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Toner L, Chen JXC, Ramchand J, Srivastava P, O'Donnell D, Calafiore P, Jones E. Biventricular Function is Impaired in Right Ventricular Septal Pacing-A Prospective Study Using Myocardial Strain Imaging. Heart Lung Circ 2023; 32:373-378. [PMID: 36550006 DOI: 10.1016/j.hlc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Left ventricular (LV) dysfunction is known to occur after right ventricular (RV) pacing; the effect on RV function is less well studied. The aim of this study was to assess the impact of RV mid-septal pacing upon RV function using the novel parameters of speckle-tracking derived RV global longitudinal strain (RV GLS) and RV free wall strain (RV FWS), as well as the conventional parameters RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and tricuspid annular systolic velocity (RV S'). METHODS Thirty-two (32) consecutive patients with normal baseline LV and RV function requiring permanent pacemaker insertion (for high-grade AV block or sinus node dysfunction) were prospectively recruited. Echocardiography was performed prior to implantation, at 1 day, 1 month and 1 year after implantation, with 29 patients completing follow-up. RESULTS After 1 year, three patients (10%) with otherwise normal RV parameters developed abnormal RV strain patterns. Compared to 1 day after implantation, at 1 year significant reductions were observed in mean RV GLS (-24.8 to -21.8%) RV S' (15.1 to 12.2 cm/s), TAPSE (24.2 to 21.9 mm), RV GLS (-24.8 to -21.8%), left ventricular ejection fraction (LVEF) (66.0 to 57.9%), LV GLS (-19.9 to 17.0), all p<0.01. There was a non-significant reduction for RV FWS (-29.0 to -26.7%, p=0.06) and there was no change in RV FAC (49.1 to 46.9%, p=0.24). CONCLUSION We report abnormalities of RV strain developing 1 year after pacemaker insertion. Measurement of myocardial strain is emerging as an additional method to detect patients at risk of RV dysfunction in those who have undergone pacemaker implantation.
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Affiliation(s)
- Liam Toner
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia.
| | - Janet X C Chen
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Jay Ramchand
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | | | - David O'Donnell
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Paul Calafiore
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Elizabeth Jones
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
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Toner L, Proimos H, Scully T, Ko J, Koshy A, Horrigan M, Lim HS, Lin T, Farouque O. Late recurrence of atrial fibrillation and flutter in patients referred for elective electrical cardioversion. Kardiologiia 2023; 63:54-59. [PMID: 36749202 DOI: 10.18087/cardio.2023.1.n2145] [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] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/28/2022] [Indexed: 02/08/2023]
Abstract
Aim The primary aim was to ascertain long-term rates of atrial fibrillation (AF) recurrence in this all-comer patient population undergoing elective electrical cardioversion (DCR). Secondary aims included procedural DCR success, clinical predictors of long-term maintenance of sinus rhythm (SR) and AF related hospitalizations.Material and Methods A retrospective cohort study was conducted. Consecutive patients (n=316) undergoing elective DCR were included.Results Successful immediate reversion to SR was attained in 266 (84 %) of patients. 224 (84 %) patients were followed up for a median period of 3.5 years (IQR 2.7-4.3). Most patients (150 [67 %]) had recurrence of AF / flutter at a median time of 240 days. Clinical predictors of AF recurrence included a history of AF (HR 0.63, p=0.038) and a dilated left atrium (HR 4.13, p=0.048). Maintenance of SR was associated with fewer unplanned hospitalizations for AF (HR 3.25, p<0.01).Conclusion There was high procedural success post DCR. However, long-term rates of AF recurrence were high, and AF recurrences were associated with increased hospitalizations. These findings underscore the importance of clinical vigilance and multi-modal management as part of a comprehensive and effective rhythm control strategy.
