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Black EK, MacLean D, Bell M, Neville HL, Kits O, Ramsey TD, Sketris I, Johnston L. A qualitative study evaluating barriers and enablers to improving antimicrobial use for the management of bacteriuria in hospitalized adults. Antimicrob Steward Healthc Epidemiol 2024; 4:e17. [PMID: 38415086 PMCID: PMC10897712 DOI: 10.1017/ash.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 02/29/2024]
Abstract
Objective The objective of this study was to explore barriers and enablers to improving the management of bacteriuria in hospitalized adults. Design Qualitative study. Setting Nova Scotia, Canada. Participants Nurses, physicians, and pharmacists involved in the assessment, diagnosis, and treatment of bacteriuria in hospitalized patients. Methods Focus groups (FGs) were completed between May and July 2019. FG discussions were facilitated using an interview guide that consisted of open-ended questions coded to the theoretical domains framework (TDF) v2. Discussions were transcribed verbatim then independently coded to the TDFv2 by two members of the research team and compared. Thematic analysis was used to identify themes. Results Thirty-three healthcare providers from five hospitals participated (15 pharmacists, 11 nurses, and 7 physicians). The use of antibiotics for the treatment of asymptomatic bacteriuria (ASB) was the main issue identified. Subthemes that related to management of ASB included: "diagnostic uncertainty," difficulty "ignoring positive urine cultures," "organizational challenges," and "how people learn." Barriers and/or enablers to improving the management of bacteriuria were mapped to 12 theoretical domains within these subthemes. Barriers and enablers identified by participants that were most extensively discussed related to the domains of environmental context and resources, belief about capabilities, social/professional role and identity, and social influences. Conclusions Healthcare providers highlighted barriers and recognized enablers that may improve delivery of care to patients with bacteriuria. A wide range of barriers at the individual and organization level to address diagnostic challenges and improve workload should be considered to improve management of bacteriuria.
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Affiliation(s)
- Emily K. Black
- Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Dianne MacLean
- IWK Health Centre, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Madison Bell
- Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Olga Kits
- Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Tasha D. Ramsey
- Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Lynn Johnston
- Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
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2
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Qaddoura A, Bartoszko J, Mitchell R, Frenette C, Johnston L, Mertz D, Pelude L, Thampi N, Smith SW. Extracorporeal membrane oxygenation for COVID-19-associated severe acute respiratory distress syndrome in Canada: Analysis of data from the Canadian Nosocomial Infection Surveillance Program. J Assoc Med Microbiol Infect Dis Can 2024; 8:272-282. [PMID: 38250620 PMCID: PMC10797765 DOI: 10.3138/jammi-2023-0015] [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] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 01/23/2024]
Abstract
Background Extracorporeal membrane oxygenation (ECMO) for COVID-19 across Canada has not been well-described. We studied trends for patients with COVID-19-related acute respiratory distress syndrome who received ECMO. Methods Multicentre retrospective cohort study using data from the Canadian Nosocomial Infection Surveillance Program across four different waves. Surveillance data was collected between March 2020 and June 2022. We reported data stratified by ECMO status and wave. Results ECMO recipients comprised 299 (6.8%) of the 4,408 critically ill patients included. ECMO recipients were younger (median age 49 versus 62 years, p < 0.001), less likely to be vaccinated against COVID-19 (Wave 4 data: 5.3% versus 19%; p = 0.002), and had fewer comorbidities compared to patients who did not receive ECMO. Thirty-day all-cause mortality was similar between the ECMO and non-ECMO groups (23% versus 26%; p = 0.25). Among ECMO recipients, mortality tended to decrease across Waves 1 to 4: 48%, 31%, 18%, and 16%, respectively (p = 0.04 for trend). However, this was no longer statistically significant when removing the high mortality during Wave 1 (p = 0.15). Conclusions Our findings suggest that critically ill patients in Canadian hospitals who received ECMO had different characteristics from those who did not receive ECMO. We also observed a trend of decreased mortality over the waves for the ECMO group. Possible explanatory factors may include potential delay in ECMO initiation during Wave 1, evolution of the virus, better understanding of COVID-19 disease and ECMO use, and new medical treatments and vaccines available in later waves. These findings may provide insight for future potential pandemics.
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Affiliation(s)
- Amro Qaddoura
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Bartoszko
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Robyn Mitchell
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Charles Frenette
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lynn Johnston
- Division of Infectious Diseases, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Dominik Mertz
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Linda Pelude
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Nisha Thampi
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Stephanie W Smith
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
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3
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Baniel CC, Johnston L, Jackson C, Arai S, Hiniker SM, Hoppe RT, Binkley MS. Low Dose Splenic Radiotherapy for Myeloproliferative Neoplasms prior to Allogeneic Hematopoietic Stem Cell Transplant. Int J Radiat Oncol Biol Phys 2023; 117:e458. [PMID: 37785467 DOI: 10.1016/j.ijrobp.2023.06.1651] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Myeloproliferative neoplasms including primary and secondary myelofibrosis (MF) are a rare spectrum of chronic myeloproliferative disorders in which nearly 90% of patients experience splenomegaly. Importantly, splenic radiotherapy (SRT) may be used in combination with allogeneic stem cell transplant (alloSCT) to improve symptoms related to splenomegaly, though there currently is no consensus SRT dose/fractionation protocol reported in the literature for use in combination with alloSCT. We sought to report our institutional experience utilizing low dose SRT prior to alloSCT in the post-Jakafi era. MATERIALS/METHODS We performed a retrospective review of all patients diagnosed with MF at our institution from 2017-2022 who received reduced intensity alloHCT. Patients who underwent total lymphoid or body irradiation were excluded. Descriptive demographic and clinical characteristics of patients were summarized by means, medians, standard deviations, ranges and proportions as appropriate. RESULTS We identified 39 patients with MF who underwent reduced intensity conditioning (RIC) consisting of fludarabine/melphalan in preparation for alloHCT (median age 64.5, 12/16 males, median follow up 21 months). 16 patients with Jakafi-resistant splenomegaly completed low dose SRT prior to transplant (median spleen size: 24.5cm) with a median dose of 5Gy delivered in 5 fractions. 3D conformal therapy was used for all patients. All patients completed the planned total radiation course without treatment break or dose limiting acute toxicity. Thrombocytopenia was the most reported toxicity (CTCAE v5.0; 2 patients experienced grade 1, 1 patient experienced grade 2). No patients experienced grade 3 or higher acute cytopenias nor required transfusion during radiotherapy. All patients successfully received alloHCT a median of 7 days (range: 2-11) after the completion of SRT with a 94% (15/16) engraftment rate. Median neutrophil recovery (ANC > 500 × 3 days) time was 18 days (range: 13-31); median length of hospital stay was 23 days (range: 20-129). Overall survival was 75% in the SRT cohort (12/16, 2 with persistent disease, 2 due to other causes). Symptom burden data was available for 14/16 patients; 79% (11/14) of patients reported improvement in symptoms associated with splenomegaly or reduction in splenic size on physical examination. CONCLUSION In the largest reported experience of a low dose SRT only cohort to date, we observe low dose SRT is feasible, safe in combination with alloHCT with high engraftment rates, and may reduce symptoms related to splenomegaly thereby improving patient quality of life without compromising transplant related outcomes. A prospective study validating this protocol is currently underway.
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Affiliation(s)
- C C Baniel
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - S Arai
- Stanford University, Stanford, CA
| | - S M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - R T Hoppe
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M S Binkley
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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4
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Mitchell R, Lee D, Pelude L, Comeau J, Conly J, Ellis C, Ellison J, Embil J, Evans G, Johnston L, Johnstone J, Katz K, Kibsey P, Lee B, Lefebvre MA, Longtin Y, McGeer A, Mertz D, Minion J, Smith S, Srigley J, Suh K, Tomlinson J, Wong A, Thampi N, Frenette C. Nirmatrelvir-ritonavir use among adults hospitalized with COVID-19 during the Omicron phase of the COVID-19 pandemic, Canadian Nosocomial Infection Surveillance Program. Can Commun Dis Rep 2023; 49:351-357. [PMID: 38455882 PMCID: PMC10917417 DOI: 10.14745/ccdr.v49i78a07] [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] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background Recent studies have demonstrated the effectiveness of nirmatrelvir-ritonavir in reducing the risk of progression to severe disease among outpatients with mild to moderate coronavirus disease 2019 (COVID-19); however, data are limited regarding the use and role of nirmatrelvir-ritonavir among hospitalized patients. This study describes the use and outcomes of nirmatrelvir-ritonavir among adults hospitalized with COVID-19 in a sentinel network of Canadian acute care hospitals during the Omicron variant phase of the pandemic. Methods The Canadian Nosocomial Infection Surveillance Program conducts surveillance of hospitalized patients with COVID-19 in acute care hospitals across Canada. Demographic, clinical, treatment and 30-day outcome data were collected by chart review by trained infection control professionals using standardized questionnaires. Results From January 1 to December 31, 2022, 13% (n=490/3,731) of adult patients (18 years of age and older) hospitalized with COVID-19 in 40 acute care hospitals received nirmatrelvir-ritonavir either at admission or during hospitalization. Most inpatients who received nirmatrelvir-ritonavir, 79% of whom were fully vaccinated, had at least one pre-existing comorbidity (97%) and were of advanced age (median=79 years). Few were admitted to an intensive care unit (2.3%) and among the 490 nirmatrelvir-ritonavir treated inpatients, there were 13 (2.7%) deaths attributable to COVID-19. Conclusion These findings from a large sentinel network of Canadian acute-care hospitals suggest that nirmatrelvir-ritonavir is being used to treat adult COVID-19 patients at admission who are at risk of progression to severe disease or those who acquired COVID-19 in hospital. Additional research on the efficacy and indications for nirmatrelvir-ritonavir use in hospitalized patients is warranted to inform future policies and guidelines.
