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Eisen A, Fletcher GG, Fienberg S, George R, Holloway C, Kulkarni S, Seely JM, Muradali D. Breast Magnetic Resonance Imaging for Preoperative Evaluation of Breast Cancer: A Systematic Review and Meta-Analysis. Can Assoc Radiol J 2024; 75:118-135. [PMID: 37593787 DOI: 10.1177/08465371231184769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Purpose: Preoperative breast magnetic resonance imaging (MRI) is known to detect additional cancers that are occult on mammography and ultrasound. There is debate as to whether these additional lesions affect clinical outcomes. The objective of this systematic review was to summarize the evidence on whether additional information on disease extent obtained with preoperative breast MRI in patients with newly diagnosed breast cancer affects surgical management, rates of recurrence, survival, re-excision, and early detection of bilateral cancer. Methods: Embase, MEDLINE, and Cochrane Central Register of Controlled Trials were searched until January 2021 (partial update July 2022) for studies comparing outcomes with versus without pre-operative MRI. Included were both randomized controlled trials and other comparative studies provided MRI and control groups had equivalent disease and patient characteristics or methods such as multivariable analysis or propensity score matching were used to control potential confounders. Results: The search resulted in 26,399 citations, of which 8 randomized control trials, 1 prospective cohort study, and 42 retrospective studies met the inclusion criteria. Use of MRI resulted in decreased rates of reoperations (OR = 0.73, 95% CI = 0.63 to 0.85), re-excisions (OR = 0.63, 95% CI = 0.45 to 0.89), and recurrence (HR = 0.77, 95% CI = 0.65 to 0.90). Increased detection of synchronous contralateral breast cancers led to a reduction in metachronous contralateral breast cancer (HR = 0.71, 95% CI = 0.59 to 0.85). Hazard ratios for recurrence-free and overall survival were 0.77 (95% CI = 0.53 to 1.12) and 0.89 (95% CI = 0.74 to 1.07). Conclusion: This systematic review indicates substantial benefits of pre-operative breast MRI in decreasing reoperations and recurrence.
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Affiliation(s)
- Andrea Eisen
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences, Toronto, ON, Canada
| | - Glenn G Fletcher
- Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Samantha Fienberg
- Ontario Breast Screening Program, Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
- Department of Medical Imaging, Lakeridge Health, Oshawa, ON, Canada
| | - Ralph George
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Claire Holloway
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Disease Pathway Management, Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Supriya Kulkarni
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jean M Seely
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Derek Muradali
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Medical and Diagnostic Imaging, St. Michael's Hospital, Toronto, ON, Canada
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Habbous S, Barisic A, Homenauth E, Kandasamy S, Forster K, Eisen A, Holloway C. Estimating the incidence of breast cancer recurrence using administrative data. Breast Cancer Res Treat 2023; 198:509-522. [PMID: 36422755 DOI: 10.1007/s10549-022-06812-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/20/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer among women, but most cancer registries do not capture recurrences. We estimated the incidence of local, regional, and distant recurrences using administrative data. METHODS Patients diagnosed with stage I-III primary breast cancer in Ontario, Canada from 2013 to 2017 were included. Patients were followed until 31/Dec/2021, death, or a new primary cancer diagnosis. We used hospital administrative data (diagnostic and intervention codes) to identify local recurrence, regional recurrence, and distant metastasis after primary diagnosis. We used logistic regression to explore factors associated with developing a distant metastasis. RESULTS With a median follow-up 67 months, 5,431/45,857 (11.8%) of patients developed a distant metastasis a median 23 (9, 42) months after diagnosis of the primary tumor. 1086 (2.4%) and 1069 (2.3%) patients developed an isolated regional or a local recurrence, respectively. Patients with distant metastatic disease had a median overall survival of 15.4 months (95% CI 14.4-16.4 months) from the time recurrence/metastasis was identified. In contrast, the median survival for all other patients was not reached. Patients were more likely to develop a distant metastasis if they had more advanced stage, greater comorbidity, and presented with symptoms (p < 0.0001). Trastuzumab halved the risk of recurrence [OR 0.53 (0.45-0.63), p < 0.0001]. CONCLUSION Distant metastasis is not a rare outcome for patients diagnosed with breast cancer, translating to an annual incidence of 2132 new cases (17.8% of all breast cancer diagnoses). Overall survival remains high for patients with locoregional recurrences, but was poor following a diagnosis of a distant metastasis.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON, M5G2L3, Canada.
- Department of Epidemiology & Biostatistics, Western University, London, ON, N6A 5C1, Canada.
| | - Andriana Barisic
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON, M5G2L3, Canada
| | - Esha Homenauth
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON, M5G2L3, Canada
| | - Sharmilaa Kandasamy
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON, M5G2L3, Canada
| | - Katharina Forster
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON, M5G2L3, Canada
| | - Andrea Eisen
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON, M5G2L3, Canada
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, M4Y 1H1, Canada
| | - Claire Holloway
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON, M5G2L3, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5T1P5, Canada
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3
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Chan TCY, Forster K, Habbous S, Holloway C, Ieraci L, Shalaby Y, Yousefi N. Inverse optimization on hierarchical networks: an application to breast cancer clinical pathways. Health Care Manag Sci 2022; 25:590-622. [PMID: 35802305 DOI: 10.1007/s10729-022-09599-z] [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: 08/13/2021] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
Clinical pathways are standardized processes that outline the steps required for managing a specific disease. However, patient pathways often deviate from clinical pathways. Measuring the concordance of patient pathways to clinical pathways is important for health system monitoring and informing quality improvement initiatives. In this paper, we develop an inverse optimization-based approach to measuring pathway concordance in breast cancer, a complex disease. We capture this complexity in a hierarchical network that models the patient's journey through the health system. A novel inverse shortest path model is formulated and solved on this hierarchical network to estimate arc costs, which are used to form a concordance metric to measure the distance between patient pathways and shortest paths (i.e., clinical pathways). Using real breast cancer patient data from Ontario, Canada, we demonstrate that our concordance metric has a statistically significant association with survival for all breast cancer patient subgroups. We also use it to quantify the extent of patient pathway discordances across all subgroups, finding that patients undertaking additional clinical activities constitute the primary driver of discordance in the population.
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Affiliation(s)
- Timothy C Y Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | - Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Claire Holloway
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Luciano Ieraci
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Yusuf Shalaby
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Nasrin Yousefi
- Smith School of Business, Queen's University, Kingston, Ontario, Canada.
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4
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Krishnan A, Ellenberger K, Chansavath P, Kelleher A, Matthews G, Darley D, Holloway C. Myocardial Fibrosis Occurs in Non-Hospitalised Patients With Chronic Symptoms After COVID-19. Heart Lung Circ 2022. [PMCID: PMC9345568 DOI: 10.1016/j.hlc.2022.06.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Singh S, Farrelly A, Chan C, Nicholls B, Nazeri-Rad N, Bellicoso D, Eisen A, Falkson CB, Fox C, Holloway C, Kennedy E, McLeod R, Rothenberger D, Trudeau M, Shanafelt T, Bauman G. Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada. JCO Oncol Pract 2021; 18:e60-e71. [PMID: 34506217 DOI: 10.1200/op.21.00170] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada. METHODS This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory. RESULTS A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001). CONCLUSION Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.
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Affiliation(s)
- Simron Singh
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ashley Farrelly
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Catherine Chan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Brett Nicholls
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | | | - Andrea Eisen
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Colleen Fox
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | - Erin Kennedy
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Robin McLeod
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | | | - Tait Shanafelt
- Department of Medicine & WellMD Center, Stanford University, Palo Alto, CA
| | - Glenn Bauman
- Western University, London Regional Cancer Program, London, Ontario, Canada
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6
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Paramlall M, Bakar I, Kandasamy R, Gadhvi A, Holloway C, Harding S, Tyagi H. #3105 How does self-report of mood symptoms compare with observer assessments after acquired brain injury. J Neurol Psychiatry 2021. [DOI: 10.1136/jnnp-2021-bnpa.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesPost acquired brain injury (ABI) depression has been implicated in different patient outcomes such as prospective cognition, cognitive impairment, rehabilitation outcome, and quality of life. However, there have been no studies identified in the literature, investigating post ABI insight into depression across varied cognitive abilities. Here we looked at ABI patient insight into their depression across a range of cognitive abilities and compared this to an observed or an objective measure of depression.MethodsA retrospective cohort of 24 individuals with ABI (depressed and non-depressed) seen in a neuropsychiatry outpatient clinic between 2019 and 2020 completed a Patient Health Questionnaire-9 (PHQ-9), self-reported depression scale and had a Neuropsychiatry Inventory Questionnaire(NPI-Q), an observer assessment with a depression domain. The patients also underwent a formal cognitive examination using the Montreal Cognitive Assessment (MoCA).ResultsNon-depressed ABI and depressed ABI individuals with a wide range of cognitive abilities demonstrated good insight into their depression when matched to the observer rating. Chi-Square Test showed little variation between the PHQ-9 and NPI-Q Depression data sets; Wilcoxon Signed Ranks Test: Z Test -4.08, p<0.001, Effect Size 0.87 and Spearman’s rho showed positive correlation between the two data sets (Correlation Coefficient 0.527, P<0.008). Therefore, there was a statistically significant agreement between the subjective measure (PHQ-9) and the observed (objective) measure NPIQD and that there was a positive correlation between the two measurement scales for patients with ABI regardless of cognition (as measured by MoCAz score; range -6 to 2.21, mean: -1.17)ConclusionsThese findings indicate (1) self-reported measures of depression in ABI are consistent with observed (objective measures) thus can be used to assess depression in this cohort and (2) ABI patients with a wide range of cognitive abilities would appear to have good insight into their depression.