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Affiliation(s)
| | | | | | | | | | | | - Han S Lim
- Austin Hospital; University of Melbourne
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Toner L, Rodrigues TS, Undrill S, Ajani AE, Yeoh J, Clark D. Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock Secondary to Left Ventricular Outflow Tract Obstruction and Severe Mitral Regurgitation. Cardiovasc Revasc Med 2021; 28S:236-238. [PMID: 33839050 DOI: 10.1016/j.carrev.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Liam Toner
- Austin Hospital, Department of Cardiology, Australia
| | | | - Simon Undrill
- Austin Hospital, Department of Cardiology, Australia
| | - Andrew E Ajani
- The University of Melbourne, Department of Medicine, Australia; Royal Melbourne Hospital, Department of Cardiology, Australia; Monash University, Department of Medicine, Australia.
| | - Julian Yeoh
- Austin Hospital, Department of Cardiology, Australia; The University of Melbourne, Department of Medicine, Australia
| | - David Clark
- Austin Hospital, Department of Cardiology, Australia; The University of Melbourne, Department of Medicine, Australia
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Scully TG, Toner L, Yeoh J, Farouque O, Yudi MB, Horrigan M, Clark DJ. Safety and Long-Term Clinical Outcomes of Fractional Flow Reserve Guided Coronary Revascularisation. Heart Lung Circ 2021; 30:1343-1347. [PMID: 33781698 DOI: 10.1016/j.hlc.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/31/2020] [Accepted: 02/11/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increasingly, fractional flow reserve (FFR) is employed to assess coronary artery stenoses although there is limited real world long-term outcome data with a recent report questioning its safety. This study aimed to assess the in-hospital complications and clinical outcomes up to 10 years after FFR-guided revascularisation at a tertiary Australian hospital. METHODS The cohort comprised 274 consecutive patients undergoing FFR from 2010 to 2015 with follow-up to 2020. In-hospital complications and long-term outcomes were compared between patients with FFR≤0.80 and FFR>0.80. Major adverse cardiac events (MACE) comprised cardiac death, myocardial infarction (MI) and target vessel revascularisation (TVR). RESULTS The FFR was ≤0.80 in 166 and >0.80 in 108 patients. Stable coronary disease was present in 95%. Revascularisation was undertaken in 86.7% of the FFR≤0.80 group and in 2.8% of the group with an FFR>0.80. In-hospital adverse events were 3.3% with no pressure wire-related coronary dissection, stroke or death. At median follow-up of 5 years, patients with FFR≤0.80 and FFR>0.80 had a similar rate of cardiac death (2.6% versus 5.0%, p=0.335) and MI (2.6% versus 6.9%, p=0.154). In the FFR>0.80 group, MACE (17.8% v 7.9%; p=0.018) and TVR (12.9% v 5.3%; p=0.033) were significantly higher. CONCLUSION This observational study highlights the safety and long-term effectiveness of FFR-guided coronary revascularisation in patients with predominantly stable disease.
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Affiliation(s)
- Timothy G Scully
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Liam Toner
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
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Toner L, Chen J, Ramchand J, O'Donnell D, Srivastava P, Calafiore P, Jones E. Biventricular Function is Impaired in RV Septal Pacing – A Prospective Study Using Myocardial Strain Imaging. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.187] [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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Toner L, Sampaio Rodrigues T, Undrill S, Ajani A, Yeoh J, Clark D. Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock Secondary to Left Ventricular Outflow Tract Obstruction and Severe Mitral Regurgitation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Toner L, Proimos H, Scully T, Ko J, Koshy A, Lim H, Lin T, Farouque O. Delayed Recurrence of Atrial Fibrillation and Flutter in Patients Referred for Electrical Cardioversion: A 5-year Study in a Real-World Setting. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Toner L, Koshy A, Farouque O, Cotroneo J. Left ventricular aneurysm complicating apical hypertrophic cardiomyopathy. BMJ Case Rep 2020; 13:13/10/e238861. [PMID: 33028573 DOI: 10.1136/bcr-2020-238861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Liam Toner
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Anoop Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - John Cotroneo
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
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Toner L, Koshy AN, Ko J, Driscoll A, Farouque O. Clinical Characteristics and Trends in Heart Failure Hospitalizations: An Australian Experience During the COVID-19 Lockdown. JACC Heart Fail 2020; 8:872-875. [PMID: 33004116 PMCID: PMC7418698 DOI: 10.1016/j.jchf.2020.05.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/04/2022]
