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Atrey A, Navacchia A, Ward SE, Rister D, Brillantes J, Stavrakis A, Khoshbin A. Does-dual mobility still offer improved stability in smaller cup sizes? A computer modelling comparison of stability with 22-mm versus 28-mm inner heads in dual-mobility versus single-bearing constructs. Hip Int 2024:11207000231220031. [PMID: 38372123 DOI: 10.1177/11207000231220031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
PURPOSE Dislocation remains 1 of the leading causes of revision after primary total hip arthroplasty (THA) and there is clear evidence the dual-mobility (DM) is used more frequently to minimise this. But in smaller cups, whether the use of DM with smaller 22-mm heads imparts any increased stability compared to standard bearing is unknown; especially when those smaller cups now allow for large single-bearing (SB) heads. METHODS 3 primary cup sizes (48 mm, 50 mm, 52 mm) were chosen a priori for modelling. Head sizes trialled for the standard bearing (SB) constructs group were 28-0 mm, 32-0 mm and 36-0 mm against neutral polyethylene liners. In the modular sub-hemispheric DM constructs the inner head sizes for the DM constructs were altered where appropriate (22-0 mm vs. 28-0 mm). Cup position, stem offset, and stem size were standardised. RESULTS Both DM constructs outperformed all SB constructs because of a statistically significant jump distance increase (p < 0.001). However, there was no difference in range of motion (ROM) or jump distances between the 22-mm and 28-mm DM inner heads.The ROM angle before impingement between the DM (with 22-mm or 28-mm heads) and SB (with different head sizes where appropriate) showed no statistically significant difference. However, DM constructs presented significantly larger jump distances than SB constructs for both provocative dislocation tests across all 3 cup sizes.Of interest, for 50-mm and 52-mm cup sizes (for which this particular DM construct design can accommodate both 22-mm and 28-mm inner heads), there were no differences in ROM or jump distance between 22-mm versus 28-mm inner heads. CONCLUSIONS In this computer-modelling study, DM constructs are advantageous over SB constructs for improving jump distances in clinically provocative positions, but not range of motion angles. Inner head diameter of DM has no effect on stability.
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Affiliation(s)
- Amit Atrey
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Sarah E Ward
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | - Alexandra Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Amir Khoshbin
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Hammond M, Law V, de Launay KQ, Cooper J, Togo E, Silveira K, MacKinnon D, Lo N, Ward SE, Chan SKW, Straus SE, Fahim C, Wong CL. Using implementation science to promote the use of the fascia iliaca blocks in hip fracture care. Can J Anaesth 2023:10.1007/s12630-023-02665-2. [PMID: 38085456 DOI: 10.1007/s12630-023-02665-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 02/15/2024] Open
Abstract
PURPOSE There is variable and suboptimal use of fascia iliaca compartment nerve blocks (FICBs) in hip fracture care. Our objective was to use an evidence-based and theory-informed implementation science approach to analyze barriers and facilitators to timely administration of FICB and select evidence-based interventions to enhance uptake. METHODS We conducted a qualitative study at a single centre using semistructured interviews and site observations. We interviewed 35 stakeholders including health care providers, managers, patients, and caregivers. We mapped barriers and facilitators to the Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR). We compared the rate and timeliness of FICB administration before and after evidence-based implementation strategies were applied. RESULTS The study identified 18 barriers and 11 facilitators within seven themes of influences of FICB use: interpersonal relationships between health care professionals; clinician knowledge and skills related to FICB; roles, responsibilities, and processes for delivering FICB; perceptions on using FICB for pain; patient and caregiver perceptions on using FICB for pain; communication of hip fracture care between departments; and resources for delivering FICBs. We mapped the behaviour change domains to eight implementation strategies: restructure the environment, create and distribute educational materials, prepare patients to be active participants, perform audits and give feedback, use local opinion leaders, use champions, train staff on FICB procedures, and mandate change. We observed an increase in the rates of FICBs administered (48% vs 65%) and a decrease in the median time to administration (1.63 vs 0.81 days). CONCLUSION Our study explains why FICBs are underused and shows that the TDF and CFIR provide a framework to identify barriers and facilitators to FICB implementation. The mapped implementation strategies can guide institutions to improve use of FICB in hip fracture care.
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Affiliation(s)
- Marjorie Hammond
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vivian Law
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Keelia Quinn de Launay
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Jeanette Cooper
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Elikem Togo
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Kyle Silveira
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - David MacKinnon
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Nick Lo
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sarah E Ward
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Stephen K W Chan
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Sharon E Straus
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Christine Fahim
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Camilla L Wong
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
- St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
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Lister JF, Chiulli D, Ward SE, Frazier E. A Veterans Affairs' perspective in response to Best Practice Model Subcommittee attribute statements for outpatient psychiatric pharmacists. Ment Health Clin 2022; 12:327-328. [DOI: 10.9740/mhc.2022.10.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jonathan F. Lister
- (Corresponding author) Clinical Pharmacist Practitioner – Mental Health, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee,
| | - Dana Chiulli
- Clinical Pharmacist Practitioner – Mental Health, VISN 6 Clinical Resource Hub, Flower Mound, Texas
| | - Sarah E. Ward
- Clinical Pharmacist Practitioner – Mental Health, Veterans Affairs Tennessee Valley Healthcare System, Chattanooga, Tennessee
| | - Erica Frazier
- Clinical Pharmacist Practitioner – Mental Health, William S. Middleton Veterans Affairs Medical Center, Madison, Wisconsin
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Abstract
AIMS In 2020, the COVID-19 pandemic meant that proceeding with elective surgery was restricted to minimize exposure on wards. In order to maintain throughput of elective cases, our hospital (St Michaels Hospital, Toronto, Canada) was forced to convert as many cases as possible to same-day procedures rather than overnight admission. In this retrospective analysis, we review the cases performed as same-day arthroplasty surgeries compared to the same period in the previous 12 months. METHODS We conducted a retrospective analysis of patients undergoing total hip and knee arthroplasties over a three-month period between October and December in 2019, and again in 2020, in the middle of the COVID-19 pandemic. Patient demographics, number of outpatient primary arthroplasty cases, length of stay for admissions, 30-day readmission, and complications were collated. RESULTS In total, 428 patient charts were reviewed for October to December of 2019 (n = 195) and 2020 (n = 233). Of those, total hip arthroplasties (THAs) comprised 60% and 58.8% for 2019 and 2020, respectively. Demographic data was comparable with no statistical difference for age, sex, contralateral joint arthroplasty, or BMI. American Society of Anesthesiologists grade I was more highly prevalent in the 2020 cohort (5.1-times increase; n = 13 vs n = 1). Degenerative disc disease and fibromyalgia were less significantly prevalent in the 2020 cohort. There was a significant increase in same day discharges for non-direct anterior approach THAs (two-times increase) and total knee arthroplasty (ten-times increase), with a reciprocal decrease in next day discharges. There were significantly fewer reported superficial wound infections in 2020 (5.6% vs 1.7%) and no significant differences in readmissions or emergency department visits (3.1% vs 3.0%). CONCLUSION The COVID-19 pandemic meant that hospitals and patients were hopeful to minimize the exposure to the wards, and minimize strain on the already taxed inpatient beds. With few positives during the COVID-19 crisis, the pandemic was the catalyst to speed up the outpatient arthroplasty programme that has resulted in our institution being more efficient, and with no increase in readmissions or early complications. Cite this article: Bone Jt Open 2021;2(7):545-551.
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Affiliation(s)
- Ahmed Cherry
- Orthopaedics, University of Toronto, Toronto, Ontario, Canada.,Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Spencer Montgomery
- Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopaedics, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Tasha Osborne
- Orthopaedics, St Michael's Hospital, Toronto, Ontario, Canada
| | - Amir Khoshbin
- Orthopaedics, University of Toronto, Toronto, Ontario, Canada.,Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Timothy Daniels
- Orthopaedics, University of Toronto, Toronto, Ontario, Canada.,Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Ward
- Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopaedics, St Michael's Hospital, Toronto, Ontario, Canada
| | - Amit Atrey
- Orthopaedics, St Michael's Hospital, Toronto, Ontario, Canada
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Nanziri C, Ario AR, Ntono V, Monje F, Aliddeki DM, Bainomugisha K, Kadobera D, Bulage L, Nsereko G, Kayiwa J, Nakiire L, Walwema R, Tusiime PK, Mabumba E, Makumbi I, Ocom F, Lamorde M, Kasule JN, Ward SE, Merrill RD. Ebola Virus Disease Preparedness Assessment and Risk Mapping in Uganda, August-September 2018. Health Secur 2020; 18:105-113. [PMID: 32324074 PMCID: PMC10838606 DOI: 10.1089/hs.2019.0118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Uganda's proximity to the tenth Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) presents a high risk of cross-border EVD transmission. Uganda conducted preparedness and risk-mapping activities to strengthen capacity to prevent EVD importation and spread from cross-border transmission. We adapted the World Health Organization (WHO) EVD Consolidated Preparedness Checklist to assess preparedness in 11 International Health Regulations domains at the district level, health facilities, and points of entry; the US Centers for Disease Control and Prevention (CDC) Border Health Capacity Discussion Guide to describe public health capacity; and the CDC Population Connectivity Across Borders tool kit to characterize movement and connectivity patterns. We identified 40 ground crossings (13 official, 27 unofficial), 80 health facilities, and more than 500 locations in 12 high-risk districts along the DRC border with increased connectivity to the EVD epicenter. The team also identified routes and congregation hubs, including origins and destinations for cross-border travelers to specified locations. Ten of the 12 districts scored less than 50% on the preparedness assessment. Using these results, Uganda developed a national EVD preparedness and response plan, including tailored interventions to enhance EVD surveillance, laboratory capacity, healthcare professional capacity, provision of supplies to priority locations, building treatment units in strategic locations, and enhancing EVD risk communication. We identified priority interventions to address risk of EVD importation and spread into Uganda. Lessons learned from this process will inform strategies to strengthen public health emergency systems in their response to public health events in similar settings.
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Affiliation(s)
- Carol Nanziri
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Alex Riolexus Ario
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Vivian Ntono
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Fred Monje
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Dativa Maria Aliddeki
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Kenneth Bainomugisha
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Daniel Kadobera
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Lilian Bulage
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Godfrey Nsereko
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Joshua Kayiwa
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Lydia Nakiire
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Richard Walwema
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Patrick K Tusiime
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Eldard Mabumba
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Issa Makumbi
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Felix Ocom
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Mohammed Lamorde
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Juliet Namugga Kasule
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah E Ward
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Rebecca D Merrill
- Carol Nanziri, MPH; Vivian Ntono, MPH; Fred Monje, MVPM; Dativa Maria Aliddeki, MPH; Kenneth Bainomugisha, MPH; and Godfrey Nsereko, MPH, are Epidemiologists; Daniel Kadobera, MSc, is Field Supervisor; and Lilian Bulage, MSc, is a Scientific Writer; all in the Field Epidemiology Track, Uganda Public Health Fellowship Program, Kampala, Uganda. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. Joshua Kayiwa, MSc, is an Information Analyst, and Issa Makumbi, MSc, is Director; both in the Public Health Emergency Operations Centre, Ministry of Health, Kampala. Lydia Nakiire, MPH, is an Epidemiologist; Richard Walwema, MBA, is Project Manager; and Mohammed Lamorde, PhD, is Head of Department; all in Global Health Security, Infectious Diseases Institute, Makerere University, Kampala. Patrick K. Tusiime, MPH, is Commissioner, and Eldard Mabumba, MPH, is Principal Medical Officer; both in National Disease Prevention and Control, Ministry of Health, Kampala. Felix Ocom, MPH, is an Epidemiologist, Health Emergencies Program, World Health Organization Country Office, Kampala. Juliet Namugga Kasule, MSc, is a Public Health Specialist, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala. Sarah E. Ward, MPH, is a Health Scientist, and Rebecca D. Merrill, PhD, is an Epidemiologist; both in the Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, GA
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6
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Ward SE, Holmes GR, Morgan JL, Broggio JW, Collins K, Richards PD, Reed MWR, Wyld L. Bridging the Age Gap: a prognostic model that predicts survival and aids in primary treatment decisions for older women with oestrogen receptor-positive early breast cancer. Br J Surg 2020; 107:1625-1632. [PMID: 32602959 DOI: 10.1002/bjs.11748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/28/2020] [Accepted: 05/03/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND A prognostic model was developed and validated using cancer registry data. This underpins an online decision support tool, informing primary treatment choice for women aged 70 years or older with hormone receptor-positive early breast cancer. METHODS Data from women diagnosed between 2002 and 2010 in the English Northern and Yorkshire and West Midlands regions were used to develop the model. Primary treatment options of surgery with adjuvant endocrine therapy or primary endocrine therapy were compared. Models predicting the hazard of breast cancer-specific mortality and hazard of other-cause mortality were combined to derive survival probabilities. The model was validated externally using data from the Eastern Cancer Registration and Information Centre. RESULTS The model was developed using data from 23 842 women, and validated externally on a data set from 14 526 patients. The overall model calibration was good. At 2 and 5 years, predicted mortality from breast cancer and other causes differed from the observed rate by less than 1 per cent. At 5 years, there were slight overpredictions in breast cancer mortality (2629 predicted versus 2556 observed deaths; P = 0·142) and mortality from all causes (6399 versus 6320 respectively; P = 0·583). The discrepancy varied between subgroups. Model discrimination was 0·75 or above for all mortality measures. CONCLUSION A prognostic model for older women with oestrogen receptor-positive early breast cancer was developed and validated in the present study. This forms a basis for an online decision support tool (https://agegap.shef.ac.uk/).