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Affiliation(s)
| | - Diane Lee
- Public Health Agency of Canada, Ottawa, ON
| | | | | | | | | | | | | | | | | | | | - Kevin Katz
- North York General Hospital, Toronto, ON
| | | | - Bonita Lee
- Stollery Children’s Hospital, Edmonton, AB
| | | | | | | | - Dominik Mertz
- McMaster University and Hamilton Health Sciences, Hamilton, ON
| | | | | | | | | | | | - Alice Wong
- Royal University Hospital, Saskatoon, SK
| | - Nisha Thampi
- Children’s Hospital of Eastern Ontario, Ottawa, ON
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5
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Sultan W, Naik S, Kondapally K, Johnston L. A Rare Case of Chylothorax Following a Redo Laparoscopic Nissen Fundoplication. Cureus 2023; 15:e41419. [PMID: 37546033 PMCID: PMC10403242 DOI: 10.7759/cureus.41419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a highly prevalent disease. Mechanical etiology, including hiatal hernia, can be resistant to empiric proton pump inhibitor (PPI) trials; Nissen fundoplication is commonly used to treat mechanical GERD. Chylothorax is a rare complication of abdominal surgeries, including anti-reflux procedures. In this case report, a 75-year-old female presented with shortness of breath following a redo laparoscopic Nissen fundoplication. Chest CT pulmonary angiography (CTPA) showed bilateral large pleural effusions that were managed by fluid restriction, repeated thoracocentesis, and chest tube insertion; the pleural fluid analysis was significant for fluid triglycerides high at 232 mg/dL which was diagnostic for chylothorax. The patient was treated conservatively. Appropriate management of chylothorax is crucial to avoid subsequent respiratory failure, immunodeficiency, and malnutrition. Chylomicrons and triglycerides in the pleural fluid can be diagnostic for chylothorax. Treatment of chylothorax includes three main approaches: controlling the cause, conservative treatment, and surgical interventions.
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Affiliation(s)
- Waleed Sultan
- Family Medicine, Conemaugh Memorial Medical Center, Johnstown, USA
| | - Sarvesh Naik
- Family Medicine, Conemaugh Memorial Medical Center, Johnstown, USA
| | | | - Lynn Johnston
- Family Medicine, Conemaugh Memorial Medical Center, Johnstown, USA
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6
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Mitchell R, Cayen J, Thampi N, Frenette C, Bartoskzo J, Choi KB, Comeau JL, Conly J, Ellis C, Ellison J, Embil J, Evans G, Johnston L, Johnstone J, Katz KC, Kibsey P, Lee B, Lefebvre MA, Longtin Y, McGeer A, Mertz D, Minion J, Rudnick W, Silva A, Smith SW, Srigley JA, Suh KN, Tomlinson J, Wong A, Pelude L. Trends in Severe Outcomes Among Adult and Pediatric Patients Hospitalized With COVID-19 in the Canadian Nosocomial Infection Surveillance Program, March 2020 to May 2022. JAMA Netw Open 2023; 6:e239050. [PMID: 37079304 PMCID: PMC10119741 DOI: 10.1001/jamanetworkopen.2023.9050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Importance Trends in COVID-19 severe outcomes have significant implications for the health care system and are key to informing public health measures. However, data summarizing trends in severe outcomes among patients hospitalized with COVID-19 in Canada are not well described. Objective To describe trends in severe outcomes among patients hospitalized with COVID-19 during the first 2 years of the COVID-19 pandemic. Design, Setting, and Participants Active prospective surveillance in this cohort study was conducted from March 15, 2020, to May 28, 2022, at a sentinel network of 155 acute care hospitals across Canada. Participants included adult (aged ≥18 years) and pediatric (aged 0-17 years) patients hospitalized with laboratory-confirmed COVID-19 at a Canadian Nosocomial Infection Surveillance Program (CNISP)-participating hospital. Exposures COVID-19 waves, COVID-19 vaccination status, and age group. Main Outcomes and Measures The CNISP collected weekly aggregate data on the following severe outcomes: hospitalization, admission to an intensive care unit (ICU), receipt of mechanical ventilation, receipt of extracorporeal membrane oxygenation, and all-cause in-hospital death. Results Among 1 513 065 admissions, the proportion of adult (n = 51 679) and pediatric (n = 4035) patients hospitalized with laboratory-confirmed COVID-19 was highest in waves 5 and 6 of the pandemic compared with waves 1 to 4 (77.3 vs 24.7 per 1000 patient admissions). Despite this, the proportion of patients with positive test results for COVID-19 who were admitted to an ICU, received mechanical ventilation, received extracorporeal membrane oxygenation, and died were each significantly lower in waves 5 and 6 when compared with waves 1 through 4. Admission to the ICU and in-hospital all-cause death rates were significantly higher among those who were unvaccinated against COVID-19 when compared with those who were fully vaccinated (incidence rate ratio, 4.3 and 3.9, respectively) or fully vaccinated with an additional dose (incidence rate ratio, 12.2 and 15.1, respectively). Conclusions and Relevance The findings of this cohort study of patients hospitalized with laboratory-confirmed COVID-19 suggest that COVID-19 vaccination is important to reduce the burden on the Canadian health care system as well as severe outcomes associated with COVID-19.
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Affiliation(s)
- Robyn Mitchell
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Joelle Cayen
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Nisha Thampi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Charles Frenette
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Jessica Bartoskzo
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Kelly Baekyung Choi
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jeannette L Comeau
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Conly
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chelsey Ellis
- Department of Laboratory Medicine, The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Jennifer Ellison
- Infection, Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - John Embil
- Infection Prevention and Control, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Gerald Evans
- Division of Infectious Diseases, Queen's University, Kingston, Ontario, Canada
| | - Lynn Johnston
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jennie Johnstone
- Infection Prevention and Control, Sinai Health, Toronto, Ontario, Canada
| | - Kevin C Katz
- Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada
| | - Pamela Kibsey
- Department of Pathology and Laboratory Medicine, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Bonita Lee
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Marie-Astrid Lefebvre
- Montreal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Yves Longtin
- Infection Prevention and Control, SMBD Jewish General Hospital, Montréal, Québec, Canada
| | - Allison McGeer
- Infection Prevention and Control, Sinai Health, Toronto, Ontario, Canada
| | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jessica Minion
- Department of Laboratory Medicine, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Wallis Rudnick
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Anada Silva
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Stephanie W Smith
- Faculty of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Jocelyn A Srigley
- Infection Prevention and Control, BC Women's and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kathryn N Suh
- Infection Prevention and Control, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jen Tomlinson
- Infection Prevention and Control, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Alice Wong
- Division of Infectious Diseases, Department of Medicine, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Linda Pelude
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
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7
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Humphrey M, MacDonald G, Neville H, Helwig M, Ramsey T, MacKinnon H, Sketris I, Johnston L, Black EK. A Systematic Review of Antimicrobial Stewardship Interventions to Improve Management of Bacteriuria in Hospitalized Adults. Ann Pharmacother 2022:10600280221134539. [DOI: 10.1177/10600280221134539] [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: 11/13/2022] Open
Abstract
Objective: To determine whether implementation of antimicrobial stewardship (AMS) interventions improve management of bacteriuria in hospitalized adults. Data Sources: EMBASE, MEDLINE, CINAHL, and Clinical Trials Registries via Cochrane CENTRAL were searched from inception through May 2021. Reference lists of included studies were searched, and Scopus was used to retrieve articles that cited included references. Study Selection and Data Extraction: Randomized and nonrandomized trials, controlled before-after studies, interrupted time-series studies, and repeated measures studies evaluating AMS interventions for hospitalized adult inpatients with bacteriuria were included. Risk of bias was assessed independently by 3 team members and compared. Results were summarized descriptively. Data Synthesis: The search yielded 5509 articles, of which 13 met inclusion criteria. Most common interventions included education (N = 8) and audit and feedback (N = 5) alone or in combination with other interventions. Where assessed, resource and antimicrobial use primarily decreased and appropriateness of antimicrobial use improved; however, impact on guideline adherence was variable. All studies were rated as having unclear or serious risk of bias. This review summarizes and assesses the quality of evidence for AMS interventions to improve the management of bacteriuria. Results provide guidance to both AMS teams and researchers aiming to develop and/or evaluate AMS interventions for management of bacteriuria. Conclusions: This review demonstrated benefit of AMS interventions on management of bacteriuria. However, most studies had some risk of bias, and an overall effect across studies is unclear due to heterogeneity in outcome measures.