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Toner L, Koshy AN, Hamilton GW, Clark D, Farouque O, Yudi MB. Acute coronary syndromes undergoing percutaneous coronary intervention in the COVID-19 era: comparable case volumes but delayed symptom onset to hospital presentation. Eur Heart J Qual Care Clin Outcomes 2020; 6:225-226. [PMID: 32379888 PMCID: PMC7239230 DOI: 10.1093/ehjqcco/qcaa038] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Liam Toner
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, 3084 Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, 3084 Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Garry W Hamilton
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, 3084 Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, 3084 Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, 3084 Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, 3084 Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Toner L, Al-Kaisey AM, Koshy A, Lim HS. Spontaneous reversion of paroxysmal atrial fibrillation detected by smart watch. BMJ Case Rep 2020; 13:13/2/e233431. [PMID: 32024718 DOI: 10.1136/bcr-2019-233431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Liam Toner
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia .,Department of Cardiology, The Northern Hospital, Melbourne, Victoria, Australia
| | - Ahmed M Al-Kaisey
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Anoop Koshy
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Han Sung Lim
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia.,Department of Cardiology, The Northern Hospital, Melbourne, Victoria, Australia
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Scully T, Toner L, Yeoh J, Clark D. 836 Identification of Risk Factors for Failure of a Deferred Revascularisation Strategy in Patients With Fractional Flow Reserve >0.8. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Al-Kaisey AM, Koshy AN, Ha FJ, Spencer R, Toner L, Sajeev JK, Teh AW, Farouque O, Lim HS. Accuracy of wrist-worn heart rate monitors for rate control assessment in atrial fibrillation. Int J Cardiol 2019; 300:161-164. [PMID: 31787389 DOI: 10.1016/j.ijcard.2019.11.120] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/14/2019] [Accepted: 11/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wrist-worn heart rate (HR) monitors are increasingly popular. A paucity of data exists on their accuracy in atrial fibrillation (AF) in ambulatory patients. We sought to assess the HR accuracy of two commercially available smart watches [SW] (Fitbit Charge HR [FB] and Apple Watch Series 3 [AW]) compared with Holter monitoring in an ambulant patient cohort. METHODS Thirty-two participants ≥18 years referred for 24-hour Holter monitoring were prospectively recruited. Each participant was randomly allocated to wear either a FB or AW along with their Holter monitor. RESULTS Across all devices, 53,288 heart rate values were analysed from 32 participants. Twenty wore the AW (17 had persistent AF and 3 had sinus rhythm [SR]) while 12 participants wore the FB (9 in persistent AF and 3 in SR). Participants in SR demonstrated strong agreement compared to Holter monitoring (bias <1 beat, limits of agreement [LoA] -11 to 11 beats). In AF, both devices underestimated HR measurements (bias -9 beats, LoA -41 to 23). The degree of underestimation was more pronounced when HR > 100 bpm (bias of -28 beats for HR range 100-120 bpm, -48 for 120-140 bpm, and -69 for >140 bpm) compared to a slower HR (bias of -6 for HR range 80-100 bpm, <1 for 60-80 bpm, and -1 for <60 bpm). CONCLUSION In ambulatory patients, smartwatches underestimated HR in AF particularly at HR ranges >100 bpm. Further improvements in device technology are needed before integrating them into the clinical management of rate control in AF.
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Affiliation(s)
- Ahmed M Al-Kaisey
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Eastern Health, Boxhill, Victoria, Australia; University of Melbourne, Melbourne, Australia
| | - Francis J Ha
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Ryan Spencer
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Liam Toner
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Jithin K Sajeev
- Department of Cardiology, Eastern Health, Boxhill, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Eastern Health, Boxhill, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia; University of Melbourne, Melbourne, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia; University of Melbourne, Melbourne, Australia.
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Al-Kaisey A, Koshy A, Ha FJ, Sajeev J, Toner L, Spencer R, Teh A, Farouque O, Lim HS. P574Accuracy of wrist-worn heart rate monitors for chronotropic assessment in atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0185] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Wrist-worn fitness and heart rate (HR) monitors are increasingly popular. Previous studies in healthy participants with sinus rhythm (SR) have yielded variable results depending on HR, activity levels and device tested. A paucity of data exists on their accuracy in atrial fibrillation (AF) in ambulatory patients.