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Affiliation(s)
- S E Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, Sheffield
| | - G R Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, Sheffield
| | - J L Morgan
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield
| | - J W Broggio
- National Cancer Registration and Analysis Service, Public Heath England, Birmingham, UK.,Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield
| | - P D Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, Sheffield
| | - M W R Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - L Wyld
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield
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Malahias MA, Ma QL, Gu A, Ward SE, Alexiades MM, Sculco PK. Outcomes of Acetabular Reconstructions for the Management of Chronic Pelvic Discontinuity: A Systematic Review. J Arthroplasty 2020; 35:1145-1153.e2. [PMID: 31784362 DOI: 10.1016/j.arth.2019.10.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 09/05/2019] [Revised: 10/11/2019] [Accepted: 10/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A number of articles have been published reporting on the clinical outcomes of various acetabular reconstructions for the management of chronic pelvic discontinuity (PD). However, no systematic review of the literature has been published to date comparing the outcome and complications of different approaches to reconstruction. METHODS The US National Library of Medicine (PubMed/MEDLINE) and EMBASE were queried for publications from January 1980 to January 2019 using keywords pertinent to total hip arthroplasty, PD, acetabular dissociation, clinical or functional outcomes, and revision total hip arthroplasty or postoperative complications. RESULTS Overall, 18 articles were included in this analysis (569 cases with chronic PD). The overall survival rate of the acetabular components used for the treatment of chronic PD was 84.7% (482 of 569 cases) at mid-term follow-up, whereas the most common reasons for revision were aseptic loosening (54 of 569 hips; 9.5%), dislocations (45 of 569 hips; 7.9%), periprosthetic joint infection (30 of 569 hips; 5.3%), and periprosthetic fractures (11 of 569 hips; 1.9%). Both pelvic distraction technique (combined with highly porous shells) and custom triflanges resulted in less than 5% failure rates (96.2% and 95.8%, respectively) at final follow-up. Also, highly effective in the treatment of PD were cup-cages and highly porous shells with and/or without augments with 92% survivorship free of revision for aseptic loosening for both reconstruction methods. Inferior outcomes were reported for conventional cementless shells combined with acetabular plates (72.7%) as well as ilioischial cages and reconstruction rings (66.7% and 60.6% survivorship, respectively). CONCLUSION The current literature contains moderate quality evidence in support of the use of custom triflange implants and pelvic distraction techniques for the treatment of chronic PD, with a less than 5% all-cause revision rate and low complication rates at mean mid-term follow-up. Cup-cages and highly porous shells with or without augments could also be considered for the treatment of PD because both resulted in greater than 90% survival rates. Finally, there is still no consensus regarding the impact of different types of acetabular reconstruction methods on optimizing the healing potential of PD, and further studies are required in this area to better understand the influence of PD healing on construct survivorship and functional outcomes with each reconstruction method.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Qian-Li Ma
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY; Department of Orthopedic Surgery, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, Fujian, China
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Sarah E Ward
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael M Alexiades
- Department of Orthopaedics, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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8
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Aceng JR, Ario AR, Muruta AN, Makumbi I, Nanyunja M, Komakech I, Bakainaga AN, Talisuna AO, Mwesigye C, Mpairwe AM, Tusiime JB, Lali WZ, Katushabe E, Ocom F, Kaggwa M, Bongomin B, Kasule H, Mwoga JN, Sensasi B, Mwebembezi E, Katureebe C, Sentumbwe O, Nalwadda R, Mbaka P, Fatunmbi BS, Nakiire L, Lamorde M, Walwema R, Kambugu A, Nanyondo J, Okware S, Ahabwe PB, Nabukenya I, Kayiwa J, Wetaka MM, Kyazze S, Kwesiga B, Kadobera D, Bulage L, Nanziri C, Monje F, Aliddeki DM, Ntono V, Gonahasa D, Nabatanzi S, Nsereko G, Nakinsige A, Mabumba E, Lubwama B, Sekamatte M, Kibuule M, Muwanguzi D, Amone J, Upenytho GD, Driwale A, Seru M, Sebisubi F, Akello H, Kabanda R, Mutengeki DK, Bakyaita T, Serwanjja VN, Okwi R, Okiria J, Ainebyoona E, Opar BT, Mimbe D, Kyabaggu D, Ayebazibwe C, Sentumbwe J, Mwanja M, Ndumu DB, Bwogi J, Balinandi S, Nyakarahuka L, Tumusiime A, Kyondo J, Mulei S, Lutwama J, Kaleebu P, Kagirita A, Nabadda S, Oumo P, Lukwago R, Kasozi J, Masylukov O, Kyobe HB, Berdaga V, Lwanga M, Opio JC, Matseketse D, Eyul J, Oteba MO, Bukirwa H, Bulya N, Masiira B, Kihembo C, Ohuabunwo C, Antara SN, Owembabazi W, Okot PB, Okwera J, Amoros I, Kajja V, Mukunda BS, Sorela I, Adams G, Shoemaker T, Klena JD, Taboy CH, Ward SE, Merrill RD, Carter RJ, Harris JR, Banage F, Nsibambi T, Ojwang J, Kasule JN, Stowell DF, Brown VR, Zhu BP, Homsy J, Nelson LJ, Tusiime PK, Olaro C, Mwebesa HG, Woldemariam YT. Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019. Global Health 2020; 16:24. [PMID: 32192540 PMCID: PMC7081536 DOI: 10.1186/s12992-020-00548-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies.
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Affiliation(s)
| | - Alex R Ario
- Ministry of Health, Kampala, Uganda.
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda.
| | | | - Issa Makumbi
- Ministry of Health, Kampala, Uganda
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | | | | | | | | | | | | | | | - William Z Lali
- World Health Organisation, Country Office, Kampala, Uganda
| | | | - Felix Ocom
- World Health Organisation, Country Office, Kampala, Uganda
| | - Mugagga Kaggwa
- World Health Organisation, Country Office, Kampala, Uganda
| | - Bodo Bongomin
- World Health Organisation, Country Office, Kampala, Uganda
| | - Hafisa Kasule
- World Health Organisation, Country Office, Kampala, Uganda
| | - Joseph N Mwoga
- World Health Organisation, Country Office, Kampala, Uganda
| | | | | | | | | | - Rita Nalwadda
- World Health Organisation, Country Office, Kampala, Uganda
| | - Paul Mbaka
- World Health Organisation, Country Office, Kampala, Uganda
| | | | | | | | | | | | | | - Solome Okware
- Ministry of Health, Kampala, Uganda
- Infectious Disease Institute, Kampala, Uganda
| | | | - Immaculate Nabukenya
- Ministry of Health, Kampala, Uganda
- Infectious Disease Institute, Kampala, Uganda
| | - Joshua Kayiwa
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Milton M Wetaka
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Simon Kyazze
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
- African Field Epidemiology Network, Kampala, Uganda
| | - Carol Nanziri
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Fred Monje
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Dativa M Aliddeki
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Vivian Ntono
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Doreen Gonahasa
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Sandra Nabatanzi
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Godfrey Nsereko
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | | | | | | | | | | | | | | | | | | | | | | | - Harriet Akello
- Ministry of Health, Kampala, Uganda
- Management Sciences for Health, Kampala, Uganda
| | | | | | | | | | | | | | | | | | - Derrick Mimbe
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Denis Kyabaggu
- East African Public Health Laboratory Network, Kampala, Uganda
| | | | - Juliet Sentumbwe
- Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | - Moses Mwanja
- Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | - Deo B Ndumu
- Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | | | | | | | | | | | - Sophia Mulei
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Atek Kagirita
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Susan Nabadda
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Peter Oumo
- Ministry of Internal Affairs, Uganda Police Force, Kampala, Uganda
| | - Robinah Lukwago
- Department for International Development, UKAID, Kampala, Uganda
| | - Julius Kasozi
- United Nations High Commissioner for Refugees, Kampala, Uganda
| | | | | | | | | | - Joe C Opio
- United Nations Children's Fund, Kampala, Uganda
| | | | - James Eyul
- Civil Aviation Authority, Entebbe, Uganda
| | | | | | - Nulu Bulya
- African Field Epidemiology Network, Kampala, Uganda
| | - Ben Masiira
- African Field Epidemiology Network, Kampala, Uganda
| | | | | | | | | | | | | | | | - Victoria Kajja
- Intenational Organisation for Migration, Kampala, Uganda
| | | | - Isabel Sorela
- Intenational Organisation for Migration, Kampala, Uganda
| | - Gregory Adams
- United States Agency for International Development, Kampala, Uganda
| | - Trevor Shoemaker
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John D Klena
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Celine H Taboy
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah E Ward
- Division of Global Migration and Quarantine, Global Border Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca D Merrill
- Division of Global Migration and Quarantine, Global Border Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rosalind J Carter
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie R Harris
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Flora Banage
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Thomas Nsibambi
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Joseph Ojwang
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Juliet N Kasule
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Dan F Stowell
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Vance R Brown
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Jaco Homsy
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Lisa J Nelson
- US Centers for Disease Control and Prevention, Kampala, Uganda