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Affiliation(s)
- Mari Humphrey
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Gemma MacDonald
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Heather Neville
- Department of Pharmacy, Nova Scotia Health, Halifax, NS, Canada
| | - Melissa Helwig
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
| | - Tasha Ramsey
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
- Department of Pharmacy, Nova Scotia Health, Halifax, NS, Canada
- Division of Infectious Diseases, Nova Scotia Health, Halifax, NS, Canada
| | - Holly MacKinnon
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Lynn Johnston
- Division of Infectious Diseases, Nova Scotia Health, Halifax, NS, Canada
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Emily K. Black
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
- Department of Pharmacy, IWK Health, Halifax, NS, Canada
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8
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Alkhedhairi SAA, Aba Alkhayl FF, Ismail AD, Rozendaal A, German M, MacLean B, Johnston L, Miller A, Hunter A, Macgregor L, Combet E, Quinn T, Gray S. The effects of krill oil supplementation on skeletal muscle function and size in older adults: a randomised controlled trial. Clin Nutr 2022; 41:1228-1235. [DOI: 10.1016/j.clnu.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
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9
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Francia C, Johnston L, Justo R, Manoy S, Cassimatis J, Fraser J. Latent Rheumatic Heart Disease Progression in Children and Youths Living in Endemic Regions: A Global Systematic Review. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.478] [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: 10/16/2022]
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10
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Sapa H, Johnston L, Casaus A. Holistic radiographic interpretation. Br Dent J 2021; 230:625-626. [PMID: 34050275 DOI: 10.1038/s41415-021-3101-1] [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: 11/09/2022]
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11
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Shah A, Stanworth SJ, Lee A, Johnston L, Docherty AB. Prevalence, management and outcomes associated with anaemia in ICU survivors: a retrospective study. Anaesthesia 2021; 76:1421-1423. [PMID: 33789355 DOI: 10.1111/anae.15461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Affiliation(s)
- A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - S J Stanworth
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - A Lee
- Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - L Johnston
- University of Edinburgh Medical School, Edinburgh, UK
| | - A B Docherty
- The Usher Institute, University of Edinburgh, Edinburgh, UK
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12
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Hockley J, Johnston L, Watson J, Shenkin SD. 102 Online Supportive Conversations & Reflection Sessions [OSCARS] with Care Home Staff Following A Resident’s Death: Improving Coping Mechanisms, Team Cohesion and Communication. Age Ageing 2021. [PMCID: PMC7989628 DOI: 10.1093/ageing/afab030.63] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction COVID-19 Trauma Guidance suggests opportunities for structured, time-limited discussions about challenging experiences should be offered. It is unknown if such discussions can be effectively delivered online by palliative care specialists to support care home (CH) staff in relation to death/dying. Funded by Scotland’s Chief Scientist Office COVID-19 “rapid research” fund, online OSCaRS is being piloted. Methods Fortnightly OSCaRS delivered to small groups of CH staff via a secure online platform in three local CHs over 10 weeks. Sessions are digitally recorded. The shortened version of the Chesney coping self-efficacy questionnaire is completed by all staff pre/post. Additional post-study questions asked of OSCaRS participants and in-depth staff interviews will be undertaken (n = 10). Thematic analysis of the recorded sessions and interviews will be undertaken and related to the staff questionnaire and context of each CH. Results New learning on the feasibility and acceptability of providing OSCaRS to frontline staff. The benefit of OSCaRS to CH staff coping mechanisms, team cohesion and communicaton with relatives during the COVID-19 pandemic will be presented. Initial results show that OSCaRS are feasible, valued by all care home staff and support staff in coping with the challenges of COVID-19/. Key Conclusions The analysis will inform future practice, and an Implementation Guide for OSCaRS in CHs will be produced. Key learning on the potential for online support in relation to death/dying during the pandemic and beyond will contribute to future education, training and staff wellbeing resources. It will also inform the role of such sessions in developing individual coping mechanisms and team working alongside communication with relatives during lockdown.
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Affiliation(s)
- J Hockley
- University of Edinburgh; Edinburgh Napier University; University of Edinburgh; University of Edinburgh
| | - L Johnston
- University of Edinburgh; Edinburgh Napier University; University of Edinburgh; University of Edinburgh
| | - J Watson
- University of Edinburgh; Edinburgh Napier University; University of Edinburgh; University of Edinburgh
| | - S D Shenkin
- University of Edinburgh; Edinburgh Napier University; University of Edinburgh; University of Edinburgh
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Johnston L, Malcolm C, Rambabu L, Hockley J, Shenkin SD. 101 Avoiding Burnout of the Care Home Workforce During the COVID-19 Pandemic and Beyond: Sharing National Learning and Local Initiatives. Age Ageing 2021. [PMCID: PMC7989615 DOI: 10.1093/ageing/afab030.62] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction COVID-19 in care homes has heightened the risk of staff burnout, undermining already problematic staff retention and low morale. There has been an associated proliferation of resources and online initiatives to support frontline workers, however, few of these are directly targeted at the care home workforce. Care home workers are highly skilled in caring for people with complex needs, but have very variable levels of formal training, and just over half of care homes in Scotland include registered nurses. This project will rapidly collate existing resources and identify, direct from care home workers, their best practice, initiatives, and resources used to support resilience and retention during this pandemic and moving forward. Methods 1) Rapid review of care home specific evidence and resources (including published research and social media); 2) Online survey of Enabling Research in Care Homes (ENRICH) members across Scotland (n = 55); 3) Case studies within six care homes to identify what is working well and what is not in terms of promoting resilience and emotional support. Results The rapid review has identified a wide range of resources directed at supporting staff working in care homes; the survey and case studies will provide data on the key learning and resources that have supported staff, and outline the challenges identified. There are many resources available but staff do not access these. The role of the care home manager is key. Key conclusions This comprehensive review of resources and initiatives will make a valuable contribution to policy and practice designed to reduce burnout and foster retention not just in care homes but more widely across health and social care.
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Affiliation(s)
- L Johnston
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
| | - C Malcolm
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
| | - L Rambabu
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
| | - J Hockley
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
| | - S D Shenkin
- Edinburgh Napier University; Edinburgh Napier University; University of Edinburgh; University of Edinburgh; University of Edinburgh
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Johnston L, Mackay B, King T, Krockenberger MB, Malik R, Tebb A. Abdominal cryptococcosis in dogs and cats: 38 cases (2000-2018). J Small Anim Pract 2020; 62:19-27. [PMID: 33107069 DOI: 10.1111/jsap.13232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/05/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To report the clinical presentation, laboratory and imaging findings, treatment and outcome of abdominal cryptococcosis in dogs and cats in Australia. MATERIALS AND METHODS Canine and feline cases from Australia were retrospectively identified (2000 to 2018) via laboratory and referral centre searches for abdominal cryptococcosis diagnosed by cytology (needle aspirates) or histopathology (biopsy or necropsy) of abdominal organs/tissues. Signalment, presenting complaints, clinical signs, laboratory findings, medical imaging, latex cryptococcal antigen agglutination test (LCAT) titres, treatment and outcome data was collected. RESULTS Thirty-eight cases were included (35 dogs, three cats) in the study. Median age of presentation was 2 years for dogs and 6 years for cats. Common presenting complaints included vomiting (23/38), lethargy (19/38) and inappetence/anorexia (15/38). Abdominal ultrasound (25/38 cases) revealed mesenteric and intestinal lesions in most of the cases. On surgical exploration, seven cases had an intestinal lesion associated with an intussusception. Nineteen cases had a pre-treatment LCAT performed, with a median initial titre of 1:2048 (range 1:2 to 65,536). Twenty-four cases (23 dogs, one cat) received treatment, either medical, surgical or both. Median survival time for cases with combined medical and surgical treatment, surgical treatment alone or medical treatment alone was 730, 140 and 561 days, respectively. Eleven remain alive at the time of follow up. CLINICAL SIGNIFICANCE Abdominal cryptococcosis although rare should be a considered as a diagnostic possibility in an especially young dog presenting with gastro-intestinal signs. Older dogs can also present with this condition and should not be euthanised based on imaging alone due to the likenesses with neoplasia. With appropriate treatment and monitoring many dogs may have a prolonged survival period and some may be cured.