Purpose
We sought to assess the HR accuracy of 2 commercially available smart watches (Fitbit Charge HR [FB] and Apple Watch Series 3 [AW]) compared with Holter monitoring in an ambulant patient cohort.
Methods
Patients aged >18 years referred for 24-hour Holter monitoring were prospectively recruited. The Holter monitor was the criterion measure. Each patient was randomly allocated to either a FB or AW along with their Holter monitor. The study protocol was approved by the institutional review board.
Statistical analysis: Pearson (r) correlation coefficients and Bland-Altman comparison with 95% limits of agreement (LoA) were evaluated to assess criterion validity and agreement between the smart watch and Holter ECG-HR. Bias was the calculated mean difference between the smart watch and ECG-HR. A ± 10-beat different between Holter-HR and SW-HR was used as a clinically relevant range to establish the accuracy of HR estimation by SW.
Results
Across all devices, 53,288 hear rate values were recorded from 32 patients. Twenty six patients were in persistent AF and six were in SR. Twelve patients wore the FB while 20 wore the AW. In the FB arm, nice patient were in persistent AF and three in SR. In the AW arm, persistent AF was the rhythm in seventeen and SR in three. Patients in SR demonstrated overall strong agreement compared to Holter monitoring (Mean Bias <1 beat, LoA −11 to 11 beats) and a correlation coefficient of 0.87 (p<0.001). In AF, both devices underestimated HR measurements (Overall Bias −9 beats, LoA −41 to 23, r=0.60, p<0.001). The AW had lower bias and narrower LoA compared to FB (−5 beats vs −13 beats, LoA −31 to 21 beats vs −50 to 22 beats). Using a ± 10-beat range against ECG-HR for clinical accuracy, both the AW and FB performed satisfactorily in SR with 95.2% of AW and 92.2% of FB HR readings considered valid. In AF, however, the AW-HR readings were within the ± 10-beat threshold in 76.5% of the time compared with only 56.1% of FB readings.
Conclusion
In ambulatory patients, smart watches were accurate in HR estimation when compared to Holter monitor in SR; however tended to underestimate HR in AF. Further improvements in device technology are needed before the widespread consumer adoption of this nascent technology for chronotropic assessment in arrhythmias.
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Affiliation(s)
- A Al-Kaisey
- Austin Health Hospital, Melbourne, Australia
| | - A Koshy
- Austin Health Hospital, Melbourne, Australia
| | - F J Ha
- Austin Health Hospital, Melbourne, Australia
| | - J Sajeev
- Box Hill Hospital, Cardiology, Melbourne, Australia
| | - L Toner
- Austin Health Hospital, Melbourne, Australia
| | - R Spencer
- Austin Health Hospital, Melbourne, Australia
| | - A Teh
- Austin Health Hospital, Melbourne, Australia
| | - O Farouque
- Austin Health Hospital, Melbourne, Australia
| | - H S Lim
- Austin Health Hospital, Melbourne, Australia
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Toner L, Al-Kaisey A, Koshy A, Ha F, Spencer R, Sajeev J, Teh A, Farouque O, Lim H. The Accuracy of Smartwatches Compared to Holter Monitors for Heart Rate Monitoring in Atrial Fibrillation: A Pilot Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Toner L, Scully T, Yeoh J, Yudi M, Farouque O, Clarke D. Safety and Long-Term Clinical Outcomes of Fractional Flow Reserve (FFR): An 8-year Study in a Real-world Setting. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.684] [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: 11/24/2022]
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Toner L, Flannery D, Sugumar H, Ord M, Lin T, O'Donnell D. Electrical remodelling and response following cardiac resynchronization therapy: A novel analysis of intracardiac electrogram using a quadripolar lead. J Arrhythm 2018; 34:274-280. [PMID: 29951143 PMCID: PMC6009766 DOI: 10.1002/joa3.12063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/29/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves morbidity and mortality in patients with heart failure. Although structural remodelling correlates with improved long-term outcomes, the role of electrical remodelling is poorly understood. This study aimed to evaluate electrical remodelling following CRT using a quadripolar left ventricular (LV) lead and to correlate