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Borges FK, Bhandari M, Guerra-Farfan E, Patel A, Sigamani A, Umer M, Tiboni ME, Villar-Casares MDM, Tandon V, Tomas-Hernandez J, Teixidor-Serra J, Avram VRA, Winemaker M, Ramokgopa MT, Szczeklik W, Landoni G, Wang CY, Begum D, Neary JD, Adili A, Sancheti PK, Lawendy AR, Balaguer-Castro M, Ślęczka P, Jenkinson RJ, Nur AN, Wood GCA, Feibel RJ, McMahon SJ, Sigamani A, Popova E, Biccard BM, Moppett IK, Forget P, Landais P, McGillion MH, Vincent J, Balasubramanian K, Harvey V, Garcia-Sanchez Y, Pettit SM, Gauthier LP, Guyatt GH, Conen D, Garg AX, Bangdiwala SI, Belley-Cote EP, Marcucci M, Lamy A, Whitlock R, Le Manach Y, Fergusson DA, Yusuf S, Devereaux PJ, Veevaete L, le Polain de Waroux B, Lavand'homme P, Cornu O, Tribak K, Yombi JC, Touil N, Reul M, Bhutia JT, Clinckaert C, De Clippeleir D, Reul M, Patel A, Tandon V, Gauthier LP, Avram VRA, Winemaker M, de Beer J, Simpson DL, Worster A, Alvarado KA, Gregus KK, Lawrence KH, Leong DP, Joseph PG, Magloire P, Deheshi B, Bisland S, Wood TJ, Tushinski DM, Wilson DAJ, Kearon C, Le Manach Y, Adili A, Tiboni ME, Neary JD, Cowan DD, Khanna V, Zaki A, Farrell JC, MacDonald AM, Conen D, Wong SCW, Karbassi A, Wright DS, Shanthanna H, Coughlin R, Khan M, Wikkerink S, Quraishi FA, Lawendy AR, Kishta W, Schemitsch E, Carey T, Macleod MD, Sanders DW, Vasarhelyi E, Bartley D, Dresser GK, Tieszer C, Jenkinson RJ, Shadowitz S, Lee JS, Choi S, Kreder HJ, Nousiainen M, Kunz MR, Tuazon R, Shrikumar M, Ravi B, Wasserstein D, Stephen DJG, Nam D, Henry PDG, Wood GCA, Mann SM, Jaeger MT, Sivilotti MLA, Smith CA, Frank CC, Grant H, Ploeg L, Yach JD, Harrison MM, Campbell AR, Bicknell RT, Bardana DD, Feibel RJ, McIlquham K, Gallant C, Halman S, Thiruganasambandamoorth V, Ruggiero S, Hadden WJ, Chen BPJ, Coupal SA, McMahon SJ, McLean LM, Shirali HR, Haider SY, Smith CA, Watts E, Santone DJ, Koo K, Yee AJ, Oyenubi AN, Nauth A, Schemitsch EH, Daniels TR, Ward SE, Hall JA, Ahn H, Whelan DB, Atrey A, Khoshbin A, Puskas D, Droll K, Cullinan C, Payendeh J, Lefrancois T, Mozzon L, Marion T, Jacka MJ, Greene J, Menon M, Stiegelmahr R, Dillane D, Irwin M, Beaupre L, Coles CP, Trask K, MacDonald S, Trenholm JAI, Oxner W, Richardson CG, Dehghan N, Sadoughi M, Sharma A, White NJ, Olivieri L, Hunt SB, Turgeon TR, Bohm ER, Tran S, Giilck SM, Hupel T, Guy P, O'Brien PJ, Duncan AW, Crawford GA, Zhou J, Zhao Y, Liu Y, Shan L, Wu A, Muñoz JM, Chaudier P, Douplat M, Fessy MH, Piriou V, Louboutin L, David JS, Friggeri A, Beroud S, Fayet JM, Landais P, Leung FKL, Fang CX, Yee DKH, Sancheti PK, Pradhan CV, Patil AA, Puram CP, Borate MP, Kudrimoti KB, Adhye BA, Dongre HV, John B, Abraham V, Pandey RA, Rajkumar A, George PE, Sigamani A, Stephen M, Chandran N, Ashraf M, Georgekutty AM, Sulthan AS, Adinarayanan S, Sharma D, Barnawal SP, Swaminathan S, Bidkar PU, Mishra SK, Menon J, M N, K VZ, Hiremath SA, NC M, Jawali A, Gnanadurai KR, George CE, Maddipati T, KP MKP, Sharma V, Farooque K, Malhotra R, Mittal S, Sawhney C, Gupta B, Mathur P, Gamangati S, Tripathy V, Menon PH, Dhillon MS, Chouhan DK, Patil S, Narayan R, Lal P, Bilchod PN, Singh SU, Gattu UV, Dashputra RP, Rahate PV, Turiel M, De Blasio G, Accetta R, Perazzo P, Stella D, Bonadies M, Colombo C, Fozzato S, Pino F, Morelli I, Colnaghi E, Salini V, Denaro G, Beretta L, Placella G, Giardina G, Binda M, Marcato A, Guzzetti L, Piccirillo F, Cecconi M, Khor HM, Lai HY, Kumar CS, Chee KH, Loh PS, Tan KM, Singh S, Foo LL, Prakasam K, Chaw SH, Lee ML, Ngim JHL, Boon HW, Chin II, Kleinlugtenbelt YV, Landman EBM, Flikweert ER, Roerdink HW, Brokelman RB, Elskamp-Meijerman HF, Horst MR, Cobben JHMG, Umer M, Begum D, Anjum A, Hashmi PM, Ahmed T, Rashid HU, Khattak MJ, Rashid RH, Lakdawala RH, Noordin S, Juman NM, Khan RI, Riaz MM, Bokhari SS, Almas A, Wahab H, Ali A, Khan HN, Khan EK, Nur AN, Janjua KA, Orakzai SH, Khan AS, Mustafa KJ, Sohail MA, Umar M, Khan SA, Ashraf M, Khan MK, Shiraz M, Furgan A, Ślęczka P, Dąbek P, Kumoń A, Satora W, Ambroży W, Święch M, Rycombel J, Grzelak A, Gucwa J, Machala W, Ramokgopa MT, Firth GB, Karera M, Fourtounas M, Singh V, Biscardi A, Iqbal MN, Campbell RJ, Maluleke ML, Moller C, Nhlapo L, Maqungo S, Flint M, Nejthardt MB, Chetty S, Naidoo R, Guerra-Farfan E, Tomas-Hernandez J, Garcia-Sanchez Y, Garrido Clua M, Molero-Garcia V, Minguell-Monyart J, Teixidor-Serra J, Villar-Casares MDM, Selga Marsa J, Porcel-Vazquez JA, Andres-Peiro JV, Aguilar M, Mestre-Torres J, Colomina MJ, Guilabert P, Paños Gozalo ML, Abarca L, Martin N, Usua G, Martinez-Ripol P, Gonzalez Posada MA, Lalueza-Broto P, Sanchez-Raya J, Nuñez Camarena J, Fraguas-Castany A, Balaguer-Castro M, Torner P, Jornet-Gibert M, Serrano-Sanz J, Cámara-Cabrera J, Salomó-Domènech M, Yela-Verdú C, Peig-Font A, Ricol L, Carreras-Castañer A, Martínez-Sañudo L, Herranz S, Feijoo-Massó C, Sianes-Gallén M, Castillón P, Bernaus M, Quintas S, Gómez O, Salvador J, Abarca J, Estrada C, Novellas M, Torra M, Dealbert A, Macho O, Ivanov A, Valldosera E, Arroyo M, Pey B, Yuste A, Mateo L, De Caso J, Anaya R, Higa-Sansone JL, Millan A, Baños V, Herrera-Mateo S, Aguado HJ, Martinez-Municio G, León R, Santiago-Maniega S, Zabalza A, Labrador G, Guerado E, Cruz E, Cano JR, Bogallo JM, Sa-ngasoongsong P, Kulachote N, Sirisreetreerux N, Pengrung N, Chalacheewa T, Arnuntasupakul V, Yingchoncharoen T, Naratreekoon B, Kadry MA, Thayaparan S, Abdlaziz I, Aframian A, Imbuldeniya A, Bentoumi S, Omran S, Vizcaychipi MP, Correia P, Patil S, Haire K, Mayor ASE, Dillingham S, Nicholson L, Elnaggar M, John J, Nanjayan SK, Parker MJ, O'Sullivan S, Marmor MT, Matityahu A, McClellan RT, Comstock C, Ding A, Toogood P, Slobogean G, Joseph K, O'Toole R, Sciadini M, Ryan SP, Clark ME, Cassidy C, Balonov K, Bergese SD, Phieffer LS, Gonzalez Zacarias AA, Marcantonio AJ, Devereaux PJ, Bhandari M, Borges FK, Balasubramanian K, Bangdiwala SI, Harvey V, McGillion MH, Pettit SM, Vincent J, Vincent J, Harvey V, Dragic-Taylor S, Maxwell C, Molnar S, Pettit SM, Wells JR, Forget P, Borges FK, Landais P, Sigamani A, Landoni G, Wang CY, Szczeklik W, Biccard BM, Popova E, Moppett IK, Lamy A, Whitlock R, Ofori SN, Yang SS, Wang MK, Duceppe E, Spence J, Vasquez JP, Marcano-Fernández F, Conen D, Ham H, Tiboni ME, Prada C, Yung TCH, Sanz Pérez I, Neary JD, Bosch MJ, Prystajecky MR, Chowdhury C, Khan JS, Belley-Cote EP, Stella SF, Marcucci M, Heidary B, Tran A, Wawrzycka-Adamczyk K, Chen YCP, Tandon V, González-Osuna A, Patel A, Biedroń G, Wludarczyk A, Lefebvre M, Ernst JA, Staffhorst B, Woodfine JD, Alwafi EM, Mrkobrada M, Parlow S, Roberts R, McAlister F, Sackett D, Wright J. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet 2020; 395:698-708. [PMID: 32050090 DOI: 10.1016/s0140-6736(20)30058-1] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. METHODS HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). FINDINGS Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4-9) in the accelerated-surgery group and 24 h (10-42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (-1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (-2 to 4; p=0·71). INTERPRETATION Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. FUNDING Canadian Institutes of Health Research.
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Ross TD, Dvorani E, Saskin R, Khoshbin A, Atrey A, Ward SE. Temporal Trends and Predictors of Thirty-Day Readmissions and Emergency Department Visits Following Total Knee Arthroplasty in Ontario Between 2003 and 2016. J Arthroplasty 2020; 35:364-370. [PMID: 31732370 DOI: 10.1016/j.arth.2019.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is the second most common surgery performed in Canada. Understanding and improving quality metrics associated with such high-volume procedures is of utmost importance to maximize value within the healthcare system, which is a balance between cost and quality. Although rates and predictors of hospital readmission and emergency department (ED) visits following TKA have previously been described in privatized healthcare settings, few studies have evaluated trends in length of stay (LOS), hospital readmissions, and ED visits following TKA in a universal single-payer system. METHODS Using data from a provincially held and validated registry, the Institute for Clinical and Evaluative Sciences, we undertook a review of all 205,152 TKAs performed in the province of Ontario, Canada, between 2003 and 2016. We determined temporal trends in utilization, LOS, readmissions, and ED visits and evaluated patient and provider predictors of hospital readmissions and ED visits using multivariate logistic regression modeling. We also grouped and described the most common reasons for readmission and ED visits based on the available International Classification of Diseases, Ninth Revision and Tenth Revision coding information. RESULTS LOS decreased significantly over the study period (P < .0001), from a median of 5 days (10th percentile 3 days, 90th percentile 8 days) in 2003 to a median of 3 days (10th percentile 2 days, 90th percentile 4 days) in 2016. All-cause 30-day readmissions did not change significantly over the study period, but the rate of ED visits increased significantly over time. Predictors of 30-day readmission following TKA included older age, male gender, lower income quartile, not having a postoperative visit with a primary care physician (PCP), increased comorbidities, longer LOS, urgent or revision surgery, admission to a teaching hospital, and discharge to an inpatient rehabilitation facility. Variables that predicted increased odds of an ED visit included older age, male gender, lower income quartile, not having a postop visit with a PCP, increasing comorbidities, year of surgery, longer LOS, and revision surgery. Admission to a teaching hospital and discharge to an inpatient rehabilitation facility showed a trend toward increased odds of an ED visit. CONCLUSIONS We identified a significant increase in ED visits following TKA in Ontario between 2003 and 2016, with no corresponding increase in hospital readmissions despite a significant temporal trend toward shorter LOS. Predictors of ED visits and readmissions were similar, including male gender, lower income, higher comorbidities, and lacking a PCP visit postoperatively. Increased rates of ED visits following TKA in Ontario represent a quality problem, as they are associated with increased cost to the public healthcare system without any substantial benefit. Interventions aimed at redirecting patients from the ED for minor postoperative concerns should be investigated, as this is likely to improve care by reducing costs, improving efficiency, and enhancing patient experience.