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Affiliation(s)
- L Johnston
- Department of Internal Medicine, Veterinary Specialist Services, Carrara, 4211, Australia
| | - B Mackay
- Department of Internal Medicine, Veterinary Specialist Services, Carrara, 4211, Australia
| | - T King
- Department of Internal Medicine, Veterinary Specialist Services, Carrara, 4211, Australia
| | - M B Krockenberger
- Sydney School of Veterinary Science, The University of Sydney, Sydney, 2006, Australia
| | - R Malik
- Centre for Veterinary Education, The University of Sydney, Sydney, 2006, Australia.,School of Animal and Veterinary Science, Charles Sturt University, Wagga Wagga, 2678, Australia
| | - A Tebb
- Western Australian Veterinary Emergency and Speciality, Success, 6164, Australia
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Johnston L, Leister E, Singer L. Severe metabolic acidosis due to acetazolamide intoxication in a dog. Aust Vet J 2020; 99:11-14. [PMID: 33025586 DOI: 10.1111/avj.13027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Abstract
CASE REPORT This case report describes the clinical signs and case management of a 1-year-old neutered male Siberian Husky that accidentally ingested 635 mg/kg of oral acetazolamide (a carbonic anhydrase inhibitor). The dog presented with severe tachypnoea due to the development of hyperchloraemic metabolic acidosis and associated hypokalaemia that persisted for 7 days. Clinical and biochemical changes resolved with intravenous and subsequent oral supplementation of sodium bicarbonate and potassium. Complete recovery occurred within 9 days of presentation. CONCLUSION To the authors' knowledge, this is the first case that reports overdosage of an oral carbonic anhydrase inhibitor in a dog and subsequent recovery with adequate supplementation and supportive care.
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Affiliation(s)
- L Johnston
- Internal Medicine, Veterinary Specialist Services, Eastlake Street, Carrara, Queensland, 4211, Australia
| | - E Leister
- Emergency and Critical care, Pet ICU, Lexington Road, Underwood, Queensland, 4119, Australia
| | - L Singer
- Internal Medicine, Veterinary Specialist Services, Eastlake Street, Carrara, Queensland, 4211, Australia
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McCracken M, Mitchell R, Smith S, Hota S, Conly J, Du T, Embil J, Johnston L, Ormiston D, Parsonage J, Simor A, Wong A, Golding G. Emergence of pstS-Null Vancomycin-Resistant Enterococcus faecium Clone ST1478, Canada, 2013-2018. Emerg Infect Dis 2020; 26:2247-2250. [PMID: 32818423 PMCID: PMC7454069 DOI: 10.3201/eid2609.201576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rates of vancomycin-resistant enterococci bloodstream infections have remained relatively low in Canada. We recently observed an increase of 113% in these infections rates, which coincided with emergence of Enterococcus faecium pstS-null sequence type 1478. The proportion of this sequence type increased from 2.7% to 38.7% for all tested isolates from 2013-2018.
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Dearing ME, Burgess SV, Murphy V, Campbell S, Johnston L, Ramsey TD. Prescribing Patterns and Patient Outcomes for Bone and Joint Infections Treated with Cefazolin and Probenecid: A Retrospective Observational Study. Can J Hosp Pharm 2020. [DOI: 10.4212/cjhp.v73i3.2998] [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: 11/10/2022]
Abstract
ABSTRACTBackground: Previous studies have described the use of cefazolin with probenecid to treat uncomplicated skin and soft-tissue infections. Some prescribers are extrapolating from this evidence to treat more invasive infections, which have a greater potential for poor outcomes, including treatment failure that could lead to increased morbidity and mortality. Information supporting cefazolin with probenecid as effective treatment in this context is needed.Objectives: To describe prescribing patterns and outcomes for patients who received cefazolin with probenecid for the treatment of bone and joint infections.Methods: This single-centre retrospective study involved adult outpatients for whom cefazolin and probenecid were prescribed for bone and joint infections between April 1, 2012, and March 31, 2017. Patient charts were reviewed, and data were collected for clinical and microbiological variables using a standardized data collection form.Results: In a total of 80 cases, the patient received cefazolin and probenecid for treatment of a bone or joint infection, of which 69 cases met the inclusion criteria. In most cases (n = 67), the patients were treated with cefazolin 2 g IV plus probenecid 1 g PO, both given twice daily. Completion of prescribed treatment occurred in 56 patient cases (81%), resolution of signs and symptoms in 53 (77%), readmission to hospital in 11 (16%), recurrence of infection in 6 (9%), and treatment failure requiring a change in therapy in 7 (10%).Conclusions: The effectiveness of cefazolin and probenecid for the treatment of bone and joint infections appears to be similar to that of standard treatment, as reported in the literature. Antibiotic effectiveness is difficult to determine conclusively in a retrospective analysis, so these results should be interpreted with caution, but they may stimulate further research.RÉSUMÉContexte : Des études précédentes ont décrit l’utilisation de la céfazoline et du probénécide pour traiter les infections cutanées et les infections de tissus mous. Quelques prescripteurs extrapolent ces éléments probants pour traiter des infections plus invasives, dont les résultats risquent d’être défavorables, comme un échec du traitement pouvant entraîner une morbidité et une mortalité accrues. De l’information supplémentaire étayant l’efficacité du traitement à l’aide de la céfazoline et du probénécide dans ce contexte est nécessaire.Objectifs : Décrire les modes de prescription et les résultats obtenus par des patients ayant reçu de la céfazoline et du probénécide pour traiter des infections osseuses et articulaires.Méthodes : Cette étude rétrospective unicentrique porte sur des patients ambulatoires adultes à qui on a prescrit de la céfazoline et du probénécide pour traiter des infections osseuses et articulaires entre le 1er avril 2012 et le 31 mars 2017. L’examen des dossiers médicaux des patients a permis la récolte de données sur les variables cliniques et microbiologiques à l’aide d’un formulaire de recueil de données standard.Résultats : Les patients, soit 80 cas en tout, ont reçu de la céfazoline et du probénécide pour traiter une infection osseuse ou articulaire et 69 de ces cas répondaient aux critères d’inclusion. Dans la plupart des cas (n = 67), les patients étaient traités avec de la céfazoline IV dosée à 2 g et du probénécide dosé à 1 g PO, les deux produits étant administrés deux fois par jour. Le traitement a été appliqué au complet dans 56 cas (81 %), la résolution des signes et des symptômes a eu lieu dans 53 cas (77 %), la réadmission à l’hôpital s’est produite dans 11 cas (16 %), les infections ont récidivé dans 6 cas (9 %) et le traitement s’est soldé par un échec et a nécessité un changement de thérapie dans 7 cas (10 %).Conclusions : L’efficacité de la céfazoline et du probénécide dans le traitement des infections osseuses et articulaires semble être similaire à celle des traitements standard, comme le rapporte la littérature scientifique. L’efficacité des antibiotiques est difficile à déterminer de façon concluante dans une analyse rétrospective, ces résultats doivent donc être interprétés avec prudence, mais ils pourraient stimuler des recherches supplémentaires.
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Andonov A, Robbins M, Borlang J, Cao J, Hatchette T, Stueck A, Deschambault Y, Murnaghan K, Varga J, Johnston L. Rat Hepatitis E Virus Linked to Severe Acute Hepatitis in an Immunocompetent Patient. J Infect Dis 2020; 220:951-955. [PMID: 30649379 DOI: 10.1093/infdis/jiz025] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) is a major public health concern in developing countries where the primary transmission is via contaminated water. Zoonotic HEV cases have been increasingly described in Europe, Japan, and the United States, with pigs representing the main animal reservoir of infection. We report an unusual acute hepatitis infection in a previously healthy man caused by a rat HEV with a considerably divergent genomic sequence compared with other rat HEV strains. It is possible that rat HEV is an underrecognized cause of hepatitis infection, and further studies are necessary to elucidate its potential risk and mode of transmission.
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Affiliation(s)
- Anton Andonov
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Mark Robbins
- Division of Infectious Diseases, Nova Scotia, Canada
| | - Jamie Borlang
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Jingxin Cao
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Todd Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Nova Scotia, Canada
| | - Ashley Stueck
- Department of Pathology and Laboratory Medicine, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Nova Scotia, Canada
| | - Yvon Deschambault
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Kyle Murnaghan
- Department of Medicine, Halifax, Nova Scotia Health Authority, Nova Scotia, Canada
| | - Jessy Varga
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Lynn Johnston
- Department of Medicine, Halifax, Nova Scotia Health Authority, Nova Scotia, Canada
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Dearing ME, Burgess SV, Murphy V, Campbell S, Johnston L, Ramsey TD. Prescribing Patterns and Patient Outcomes for Bone and Joint Infections Treated with Cefazolin and Probenecid: A Retrospective Observational Study. Can J Hosp Pharm 2020; 73:202-208. [PMID: 32616946 PMCID: PMC7308159] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Previous studies have described the use of cefazolin with probenecid to treat uncomplicated skin and soft-tissue infections. Some prescribers are extrapolating from this evidence to treat more invasive infections, which have a greater potential for poor outcomes, including treatment failure that could lead to increased morbidity and mortality. Information supporting cefazolin with probenecid as effective treatment in this context is needed. OBJECTIVES To describe prescribing patterns and outcomes for patients who received cefazolin with probenecid for the treatment of bone and joint infections. METHODS This single-centre retrospective study involved adult outpatients for whom cefazolin and probenecid were prescribed for bone and joint infections between April 1, 2012, and March 31, 2017. Patient charts were reviewed, and data were collected for clinical and microbiological variables using a standardized data collection form. RESULTS In a total of 80 cases, the patient received cefazolin and probenecid for treatment of a bone or joint infection, of which 69 cases met the inclusion criteria. In most cases (n = 67), the patients were treated with cefazolin 2 g IV plus probenecid 1 g PO, both given twice daily. Completion of prescribed treatment occurred in 56 patient cases (81%), resolution of signs and symptoms in 53 (77%), readmission to hospital in 11 (16%), recurrence of infection in 6 (9%), and treatment failure requiring a change in therapy in 7 (10%). CONCLUSIONS The effectiveness of cefazolin and probenecid for the treatment of bone and joint infections appears to be similar to that of standard treatment, as reported in the literature. Antibiotic effectiveness is difficult to determine conclusively in a retrospective analysis, so these results should be interpreted with caution, but they may stimulate further research.