this with structural remodelling. METHODS Consecutive patients undergoing initial CRT implantation using a quadripolar LV lead were enrolled. Patients were followed up for 12 months. Twelve lead ECG, transthoracic echocardiogram, and evaluation of intracardiac electrograms (EGM) were performed. Measures included right and left ventricular lead intrinsic delay, RV-pacing to LV-sensing (RVp-LVs) delay, and LV-pacing to RV-sensing (LVp-RVs) delay. The electrical changes were then correlated with echocardiographic response to CRT, defined by ≥15% relative reduction in LVESV and ≥ 5% absolute improvement in EF on TTE. Activation sequence was determined using the quadripolar lead. RESULTS Forty patients were enrolled. Mean intrinsic RV-LV EGM values decreased from 121.9 ± 14.7 ms to 109.1 ± 15.0 ms (P < .01), mean RVp-LVs EGM values from 146.7 ± 16.7 ms to 135.1 ± 13.1 ms, (P < .01), and mean LVp-RVs EGM values from 155.7 ± 18.1 ms to 144.2 ± 17.1 ms (P < .01). The improvement in intrinsic RV-LV EGM was 14.9 ± 8.5 ms in responders vs 8.9 ± 7.9 ms in nonresponders to CRT (P < .05). Changes in activation sequence did not correlate with CRT response. CONCLUSIONS This novel study used EGMs from a quadripolar LV lead to demonstrate electrical remodelling occurs following CRT. A nonsignificant trend suggests that electrical remodelling in CRT is greater in responders compared to nonresponders, although further study is needed.
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Affiliation(s)
- Liam Toner
- Electrophysiology UnitDepartment of CardiologyAustin HealthHeidelbergVICAustralia
| | - Darragh Flannery
- Electrophysiology UnitDepartment of CardiologyAustin HealthHeidelbergVICAustralia
| | - Hariharan Sugumar
- Electrophysiology UnitDepartment of CardiologyAustin HealthHeidelbergVICAustralia
| | - Michelle Ord
- Electrophysiology UnitDepartment of CardiologyAustin HealthHeidelbergVICAustralia
| | - Tina Lin
- Electrophysiology UnitDepartment of CardiologyAustin HealthHeidelbergVICAustralia
| | - David O'Donnell
- Electrophysiology UnitDepartment of CardiologyAustin HealthHeidelbergVICAustralia
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Toner L, Papa N, Perera M, Aliyu SH, Dev H, Lawrentschuk N, Al-Hayek S. Staphylococcus aureus urinary tract bacteriuria: single-institutional antibiotic susceptibility trends over a decade. Bladder (San Franc) 2017. [DOI: 10.14440/bladder.2017.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: Methicillin resistant Staphylococcus aureus (MRSA) is a troublesome pathogen which is difficult for clinicians to treat. The purpose of this surveillance program is to assess the prevalence of MRSA urinary tract infections and determine risk factors for methicillin resistance in adults amongst urinary isolates of SA and to describe the antibiotic susceptibilities to guide empirical therapy.Methods: From 2005 through to 2014, we retrospectively reviewed urine cultures recorded in a laboratory database at a university hospital in Cambridge, UK. Susceptibility testing was performed by BSAC (British Society of Antimicrobial Chemotherapy) disc diffusion testing and reported for fluoroquinolones, gentamicin, nitrofurantoin, linezolid, trimethoprim and vancomycin. Samples were denoted “MRSA” if they were resistant to oxacillin or cefoxitin.Results: In total, 690 cultures were positive for SA, of which 293 (42.5%) were methicillin resistant. The number of SA bacteriuria decreased from around 100 per year to 40 per year. The proportion demonstrating methicillin resistance decreased from around 60% to around 20%. Both methicillin-sensitive Staphylococcus aureus (MSSA) and MRSA isolates were susceptible to vancomycin and nitrofurantoin. MRSA isolates demonstrated some increased resistance to trimethoprim and gentamicin and greatly increased resistance to fluoroquinolones. Urinary catheterization and increasing age were risk factors for methicillin resistance.Conclusion: The incidence of SA and MRSA bacteriuria decreased during the study period. A high degree of resistance to fluoroquinolones was observed in MRSA compared to MSSA. Analysis of antibiotic susceptibility profiles suggests nitrofurantoin and trimethoprim may be useful in treating uncomplicated MSSA and MRSA urinary tract infections without concurrent bacteremia.