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Affiliation(s)
- Tayler D Ross
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Erind Dvorani
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amit Atrey
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Ward
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Wolfstadt JI, Wayment L, Koyle MA, Backstein DJ, Ward SE. The Development of a Standardized Pathway for Outpatient Ambulatory Fracture Surgery: To Admit or Not to Admit. J Bone Joint Surg Am 2020; 102:110-118. [PMID: 31644523 DOI: 10.2106/jbjs.19.00634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/01/2023]
Abstract
BACKGROUND Increased scrutiny of health-care costs and inpatient length of stay has resulted in many orthopaedic procedures transitioning to outpatient settings. Recent studies have supported the safety and efficiency of outpatient fracture procedures. The aim of the present study was to reduce unnecessary inpatient hospitalizations for healthy patients awaiting surgical treatment of a fracture by 80% by June 30, 2017, with a focus on timely, efficient, and patient-centered care. METHODS The study design was a time series using statistical process control methodology. Baseline data from October 2014 to June 2016 were compared with the intervention period from July 2016 to December 2018. The Model for Improvement was used as the framework for developing and implementing interventions. The main interventions were a policy change to allow booking of outpatient urgent-room cases, education for patients and nurses, and the development of a standardized outpatient pathway. RESULTS One hundred and eighty-seven patients during the pre-intervention period and 308 patients during the intervention period were eligible for the ambulatory pathway. The percentage of patients managed as outpatients increased from 1.6% pre-intervention to 89.1% post-intervention. The length of stay was reduced from 2.8 to 0.2 days, a decrease of 94.0%. Patient satisfaction remained high, and there were no safety concerns while patients waited at home for the surgical procedure. CONCLUSIONS The outpatient fracture pathway vastly improved the efficiency and timeliness of care and reduced health-care costs. A patient-centered culture and support from hospital administration were integral in producing sustainable improvement. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jesse I Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Wayment
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David J Backstein
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Ward
- Division of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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12
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Nakiire L, Mwanja H, Pillai SK, Gasanani J, Ntungire D, Nsabiyumva S, Mafigiri R, Muneza N, Ward SE, Daffe Z, Ahabwe PB, Kyazze S, Ojwang J, Homsy J, Mclntyre E, Lamorde M, Walwema R, Makumbi I, Muruta A, Merrill RD. Population Movement Patterns Among the Democratic Republic of the Congo, Rwanda, and Uganda During an Outbreak of Ebola Virus Disease: Results from Community Engagement in Two Districts - Uganda, March 2019. MMWR Morb Mortal Wkly Rep 2020; 69:10-13. [PMID: 31917781 PMCID: PMC6973344 DOI: 10.15585/mmwr.mm6901a3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Hannick JH, O'Kelly F, Wolfstadt JI, Ward SE, Koyle MA. Improving care in pediatric urology-A primer on quality improvement methodology and how to apply it to pediatric urology. J Pediatr Urol 2019; 15:503-512. [PMID: 31648888 DOI: 10.1016/j.jpurol.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/12/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Jessica H Hannick
- Division of Pediatric Urology, UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA; Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Fardod O'Kelly
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jesse Isaac Wolfstadt
- Granovsky Gluskin Division of Orthopedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sarah E Ward
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Orthopedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Ward SE, Holmes GR, Ring A, Richards PD, Morgan JL, Broggio JW, Collins K, Reed MWR, Wyld L. Adjuvant Chemotherapy for Breast Cancer in Older Women: An Analysis of Retrospective English Cancer Registration Data. Clin Oncol (R Coll Radiol) 2019; 31:444-452. [PMID: 31122807 DOI: 10.1016/j.clon.2019.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/28/2018] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 10/26/2022]
Abstract
AIMS Adjuvant chemotherapy is recommended as a treatment for women with high recurrence risk early breast cancer. Older women are less likely to receive chemotherapy than younger women. This study investigated the impact of chemotherapy on breast cancer-specific survival in women aged 70 + years using English registry data. MATERIALS AND METHODS Cancer registration data were obtained from two English regions from 2002 to 2012 (n = 29 728). The impact of patient-level characteristics on the probability of receiving adjuvant chemotherapy was explored using logistic regression. Survival modelling was undertaken to show the effect of chemotherapy and age/health status on breast cancer-specific survival. Missing data were handled using multiple imputation. RESULTS In total, 11 735 surgically treated early breast cancer patients were identified. Use of adjuvant chemotherapy has increased over time. Younger age at diagnosis, increased nodal involvement, tumour size and grade, oestrogen receptor-negative or human epidermal growth factor receptor 2-positive disease were all associated with increased probability of receiving chemotherapy. Chemotherapy was associated with a significant reduction in the hazard of breast cancer-specific mortality in women with high risk cancer, after adjusting for patient-level characteristics (hazard ratio 0.74, 95% confidence interval 0.67-0.81). DISCUSSION Chemotherapy is associated with an improved breast cancer-specific survival in older women with early breast cancer at high risk of recurrence . Lower rates of chemotherapy use in older women may, therefore, contribute to inferior cancer outcomes. Decisions on potential benefits for individual patients should be made on the basis of life expectancy, treatment tolerance and patient preference.
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Affiliation(s)
- S E Ward
- Department of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - G R Holmes
- Department of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Ring
- Breast Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - P D Richards
- Department of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J L Morgan
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - J W Broggio
- National Cancer Registration and Analysis Service, Public Heath England, Birmingham, UK; Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - K Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - L Wyld
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
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Wolfstadt JI, Soong C, Ward SE. Improving patient outcomes following total joint arthroplasty: is there an app for that? BMJ Qual Saf 2019; 28:775-777. [PMID: 31110141 DOI: 10.1136/bmjqs-2019-009571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Jesse I Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada .,Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | | | - Sarah E Ward
- Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Department of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
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Pavenski K, Ward SE, Hare GMT, Freedman J, Pulendrarajah R, Pirani RA, Sheppard N, Vance C, White A, Lo N, Waddell JP, Ho A, Schemitsch EH, Kataoka M, Bogoch ER, Saini K, David Mazer C, Baker JE. A rationale for universal tranexamic acid in major joint arthroplasty: overall efficacy and impact of risk factors for transfusion. Transfusion 2018; 59:207-216. [PMID: 30383292 DOI: 10.1111/trf.14995] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Tranexamic acid (TXA) therapy is effective in reducing postoperative red blood cell (RBC) transfusion in total joint arthroplasty (TJA), yet uncertainty persists regarding comparative efficacy and safety among specific patient subgroups. We assessed the impact of a universal TXA protocol on RBC transfusion, postoperative hemoglobin (Hb), and adverse outcomes to determine whether TXA is safe and effective in TJA, both overall and in clinically relevant subgroups. STUDY DESIGN AND METHODS A retrospective observational study was performed on patients undergoing TJA at our institution spanning 1 year before and after the implementation of a universal protocol to administer intravenous (IV) TXA. The primary outcome was percentage of patients transfused, and secondary outcomes were perioperative Hb and occurrence of adverse events (death, myocardial infarction, stroke, seizure, pulmonary embolism, deep vein thrombosis, and acute kidney injury ). Outcomes were compared in pre- and post-protocol groups with χ2 analysis. Logistic regression compared risk of transfusion in pre- and post-protocol subgroups of patients with differing risk for transfusion (anemia, body mass index [BMI], and sex). RESULTS No differences were found in baseline patient characteristics across pre- and post-protocol groups (n = 1084 and 912, respectively). TXA use increased from 32.3% to 92.2% while transfusion rates decreased from 10.3% to 4.8% (p < 0.001). Postoperative Day 3 Hb increased from 95.8 to 101.4 g/L (p < 0.001). Logistic regression demonstrated reduced transfusion in post-protocol subgroups regardless of sex, anemia, or BMI (p < 0.001). No increase in adverse events was observed (p = 0.8451). CONCLUSIONS Universal TXA was associated with a reduction of RBC transfusion, overall and in clinically relevant subgroups, strengthening the rationale for universal therapy.
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Affiliation(s)
- Katerina Pavenski
- Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, Ontario, Canada
| | - Sarah E Ward
- Division of Orthopedics, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gregory M T Hare
- St. Michael's Hospital Centre of Excellence for Patient Blood Management, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John Freedman
- Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Ontario Transfusion Coordinators (ONTraC), Toronto, Ontario, Canada
| | - Robisa Pulendrarajah
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Razak A Pirani
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Sheppard
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Colm Vance
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alexander White
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nick Lo
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James P Waddell
- Division of Orthopedics, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alex Ho
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Emil H Schemitsch
- Division of Orthopedics, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark Kataoka
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Earl R Bogoch
- Division of Orthopedics, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kiran Saini
- Department of Pharmacy, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - James E Baker
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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17
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Wolfstadt JI, Ward SE, Kim S, Bell CM. Improving Care in Orthopaedics: How to Incorporate Quality Improvement Techniques into Surgical Practice. J Bone Joint Surg Am 2018; 100:1791-1799. [PMID: 30334891 DOI: 10.2106/jbjs.18.00225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/01/2023]
Affiliation(s)
- Jesse Isaac Wolfstadt
- Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Ward
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Scott Kim
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Chaim M Bell
- Department of Medicine and Centre for Quality Improvement and Patient Safety, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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18
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Affiliation(s)
- Sarah E. Ward
- Institute of Ecology and Evolution 335 Pacific Hall, 5289 University of Oregon Eugene Oregon 97403 USA
| | - Mark Schulze
- H.J. Andrews Experimental Forest P.O. Box 300, 91991 Blue River Reservoir Road Blue River Oregon 97413 USA
| | - Bitty Roy
- Institute of Ecology and Evolution 335 Pacific Hall, 5289 University of Oregon Eugene Oregon 97403 USA
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19
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Burns J, Polus S, Brereton L, Chilcott J, Ward SE, Pfadenhauer LM, Rehfuess EA. Looking beyond the forest: Using harvest plots, gap analysis, and expert consultations to assess effectiveness, engage stakeholders, and inform policy. Res Synth Methods 2017; 9:132-140. [PMID: 29106058 DOI: 10.1002/jrsm.1284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 04/27/2017] [Revised: 10/04/2017] [Accepted: 10/23/2017] [Indexed: 11/09/2022]
Abstract
We describe a combination of methods for assessing the effectiveness of complex interventions, especially where substantial heterogeneity with regard to the population, intervention, comparison, outcomes, and study design of interest is expected. We applied these methods in a recent systematic review of the effectiveness of reinforced home-based palliative care (rHBPC) interventions, which included home-based care with an additional and explicit component of lay caregiver support. We first summarized the identified evidence, deemed inappropriate for statistical pooling, graphically by creating harvest plots. Although very useful as a tool for summary and presentation of overall effectiveness, such graphical summary approaches may obscure relevant differences between studies. Thus, we then used a gap analysis and conducted expert consultations to look beyond the aggregate level at how the identified evidence of effectiveness may be explained. The goal of these supplemental methods was to step outside of the conventional systematic review and explore this heterogeneity from a broader perspective, based on the experience of palliative care researchers and practitioners. The gap analysis and expert consultations provided valuable input into possible underlying explanations in the evidence, which could be helpful in the further adaptation and testing of existing rHBPC interventions or the development and evaluation of new ones. We feel that such a combination of methods could prove accessible, understandable, and useful in informing decisions and could thus help increase the relevance of systematic reviews to the decision-making process.
