial impact on cervical screening and follow‐up services in Ontario, Canada.
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Affiliation(s)
- O Meggetto
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - N Jembere
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - J Gao
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - M J Walker
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - M Rey
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - L Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - K J Murphy
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.,Trillium Health Partners, Mississauga/Toronto, ON, Canada
| | - R Kupets
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.,Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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4
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Tinmouth J, Paramalingam A, Bellini A, Cotterchio M, Dekker E, Doctorow R, Hassan C, Haddad E, Lofters A, MacIntosh D, Martin J, McCurdy B, Murray I, Naglie H, Paroschy-Harris C, Rabeneck L, Stogios C, Telford JJ, Venkatesh R, Wong C, Zenlea T, Dube C. A63 REFINING THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY GUIDELINE ON SCREENING IN PERSONS WITH A FAMILY HISTORY OF NONHEREDITARY COLORECTAL CANCER OR ADENOMA: A MODIFIED DELPHI PROCESS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.061] [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: 11/12/2022] Open
Abstract
Abstract
Background
In 2018, the Canadian Association of Gastroenterology (CAG) published an extensive systematic review and guideline on screening in persons with a family history (FHx) of nonhereditary colorectal cancer (CRC) and adenoma. While CAG’s recommendations were evidence-based, some recommendations lacked precision (e.g. ranges for some start ages & intervals) and screening cessation age was not addressed, leading to implementation challenges for practitioners and CRC screening programs.
Aims
To review and update the evidence since the 2018 guideline and to formulate implementable recommendations in the Ontario context that are aligned with the CAG guideline.
Methods
ColonCancerCheck (Ontario’s organized CRC screening program) conducted a modified version of the literature search used by CAG (Jan 2017 - Sept 2019). A 19-member expert panel with Canadian and international representatives from endoscopy, primary care, epidemiology, organized CRC screening programs, Ontario’s cancer system and the general public refined the recommendations of the CAG guideline for the purposes of implementation in an organized CRC screening program using a modified Delphi process. This iterative process involved a series of webinars and anonymous survey rounds where the panel reviewed evidence materials and provided online feedback to develop, refine & achieve consensus on screening recommendations in persons with a FHx of CRC/adenoma. Consensus was achieved if ≥75% of members agreed or strongly agreed with the statement.
Results
Six new systematic reviews and 2 new guidelines were identified. New evidence included data on the absolute risk (10 year & lifetime risk) of CRC by type of FHx, as well as the performance of fecal immunochemical testing (FIT) and barriers to CRC screening in persons with a FHx of CRC. The expert panel participated in 3 webinars and 4 online surveys to arrive at consensus. Panel recommendations and level of consensus will be reported for the 6 statements (Table).
Conclusions
Building from the CAG guideline, we derived evidence-based and implementable recommendations for screening persons with a FHx of CRC or adenoma.
Funding Agencies
Ontario Health (Cancer Care Ontario)
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Affiliation(s)
- J Tinmouth
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - A Bellini
- William Osler Health Centre-Brampton Civic Hospital, Toronto, ON, Canada
| | | | - E Dekker
- Universiteit van Amsterdam Faculteit Geneeskunde, Amsterdam, Noord-Holland, Netherlands
| | | | - C Hassan
- Poliambulatorio Nuovo Regina Margherita, Roma, Lazio, Italy
| | - E Haddad
- Chatham-Kent Health Alliance, Chatham, ON, Canada
| | - A Lofters
- Women’s College Hospital, Toronto, ON, Canada
| | - D MacIntosh
- Queen Elizabeth II Health Science Centre, Halifax, NS, Canada
| | - J Martin
- Grand River Hospital, Kitchener, ON, Canada
| | | | - I Murray
- Intestinal Health Institute, Unionville, ON, Canada
| | - H Naglie
- General Public, Toronto, ON, Canada
| | - C Paroschy-Harris
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | | | | | - J J Telford
- University of British Columbia, Vancouver, BC, Canada
| | | | - C Wong
- University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - T Zenlea
- Women’s College Hospital, Toronto, ON, Canada
| | - C Dube
- Ottawa Hospital Civic Campus, Ottawa, ON, Canada
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5
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Evans W, Truscott R, Cameron E, Timmings C, Haque M, Halligan M, Rana S, Keen D, Rabeneck L. ES20.03 Tobacco Control Integration in Cancer Care: The Canadian Experience. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.158] [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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6
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O'Brien M, Lofters A, Wall B, Pinto A, Elliott R, Pietrusiak MA, Snider C, Riordan B, Grunfeld E, Makuwaza T, Sivayoganathan K, Manca D, Sopcak N, Donnelly P, Selby P, Kyle R, Baxter N, Rabeneck L, Cornacchi S, Paszat L. Better Health Durham: Community Engagement in a Cluster RCT of a Prevention Practitioner Intervention in Low-Income Neighbourhoods. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.53100] [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: 11/20/2022] Open
Abstract
Background: The Building on Existing Tools to Improve Chronic Disease Prevention and Screening (BETTER) intervention has improved uptake of chronic disease prevention and screening activities in primary care. The BETTER intervention consists of 1:1 visits between prevention practitioners (PPs) and patients (40-65 years). It is unknown if an adapted BETTER could be effective in the community with public health nurses as PPs. Aim: The presentation objective is to describe community engagement strategies in a cluster RCT in low income neighborhoods with low cancer screening rates and low uptake of primary care. Methods: Principles of community-based participatory research were used to design the community engagement strategy in Durham region, Ontario. Key elements included close collaboration with public health partners to identify stakeholders and creating a community advisory committee (CAC) and a primary care engagement group to provide advice. Results: We identified 15 community stakeholder groups (∼47 subgroups) including service organizations, faith groups, and charitable organizations representing diverse constituents. Community outreach activities included in-person meetings and information displays at local events. The CAC is comprised of members of the public and representatives from primary care, social services, and community organizations. The CAC and primary care engagement groups have provided advice on trial recruitment strategies and on the design of the PP visit. Conclusion: The partnership between public health, primary care, and the study team has been crucial to connect with community stakeholders. Community engagement is essential in raising awareness about the study and will contribute to successful recruitment. Trial Registration: NCT03052959
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Affiliation(s)
- M.A. O'Brien
- University of Toronto, Family and Community Medicine, Toronto, Canada
| | - A. Lofters
- University of Toronto, Family and Community Medicine, Toronto, Canada
| | - B. Wall
- Durham Region Health Department, Whitby, Canada
| | - A.D. Pinto
- University of Toronto, Family and Community Medicine, Toronto, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
- University of Toronto, Dalla Lana School of Public Health, Toronto, Canada
| | - R. Elliott
- Durham Region Health Department, Whitby, Canada
| | | | - C. Snider
- Durham Region Health Department, Whitby, Canada
| | - B. Riordan
- Durham Region Health Department, Whitby, Canada
| | - E. Grunfeld
- University of Toronto, Family and Community Medicine, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - T. Makuwaza
- University of Toronto, Family and Community Medicine, Toronto, Canada
| | | | - D. Manca
- University of Alberta, Family Medicine, Edmonton, Canada
| | - N. Sopcak
- University of Alberta, Family Medicine, Edmonton, Canada
| | - P. Donnelly
- University of Toronto, Dalla Lana School of Public Health, Toronto, Canada
| | - P. Selby
- University of Toronto, Family and Community Medicine, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - R. Kyle
- Durham Region Health Department, Whitby, Canada
| | - N. Baxter
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - L. Rabeneck
- University of Toronto, Faculty of Medicine, Toronto, Canada
- University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | - S. Cornacchi
- University of Toronto, Family and Community Medicine, Toronto, Canada
| | - L. Paszat
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
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7
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Tinmouth J, Baxter N, Li Q, Paszat L, Patel J, Rabeneck L. A44 MEASURING COLONOSCOPY QUALITY AT THE POPULATION LEVEL IN ONTARIO, CANADA. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Tinmouth
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - N Baxter
- St.Michael’s Hospital, Toronto, ON, Canada
| | - Q Li
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - L Paszat
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - J Patel
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - L Rabeneck
- Cancer Care Ontario, Toronto, ON, Canada
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8
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Cenin D, Tinmouth J, Dube C, McCurdy B, Paszat L, Rabeneck L, Lansdorp-Vogelaar I. A198 PERSONALIZING THE AGE TO STOP COLORECTAL CANCER SCREENING IN CANADA BASED ON COMORBIDITY AND PRIOR SCREENING HISTORY: MODEL ESTIMATES OF HARMS AND BENEFITS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Cenin
- Erasmus MC, Rotterdam, Netherlands
| | - J Tinmouth
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Dube
- The Ottawa Hospital, Ottawa, ON, Canada
| | - B McCurdy
- Cancer Care Ontario, Toronto, ON, Canada
| | - L Paszat
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Rabeneck
- Cancer Care Ontario, Toronto, ON, Canada
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9
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Stock D, Rabeneck L, Baxter NN, Paszat LF, Sutradhar R, Yun L, Tinmouth J. A centrally generated primary care physician audit report does not improve colonoscopy uptake after a positive result on a fecal occult blood test in Ontario's ColonCancerCheck program. ACTA ACUST UNITED AC 2017; 24:47-51. [PMID: 28270725 DOI: 10.3747/co.24.3025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. In the present study, we evaluated the effectiveness of centrally generated, physician-targeted audit and feedback to improve colonoscopy uptake after a positive fecal occult blood test (fobt) result within Ontario's population-wide ColonCancerCheck Program. METHODS This prospective cohort study used data sets from Ontario's ColonCancerCheck Program (2008-2011) that were linked to provincial administrative health databases. Cox proportional hazards regression was used to estimate the effect of centralized, physician-targeted audit and feedback on colonoscopy uptake in an Ontario-wide fobt-positive cohort. RESULTS A mailed physician audit and feedback report identifying individuals outstanding for colonoscopy for 3 or more months after a positive fobt result did not increase the likelihood of colonoscopy uptake (hazard ratio: 0.95; 95% confidence interval: 0.79 to 1.13). Duration of positive fobt status was strongly inversely associated with the hazard of follow-up colonoscopy (p for linear trend: <0.001). CONCLUSIONS In a large population-wide setting, centralized tracking in the form of physician-targeted mailed audit and feedback reports does not improve colonoscopy uptake for screening participants with a positive fobt result outstanding for 3 or more months. Mailed physician-targeted screening audit and feedback reports alone are unlikely to improve compliance with follow-up colonoscopy in Ontario. Other interventions such as physician audits or automatic referrals, demonstrated to be effective in other jurisdictions, might be warranted.
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Affiliation(s)
- D Stock
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre
| | - L Rabeneck
- Department of Medicine, University of Toronto; Institute for Clinical Evaluative Sciences; Dalla Lana School of Public Health, University of Toronto; Institute of Health Policy Management and Evaluation, University of Toronto; Cancer Care Ontario
| | - N N Baxter
- Institute for Clinical Evaluative Sciences; Institute of Health Policy Management and Evaluation, University of Toronto; Department of General Surgery and Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Medical Sciences, University of Toronto, and
| | - L F Paszat
- Institute for Clinical Evaluative Sciences; Dalla Lana School of Public Health, University of Toronto; Radiation Oncology, University of Toronto, Toronto, ON
| | - R Sutradhar
- Institute for Clinical Evaluative Sciences; Dalla Lana School of Public Health, University of Toronto
| | - L Yun
- Institute for Clinical Evaluative Sciences
| | - J Tinmouth
- Department of Medicine, University of Toronto; Institute for Clinical Evaluative Sciences; Institute of Health Policy Management and Evaluation, University of Toronto; Cancer Care Ontario
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10
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Ruco A, Walsh CM, Cooper MA, Rabeneck L. Training non-physicians to do endoscopy: Feasibility, effectiveness and cost-effectiveness. Best Pract Res Clin Gastroenterol 2016; 30:389-96. [PMID: 27345647 DOI: 10.1016/j.bpg.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/25/2016] [Revised: 04/12/2016] [Accepted: 04/28/2016] [Indexed: 01/31/2023]
Abstract
Colorectal cancer (CRC) is one of the most common cancers in women and men worldwide. Training non-physicians including nurses, nurse practitioners, and physician assistants to perform endoscopy can provide the opportunity to expand access to CRC screening as demand for endoscopic procedures continues to grow. A formal program, incorporating didactic instruction and hands-on practice in addition to oversight, is required to train non-physicians to perform endoscopy as safely and effectively as physicians. Additionally, the context in which the non-physician endoscopy program is organized will dictate key program characteristics including remuneration, participant recruitment and professional and legal considerations. This review explores the evidence in support of non-physician based endoscopy, potential challenges in implementing non-physician endoscopy and requirements for a high-quality program to support training and implementation.
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Affiliation(s)
- A Ruco
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - C M Walsh
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Learning and Research Institutes, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Peadiatrics, University of Toronto, Canada
| | - M A Cooper
- Thunder Bay Regional Health Sciences Centre, Canada
| | - L Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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11
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Sanduleanu S, le Clercq CMC, Dekker E, Meijer GA, Rabeneck L, Rutter MD, Valori R, Young GP, Schoen RE. Definition and taxonomy of interval colorectal cancers: a proposal for standardising nomenclature. Gut 2015; 64:1257-67. [PMID: 25193802 DOI: 10.1136/gutjnl-2014-307992] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [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] [Received: 07/07/2014] [Accepted: 08/13/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Interval colorectal cancers (interval CRCs), that is, cancers occurring after a negative screening test or examination, are an important indicator of the quality and effectiveness of CRC screening and surveillance. In order to compare incidence rates of interval CRCs across screening programmes, a standardised definition is required. Our goal was to develop an internationally applicable definition and taxonomy for reporting on interval CRCs. DESIGN Using a modified Delphi process to achieve consensus, the Expert Working Group on interval CRC of the Colorectal Cancer Screening Committee of the World Endoscopy Organization developed a nomenclature for defining and characterising interval CRCs. RESULTS We define an interval CRC as a "colorectal cancer diagnosed after a screening or surveillance exam in which no cancer is detected, and before the date of the next recommended exam". Guidelines and principles for describing and reporting on interval CRCs are provided, and clinical scenarios to demonstrate the practical application of the nomenclature are presented. CONCLUSIONS The Working Group on interval CRC of the World Endoscopy Organization endorses adoption of this standardised nomenclature. A standardised nomenclature will facilitate benchmarking and comparison of interval CRC rates across programmes and regions.