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Affiliation(s)
- Marci E Dearing
- , RPh, BSc(Pharm), ACPR, PharmD, is with the Pharmacy Department, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Sarah V Burgess
- , RPh, BSc(Pharm), ACPR, PharmD, is with the Pharmacy Department, Nova Scotia Health Authority, and the College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | - Valerie Murphy
- , RPh, BSc(Pharm), ACPR, is with the Pharmacy Department, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Samuel Campbell
- , MB BCh, CCFP(EM), DipPEC(SA), FCCHL, is with the Department of Emergency Medicine, Charles V Keating Emergency and Trauma Centre, Central Zone, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Lynn Johnston
- , MD, MSc, FRCPC, is with the Division of Infectious Diseases, Central Zone, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Tasha D Ramsey
- , RPh, BSc(Pharm), ACPR, PharmD, is with the Pharmacy Department, Nova Scotia Health Authority, and the College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
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Kumar D, Vachharajani AJ, Wertheimer F, Vergales B, Glass K, Dannaway D, Winter L, Delaney H, Ganster A, Arnold J, Urban A, Johnston L, Bruno C, Gray MM, Sawyer T. Boot camps in neonatal-perinatal medicine fellowship programs: A national survey. J Neonatal Perinatal Med 2020; 12:231-237. [PMID: 30829620 DOI: 10.3233/npm-18117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Simulation is widely used in graduate medical education. A prior survey showed that 80% of Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. use simulation. There are multiple ways to provide simulation-based education. One such method is through intensive simulation-based education sessions held at the beginning of a training program, common called 'boot camps'. The aim of this study was to describe the use of simulation-based boot camps in NPM fellowship programs. METHODS Survey study of Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowships in the U.S. RESULTS Fifty-nine of 98 programs (60%) responded. Thirty six (61%) participated in 1st year fellow boot camps, which focused on procedural skills and newborn resuscitation. Nearly half of programs participated in regional boot camps. Most boot camps were one or two days long. Eleven programs (19%) held 2nd or 3rd year fellow boot camps, which focused on advanced resuscitation and communication. Barriers included lack of faculty protected time (57%), funding (39%), and lack of faculty experience (31%). CONCLUSIONS A majority of ACGME accredited NPM fellowships participate in 1st year fellows' boot camps. Many participate in regional boot camps. A few programs have 2nd or 3rd year fellow boot camps. Lack of time, funding, and faculty experience were common barriers.
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Affiliation(s)
- D Kumar
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - A J Vachharajani
- Department of Pediatrics, Division of Newborn Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - F Wertheimer
- Department of Pediatrics, Division of Neonatology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - B Vergales
- Department of Pediatrics, Division of Neonatology, University of Virginia Health System, Charlottesville, VA, USA
| | - K Glass
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - D Dannaway
- Department of Pediatrics, Section of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - L Winter
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - H Delaney
- Department of Pediatrics, Division of Neonatology, Brooke Army Medical Center, San Antonio, TX, USA
| | - A Ganster
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J Arnold
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - A Urban
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - C Bruno
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - M M Gray
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital. Seattle, WA, USA
| | - T Sawyer
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital. Seattle, WA, USA
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Janz DR, Casey JD, Semler MW, Russell DW, Dargin J, Vonderhaar DJ, Dischert KM, West JR, Stempek S, Wozniak J, Caputo N, Heideman BE, Zouk AN, Gulati S, Stigler WS, Bentov I, Joffe AM, Rice TW, Janz DR, Vonderhaar DJ, Hoffman R, Turlapati N, Samant S, Clark P, Krishnan A, Gresens J, Hill C, Matthew B, Henry J, Miller J, Paccione R, Majid-Moosa A, Santanilla JI, Semler MW, Rice TW, Casey JD, Heideman BE, Wilfong EM, Hewlett JC, Halliday SJ, Kerchberger VE, Brown RM, Huerta LE, Merrick CM, Atwater T, Kocurek EG, McKown AC, Winters NI, Habegger LE, Mart MF, Berg JZ, Noblit CC, Flemmons LN, Dischert K, Joffe A, Bentov I, Archibald T, Arenas A, Baldridge C, Bansal G, Barnes C, Bishop N, Bryce B, Byrne L, Clement R, DeLaCruz C, Deshpande P, Gong Z, Green J, Henry A, Herstein A, Huang J, Heier J, Jenson B, Johnston L, Langeland C, Lee C, Nowlin A, Reece-Nguyen T, Schultz H, Segal G, Slade I, Solomon S, Stehpey S, Thompson R, Trausch D, Welker C, Zhang R, Russell D, Zouk A, Gulati S, Stigler W, Fain J, Garcia B, Lafon D, He C, O'Connor J, Campbell D, Powner J, McElwee S, Bardita C, D'Souza K, Pereira GB, Robinson S, Blumhof S, Dargin J, Stempek S, Wozniak J, Pataramekin P, Desai D, Yayarovich E, DeMatteo R, Somalaraiu S, Adler C, Reid C, Plourde M, Winnicki J, Noland T, Geva T, Gazourian L, Patel A, Eissa K, Giacotto J, Fitelson D, Colancecco M, Gray A, West JR, Caputo N, Ryan M, Parry T, Azan B, Khairat A, Morton R, Lewandowski D, Vaca C. Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial. The Lancet Respiratory Medicine 2019; 7:1039-1047. [DOI: 10.1016/s2213-2600(19)30246-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/29/2019] [Accepted: 06/13/2019] [Indexed: 01/17/2023]
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Black EK, MacDonald L, Neville HL, Abbass K, Slayter K, Johnston L, Sketris I. Health Care Providers’ Perceptions of Antimicrobial Use and Stewardship at Acute Care Hospitals in Nova Scotia. Can J Hosp Pharm 2019. [DOI: 10.4212/cjhp.v72i4.2912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
ABSTRACTBackground: Antimicrobial use is the major factor in the development of antimicrobial resistance. Antimicrobial stewardship has been recom-mended as a strategy to improve antimicrobial use. Objective: To learn about health care providers’ perceptions of current antimicrobial use and stewardship, including barriers and facilitators to improving antimicrobial use at acute care hospitals in Nova Scotia.Methods: This qualitative research study was conducted at acute care hospitals in Nova Scotia using focus groups and semistructured interviews. Health care providers (nurses, nurse practitioners, pharmacists, pharmacy students, and physicians) were invited to participate. Focus groups and interviews were conducted at each participant’s place of employment. Interviews and focus groups were facilitated with an interview guide, audio-recorded, and transcribed verbatim. Transcripts were independently coded by 2 investigators and analyzed using thematic analysis.Results: A total of 9 focus groups and 3 individual interviews were conducted between June and August 2017. Fifty-four health care professionals and trainees (24 pharmacists and pharmacy students, 14 physicians, and 16 nurses and nurse practitioners) from 5 hospitals participated. The following themes were identified: current practices, prescribing influences, access to information, collaboration and communi -cation, resources, and antimicrobial stewardship. Within each theme, barriers and facilitators to improving antimicrobial use were identified as subthemes. Conclusion: Participants identified current barriers to appropriate use of antimicrobials and suggested facilitators that might improve the use of these drugs. The results of this study could be used by antimicrobial stewardship teams and decision-makers to improve antimicrobial use and stewardship initiatives throughout Nova Scotia, and may be applicable to hospitals outside the province.RÉSUMÉContexte: L’utilisation des antimicrobiens est le principal facteur de développement de la résistance à cette classe de médicaments. La gestion des antimicrobiens a été recommandée comme stratégie visant à améliorer leur utilisation. Objectif : Découvrir la perception des fournisseurs de soins de santé au sujet de l’utilisation et de la gestion actuelles des antimicrobiens, y compris les obstacles et les moyens destinés à favoriser l’amélioration de leur utilisation dans des hôpitaux de soins actifs en Nouvelle-Écosse.Méthodes : Cette recherche qualitative a été menée dans des hôpitaux de soins actifs en Nouvelle-Écosse à l’aide de groupes de discussion et d’entretiens semi-structurés. Les fournisseurs de soins de santé (infirmières, infirmières praticiennes, pharmaciens, étudiants en pharmacie et médecins) ont été invités à y participer. Les groupes de discussion et les entretiens ont été menés sur chaque lieu de travail des participants. Ils ont été facilités grâce à un guide d’entretien. Ils ont aussi été enregistrés (audio) et retran-scrits textuellement. Les transcriptions ont été codées de façon indépen-dante par deux enquêteurs et étudiées à l’aide d’une analyse thématique.Résultats : Neuf groupes de discussion et trois entretiens individuels ont été menés entre juin et août 2017. Cinquante-quatre professionnels et stagiaires de la santé (24 pharmaciens et étudiants en pharmacie, 14 médecins, 16 infirmières et infirmières praticiennes) provenant de cinq hôpitaux y ont participé. Les thèmes suivants ont été soumis à la discussion : pratiques actuelles, influences en matière de prescription, accès aux informations, collaboration et communication, ressources et gestion des antimicrobiens. Chaque thème comportait deux sous-thèmes abordant les obstacles et les mesures favorisant l’amélioration de l’utilisation des antimicrobiens. Conclusion : Les participants ont relevé les obstacles actuels nuisant à une bonne utilisation des antimicrobiens et ont proposé des moyens pour améliorer l’utilisation de ces médicaments. Les résultats de cette étude pourraient être utilisés par les équipes de gestion des antimicrobiens ainsi que par les décideurs qui doivent favoriser l’amélioration de l’utilisation des antimicrobiens et les initiatives relatives à leur gestion partout en Nouvelle-Écosse. Ils sont aussi applicables aux hôpitaux extérieurs à la province.