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Affiliation(s)
- J Burns
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - S Polus
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - L Brereton
- The School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.,College of Health and Social Sciences, University of Lincoln, Lincoln, UK
| | - J Chilcott
- The School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - S E Ward
- The School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - L M Pfadenhauer
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - E A Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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20
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O'Sullivan JM, Aguila S, McRae E, Ward SE, Rawley O, Fallon PG, Brophy TM, Preston RJS, Brady L, Sheils O, Chion A, O'Donnell JS. N-linked glycan truncation causes enhanced clearance of plasma-derived von Willebrand factor. J Thromb Haemost 2016; 14:2446-2457. [PMID: 27732771 DOI: 10.1111/jth.13537] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 04/21/2016] [Indexed: 12/31/2022]
Abstract
Essentials von Willebrands factor (VWF) glycosylation plays a key role in modulating in vivo clearance. VWF glycoforms were used to examine the role of specific glycan moieties in regulating clearance. Reduction in sialylation resulted in enhanced VWF clearance through asialoglycoprotein receptor. Progressive VWF N-linked glycan trimming resulted in increased macrophage-mediated clearance. Click to hear Dr Denis discuss clearance of von Willebrand factor in a free presentation from the ISTH Academy SUMMARY: Background Enhanced von Willebrand factor (VWF) clearance is important in the etiology of both type 1 and type 2 von Willebrand disease (VWD). In addition, previous studies have demonstrated that VWF glycans play a key role in regulating in vivo clearance. However, the molecular mechanisms underlying VWF clearance remain poorly understood. Objective To define the molecular mechanisms through which VWF N-linked glycan structures influence in vivo clearance. Methods By use of a series of exoglycosidases, different plasma-derived VWF (pd-VWF) glycoforms were generated. In vivo clearance of these glycoforms was then assessed in VWF-/- mice in the presence or absence of inhibitors of asialoglycoprotein receptor (ASGPR), or following clodronate-induced macrophage depletion. Results Reduced amounts of N-linked and O-linked sialylation resulted in enhanced pd-VWF clearance modulated via ASGPR. In addition to this role of terminal sialylation, we further observed that progressive N-linked glycan trimming also resulted in markedly enhanced VWF clearance. Furthermore, these additional N-linked glycan effects on clearance were ASGPR-independent, and instead involved enhanced macrophage clearance that was mediated, at least in part, through LDL receptor-related protein 1. Conclusion The carbohydrate determinants expressed on VWF regulate susceptibility to proteolysis by ADAMTS-13. In addition, our findings now further demonstrate that non-sialic acid carbohydrate determinants expressed on VWF also play an unexpectedly important role in modulating in vivo clearance through both hepatic ASGPR-dependent and macrophage-dependent pathways. In addition, these data further support the hypothesis that variation in VWF glycosylation may be important in the pathophysiology underlying type 1C VWD.
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Affiliation(s)
- J M O'Sullivan
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - S Aguila
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - E McRae
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - S E Ward
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - O Rawley
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - P G Fallon
- Inflammation and Immunity Research Group, Institute of Molecular Medicine, St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - T M Brophy
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - R J S Preston
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
- National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - L Brady
- Department of Histopathology, Sir Patrick Dun Research Laboratory, Trinity College Dublin, St James's Hospital Dublin, Dublin, Ireland
| | - O Sheils
- Department of Histopathology, Sir Patrick Dun Research Laboratory, Trinity College Dublin, St James's Hospital Dublin, Dublin, Ireland
| | - A Chion
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - J S O'Donnell
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland
- National Centre for Hereditary Coagulation Disorders, St James's Hospital, Dublin, Ireland
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21
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Dalley C, Basarir H, Wright JG, Fernando M, Pearson D, Ward SE, Thokula P, Krishnankutty A, Wilson G, Dalton A, Talley P, Barnett D, Hughes D, Porter NR, Reilly JT, Snowden JA. Specialist integrated haematological malignancy diagnostic services: an Activity Based Cost (ABC) analysis of a networked laboratory service model. J Clin Pathol 2015; 68:292-300. [PMID: 25631214 DOI: 10.1136/jclinpath-2014-202624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Specialist Integrated Haematological Malignancy Diagnostic Services (SIHMDS) were introduced as a standard of care within the UK National Health Service to reduce diagnostic error and improve clinical outcomes. Two broad models of service delivery have become established: 'co-located' services operating from a single-site and 'networked' services, with geographically separated laboratories linked by common management and information systems. Detailed systematic cost analysis has never been published on any established SIHMDS model. METHODS We used Activity Based Costing (ABC) to construct a cost model for our regional 'networked' SIHMDS covering a two-million population based on activity in 2011. RESULTS Overall estimated annual running costs were £1 056 260 per annum (£733 400 excluding consultant costs), with individual running costs for diagnosis, staging, disease monitoring and end of treatment assessment components of £723 138, £55 302, £184 152 and £94 134 per annum, respectively. The cost distribution by department was 28.5% for haematology, 29.5% for histopathology and 42% for genetics laboratories. Costs of the diagnostic pathways varied considerably; pathways for myelodysplastic syndromes and lymphoma were the most expensive and the pathways for essential thrombocythaemia and polycythaemia vera being the least. CONCLUSIONS ABC analysis enables estimation of running costs of a SIHMDS model comprised of 'networked' laboratories. Similar cost analyses for other SIHMDS models covering varying populations are warranted to optimise quality and cost-effectiveness in delivery of modern haemato-oncology diagnostic services in the UK as well as internationally.
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Affiliation(s)
- C Dalley
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - H Basarir
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - J G Wright
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Fernando
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - D Pearson
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S E Ward
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - P Thokula
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - A Krishnankutty
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - G Wilson
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - A Dalton
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - P Talley
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - D Barnett
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - D Hughes
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - N R Porter
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J T Reilly
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J A Snowden
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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22
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Rafia R, Ward SE. Approaches Used to Model the Relationship Between Progression-Free Survival (PFS) / Time-To-Progression (TTP) And Overall Survival (OS) Within Health Economic Models of Cancer Therapies. Value Health 2014; 17:A557. [PMID: 27201831 DOI: 10.1016/j.jval.2014.08.1834] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- R Rafia
- University of Sheffield, Sheffield, UK
| | - S E Ward
- University of Sheffield, Sheffield, UK
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23
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Degen B, Ward SE, Lemes MR, Navarro C, Cavers S, Sebbenn AM. Verifying the geographic origin of mahogany (Swietenia macrophylla King) with DNA-fingerprints. Forensic Sci Int Genet 2012; 7:55-62. [PMID: 22770645 DOI: 10.1016/j.fsigen.2012.06.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/18/2012] [Accepted: 06/03/2012] [Indexed: 11/26/2022]
Abstract
Illegal logging is one of the main causes of ongoing worldwide deforestation and needs to be eradicated. The trade in illegal timber and wood products creates market disadvantages for products from sustainable forestry. Although various measures have been established to counter illegal logging and the subsequent trade, there is a lack of practical mechanisms for identifying the origin of timber and wood products. In this study, six nuclear microsatellites were used to generate DNA fingerprints for a genetic reference database characterising the populations of origin of a large set of mahogany (Swietenia macrophylla King, Meliaceae) samples. For the database, leaves and/or cambium from 1971 mahogany trees sampled in 31 stands from Mexico to Bolivia were genotyped. A total of 145 different alleles were found, showing strong genetic differentiation (δ(Gregorious)=0.52, F(ST)=0.18, G(ST(Hedrick))=0.65) and clear correlation between genetic and spatial distances among stands (r=0.82, P<0.05). We used the genetic reference database and Bayesian assignment testing to determine the geographic origins of two sets of mahogany wood samples, based on their multilocus genotypes. In both cases the wood samples were assigned to the correct country of origin. We discuss the overall applicability of this methodology to tropical timber trading.
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Affiliation(s)
- B Degen
- Johann Heinrich von Thünen-Institut, Institut für Forstgenetik, Sieker Landstrasse 2, D-22927 Grosshansdorf, Germany.
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24
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Cooper KL, Meng Y, Harnan S, Ward SE, Fitzgerald P, Papaioannou D, Wyld L, Ingram C, Wilkinson ID, Lorenz E. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for the assessment of axillary lymph node metastases in early breast cancer: systematic review and economic evaluation. Health Technol Assess 2011; 15:iii-iv, 1-134. [PMID: 21276372 DOI: 10.3310/hta15040] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Breast cancer is the most common type of cancer in women. Evaluation of axillary lymph node metastases is important for breast cancer staging and treatment planning. OBJECTIVES To evaluate the diagnostic accuracy, cost-effectiveness and effect on patient outcomes of positron emission tomography (PET), with or without computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of axillary lymph node metastases in patients with newly diagnosed early-stage breast cancer. DATA SOURCES A systematic review of literature and an economic evaluation were carried out. Key databases (including MEDLINE, EMBASE and nine others) plus research registers and conference proceedings were searched for relevant studies up to April 2009. A decision-analytical model was developed to determine cost-effectiveness in the UK. REVIEW METHODS One reviewer assessed titles and abstracts of studies identified by the search strategy, obtained the full text of relevant papers and screened them against inclusion criteria. Data from included studies were extracted by one reviewer using a standardised data extraction form and checked by a second reviewer. Discrepancies were resolved by discussion. Quality of included studies was assessed using the quality assessment of diagnostic accuracy studies (QUADAS) checklist, applied by one reviewer and checked by a second. RESULTS Forty-five citations relating to 35 studies were included in the clinical effectiveness review: 26 studies of PET and nine studies of MRI. Two studies were included in the cost-effectiveness review: one of PET and one of MRI. Of the seven studies evaluating PET/CT (n = 862), the mean sensitivity was 56% [95% confidence interval (CI) 44% to 67%] and mean specificity 96% (95% CI 90% to 99%). Of the 19 studies evaluating PET only (n = 1729), the mean sensitivity was 66% (95% CI 50% to 79%) and mean specificity 93% (95% CI 89% to 96%). PET performed less well for small metastases; the mean sensitivity was 11% (95% CI 5% to 22%) for micrometastases (≤ 2 mm; five studies; n = 63), and 57% (95% CI 47% to 66%) for macrometastases (> 2 mm; four studies; n = 111). The smallest metastatic nodes detected by PET measured 3 mm, while PET failed to detect some nodes measuring > 15 mm. Studies in which all patients were clinically node negative showed a trend towards lower sensitivity of PET compared with studies with a mixed population. Across five studies evaluating ultrasmall super-paramagnetic iron oxide (USPIO)-enhanced MRI (n = 93), the mean sensitivity was 98% (95% CI 61% to 100%) and mean specificity 96% (95% CI 72% to 100%). Across three studies of gadolinium-enhanced MRI (n = 187), the mean sensitivity was 88% (95% CI 78% to 94%) and mean specificity 73% (95% CI 63% to 81%). In the single study of in vivo proton magnetic resonance spectroscopy (n = 27), the sensitivity was 65% (95% CI 38% to 86%) and specificity 100% (95% CI 69% to 100%). USPIO-enhanced MRI showed a trend towards higher sensitivity and specificity than gadolinium-enhanced MRI. Results of the decision modelling suggest that the MRI replacement strategy is the most cost-effective strategy and dominates the baseline 4-node sampling (4-NS) and sentinel lymph node biopsy (SLNB) strategies in most sensitivity analyses undertaken. The PET replacement strategy is not as robust as the MRI replacement strategy, as its cost-effectiveness is significantly affected by the utility decrement for lymphoedema and the probability of relapse for false-negative (FN) patients. LIMITATIONS No included studies directly compared PET and MRI. CONCLUSIONS Studies demonstrated that PET and MRI have lower sensitivity and specificity than SLNB and 4-NS but are associated with fewer adverse events. Included studies indicated a significantly higher mean sensitivity for MRI than for PET, with USPIO-enhanced MRI providing the highest sensitivity. However, sensitivity and specificity of PET and MRI varied widely between studies, and MRI studies were relatively small and varied in their methods; therefore, results should be interpreted with caution. Decision modelling based on these results suggests that the most cost-effective strategy may be MRI rather than SLNB or 4-NS. This strategy reduces costs and increases quality-adjusted life-years (QALYs) because there are fewer adverse events for the majority of patients. However, this strategy leads to more FN cases at higher risk of cancer recurrence and more false- positive (FP) cases who would undergo unnecessary axillary lymph node dissection. Adding MRI prior to SLNB or 4-NS has little effect on QALYs, though this analysis is limited by lack of available data. Future research should include large, well-conducted studies of MRI, particularly using USPIO; data on the long-term impacts of lymphoedema on cost and patient utility; studies of the comparative effectiveness and cost-effectiveness of SLNB and 4-NS; and more robust UK cost data for 4-NS and SLNB as well as the cost of MRI and PET techniques. FUNDING This study was funded by the Health Technology Assessment programme of the National Institute of Health Research.