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Affiliation(s)
- S Sanduleanu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine; and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht The Netherlands
| | - C M C le Clercq
- Division of Gastroenterology and Hepatology, Department of Internal Medicine; and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht The Netherlands
| | - E Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - G A Meijer
- Department of Pathology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - L Rabeneck
- Department of Medicine, University of Toronto; and Cancer Care Ontario, Toronto, Ontario, Canada
| | - M D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK; and Durham University School of Medicine, Pharmacy and Health, Stockton-on-Tees, Cleveland, UK
| | - R Valori
- Gloucestershire Royal Hospital, Gloucester, UK
| | - G P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
| | - R E Schoen
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, USA
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12
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Sung JJY, Ng SC, Chan FKL, Chiu HM, Kim HS, Matsuda T, Ng SSM, Lau JYW, Zheng S, Adler S, Reddy N, Yeoh KG, Tsoi KKF, Ching JYL, Kuipers EJ, Rabeneck L, Young GP, Steele RJ, Lieberman D, Goh KL. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut 2015; 64:121-32. [PMID: 24647008 DOI: 10.1136/gutjnl-2013-306503] [Citation(s) in RCA: 302] [Impact Index Per Article: 33.6] [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: 12/12/2022]
Abstract
OBJECTIVE Since the publication of the first Asia Pacific Consensus on Colorectal Cancer (CRC) in 2008, there are substantial advancements in the science and experience of implementing CRC screening. The Asia Pacific Working Group aimed to provide an updated set of consensus recommendations. DESIGN Members from 14 Asian regions gathered to seek consensus using other national and international guidelines, and recent relevant literature published from 2008 to 2013. A modified Delphi process was adopted to develop the statements. RESULTS Age range for CRC screening is defined as 50-75 years. Advancing age, male, family history of CRC, smoking and obesity are confirmed risk factors for CRC and advanced neoplasia. A risk-stratified scoring system is recommended for selecting high-risk patients for colonoscopy. Quantitative faecal immunochemical test (FIT) instead of guaiac-based faecal occult blood test (gFOBT) is preferred for average-risk subjects. Ancillary methods in colonoscopy, with the exception of chromoendoscopy, have not proven to be superior to high-definition white light endoscopy in identifying adenoma. Quality of colonoscopy should be upheld and quality assurance programme should be in place to audit every aspects of CRC screening. Serrated adenoma is recognised as a risk for interval cancer. There is no consensus on the recruitment of trained endoscopy nurses for CRC screening. CONCLUSIONS Based on recent data on CRC screening, an updated list of recommendations on CRC screening is prepared. These consensus statements will further enhance the implementation of CRC screening in the Asia Pacific region.
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Affiliation(s)
- J J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - S C Ng
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - F K L Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, NT, Hong Kong Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - H M Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - H S Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - T Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - S S M Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - J Y W Lau
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - S Zheng
- Cancer Institute, Zhejiang University, Hanggzhou, Zhejiang, China
| | - S Adler
- Division of Gastroenterology, Bikur Holim Hospital, Jerusalem, Israel
| | - N Reddy
- Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
| | - K G Yeoh
- Department of Medicine, Asian Healthcare Foundation, National University of Singapore and Senior Consultant Gastroenterologist, Singapore
| | - K K F Tsoi
- School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - J Y L Ching
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - E J Kuipers
- Department of Medicine & Therapeutics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - L Rabeneck
- Institute of Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - G P Young
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - R J Steele
- Department of Surgery and Molecular Oncology, University of Dundee, Dundee, UK
| | - D Lieberman
- Portland VA Medical Centre, Portland, Oregon, USA
| | - K L Goh
- Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
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13
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von Karsa L, Patnick J, Segnan N, Atkin W, Halloran S, Lansdorp-Vogelaar I, Malila N, Minozzi S, Moss S, Quirke P, Steele RJ, Vieth M, Aabakken L, Altenhofen L, Ancelle-Park R, Antoljak N, Anttila A, Armaroli P, Arrossi S, Austoker J, Banzi R, Bellisario C, Blom J, Brenner H, Bretthauer M, Camargo Cancela M, Costamagna G, Cuzick J, Dai M, Daniel J, Dekker E, Delicata N, Ducarroz S, Erfkamp H, Espinàs JA, Faivre J, Faulds Wood L, Flugelman A, Frkovic-Grazio S, Geller B, Giordano L, Grazzini G, Green J, Hamashima C, Herrmann C, Hewitson P, Hoff G, Holten I, Jover R, Kaminski MF, Kuipers EJ, Kurtinaitis J, Lambert R, Launoy G, Lee W, Leicester R, Leja M, Lieberman D, Lignini T, Lucas E, Lynge E, Mádai S, Marinho J, Maučec Zakotnik J, Minoli G, Monk C, Morais A, Muwonge R, Nadel M, Neamtiu L, Peris Tuser M, Pignone M, Pox C, Primic-Zakelj M, Psaila J, Rabeneck L, Ransohoff D, Rasmussen M, Regula J, Ren J, Rennert G, Rey J, Riddell RH, Risio M, Rodrigues V, Saito H, Sauvaget C, Scharpantgen A, Schmiegel W, Senore C, Siddiqi M, Sighoko D, Smith R, Smith S, Suchanek S, Suonio E, Tong W, Törnberg S, Van Cutsem E, Vignatelli L, Villain P, Voti L, Watanabe H, Watson J, Winawer S, Young G, Zaksas V, Zappa M, Valori R. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45:51-9. [PMID: 23212726 PMCID: PMC4482205 DOI: 10.1055/s-0032-1325997] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [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: 12/13/2022]
Abstract
Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010. They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.
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Affiliation(s)
| | - L. von Karsa
- International Agency for Research on Cancer, Lyon, France
| | - J. Patnick
- NHS Cancer Screening Programmes Sheffield, United Kingdom,Oxford University Cancer Screening Research Unit, Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - N. Segnan
- International Agency for Research on Cancer, Lyon, France,CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - W. Atkin
- Imperial College London, London, United Kingdom
| | - S. Halloran
- Bowel Cancer Screening Southern Programme Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom,University of Surrey, Guildford, United Kingdom
| | | | - N. Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - S. Minozzi
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - S. Moss
- The Institute of Cancer Research, Royal Cancer Hospital, Sutton, United Kingdom
| | - P. Quirke
- Leeds Institute of Molecular Medicine, St James’ University Hospital, Leeds, United Kingdom
| | - R. J. Steele
- Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - M. Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - L. Aabakken
- Department of Medical Gastroenterology, Stavanger University Hospital, Stavanger, Norway
| | - L. Altenhofen
- Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | | | - N. Antoljak
- Croatian National Institute of Public Health, Zagreb, Croatia,University of Zagreb School of Medicine, Zagreb, Croatia
| | - A. Anttila
- Finnish Cancer Registry, Helsinki, Finland
| | - P. Armaroli
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | | | - J. Austoker
- University of Oxford, Oxford, United Kingdom
| | - R. Banzi
- Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - C. Bellisario
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - J. Blom
- Karolinska Institutet, Stockholm, Sweden
| | - H. Brenner
- German Cancer Research Center, Heidelberg, Germany
| | - M. Bretthauer
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - M. Camargo Cancela
- National Cancer Registry, Cork, Ireland,Formerly International Agency for Research on Cancer, Lyon, France
| | | | - J. Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | - M. Dai
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - J. Daniel
- Formerly International Agency for Research on Cancer, Lyon, France,American Cancer Society, Atlanta, Georgia, United States of America
| | - E. Dekker
- Academic Medical Centre, Amsterdam, the Netherlands
| | - N. Delicata
- National Health Screening Services, Ministry of Health, Elderly & Community Care, Valletta, Malta
| | - S. Ducarroz
- International Agency for Research on Cancer, Lyon, France
| | - H. Erfkamp
- University of Applied Sciences FH Joanneum, Graz, Austria
| | - J. A. Espinàs
- Catalan Cancer Strategy, L’Hospitalet de Llobregat, Spain
| | - J. Faivre
- Digestive Cancer Registry of Burgundy, INSERM U866, University and CHU, Dijon, France
| | - L. Faulds Wood
- Lynn’s Bowel Cancer Campaign, Twickenham, United Kingdom
| | - A. Flugelman
- National Israeli Breast and Colorectal Cancer Detection, Haifa, Israel
| | - S. Frkovic-Grazio
- Department of Gynecological Pathology and Cytology, University Medical Center Ljubljana, Slovenia
| | - B. Geller
- University of Vermont, Burlington, Vermont, United States of America
| | - L. Giordano
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - G. Grazzini
- Cancer Prevention and Research Institute (ISPO), Florence, Italy
| | - J. Green
- University of Oxford, Oxford, United Kingdom
| | | | - C. Herrmann
- Formerly International Agency for Research on Cancer, Lyon, France,Cancer League of Eastern Switzerland, St. Gallen, Switzerland
| | - P. Hewitson
- University of Oxford, Oxford, United Kingdom
| | - G. Hoff
- Cancer Registry of Norway, Oslo, Norway,Telemark Hospital, Skien, Norway
| | - I. Holten
- Danish Cancer Society, Copenhagen, Denmark
| | - R. Jover
- Hospital General Universitario de Alicante, Alicante, Spain
| | - M. F. Kaminski
- Maria Sklodowska-Curie Memorial Cancer Centre and Medical Centre for Postgraduate Education, Warsaw, Poland
| | | | | | - R. Lambert
- International Agency for Research on Cancer, Lyon, France
| | - G. Launoy
- U1086 INSERM – UCBN, CHU Caen, France
| | - W. Lee
- The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | | | - M. Leja
- University of Latvia, Riga, Latvia
| | - D. Lieberman
- Oregon Health & Science University, Portland, Oregon, United States of America
| | - T. Lignini
- International Agency for Research on Cancer, Lyon, France
| | - E. Lucas
- International Agency for Research on Cancer, Lyon, France
| | - E. Lynge
- University of Copenhagen, Copenhagen, Denmark
| | - S. Mádai
- MaMMa Healthcare Institute, Budapest, Hungary
| | - J. Marinho
- Health Administration Central Region Portugal, Aveiro, Portugal
| | | | - G. Minoli
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - C. Monk
- GlaxoSmithKline Pharma Europe, London, United Kingdom
| | - A. Morais
- Regional Health Administration, Coimbra, Portugal
| | - R. Muwonge
- International Agency for Research on Cancer, Lyon, France
| | - M. Nadel
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - L. Neamtiu
- Prof. Dr Ion Chiricuţă, Cluj-Napoca, Romania
| | - M. Peris Tuser
- Catalan Institute of Oncology, L’Hospitalet de Llobregat, Spain
| | - M. Pignone
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - C. Pox
- Ruhr Universität, Bochum, Germany
| | - M. Primic-Zakelj
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Slovenia
| | - J. Psaila
- National Health Screening Services, Ministry of Health, Elderly & Community Care, Valletta, Malta
| | - L. Rabeneck
- University of Toronto and Cancer Care Ontario, Toronto, Canada
| | - D. Ransohoff
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - M. Rasmussen
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - J. Regula
- Maria Sklodowska-Curie Memorial Cancer Centre and Medical Centre for Postgraduate Education, Warsaw, Poland
| | - J. Ren
- Formerly International Agency for Research on Cancer, Lyon, France
| | - G. Rennert
- National Israeli Breast and Colorectal Cancer Detection, Haifa, Israel
| | - J. Rey
- Institut Arnault Tzanck, St Laurent du Var, France
| | | | - M. Risio
- Institute for Cancer Research and Treatment, Candiolo-Torino, Italy
| | - V. Rodrigues
- Faculdade de Medicina – Universidade de Coimbra, Coimbra, Portugal
| | - H. Saito
- National Cancer Centre, Tokyo, Japan
| | - C. Sauvaget
- International Agency for Research on Cancer, Lyon, France
| | | | | | - C. Senore
- CPO Piemonte, AO Città della Salute e della Scienza di Torino, Turin Italy
| | - M. Siddiqi
- Cancer Foundation of India, Kolkata, India
| | - D. Sighoko
- Formerly International Agency for Research on Cancer, Lyon, France,The University of Chicago, Department of Medicine, Hematology–Oncology Section, Center for Clinical Cancer Genetics, Global Health, Chicago, United States of America
| | - R. Smith
- American Cancer Society, Atlanta, Georgia, United States of America
| | - S. Smith
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - S. Suchanek
- Charles University and Military University Hospital, Prague, Czech Republic
| | - E. Suonio
- International Agency for Research on Cancer, Lyon, France
| | - W. Tong
- Chinese Academy of Medical Sciences, Beijing, China
| | - S. Törnberg
- Department of Cancer Screening, Stockholm Gotland Regional Cancer Centre, Stockholm, Sweden
| | | | - L. Vignatelli
- Agenzia Sanitaria e Sociale Regionale–Regione Emilia-Romagna, Bologna, Italy
| | - P. Villain
- University of Oxford, Oxford, United Kingdom
| | - L. Voti
- Formerly International Agency for Research on Cancer, Lyon, France,University of Miami, Miami, Florida, United States of America
| | | | - J. Watson
- University of Oxford, Oxford, United Kingdom
| | - S. Winawer
- Memorial Sloan–Kettering Cancer Center, New York, United States of America
| | - G. Young
- Gastrointestinal Services, Flinders University, Adelaide, Australia
| | - V. Zaksas
- State Patient Fund, Vilnius, Lithuania
| | - M. Zappa
- Cancer Prevention and Research Institute (ISPO), Florence, Italy
| | - R. Valori
- NHS Endoscopy, Leicester, United Kingdom
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Eisen A, Carroll J, Chiarelli AM, Horgan M, Meschino W, Rabeneck L, Shumak R, Warner E. Abstract P3-02-10: Implementation and uptake of a provincial, population-based, organized breast screening program for high risk women in Ontario: The Ontario breast screening program (OBSP) high risk program. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-02-10] [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: Genetic testing for mutations in BRCA1/2 has been clinically available in Ontario since 2000. Over 15000 individuals have been tested. Evidence from clinical trials has consistently shown that women at high risk of breast cancer (BrCa) benefit from BrCa screening that includes both magnetic resonance imaging (MRI) of the breast and mammography, yet access to MRI in Ontario was variable. In 2011, Cancer Care Ontario (CCO) established an expert panel to develop a protocol for expanding the OBSP, initially created for average risk women 50–74, to include MRI and mammography for eligible high risk women.
Methods: The panel's tasks included: 1. determining high risk criteria 2. estimating the prevalence of high risk women 3. selecting a cancer risk model 4. developing a referral and assessment pathway for potentially eligible subjects 5. developing educational resources, training plan and communication strategy for relevant stakeholders 6. developing indicators for program evaluation, 7. providing guidance for post-implementation issues.
Results: The program was initiated July, 2011 and now includes 28 sites. Women aged 30–69 with and without a history of breast cancer are eligible if they 1. are BRCA1/2 mutation carriers or untested first degree relatives of carriers, 2. have a lifetime risk of breast cancer >=25% based on family history according to IBIS or BOADICEA risk models, or 3. received prior radiation therapy to the chest. It is estimated that 34000 high risk women in the target age group live in Ontario. Preliminary volume data for the first 9 mos are shown in Table 1. Of the 5037 women participating, 802 have been referred directly by their physician and 4,235 have been referred for genetic assessment. Of the 2,946 women who received genetic assessment, 31% met the high risk criteria. To date, 729 high risk MRI scans have been performed.
Conclusions: A population based organized screening program for high risk women that includes genetic risk assessment has been implemented in Ontario. Further evaluation of risk assessment and screen results are underway. To our knowledge, this is the first organized screening program for women at high risk of breast cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-10.
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Affiliation(s)
- A Eisen
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - J Carroll
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - AM Chiarelli
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - M Horgan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - W Meschino
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - L Rabeneck
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - R Shumak
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - E Warner
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Cancer Care Ontario, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
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15
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Brouwers M, Oliver TK, Crawford J, Ellison P, Evans WK, Gagliardi A, Lacourciere J, Lo D, Mai V, McNair S, Minuk T, Rabeneck L, Rand C, Ross J, Smylie J, Srigley J, Stern H, Trudeau M. Cancer diagnostic assessment programs: standards for the organization of care in Ontario. ACTA ACUST UNITED AC 2011; 16:29-41. [PMID: 20016744 PMCID: PMC2794680 DOI: 10.3747/co.v16i6.400] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Improving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a high-quality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap. Methods As a quality initiative of Cancer Care Ontario’s Program in Evidence-Based Care, the Diagnostic Assessment Standards Panel, with representation from clinical oncology experts, institutional and clinical administrative leaders, health service researchers, and methodologists, conducted a systematic review and a targeted environmental scan of the unpublished literature. Standards were developed based on expert consensus opinion informed by the identified evidence. Through external review, clinicians and administrators across Ontario were given the opportunity to provide feedback. Results The body of evidence consists of thirty-five published studies and fifteen unpublished guidance documents. The evidence and consensus opinion consistently favoured an organized, centralized system with multidisciplinary team membership as the optimal approach for the delivery of diagnostic cancer assessment services. Independent external stakeholders agreed (with higher mean values, maximum 5, indicating stronger agreement) that dap standards are needed (mean: 4.6), that standards should be formally approved (mean: 4.3), and importantly, that standards reflect an effective approach that will lead to quality improvements in the cancer system (mean: 4.5) and in patient care (mean: 4.3). Interpretation Based on the best available evidence, standards for the organization of daps are offered. There is clear need to integrate formal and comprehensive evaluation strategies with the implementation of the standards to advance this field.