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Luvai A, Johnston L, Curtis A, Potter A, Musson S, Pattman S, Kamarrudin S, Weaver J, Arutchevelam V, Anderson M, Burns M, Hopper N, McAnulty C, Sutton R, Neely R, Carey P. High Polygenic Snp Scores Do Not Exclude Monogenic Familial Hypercholesterolaemia. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.270] [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: 11/17/2022]
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Black EK, MacDonald L, Neville HL, Abbass K, Slayter K, Johnston L, Sketris I. Health Care Providers' Perceptions of Antimicrobial Use and Stewardship at Acute Care Hospitals in Nova Scotia. Can J Hosp Pharm 2019; 72:263-270. [PMID: 31452537 PMCID: PMC6699866] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Antimicrobial use is the major factor in the development of antimicrobial resistance. Antimicrobial stewardship has been recommended as a strategy to improve antimicrobial use. OBJECTIVE To learn about health care providers' perceptions of current antimicrobial use and stewardship, including barriers and facilitators to improving antimicrobial use at acute care hospitals in Nova Scotia. METHODS This qualitative research study was conducted at acute care hospitals in Nova Scotia using focus groups and semistructured interviews. Health care providers (nurses, nurse practitioners, pharmacists, pharmacy students, and physicians) were invited to participate. Focus groups and interviews were conducted at each participant's place of employment. Interviews and focus groups were facilitated with an interview guide, audio-recorded, and transcribed verbatim. Transcripts were independently coded by 2 investigators and analyzed using thematic analysis. RESULTS A total of 9 focus groups and 3 individual interviews were conducted between June and August 2017. Fifty-four health care professionals and trainees (24 pharmacists and pharmacy students, 14 physicians, and 16 nurses and nurse practitioners) from 5 hospitals participated. The following themes were identified: current practices, prescribing influences, access to information, collaboration and communication, resources, and antimicrobial stewardship. Within each theme, barriers and facilitators to improving antimicrobial use were identified as subthemes. CONCLUSION Participants identified current barriers to appropriate use of antimicrobials and suggested facilitators that might improve the use of these drugs. The results of this study could be used by antimicrobial stewardship teams and decision-makers to improve antimicrobial use and stewardship initiatives throughout Nova Scotia, and may be applicable to hospitals outside the province.
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Affiliation(s)
- Emily K Black
- , BSc(Pharm), ACPR, PharmD, is with the College of Pharmacy, Dalhousie University, Halifax, Nova Scotia
| | - Lindsay MacDonald
- , BSc(Pharm), was, at the time of this study, a student with the College of Pharmacy, Dalhousie University, Halifax, Nova Scotia. She is now a pharmacy intern at the Chaleur Regional Hospital in Bathurst, New Brunswick
| | - Heather L Neville
- , BSc(Pharm), MSc, FCSHP, is with the Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Kim Abbass
- , BSc(Pharm), PharmD, is with the Antimicrobial Stewardship Program, Nova Scotia Health Authority, Sydney, Nova Scotia
| | - Kathryn Slayter
- , BSc(Pharm), PharmD, FCSHP, is with the IWK Health Centre, Halifax, Nova Scotia
| | - Lynn Johnston
- , MD, MSc, FRCPC, is with Dalhousie University and the Department of Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Ingrid Sketris
- , BSc(Pharm), PharmD, MPA(HSA), FCCP, FCSHP, FCAHS, is with the College of Pharmacy, Dalhousie University, Halifax, Nova Scotia
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Agarwal A, Miller S, Hadden W, Johnston L, Wang W, Arnold G, Abboud RJ. Comparison of gait kinematics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl 2019; 101:391-398. [PMID: 31155888 DOI: 10.1308/rcsann.2019.0016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study is aimed to compare kinematic gait data of patients who have undergone total and unicondylar knee replacement. MATERIALS AND METHODS This single-surgeon retrospective cohort study evaluated 13 patients with unilateral total knee arthroplasty (TKA) and 14 unicondylar knee arthroplasty (UKA). Gait analysis was carried out using a Vicon motion analysis system. The limits of knee flexion during stance phase, at heel strike and at loading response were measured. RESULTS The total range of motion of the UKA knees was significantly greater than the TKA knees. UKA knees exhibited significantly greater knee extension during the stance phase than the TKA knees. Unlike TKA, UKA knees demonstrated improved knee flexion during the gait cycle when compared to the contralateral non-operated knee. The hips also demonstrated near normal hip flexion in UKA patients. Predictably, UKA knees had significantly greater varus compared with TKA in the coronal plane. Spatiotemporal variables demonstrated similar walking speed and step length to aid a fair comparison between knee replacement groups. CONCLUSIONS The UKA knees moved more physiologically in the sagittal plane with a greater range of motion during gait. Despite having a stiff gait pattern, the patients undergoing TKA demonstrated a more neutral alignment in the coronal plane. Neither type of knee arthroplasty restored knee kinematics to those of the non-operated side.
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Affiliation(s)
- A Agarwal
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - S Miller
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - W Hadden
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - L Johnston
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - W Wang
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - G Arnold
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - R J Abboud
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
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Colditz IG, Paull DR, Lloyd JB, Johnston L, Small AH. Efficacy of meloxicam in a pain model in sheep. Aust Vet J 2019; 97:23-32. [DOI: 10.1111/avj.12779] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- IG Colditz
- CSIRO FD McMaster Laboratory; Locked Bag 1, Delivery Centre, Armidale New South Wales 2350 Australia
| | - DR Paull
- CSIRO FD McMaster Laboratory; Locked Bag 1, Delivery Centre, Armidale New South Wales 2350 Australia
| | - JB Lloyd
- Joan Lloyd Consulting Pty Ltd; West Ryde, NSW Australia
| | - L Johnston
- Boehringer Ingelheim Animal Health Pty Ltd; Sydney NSW Australia
| | - AH Small
- CSIRO FD McMaster Laboratory; Locked Bag 1, Delivery Centre, Armidale New South Wales 2350 Australia
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Affiliation(s)
- L. Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Lawrence S. Bloomberg Limited Term Professor in Critical Care, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
| | - J. J. Presneill
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Intensive Care Unit, St Vincent's Hospital and Associate Professor, Department of Medicine, University of Melbourne
| | - L. Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- School of Nursing and Midwifery, Queen's University Belfast
| | - S. Nelson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
| | - J. F. Cade
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada and Intensive Care Unit, St Vincent's Hospital, Department of Medicine, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
- Intensive Care Unit, Royal Melbourne Hospital
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Li Y, Cui S, Baidoo S, Johnston L. PSX-39 Effect of body condition measured using a sow caliper on performance of group-housed gestating sows. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.1070] [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: 11/12/2022] Open
Affiliation(s)
- Y Li
- West Central Research and Outreach Center, University of Minnesota,Morris, MN, United States
| | - S Cui
- West Central Research and Outreach Center, University of Minnesota,Morris, MN, United States
| | - S Baidoo
- Southern Research and Outreach Center, University of Minnesota,Waseca, MN, United States
| | - L Johnston
- West Central Research and Outreach Center, University of Minnesota,Morris, MN, United States
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Abstract
This paper describes the work of the National Advisory Committee on Infection Prevention and Control (NAC-IPC), previously Infection Prevention and Control Expert Working Group, a longstanding external advisory body that provides subject matter expertise and advice to the Public Health Agency of Canada (PHAC) on the prevention and control of infectious diseases in Canadian health care settings. Originally established by Health Canada as the Infection Control Guidelines Steering Committee in 1992, this advisory board has been providing expert advice on infection prevention and control (IPC) guideline development for over 25 years. The NAC-IPC provides advice to inform the development of comprehensive or concise guidelines, quick reference guides and interim guidelines (usually for emerging pathogens), working closely with PHAC's national Healthcare-Associated Infections (HAIs) surveillance programs for Canadian health care facilities. PHAC's HAI-IPC professionals conduct the necessary literature research, data extraction, evidence synthesis, evidence grading (where applicable) and scientific writing for the guidelines. Due to the paucity of clinical trials and high quality observational studies to inform recommendations for emerging pathogens, expert opinion is critical for interpreting available evidence. .