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Affiliation(s)
- K L Cooper
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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25
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Cooper KL, Meng Y, Harnan S, Ward SE, Fitzgerald P, Papaioannou D, Wyld L, Ingram C, Wilkinson ID, Lorenz E. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for the assessment of axillary lymph node metastases in early breast cancer: systematic review and economic evaluation. Health Technol Assess 2011. [PMID: 21276372 DOI: 10.3310/hta15040.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Breast cancer is the most common type of cancer in women. Evaluation of axillary lymph node metastases is important for breast cancer staging and treatment planning. OBJECTIVES To evaluate the diagnostic accuracy, cost-effectiveness and effect on patient outcomes of positron emission tomography (PET), with or without computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of axillary lymph node metastases in patients with newly diagnosed early-stage breast cancer. DATA SOURCES A systematic review of literature and an economic evaluation were carried out. Key databases (including MEDLINE, EMBASE and nine others) plus research registers and conference proceedings were searched for relevant studies up to April 2009. A decision-analytical model was developed to determine cost-effectiveness in the UK. REVIEW METHODS One reviewer assessed titles and abstracts of studies identified by the search strategy, obtained the full text of relevant papers and screened them against inclusion criteria. Data from included studies were extracted by one reviewer using a standardised data extraction form and checked by a second reviewer. Discrepancies were resolved by discussion. Quality of included studies was assessed using the quality assessment of diagnostic accuracy studies (QUADAS) checklist, applied by one reviewer and checked by a second. RESULTS Forty-five citations relating to 35 studies were included in the clinical effectiveness review: 26 studies of PET and nine studies of MRI. Two studies were included in the cost-effectiveness review: one of PET and one of MRI. Of the seven studies evaluating PET/CT (n = 862), the mean sensitivity was 56% [95% confidence interval (CI) 44% to 67%] and mean specificity 96% (95% CI 90% to 99%). Of the 19 studies evaluating PET only (n = 1729), the mean sensitivity was 66% (95% CI 50% to 79%) and mean specificity 93% (95% CI 89% to 96%). PET performed less well for small metastases; the mean sensitivity was 11% (95% CI 5% to 22%) for micrometastases (≤ 2 mm; five studies; n = 63), and 57% (95% CI 47% to 66%) for macrometastases (> 2 mm; four studies; n = 111). The smallest metastatic nodes detected by PET measured 3 mm, while PET failed to detect some nodes measuring > 15 mm. Studies in which all patients were clinically node negative showed a trend towards lower sensitivity of PET compared with studies with a mixed population. Across five studies evaluating ultrasmall super-paramagnetic iron oxide (USPIO)-enhanced MRI (n = 93), the mean sensitivity was 98% (95% CI 61% to 100%) and mean specificity 96% (95% CI 72% to 100%). Across three studies of gadolinium-enhanced MRI (n = 187), the mean sensitivity was 88% (95% CI 78% to 94%) and mean specificity 73% (95% CI 63% to 81%). In the single study of in vivo proton magnetic resonance spectroscopy (n = 27), the sensitivity was 65% (95% CI 38% to 86%) and specificity 100% (95% CI 69% to 100%). USPIO-enhanced MRI showed a trend towards higher sensitivity and specificity than gadolinium-enhanced MRI. Results of the decision modelling suggest that the MRI replacement strategy is the most cost-effective strategy and dominates the baseline 4-node sampling (4-NS) and sentinel lymph node biopsy (SLNB) strategies in most sensitivity analyses undertaken. The PET replacement strategy is not as robust as the MRI replacement strategy, as its cost-effectiveness is significantly affected by the utility decrement for lymphoedema and the probability of relapse for false-negative (FN) patients. LIMITATIONS No included studies directly compared PET and MRI. CONCLUSIONS Studies demonstrated that PET and MRI have lower sensitivity and specificity than SLNB and 4-NS but are associated with fewer adverse events. Included studies indicated a significantly higher mean sensitivity for MRI than for PET, with USPIO-enhanced MRI providing the highest sensitivity. However, sensitivity and specificity of PET and MRI varied widely between studies, and MRI studies were relatively small and varied in their methods; therefore, results should be interpreted with caution. Decision modelling based on these results suggests that the most cost-effective strategy may be MRI rather than SLNB or 4-NS. This strategy reduces costs and increases quality-adjusted life-years (QALYs) because there are fewer adverse events for the majority of patients. However, this strategy leads to more FN cases at higher risk of cancer recurrence and more false- positive (FP) cases who would undergo unnecessary axillary lymph node dissection. Adding MRI prior to SLNB or 4-NS has little effect on QALYs, though this analysis is limited by lack of available data. Future research should include large, well-conducted studies of MRI, particularly using USPIO; data on the long-term impacts of lymphoedema on cost and patient utility; studies of the comparative effectiveness and cost-effectiveness of SLNB and 4-NS; and more robust UK cost data for 4-NS and SLNB as well as the cost of MRI and PET techniques. FUNDING This study was funded by the Health Technology Assessment programme of the National Institute of Health Research.
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Affiliation(s)
- K L Cooper
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Mandell DJ, Ward SE. Building the blocks of executive functioning: differentiating early developing processes contributing to executive functioning skills. Dev Psychobiol 2011; 53:796-805. [PMID: 21563178 DOI: 10.1002/dev.20552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 04/02/2011] [Indexed: 11/06/2022]
Abstract
The neural processes that underlie executive function begin to develop in infancy. However, it is unclear how the behavior manifested by these processes are related or if they can be differentiated early in development. This study seeks to examine early emerging executive functioning skills in monkeys (Macaca fascicularis) by using an error analysis approach where traditional measures of the tasks, as well as identification of major error patterns are related. Results show that during the infancy and early juvenile period, two processes that help support set-maintenance could be differentiated: modulation of responses to novelty and persistence despite negative feedback. The results suggest that these two aspects of set-maintenance were largely independent. Modulation of responses to novelty was most prominent in the infancy and early juvenile period. The ability to persist with a response set despite negative feedback emerged in the early juvenile period and was related to task performance until the end of the study.
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Affiliation(s)
- Dorothy J Mandell
- Department of Pyschology & Cognitive Science Center Amsterdam, University of Amsterdam, the Netherlands.
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Ara R, Pandor A, Stevens J, Rafia R, Ward SE, Rees A, Durrington PN, Reynolds TM, Wierzbicki AS, Stevenson M. Prescribing high-dose lipid-lowering therapy early to avoid subsequent cardiovascular events: is this a cost-effective strategy? Eur J Prev Cardiol 2011; 19:474-83. [PMID: 21460076 DOI: 10.1177/1741826711406616] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 12/19/2022]
Abstract
BACKGROUND While evidence shows high-dose statins reduce cardiovascular events compared with moderate doses in individuals with acute coronary syndrome (ACS), many primary care trusts (PCT) advocate the use of generic simvastatin 40 mg/day for these patients. METHODS AND RESULTS Data from 28 RCTs were synthesized using a mixed treatment comparison model. A Markov model was used to evaluate the cost-effectiveness of treatments taking into account adherence and the likely reduction in cost for atorvastatin when the patent expires. There is a clear dose-response: rosuvastatin 40 mg/day produces the greatest reduction in low-density lipoprotein cholesterol (56%) followed by atorvastatin 80 mg/day (52%), and simvastatin 40 mg/day (37%). Using a threshold of £20,000 per QALY, if adherence levels in general practice are similar to those observed in RCTs, all three higher dose statins would be considered cost-effective compared to simvastatin 40 mg/day. Using the net benefits of the treatments, rosuvastatin 40 mg/day is estimated to be the most cost-effective alternative. If the cost of atorvastatin reduces in line with that observed for simvastatin, atorvastatin 80 mg/day is estimated to be the most cost-effective alternative. CONCLUSION Our analyses show that current PCT policies intended to minimize primary care drug acquisition costs result in suboptimal care.
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Affiliation(s)
- R Ara
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK.
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Malagodi EF, Gardner ML, Ward SE, Magyar RL. Responding maintained under intermittent schedules of electric-shock presentation: "Safety" or schedule effects? J Exp Anal Behav 2010; 36:171-90. [PMID: 16812238 PMCID: PMC1333066 DOI: 10.1901/jeab.1981.36-171] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Four experiments were conducted in which lever pressing by squirrel monkeys was maintained under multiple, mixed, or chained schedules of electric-shock presentation. In the first two experiments, a multiple schedule was employed in which a fixed-interval schedule of shock presentation alternated with a signaled two-minute component. Initially, no events were scheduled during the two-minute component (a safety period). In the first experiment, the safety period was "degraded" by introducing and systematically increasing the frequency of periodic shocks presented during that component. In the second experiment, the proportion of overall safe time to unsafe time was decreased by decreasing the value of the fixed-interval schedule while holding constant shock frequency during the two-minute component. In the third experiment, the overall arrangement was changed from a multiple to a mixed schedule in an attempt to determine whether fixed-interval responding would be maintained when a single exteroceptive stimulus was associated with both components. In the fourth experiment, the overall arrangement was changed from a multiple to a chained schedule in an effort to determine whether fixed-interval responding would be maintained when its consequence was presentation of a signaled "unsafe" period. Fixed-interval responding was well maintained under all experimental conditions; the varied relationships obtained lend more support to conceptualizations of shock-maintained behavior as exemplifying schedule-controlled behavior than to suggestions that such behavior may be readily accounted for by "safety theory."
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Weickert CS, Miranda-Angulo AL, Wong J, Perlman WR, Ward SE, Radhakrishna V, Straub RE, Weinberger DR, Kleinman JE. Variants in the estrogen receptor alpha gene and its mRNA contribute to risk for schizophrenia. Hum Mol Genet 2008; 17:2293-309. [PMID: 18424448 PMCID: PMC2465798 DOI: 10.1093/hmg/ddn130] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [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] [Indexed: 01/06/2023] Open
Abstract
Estrogen modifies human emotion and cognition and impacts symptoms of schizophrenia. We hypothesized that the variation in the estrogen receptor alpha (ESR1) gene and cortical ESR1 mRNA is associated with schizophrenia. In a small case–control genetic association analysis of postmortem brain tissue, genotype CC (rs2234693) and haplotypes containing the C allele of a single-nucleotide polymorphism (SNP) in intron1 (PvuII) were more frequent in African American schizophrenics (P = 0.01–0.001). In a follow-up family-based association analysis, we found overtransmission of PvuII allele C and a PvuII C-containing haplotype (P = 0.01–0.03) to African American and Caucasian patients with schizophrenia. Schizophrenics with the ‘at risk’ PvuII genotype had lower ESR1 mRNA levels in the frontal cortex. Eighteen ESR1 splice variants and decreased frequencies of the wild-type ESR1 mRNA were detected in schizophrenia. In one patient, a unique ESR1 transcript with a genomic insert encoding a premature stop codon and a truncated ESR1 protein lacking most of the estrogen binding domain was the only transcript detected. Using a luciferase assay, we found that mRNA encoding a truncated ESR1 significantly attenuates gene expression at estrogen-response elements demonstrating a dominant negative function. An intron 6 SNP [rs2273207(G)] was associated with an ESR1 splice variant missing exon seven. The T allele of another intron 6 SNP was part of a 3′ haplotype less common in schizophrenia [rs2273206(T), rs2273207(G), rs2228480(G)]. Thus, the variation in the ESR1 gene is associated with schizophrenia and the mechanism of this association may involve alternative gene regulation and transcript processing.