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Affiliation(s)
- M Brouwers
- Program in Evidence-Based Care, Hamilton, ON.
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Del Giudice EM, Paszat LF, Rabeneck L, Sutradhar R, Urbach D, Wilton D, Baxter NN. Long-term surveillance and preventive practices among healthy young adult cancer survivors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6121] [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: 11/20/2022] Open
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Benchimol EI, Guttmann A, Griffiths AM, Rabeneck L, Mack DR, Brill H, Howard J, Guan J, To T. Increasing incidence of paediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data. Gut 2009; 58:1490-7. [PMID: 19651626 DOI: 10.1136/gut.2009.188383] [Citation(s) in RCA: 299] [Impact Index Per Article: 19.9] [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: 12/11/2022]
Abstract
OBJECTIVE Health administrative databases can be used to track chronic diseases. The aim of this study was to validate a case ascertainment definition of paediatric-onset inflammatory bowel disease (IBD) using administrative data and describe its epidemiology in Ontario, Canada. METHODS A population-based clinical database of patients with IBD aged <15 years was used to define cases, and patient information was linked to health administrative data to compare the accuracy of various patterns of healthcare use. The most accurate algorithm was validated with chart data of children aged <18 years from 12 medical practices. Administrative data from the period 1991-2008 were used to describe the incidence and prevalence of IBD in Ontario children. Changes in incidence were tested using Poisson regression. RESULTS Accurate identification of children with IBD required four physician contacts or two hospitalisations (with International Classification of Disease (ICD) codes for IBD) within 3 years if they underwent colonoscopy and seven contacts or three hospitalisations within 3 years in those without colonoscopy (children <12 years old, sensitivity 90.5%, specificity >99.9%; children <15 years old, sensitivity 89.6%, specificity >99.9%; children <18 years old, sensitivity 91.1%, specificity 99.5%). Age- and sex-standardised prevalence per 100 000 population of paediatric IBD has increased from 42.1 (in 1994) to 56.3 (in 2005). Incidence per 100 000 has increased from 9.5 (in 1994) to 11.4 (in 2005). Statistically significant increases in incidence were noted in 0-4 year olds (5.0%/year, p = 0.03) and 5-9 year olds (7.6%/year, p<0.0001), but not in 10-14 or 15-17 year olds. CONCLUSION Ontario has one of the highest rates of childhood-onset IBD in the world, and there is an accelerated increase in incidence in younger children.
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Affiliation(s)
- E I Benchimol
- The Institute for Clinical Evaluative Sciences, University of Toronto, Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M4S 1C5, Canada.
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Nenshi R, Kennedy E, Baxter NN, Saskin R, Sutradhar R, Urbach DR, Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM, Krajewski SA, Brown CJ, Hur C, McCrea PH, Mitchell A, Porter G, Grushka J, Razek T, Khwaja K, Fata P, Martel G, Moloo H, Picciano G, Boushey RP, Poulin EC, Mamazza J, Haas B, Xiong W, Brennan-Barnes M, Gomez D, Nathens AB, Yang I, Forbes SS, Stephen WJ, Loeb M, Smith R, Christoffersen EP, McLean RF, Westerholm J, Garcia-Osogobio S, Farrokhyar F, Cadeddu M, Anvari M, Ponton-Carss A, Hutchison C, Violato C, Segedi M, Mittleman M, Fisman D, Kinlin L, Rousseau M, Saleh W, Ferri LE, Feldman LS, Stanbridge DD, Mayrand S, Fried GM, Pandya A, Gagliardi A, Nathens A, Ahmed N, Tran T, Demyttenaere SV, Polyhronopoulos G, Seguin C, Artho GP, Kaneva P, Fried GM, Feldman LS, Demyttenaere SV, Bergman S, Anderson J, Mikami DJ, Melvin WS, Racz JM, Dubois L, Katchky A, Wall WJ, Faryniuk A, Hochman D, Clarkson CA, Rubiano AM, Clarkson CA, Boone D, Ball CG, Dixon E, Kirkpatrick AW, Sutherland FR, Feliciano DV, Wyrzykowski AD, Nicholas JM, Dente CJ, Ball CG, Feliciano DV, Ullah SM, McAlister VC, Malik S, Ramsey D, Pooler S, Teague B, Misra M, Cadeddu M, Anvari M, Kaminsky M, Vergis A, Gillman LM, Gillman LM, Vergis A, Altaf A, Ellsmere J, Bonjer HJ, Klassen D, Orzech N, Palter V, Aggarwal R, Okrainec A, Grantcharov TP, Ghaderi I, Feldman LS, Sroka G, Kaneva PA, Fried GM, Shlomovitz E, Reznick RK, Kucharczyk W, Lee L, Iqbal S, Barayan H, Lu Y, Fata P, Razek T, Khwaja K, Boora PS, White JS, Vogt KN, Charyk-Stewart T, Minuk L, Eckert K, Chin-Yee I, Gray D, Parry N, Humphrey RJ, Bütter A, Schmidt J, Grieci T, Gagnon R, Han V, Duhaime S, Pitt DF, Palter V, Orzech N, Aggarwal R, Okrainec A, Grantcharov TP, Dubois L, Vogt KN, Davies W, Schlachta CM, Shi X, Birch DW, Gu Y, Moser MA, Swanson TW, Schaeffer DF, Tang BQ, Rusnak CH, Amson BJ, Vogt KN, Dubois L, Hobbs A, Etemad-Rezai R, Schlachta CM, Claydon E, McAlister V, Grushka J, Sur W, Laberge JM, Tchervenkov J, Bell L, Flageole H, Labidi S, Gagné JP, Gowing R, Kahnamoui K, McAlister CC, Marble A, Coughlin S, Karanicolas P, Emmerton-Coughlin H, Kanbur B, Kanbur S, Colquhoun P, Trottier DC, Doucette S, Huynh H, Soto CM, Poulin EC, Mamazza J, Boushey RP, Jamal MH, Rousseau M, Meterissian S, Snell L, Racz JM, Davies E, Aminazadeh N, Farrokhyar F, Reid S, Naeeni A, Naeeni M, Kashfi A, Kahnamoui K, Martin K, Weir M, Taylor B, Martin KM, Girotti MJ, Parry NG, Hanna WC, Fraser S, Weissglas I, Ghitulescu G, Bilek A, Marek J, Galatas C, Bergman S, Chiu CG, Nguyen NH, Bloom SW, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Menezes AC, Karmali S, Birch DW, Forbes SS, Eskicioglu C, Brenneman FD, McLeod RS, Fraser SA, Bergman S, Garzon J, Gomez D, Lawless B, Haas B, Nathens AB, Lumb KJ, Harkness L, Williamson J, Charyk-Stewart T, Gray D, Malthaner RA, Van Koughnett JA, Vogt KN, Gray DK, Parry NG, Teague B, Cadeddu M, Anvari M, Misra M, Pooler S, Malik S, Swain P, Chackungal S, Vogt KN, Yoshy C, Etemad-Rezai R, Cunningham I, Dubois L, Schlachta CM, Scott L, Vinden C, Okrainec A, Henao O, Azzie G, Deen S, Hameed M, Ramirez V, Veillette C, Bray P, Jewett M, Okrainec A, Pagliarello G, Brenneman F, Buczkowski A, Nathens A, Razek T, Widder S, Anderson I, Klassen D, Saadia R, Johner A, Hameed SM, Qureshi AP, Vergis A, Jimenez CM, Green J, Pryor AD, Schlachta CM, Okrainec A, Perri MT, Trejos AL, Naish MD, Patel RV, Malthaner RA, Stanger J, Stewart K, Yasui Y, Cass C, Damaraju S, Graham K, Bharadwaj S, Srinathan S, Tan L, Unruh H, Finley C, Miller L, Ferri LE, Urbach DR, Darling G, Spicer J, Ergun S, McDonald B, Rousseau M, Kaneva P, Ferri LE, Spicer J, Andalib A, Benay C, Rousseau M, Kushner Y, Marcus V, Ferri LE, Hunt I, Gazala S, Razzak R, Chuck A, Valji A, Stewart K, Tsuyuki R, Bédard ELR, Bottoni DA, Campbell G, Malthaner RA, Rousseau M, Guevremont P, Chasen M, Spicer J, Eckert E, Alcindor T, Ades S, Ferri LE, McGory R, Nagpal D, Fortin D, Inculet RI, Malthaner RA, Ko M, Shargall Y, Compeau C, Razzak R, Gazala S, Hunt I, Veenstra J, Valji A, Stewart K, Bédard ELR, Davis PJ, Mancuso M, Mujoomdar AA, Gazala S, Bédard ELR, Lee L, Spicer J, Robineau C, Sirois C, Mulder D, Ferri LE, Cools-Lartigue J, Chang SY, Mayrand S, Marcus V, Fried GM, Ferri LE, Perry T, Hunt I, Allegretto M, Maguire C, Abele J, Williams D, Stewart K, Bédard ELR, Grover HS, Basi S, Chiasson P, Basi S, Gregory W, Irshad K, Schieman C, MacGregor JH, Kelly E, Gelfand G, Graham AJ, McFadden SP, Grondin SC, Croome KP, Chudzinski R, Hanto DW, Jamal MH, Doi SA, Barkun JS, Wong SL, Kwan AHL, Yang S, Law C, Luo Y, Spiers J, Forse A, Taylor W, Apriasz I, Mysliwiec B, Sarin N, Gregor J, Moulton CE, McLeod RS, Barnett H, Nhan C, Gallinger S, Demyttenaere SV, Nau P, Muscarella P, Melvin WS, Ellison EC, Wiseman SM, Melck AL, Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC, Edwards JP, Kelly EJ, Lin Y, Lenders T, Ghali WA, Graham A, Francescutti V, Farrokhyar F, Tozer R, Heller B, Lovrics P, Jansz G, Kahnamoui K, Spiegle G, Schmocker S, Huang H, Victor C, Law C, Kennedy ED, McCart JA, Aslani N, Swanson T, Kennecke H, Woods R, Davis N, Klevan AE, Ramsay JA, Stephen WJ, Smith M, Plourde M, Johnson PM, Yaffe P, Walsh M, Hoskin D, Huynh HP, Trottier DC, Soto C, Auer R, Poulin EC, Mamazza J, Boushey RP, Moloo H, Huynh HP, Trottier DC, Soto C, Moloo H, Poulin EC, Mamazza J, Boushey RP, Nhan C, Driman DK, Smith AJ, Hunter A, McLeod RS, Eskicioglu C, Fenech DS, Victor C, McLeod RS, Trottier DC, Huynh H, Sabri E, Soto C, Scheer A, Zolfaghari S, Moloo H, Mamazza J, Poulin EC, Boushey RP, Hallet J, Guénette-Lemieux M, Bouchard A, Grégoire RC, Thibault C, Dionne G, Côté F, Langis P, Gagné JP, Raval MJ, Phang PT, Brown CJ, Kuzmanovic A, Planting A, Raval MJ, Phang PT, Brown CJ, Huynh HP, Trottier DC, Moloo H, Poulin EC, Mamazza J, Friedlich M, Stern HS, Boushey RP, Tang BQ, Moloo H, Bleier J, Goldberg SM, Alsharif J, Martel G, Bouchard A, Sabri E, Ramsay CR, Mamazza J, Poulin EC, Boushey RP, Richardson D, Porter G, Johnson P, Al-Sukhni E, Ridgway PF, O'Connor B, McLeod RS, Swallow CJ, Forbes SS, Urbach DR, Sutradhar R, Paszat L, Rabeneck L, Baxter NN, Chung W, Ko D, Sun C, Brown CJ, Raval M, Phang PT, Pao JS, Woods R, Raval MJ, Phang PT, Brown CJ, Power A, Francescutti V, Ramsey D, Kelly S, Stephen W, Simunovic M, Coates A, Goldsmith CH, Thabane L, Reeson D, Smith AJ, McLeod RS, DeNardi F, Whelan TJ, Levine MN, Al-Khayal KA, Buie WD, Wallace L, Sigalet D, Eskicioglu C, Gagliardi A, Fenech DS, Victor C, McLeod RS. Abstracts of presentations to the Annual Meetings of the Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons Canadian Hepato-Pancreato-Biliary Society Canadian Society of Surgical Oncology Canadian Society of Colon and Rectal Surgeons: Victoria, BC Sept. 10-13, 2009. Can J Surg 2009; 52:S1-S48. [PMID: 35488397 PMCID: PMC2726442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- R Nenshi
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - E Kennedy
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - N N Baxter
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Saskin
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Sutradhar
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - D R Urbach
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - M C Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - R Fayez
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - S A Krajewski
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C J Brown
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C Hur
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - P H McCrea
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - A Mitchell
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - G Porter
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - J Grushka
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - T Razek
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - K Khwaja
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - P Fata
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - G Martel
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Picciano
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Haas
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - W Xiong
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - M Brennan-Barnes
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - D Gomez
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - A B Nathens
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - I Yang
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - S S Forbes
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - M Loeb
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R Smith
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - E P Christoffersen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R F McLean
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - J Westerholm
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - S Garcia-Osogobio
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - A Ponton-Carss
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Hutchison
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Violato
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - M Segedi
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Mittleman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - D Fisman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - L Kinlin
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Rousseau
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - W Saleh
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - D D Stanbridge
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - S Mayrand
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - A Pandya
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Nathens
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - N Ahmed
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - T Tran
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, McGill University, Montréal, Que
| | | | - C Seguin
- From the Department of Surgery, McGill University, Montréal, Que
| | - G P Artho
- From the Department of Surgery, McGill University, Montréal, Que
| | - P Kaneva
- From the Department of Surgery, McGill University, Montréal, Que
| | - G M Fried
- From the Department of Surgery, McGill University, Montréal, Que
| | - L S Feldman
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Anderson
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - D J Mikami
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - W S Melvin
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Katchky
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W J Wall
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Faryniuk
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C A Clarkson
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - A M Rubiano
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - C A Clarkson
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - D Boone
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - C G Ball
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - E Dixon
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A W Kirkpatrick
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - F R Sutherland
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - D V Feliciano
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A D Wyrzykowski
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - J M Nicholas
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C J Dente
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C G Ball
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - D V Feliciano
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - S M Ullah
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - V C McAlister
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Kaminsky
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Altaf
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - H J Bonjer
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - I Ghaderi
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - E Shlomovitz
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - R K Reznick
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - W Kucharczyk
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - L Lee
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - S Iqbal
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - H Barayan
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - Y Lu
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P Fata
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - T Razek
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - K Khwaja
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P S Boora
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - J S White
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - K N Vogt
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Minuk
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - K Eckert
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - I Chin-Yee
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - N Parry
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - R J Humphrey
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Bütter
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Schmidt
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - T Grieci
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Gagnon
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - V Han
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - S Duhaime
- From the University of Ottawa, Ottawa, Ont
| | - D F Pitt
- From the University of Ottawa, Ottawa, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - X Shi
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - Y Gu
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - M A Moser
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - T W Swanson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - D F Schaeffer
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B Q Tang
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - C H Rusnak
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B J Amson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - K N Vogt
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - L Dubois
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - A Hobbs
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - R Etemad-Rezai
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - C M Schlachta
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - E Claydon
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - V McAlister
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - J Grushka
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - W Sur
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J-M Laberge
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J Tchervenkov
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - L Bell
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - H Flageole
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - S Labidi
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - J P Gagné
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - R Gowing
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - C C McAlister
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - A Marble
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - S Coughlin
- From the University of Western Ontario, London, Ont
| | | | | | - B Kanbur
- From the University of Western Ontario, London, Ont
| | - S Kanbur
- From the University of Western Ontario, London, Ont
| | - P Colquhoun
- From the University of Western Ontario, London, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Doucette
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C M Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - M H Jamal
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - M Rousseau
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - S Meterissian
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - L Snell
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - E Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - N Aminazadeh
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Reid
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Kashfi
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Martin
- From the London Health Sciences Centre, London, Ont
| | - M Weir
- From the London Health Sciences Centre, London, Ont
| | - B Taylor
- From the London Health Sciences Centre, London, Ont
| | - K M Martin
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - M J Girotti
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - N G Parry
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - W C Hanna
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Fraser
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - I Weissglas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - G Ghitulescu
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - A Bilek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Marek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C Galatas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C G Chiu
- From the Richmond Hospital, Richmond, BC
| | - N H Nguyen
- From the Richmond Hospital, Richmond, BC
| | - S W Bloom
- From the Richmond Hospital, Richmond, BC
| | - S Wiebe
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Bonjer
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Lawlor
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Plowman
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - T Ransom
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - M Vallis
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - A C Menezes
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S Karmali
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - F D Brenneman
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - S A Fraser
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - J Garzon
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - D Gomez
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Lawless
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Haas
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A B Nathens
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - K J Lumb
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Harkness
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J Williamson
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J A Van Koughnett
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - D K Gray
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - N G Parry
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - P Swain
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Chackungal
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Yoshy
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Etemad-Rezai
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - I Cunningham
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Dubois
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Scott
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Vinden
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Okrainec
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - O Henao
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - G Azzie
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - S Deen
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - M Hameed
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - V Ramirez
- From the University Health Network, University of Toronto, Toronto, Ont
| | - C Veillette
- From the University Health Network, University of Toronto, Toronto, Ont
| | - P Bray
- From the University Health Network, University of Toronto, Toronto, Ont
| | - M Jewett
- From the University Health Network, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University Health Network, University of Toronto, Toronto, Ont
| | - G Pagliarello
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - F Brenneman
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Buczkowski
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Nathens
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - T Razek
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S Widder
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - I Anderson
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - D Klassen
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - R Saadia
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Johner
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S M Hameed
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A P Qureshi
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Vergis
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Jimenez
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - J Green
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A D Pryor
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Schlachta
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Okrainec
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - M T Perri
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - A L Trejos
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - M D Naish
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R V Patel
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R A Malthaner
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - J Stanger
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - Y Yasui
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - C Cass
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Damaraju
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Graham
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Bharadwaj
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - L Tan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - H Unruh