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7
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Brown T, Beck C, Holloway C, Kerns J, Fagerstrom J, Kaurin D, Kielar K. PO-1576 A novel anthropomorphic phantom for the commissioning of MLC-based stereotactic radiosurgery. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Milkovich J, Hanna T, Nessim C, Petrella TM, Weatherhead L, Chan AW, Irish JC, Murray C, Bannerman G, Holloway C, Forster K, Pazzano L, Wright FC. Restructuring Skin Cancer Care in Ontario: A Provincial Plan. ACTA ACUST UNITED AC 2021; 28:1183-1196. [PMID: 33809399 PMCID: PMC8025818 DOI: 10.3390/curroncol28020114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/28/2021] [Accepted: 03/06/2021] [Indexed: 11/16/2022]
Abstract
There is a global rise in skin cancer incidence, resulting in an increase in patient care needs and healthcare costs. To optimize health care planning, costs, and patient care, Ontario Health developed a provincial skin cancer plan to streamline the quality of care. We conducted a systematic review and a grey literature search to evaluate the definitions and management of skin cancer within other jurisdictions, as well as a provincial survey of skin cancer care practices, to identify care gaps. The systematic review did not identify any published comprehensive skin cancer management plans. The grey literature search revealed skin cancer plans in isolated regions of the United Kingdom (U.K.), National Institute for Health and Care Excellence (NICE) guidelines for skin cancer quality indicators and regional skin cancer biopsy clinics, and wait time guidelines in Australia and the U.K. With the input of the Ontario Cancer Advisory Committee (CAC), unique definitions for complex and non-complex skin cancers and the appropriate cancer services were created. A provincial survey of skin cancer care yielded 44 responses and demonstrated gaps in biopsy access. A skin cancer pathway map was created and a recommendation was made for regional skin cancer biopsy clinics. We have created unique definitions for complex and non-complex skin cancer and a skin cancer pathways map, which will allow for the implementation of both process and performance metrics to address identified gaps in care.
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Affiliation(s)
- John Milkovich
- Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (J.M.); (J.C.I.)
| | - Tim Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston, ON K7L 3N6, Canada;
- Department of Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada
| | - Carolyn Nessim
- Division of Dermatology and Medical Oncology, The University of Ottawa, Ottawa, ON K1H 8L6, Canada; (C.N.); (L.W.)
| | - Teresa M. Petrella
- Sunnybrook Health Sciences Centre, Department of Medical Oncology, Toronto, ON M4N 3M5, Canada;
| | - Louis Weatherhead
- Division of Dermatology and Medical Oncology, The University of Ottawa, Ottawa, ON K1H 8L6, Canada; (C.N.); (L.W.)
| | - An-Wen Chan
- Department of Medicine, Women’s College Hospital, Toronto, ON M5S 1B2, Canada;
| | - Jonathan C. Irish
- Surgical Oncology Program, Ontario Health-Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (J.M.); (J.C.I.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1B2, Canada;
| | - Christian Murray
- Department of Medicine, University of Toronto, Toronto, ON M5S 1B2, Canada;
| | - Grace Bannerman
- Clinical Institutes and Quality Programs, Ontario Health, Toronto, ON M5G 2L7, Canada; (G.B.); (C.H.); (K.F.); (L.P.)
| | - Claire Holloway
- Clinical Institutes and Quality Programs, Ontario Health, Toronto, ON M5G 2L7, Canada; (G.B.); (C.H.); (K.F.); (L.P.)
| | - Katharina Forster
- Clinical Institutes and Quality Programs, Ontario Health, Toronto, ON M5G 2L7, Canada; (G.B.); (C.H.); (K.F.); (L.P.)
| | - Laura Pazzano
- Clinical Institutes and Quality Programs, Ontario Health, Toronto, ON M5G 2L7, Canada; (G.B.); (C.H.); (K.F.); (L.P.)
| | - Frances C. Wright
- Sunnybrook Health Sciences Centre, Department of Medical Oncology, Toronto, ON M4N 3M5, Canada;
- Department of Medicine, University of Toronto, Toronto, ON M5S 1B2, Canada;
- Clinical Institutes and Quality Programs, Ontario Health, Toronto, ON M5G 2L7, Canada; (G.B.); (C.H.); (K.F.); (L.P.)
- Correspondence:
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9
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Oldfrey B, Tchorzewska A, Jackson R, Croysdale M, Loureiro R, Holloway C, Miodownik M. Additive manufacturing techniques for smart prosthetic liners. Med Eng Phys 2020; 87:45-55. [PMID: 33461673 DOI: 10.1016/j.medengphy.2020.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/16/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
Elastomeric liners are commonly worn between the prosthetic socket and the limb. A number of improvements to the state of the art of liner technology are required to address outstanding problems. A liner that conforms to the residuum more accurately, may improve the skin health at the stump-socket interface. Previous work has shown that for effective thermal management of the socket environment, an active heat removal system is required, yet this is not available. Volume tracking of the stump could be used as a diagnostic tool for looking at the changes that occur across the day for all users, which depend on activity level, position, and the interaction forces of the prosthetic socket with the limb. We believe that it would be advantageous to embed these devices into a smart liner, which could be replaced and repaired more easily than the highly costly and labour-intensive custom-made socket. This paper presents the work to develop these capabilities in soft material technology, with: the development of a printable nanocomposite stretch sensor system; a low-cost digital method for casting bespoke prosthetic liners; a liner with an embedded stretch sensor for growth / volume tracking; a model liner with an embedded active cooling system.
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Affiliation(s)
- B Oldfrey
- Department of Mechanical Engineering, UCL, London, UK; Institute of Making, UCL, UK; Global Disability Innovation Hub, UCL, UK.
| | - A Tchorzewska
- Department of Mechanical Engineering, UCL, London, UK
| | | | - M Croysdale
- Royal National Orthopaedic Hospital, Stanmore, UK; Aspire Create, Department of Orthopaedics and Musculoskeletal Science, UCL, UK
| | - R Loureiro
- Royal National Orthopaedic Hospital, Stanmore, UK; Aspire Create, Department of Orthopaedics and Musculoskeletal Science, UCL, UK
| | - C Holloway
- Global Disability Innovation Hub, UCL, UK; UCLIC, UCL, UK
| | - M Miodownik
- Department of Mechanical Engineering, UCL, London, UK; Institute of Making, UCL, UK
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10
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Groome PA, Webber C, Whitehead M, Moineddin R, Grunfeld E, Eisen A, Gilbert J, Holloway C, Irish JC, Langley H. Determining the Cancer Diagnostic Interval Using Administrative Health Care Data in a Breast Cancer Cohort. JCO Clin Cancer Inform 2020; 3:1-10. [PMID: 31112418 PMCID: PMC6874005 DOI: 10.1200/cci.18.00131] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/07/2023] Open
Abstract
PURPOSE Population-based administrative health care data could be a valuable resource with which to study the cancer diagnostic interval. The objective of the current study was to determine the first encounter in the diagnostic interval and compute that interval in a cohort of patients with breast cancer using an empirical approach. METHODS This is a retrospective cohort study of patients with breast cancer diagnosed in Ontario, Canada, between 2007 and 2015. We used cancer registry, physician claims, hospital discharge, and emergency department visit data to identify and categorize cancer-related encounters that were more common in the three months before diagnosis. We used statistical control charts to define lookback periods for each encounter category. We identified the earliest cancer-related encounter that marked the start of the diagnostic interval. The end of the interval was the cancer diagnosis date. RESULTS The final cohort included 69,717 patients with breast cancer. We identified an initial encounter in 97.8% of patients. Median diagnostic interval was 36 days (interquartile range [IQR], 19 to 71 days). Median interval decreased with increasing stage at diagnosis and varied across initial encounter categories, from 9 days (IQR, 1 to 35 days) for encounters with other cancer as the diagnosis to 231 days (IQR 77 to 311 days) for encounters with cyst aspiration or drainage as the procedure. CONCLUSION Diagnostic interval research can inform early detection guidelines and assess the success of diagnostic assessment programs. Use of administrative data for this purpose is a powerful tool for improving diagnostic processes at the population level.