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Sugumar H, Matalanis G, Toner L, O’Donnell D. Epicardial CRT-D in a Pacing Dependant Patient Without Transvenous Options. Heart Lung Circ 2017; 26:e48-e49. [DOI: 10.1016/j.hlc.2016.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 11/28/2016] [Accepted: 12/30/2016] [Indexed: 11/25/2022]
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Toner L, Voskoboinik A, Spencer R, Ord M, Teh A, Liam H, O’Donnell D. Heart Failure with Preserved Ejection Fraction–Association of Diastolic Dysfunction and Left Bundle Branch Block. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Toner L, Papa N, Perera M, Katelaris N, Weerakoon M, Chin K, Harewood L, Bolton DM, Lawrentschuk N. Multiparametric magnetic resonance imaging for prostate cancer—a comparative study including radical prostatectomy specimens. World J Urol 2016; 35:935-941. [DOI: 10.1007/s00345-016-1960-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/19/2016] [Indexed: 01/26/2023] Open
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Toner L, Voskoboinik A, Ord M, Liam H, Teh A, O’Donnell D. QRS Duration and Bundle Branch Block Pattern - Prevalence in Heart Failure with Preserved Ejection Fraction. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.311] [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: 11/15/2022]
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Toner L, Flannery D, Sugumar H, Ord M, Teh A, Liam H, O’Donnell D. Electrical Remodelling Following CRT as Assessed by Intracardiac Electrograms Using a Quadripolar Left Ventricular Lead. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Toner L, Voskoboinik A, Ord M, Teh A, Lim H, O'Donnell D. 216-70: QRS duration and bundle branch block pattern - Prevalence in heart failure with preserved ejection fraction. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i159a] [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: 11/14/2022] Open
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Toner L, Papa N, Aliyu SH, Dev H, Lawrentschuk N, Al-Hayek S. Candida growth in urine cultures: a contemporary analysis of species and antifungal susceptibility profiles. QJM 2016; 109:325-9. [PMID: 26537955 PMCID: PMC4888329 DOI: 10.1093/qjmed/hcv202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent publications suggest the distribution of Candida species causing candiduria may vary geographically, which has implications for the continued efficacy of antifungal therapy and emerging resistance. AIM To investigate the incidence of Candiduria at a university hospital in the UK. Further, to assess the distribution of species and the accompanying antifungal susceptibility profile, in order to monitor the clinical utility of current antifungal treatment guidelines for candiduria so that patients receive the best possible outcomes from the most up to date care. DESIGN Retrospective audit. METHODS From 1st January 2005 to 31st October 2014, we retrospectively reviewed 37 538 positive urine cultures recorded in a computerized laboratory results database. Identification and susceptibility testing was performed using the VITEK® 2 fungal susceptibility card (bioMérieux, Marcy d'Etoile, France). RESULTS In total, 96 cultures were positive for Candida species, of which 69 (72%) were C.albicans, which translates to a prevalence of 2.6 per 1000 positive urine cultures. Candiduria was more common in younger patients, males and catheterized females. We report 94 and 73% of isolates of C.albicans and other non-C.albicans Candida species were susceptible to fluconazole. All isolates were susceptible to amphotericin B. CONCLUSIONS Our results add weight to the evidence supporting current European and North American guidelines recommending fluconazole or amphotericin B for treatment of candiduria, if antifungal treatment is clinically indicated.