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Affiliation(s)
- T Ogunremi
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - K Dunn
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | | | - J Embree
- University of Manitoba, Winnipeg, MB
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Black E, Neville H, Losier M, Harrison M, Abbass K, Slayter K, Johnston L, Sketris I. Antimicrobial Use at Acute Care Hospitals in Nova Scotia: A Point Prevalence Survey. Can J Hosp Pharm 2018. [DOI: 10.4212/cjhp.v71i4.2825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
<p><strong>ABSTRACT</strong></p><p><strong>Background:</strong> Point prevalence surveys are used to monitor antimicrobial use and identify targets for improvement through antimicrobial stewardship activities. Few studies have evaluated antimicrobial use in Nova Scotia acute care institutions.</p><p><strong>Objectives: </strong>To determine the prevalence and characteristics of antimicrobial use in Nova Scotia hospitals.</p><p><strong>Methods:</strong> A point prevalence survey was conducted between June and November 2015 for patients admitted to hospitals with at least 30 acute care beds. On each survey day, charts were reviewed to identify patients receiving antimicrobial agents on that day. Data were gathered on the type of antimicrobial agent prescribed, route of administration, intended duration of use, and indication. Adherence to regional and local treatment guidelines was assessed. Results were summarized descriptively. Findings were compared using the Fisher exact test or the Cochran–Armitage trend test.</p><p><strong>Results:</strong> Twelve of the 13 eligible hospitals participated, and a total of 1499 patient charts were examined. The overall prevalence of antimicrobial use was 30.6% (458/1499). The prevalence of antimicrobial use differed<br />significantly according to area of specialty, with the highest prevalence occurring in intensive care wards (47.2%, 50/106) and surgical wards (43.4%, 179/412), as compared with medical wards (27.9%, 192/687) and “other” specialty wards (11.1%, 32/289) (p < 0.001). Among the 520 indications for antimicrobial use, the most common was respiratory tract infection (81 or 15.6%). In total, 660 antimicrobial agents were prescribed to the 458 patients; a third of these patients (152 or 33.2%) received more than 1 antimicrobial agent. The class of antimicrobials most frequently prescribed was “other beta-lactam antimicrobials” (31.2%, 206/660). The majority of antimicrobials (62.0%, 409/660) were prescribed for administration via the parenteral route. Adherence to regional treatment guidelines was 29.9% (26 of 87 indications analyzed). Documentation of indication was lacking for 104 (20.0%) of the 520 indications, and documentation of the intended duration of antimicrobial use was lacking for 326 (62.7%) of the 520 indications.</p><p><strong>Conclusions:</strong> Antimicrobial agents were prescribed for about one-third of acute care patients in Nova Scotia. Specific targets for improvement in antimicrobial use include decreases in prescribing of broad-spectrum and parenteral antimicrobials, better adherence to guidelines, and improved documentation. In developing initiatives, antimicrobial stewardship programs in Nova Scotia should focus on identified targets for improvement.</p><p><strong>RÉSUMÉ</strong></p><p>Contexte: Les enquêtes de prévalence ponctuelle sont employées pour surveiller l’utilisation des antimicrobiens et cibler des points à améliorer grâce aux activités de gestion responsable des antimicrobiens. Peu d’études se sont penchées sur l’utilisation des antimicrobiens dans les établissements de soins de courte durée en Nouvelle-Écosse.</p><p><strong>Objectifs :</strong> Déterminer quelle est la prévalence de l’utilisation des anti -microbiens dans les hôpitaux de la Nouvelle-Écosse et offrir un portrait de cette utilisation.</p><p><strong>Méthodes :</strong> Une enquête de prévalence ponctuelle a été menée entre juin et novembre 2015 pour les patients admis aux hôpitaux dotés d’au moins 30 lits de soins de courte durée. À chaque jour d’enquête, des dossiers médicaux ont été examinés afin de repérer les patients ayant reçu des agents antimicrobiens cette journée-là. On a recueilli des données sur le type d’agent antimicrobien prescrit, la voie d’administration, la durée attendue d’utilisation et l’indication. Le respect des lignes directrices thérapeutiques régionales et locales a aussi été évalué. Les résultats ont été résumés de façon descriptive. Les comparaisons ont été vérifiées à l’aide du test exact de Fisher ou du test de tendance de Cochran-Armitage.</p><p><strong>Résultats :</strong> Douze des 13 hôpitaux admissibles ont été inclus et un total de 1 499 dossiers médicaux de patients ont été examinés. Le taux de prévalence globale d’utilisation d’antimicrobiens était de 30,6 % (458/1499).<br />La prévalence d’utilisation d’antimicrobiens variait significativement selon les unités de soins : en tête de liste, les unités de soins intensifs (47,2 %, 50/106) et les unités de chirurgie (43,4 %, 179/412) comparativement aux unités de médecine (27,9 %, 192/687) et aux « autres » unités de soins (11,1 %, 32/289) (p < 0.001). Parmi les 520 indications pour l’utilisation des antimicrobiens, la plus fréquente était l’infection des voies respiratoires (81 ou 15,6 %). Au total, 660 agents antimicrobiens ont été prescrits aux 458 patients et le tiers de ces patients (152 ou 33,2 %) ont reçu plus d’un agent antimicrobien. La classe d’antimicrobien la plus souvent prescrite était les « autres bêtalactamines » (31,2 %, 206/660). La voie parentérale était prescrite pour l’administration de la majorité desantimicrobiens (62,0%, 409/660). Le respect des lignes directrices régionales de traitement était de 29,9 % (26 des 87 indications analysées). Parmi les 520 indications, 104 (20,0 %) n’étaient pas mentionnées au dossier et 326 (62,7 %) étaient dépourvues de mention de la durée du traitement antimicrobien au dossier.</p><p><strong>Conclusions :</strong> Des agents antimicrobiens ont été prescrits à environ un tiers des patients recevant des soins de courte durée en Nouvelle-Écosse. L’amélioration de l’utilisation des antimicrobiens devrait cibler précisément les réductions de la prescription d’antibiotiques à large spectre et du recours à la voie parentérale, un plus grand respect des lignes directrices et une meilleure consignation. Les programmes de gestion responsable des antimicrobiens en Nouvelle-Écosse devraient être axés sur des objectifs d’amélioration définis afin de mettre au point des stratégies.</p>
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Johnston L, Potter A, Carey P, Luvai A, McKenna P, Weaver J, Pattman S, Kamaruddin S, Arutchevelam V, Anderson M, Burns M, Hopper N, Sutton R, McAnulty C, Curtis A, Neely R. Mutations in LDLR, APOB, PCSK9 and APOE genes contribute to the genetic spectrum of familial hypercholesterolaemia in the north of England. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.217] [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: 11/27/2022]
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Black E, Neville H, Losier M, Harrison M, Abbass K, Slayter K, Johnston L, Sketris I. Antimicrobial Use at Acute Care Hospitals in Nova Scotia: A Point Prevalence Survey. Can J Hosp Pharm 2018; 71:234-242. [PMID: 30185997 PMCID: PMC6118829] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Point prevalence surveys are used to monitor antimicrobial use and identify targets for improvement through antimicrobial stewardship activities. Few studies have evaluated antimicrobial use in Nova Scotia acute care institutions. OBJECTIVES To determine the prevalence and characteristics of antimicrobial use in Nova Scotia hospitals. METHODS A point prevalence survey was conducted between June and November 2015 for patients admitted to hospitals with at least 30 acute care beds. On each survey day, charts were reviewed to identify patients receiving antimicrobial agents on that day. Data were gathered on the type of antimicrobial agent prescribed, route of administration, intended duration of use, and indication. Adherence to regional and local treatment guidelines was assessed. Results were summarized descriptively. Findings were compared using the Fisher exact test or the Cochran-Armitage trend test. RESULTS Twelve of the 13 eligible hospitals participated, and a total of 1499 patient charts were examined. The overall prevalence of antimicrobial use was 30.6% (458/1499). The prevalence of antimicrobial use differed significantly according to area of specialty, with the highest prevalence occurring in intensive care wards (47.2%, 50/106) and surgical wards (43.4%, 179/412), as compared with medical wards (27.9%, 192/687) and "other" specialty wards (11.1%, 32/289) (p < 0.001). Among the 520 indications for antimicrobial use, the most common was respiratory tract infection (81 or 15.6%). In total, 660 antimicrobial agents were prescribed to the 458 patients; a third of these patients (152 or 33.2%) received more than 1 antimicrobial agent. The class of antimicrobials most frequently prescribed was "other beta-lactam antimicrobials" (31.2%, 206/660). The majority of antimicrobials (62.0%, 409/660) were prescribed for administration via the parenteral route. Adherence to regional treatment guidelines was 29.9% (26 of 87 indications analyzed). Documentation of indication was lacking for 104 (20.0%) of the 520 indications, and documentation of the intended duration of antimicrobial use was lacking for 326 (62.7%) of the 520 indications. CONCLUSIONS Antimicrobial agents were prescribed for about one-third of acute care patients in Nova Scotia. Specific targets for improvement in antimicrobial use include decreases in prescribing of broad-spectrum and parenteral antimicrobials, better adherence to guidelines, and improved documentation. In developing initiatives, antimicrobial stewardship programs in Nova Scotia should focus on identified targets for improvement.