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C Finley
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L Miller
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - G Darling
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - S Ergun
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - B McDonald
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - P Kaneva
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - A Andalib
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - C Benay
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - Y Kushner
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - V Marcus
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - I Hunt
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Razzak
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Chuck
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Tsuyuki
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - D A Bottoni
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - G Campbell
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - M Rousseau
- From the McGill University Health Centre, Montréal, Que
| | - P Guevremont
- From the McGill University Health Centre, Montréal, Que
| | - M Chasen
- From the McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the McGill University Health Centre, Montréal, Que
| | - E Eckert
- From the McGill University Health Centre, Montréal, Que
| | - T Alcindor
- From the McGill University Health Centre, Montréal, Que
| | - S Ades
- From the McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the McGill University Health Centre, Montréal, Que
| | - R McGory
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Nagpal
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Fortin
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R I Inculet
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - M Ko
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - Y Shargall
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - C Compeau
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - R Razzak
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - J Veenstra
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - P J Davis
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - M Mancuso
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - A A Mujoomdar
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - S Gazala
- From the University of Alberta, Edmonton, Alta
| | | | - L Lee
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Robineau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Sirois
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - D Mulder
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Cools-Lartigue
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S-Y Chang
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S Mayrand
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - V Marcus
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - G M Fried
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - L E Ferri
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - T Perry
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - M Allegretto
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - C Maguire
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - J Abele
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - D Williams
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - H S Grover
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - P Chiasson
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - W Gregory
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - K Irshad
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - C Schieman
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - J H MacGregor
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - E Kelly
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - G Gelfand
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - A J Graham
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S P McFadden
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S C Grondin
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - K P Croome
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - R Chudzinski
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - D W Hanto
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - M H Jamal
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S A Doi
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - J S Barkun
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S L Wong
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - A H L Kwan
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - S Yang
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - C Law
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Y Luo
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - J Spiers
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - A Forse
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - W Taylor
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - I Apriasz
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - B Mysliwiec
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - N Sarin
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Gregor
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C E Moulton
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - R S McLeod
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - H Barnett
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - C Nhan
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S Gallinger
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Nau
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Muscarella
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - W S Melvin
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - E C Ellison
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - S M Wiseman
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - A L Melck
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - K M Davidge
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J Lipa
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - P Ferguson
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - F C Wright
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J P Edwards
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - E J Kelly
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - Y Lin
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - T Lenders
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - W A Ghali
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - A Graham
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - V Francescutti
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - R Tozer
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - B Heller
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - P Lovrics
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Jansz
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Spiegle
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S Schmocker
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - H Huang
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Victor
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Law
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - E D Kennedy
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - J A McCart
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - N Aslani
- From the British Columbia Cancer Agency, Vancouver, BC
| | - T Swanson
- From the British Columbia Cancer Agency, Vancouver, BC
| | - H Kennecke
- From the British Columbia Cancer Agency, Vancouver, BC
| | - R Woods
- From the British Columbia Cancer Agency, Vancouver, BC
| | - N Davis
- From the British Columbia Cancer Agency, Vancouver, BC
| | - A E Klevan
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - J A Ramsay
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M Smith
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - M Plourde
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P M Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Yaffe
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - M Walsh
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - D Hoskin
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Nhan
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - D K Driman
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A J Smith
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A Hunter
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - R S McLeod
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E Sabri
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - A Scheer
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Zolfaghari
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Hallet
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M Guénette-Lemieux
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - A Bouchard
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - R C Grégoire
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - C Thibault
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - G Dionne
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - F Côté
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - P Langis
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - J-P Gagné
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Kuzmanovic
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Planting
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M J Raval
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - M Friedlich
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H S Stern
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Q Tang
- From the Department of Surgery, Division of General Surgery, Royal Jubilee Hospital, Vancouver Island Health Authority, Victoria, BC
| | - H Moloo
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Bleier
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - S M Goldberg
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Alsharif
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Martel
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A Bouchard
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Sabri
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C R Ramsay
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D Richardson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - G Porter
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - E Al-Sukhni
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - P F Ridgway
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - B O'Connor
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R Sutradhar
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Paszat
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Rabeneck
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - N N Baxter
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - W Chung
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - D Ko
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C Sun
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M Raval
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - J S Pao
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - R Woods
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - A Power
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - V Francescutti
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Kelly
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - W Stephen
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Simunovic
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A Coates
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - C H Goldsmith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - L Thabane
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - D Reeson
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A J Smith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - R S McLeod
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - F DeNardi
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - T J Whelan
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M N Levine
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - K A Al-Khayal
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - W D Buie
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - L Wallace
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - D Sigalet
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
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Rabeneck L, Rumble RB, Axler J, Smith A, Armstrong D, Vinden C, Belliveau P, Rhodes K, Zwaal C, Mai V, Dixon P. Cancer Care Ontario Colonoscopy Standards: standards and evidentiary base. Can J Gastroenterol 2007; 21 Suppl D:5D-24D. [PMID: 18026582 PMCID: PMC2802327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Colorectal cancer (CRC) is the most common cause of non-tobacco-related cancer deaths in Canadian men and women, accounting for 10% of all cancer deaths. An estimated 7800 men and women will be diagnosed with CRC, and 3250 will die from the disease in Ontario in 2007. Given that CRC incidence and mortality rates in Ontario are among the highest in the world, the best opportunity to reduce this burden of disease would be through screening. The present report describes the findings and recommendations of Cancer Care Ontario's Colonoscopy Standards Expert Panel, which was convened in March 2006 by the Program in Evidence-Based Care. The recommendations will form the basis of the quality assurance program for colonoscopy delivered in support of Ontario's CRC screening program.
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Devon KM, Vergara O, Victor JC, Swallow CJ, Cohen Z, Gryfe R, MacRae HM, McLeod RS, Murata A, Phang PT, Jones K, Merritt N, Belliveau P, Hurlbut D, Scheer A, Sabri E, Moloo H, Poulin EC, Mamazza J, Boushey R, Brown CJ, Zhang H, Gallinger S, Gryfe R, McLeod RS, Walters TD, Steinhart AH, Bernstein C, Tremaine W, Wolff BG, Ross S, Parkes R, McKenzie M, McLeod RS, Richardson D, deMontbrun S, McIntyre PB, Johnson PM, Shum J, Colquhoun PHD, Taylor BM, Polyhronopoulos GN, Feldman LS, McCluney AL, Buithieu J, Martinie J, Metrakos P, Fried GM, Chiasson PM, Burpee SE, Corrigan R, Manson P, Omiccioli A, Singh R, Hegge SG, McKinley CA, Lemieux P, Rhéaume P, Lévesque I, Bujold E, Brochu G, Mrad BA, Stoklossa CJ, Birch DW, Chen J, Christou NV, Turcotte S, Forget MA, Beauseigle D, Lapointe R, Garzon PM, Shah SA, Wei AC, Girgrah N, Levy GA, Wong P, Lilly LB, Grant DR, Cattral MS, McGilvary I, Greig PD, Tawadros PS, Wang Z, Birch S, Szaszi K, Kapus A, Rotstein OD, Mihailovic A, Nansamba C, Coyte P, Howar A, Urbach D, Govindarajan A, Cranford V, Wirtzfeld D, Gallinger S, Law CHL, Smith AJ, Gagliardi AR, Haggar F, Moloo H, Grimshaw J, Poulin EC, Mamazza J, Boushey RP, McConnell Y, Johnson P, Porter G, Govindarajan A, Kiss A, Rabeneck L, Smith AJ, Hodgson D, Law CHL, White C, Taylor MC, Borowiec AM, Fedorak RN, Polyhronopoulos GN, Feldman LS, Kaneva PA, Fried GM, Keshoofy M, Gutauskas A, Smith RF, Christou NV, Al-Sabah S, Ladouceur M, Christou NV, Thompson SK, Ruszkiewicz AR, Jamieson GG, Wijnhoven BPL, Game PA, Devitt PG, Watson DI, Poole B, Ehlen TG, Davis NL, Tuma F, Smith T, Hamoud M, Elfeitori A, Boushey R, Poulin E, Mamazza J, MacKenzie JR, Teel W, Reinhartz A, Schieman J, Brophy J, Hsu KE, Ferri LE, Feldman LS, Fried GM, Hsu KE, Man FY, Gizicki RA, Feldman LS, Fried GM, Taylor MC, Bruce S, Burtally A, Brochu G, Gagné JP, Martel G, Poulin EC, Mamazza J, Boushey RP, Deen S, Griffith O, Masoudi H, Wiseman SM, Cox H, Pasieka JL, Parr ZE, Thompson SK, Jamieson GG, Myers JC, Game PA, Devitt PG, Bélanger M, Brochu G, Moloo H, Haggar F, Grimshaw J, Coyle D, Graham ID, Sabri E, Poulin EC, Mamazza J, Balaa F, Stern H, Boushey RP, Moloo H, Sabri E, Wassif E, Haggar F, Poulin EC, Mamazza J, Boushey RP, Reso A, Estifanos D, Church N, Mitchell P, O'Neill C, Colquhoun P, Schlachta CM, Etemad-Rezai R, Jayaraman S, Passi R, Hodder AS, Pace DE, Chuah TK, Wirtzfeld D, Lee TYY, Pollett W, Trottier D, May G, Moloo H, Haggar F, Boushey R, Poulin E, Mamazza J, Singh R, Boutross-Tadross O, Deif B, Elias R, Stephen WJ, Omiccioli A, Singh R, Hegge SG, McKinley CA, Singh R, Omiccioli A, Hegge SG, McKinley CA, Sampath S, Segal BE, Carter JJ, Nguyen NH, Frimer M, Houston G, Bloom SW, Lemieux P, Couture C, Simard S, Lebel S, El Fitori A, Sabri E, Wassif E, Mamazza J, Poulin E, Boushey R, Warnock GL, Waddell J, Proctor G, Krajewski SA, Brown JA, Phang PT, Raval MJ, Brown CJ, Simunovic M, Major D, Qui F, To T, Baxter N, Urbach D, McGuire A, George R, Berg R, George R, Hristov H, McAlister ED, George R, Jones K, Bardell A, Isotalo P, Stotland PK, Chia S, Cyriac JS, Hagen JA, Klein LV, Hodgson N, Holowaty E, Lee G, Sussman J, Whelan T, Simunovic M, Apriasz I, Mohan S, Mccreery G, Patel R, Schlachta CM, Schlachta CM, Sorsdahl AK, Lefebvre KL, McCune ML, Hebbard PC, Wirtzfeld DA, Huynh QHP, Klein LV, Hagen JA, Xeroulis G, Dubrowski A, Leslie K, Mihailovic A, Howard A, Willan A, Coyte P, Urbach D, Sawisky G, Stoklossa CJ, Birch DW, Dickie BH, Stoklossa CJ, Davey D, Birch DW, Bohacek L, Pace DE, Karanicolas PJ, Colquhoun PH, Dahlke E, Guyatt GH, Butler MS, de Gara CJ, Boutros M, Zabalotny B, Charlin B, Meterissian S, Finley C, Clifton J, Fitzgerald M, Yee J, Quadri S, Knox J, Wong R, Xu W, Hornby J, Keshavjee S, Darling G, Schieman C, Tiruta C, Blitz M, Graham A, Gelfand G, McFadden S, Grondin S, de Perrot M, Anraku M, Feld R, Bezjak A, Burkes R, Roberts H, Cho J, Visbal A, Leighl N, Keshavjee S, Johnston M, Villeneuve PJ, Sundaresan RS, Gray DA, Rakovich G, Brigand C, Gaboury L, Martin J, Ferraro P, Duranceau A, Low D, Huang J, Cantone N, Schembre D, Mohan S, Trejos AL, Bassan H, Lin AW, Patel RV, Malthaner RA, Blitz M, Graham AJ, Gelfand G, McFadden SD, Grondin SC, Kondra J, Clifton J, Suarez G, Ross B, Evans K, Finley RJ, Yee J, Sugimura H, Spratt EH, Compeau CG, Shargall Y, Lara-Guerra H, Leighl N, Salvarrey A, Sakurada A, Paul N, Boerner S, Geddie W, Pond G, Shepherd FA, Tsao MS, Waddell TK. Abstracts of presentations to the Annual Meetings of the Canadian Society of Colon and Rectal Surgeons Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons: Canadian Surgery Forum, Toronto, Ont., September 6-9, 2007. Can J Surg 2007; 50:1-32. [PMID: 37353894 PMCID: PMC10390043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- K M Devon
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - O Vergara
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - J C Victor
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C J Swallow
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Z Cohen
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - R Gryfe
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - H M MacRae
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - R S McLeod
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - A Murata
- Division of General Surgery, University of British Columbia, Vancouver, BC
| | - P T Phang
- Division of General Surgery, University of British Columbia, Vancouver, BC
| | - K Jones
- Departments of Surgery and Pathology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - N Merritt
- Departments of Surgery and Pathology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - P Belliveau
- Departments of Surgery and Pathology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - D Hurlbut
- Departments of Surgery and Pathology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - A Scheer
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - E Sabri
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - R Boushey
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - C J Brown
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - H Zhang
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - S Gallinger
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - R Gryfe
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - R S McLeod
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - T D Walters
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - A H Steinhart
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - C Bernstein
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - W Tremaine
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - B G Wolff
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - S Ross
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - R Parkes
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - M McKenzie
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - R S McLeod
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - D Richardson
- Department of Surgery, Dalhousie University, Halifax, NS
| | - S deMontbrun
- Department of Surgery, Dalhousie University, Halifax, NS
| | - P B McIntyre
- Department of Surgery, Dalhousie University, Halifax, NS
| | - P M Johnson
- Department of Surgery, Dalhousie University, Halifax, NS
| | - J Shum
- London Health Sciences Centre, University of Western Ontario, London, Ont
| | - P H D Colquhoun
- London Health Sciences Centre, University of Western Ontario, London, Ont
| | - B M Taylor
- London Health Sciences Centre, University of Western Ontario, London, Ont
| | - G N Polyhronopoulos
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - A L McCluney
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - J Buithieu
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - J Martinie
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - P Metrakos
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - G M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - P M Chiasson
- Southern Arizona Center for Minimally Invasive Surgery, Northwest Medical Center, Tucson, Ariz., USA
| | - S E Burpee
- Southern Arizona Center for Minimally Invasive Surgery, Northwest Medical Center, Tucson, Ariz., USA
| | - R Corrigan
- Southern Arizona Center for Minimally Invasive Surgery, Northwest Medical Center, Tucson, Ariz., USA
| | - P Manson
- Southern Arizona Center for Minimally Invasive Surgery, Northwest Medical Center, Tucson, Ariz., USA
| | - A Omiccioli
- Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - R Singh
- Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - S G Hegge
- Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - C A McKinley
- Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - P Lemieux
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - P Rhéaume
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - I Lévesque
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - E Bujold
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - G Brochu
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - B A Mrad
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - C Johnson Stoklossa
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - J Chen
- Section of Bariatric Surgery, Division of General Surgery, McGill University, Montréal, Que
| | - N V Christou
- Section of Bariatric Surgery, Division of General Surgery, McGill University, Montréal, Que
| | - S Turcotte
- Immuno-oncology Laboratory, Institut du cancer de Montréal, Centre hospitalier de l'Université de Montréal, CHUM Research Center and Department of Surgery, Université de Montréal, Montréal, Que
| | - M-A Forget
- Immuno-oncology Laboratory, Institut du cancer de Montréal, Centre hospitalier de l'Université de Montréal, CHUM Research Center and Department of Surgery, Université de Montréal, Montréal, Que
| | - D Beauseigle
- Immuno-oncology Laboratory, Institut du cancer de Montréal, Centre hospitalier de l'Université de Montréal, CHUM Research Center and Department of Surgery, Université de Montréal, Montréal, Que
| | - R Lapointe
- Immuno-oncology Laboratory, Institut du cancer de Montréal, Centre hospitalier de l'Université de Montréal, CHUM Research Center and Department of Surgery, Université de Montréal, Montréal, Que
| | - P M Garzon
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - S A Shah
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - A C Wei
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - N Girgrah
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - G A Levy
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - P Wong
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - L B Lilly
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - D R Grant
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - M S Cattral
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - I McGilvary
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - P D Greig
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - P S Tawadros
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Z Wang
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - S Birch
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - K Szaszi
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A Kapus
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - O D Rotstein