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Affiliation(s)
- L Toner
- From the Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | - N Papa
- From the Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | | | - H Dev
- Department of Urology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK
| | - N Lawrentschuk
- From the Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Samih Al-Hayek
- Department of Urology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK
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Toner L, Papa N, Aliyu SH, Dev H, Lawrentschuk N, Al-Hayek S. Vancomycin resistant enterococci in urine cultures: Antibiotic susceptibility trends over a decade at a tertiary hospital in the United Kingdom. Investig Clin Urol 2016; 57:129-34. [PMID: 26981595 PMCID: PMC4791667 DOI: 10.4111/icu.2016.57.2.129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/23/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose Enterococci are a common cause of urinary tract infection and vancomycin-resistant strains are more difficult to treat. The purpose of this surveillance program was to assess the prevalence of and determine the risk factors for vancomycin resistance in adults among urinary isolates of Enterococcus sp. and to detail the antibiotic susceptibility profile, which can be used to guide empirical treatment. Materials and Methods From 2005 to 2014 we retrospectively reviewed 5,528 positive Enterococcus sp. urine cultures recorded in a computerized laboratory results database at a tertiary teaching hospital in Cambridge, United Kingdom. Results Of these cultures, 542 (9.8%) were vancomycin resistant. No longitudinal trend was observed in the proportion of vancomycin-resistant strains over the course of the study. We observed emerging resistance to nitrofurantoin with rates climbing from near zero to 40%. Ampicillin resistance fluctuated between 50% and 90%. Low resistance was observed for linezolid and quinupristin/dalfopristin. Female sex and inpatient status were identified as risk factors for vancomycin resistance. Conclusions The incidence of vancomycin resistance among urinary isolates was stable over the last decade. Although resistance to nitrofurantoin has increased, it still serves as an appropriate first choice in uncomplicated urinary tract infection caused by vancomycin-resistant Enterococcus sp.
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Affiliation(s)
- Liam Toner
- Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | - Nathan Papa
- Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | - Sani H Aliyu
- Department of Microbiology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK
| | - Harveer Dev
- Department of Urology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK
| | - Nathan Lawrentschuk
- Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia.; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Samih Al-Hayek
- Department of Urology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK
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Abstract
Purpose Urosepsis is the most feared complication of transrectal prostate biopsy. The incidence may be increasing from <1% to 2%–3% in contemporary series. Historically, fluoroquinolones have been effective antibiotic prophylaxis to prevent infective complications but antibiotic resistance is increasing. The increase in antibiotic resistance may contribute to reported increases in urosepsis and hospitalization after transrectal biopsy. This article will review other methods clinicians may employ to reduce the incidence of infective complications after prostate biopsy. Materials and Methods A systematic review of the literature was conducted using literature databases PubMed and Ovid MEDLINE in August 2015 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria. Results Effective strategies to reduce infective complications after transrectal prostate biopsy include augmented prophylaxis with other antibiotics, rectal swab culture directed antibiotic prophylaxis or a transperineal biopsy approach. Needle disinfection, minimizing the number of biopsy needles and rectal disinfectants may also be of use. These methods may be of particular utility in patients with risk factors for developing urosepsis such as recent antibiotic use and overseas travel. Conclusions The scientific literature describes various techniques designed to reduce infective complications caused by prostate biopsy. Clinicians should consider incorporating these novel techniques into their contemporary practice.
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Affiliation(s)
- Liam Toner
- Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | - Damien M Bolton
- Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia.; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.; School of Cancer Medicine, La Trobe University, Melbourne, Australia
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Toner L, Papa N, Aliyu SH, Dev H, Lawrentschuk N, Al-Hayek S. Extended-spectrum beta-lactamase-producing Enterobacteriaceae in hospital urinary tract infections: incidence and antibiotic susceptibility profile over 9 years. World J Urol 2015; 34:1031-7. [DOI: 10.1007/s00345-015-1718-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/19/2015] [Indexed: 01/06/2023] Open
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Toner L, Weerakoon M, Bolton DM, Ryan A, Katelaris N, Lawrentschuk N. Magnetic resonance imaging for prostate cancer: Comparative studies including radical prostatectomy specimens and template transperineal biopsy. Prostate Int 2015; 3:107-14. [PMID: 26779455 PMCID: PMC4685231 DOI: 10.1016/j.prnil.2015.09.006] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/31/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose Multiparametric magnetic resonance imaging (mpMRI) is an emerging technique aiming to improve upon the diagnostic sensitivity of prostate biopsy. Because of variance in interpretation and application of techniques, results may vary. There is likely a learning curve to establish consistent reporting of mpMRI. This study aims to review current literature supporting the diagnostic utility of mpMRI when compared with radical prostatectomy (RP) and template transperineal biopsy (TTPB) specimens. Methods MEDLINE and PubMed database searches were conducted identifying relevant literature related to comparison of mpMRI with RP or TTPB histology. Results Data suggest that compared with RP and TTPB specimens, the sensitivity of mpMRI for prostate cancer (PCa) detection is 80–90% and the specificity for suspicious lesions is between 50% and 90%. Conclusions mpMRI has an increasing role for PCa diagnosis, staging, and directing management toward improving patient outcomes. Its sensitivity and specificity when compared with RP and TTPB specimens are less than what some expect, possibly reflecting a learning curve for the technique of mpMRI.
