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Fahim C, Wiebe N, Nisenbaum R, Hamid JS, Ewusie JE, Tonelli M, Brauer P, Shaw E, Bell N, Stacey D, Holmes NM, Straus SE. Changes in mammography screening in Ontario and Alberta following national guideline dissemination: an interrupted time series analysis. F1000Res 2022; 10:1044. [PMID: 36544564 PMCID: PMC9745205 DOI: 10.12688/f1000research.55004.2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background: In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods: We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a release of a national breast screening guideline. Women aged 40 to 74 years living in Ontario or Alberta from 30th November 2008 to 30th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results: In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 women in Ontario and Alberta, respectively). In Ontario, mammography trends decreased following guideline release to align with recommendations for women aged 40 to 74 (decrease of 2.21/1000 women, SE 0.26/1000, p<0.0001). In Alberta, mammography trends decreased for women aged 40 to 49 years (3/1000 women, SE 0.32, p<0.001) and 50 to 69 (2.9/1000 women, SE 0.79, p<0.001), but did not change for women aged 70 to 74 (0.7/1000 women, SE 1.23, p=0.553). In both provinces, trends in mammography use rates were sustained for up to three years after guideline release. Conclusions: We observed a decrease in screening for women aged 40-49. Additional research to explore whether shared decision making was used to optimize guideline-concordant screening for women aged 50-74 is needed.
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Affiliation(s)
- Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1T8, Canada,
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Ontario, M5B 1T8, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada
| | - Jemila S. Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Joycelyne E. Ewusie
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, Hamilton, Ontario, L8N 4A6, Canada
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
| | - Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - Elizabeth Shaw
- Department of Family Medicine, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
| | - Neil Bell
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, T6G 2R3, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada,Ottawa Hospital Research Institute, Ottawa, Ontario, K1H 8L6, Canada
| | | | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1T8, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
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Delaney AJ, Crane JW, Holmes NM, Fam J, Westbrook RF. Baclofen acts in the central amygdala to reduce synaptic transmission and impair context fear conditioning. Sci Rep 2018; 8:9908. [PMID: 29967489 PMCID: PMC6028433 DOI: 10.1038/s41598-018-28321-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 03/04/2018] [Accepted: 06/15/2018] [Indexed: 12/14/2022] Open
Abstract
The two main sub-divisions of the Central amygdala (CeA), the lateral-capsular (CeA-LC) and the medial (CeA-M), contain extensive networks of inhibitory interneurons. We have previously shown that activation of GABAB-receptors reduces excitatory transmission between axons of the pontine parabrachial nucleus and neurons of the CeA-LC by inhibiting glutamate release from presynaptic terminals13. Here we have characterised GABAB-receptor activation on other excitatory and inhibitory projections within the CeA. Using whole-cell, patch-clamp recordings, we found that the GABAB-receptor agonist baclofen significantly reduced excitatory and inhibitory transmission from all tested inputs into the CeA-LC and CeA-M. In all but one of the inputs, reductions in transmission were accompanied by an increase in paired pulse ratio, indicating that presynaptic GABAB-receptors acted to reduce the release probability of synaptic vesicles. To examine the impact of GABAB-receptors in the CeA on contextual fear-conditioning, we infused baclofen into the CeA immediately prior to training. Compared to vehicle-infused rats, baclofen-infused rats displayed significantly less freezing both during the final stages of the training period and at test 24 hours later. The results of this study demonstrate that, by suppressing excitatory and inhibitory transmission, activation of presynaptic GABAB-receptors in the CeA inhibits the development of context conditioned fear.
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Affiliation(s)
- A J Delaney
- School of Biomedical Sciences, Charles Sturt University, Orange, NSW, 2800, Australia.
| | - J W Crane
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia
| | - N M Holmes
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - J Fam
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - R F Westbrook
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
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Holmes NM, Crane JW, Tang M, Fam J, Westbrook RF, Delaney AJ. α 2-adrenoceptor-mediated inhibition in the central amygdala blocks fear-conditioning. Sci Rep 2017; 7:11712. [PMID: 28916748 PMCID: PMC5601913 DOI: 10.1038/s41598-017-12115-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/25/2017] [Indexed: 11/16/2022] Open
Abstract
The central amygdala is critical for the acquisition and expression of fear memories. This region receives a dense innervation from brainstem noradrenergic cell groups and has a high level of α2-adrenoceptor expression. Using whole-cell electrophysiological recordings from rat brain slices, we characterise the role of pre-synaptic α2-adrenoceptor in modulating discrete inhibitory and excitatory connections within both the lateral and medial division of the central amygdala. The selective α2-adrenoceptor agonist clonidine blocked the excitatory input from the pontine parabrachial neurons onto neurons of the lateral central amygdala. In addition, clonidine blocked inhibitory connections from the medial paracapsular intercalated cell mass onto both lateral and medial central amygdala neurons. To examine the behavioural consequence of α2-adrenoceptor-mediated inhibition of these inputs, we infused clonidine into the central amygdala prior to contextual fear-conditioning. In contrast to vehicle-infused rats, clonidine-infused animals displayed reduced levels of freezing 24 hours after training, despite showing no difference in freezing during the training session. These results reveal a role for α2-adrenoceptors within the central amygdala in the modulation of synaptic transmission and the formation of fear-memories. In addition, they provide further evidence for a role of the central amygdala in fear-memory formation.