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Ward SE, Laughren JJ, Escott BG, Elliot-Gibson V, Bogoch ER, Beaton DE. A program with a dedicated coordinator improved chart documentation of osteoporosis after fragility fracture. Osteoporos Int 2007; 18:1127-36. [PMID: 17333450 DOI: 10.1007/s00198-007-0341-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/02/2006] [Accepted: 01/17/2007] [Indexed: 01/06/2023]
Abstract
UNLABELLED Post-fracture osteoporosis care is becoming recognized as essential by the orthopaedic community, but programs and systems are needed to ensure that this care is routinely provided. Chart documentation related to OP, which is valuable for continuity of care, increased significantly following establishment of an osteoporosis program with a dedicated coordinator. INTRODUCTION Post-fracture osteoporosis (OP) care has been repeatedly reported to be inadequate. Through a coordinator-based program, we addressed OP care for more than 95% of fragility fracture patients (1), but we do not know if documentation by orthopaedic surgeons improved. The literature suggests that chart documentation, though underestimating true care, is an indicator of the salient aspects of a condition. Thus chart documentation could be used to reflect an emerging recognition of OP as an important issue to be addressed in the orthopaedic management of the fragility fracture. The purpose of this study was to evaluate if there was an increased documentation of OP by orthopaedic surgeons before and after introduction of a coordinator-based program where the coordinator was known to address OP in 95% of cases. METHODS Chart audits were conducted to quantify OP documentation for patients treated after program initiation compared with age-, sex-, and fracture type-matched controls who presented prior to program implementation. Documentation rates were compared using chi(2) tests. Multivariable logistic regression analyses were performed to identify patient characteristics associated with OP-related documentation. RESULTS After program implementation, chart documentation of OP diagnosis (unadjusted OR 2.2, 95% CI 1.1-4.4), of referral for OP follow-up (unadjusted OR 3.1, 95% CI 1.5-6.1), and of initiation of OP management (unadjusted OR 8.2, 95% CI 4.0-16.5) by orthopaedic surgeons was more likely. Being in the post-implementation group was stronger than any patient factors in predicting OP charting. CONCLUSIONS Physicians working in a clinic with a coordinator-based OP program were more likely to document OP-related care in patients' medical charts. We believe this in turn reflected increased attention to OP by physicians in the orthopaedic management of fragility fractures.
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Affiliation(s)
- S E Ward
- Mobility Program Clinical Research Unit, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
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Ward SE, Kaltenthaler E, Cowan J, Marples M, Orr B, Seymour MT. The clinical and economic benefits of capecitabine and tegafur with uracil in metastatic colorectal cancer. Br J Cancer 2006; 95:27-34. [PMID: 16804526 PMCID: PMC2360498 DOI: 10.1038/sj.bjc.6603215] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 05/11/2006] [Accepted: 05/11/2006] [Indexed: 12/27/2022] Open
Abstract
Two oral fluoropyrimidine therapies have been introduced for metastatic colorectal cancer. One is a 5-fluorouracil pro-drug, capecitabine; the other is a combination of tegafur and uracil administered together with leucovorin. The purpose of this study was to compare the clinical effectiveness and cost-effectiveness of these oral therapies against standard intravenous 5-fluorouracil regimens. A systematic literature review was conducted to assess the clinical effectiveness of the therapies and costs were calculated from the UK National Health Service perspective for drug acquisition, drug administration, and the treatment of adverse events. A cost-minimisation analysis was used; this assumes that the treatments are of equal efficacy, although direct randomised controlled trial (RCT) comparisons of the oral therapies with infusional 5-fluorouracil schedules were not available. The cost-minimisation analysis showed that treatment costs for a 12-week course of capecitabine (Pounds 2132) and tegafur with uracil (Pounds 3385) were lower than costs for the intravenous Mayo regimen (Pounds 3593) and infusional regimens on the de Gramont (Pounds 6255) and Modified de Gramont (Pounds 3485) schedules over the same treatment period. Oral therapies result in lower costs to the health service than intravenous therapies. Further research is needed to determine the relative clinical effectiveness of oral therapies vs infusional regimens.
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Affiliation(s)
- S E Ward
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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32
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Affiliation(s)
- Thomas T Murooka
- University of Toronto, Department of Immunology & Toronto General Research Institute, University of Health Network, Toronto, ON
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33
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Ward SE, Loutfy MR, Blatt LM, Siminovitch KA, Chen J, Hinek A, Wolff B, Pham DH, Deif H, LaMere EA, Kain KC, Farcas GA, Ferguson P, Latchford M, Levy G, Fung L, Dennis JW, Lai EKY, Fish EN. Dynamic Changes in Clinical Features and Cytokine/Chemokine Responses in Sars Patients Treated with Interferon Alfacon-1 plus Corticosteroids. Antivir Ther 2005. [DOI: 10.1177/135965350501000210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Severe acute respiratory syndrome (SARS), caused by a novel coronavirus, emerged in early 2003 as a major international health crisis. We report on serum cytokine levels, viral load and clinical parameters over the course of the disease in a cohort of nine adult SARS patients treated with steroids and interferon alfacon-1 at North York General Hospital in Toronto, Ontario. Considerable variation among SARS patients with respect to circulating viral load and patterns of SARS-CoV-evoked cytokine responses was recorded. No single cytokine profile was observed in all patients, yet serum concentrations of interferon (IFN)-γ, interleukin (IL)-10, CXCL10, CCL5 and CXCL8 were found to be elevated above normal levels during the course of the disease in all patients. Expression levels for IL-10, IFN-γ and CXCL10 consistently peaked within 4 days of peak viral load. IL-12p70, IL-4 and tumour necrosis factor-α concentrations were consistently highest within 5 days of peak viral load. These results suggest that elevated levels of inflammatory cytokines are sensitive correlates of disease severity, including lung abnormalities and viral load in serum, and may provide a tool for monitoring disease progression in affected individuals.
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Affiliation(s)
- Sarah E Ward
- Toronto General Research Institute & University of Toronto, ON, Canada
| | | | | | | | - Jiabing Chen
- Toronto General Research Institute & University of Toronto, ON, Canada
| | - Anna Hinek
- Toronto General Research Institute & University of Toronto, ON, Canada
| | - Bryan Wolff
- North York General Hospital, Toronto, ON, Canada
| | - Dieu H Pham
- North York General Hospital, Toronto, ON, Canada
| | - Hassan Deif
- North York General Hospital, Toronto, ON, Canada
| | | | - Kevin C Kain
- Toronto General Research Institute & University of Toronto, ON, Canada
| | | | | | | | - Gary Levy
- Toronto General Research Institute & University of Toronto, ON, Canada
| | - Liasum Fung
- Toronto General Research Institute & University of Toronto, ON, Canada
| | - James W Dennis
- Mt Sinai Hospital Toronto & University of Toronto, ON, Canada
| | - Enoch KY Lai
- North York General Hospital, Toronto, ON, Canada
| | - Eleanor N Fish
- Toronto General Research Institute & University of Toronto, ON, Canada
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34
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Ward SE, Loutfy MR, Blatt LM, Siminovitch KA, Chen J, Hinek A, Wolff B, Pham DH, Deif H, LaMere EA, Kain KC, Farcas GA, Ferguson P, Latchford M, Levy G, Fung L, Dennis JW, Lai EKY, Fish EN. Dynamic changes in clinical features and cytokine/chemokine responses in SARS patients treated with interferon alfacon-1 plus corticosteroids. Antivir Ther 2005; 10:263-75. [PMID: 15865221] [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: 05/02/2023]
Abstract
Severe acute respiratory syndrome (SARS), caused by a novel coronavirus, emerged in early 2003 as a major international health crisis. We report on serum cytokine levels, viral load and clinical parameters over the course of the disease in a cohort of nine adult SARS patients treated with steroids and interferon alfacon-1 at North York General Hospital in Toronto, Ontario. Considerable variation among SARS patients with respect to circulating viral load and patterns of SARS-CoV-evoked cytokine responses was recorded. No single cytokine profile was observed in all patients, yet serum concentrations of interferon (IFN)-gamma, interleukin (IL)-10, CXCL10, CCL5 and CXCL8 were found to be elevated above normal levels during the course of the disease in all patients. Expression levels for IL-10, IFN-gamma and CXCL10 consistently peaked within 4 days of peak viral load. IL-12p70, IL-4 and tumour necrosis factor-alpha concentrations were consistently highest within 5 days of peak viral load. These results suggest that elevated levels of inflammatory cytokines are sensitive correlates of disease severity, including lung abnormalities and viral load in serum, and may provide a tool for monitoring disease progression in affected individuals.
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Affiliation(s)
- Sarah E Ward
- Toronto General Research Institute & University of Toronto, ON, Canada
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Ward SE. International Managed Care Congress explores collaboration, coordination, and continuity of services. J Healthc Qual 2001; 23:35-7, 40. [PMID: 23413477 DOI: 10.1111/j.1945-1474.2001.tb00389.x] [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: 12/01/2022]
Affiliation(s)
- S E Ward
- Quality/Risk Management Department, HIP Health Plan of New York, NY, USA
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Ward SE, Taves DH, McCurdy LI. Stereotaxic core needle biopsy of breast microcalcifications obtained using a standard mammography table with an add-on unit. Can Assoc Radiol J 2000; 51:10-5. [PMID: 10711288] [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: 02/15/2023] Open
Abstract
OBJECTIVE To demonstrate the reliability of stereotaxic biopsy of indeterminate microcalcifications using a standard mammography table with an add-on unit. METHODS In 121 cases of indeterminate microcalcifications, core biopsy was performed using a standard mammography table with an add-on stereotaxic unit. Microcalcifications were identified on radiography of core specimens. RESULTS Microcalcifications and a definitive histologic diagnosis were obtained in 112 core biopsies (92.6%), with no significant complications. In 23 lesions frank malignancy was diagnosed, and all of these diagnoses were confirmed on surgery. Pathologic examination suggested carcinoma in 4 lesions, and open biopsy confirmed malignancy in 3 of these cases. Four lesions showed atypical ductal hyperplasia. Benign disease was diagnosed in 81 lesions, of which 78 remained stable on mammographic follow-up (mean 16 months later) and 3 were subjected to surgical biopsy (of which 1 was malignant and 2 were benign). Nine cases were technically unsatisfactory because microcalcifications were not sampled. CONCLUSION Stereotaxic core biopsy performed with an add-on unit is a safe and reliable technique for biopsy of indeterminate microcalcifications. For successful biopsy, microcalcifications must be harvested. Pathologic results should be correlated with mammographic findings. The accuracy rate compares favourably with results reported using prone biopsy tables. In an era of cost containment, this alternative to prone biopsy tables could result in significant savings in terms of capital investment and use of hospital rooms. In this study, surgical biopsy could have been avoided in 64.5% of cases.
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Affiliation(s)
- S E Ward
- St. Joseph's Health Centre, London, Ont
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Nixon PP, Ward SE. Tetracycline sclerotherapy for the treatment of recurrent pooling of plasma in the submandibular tissue space: case report. Br J Oral Maxillofac Surg 1999; 37:137-8. [PMID: 10371321 DOI: 10.1054/bjom.1997.0093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present an unusual case of recurrent swelling after removal of the submandibular and sublingual salivary glands which was found to be the result of a collection of plasma. This was successfully treated by an injection of tetracycline to induce sclerosis.
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Affiliation(s)
- P P Nixon
- Department of Maxillofacial Surgery, Charles Clifford Dental Hospital, Sheffield, UK
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Abstract
Several on-line studies in the literature have been cited in support of a two-stage model of name-retrieval in which semantic processing precedes and mediates access to phonology. Because of inconsistencies in prior studies an off-line experiment was designed to provide converging evidence on this issue. An experiment is reported in which young and elderly adults were required to give speeded judgments of whether a pictured object matched a named category, a named physical attribute, or a rhyming cue. Latencies for the young adults were fastest for category judgments and slowest for rhyming judgments. For the elderly adults physical attributes and rhyming judgments were equivalent. Results are discussed in terms of "lemma" theory in object naming.
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Affiliation(s)
- H Goodglass
- Aphasia Research Center, Boston University School of Medicine, Boston, MA 02130, USA.
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Ward SE, Carlson-Dakes K, Hughes SH, Kwekkeboom KL, Donovan HS. The impact on quality of life of patient-related barriers to pain management. Res Nurs Health 1998. [PMID: 9761138 DOI: 10.1002/(sici)1098-240x(199810)21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A stress-coping model of relationships between patients' beliefs about pain, coping (analgesic use), pain severity, analgesic side-effects, and three quality of life (QOL) outcomes was tested. Participants were 182 men and women with cancer who completed valid and reliable self-report measures of relevant variables. Antecedent variables (age and education) showed expected relationships with beliefs. As predicted, beliefs were significantly related to analgesic use. Analgesic use was inversely related to pain severity, but was not related to side-effect severity. Analgesic use was inversely related to impairments in QOL before controlling for pain and side-effect severity, but not after these two variables were controlled. Both analgesic side-effects and pain severity were related to impaired QOL outcomes, including difficulty performing life activities, depressed mood, and poor perceived health status.