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Affiliation(s)
- Patti A Groome
- Queen's University, Kingston, Ontario, Canada.,ICES Queen's, Kingston, Ontario, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Eva Grunfeld
- University of Toronto, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Andrea Eisen
- University of Toronto, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Gilbert
- University of Toronto, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Hugh Langley
- Queen's University, Kingston, Ontario, Canada.,South East Regional Cancer Program, Kingston, Ontario, Canada
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11
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Situ Y, Subbiah R, Brew B, Holloway C. 243 Pilot Study of the Samsung S-patch for Cardiac Monitoring. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Anthony C, Imran M, Pouliopoulos J, Emmanuel S, Iliff J, Ross J, Moffat K, Mccrohon J, Holloway C, Kotlyar E, Muthiah K, Keogh A, Hayward C, Macdonald P, Jabbour A. 004 Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac Transplantation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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de Bruyns A, Li H, MacNeil A, Simmons C, Clarkson P, Goddard K, Munk PL, Hart JJ, Holloway C, Truong P, Feng X. Evolving Practice Patterns Over Two Decades (1993-2013) in the Management of Desmoid-type Fibromatosis in British Columbia. Clin Oncol (R Coll Radiol) 2019; 32:e102-e110. [PMID: 31685376 DOI: 10.1016/j.clon.2019.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/04/2019] [Revised: 09/19/2019] [Accepted: 10/04/2019] [Indexed: 01/24/2023]
Abstract
AIMS Due to the rarity and varied natural history of desmoid-type fibromatosis, evidence-based treatment standards for this disease remain lacking. This study evaluated outcomes in patients with desmoid-type fibromatosis managed at a Canadian institution over two decades. MATERIALS AND METHODS Records of 227 patients with desmoid-type fibromatosis referred from 1990 to 2013 were retrospectively reviewed to investigate management strategies including active surveillance, surgery, radiation therapy, cryoablation, and systemic therapy, including tamoxifen and chemotherapy. RESULTS Thirty-two per cent of cases were men, median age 40 years, median tumour size 5.4 cm. Initial treatments were surgery (79%), tamoxifen (13%), radiation therapy (5.0%), chemotherapy (1.8%) and cryoablation (1.2%). Active surveillance was used upfront in 26% of cases, most after 2005. At a median follow-up of 77 months, one patient died of disease, 13 died of unrelated causes and the remainder were alive with no evidence of disease (56%), stable/responding disease (33%) or progressive disease (4%). The recurrence rate was 25% after upfront surgery. Response rates and disease control rates were 40% and 76% for active surveillance; 68% and 96% for radiation therapy; 31% and 67% for tamoxifen; and 53% and 80% for chemotherapy. On univariable analysis, factors associated with a higher recurrence after initial surgery were young age (P = 0.012), male gender (P = 0.012) and extremity location (P = 0.005). On multivariable analysis, only young age was significantly associated with recurrence risk (P = 0.010). CONCLUSIONS Active surveillance was associated with spontaneous regression and long-term disease control consistent with other studies. Primary radiation therapy appeared to provide a similar response and disease control compared with systemic treatments and may be a viable option for patients who are not candidates for surgery or active surveillance.
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Affiliation(s)
- A de Bruyns
- Faculty of Medicine, Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - H Li
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - A MacNeil
- Department of Surgery, Vancouver General Hospital, University of British Columbia, British Columbia Cancer Agency - Vancouver Center, Vancouver, British Columbia, Canada
| | - C Simmons
- Department of Medical Oncology, University of British Columbia, British Columbia Cancer Agency - Vancouver Center, Vancouver, British Columbia, Canada
| | - P Clarkson
- Department of Surgery, Vancouver General Hospital, University of British Columbia, British Columbia Cancer Agency - Vancouver Center, Vancouver, British Columbia, Canada
| | - K Goddard
- Department of Radiation Oncology, University of British Columbia, British Columbia Cancer Agency - Vancouver Center, Vancouver, British Columbia, Canada
| | - P L Munk
- Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, British Columbia Cancer Agency - Vancouver Center, Vancouver, British Columbia, Canada
| | - J J Hart
- Department of Medical Oncology, University of British Columbia, British Columbia Cancer Agency - Vancouver Center, Vancouver, British Columbia, Canada
| | - C Holloway
- Department of Radiation Oncology, University of British Columbia, British Columbia Cancer Agency - Vancouver Center, Vancouver, British Columbia, Canada
| | - P Truong
- Department of Radiation Oncology, University of British Columbia, British Columbia Cancer Agency - Vancouver Center, Vancouver, British Columbia, Canada
| | - X Feng
- Department of Medical Oncology, University of British Columbia, British Columbia Cancer Agency - Vancouver Center, Vancouver, British Columbia, Canada.
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Khan JS, Hodgson N, Choi S, Reid S, Paul JE, Hong NJL, Holloway C, Busse JW, Gilron I, Buckley DN, McGillion M, Clarke H, Katz J, Mackey S, Avram R, Pohl K, Rao-Melacini P, Devereaux P. Perioperative Pregabalin and Intraoperative Lidocaine Infusion to Reduce Persistent Neuropathic Pain After Breast Cancer Surgery: A Multicenter, Factorial, Randomized, Controlled Pilot Trial. The Journal of Pain 2019; 20:980-993. [DOI: 10.1016/j.jpain.2019.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/29/2019] [Accepted: 02/23/2019] [Indexed: 11/15/2022]
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Tadayyon H, Gangeh M, Sannachi L, Trudeau M, Pritchard K, Ghandi S, Eisen A, Look-Hong N, Holloway C, Wright F, Rakovitch E, Vesprini D, Tran WT, Curpen B, Czarnota G. A priori prediction of breast tumour response to chemotherapy using quantitative ultrasound imaging and artificial neural networks. Oncotarget 2019; 10:3910-3923. [PMID: 31231468 PMCID: PMC6570472 DOI: 10.18632/oncotarget.26996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/13/2019] [Indexed: 11/25/2022] Open
Abstract
We demonstrate the clinical utility of combining quantitative ultrasound (QUS) imaging of the breast with an artificial neural network (ANN) classifier to predict the response of breast cancer patients to neoadjuvant chemotherapy (NAC) administration prior to the start of treatment. Using a 6 MHz ultrasound system, radiofrequency (RF) ultrasound data were acquired from 100 patients with biopsy-confirmed locally advanced breast cancer prior to the start of NAC. Quantitative ultrasound mean parameter intensity and texture features were computed from the tumour core and margin, and were compared to the clinical/pathological response and 5-year recurrence-free survival (RFS) of patients. A multi-parametric QUS model in conjunction with an ANN classifier predicted patient response with 96 ± 6% accuracy, and a 0.96 ± 0.08 area under the receiver operating characteristic curve (AUC), compared to 65 ± 10 % accuracy and 0.67 ± 0.14 AUC achieved using a K-Nearest Neighbour (KNN) algorithm. A separate ANN model predicted patient RFS with 85 ± 7% accuracy, and a 0.89 ± 0.11 AUC, whereas the KNN methodology achieved a 58 ± 6 % accuracy and a 0.64 ± 0.09 AUC. The application of ANN for classifying patient response based on tumour QUS features performs well in terms of predicting response to chemotherapy. The findings here provide a framework for developing personalized a priori chemotherapy selection for patients that are candidates for NAC, potentially resulting in improved patient treatment outcomes and prognosis.