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A Mihailovic
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - C Nansamba
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - P Coyte
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - A Howar
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - D Urbach
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - A Govindarajan
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - V Cranford
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - D Wirtzfeld
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - S Gallinger
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - C H L Law
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - A J Smith
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - A R Gagliardi
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - F Haggar
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - J Grimshaw
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - Y McConnell
- Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - P Johnson
- Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - G Porter
- Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - A Govindarajan
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - A Kiss
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - L Rabeneck
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - A J Smith
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - D Hodgson
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - C H L Law
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - C White
- Department of Surgery, University of Manitoba, Winnipeg, Man
| | - M C Taylor
- Department of Surgery, University of Manitoba, Winnipeg, Man
| | - A M Borowiec
- Departments of General Surgery and Gastroenterology, University of Alberta, Edmonton, Alta
| | - R N Fedorak
- Departments of General Surgery and Gastroenterology, University of Alberta, Edmonton, Alta
| | - G N Polyhronopoulos
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - P A Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - G M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - M Keshoofy
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - A Gutauskas
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | | | - N V Christou
- Section of Bariatric Surgery, Division of General Surgery, McGill University, Montréal, Que
| | - S Al-Sabah
- Section of Bariatric Surgery, Division of General Surgery, McGill University Health Centre, Montréal, Que
| | - M Ladouceur
- Section of Bariatric Surgery, Division of General Surgery, McGill University Health Centre, Montréal, Que
| | - N V Christou
- Section of Bariatric Surgery, Division of General Surgery, McGill University Health Centre, Montréal, Que
| | - S K Thompson
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - A R Ruszkiewicz
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - G G Jamieson
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - B P L Wijnhoven
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - P A Game
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - P G Devitt
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - D I Watson
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - B Poole
- Department of Surgical Oncology, BC Cancer Agency, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - T G Ehlen
- Department of Surgical Oncology, BC Cancer Agency, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - N L Davis
- Department of Surgical Oncology, BC Cancer Agency, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - F Tuma
- Department of Head and Neck Surgery, St. Clare's Mercy Hospital, St. John's, Nfld
| | - T Smith
- Department of Head and Neck Surgery, St. Clare's Mercy Hospital, St. John's, Nfld
| | - M Hamoud
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A Elfeitori
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Boushey
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Poulin
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J R MacKenzie
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - W Teel
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - A Reinhartz
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - J Schieman
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - J Brophy
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - K E Hsu
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - L E Ferri
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - G M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - K E Hsu
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - F Y Man
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - R A Gizicki
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - G M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - M C Taylor
- Manitoba Centre for Health Policy and the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - S Bruce
- Manitoba Centre for Health Policy and the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - A Burtally
- Québec Centre for Minimally Invasive Surgery, Centre Hospitalier Universitaire de Québec, Québec, Que
| | - G Brochu
- Québec Centre for Minimally Invasive Surgery, Centre Hospitalier Universitaire de Québec, Québec, Que
| | - J P Gagné
- Québec Centre for Minimally Invasive Surgery, Centre Hospitalier Universitaire de Québec, Québec, Que
| | - G Martel
- Minimally Invasive Surgery Group, Division of General Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- Minimally Invasive Surgery Group, Division of General Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- Minimally Invasive Surgery Group, Division of General Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- Minimally Invasive Surgery Group, Division of General Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - S Deen
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - O Griffith
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - H Masoudi
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - S M Wiseman
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - H Cox
- Department of Surgery, University of Calgary, Calgary, Alta
| | - J L Pasieka
- Department of Surgery, University of Calgary, Calgary, Alta
| | - Z E Parr
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - S K Thompson
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - G G Jamieson
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - J C Myers
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - P A Game
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - P G Devitt
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - M Bélanger
- Service de chirurgie générale, CHUL-CHUQ, Québec, Que
| | - G Brochu
- Service de chirurgie générale, CHUL-CHUQ, Québec, Que
| | - H Moloo
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - F Haggar
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - J Grimshaw
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - D Coyle
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - I D Graham
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - E Sabri
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - F Balaa
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - H Stern
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - H Moloo
- Ottawa Hospital, Ottawa, Ont
| | - E Sabri
- Ottawa Hospital, Ottawa, Ont
| | | | | | | | | | | | - A Reso
- Division of General Surgery, Peter Lougheed Centre, Calgary, Alta
| | - D Estifanos
- Division of General Surgery, Peter Lougheed Centre, Calgary, Alta
| | - N Church
- Division of General Surgery, Peter Lougheed Centre, Calgary, Alta
| | - P Mitchell
- Division of General Surgery, Peter Lougheed Centre, Calgary, Alta
| | - C O'Neill
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - P Colquhoun
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - C M Schlachta
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - R Etemad-Rezai
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - S Jayaraman
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - R Passi
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - A S Hodder
- Division of General Surgery, Memorial University, St. John's, Nfld
| | - D E Pace
- Division of General Surgery, Memorial University, St. John's, Nfld
| | - T K Chuah
- Discipline of Surgery, Health Sciences Centre, Memorial University, St. John's, Nfld
| | - D Wirtzfeld
- Discipline of Surgery, Health Sciences Centre, Memorial University, St. John's, Nfld
| | - T Y Y Lee
- Discipline of Surgery, Health Sciences Centre, Memorial University, St. John's, Nfld
| | - W Pollett
- Discipline of Surgery, Health Sciences Centre, Memorial University, St. John's, Nfld
| | - D Trottier
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - G May
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - H Moloo
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - F Haggar
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - R Boushey
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - E Poulin
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - J Mamazza
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - R Singh
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - O Boutross-Tadross
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - B Deif
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - R Elias
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - W J Stephen
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - A Omiccioli
- The Center for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - R Singh
- The Center for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - S G Hegge
- The Center for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - C A McKinley
- The Center for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - R Singh
- The Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - A Omiccioli
- The Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - S G Hegge
- The Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - C A McKinley
- The Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - S Sampath
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - B E Segal
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - J J Carter
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - N H Nguyen
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - M Frimer
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - G Houston
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - S W Bloom
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - P Lemieux
- Surgery and Pathology Departments, Hôpital Laval, Université Laval, Québec, Que
| | - C Couture
- Surgery and Pathology Departments, Hôpital Laval, Université Laval, Québec, Que
| | - S Simard
- Surgery and Pathology Departments, Hôpital Laval, Université Laval, Québec, Que
| | - S Lebel
- Surgery and Pathology Departments, Hôpital Laval, Université Laval, Québec, Que
| | - A El Fitori
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Sabri
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Wassif
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Poulin
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Boushey
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G L Warnock
- Department of Surgery, University of British Columbia, Vancouver, BC, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ont., Canadian Medical Association, Ottawa, Ont
| | - J Waddell
- Department of Surgery, University of British Columbia, Vancouver, BC, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ont., Canadian Medical Association, Ottawa, Ont
| | - G Proctor
- Department of Surgery, University of British Columbia, Vancouver, BC, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ont., Canadian Medical Association, Ottawa, Ont
| | - S A Krajewski
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - J A Brown
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M J Raval
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M Simunovic
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - D Major
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - F Qui
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - T To
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - N Baxter
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - D Urbach
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - A McGuire
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - R George
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - R Berg
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - R George
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - H Hristov
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - E D McAlister
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - R George
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - K Jones
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - A Bardell
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - P Isotalo
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - P K Stotland
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - S Chia
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - J S Cyriac
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - J A Hagen
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - L V Klein
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - N Hodgson
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - E Holowaty
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - G Lee
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - J Sussman
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - T Whelan
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - M Simunovic
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - I Apriasz
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - S Mohan
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - G Mccreery
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - R Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - C M Schlachta
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - C M Schlachta
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont., Stratford General Hospital, Stratford, Ont
| | - A K Sorsdahl
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont., Stratford General Hospital, Stratford, Ont
| | - K L Lefebvre
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont., Stratford General Hospital, Stratford, Ont
| | - M L McCune
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont., Stratford General Hospital, Stratford, Ont
| | - P C Hebbard
- Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - D A Wirtzfeld
- Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - Q H P Huynh
- The Minimally Invasive Surgery Program, Humber River Regional Hospital, Department of Surgery, University of Toronto, Toronto, Ont
| | - L V Klein
- The Minimally Invasive Surgery Program, Humber River Regional Hospital, Department of Surgery, University of Toronto, Toronto, Ont
| | - J A Hagen
- The Minimally Invasive Surgery Program, Humber River Regional Hospital, Department of Surgery, University of Toronto, Toronto, Ont
| | - G Xeroulis
- Department of Surgery, Division of General Surgery, University of Western Ontario, London, Ont
| | - A Dubrowski
- Department of Surgery, Division of General Surgery, University of Western Ontario, London, Ont
| | - K Leslie
- Department of Surgery, Division of General Surgery, University of Western Ontario, London, Ont
| | - A Mihailovic
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - A Howard
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - A Willan
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - P Coyte
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - D Urbach
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - G Sawisky
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - C Johnson Stoklossa
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - B H Dickie
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - C Johnson Stoklossa
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - D Davey
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - L Bohacek
- Department of Surgery, Memorial University, St. John's, Nfld
| | - D E Pace
- Department of Surgery, Memorial University, St. John's, Nfld
| | - P J Karanicolas
- Department of Surgery, University of Western Ontario, London, Ont., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - P H Colquhoun
- Department of Surgery, University of Western Ontario, London, Ont., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - E Dahlke
- Department of Surgery, University of Western Ontario, London, Ont., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - G H Guyatt
- Department of Surgery, University of Western Ontario, London, Ont., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - M S Butler
- Department of General Surgery, Royal Alexandra Hospital and University of Alberta Hospital, Edmonton, Alta
| | - C J de Gara
- Department of General Surgery, Royal Alexandra Hospital and University of Alberta Hospital, Edmonton, Alta
| | - M Boutros
- Centre for Medical Education and the Division of General Surgery, McGill University, Centre for Medical Education, Univeristé de Montréal, Montréal, Que
| | - B Zabalotny
- Centre for Medical Education and the Division of General Surgery, McGill University, Centre for Medical Education, Univeristé de Montréal, Montréal, Que
| | - B Charlin
- Centre for Medical Education and the Division of General Surgery, McGill University, Centre for Medical Education, Univeristé de Montréal, Montréal, Que
| | - S Meterissian
- Centre for Medical Education and the Division of General Surgery, McGill University, Centre for Medical Education, Univeristé de Montréal, Montréal, Que
| | - C Finley
- Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - J Clifton
- Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - M Fitzgerald
- Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - J Yee
- Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - S Quadri
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - J Knox
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - R Wong
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - W Xu
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - J Hornby
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - S Keshavjee
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - G Darling
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - C Schieman
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - C Tiruta
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - M Blitz
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - A Graham
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - G Gelfand
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - S McFadden
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - S Grondin
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - M de Perrot
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - M Anraku
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - R Feld
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - A Bezjak
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - R Burkes
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - H Roberts
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - J Cho
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - A Visbal
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - N Leighl
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - S Keshavjee
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - M Johnston
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - P J Villeneuve
- Centre for Cancer Therapeutics, Ottawa Health Research Institute, Division of Thoracic Surgery, University of Ottawa, Ottawa, Ont
| | - R S Sundaresan
- Centre for Cancer Therapeutics, Ottawa Health Research Institute, Division of Thoracic Surgery, University of Ottawa, Ottawa, Ont
| | - D A Gray
- Centre for Cancer Therapeutics, Ottawa Health Research Institute, Division of Thoracic Surgery, University of Ottawa, Ottawa, Ont
| | - G Rakovich
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - C Brigand
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - L Gaboury
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - J Martin
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - P Ferraro
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - A Duranceau
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - D Low
- Departments of Thoracic Surgery and Gastroenterology, Virginia Mason Medical Center, Seattle, Wash., USA
| | - J Huang
- Departments of Thoracic Surgery and Gastroenterology, Virginia Mason Medical Center, Seattle, Wash., USA
| | - N Cantone
- Departments of Thoracic Surgery and Gastroenterology, Virginia Mason Medical Center, Seattle, Wash., USA
| | - D Schembre
- Departments of Thoracic Surgery and Gastroenterology, Virginia Mason Medical Center, Seattle, Wash., USA
| | - S Mohan
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - A L Trejos
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - H Bassan
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - A W Lin
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - R V Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - R A Malthaner
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - M Blitz
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - A J Graham
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - G Gelfand
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - S D McFadden
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - S C Grondin
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - J Kondra
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - J Clifton
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - G Suarez
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - B Ross
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - K Evans
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - R J Finley
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - J Yee
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - H Sugimura
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, St. Joseph's Health Centre, Toronto, Ont
| | - E H Spratt
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, St. Joseph's Health Centre, Toronto, Ont
| | - C G Compeau
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, St. Joseph's Health Centre, Toronto, Ont
| | - Y Shargall
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, St. Joseph's Health Centre, Toronto, Ont
| | - H Lara-Guerra
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - N Leighl
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - A Salvarrey
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - A Sakurada
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - N Paul
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - S Boerner
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - W Geddie
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - G Pond
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - F A Shepherd
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - M S Tsao
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - T K Waddell
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
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Braithwaite RS, Conigliaro J, Roberts MS, Shechter S, Schaefer A, McGinnis K, Rodriguez MC, Rabeneck L, Bryant K, Justice AC. Estimating the impact of alcohol consumption on survival for HIV+ individuals. AIDS Care 2007; 19:459-66. [PMID: 17453583 PMCID: PMC3460376 DOI: 10.1080/09540120601095734] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Alcohol consumption is associated with decreased antiretroviral adherence, and decreased adherence results in poorer outcomes. However the magnitude of alcohol's impact on survival is unknown. Our objective was to use a calibrated and validated simulation of HIV disease to estimate the impact of alcohol on survival. We incorporated clinical data describing the temporal and dose-response relationships between alcohol consumption and adherence in a large observational cohort (N=2,702). Individuals were categorized as nondrinkers (no alcohol consumption), hazardous drinkers (consume > or =5 standard drinks on drinking days), and nonhazardous drinkers (consume <5 standard drinks on drinking days). Our results showed that nonhazardous alcohol consumption decreased survival by more than 1 year if the frequency of consumption was once per week or greater, and by 3.3 years (from 21.7 years to 18.4 years) with daily consumption. Hazardous alcohol consumption decreased overall survival by more than 3 years if frequency of consumption was once per week or greater, and by 6.4 years (From 16.1 years to 9.7 years) with daily consumption. Our results suggest that alcohol is an underappreciated yet modifiable risk factor for poor survival among individuals with HIV.