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Affiliation(s)
- N M Holmes
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - J W Crane
- School of Biomedical Sciences, Charles Sturt University, Orange, NSW, 2800, Australia
| | - M Tang
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - J Fam
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - R F Westbrook
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - A J Delaney
- School of Biomedical Sciences, Charles Sturt University, Orange, NSW, 2800, Australia.
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Abstract
PURPOSE Myelomeningocele is the most common congenital malformation of the central nervous system noted on prenatal ultrasound. Due to its significant postnatal sequelae, treatment in utero could potentially have a profound impact on the newborn. Others have reported fetal surgical techniques for in utero repair of myelomeningocele and its potential benefits on motor and neurological function. We report our urodynamic findings in the newborn after in utero repair of spina bifida in an effort to characterize postnatal bladder function. MATERIALS AND METHODS A retrospective review of the fetal surgery database at University of California San Francisco was performed identifying patients with a diagnosis of myelomeningocele. Prenatal surgical repair of myelomeningocele was considered if a normal karyotype was present, no other significant congenital anomalies were evident and gestational age was less than 24 weeks. The spinal defects were in the lumbar or lumbosacral region. All surgery was performed before 24 weeks of gestations. RESULTS Fetal surgery to correct myelomeningocele was performed in 6 patients. All patients were born premature at 32 weeks of gestation or less. Videourodynamics performed at age 1 month in 4 patients indicated decreased bladder capacity for weight, increased detrusor storage pressures and significant post-void residual. Hydronephrosis was demonstrated in 4 patients on renal/bladder ultrasound, and moderate vesicoureteral reflux was seen in 3. CONCLUSIONS Patients with spinal bifida treated in utero appear to have the same changes in urodynamic parameters and anatomical abnormalities in the urinary tract as other children with spinal defects who have undergone standard postnatal care. In utero treatment of spinal bifida may expose the newborn to the effects of prematurity. The long-term effects on bladder function in the fetus after in utero repair of myelomeningocele remain unknown. A randomized controlled trial is necessary to evaluate long-term bladder function as well as other outcome variables in this experimental approach to patients with myelomeningocele.
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Affiliation(s)
- N M Holmes
- Department of Urology, University of California San Francisco, San Francisco, California, USA
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Holmes NM, Baskin LS. Heterotopic bone formation in the urinary tract. J Urol 2001; 166:1859. [PMID: 11586247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- N M Holmes
- Department of Urology and Pediatrics, University of California San Francisco, San Francisco, California, USA
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Abstract
PURPOSE Previous studies have described placement of an artificial urinary sphincter and simultaneous augmentation cystoplasty with a segment of bowel. Conclusions from these studies indicated that infection rates were higher and a staged approach should be undertaken. Others have suggested that concurrent urinary reconstruction with stomach and sphincter placement can be performed safely. Results comparing infection rates of simultaneous sphincter placement and gastrocystoplasty versus staged sphincter placement and augmentation cystoplasty using a segment of ileum or stomach versus sphincter placement alone in a pediatric population have not been previously described to our knowledge. We reviewed these various groups of patients to determine if the difference in infectious complications were clinically and statistically significant. MATERIALS AND METHODS A retrospective review of medical records from 1986 to 1999 identified 28 pediatric patients (age 18 years or less) who had undergone placement of an AS800dagger artificial urinary sphincter. Data points were collected focusing on etiology of the neurogenic bladder, age at time of surgery, types of surgery performed, length of followup and complication rates. RESULTS Complete data were available for 27 of the 28 patients. Neurogenic bladder was secondary to myelomeningocele in 25 cases, transverse myelitis in 1 and spinal cord injury in 2. Mean patient age at surgery was 12.7 years (range 6.1 to 18.2) and mean followup was 4.3 years (range 1 month to 13 years). Simultaneous gastrocystoplasty was performed in 7 cases (group 1), staged sphincter placement followed by augmentation cystoplasty with a segment of ileum or stomach was done in 8 (group 2) and 12 did not require bladder augmentation (group 3). Urethral device erosion requiring explantation was the most common complication, occurring in 3 patients in group 1 and 2 in group 3 (p = 0.101). Mean time to erosion was 22.1 months (range 2 to 46.4). Previous surgery (bladder neck or hernia repair) was a common factor in each group with complications. Urine cultures and culture of the explanted device were positive in 2 patients in group 1. CONCLUSIONS Simultaneous placement of artificial urinary sphincter at the time of gastrocystoplasty can be performed in carefully selected patients, although those undergoing staged procedures did well without complications. Prior bladder neck surgery seems to be a significant risk for infection. A staged approach to lower urinary tract reconstruction would be more advantageous due to the absence of infection and erosion in those undergoing staged sphincter placement and augmentation cystoplasty.