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Affiliation(s)
- Hadi Tadayyon
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mehrdad Gangeh
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lakshmanan Sannachi
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Maureen Trudeau
- Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kathleen Pritchard
- Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sonal Ghandi
- Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrea Eisen
- Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole Look-Hong
- Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Claire Holloway
- Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frances Wright
- Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Eileen Rakovitch
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - William Tyler Tran
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Belinda Curpen
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, and Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregory Czarnota
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Abstract
OBJECTIVES Theoretical and untested interactions between antiretrovirals and direct-acting oral anticoagulants have limited the use of this new class of anticoagulant in people with HIV infection. This case series, the first of its kind, reports on the successful concurrent use of the direct-acting oral anticoagulant dabigatran and antiretroviral therapy. METHODS This series involved 14 patients requiring anticoagulation for management of atrial fibrillation, who were either unable or unwilling to take warfarin, and who were receiving concurrent treatment for HIV infection. Participants were treated with dabigatran with dose monitoring to establish the safety and efficacy of concurrent use with antiretrovirals. All were commenced on 110 mg twice daily, increased to 150 mg twice daily if the trough level was < 69.3 ng/mL. RESULTS In the 14 patients treated with dabigatran and antiretrovirals, there were no thromboembolic or bleeding complications. Dabigatran treatment was discontinued in one patient because of undetectable dabigatran levels despite dose escalation. Dabigatran levels fell within the fivefold variance seen in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) study at a dose of either 110 or 150 mg twice daily. CONCLUSIONS This case series represents the largest published population to date successfully receiving antiretroviral and direct-acting oral anticoagulant therapy. Given the significant health care burden faced by people living with HIV, the availability of safe anticoagulant therapy without the requirement for monitoring is an important option in this patient population.
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Affiliation(s)
- J Perram
- Royal Prince Alfred and Concord Hospitals, Sydney, NSW, Australia
| | - E O'Dwyer
- St Vincent's Hospital, Sydney, NSW, Australia
| | - C Holloway
- St Vincent's Hospital, Sydney, NSW, Australia
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Conte S, Jones K, Molan N, Holloway C. Direct Oral Anticoagulants for Left Ventricular Thrombus. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Situ Y, Lin L, Namasivayam M, Watson B, Emmanuel S, Jabbour A, McCrohon J, Holloway C. The Utility of Cardiovascular Magnetic Resonance in the Assessment of Patients before Pacemaker Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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McGrath-Cadell L, Hesselson S, Iismaa S, Mishra K, Wong C, Fatkin D, Dunwoodie S, Harvey R, Holloway C, Muller D, Giannoulatou E, Graham R. Familial Clustering of Spontaneous Coronary Artery Dissection. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kaurin D, Eagle A, Hart A, Holloway C, Courlas G, Stevens P, Gopan O, Schoen A. Profile- and output-determined Prp output corrections for a Varian TrueBeam and Elekta Versa HD. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mahmod M, Hundertmark M, Stoll V, Raman B, Ariga R, Dass S, Holloway C, Karamitsos T, Rodgers C, Rider O, Neubauer S. P1808Patients with heart failure with mid-range and reduced left ventricular ejection fraction show similar derangement of cardiac energy and lipid metabolism. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Mahmod
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - V Stoll
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - B Raman
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - R Ariga
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S Dass
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - C Holloway
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - T Karamitsos
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - C Rodgers
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - O Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Oxford, United Kingdom
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Lin L, Namasivayam M, Muller D, Holloway C. Advanced Imaging Using Cardiac Magnetic Resonance Imaging and Three-Dimensional Echocardiography of Tendyne Valve Implantation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ko J, Gelowitz G, Tinker A, Holloway C, Kumar A. Impact of the adjuvant management and risk factors on survival in FIGO stage 3 endometrial cancer patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kaan M, Holloway C, Gilbert J, Simanovski V, Matheson G. Faster and better: Improving the diagnostic phase of lung cancer at a system level. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
115 Background: For many patients going through diagnostic testing for cancer, the time from suspicion to diagnosis or rule-out, can be a confusing and anxious time. In 2007, Cancer Care Ontario began investing in the implementation of diagnostic assessment programs (DAPs) across Ontario, Canada to improve the quality of care during the diagnostic phase of lung cancer. DAPs consist of multidisciplinary healthcare teams that manage and coordinate a patient’s diagnostic care from testing to a definitive diagnosis. The objectives of the DAPs are to: 1) decrease time from suspicion to diagnosis or resolution; 2) optimize the patient’s experience during the diagnostic process; 3) optimize satisfaction and experience among primary care providers and specialists; and 4) provide a sustainable solution by offering good value for money. Today over 35,000 patients have been diagnosed in one of the 18 lung DAPs that exist across the province. Methods: The implementation of DAPs featured the introduction of a patient navigator to act as the primary point of contact for patients, improve the patient experience and ensure their patients were progressing through any required diagnostic imaging and consultations in a timely manner. Cancer Care Ontario also engaged with primary care providers to refer patients with findings suspicious for lung cancer to DAPs as early as possible to ensure they benefited from organized assessment. Cancer Care Ontario has collected patient level data to measure wait times and implemented a patient survey to assess patient experience. Results: In the past five years, the median wait time from referral to a lung DAP to diagnosis or rule out has decreased by 19% to 24 days and the 90th %tile has decreased by 28% to 51 days. The large majority of patients have had a positive experience with their DAPs, with 95% of patients scoring their experience in the diagnostic process as “good” or “excellent”. Conclusions: The implementation of DAPs across the province is seen as a valuable component of quality of care by improving the diagnostic phase of cancer. The sustainability of the DAP model is demonstrated by the continued improvements in access and maintained patient experience in spite of growing volumes (91% increase in the past five years).
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Savage P, Holloway C, Lindsay G, Shubrook K, Jones C, Fung M, Schaff K, Anderson H, Nystedt K, Rauw J. Cancer referral and treatment activity 2010-2015: a population-based study from Vancouver Island. ACTA ACUST UNITED AC 2017; 23:e626-e629. [PMID: 28050153 DOI: 10.3747/co.23.3306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The years since 2005 have seen major changes in cancer treatment and significant increases in the number of anticancer drugs available. However, there are relatively few published data to reflect how those changes are affecting the activity and workload of oncology services. To explore the effects of those changes, we reviewed the population-based cancer treatment activity on Vancouver Island for the period 2010-2015. METHODS Information about new patient referrals, radiation courses, new chemotherapy cycles commenced, total intravenous (IV) chemotherapy treatment visits, and pharmacy activity for oral anticancer drug prescriptions was obtained from BC Cancer Agency databases. RESULTS During the 5-year study period, the Vancouver Island population increased by 2.8% and the number of new referrals to the BC Cancer Agency increased by 17.7%. The overall number of radiation courses increased by 6.1%. In contrast, IV chemotherapy activity increased by 52.1% for new courses commenced and by 62% for total IV chemotherapy attendances. Oral anticancer drug prescriptions rose by 22.9% during the 5-year period. CONCLUSIONS Our study documents substantial recent increases in cancer therapy activity in terms of patient referrals and particularly IV chemotherapy and oral anticancer therapy. The data reported here could be of value in planning for future care provision.
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Affiliation(s)
- P Savage
- BC Cancer Agency, Vancouver Island, Victoria, BC
| | - C Holloway
- BC Cancer Agency, Vancouver Island, Victoria, BC
| | - G Lindsay
- BC Cancer Agency, Vancouver Island, Victoria, BC
| | - K Shubrook
- BC Cancer Agency, Vancouver Island, Victoria, BC
| | - C Jones
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, U.K
| | - M Fung
- BC Cancer Agency, Vancouver Island, Victoria, BC
| | - K Schaff
- BC Cancer Agency, Vancouver Island, Victoria, BC
| | - H Anderson
- BC Cancer Agency, Vancouver Island, Victoria, BC
| | - K Nystedt
- BC Cancer Agency, Vancouver Island, Victoria, BC
| | - J Rauw
- BC Cancer Agency, Vancouver Island, Victoria, BC
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Imran M, Wang L, McCrohon J, Holloway C, Otton J, Yu C, Hunag J, Grover R, Moffat K, Ross J, Kotlyar E, Keogh A, Hayward C, Macdonald P, Jabbour A. Multiparametric Tissue Mapping in the Diagnosis and Management of Cardiac Transplant Rejection: A Prospective, Histologically-Validated Study. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holloway C, Robinson H, Rees D, McDowell J, Andrews S, Joshi A, Jolliffe V, Trickey J, Peall A. AB1114-HPR Biologic Dose Tapering Improves Patient Care and Advances The Rheumatology Service. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Trickey J, Holloway C, Robinson H, McDowell J, Andrews S, Jolliffe V, Joshi A, Rees D, Peall A. AB0351 Biologic Tapering in Rheumatoid Arthritis: Initial Experiences in An English District General Hospital. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mackay H, Soobrian J, Ferguson SE, Faught W, Ross J, Holloway C. Ovarian cancer pathway map development as an approach to identifying priority areas for quality improvement in Ontario. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Helen Mackay
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Sarah E. Ferguson
- Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | | | - Jillian Ross
- Clinical Programs and Quality Initiatives, Cancer Care Ontario, Toronto, ON, Canada
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Imran M, Wang L, McCrohon J, Yu C, Huang J, Holloway C, James O, Stehning C, Moffat K, Ross J, Kotlyar E, Hayward C, Keogh A, Macdonald P, Jabbour A. Role of Novel Cardiovascular Magnetic Resonance Based Tissue Characterization in the Detection of Cardiac Transplant Rejection. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mackay H, Soobrian J, Murphy J, Elit L, Milosevic MF, Gollnow A, Ross J, Holloway C. Pathway map development as an approach to identifying priority areas for quality improvement in Ontario. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
108 Background: Disease Pathway Management (DPM) is the unifying approach to the way in which Cancer Care Ontario (CCO) sets priorities for cancer control, plans cancer services and improves the quality of care in Ontario. In 2014 DPM began developing a cervical cancer pathway map (CCPM) to map the patient journey along the cervical cancer care continuum. Objective: to report on the CPPM development process as a tool to identify key priorities for cervical cancer management in Ontario. Methods: DPM convened a multidisciplinary/multi-stakeholder cervical cancer working group with regional and specialty representation from across Ontario. Over 12 months, 33 individuals participated in an in-person meeting and monthly teleconferences. The CCPM was drafted using guidelines developed by CCO’s Program in Evidence Based Care (PEBC) and considering clinical guidance documents from several jurisdictions. Throughout the development process the team were asked to discuss and reach consensus on key priorities for improving care. Results: Twenty-two priority areas were identified across the continuum in: prevention, diagnosis, treatment, follow-up and survivorship. Opportunities were identified for: development/endorsement of evidence based guidelines; patient-centered approaches to screening; quality improvement; survivorship; drug funding implementation and a CPPM Knowledge Translation strategy. Potentially actionable items were aligned with relevant internal and external stakeholders including organized screening programs, the PEBC, provincial drug reimbursement programs and other quality improvement teams within CCO. Conclusions: The process of bringing multidisciplinary experts together in order to develop the CPPM successfully identified key priorities across the spectrum of care in Ontario and allowed identification of potential opportunities for quality improvement, development of practice guidelines and new models of care. In turn, the CCPM provides a patient-centred disease focused framework from which stakeholders can approach and evaluate new initiatives in the context of the cervical cancer continuum.