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Lopushinsky SR, Covarrubia KA, Rabeneck L, Austin PC, Urbach DR. Accuracy of administrative health data for the diagnosis of upper gastrointestinal diseases. Surg Endosc 2007; 21:1733-7. [PMID: 17285379 DOI: 10.1007/s00464-006-9136-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Revised: 08/21/2006] [Accepted: 09/25/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The use of administrative health data is increasingly common for the study of various medical and surgical diseases. The validity of diagnosis codes for the study of benign upper gastrointestinal disorders has not been well studied. METHODS The authors abstracted the charts for 590 adult patients who underwent upper gastrointestinal endoscopy between January 1, 2000 and June 30, 2001 in Toronto, Ontario, Canada. Clinical diagnoses from medical records were compared with International Classification of Diseases Version 9 (ICD-9) codes in electronic hospital discharge abstracts. The primary analysis aimed to determine the sensitivity, specificity, and positive predictive value (PPV) of a most responsible "esophagitis" diagnosis code for the prediction of esophagitis. Secondary analyses determined the performance characteristics of the diagnostic codes for esophageal ulcer, esophageal stricture, gastroesophageal reflux disease (GERD), gastritis, gastric ulcer, and duodenal ulcer. RESULTS The authors linked 500 patient records to electronic discharge abstracts. When listed as the most responsible diagnosis for admission, the ICD-9 codes for esophagitis showed a sensitivity of 46.79%, a specificity of 98.83%, and a PPV of 94.81%. When listed as a secondary diagnosis, the ICD-9 codes showed a sensitivity of 70.51%, a specificity of 97.67%, and a PPV of 93.22%. The diagnostic properties of ICD-9 codes for GERD (most responsible, secondary) were as follows: sensitivity (56.10%, 78.66%), specificity (98.51%, 96.73%), and PPV (94.84%, 92.14%). CONCLUSIONS The ICD-9 diagnosis codes for benign upper gastrointestinal diseases are highly specific and associated with strong PPVs, but have poor sensitivity.
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Affiliation(s)
- S R Lopushinsky
- Department of Surgery, University of Toronto, 10EN-214, Toronto, ON, Canada, M5G 2C4
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Ramji F, Cotterchio M, Manno M, Rabeneck L, Gallinger S. 060-S: Association Between Subject Factors and Colorectal Cancer Screening Participation in Ontario, Canada. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s15c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Ramji
- Division of Preventive Oncology, Cancer Care Ontario, Toronto, Ontario, M5G 2L7
| | - M Cotterchio
- Division of Preventive Oncology, Cancer Care Ontario, Toronto, Ontario, M5G 2L7
| | - M. Manno
- Division of Preventive Oncology, Cancer Care Ontario, Toronto, Ontario, M5G 2L7
| | - L. Rabeneck
- Division of Preventive Oncology, Cancer Care Ontario, Toronto, Ontario, M5G 2L7
| | - S. Gallinger
- Division of Preventive Oncology, Cancer Care Ontario, Toronto, Ontario, M5G 2L7
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Abstract
BACKGROUND Two surgical procedures with curative intent are available to patients with rectal cancer: lower anterior resection and abdominoperineal resection; however, lower anterior resection may improve quality of life and functional status. AIM To examine temporal changes in after lower anterior resection and abdominoperineal resection between 1989 and 2000. Potential factors associated with the use of lower anterior resection were evaluated. METHODS Using national administrative data, we identified patients who received lower anterior resection or abdominoperineal resection. Logistic regression models examined the association between use of lower anterior resection and time period of surgical resection. RESULTS A total of 5201 rectal cancer patients underwent resection. The use of lower anterior resection increased from 40.0% (1989-91) to 50.1% (1998-2000) paralleled by a corresponding decline in abdominoperineal resection (60.1 to 49.9%; P < 0.001). Patients who received surgery during 1992-94, 1995-97 and 1998-2000 were 6, 7 and 28% more likely to receive lower anterior resection, when compared with 1989-1991 after adjusting for demographic characteristics, co-morbidity and hospital surgical volume. Older age, lower co-morbidity score and lower hospital surgical volume were predictive of lower anterior resection. CONCLUSIONS An increase in the use of lower anterior resection for rectal cancer was observed over time. This observed increase in use is not confined to high-volume hospitals.
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Affiliation(s)
- N S Abraham
- Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, TX 77030, USA.
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Abstract
BACKGROUND Although diet has been associated with gastro-oesophageal reflux disease (GORD), the role of dietary components (total energy, macro and micronutrients) is unknown. We examined associations of GORD symptoms with intakes of specific dietary components. METHODS We conducted a cross sectional study in a sample of employees (non-patients) at the Houston VAMC. The Gastro Esophageal Reflux Questionnaire was used to identify the onset, frequency, and severity of GORD symptoms. Dietary intake (usual frequency of consumption of various foods and portion sizes) over the preceding year was assessed using the Block 98 food frequency questionnaire. Upper endoscopy was offered to all participants and oesophageal erosions recorded according to the LA classification. We compared the dietary intake (macronutrients, micronutrients, food groups) of participants with or without GORD symptoms, or erosive oesophagitis. Stepwise multiple logistic regression analyses were used to examine associations between nutrients and GORD symptoms or oesophageal erosions, adjusting for demographic characteristics, body mass index (BMI), and total energy intake. RESULTS A total of 371 of 915 respondents (41%) had complete and interpretable answers to both heartburn and regurgitation questions and met validity criteria for the Block 98 FFQ. Mean age was 43 years, 260 (70%) were women, and 103 (28%) reported at least weekly occurrences of heartburn or regurgitation. Of the 164 respondents on whom endoscopies were performed, erosive oesophagitis was detected in 40 (24%). Compared to participants without GORD symptoms, daily intakes of total fat, saturated fat, cholesterol, percentage of energy from dietary fat, and average fat servings were significantly higher in participants with GORD symptoms. In addition, there was a dose-response relationship between GORD and saturated fat and cholesterol. The effect of dietary fat became non-significant when adjusted for BMI. However, high saturated fat, cholesterol, or fat servings were associated with GORD symptoms only in participants with a BMI >25 kg/m2 (effect modification). Fibre intake remained inversely associated with the risk of GORD symptoms in adjusted full models. Participants with erosive oesophagitis had significantly higher daily intakes of total fat and protein than those without it (p<0.05). CONCLUSIONS In this cross sectional study, high dietary fat intake was associated with an increased risk of GORD symptoms and erosive oesophagitis while high fibre intake correlated with a reduced risk of GORD symptoms. It is unclear if the effects of dietary fat are independent of obesity.
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Affiliation(s)
- H B El-Serag
- Section of Gastroenterology and Health Services Research, The Houston Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030, USA.
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Abstract
AIM To compare 30-day and 5-year mortality in elderly vs. younger patients following surgical resection for colorectal cancer. METHODS A cohort study of patients admitted to VA hospitals with a new diagnosis of colorectal cancer who underwent surgical resection between October 1990 and September 2000. Cumulative survival rates (30-day and 5-year) were calculated from Kaplan-Meier estimates and adjusted risks of death were estimated using Cox proportional hazards models. RESULTS We identified 34,888 individuals with a new diagnosis of colorectal cancer between October 1990 and September 2000, of whom 22 633 (65%) underwent surgical resection. The 30-day mortality following resection for rectal and colon cancer, respectively, for patients <65 years was 2.1 and 2.8% compared with 4.9 and 5.6% for those > or =65 years. The 5-year cumulative survival for rectal and colon cancer for patients <65 years was 54.0 and 57.6% compared with 44.5 and 46.6% for those > or =65 years. In patients > or =65 years with rectal or colon cancer, after adjustment, 30-day mortality was 2 times greater and 5-year mortality was 1 times greater than in younger patients. CONCLUSIONS Older age is an independent predictor of increased short-term and long-term mortality following surgery in patients with rectal and colon cancer.
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Affiliation(s)
- L Rabeneck
- Department of Medicine, Division of Gastroenterology, University of Toronto, Toronto, Canada.
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Polgreen PM, Fultz SL, Justice AC, Wagner JH, Diekema DJ, Rabeneck L, Weissman S, Stapleton JT. Association of hypocholesterolaemia with hepatitis C virus infection in HIV-infected people. HIV Med 2004; 5:144-50. [PMID: 15139979 DOI: 10.1111/j.1468-1293.2004.00202.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study the impact of hepatitis C virus (HCV) status on serum cholesterol levels in HIV-infected patients. METHODS We retrospectively analysed data from the 881 participants of the Veterans Ageing Cohort 3 Site Study. Four different models were constructed using total cholesterol, low-density lipid (LDL) cholesterol, high-density lipid (HDL) cholesterol and triglycerides as dependent variables. The relevant covariates included HCV antibody status, HIV medication class, CD4 count, HIV viral load, glucose level, lipid-lowering drug use, gender, race, age, liver function test results, ethanol use, drug use, and HIV exposure category. Variables excluded from the final model included niacin use, gender, race, age, current ethanol use, and HIV exposure category. RESULTS Of the 881 HIV-positive patients enrolled in the study, 700 (79%) were screened for HCV antibody, with 300 (42.8%) HCV antibody positive and 400 (57.2%) HCV antibody negative. A positive HCV antibody status was independently associated with lower total cholesterol levels (P=0.001) and LDL cholesterol levels (P<0.001) but not with lower HDL cholesterol or triglyceride levels. HCV-positive patients had predicted LDL levels 19 mg/dL lower than those of HCV-negative subjects. HCV infection was also associated with a decreased use of lipid-lowering medication, and protease inhibitor use was associated with increased LDL and total cholesterol levels. CONCLUSIONS HCV infection has been associated with lower cholesterol levels in HIV-negative individuals, and the same appears to be true with HIV-infected patients. This is an interesting finding given that HCV particles bind to LDL receptors in vitro and also because HCV-lipid interactions appear to be important in the HCV replication cycle.
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Affiliation(s)
- P M Polgreen
- Iowa City Veterans Administration Medical Center and University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Rabeneck L. Measuring dyspepsia-related health in randomized trials: the Severity of Dyspepsia Assessment (SODA) and its use in treatment with NSAIDs and COX-2-specific inhibitors. Rheumatology (Oxford) 2003; 42 Suppl 3:iii32-9. [PMID: 14585916 DOI: 10.1093/rheumatology/keg496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dyspepsia is a common problem that is important from the perspectives of both patient health and economics. While there has been variability in the definitions used to describe dyspepsia, there have also been few standardized outcomes tools designed to measure dyspepsia-related health, especially in relation to changes in dyspepsia over time. An evaluative tool was developed, the Severity of Dyspepsia Assessment (SODA), which takes into account the multidimensional nature of dyspepsia using three scales (Pain, Non-pain Symptoms, and Satisfaction with Dyspepsia-related Health) and demonstrates good psychometric properties with respect to validity, reliability and sensitivity to change in the measurement of dyspepsia-related health. Although originally developed for the assessment of uninvestigated dyspepsia, the validation of SODA for use in clinical trials suggested its ability to compare treatment effects of non-specific non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2-specific inhibitors. In comparative trials of celecoxib or valdecoxib with non-specific NSAIDs, COX-2-specific inhibitors were demonstrated to have superior dyspepsia tolerability than non-specific NSAIDs. These data demonstrate that SODA is an effective instrument for measuring dyspepsia-related health with a broad range of applications.
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Affiliation(s)
- L Rabeneck
- Sunnybrook and Women's College Health Sciences Center, Toronto, Ontario, Canada.