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Affiliation(s)
- Liam Toner
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia
| | - Mahesha Weerakoon
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia
| | - Damien M Bolton
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia
| | - Andrew Ryan
- Department of Pathology, TissuPath Specialist Pathology Services, Melbourne, Australia
| | - Nikolas Katelaris
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Urology Unit, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Katelaris NC, Bolton DM, Weerakoon M, Toner L, Katelaris PM, Lawrentschuk N. Current role of multiparametric magnetic resonance imaging in the management of prostate cancer. Korean J Urol 2015; 56:337-45. [PMID: 25964833 PMCID: PMC4426504 DOI: 10.4111/kju.2015.56.5.337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/06/2015] [Indexed: 01/04/2023] Open
Abstract
The purpose of this review was to evaluate the current role of multiparametric magnetic resonance imaging (mp-MRI) in the management of prostate cancer (PC). The diagnosis of PC remains controversial owing to overdetection of indolent disease, which leads to overtreatment and subsequent patient harm. mp-MRI has the potential to equilibrate the imbalance between detection and treatment. The limitation of the data for analysis with this new technology is problematic, however. This issue has been compounded by a paradigm shift in clinical practice aimed at utilizing this modality, which has been rolled out in an ad hoc fashion often with commercial motivation. Despite a growing body of literature, pertinent clinical questions remain. For example, can mp-MRI be calibrated to reliably detect biologically significant disease? As with any new technology, objective evaluation of the clinical applications of mp-MRI is essential. The focus of this review was on the evaluation of mp-MRI of the prostate with respect to clinical utility.
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Affiliation(s)
| | - Damien Michael Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Mahesha Weerakoon
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Liam Toner
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
| | | | - Nathan Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia. ; Olivia Newton-John Cancer Research Institute, Austin Hospital, Heidelberg, VIC, Australia. ; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Gomez A, Messam LLM, Toner L. Collaboration and research as key elements for strengthening blood donation in developing nations: the case of Grenada, West Indies. W INDIAN MED J 2013; 62:48-55. [PMID: 24171328] [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: 06/02/2023]
Abstract
OBJECTIVE The purpose of the study was to identify ways to strengthen the collaboration between the Grenadian Blood Bank, the St George's University (SGU) chapter of the American Medical Students Association, and St George's University Health Clinic in order to improve the promotion of blood drives and increase the number of volunteer donors. METHODS The study had two phases. Phase 1: an assessment of the strengths and needs of the collaborators and of the blood drives. Phase 2 consisted of three student assessments: a cross-sectional survey of second year medical students, a cross-sectional survey of students in the School of Arts and Sciences and a case-control study of factors affecting student donation on the day of blood drives. Embedded within both phases were service-learning opportunities for students. Both phases received approval from SGU's Institutional Review Board. RESULTS Preliminary achievements included a transient increase in blood donation of twenty per cent during five months though advertising of blood drives remains inadequate. Assessments reveal that most students lack knowledge about the drives, and time (medical students) and fear of needles and infection (Arts and Science students) are potential hindrances to blood donation. CONCLUSIONS The Blood Bank needs to increase its profile on the university campus and develop a more effective promotion of the blood drives addressing the concerns of students. St George's University needs to continue supporting student involvement in health promotion activities and identify ways to ensure the sustainability and continuity of these activities. Collaboration and research are useful and effective means to promote blood donation. College students are potentially an excellent source of collaborators and donors if provided with the promotion skills and participation is made convenient.
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Affiliation(s)
- A Gomez
- TransGlocal.org, Miami FL 33129, USA.
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Messam L, Gomez A, Toner L. SP4-19 Use of logistic regression and receiver operating characteristic curves to discriminate between blood donors and non-donors among North American medical students in Grenada, West Indies. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976p.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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