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Affiliation(s)
| | | | - Joan Murphy
- Trillium Health Partners, Mississauga, ON, Canada
| | | | | | | | - Jillian Ross
- Clinical Programs and Quality Initiatives, Cancer Care Ontario, Toronto, ON, Canada
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Eisen A, Soobrian J, Tyrrell A, Li C, Muradali D, Forbes MF, Gollnow A, Ross J, Holloway C. Using a disease pathway management approach to improve the quality of breast cancer care in Ontario. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.109] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.
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Affiliation(s)
- Andrea Eisen
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | | | | | - Clement Li
- Cancer Care Ontario, Toronto, ON, Canada
| | | | | | | | - Jillian Ross
- Clinical Programs and Quality Initiatives, Cancer Care Ontario, Toronto, ON, Canada
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O’Dwyer E, Bhamra-Ariza P, Rao S, Emmanuel S, Holloway C. Characterisation of coronary artery disease in a contemporary cohort of Australian patients with treated HIV, using invasive coronary angiography. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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O’Dwyer E, Ntusi N, Dorrell L, Wainwright E, Holloway C, Piechnik S, Clutton G, Hancock G, Ferrier V, Cox P, Badri M, Karamitos T, Clarke K, Neubauer S. Cardiac MRI demonstrates increased pericardial effusions and subclinical myocardial inflammation, as a potential cause for cardiac dysfunction in a contemporary cohort of patients with HIV. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Metcalfe KA, Zhong T, Narod SA, Quan ML, Holloway C, Hofer S, Bagher S, Semple J. A prospective study of mastectomy patients with and without delayed breast reconstruction: long-term psychosocial functioning in the breast cancer survivorship period. J Surg Oncol 2014; 111:258-64. [PMID: 25557452 DOI: 10.1002/jso.23829] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/30/2014] [Indexed: 11/07/2022]
Abstract
INTRODUCTION For women who have mastectomy, breast reconstruction is an option which may improve psychosocial functioning. The purpose of this study was to evaluate changes in psychosocial functioning over a long follow-up period after mastectomy, specifically examining the differences between those with mastectomy alone and those who underwent postmastectomy delayed breast reconstruction (DBR). METHODS This was a prospective longitudinal survey study of women with mastectomy in which a repeated measures design was used to compare psychosocial function scores over 3 timepoints: 1) pre-mastectomy; 2) one year post-mastectomy; and 3) long-term post-mastectomy (mean 6.3 years). In addition, psychosocial functioning was compared between the mastectomy alone group and the group who elected for DBR. RESULTS 67 women who completed questionnaires at all three time points were included. The long-term follow-up time post-mastectomy was 75.2 months (6.3 years). Twenty-eight women (41.8%) underwent DBR in the study period. For the entire cohort, between one-year and long-term post-mastectomy, there were significant improvements in scores for body concerns (P = 0.03), cancer-related distress (P = 0.01), and total distress (P = 0.04). At long-term follow-up, women with DBR had significantly higher levels of total distress (P = 0.01), obsessiveness (P = 0.03), and cancer-related distress (P = 0.02) compared to those with mastectomy alone. There were no differences in quality of life between the two groups at any time point. CONCLUSIONS Psychosocial functioning improves over time in patients treated with mastectomy in the long-term breast cancer survivorship period, which may be related to the effect of time post-treatment, rather than an effect of choice for or against DBR.
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Affiliation(s)
- Kelly A Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Women's College Research Institute, Toronto, Canada; Faculty of Medicine, Department of Surgery in the Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Canada
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Lam P, Yang W, Amemiya Y, Kahn H, Yee A, Holloway C, Seth A. A human bone NOD/SCID mouse model to distinguish metastatic potential in primary breast cancers. Cancer Biol Ther 2014; 8:1010-7. [DOI: 10.4161/cbt.8.11.8343] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Cannon A, Carvey S, Holloway C, Mayer R, Dow L. 19 * UTI OVER-DIAGNOSIS IN OLDER ADULTS-INTERVENTION WITH EDUCATION AND SIGN 88. Age Ageing 2014. [DOI: 10.1093/ageing/afu124.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Simpson JS, Baltzer H, McMillian CR, Boileau JF, Wright F, Lipa J, Snell L, Holloway C. Multidisciplinary assessment for immediate breast reconstruction: A new approach. Surgical Practice 2014. [DOI: 10.1111/1744-1633.12075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jory S. Simpson
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Heather Baltzer
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Catherine R. McMillian
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Jean Francois Boileau
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Frances Wright
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Joan Lipa
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Laura Snell
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Claire Holloway
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
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Secchi F, Cannao P, Pluchinotta F, Butera G, Carminati M, Sardanelli F, Lombardi M, Monney P, Piccini D, Rutz T, Vincenti G, Coppo S, Koestner S, Stuber M, Schwitter J, Romana P, Francesco S, Gianfranco B, Mario C, Francesco S, Massimo L, Alizadeh Sani Z, Vojdan-Parast M, Alimohammadi M, Sarafan-Sadeghi S, Seifi A, Fallahabadi H, Karami Tanha F, Jamshidi M, Hesamy M, Bonello B, Sorensen C, Fouilloux V, Gorincour G, Mace L, Fraisse A, Jacquier A, de Meester C, Amzulescu M, Bouzin C, Boileau L, Melchior J, Boulif J, Lazam S, Pasquet A, Vancrayenest D, Vanoverschelde J, Gerber B, Loudon M, Bull S, Bissell M, Joseph J, Neubauer S, Myerson S, Dorniak K, Hellmann M, Rawicz-Zegrzda D, W sierska M, Sabisz A, Szurowska E, Heiberg E, Dudziak M, Kwok T, Chin C, Dweck M, Hadamitzky M, Nadjiri J, Hendrich E, Pankalla C, Will A, Schunkert H, Martinoff S, Sonne C, Pepe A, Meloni A, Terrazzino F, Spasiano A, Filosa A, Bitti P, Tangari C, Restaino G, Resta M, Ricchi P, Meloni A, Tudisca C, Grassedonio E, Positano V, Piraino B, Romano N, Keilberg P, Midiri M, Pepe A, Meloni A, Positano V, Macchi S, Ambrosio D, De Marchi D, Chiodi E, Resta M, Salvatori C, Pepe A, Artang R, Bogachkov A, Botelho M, Bou-Ayache J, Vazquez M, Carr J, Collins J, Maret E, Ahlander B, Bjorklund P, Engvall J, Cimermancic R, Inage A, Mizuno N, Positano V, Meloni A, Santarelli M, Izzi G, Maddaloni D, De Marchi D, Salvatori C, Landini L, Pepe A, Pepe A, Meloni A, Carulli G, Oliva E, Arcioni F, Fraticelli V, Toia P, Renne S, Restaino G, Salvatori C, Rizzo M, Reinstadler S, Klug G, Feistritzer H, Aschauer A, Schocke M, Franz W, Metzler B, Melonil A, Positanol V, Roccamo G, Argento C, Benni M, De Marchil D, Missere M, Prezios P, Salvatoril C, Pepel A, Meloni A, Rossi G, Positano V, Cirotto C, Filati G, Toia P, Preziosi P, De Marchi D, Pepe A, Mongeon F, Fischer K, Teixeira T, Friedrich M, Marcotte F, Vincenti G, Monney P, Rutz T, Zenge M, Schmidt M, Nadar M, Chevre P, Rohner C, Schwitter J, Mouratoglou S, Kallifatidis A, Giannakoulas G, Grapsa J, Kamperidis V, Pitsiou G, Stanopoulos I, Hadjimiltiades S, Karvounis H, Ahmed N, Lawton C, Ghosh Dastidar A, Frontera A, Jackson A, Cripps T, Diab I, Duncan E, Thomas