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Davila J, El-Serag H, Rabeneck L. The Effect of surgical volume on long term survival for colorectal cancer. Ann Epidemiol 2003. [DOI: 10.1016/s1047-2797(03)00183-2] [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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Abstract
BACKGROUND & AIMS The potential association between gastroesophageal reflux disease (GERD) and extraesophageal manifestations remains unknown in children without neurological defects. We conducted a large case-control study to examine the association between GERD and several upper and lower respiratory disorders in these children. METHODS We identified all patients between 2 and 18 years of age with GERD who were seen at Texas Children's Hospital between 1996 and 2000. Patients seen during the same time period without GERD were randomly selected as controls (4:1 ratio). Patients with mental retardation, cerebral palsy, or congenital esophageal anomalies were excluded. We compared the presence of several predefined upper and lower respiratory disorders in cases and controls. RESULTS We identified 1980 patients with GERD and 7920 controls without GERD. Cases and controls were without neurological deficits or congenital esophageal anomalies. Cases were older than controls (9.2 years +/- 4.6 vs. 8.6 +/- 4.9, P < 0.0001), and were more likely to be female (51.2% vs. 47.2%, P = 0.0028) and white (60.2% vs. 41.2%, P < 0.0001). Compared with controls in univariate analyses, cases with GERD had more sinusitis (4.2% vs. 1.4%, P < 0.0001), laryngitis (0.7% vs. 0.2%), asthma (13.2% vs. 6.8%, P < 0.0001), pneumonia (6.3% vs. 2.3%, P < 0.0001), and bronchiectasis (1.0% vs. 0.1%, P < 0.0001). However, otitis media was less common in cases than controls (2.1% vs. 4.6%, P < 0.0001). After adjusting for differences in age, gender, and ethnicity in the regression analyses, GERD remained a significant risk factor for sinusitis (adjusted odds ratio [OR], 2.3; 95% confidence intervals [CI], 1.7-3.2; P < 0.0001), laryngitis (OR, 2.6; CI, 1.2-5.6; P = 0.0228), asthma (OR, 1.9; CI, 1.6-2.3; P < 0.0001), pneumonia (OR, 2.3; CI, 1.8-2.9; P < 0.0001), and bronchiectasis (OR, 2.3; CI, 1.1-4.6; P = 0.0193). CONCLUSIONS GERD in children without neurological defects is associated with a several-fold increase in the risk of sinusitis, laryngitis, asthma, pneumonia, and bronchiectasis. Further studies are needed to examine whether a cause-effect relationship exists between GERD and these disorders in children.
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Affiliation(s)
- H B El-Serag
- Section of Gastroenterology, Houston Veterans Affairs Medical Center (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA.
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Smola S, Justice AC, Wagner J, Rabeneck L, Weissman S, Rodriguez-Barradas M. Veterans aging cohort three-site study (VACS 3): overview and description. J Clin Epidemiol 2001; 54 Suppl 1:S61-76. [PMID: 11750212 DOI: 10.1016/s0895-4356(01)00448-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Outcomes for middle-aged and older individuals with HIV infection are poor, and are likely to be mediated by age-related differences in risks and resources (access to care, relationship with the provider, comorbid conditions, health habits, and changes brought about by aging). The goal of the Veterans Aging Cohort Three-Site Study (VACS 3) is to study the influence of age and mediating factors on outcomes with HIV in order to identify mutable mediators of poorer outcomes. VACS 3 is an observational, longitudinal study. Data sources include patient and provider surveys and electronic medical data collected at baseline and 12-month follow-up from the Infections Disease Clinics at three Veterans Affairs Medical Centers (Cleveland, OH, Houston, TX, and Manhattan, NY). Trained Survey Coordinators at each site determined which patients are HIV infected, obtained consent, and asked the patient to complete a questionnaire. The primary provider also completed a questionnaire. Twelve-month follow-up will be completed July 2001. Of all veterans with HIV seen in these clinics 85% (881) have consented and enrolled. Of the 881 corresponding provider surveys, 92% were completed. Mean age is 49; 55% are African-American; 38% of the sample were men who have sex with men; and less than 2% are women. Almost a third (32%) have been without a permanent address. Complimentary or alternative therapies are common as are the use of cigarettes, alcohol, and illicit drugs. The majority (87%) of the patients are taking multiple antiretroviral medications. The median CD4 count is 331 mm(3), and the median viral load was 714 copies/ml. There is substantial variation by site. Veterans with HIV infection have characteristics that will likely become more prevalent among HIV-infected persons in the United States: they are older, commonly suffer comorbid disease, and are members of minority populations. VACS 3 may help inform the design of future clinical interventions to improve outcomes for people aging with HIV.
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Affiliation(s)
- S Smola
- Veterans Aging Cohort Study (VACS) Center, Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Kilbourne AM, Justice AC, Rabeneck L, Rodriguez-Barradas M, Weissman S. General medical and psychiatric comorbidity among HIV-infected veterans in the post-HAART era. J Clin Epidemiol 2001; 54 Suppl 1:S22-8. [PMID: 11750206 DOI: 10.1016/s0895-4356(01)00443-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined the prevalence of HIV, general medical, and psychiatric comorbidities by age based on a recent multisite cohort of HIV infected veterans receiving care: the Veterans with HIV/AIDS 3 Site Study (VACS 3). VACS 3 includes 881 adult patients with HIV infection enrolled between June 1999 and July 2000. Providers reported their patients' CDC-defined HIV comorbidities, general medical comorbidities (based on Duke and Charlson comorbidity scales), and psychiatric comorbidity. Mean age of participants was 49 years and 54% were African-American. The most common HIV comorbidities were oral candidiasis (21%), peripheral neuropathy (16%), and herpes zoster (16%). The most common general medical comorbidities included chemical hepatitis (53%), hypertension (24%), and hyperlipidemia (17%). The mean number of HIV and general medical comorbidities experienced by patients were respectively 1.1 and 1.4 (P < .001). Older (> or = 50 years) HIV-infected patients experienced a greater number of general medical comorbidities than those < 50 years (respectively 1.7 versus 1.2, P < .001). There was no significant difference in mean HIV comorbidity number by age. Based on patient report, 46% had significant depressive symptoms (> or = 10 on 10-item CES-D) and 21% reported at-risk drinking (> or = 8 on AUDIT). Providers reported 32% of patients had anxiety, 4% mania, 4% schizophrenia, and 11% cognitive impairment/dementia. General medical and psychiatric comorbidities constituted a higher disease burden for HIV-infected veterans than HIV comorbidities. Whether these comorbidities are due to antiretroviral drug toxicity or are age or lifestyle-associated conditions, the substantial prevalence of these "non-HIV" comorbidities suggest an important role for general medical and psychiatric management of HIV-infected patients.
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Affiliation(s)
- A M Kilbourne
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C 11E-124 (130-U), Pittsburgh, PA 15240, USA
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Justice AC, Holmes W, Gifford AL, Rabeneck L, Zackin R, Sinclair G, Weissman S, Neidig J, Marcus C, Chesney M, Cohn SE, Wu AW. Development and validation of a self-completed HIV symptom index. J Clin Epidemiol 2001; 54 Suppl 1:S77-90. [PMID: 11750213 DOI: 10.1016/s0895-4356(01)00449-8] [Citation(s) in RCA: 322] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traditional, open-ended provider questions regarding patient symptoms are insensitive. Better methods are needed to measure symptoms for clinical management, patient-oriented research, and adverse drug-event reporting. Our objective was to develop and initially validate a brief, self-reported HIV symptom index tailored to patients exposed to multidrug antiretroviral therapies and protease inhibitors, and to compare the new index to existing symptom measures. The research design was a multistage design including quantitative review of existing literature, qualitative and quantitative analyses of pilot data, and quantitative analyses of a prospective sample. Statistical analyses include frequencies, chi-square tests for significance, linear and logistic regression. The subjects were from a multisite convenience sample (n = 73) within the AIDS Clinical Trials Group and a prospective sample from the Cleveland Veterans Affairs Medical Center (n = 115). Measures were patient-reported symptoms and health-related quality of life, physician-assessed disease severity, CD4 cell count, and HIV-1 RNA viral quantification. A 20-item, self-completed HIV symptom index was developed based upon prior reports of symptom frequency and bother and expert opinion. When compared with prior measures the index included more frequent and bothersome symptoms, yet was easier to use (self-report rather than provider interview). The index required less than 5 minutes to complete, achieved excellent completion rates, and was thought comprehensive and comprehensible in a convenience sample. It was further tested in a prospective sample of patients and demonstrated strong associations with physical and mental health summary scores and with disease severity. These associations were independent of CD4 cell count and HIV-1 RNA viral quantification. This 20-item HIV symptom index has demonstrated construct validity, and offers a simple and rational approach to measuring HIV symptoms for clinical management, patient-oriented research, and adverse drug reporting.
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Affiliation(s)
- A C Justice
- Center for Health Equity Research and Promotion, VA Piitsburgh Healthcare System, University Drive C 11E-124 (130-U), Pittsburgh, PA 15240, USA.
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Rabeneck L, Menke T, Simberkoff MS, Hartigan PM, Dickinson GM, Jensen PC, George WL, Goetz MB, Wray NP. Using the national registry of HIV-infected veterans in research: lessons for the development of disease registries. J Clin Epidemiol 2001; 54:1195-203. [PMID: 11750188 DOI: 10.1016/s0895-4356(01)00397-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Disease-specific registries have many important applications in epidemiologic, clinical and health services research. Since 1989 the Department of Veterans Affairs has maintained a national HIV registry. VA's HIV registry is national in scope, it contains longitudinal data and detailed resource utilization and clinical information. To describe the structure, function, and limitations of VA's national HIV registry, and to test its accuracy and completeness. The VA's national HIV registry contains data that are electronically extracted from VA's computerized comprehensive clinical and administrative databases, called Veterans Integrated Health Systems Technology and Architecture (VISTA). We examined the number of AIDS patients and the number of new patients identified to the registry, by year, through December 1996. We verified data elements against information obtained from the medical records at five VA sites. By December 1996, 40,000 HIV-infected patients had been identified to the registry. We encountered missing data and problems with data classification. Missing data occurred for some elements related to the computer programming that creates the registry (e.g., pharmacy files), and for other elements because manual entry is required (e.g., ethnicity). Lack of a standardized data classification system was a problem, especially for the pharmacy and laboratory files. In using VA's national HIV registry we have learned important lessons, which, if taken into account in the future, could lead to the creation of model disease-specific registries.
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Affiliation(s)
- L Rabeneck
- Department of Veterans Affairs Health Services Research and Development, VA Medical Center for Excellence, 2002 Holcombe Blvd., Houston, TX 77030, USA.
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Rabeneck L, Cook KF, Wristers K, Souchek J, Menke T, Wray NP. SODA (severity of dyspepsia assessment): a new effective outcome measure for dyspepsia-related health. J Clin Epidemiol 2001; 54:755-65. [PMID: 11470383 DOI: 10.1016/s0895-4356(00)00365-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this research was to develop and evaluate an instrument for measuring dyspepsia-related health to serve as the primary outcome measure for randomized clinical trials. Building on our previous work we developed SODA (Severity of Dyspepsia Assessment), a multidimensional dyspepsia measure. We evaluated SODA by administering it at enrollment and seven follow-up visits to 98 patients with dyspepsia who were randomized to a 6-week course of omeprazole versus placebo and followed over 1 year. The mean age was 53 years, and six patients (6%) were women. Median Cronbach's alpha reliability estimates over the eight visits for the SODA Pain Intensity, Non-Pain Symptoms, and Satisfaction scales were 0.97, 0.90, and 0.92, respectively. The mean change scores for all three scales discriminated between patients who reported they were improved versus those who were unchanged, providing evidence of validity. The effect sizes for the Pain Intensity (.98) and Satisfaction (.87) scales were large, providing evidence for responsiveness. The effect size for the Non-Pain Symptoms scale was small (.24), indicating lower responsiveness in this study sample. SODA is a new, effective instrument for measuring dyspepsia-related health. SODA is multidimensional and responsive to clinically meaningful change with demonstrated reliability and validity.
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Affiliation(s)
- L Rabeneck
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR & D) Field Program, the VA Rehabilitation R&D Center, and Baylor College of Medicine, Houston, TX 77030, USA.
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Abstract
GOALS The objectives of this research were to use a national probability sample of the U.S. population to determine the demographic characteristics of individuals who obtained care for dyspepsia, to compare these demographic characteristics with those of the U.S. population, and to describe the amount of health care that these individuals received. STUDY We analyzed data from the 1987 National Medical Expenditure Survey, which is based on a national probability sample of the U.S. adult population. RESULTS Approximately 3.6 million individuals, or 2% of U.S. adults, obtained care for dyspepsia. Compared with the U.S. population, a predominance of women, individuals 65 years or older, and African Americans obtained care for dyspepsia. Expenditures for health care totaled $2.5 billion. CONCLUSIONS Given the major impact of dyspepsia on U.S. health care resources, a critical issue facing investigators is to identify the most cost-effective approach to managing these patients.
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Affiliation(s)
- L Rabeneck
- Department of Veterans Affairs Health Services Research and Development (HSR&D) Center of Excellence, Baylor College of Medicine, Houston, Texas, USA.
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Abstract
BACKGROUND Although the patient experiences the symptoms, only symptoms that providers recognize and report "count" in most clinical and research settings. Reliance upon provider-report has been justified by the claim that providers report only "clinically important" symptoms. OBJECTIVE To determine whether provider-reported symptoms constitute a more "clinically important" subset of patient-reported symptoms in HIV infection. DESIGN Secondary analyses of AIDS Clinical Trials 175 (ACTG 175), a randomized controlled trial of combination antiviral therapy among patients with moderate HIV disease. SETTING Large, multicenter study. PATIENTS 1,262 patients who participated in the health-related quality of life (HRQOL) sub-study and for whom providers completed symptom forms. MEASUREMENTS Patient- and provider-reported symptoms, HRQOL, risk of recent hospitalization, survival, CD4 cell count, and plasma HIV-1 RNA levels. RESULTS On average, providers reported 3-fold fewer symptoms than patients did, but the degree of under report varied by symptom. When patient-reports were used as a gold standard, provider-reports demonstrated poor sensitivity (mean 0.25) and good specificity (mean 0.96). Agreement beyond chance was fair (mean kappa 0.35) and did not improve when weighted by symptom severity. Site specific variation was greater for provider than for patient-reported symptoms (R2: 0.15 and 0.05 respectively). Patient-reported symptoms were substantially more strongly associated with the physical health scale and all HRQOL subscales than provider-reported symptoms (P <0.0001). Patient-reported symptoms were equally strongly associated with survival (P >0.50) and recent hospitalization as provider-reported symptoms (P >0.48). Of note, patient-reported symptoms were independently associated with survival and recent hospitalization after adjustment for CD4 cell count and plasma HIV-1 RNA levels (P <0.05). CONCLUSIONS Provider-reported symptoms are not a more clinically important subset of patient-reported symptoms. Patient-reported symptom checklists are likely to be more complete and more strongly associated with HRQOL. Further, patient-reported symptoms are as related to recent hospitalization and survival as provider-reported symptoms. An HIV specific, patient-completed symptom checklist might substantially improve symptom reporting for adverse drug event monitoring, clinical management and medical research.
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Affiliation(s)
- A C Justice
- Center for Research on Health Care, VA Pittsburg Healthcare System, Section of General Internal Medicine, University of Pittsburgh, Pennsylvania 15240, USA.
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39
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Griffiths RI, Rabeneck L, Guzman G, Cromwell DM, Strauss MJ, Robinson JW, Winston B, Li T, Graham DY. Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy. Helicobacter 2001; 6:66-76. [PMID: 11328368 DOI: 10.1046/j.1523-5378.2001.00008.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated for peptic ulcer disease and Helicobacter pylori infection. MATERIALS AND METHODS A decision-analytic model was used to compare (1a) urease breath testing (UBT) for assessment of H. pylori status versus (1b) observation without further testing or treatment, among patients who were symptom-free following initial antimicrobial and antisecretory therapy for endoscopically demonstrated ulcer and H. pylori infection; and (2a) UBT versus (2b) repeat endoscopy with H. pylori testing, and versus (2c) repeat antimicrobial and antisecretory therapy without further testing, among patients who remained symptomatic following initial therapy. RESULTS Among patients who were symptom free after initial therapy, 6.1% receiving UBT had symptomatic ulcer at one year, compared to 18.2% of those simply observed. The expected first-year cost per symptom-free patient following initial therapy was $591 for UBT compared to $480 for observation. Among patients with persistent symptoms after initial therapy, 21% receiving repeat therapy had symptomatic ulcer at one year, compared to 23.8% receiving repeat endoscopy, and 23.3% receiving UBT. Corresponding medical costs per patient were, respectively, $766, $1787 and $1122. CONCLUSIONS The optimal approach to managing patients following initial treatment for ulcer and H. pylori infection depends on symptom status following initial therapy. For symptomatic patients, the preferred approach is to prescribe a repeat course of antimicrobial and antisecretory therapy. For patients without symptoms following initial therapy, UBT is the preferred approach because it is associated with a threefold lower risk of symptomatic ulcer at one year, although it costs an additional $110 per patient, compared with observation.