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Affiliation(s)
- S E Ward
- University of Wisconsin-Madison, School of Nursing, 53792, USA
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Abstract
A stress-coping model of relationships between patients' beliefs about pain, coping (analgesic use), pain severity, analgesic side-effects, and three quality of life (QOL) outcomes was tested. Participants were 182 men and women with cancer who completed valid and reliable self-report measures of relevant variables. Antecedent variables (age and education) showed expected relationships with beliefs. As predicted, beliefs were significantly related to analgesic use. Analgesic use was inversely related to pain severity, but was not related to side-effect severity. Analgesic use was inversely related to impairments in QOL before controlling for pain and side-effect severity, but not after these two variables were controlled. Both analgesic side-effects and pain severity were related to impaired QOL outcomes, including difficulty performing life activities, depressed mood, and poor perceived health status.
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Affiliation(s)
- S E Ward
- University of Wisconsin-Madison, School of Nursing, 53792, USA
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Pellino TA, Ward SE. Perceived control mediates the relationship between pain severity and patient satisfaction. J Pain Symptom Manage 1998; 15:110-6. [PMID: 9494309] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The factors that account for patient satisfaction with acute pain management remain a mystery. Consistently, there has been an inverse, but very small association between pain severity and patient satisfaction; most patients are in severe pain, yet report they are satisfied with pain management. The hypothesis that perceived control mediates the relationship between pain severity and patient satisfaction was examined in 137 patients who underwent elective inpatient orthopedic surgery. Postoperatively, patients rated their pain severity (the highest level of pain experienced), their perceptions of control over the pain and taking pain medication, and their satisfaction with the relief they obtained from analgesics. Path analysis using LISREL was used to test for mediation. Pain severity was associated inversely with perceptions of control over pain and with satisfaction. There was a significant association between perceived control and satisfaction and perceived control partially mediated the relationship between pain severity and satisfaction. Although individuals who report experiencing severe pain are less satisfied with pain relief than individuals with less pain, it is the interpretation or perception of having control over the pain that most relates to satisfaction with pain relief. Clinically, it is important to examine ways in which individuals control their pain, teach them methods to exert control, and educate them that it is preferable to not allow pain to become severe--it is easier to "control" pain if you intervene at an early point.
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Affiliation(s)
- T A Pellino
- University of Wisconsin Hospitals and Clinics, USA
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Ornadel D, Ledermann JA, Eagle K, Pedley RB, Boxer G, Ward SE, Olabiran Y, Bomanji J. Biodistribution of a radiolabelled monoclonal antibody NY3D11 recognizing the neural cell adhesion molecule in tumour xenografts and patients with small-cell lung cancer. Br J Cancer 1998; 77:103-9. [PMID: 9459153 PMCID: PMC2151251 DOI: 10.1038/bjc.1998.16] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The neural cell adhesion molecule (NCAM) is highly expressed on the surface of small-cell-lung cancer (SCLC) cells. We have produced a monoclonal antibody, NY3D11, that binds to NCAM to investigate whether this antigen could be used to develop antibody-directed therapy for SCLC. 125I-labelled IgG and F(ab')2 fragments of NY3D11 localized selectively in human SCLC xenografts grown in nude mice. The human biodistribution of 131I-labelled NY3D11 after intravenous administration was investigated by gamma-camera imaging in six patients with SCLC. Three patients received IgG and three received F(ab')2. No evidence of localization to primary tumours or metastases was seen and antibody accumulated rapidly in the liver and bone marrow. The probable explanation for this distribution is that NY3D11 reacted with soluble NCAM or natural killer cells that possess the CD56 (NCAM) antigen.
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Affiliation(s)
- D Ornadel
- Department of Oncology, UCL Medical School, London, UK
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Abstract
To investigate procreation in schizophrenia, as well as gender-related differences, female patients with schizophrenia (n = 79, DSM-III-R criteria) were compared with screened female controls (n = 124) and subsequently with male patients (n = 86). Two outcomes were investigated: (i) the proportion of subjects with one or more children (an index of fertility) and (ii) the number of children per subject among those with one or more children (an index of fecundity). Multivariate analysis was used to control for confounding variables. No significant differences in fertility between female patients and controls were detected, but reduced fecundity was noted among female patients past the reproductive period. Male patients showed a significant reduction in both fertility and fecundity compared to female patients. These results suggest that there is a relatively small impairment of fecundity among female patients compared with controls, but that there are more significant gender-related differences in both fertility and fecundity. The latter have important implications for the genetics of schizophrenia.
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Affiliation(s)
- V L Nimgaonkar
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA, USA
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Dearborn P, De Muth JS, Requarth AB, Ward SE. Nurse and patient satisfaction with three types of venous access devices. Oncol Nurs Forum 1997; 24:34-40. [PMID: 9010863] [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: 02/03/2023]
Abstract
PURPOSE/OBJECTIVES To examine patient and nurse satisfaction with three types of venous access devices (VADs)--port, Groshong (Bard Access Systems, Salt Lake City, UT), and Hicman (Bard Access Systems)--and to identify the problems and benefits experienced with each type of device. DESIGN A descriptive, correlational quality-assurance study. SETTING An outpatient oncology/hematology clinic in a midwestern United States academic hospital with a comprehensive cancer center. SAMPLE A convenience sample of 85 patients who had a port, Groshong catheter, or Hickman catheter and the clinic nurses who provided their care. METHOD Consecutive patients meeting study criteria were invited to complete self-report questionnaires at the time of their clinic visits. Clinic nurses who cared for these patients also completed questionnaires. FINDINGS Patients' reports of benefits did not differ by device, but they reported fewer blood-drawing problems with ports than with Groshong on Hickman catheters. Patients and nurses reported infections and clots more often with Groshong catheters than with the other two devices, Patients indicated that healthcare workers seemed most knowledgeable about Hickman catheters. Patients with ports reported more problems with access to the device, development of hematomas, and anxiety. Nurses reported more flow rate problems with Groshong catheters than with Hickman catheters. Patients and nurses reported no flow rate problems with ports. CONCLUSIONS Each device was associated with a specific problem, yet in the global satisfaction ratings, patients expressed the greatest satisfaction with Hickman catheters and ports. Nurses tended to be least satisfied with Groshong catheters. IMPLICATIONS FOR NURSING PRACTICE Nurses need to ensure that other care providers have appropriate information on the care of VADs. This could be accomplished via written instructions on VAD care and followup telephone calls to care providers. A need exists for continued patient education on VAD care to minimize complications. The selection of an appropriate VAD should be based on the patient's best interests rather than on nurses' preferences.
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Affiliation(s)
- P Dearborn
- Oncology Clinic, University of Wisconsin Hospital and Clinics, Madison, USA
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Goodglass H, Wingfield A, Ward SE. Judgments of concept similarity by normal and aphasic subjects: relation to naming and comprehension. Brain Lang 1997; 56:138-158. [PMID: 8994701 DOI: 10.1006/brln.1997.1733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A study was conducted in which aphasic patients, age-matched normals, and normal young adults performed five types of matching judgments for object pictures. These required matching for physical identity, basic object identity, and membership in the same superordinate category. Spoken name-to-picture matching was tested for the last two conditions. An analogous set of conditions was presented for letters. Latency patterns across the conditions showed general slowing for the aphasic patients, but with a differential decrement in the conditions that involved auditory (spoken name) input for the matching task. Results showed that variations in semantic judgment capability among the aphasics did not predict the patients' object naming ability.
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Affiliation(s)
- H Goodglass
- Department of Neurology, Boston University School of Medicine, MA, USA
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Abstract
The purposes of this study were to explore the coping strategies used by patients with chronic low back pain, to test hypothesized mediators of the relationship between self-efficacy and pain outcomes, and to determine the roles of self-efficacy and outcome expectancies in coping with pain in patients (N = 85) with chronic low back pain. The most common coping behaviors were reporting pain, using pain medications, and coping self-statements. Patients' self-efficacy to cope with pain was inversely correlated with pain intensity. Self-efficacy was positively correlated with perseverance of coping effort. Perseverance of coping effort was found to mediate the effects of self-efficacy on pain outcomes; however, level of distress was not found to be a mediator. Outcome expectancies were positively correlated with perseverance of coping effort. These findings are discussed in terms of implications for practice and directions for future research.
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Affiliation(s)
- C C Lin
- School of Nursing, Taipei Medical College, Taiwan
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Abstract
Patients receiving curative treatment for cancer have concerns about reporting pain and using analgesics. These concerns are associated with underutilization of analgesics. To extend knowledge about such concerns to the context of palliative care, the concerns of hospice patients and family caregivers were compared. Within 5 days of admission to hospice, 35 patients with cancer and their caregivers each completed a measure of eight concerns such as fear of addiction, worry about tolerance, and worry about side effects. There was no correlation between caregiver and patient concerns and means for the two groups were similar, indicating that within a given dyad either the patient or the caregiver may have greater concerns. The findings highlight the need for patient and caregiver education about reporting pain and using analgesics.
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Affiliation(s)
- S E Ward
- School of Nursing, University of Wisconsin-Madison 53792-2455, USA
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Abstract
Longitudinal data from quality assurance studies of pain outcomes (pain severity and patient satisfaction) were critically examined to explore the reasons that patients are satisfied with their care even when they are in pain. Data were acquired from three sources: self-report surveys of patients during inpatient admission or ambulatory clinic visit (N = 306), telephone interviews of patients after discharge (N = 869), and chart reviews (N = 112). These data were compared to baseline data obtained 2 years ago, before the implementation of a number of programs designed to improve pain management. Findings reveal little change from baseline with respect to patient satisfaction with pain management--an overwhelming percentage are satisfied or highly satisfied. Similarly, there has been little change in pain intensity ratings--on average, patients' worst pain is approximately 7 on a 0-10 scale. In addition, almost all analgesic orders continue to be written for "as needed" administration. Based on these findings, we postulate that patients are satisfied even though they are in pain because they experience a commonly expected peak and trough pattern of pain relief, a pattern that occurs with "as needed" administration. That is, we conclude that pattern of pain relief, not pain severity, may be the critical determinant of satisfaction.
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Affiliation(s)
- S E Ward
- School of Nursing, University of Wisconsin-Madison 53792, USA
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Abstract
Cancer-related pain not only affects the patient but the family/caregiver as well. The purpose of this study was to examine concerns about reporting pain and using analgesics in a sample of primary caregivers of cancer patients receiving care from a hospice program. The Barriers Questionnaire (BQ), an instrument designed to measure eight common barriers to adequate management of cancer pain, was administered to 37 persons identified as primary caregivers. Between 62 percent and 100 percent of the caregivers reported having at least some agreement with the various concerns that are barriers to reporting pain and using analgesics, and 3 percent to 43 percent reported having strong agreement. The subscales with the highest means were fear of opioid side effects, fear of addiction, the belief that increasing pain signifies disease progression, and the fear of injections. Caregivers who were older and less educated were more likely to believe that reporting pain may distract the physician from treating or curing the cancer. In addition, caregivers with lower educational levels had higher scores on the overall BQ. Finally, caregivers of patients who reported pain was not a problem on program admission had greater concerns about tolerance and were more likely to believe that "good" patients do not complain. The caregiver, often, with time and the declining abilities of the patient, becomes the first line decision maker regarding the patient's care and treatment. Understanding caregiver perspectives is important for continued success with managing pain in hospice and, arguably, all settings.
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Gordon DB, Ward SE. Correcting patient misconceptions about pain. Am J Nurs 1995; 95:43-5. [PMID: 7604864] [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: 01/26/2023]
Affiliation(s)
- D B Gordon
- University of Wisconsin Hospital and Clinics, Madison, USA
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