G, Bucciarelli-Ducci C, Kannoly S, Gosling O, Ninan T, Fulford J, Dalrymple-Haym M, Shore A, Bellenger N, Alegret J, Beltran R, Martin M, Mendoza M, Elisabetta C, Teresa C, Zairo F, Marcello N, Clorinda M, Bruna M, Vincenzo P, Alessia P, Giorgio B, Klug G, Feistritzer H, Reinstadler S, Mair J, Schocke M, Kremser C, Franz W, Metzler B, Aschauer S, Tufaro C, Kammerlander A, Pfaffenberger S, Marzluf B, Bonderman D, Mascherbauer J, Kliegel A, Sailer A, Brustbauer R, Sedivy R, Mayr H, Manessi M, Castelvecchio S, Votta E, Stevanella M, Menicanti L, Secchi F, Sardanelli F, Lombardi M, Redaelli A, Reiter U, Reiter G, Kovacs G, Greiser A, Olschewski H, Fuchsjager M, Kammerlander A, Tufaro C, Pfaffenberger S, Marzluf B, Aschauer S, Babayev J, Bonderman D, Mascherbauer J, Mlynarski R, Mlynarska A, Sosnowski M, Pontone G, Bertella E, Petulla M, Russo E, Innocenti E, Baggiano A, Mushtaq S, Gripari P, Andreini D, Tondo C, Nyktari E, Izgi C, Haidar S, Wage R, Keegan J, Wong T, Mohiaddin R, Durante A, Rimoldi O, Laforgia P, Gianni U, Benedetti G, Cava M, Damascelli A, Laricchia A, Ancona M, Aurelio A, Pizzetti G, Esposito A, Margonato A, Colombo A, De Cobelli F, Camici P, Zvaigzne L, Sergejenko S, Kal js O, Kannoly S, Ripley D, Swarbrick D, Gosling O, Hossain E, Chawner R, Moore J, Shore A, Bellenger N, Aquaro G, Barison A, Masci P, Todiere G, Strata E, Barison A, Di Bella G, Monasterio F, Feistritzer H, Reinstadler S, Klug G, Kremser C, Schocke M, Franz W, Metzler B, Levelt E, Mahmod M, Ntusi N, Ariga R, Upton R, Piechnick S, Francis J, Schneider J, Stoll V, Davis A, Karamitsos T, Leeson P, Holloway C, Clarke K, Neubauer S, Karwat K, Tomala M, Miszalski-Jamka K, Mrozi ska S, Kowalczyk M, Mazur W, Kereiakes D, Nessler J, Zmudka K, Ja wiec P, Miszalski-Jamka T, Ben Yaacoub-Kzadri I, Harguem S, Bennaceur R, Ganzoui I, Ben Miled A, Mnif N, Rodriguez Palomares J, Ortiz J, Bucciarelli-Ducci C, Tejedor P, Lee D, Wu E, Bonow R, Khanji M, Castiello T, Westwood M, Petersen S, Pepe A, Meloni A, Carulli G, Oliva E, Arcioni F, Storti S, Grassedonio E, Renne S, Missere M, Positano V, Rizzo M, Meloni A, Quota A, Smacchia M, Paci C, Positano V, Vallone A, Valeri G, Chiodi E, keilberg P, Pepe A, Barison A, De Marchi D, Gargani L, Aquaro G, Guiducci S, Pugliese N, Lombardi M, Pingitore A, Cole B, Douglas H, Rodden S, Horan P, Harbinson M, Johnston N, Dixon L, Choudhary P, Hsu C, Grieve S, Semsarian C, Richmond D, Celermajer D, Puranik R, Hinojar Baydes R, Varma N, Goodman B, Khan S, Arroyo Ucar E, Dabir D, Schaeffter T, Nagel E, Puntmann V, Hinojar R, Ucar E, Ngah N, Kuo N, D'Cruz D, Gaddum N, Schaeffter T, Nagel E, Puntmann V, Hinojar R, Foote L, Arroyo Ucar E, Dabir D, Schnackenburg B, Higgins D, Schaeffter T, Nagel E, Puntmann V, Nucifora G, Muser D, Morocutti G, Gianfagna P, Zanuttini D, Piccoli G, Proclemer A, Nucifora G, Prati G, Vitrella G, Allocca G, Buttignoni S, Muser D, Morocutti G, Delise P, Proclemer A, Sinagra G, Silva G, Almeida A, David C, Francisco A, Magalhaes A, Placido R, Menezes M, Guimaraes T, Mendes A, Nunes Diogo A, Aneq M, Maret E, Engvall J, Douglas H, Cole B, Rodden S, Horan P, Harbinson M, Dixon L, Johnston N, Papavassiliu T, Sandberg R, Schimpf R, Schoenberg S, Borggrefe M, Doesch C, Khan S, Tamin S, Tan L, Joshi S, Khan S, Memon S, Tamin S, Tan L, Joshi S, Tangcharoen T, Prasertkulchai W, Yamwong S, Sritara P, Hinojar R, Foote L, Arroyo Ucar E, Binti Ngah N, Cruz D, Schnackenburg B, Higgins D, Schaeffter T, Nagel E, Puntmann V, Nucifora G, Muser D, Masci P, Barison A, Rebellato L, Piccoli G, Daleffe E, Zanuttini D, Facchin D, Lombardi M, Proclemer A, Melao F, Paiva M, Pinho T, Martins E, Vasconcelos M, Madureira A, Macedo F, Ramos I, Maciel M, Agoston-Coldea L, Marjanovic Z, Hadj Khelifa S, Kachenoura N, Lupu S, Soulat G, Farge-Bancel D, Mousseaux E, Ben Yaacoub-Kzadri I, Harguem S, Bennaceur R, Ben Miled A, Mnif N, Dastidar A, Ahmed N, Frontera A, Lawton C, Augustine D, McAlindon E, Bucciarelli-Ducci C, Vasconcelos M, Leite S, Sousa C, Pinho T, Rangel I, Madureira A, Ramos I, Maciel M, El ghannudi S, Lefoulon A, Noel E, Germain P, Doutreleau S, Jeung M, Gangi A, Roy C, Todiere G, Pisciella L, Barison A, Zachara E, Federica R, Emdin M, Aquaro G, El ghannudi S, Lefoulon A, Noel E, Germain P, Doutreleau S, Jeung M, Gangi A, Roy C, Baydes R, Ucar E, Foote L, Dabir D, Mahmoud I, Jackson T, Schaeffter T, Higgins D, Nagel E, Puntmann V, Melao F, Paiva M, Pinho T, Martins E, Vasconcelos M, Madureira A, Macedo F, Ramos I, Maciel M. These abstracts have been selected for VIEWING only as ePosters and in print. ePosters will be available on Screen A & B throughout the meeting, Print Posters at the times indicated below. Please refer to the PROGRAM for more details. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jennewein T, Bourgoin JP, Higgins B, Holloway C, Meyer-Scott E, Erven C, Heim B, Yan Z, Hübel H, Weihs G, Choi E, D'Souza I, Hudson D, Laflamme R. QEYSSAT: a mission proposal for a quantum receiver in space. ACTA ACUST UNITED AC 2014. [DOI: 10.1117/12.2041693] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Boileau JF, Poirier B, Basik M, Holloway C, Gaboury L, Sideris L, Meterissian SH, Arnaout A, Brackstone M, McCready DR, Karp SE, Wright FC, Younan R, Provencher L, Patocskai E, Omeroglu A, Robidoux A. Sentinel node biopsy after neoadjuvant therapy: Relevance of sentinel node micrometastases, isolated tumor cells, and value of immunohistochemistry. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.26_suppl.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
52 Background: Sentinel node biopsy (SNB) is used in breast cancer patients that present with clinically negative nodes. In this setting, most guidelines do not support the use of immunohistochemistry (IHC) and recommend against completion node dissection (CND) when only isolated tumor cells (pN0(i+)) or micrometasases (pN1mi) are identified. When SNB is used after neoadjuvant therapy (NAT), the relevance of ypN0(i+) and ypN1mi sentinel nodes (SNs) and the value of IHC are not well established. The goals of this study are to determine if CND should be recommended in the presence of ypN0(i+) or ypN1mi SNs and if IHC should be used to evaluate SNs after NAT. Methods: From March 2009 to December 2012, 152 women with biopsy proven node positive breast cancer were accrued to the multicentric prospective SN FNAC trial. After NAT, SNB was followed by a CND in all participants. SNs were cut in serial slices no thicker than 2 mm. Hematoxylin and eosin stains (H and E) were done on all slices, and if negative, IHC was used. The size of the largest SN metastasis and the primary method of identification (H and E or IHC) were recorded. ypN0(i+), ypN1mi and ypN1 SNs were considered as positive. Pathology was centrally reviewed. Results: 145 women were eligible for the trial. Axillary pathologic complete response rate = 34% (49/145). SNB success rate = 88% (127/145). False negative rate = 8.4% (7/83). If ypN0(i+) SNs are classified as node negative, the false negative rate is increased to 13.3% (11/83). For patients with ypN0(i+) (n=7), ypN1mi (n=8) and ypN1 (n=61) SNs, the rates of non-SN involvement are 57%, 38% and 56% respectively (p=NS). 40% (27/68) of positive SNBs are primarily detected by IHC. This is increased to 64% (9/14) for the identification of SN metastases ≤ 2mm. Conclusions: After NAT, particularly when presenting with biopsy proven node positive breast cancer, patients with ypN0(i+) and ypN1mi SNs have a significant rate of non-SN involvement. In the absence of evidence to show that a CND can be safely avoided, efforts should be made to identify even minimal amounts of disease when SNBs are done following NAT. IHC is useful to increase the detection of small SN metastases in this setting. Clinical trial information: NCT00909441.