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Affiliation(s)
- R I Griffiths
- Project Hope Center for Health Affairs, Bethesda, MD, USA
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Menke TJ, Rabeneck L, Hartigan PM, Simberkoff MS, Wray NP. Clinical and socioeconomic determinants of health care use among HIV-infected patients in the Department of Veterans Affairs. Inquiry 2000; 37:61-74. [PMID: 10892358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This study estimates the impact of clinical and socioeconomic characteristics on health care use for HIV-infected patients. Data come from the Department of Veterans Affairs (VA) HIV Registry, which electronically extracts data from patients' automated medical records, and from patient interviews. Unlike prior studies, this analysis includes a staging system incorporating CD4 count and AIDS-defining diagnoses. Results showed that clinical factors were the most important determinants of health care use; socioeconomic variables were seldom significant. These findings were expected, since the VA is an equal access system, providing care regardless of socioeconomic status.
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Affiliation(s)
- T J Menke
- Houston Center for Quality of Care and Utilization Studies, VAMC, TX 77030, USA
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41
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Abstract
BACKGROUND Valid, timely estimates of the costs of HIV care are needed by health planners and policy makers. OBJECTIVE To perform a methodologic critique of published estimates of resource utilization and costs of HIV care. DATA SOURCES MEDLINE database for 1990-1998. DATA SELECTION Included articles focused on adults with a spectrum of HIV disease in which the authors developed their own resource use and cost data. Thirty one articles met these criteria. DATA EXTRACTION Studies were compared based on: (1) utilization and cost estimates, in 1995 dollars; (2) study period; (3) research design; (4) sampling frame; (5) sample size and patient characteristics; (6) data sources and scope of services; and (7) methods used in the analysis. DATA SYNTHESIS The most recent estimates pertain to the first half of 1995, before the use of protease inhibitor therapy. We found wide variations in the estimates and identified three major sources for this: (1) patient samples that were restricted to subgroups of the national HIV-infected population; (2) utilization data that were limited in scope (e.g., inpatient care only); and (3) invalid methods for estimating annual or lifetime costs, particularly in dealing with decedents. CONCLUSIONS To accurately estimate resource use and costs for HIV care nationwide, a nationally representative probability sample of HIV-infected patients is required. Even in research that is not intended to provide national estimates, the scope of utilization data should be broadened and greater attention to methodologic issues in the analysis of annual and lifetime costs is needed.
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Affiliation(s)
- L Rabeneck
- Department of Veterans Affairs Health Services Research and Development Field Program, Houston, TX 77030, USA.
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42
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Justice AC, Rabeneck L, Hays RD, Wu AW, Bozzette SA. Sensitivity, specificity, reliability, and clinical validity of provider-reported symptoms: a comparison with self-reported symptoms. Outcomes Committee of the AIDS Clinical Trials Group. J Acquir Immune Defic Syndr 1999; 21:126-33. [PMID: 10360804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND If symptoms are to be recognized and effectively addressed in clinical research, they must be collected using sensitive, specific, reliable, and clinically meaningful methods. OBJECTIVE To perform a comparison of self-administered symptom survey data with data from conventional provider-reports. DESIGN/METHODS Secondary data analysis of AIDS Clinical Trials Group Study 081 (ACTG 081), a randomized trial taking place in 33 sites comparing three approaches to prophylaxis for Pneumocystis carinii-related pneumonia that found no difference among treatment arms. The study was performed on 842 subjects with advanced HIV infection. No intervention was undertaken as a result of this study. ACTG 081 included data on functional status, global quality of life and survival, and two methods of symptom measurement: an open-ended, provider-reported symptom assessment (provider-report) and a self-administered symptom survey (self-report). Agreement was measured using kappa scores. Sensitivity and specificity were calculated using self-report as the standard. Reliability was measured by intersite variation and test-retest reliability (8 weeks later). Clinical validity was evaluated by testing expected associations with functional status, global quality of life, and survival. RESULTS Symptom data were available for 808 patients (96%). Patient and provider agreement was poor (mean kappa, 0.14; range, 0.07-0.25). Compared with self-report, providers underreported the presence and severity of symptoms (mean symptom count, 5.2 versus 1.3; mean severity score, 1.3 versus 0.74). provider-report demonstrated greater variability by site (R2 associated with site, 0.02 versus 0.16) and poorer test-retest reliability (mean kappa, 0.34 versus 0.25). Provider-report severity scores were less strongly associated than were self-report with functional status (chi2, 252 versus 80), global quality of life (R2 for model, 0.57 versus 0.15), and survival (chi2, 38 versus 24). Self-reported symptom severity was strongly correlated to patient-reported global quality of life (p, 0.75; p < .0001). CONCLUSIONS Provider-reported symptoms as currently collected within the ACTG are less sensitive and reproducible than a self-administered symptom survey. Provider-reported severity scores are also more weakly associated with functional status, global quality of life, and survival. A self-reported symptom survey may provide a better method of symptom measurement for HIV research.
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Affiliation(s)
- A C Justice
- Department of Veterans Affairs Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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43
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Cook KF, Rabeneck L, Campbell CJ, Wray NP. Evaluation of a multidimensional measure of dyspepsia-related health for use in a randomized clinical trial. J Clin Epidemiol 1999; 52:381-92. [PMID: 10360332 DOI: 10.1016/s0895-4356(99)00018-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In previous work, we developed a multidimensional measure of dyspepsia-related health. To evaluate the adequacy of this instrument as an outcome measure for a large-scale, multicenter, randomized clinical trial, we used Rasch analysis to address three questions: (1) Are the scales interval-level? (2) Do the scales measure precisely across the entire range of dyspepsia outcomes? (3) Do the scales' items have an optimal number of response categories? We found that the scales were not interval-level and that they did not measure effectively at low or high levels of the dyspepsia-related outcomes. Our results also suggest that patients were capable of discriminating among only four- to seven-item response categories. Further studies are needed to identify items that effectively measure high and low levels of dyspepsia-related outcomes and to validate that decreasing the number of response categories improves the psychometric properties of these scales.
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Affiliation(s)
- K F Cook
- Department of Veterans Affairs Health Services Research and Development Field Program, Veterans Affairs Medical Center, Houston, TX 77030, USA
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44
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Abstract
PURPOSE Dyspepsia is a common primary care condition, yet its optimal management is poorly defined. We reviewed the literature to answer the following questions about patients with dyspepsia: 1) Does endoscopy result in improved patient outcomes? 2) Does endoscopy result in a reduction in the use of subsequent medical resources? 3) Does endoscopy result in improved medical decision making? 4) Is endoscopy cost effective? METHODS We performed a systematic review of English-language articles in the MEDLINE, HEALTHSTAR, and EMBASE computerized bibliographic databases from January 1985 to July 1998. We included all studies, including decision analyses, with information about the effectiveness of endoscopy, as measured by its impact on patient outcomes, resource utilization, clinical decision making, or cost effectiveness. Two independent reviewers abstracted data from each study, and assessed its methodologic quality. RESULTS Twenty-one studies met the inclusion criteria. For 3 of the 4 clinical questions, the weight of evidence does not support the effectiveness of endoscopy. The largest randomized clinical trial comparing endoscopy with empiric therapy demonstrates equivalent symptoms and quality of life at 1 year, with increased patient satisfaction and lower costs for initial endoscopy. Suboptimal study design, including lack of appropriate comparison groups, limit studies measuring the impact of endoscopy on resource utilization and decision-making. Decision analyses indicate that noninvasive H pylori testing followed by anti-H pylori therapy or empiric antisecretory therapy is more cost effective than initial endoscopy. CONCLUSIONS With the exception of one randomized clinical trial, the preponderance of available data does not support the effectiveness of endoscopy in the management of dyspepsia. Prospective clinical trials that evaluate patient outcomes and resource utilization, and take H pylori status into account, are needed to determine the effectiveness of endoscopy in the management of dyspepsia.
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Affiliation(s)
- J J Ofman
- Department of Medicine and Health Services Research, Cedars Sinai Medical Center, University of California, Los Angeles, School of Medicine, USA
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45
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Abstract
OBJECTIVE The conceptual revolution concerning the role of Helicobacter pylori in the pathogenesis of peptic ulcer disease has raised the larger question of how to integrate this new information into the management of patients with dyspepsia. The aim of this research was to critically evaluate current knowledge about dyspepsia and its management. METHODS Relevant articles on dyspepsia were identified from MEDLINE searches and from the bibliographies of identified articles. Studies that contained information on the prevalence of dyspepsia, endoscopic findings, and evaluations of alternative management strategies were reviewed. RESULTS By coupling H. pylori serological testing with clinical factors such as age and nonsteroidal antiinflammatory drug use, strategies have been developed that identify patients with organic disease. Although the use of these strategies can reduce the volume of endoscopies, their effects on dyspepsia symptoms are unknown. Computerized decision analysis models have been used to evaluate the cost-effectiveness of alternative strategies. The indirect evidence obtained from these models suggests that empiric therapy, guided by H. pylori testing, may be the preferred approach. However, the models have been hampered by the lack of information concerning dyspepsia symptoms, the primary health outcome of the majority of patients seen in primary practice settings. CONCLUSIONS Currently, the knowledge needed to integrate H. pylori tests and antimicrobial therapies into the management of patients with dyspepsia in primary practice settings has not been developed. A pressing need exists for a randomized controlled trial to evaluate alternative management strategies. In conducting such a trial, valid, reliable instruments for measuring dyspepsia will be needed.
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Affiliation(s)
- L Rabeneck
- Department of Veterans Affairs Medical Center, Houston, Texas 77030, USA
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46
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Rabeneck L, Palmer A, Knowles JB, Seidehamel RJ, Harris CL, Merkel KL, Risser JM, Akrabawi SS. A randomized controlled trial evaluating nutrition counseling with or without oral supplementation in malnourished HIV-infected patients. J Am Diet Assoc 1998; 98:434-8. [PMID: 9550167 DOI: 10.1016/s0002-8223(98)00099-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effects of nutrition counseling with or without oral supplementation in malnourished patients infected with the human immunodeficiency virus (HIV). DESIGN Randomized controlled trial. SUBJECTS HIV-infected men (n=118) who were less than 90% of usual weight for height or who had lost more than 10% of body weight. INTERVENTION Nutrition counseling alone (control group) vs nutrition counseling plus enteral supplementation (supplement group) for 6 weeks. All patients were instructed to consume a diet that exceeded estimated total energy expenditure by 960 kcal/day. MAIN OUTCOME MEASURES Weight, skinfold thickness, fat-free mass, grip strength, quality of life, and cognitive function (Buschke test). STATISTICAL ANALYSES Differences in baseline variables and outcomes were evaluated using analysis of variance or the Wilcoxon rank sum test. RESULTS Ninety-nine men completed at least 4 weeks of treatment, 49 in the supplement group and 50 in the control group. Half the patients in each treatment group achieved at least 80% of their energy target. No differences in weight, skinfold thickness measurements, or quality of life were observed. Compared with the control group, the supplement group had larger increases in fat-free mass and grip strength, although the differences did not reach statistical significance. APPLICATIONS In the short term, nutrition counseling with or without oral supplementation can achieve a substantial increase in energy intake in about 50% of malnourished HIV-infected patients. Although further study is needed to evaluate long-term effects, these findings suggest that nutrition counseling has an important role in the management of malnourished HIV-infected patients.
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Affiliation(s)
- L Rabeneck
- Department of Veterans Affairs Medical Center and the Department of Medicine, Baylor College of Medicine, Houston, Tex 77030, USA
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47
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Abstract
This study developed and validated a multidimensional measure of dyspepsia. A questionnaire was administered to 126 patients with dyspepsia who presented for care at a VA outpatient clinic and a family physician's private office. Dyspepsia-specific health was measured by self-report using: (1) an existing dyspepsia scale that produces an aggregate score by summing ratings across pain and non-pain symptoms; (2) adaptations of two scales originally designed to measure back pain; and (3) a new scale measuring satisfaction with dyspepsia-related health. Generic health was measured using the SF-36. Results from factor analysis revealed four dimensions of dyspepsia-related health: pain intensity, pain disability, non-pain symptoms, and satisfaction with dyspepsia-related health. After refinements, scales representing the four dimensions conformed to psychometric standards for reliability, and convergent and discriminant validity. The importance of measuring dyspepsia using a multidimensional approach was confirmed by demonstrating that classification of dyspepsia severity depended on the dimension that was assessed. We conclude that dyspepsia is best measured using a multidimensional approach.
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Affiliation(s)
- D H Kuykendall
- Department of Veterans Affairs Health Services Research and Development (HSR&D) Field Program, Veterans Affairs Medical Center, Houston, Texas 77030, USA
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48
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49
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Abstract
This article (Part II) and the preceding article (Part I) report the development of two clinical staging systems for HIV-infected individuals. The objective of the research reported here (Part II) was to construct a clinical staging system to predict survival in patients with AIDS. We analyzed data from VA Cooperative Study Number 298, a multicenter, double-blind, randomized trial that compared immediate versus deferred zidovudine therapy in HIV-infected individuals. Baseline variables obtained at the onset of AIDS in 204 individuals were tested in univariate Cox regression for their relationship to survival, and those that appeared predictive were examined in multivariable analysis. Based on these analyses, we constructed a new AIDS Clinical Staging System. The system is based on age, CD4+ cell count, type of first AIDS-defining condition, and functional status. The stages of the system were significant predictors of survival (p = 0.0001, log-rank test). In conclusion, valid, simple clinical staging systems for patients with AIDS can be developed based on a few variables that are readily available in clinical settings.
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Affiliation(s)
- L Rabeneck
- Department of Veterans Affairs Health Services Research, Houston, Texas, USA
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50
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Abstract
This article and the following article (Parts I and II) report the development of two clinical staging systems for HIV-infected individuals. The objective of the research reported here (Part I) was to construct a clinical staging system to predict progression to AIDS. We analyzed data from VA Cooperative Study Number 298, a multicenter, double-blind, randomized trial that compared immediate versus deferred zidovudine therapy in 338 HIV-infected individuals who did not have AIDS at enrollment. Baseline variables were tested in univariate Cox regression for their relationship to progression to AIDS, and those that appeared predictive were examined in multivariable analysis. Based on these analyses, we constructed a new clinical staging system based on CD4+ cell count, age, hemoglobin, oral hairy leukoplakia or oral thrush, and fever. The stages of the system were significant predictors of progression to AIDS (p = 0.0001, log-rank test). In conclusion, simple, valid, clinical staging systems for HIV-infected patients can be constructed using information that is readily available in clinical practice settings. Such systems provide better prognostic distinction than CD4+ cell count alone by taking into account the known prognostic effects of other variables.
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Affiliation(s)
- L Rabeneck
- Department of Veterans Affairs Health Services Research, Houston, Texas, USA
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