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Affiliation(s)
- N M Holmes
- Division of Urology, Albany Medical College, Albany, New York, USA
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Abstract
PURPOSE Previous studies have described placement of an artificial urinary sphincter and simultaneous augmentation cystoplasty with a segment of bowel. Conclusions from these studies indicated that infection rates were higher and a staged approach should be undertaken. Others have suggested that concurrent urinary reconstruction with stomach and sphincter placement can be performed safely. Results comparing infection rates of simultaneous sphincter placement and gastrocystoplasty versus staged sphincter placement and augmentation cystoplasty using a segment of ileum or stomach versus sphincter placement alone in a pediatric population have not been previously described to our knowledge. We reviewed these various groups of patients to determine if the difference in infectious complications were clinically and statistically significant. MATERIALS AND METHODS A retrospective review of medical records from 1986 to 1999 identified 28 pediatric patients (age 18 years or less) who had undergone placement of an AS800dagger artificial urinary sphincter. Data points were collected focusing on etiology of the neurogenic bladder, age at time of surgery, types of surgery performed, length of followup and complication rates. RESULTS Complete data were available for 27 of the 28 patients. Neurogenic bladder was secondary to myelomeningocele in 25 cases, transverse myelitis in 1 and spinal cord injury in 2. Mean patient age at surgery was 12.7 years (range 6.1 to 18.2) and mean followup was 4.3 years (range 1 month to 13 years). Simultaneous gastrocystoplasty was performed in 7 cases (group 1), staged sphincter placement followed by augmentation cystoplasty with a segment of ileum or stomach was done in 8 (group 2) and 12 did not require bladder augmentation (group 3). Urethral device erosion requiring explantation was the most common complication, occurring in 3 patients in group 1 and 2 in group 3 (p = 0.101). Mean time to erosion was 22.1 months (range 2 to 46.4). Previous surgery (bladder neck or hernia repair) was a common factor in each group with complications. Urine cultures and culture of the explanted device were positive in 2 patients in group 1. CONCLUSIONS Simultaneous placement of artificial urinary sphincter at the time of gastrocystoplasty can be performed in carefully selected patients, although those undergoing staged procedures did well without complications. Prior bladder neck surgery seems to be a significant risk for infection. A staged approach to lower urinary tract reconstruction would be more advantageous due to the absence of infection and erosion in those undergoing staged sphincter placement and augmentation cystoplasty.
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Affiliation(s)
- N M Holmes
- Division of Urology, Albany Medical College, Albany, New York, USA
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Affiliation(s)
- B G Cilento
- Department of Urology, Naval Medical Center San Diego, CA, USA
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Holmes NM, Kane CJ. Testicular infarction associated with sickle cell disease. J Urol 1998; 160:130. [PMID: 9628625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- N M Holmes
- Department of Urology, Naval Medical Center San Diego, California 92134-5000, USA
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Holmes NM, McBroom S, Puckett ML, Kane CJ. Renal imaging with spiral CT scan: clinical applications. Tech Urol 1998; 3:202-8. [PMID: 9531103] [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: 02/07/2023]
Abstract
Spiral computed tomography (CT) is an imaging modality that utilizes the rapid acquisition of cross-sectional data that can be reconstructed in a number of useful ways. We briefly describe the technology of spiral CT and recent advancements that have made spiral CT feasible. The advantages over conventional CT and angiography are reviewed. Urologic clinical applications are discussed including: detection of a crossing vessel prior to endopyelotomy for ureteropelvic junction (UPJ) obstruction, evaluating renal vascular anomalies preoperatively, and assistance in preoperative planning prior to partial nephrectomy in benign and malignant disease. Spiral CT has numerous advantages over conventional CT and angiography, and will likely have a notable role in future renal imaging.
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Affiliation(s)
- N M Holmes
- Department of Urology, Naval Medical Center San Diego, California 92134-5000, USA
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Affiliation(s)
- N M Holmes
- Department of Urology, Naval Medical Center San Diego, CA 92134-5000
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