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Affiliation(s)
| | | | - Mark Basik
- Segal Cancer Center/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Claire Holloway
- Odette Cancer Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada
| | - Louis Gaboury
- Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, QC, Canada
| | | | | | | | | | - David R. McCready
- University Health Network-Princess Margaret Hospital, Toronto, ON, Canada
| | | | | | - Rami Younan
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Louise Provencher
- Centre des Maladies du sein Deschênes-Fabia, Centre de Recherche du CHU de Québec, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Erika Patocskai
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Andre Robidoux
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
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Wainwright EC, Rider OJ, Asaad M, Ntusi N, Hancock G, Pitcher A, Clarke K, Dorrell L, Neubauer S, Holloway C. P2.122 HIV is an Independent Predictor of Aortic Pulse Wave Velocity. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Holloway C, Mahendra S, Kaurin D, Sweeney L. SU-E-T-85: Total Body Irradiation (TBI) Optically Stimulated Luminescence In Vivo Dosimetry. Med Phys 2013. [DOI: 10.1118/1.4814520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Boileau JF, Poirier B, Basik M, Holloway C, Gaboury L, Sideris L, Meterissian SH, Arnaout A, Brackstone M, McCready DR, Karp SE, Wright FC, Younan R, Provencher L, Patocskai E, Omeroglu A, Robidoux A. Sentinel node biopsy following neoadjuvant chemotherapy in biopsy proven node positive breast cancer: The SN FNAC study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1018 Background: A significant and increasing proportion of patients (>30%) with biopsy proven node positive breast cancer will obtain a pathological complete response (pCR) in the axilla after neoadjuvant chemotherapy (NAC). If sentinel node biopsy (SNB) can accurately identify these patients, they could potentially avoid the morbidity of an axillary node dissection. The primary aim of this study is to evaluate the identification rate (IR), false negative rate (FNR) and accuracy of SNB in this setting. The accuracy of post NAC axillary ultrasound and clinical examination are evaluated as secondary endpoints. Methods: Patients with biopsy proven node positive breast cancer (T0-3, N1-2, M0) treated with NAC were eligible to participate in this multi-centre prospective trial. Following NAC, axillary ultrasound and clinical examination results were obtained. At time of surgery, all participants underwent both a SNB and a completion node dissection. A SNB IR greater than 90% and a FNR of less than 10% were pre-determined as being optimal. Results: From September 2009 to December 2012, 153 patients were accrued to the study. 7 patients were not eligible and 5 patients had not yet undergone surgery at the time of analysis. Axillary pCR rate = 34.0% (48/141). SNB IR = 87.2% (123/141), 95% CI [81.7%-92.7%] and FNR = 9.9% (8/81), 95% CI [3.4%-16.4%]. If only one sentinel node was removed, FNR = 19.0%(4/21); if there were 2 or more sentinel nodes, FNR = 6.6% (4/61) (p < 0.0001). Accuracy of SNB, axillary ultrasound and clinical examination were 93.5%, 63.2%, and 45.5% respectively. Conclusions: SNB following NAC in biopsy proven node positive breast cancer is associated with a suboptimal IR. FNR (less than 10%) and accuracy of SNB in this study are comparable to that of patients that present with clinically negative nodes. The FNR decreases when more than one sentinel node is identified. However, in an era where regional nodal radiation is increasingly used, the relevance of leaving residual disease in the undissected axilla after NAC is unknown and remains to be investigated. Clinical trial information: NCT00909441.
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Affiliation(s)
| | | | - Mark Basik
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
| | - Claire Holloway
- Odette Cancer Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada
| | - Louis Gaboury
- Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, QC, Canada
| | | | | | | | | | - David R. McCready
- University Health Network-Princess Margaret Hospital, Toronto, ON, Canada
| | | | - Frances Catriona Wright
- Odette Cancer Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada
| | - Rami Younan
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Erika Patocskai
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Andre Robidoux
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Ferreira V, Piechnik S, Dall'Armellina E, Karamitsos T, Francis J, Ntusi N, Holloway C, Choudhury R, Kardos A, Robson M, Friedrich M, Neubauer S. 086 THE DETECTION OF ACUTE MYOCARDITIS USING CARDIOVASCULAR MRI: A CLINICAL STUDY COMPARING T1-MAPPING, T2-WEIGHTED AND LATE GADOLINIUM ENHANCEMENT IMAGING. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ferreira VM, Piechnik SK, Dall'Armellina E, Karamitsos TD, Francis JM, Ntusi N, Holloway C, Choudhury RP, Kardos A, Robson MD, Friedrich MG, Neubauer S. 1072T1 mapping is a superior method to T2-weighted imaging in
the detection of acute myocarditis using cardiovascular magnetic
resonance. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet070a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kumarasinghe G, Yu C, Moffat K, Otton J, Holloway C, McCrohon J, Jabbour A. Cardiovascular Magnetic Resonance (CMR) Imaging Produces Highly Reproducible Rodent Cardiac Volumetric and Functional Data Using a 1.5Tesla Clinical Scanner. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Clausen H, Francis J, Holloway C. A pensioner with dyspnoea: cardiac magnetic resonance reveals pulmonary embolism. Case Reports 2012; 2012:bcr-2012-006532. [DOI: 10.1136/bcr-2012-006532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Luo X, Fang F, Sun J, Xie J, Lee A, Zhang Q, Yu C, Breithardt O, Schiessl S, Schmid M, Seltmann M, Klinghammer L, Zeissler C, Kuechle M, Daniel W, Ege M, Guray U, Guray Y, Demirkan B, Kisacik H, Kim SE, Hong JY, Lee JH, Park DG, Han KR, Oh DJ, Ege M, Demirkan B, Guray U, Guray Y, Tufekcioglu O, Kisacik H, Cozma DC, Mornos C, Ionac A, Petrescu L, Tutuianu C, Dragulescu SI, Guimaraes L, Tavares G, Rodrigues A, Nagamatsu C, Fischer C, Vieira M, Oliveira W, Wilberg T, Cordovil A, Morhy S, Muraru D, Peluso M, Dal Bianco L, Beraldo M, Solda' E, Tuveri M, Cucchini U, Al Mamary A, Badano L, Iliceto S, Pizzuti A, Mabritto B, Derosa C, Tomasello A, Rovere M, Parrini I, Conte M, Lareva N, Govorin A, Cooper R, Sharif J, Somauroo JD, Hung JD, Porcelli V, Skevington R, Shahzad A, Scott S, Lindqvist P, Soderberg S, Gonzalez M, Tossavainen E, Henein M, Nciri N, Saad H, Nawas S, Ali A, Youssufzay A, Safi A, Faruk S, Yurdakul S, Erdemir V, Tayyareci Y, Yildirimturk O, Memic K, Aytekin V, Gurel M, Aytekin S, Przewlocka-Kosmala M, Cielecka-Prynda M, Mysiak A, Kosmala W, Mornos C, Ionac A, Pescariu S, Cozma D, Mornos A, Dragulescu S, Maurea N, Tocchetti CG, Coppola C, Quintavalle C, Rea D, Barbieri A, Piscopo G, Arra C, Condorelli G, Iaffaioli R, Dalen H, Thorstensen A, Moelmen H, Torp H, Stoylen A, Augustine D, Basagiannis C, Suttie J, Cox P, Aitzaz R, Lewandowski A, Lazdam M, Holloway C, Becher H, Leeson P, Radovanovic S, Djokovic A, Todic B, Zdravkovic M, Zaja-Simic M, Banicevic S, Lisulov-Popovic D, Krotin M, Grapsa J, O'regan D, Dawson D, Durighel G, Howard L, Gibbs J, Nihoyannopoulos P, Tulunay Kaya C, Kilickap M, Kurklu H, Ozbek N, Koca C, Kozluca V, Esenboga K, Erol C, Kusmierczyk-Droszcz B, Kowalik E, Niewiadomska J, Hoffman P, Satendra M, Sargento L, Lopes S, Longo S, Lousada N, Palma Reis R, Chillo P, Rieck A, Lwakatare J, Lutale J, Gerdts E, Bonapace S, Molon G, Targher G, Rossi A, Lanzoni L, Canali G, Campopiano E, Zenari L, Bertolini L, Barbieri E, Hristova K, Vladiomirova-Kitova L, Katova T, Nikolov F, Nikolov P, Georgieva S, Simova I, Kostova V, Kuznetsov VA, Krinochkin DV, Chandraratna PA, Pak YA, Zakharova EH, Plusnin AV, Semukhin MV, Gorbatenko EA, Yaroslavskaya EI, Bedetti G, Gargani L, Scalese M, Pizzi C, Sicari R, Picano E, Reali M, Canali E, Cimino S, Francone M, Mancone M, Scardala R, Boccalini F, Hiramoto Y, Frustaci A, Agati L, Savino K, Lilli A, Bordoni E, Riccini C, Ambrosio G, Silva D, Cortez-Dias N, Carrilho-Ferreira P, Jorge C, Silva-Marques J, Magalhaes A, Santos L, Ribeiro S, Pinto F, Nunes Diogo A, Kinova E, Zlatareva N, Goudev A, Bonanad C, Lopez-Lereu M, Monmeneu J, Bodi V, Sanchis J, Nunez J, Chaustre F, Llacer A, Muraru D, Beraldo M, Solda' E, Ermacora D, Cucchini U, Dal Bianco L, Peluso D, Di Lazzari M, Badano L, Iliceto S, Meimoun P, Elmkies F, Benali T, Boulanger J, Zemir H, Clerc J, Luycx-Bore A, Velasco Del Castillo MS, Cacicedo Fernandez De Bobadilla A, Onaindia Gandarias J, Telleria Arrieta M, Zugazabeitia Irazabal G, Quintana Raczka O, Rodriguez Sanchez I, Romero Pereiro A, Laraudogoitia Zaldumbide E, Lekuona Goya I, Bonello B, El Louali E, Fouilloux V, Kammache I, Ovaert C, Kreitmann B, Fraisse A, Migliore R, Adaniya M, Barranco M, Miramont G, Tamagusuku H, Alassar A, Sharma R, Marciniak A, Valencia O, Abdulkareem N, Jahangiri M, Jander N, Kienzle R, Gohlke-Baerwolf C, Gohlke H, Neumann FJ, Minners J, Valbuena S, De Torres F, Lopez T, Gomez JJ, Guzman G, Dominguez F, Refoyo E, Moreno M, Lopez-Sendon JL, Ancona R, Comenale Pinto S, Caso P, Di Salvo G, Severino S, Cavallaro M, Calabro R, Enache R, Muraru D, Piazza R, Roman-Pognuz A, Popescu B, Calin A, Beladan C, Purcarea F, Nicolosi G, Ginghina C, Savu O, Enache R, Popescu B, Calin A, Beladan C, Rosca M, Jurcut R, Serban M, Dorobantu L, Ginghina C, Donal E, Mascle S, Thebault C, Veillard D, Hamonic H, Leguerrier A, Corbineau H, Popa BA, Diena M, Bogdan A, Benea D, Lanzillo G, Casati V, Novelli E, Popa A, Cerin G, Gual Capllonch F, Teis A, Lopez Ayerbe J, Ferrer E, Vallejo N, Gomez Denia E, Bayes Genis A, Spethmann S, Schattke S, Baldenhofer G, Stangl V, Laule M, Baumann G, Stangl K, Knebel F, Labata C, Vallejo N, Gomez Denia E, Garcia Alonso C, Ferrer E, Gual F, Lopez Ayerbe J, Teis A, Nunez Aragon R, Bayes Genis A, Satendra M, Sargento L, Sousa C, Lousada N, Palma Reis R, Vasile AI, Dorobantu M, Iorgulescu C, Bogdan S, Constantinescu D, Caldararu C, Tautu O, Vatasescu R, Badran H, Elnoamany MF, Ayad M, Elshereef A, Farhan A, Nassar Y, Yacoub M, Costabel J, Avegliano G, Elissamburu P, Thierer J, Castro F, Huguet M, Frangi A, Ronderos R, Prinz C, Van Buuren F, Faber L, Bitter T, Bogunovic N, Burchert W, Horstkotte D, Kasprzak JD, Smialowski A, Rudzinski T, Lipiec P, Krzeminska-Pakula M, Wierzbowska-Drabik K, Trzos E, Kurpesa M, Motoki H, Hana M, Marwick T, Allan K, Vazquez-Alvarez M, Medrano Lopez C, Granja Da Silva S, Marcos C, Rodriguez-Ogando A, Alvarez M, Camino M, Centeno M, Maroto E, Feltes Guzman G, Serra Tomas V, Acevedo O, Calli A, Barba M, Pintos G, Valverde V, Zamorano Gomez J, Marchel M, Kochanowski J, Piatkowski R, Madej A, Filipiak K, Hausmanowa-Petrusewicz I, Opolski G, Malev E, Zemtsovsky E, Reeva S, Timofeev E, Pshepiy A, Mihaila S, Rimbas R, Mincu R, Dulgheru R, Mihaila R, Badiu C, Cinteza M, Vinereanu D, Rodrigues A, Guimaraes L, Lira E, Lebihan D, Monaco C, Cordovil A, Oliveira W, Vieira M, Fischer C, Morhy S, Ruiz Ortiz M, Mesa D, Delgado M, Romo E, Pena M, Puentes M, Santisteban M, Lopez Granados A, Arizon Del Prado J, Suarez De Lezo J, Tsai WC, Shih JY, Huang TS, Liu YW, Huang YY, Tsai LM, Cho E, Choi K, Kwon B, Kim D, Jang S, Park C, Jung H, Jeon H, Youn H, Kim J, Rieck AE, Cramariuc D, Lonnebakken M, Lund B, Gerdts E, Moceri P, Doyen D, Cerboni P, Ferrari E, Li W, Silva D, Goncalves S, Ribeiro S, Santos L, Sargento L, Vinhais De Sousa G, Almeida AG, Nunes Diogo A, Hernandez Garcia C, De La Rosa Hernandez A, Arroyo Ucar E, Jorge Perez P, Barragan Acea A, Lacalzada Almeida J, 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S, Fisicaro A, Moramarco F, Latini G, Sicari R, Picano E, Seale A, Carvalho J, Gardiner H, Roughton M, Simpson J, Tometzki A, Uzun O, Webber S, Daubeney P, Elnoamany MF, Dawood A, Dwivedi G, Mahadevan G, Jiminez D, Steeds R, Frenneaux M, Attenhofer Jost CH, Knechtle B, Bernheim A, Pfyffer M, Linka A, Faeh-Gunz A, Seifert B, De Pasquale G, Zuber M, Simova I, Hristova K, Georgieva S, Kostova V, Katova T, Tomaszewski A, Kutarski A, Tomaszewski M. Poster Session 2: Thursday 8 December 2011, 14:00-18:00 * Location: Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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