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Affiliation(s)
- Emily Black
- , BSc(Pharm), ACPR, PharmD, is with Dalhousie University, Halifax, Nova Scotia
| | - Heather Neville
- , BSc(Pharm), MSc, is with the Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Mia Losier
- , BSc(Pharm), was, at the time this study was conducted, a student at Dalhousie University, Halifax, Nova Scotia. She is now a pharmacy resident with Horizon Health Network, Saint John, New Brunswick
| | - Megan Harrison
- , BSc(Pharm), MSc, was, at the time this study was conducted, a student at Dalhousie University, Halifax, Nova Scotia. She is now a staff pharmacist with Horizon Health Network, Saint John, New Brunswick
| | - Kim Abbass
- , BSc(Pharm), PharmD, is with the Nova Scotia Health Authority, Sydney, Nova Scotia
| | - Kathy Slayter
- , BSc(Pharm), PharmD, FCSHP, is with the IWK Health Centre, Halifax, Nova Scotia
| | - Lynn Johnston
- , MD, MSc, FRCPC, is with Dalhousie University and the Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Ingrid Sketris
- , BSc(Pharm), PharmD, MPA(HSA), FCCP, FCSHP, FCAHS, is with Dalhousie University, Halifax, Nova Scotia
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Sawyer T, Foglia E, Hatch LD, Moussa A, Ades A, Johnston L, Nishisaki A. Improving neonatal intubation safety: A journey of a thousand miles. J Neonatal Perinatal Med 2018; 10:125-131. [PMID: 28409758 DOI: 10.3233/npm-171686] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neonatal intubation is one of the most common procedures performed by neonatologists, however, the procedure is difficult and high risk. Neonates who endure the procedure often experience adverse events, including bradycardia and severe oxygen desaturations. Because of low first attempt success rates, neonates are often subjected to multiple intubation attempts before the endotracheal tube is successfully placed. These factors conspire to make intubation one of the most dangerous procedures in neonatal medicine. In this commentary we review key elements in the journey to improve neonatal intubation safety. We begin with a review of intubation success rates and complications. Then, we discuss the importance of intubation training. Next, we examine quality improvement efforts and patient safety research to improve neonatal intubation safety. Finally, we evaluate new tools which may improve success rates, and decrease complications during neonatal intubation.
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Affiliation(s)
- T Sawyer
- Seattle Children's Hospital and University of Washington School of Medicine, Department of Pediatric, Division of Neonatology, Seattle, WA, USA
| | - E Foglia
- The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Department of Pediatric, Division of Neonatology, Philadelphia, PA, USA
| | - L Dupree Hatch
- Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Department of Pediatric, Division of Neonatology, Nashville, TN, USA
| | - A Moussa
- Université de Montréal, Department of Pediatric, Division of Neonatology, Montréal, QC, Canada
| | - A Ades
- The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Department of Pediatric, Division of Neonatology, Philadelphia, PA, USA
| | - L Johnston
- Yale-New Haven Hospital and Yale School of Medicine, Department of Pediatric, Division of Neonatology, New Haven, CT, USA
| | - A Nishisaki
- The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Department of Pediatric, Division of Neonatology, Philadelphia, PA, USA
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Bruno CJ, Johnston L, Lee C, Bernstein PS, Goffman D. Opinions regarding neonatal resuscitation training for the obstetric physician: a survey of neonatal and obstetric training program directors. J Matern Fetal Neonatal Med 2018; 31:1035-1039. [DOI: 10.1080/14767058.2017.1306052] [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: 10/20/2022]
Affiliation(s)
- C. J. Bruno
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - L. Johnston
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - C. Lee
- Department of Obstetrics & Gynecology and Women’s Health, Columbia Presbyterian Medical Center, New York, NY, USA
| | - P. S. Bernstein
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - D. Goffman
- Department of Obstetrics & Gynecology and Women’s Health, Columbia Presbyterian Medical Center, New York, NY, USA
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English KM, Langley JM, McGeer A, Hupert N, Tellier R, Henry B, Halperin SA, Johnston L, Pourbohloul B. Contact among healthcare workers in the hospital setting: developing the evidence base for innovative approaches to infection control. BMC Infect Dis 2018; 18:184. [PMID: 29665775 PMCID: PMC5905140 DOI: 10.1186/s12879-018-3093-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Nosocomial, or healthcare-associated infections (HAI), exact a high medical and financial toll on patients, healthcare workers, caretakers, and the health system. Interpersonal contact patterns play a large role in infectious disease spread, but little is known about the relationship between health care workers’ (HCW) movements and contact patterns within a heath care facility and HAI. Quantitatively capturing these patterns will aid in understanding the dynamics of HAI and may lead to more targeted and effective control strategies in the hospital setting. Methods Staff at 3 urban university-based tertiary care hospitals in Canada completed a detailed questionnaire on demographics, interpersonal contacts, in-hospital movement, and infection prevention and control practices. Staff were divided into categories of administrative/support, nurses, physicians, and “Other HCWs” - a fourth distinct category, which excludes physicians and nurses. Using quantitative network modeling tools, we constructed the resulting HCW “co-location network” to illustrate contacts among different occupations and with locations in hospital settings. Results Among 3048 respondents (response rate 38%) an average of 3.79, 3.69 and 3.88 floors were visited by each HCW each week in the 3 hospitals, with a standard deviation of 2.63, 1.74 and 2.08, respectively. Physicians reported the highest rate of direct patient contacts (> 20 patients/day) but the lowest rate of contacts with other HCWs; nurses had the most extended (> 20 min) periods of direct patient contact. “Other HCWs” had the most direct daily contact with all other HCWs. Physicians also reported significantly more locations visited per week than nurses, other HCW, or administrators; nurses visited the fewest. Public spaces such as the cafeteria had the most staff visits per week, but the least mean hours spent per visit. Inpatient settings had significantly more HCW interactions per week than outpatient settings. Conclusions HCW contact patterns and spatial movement demonstrate significant heterogeneity by occupation. Control strategies that address this diversity among health care workers may be more effective than “one-strategy-fits-all” HAI prevention and control programs. Electronic supplementary material The online version of this article (10.1186/s12879-018-3093-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Krista M English
- Institute for Resources, Environment and Sustainability, University of British Columbia, 2202 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Joanne M Langley
- Departments of Pediatrics, and Community Health & Epidemiology, Canadian Center for Vaccinology, IWK Health Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, B3K 6R8, Canada
| | - Allison McGeer
- Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Nathaniel Hupert
- Weill Cornell Medicine, 402 East 67 St, New York, NY, 10065, USA
| | - Raymond Tellier
- Department of Pathology & Laboratory Medicine, And Provincial Laboratory for Public Health of Alberta, 3030 Hospital Drive NW, Calgary, AB, T2N 4W4, Canada
| | - Bonnie Henry
- British Columbia Ministry of Health, 1515 Blanshard St, Victoria, BC, V8W 9P4, Canada
| | - Scott A Halperin
- Departments of Pediatrics, and Microbiology & Immunology, Canadian Center for Vaccinology, IWK Health Centre, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, B3K 6R8, Canada
| | - Lynn Johnston
- Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, NS, B3H 1V7, Canada
| | - Babak Pourbohloul
- Institute for Resources, Environment and Sustainability, University of British Columbia, 2202 Main Mall, Vancouver, BC, V6T 1Z4, Canada.
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Miller S, Agarwal A, Haddon WB, Johnston L, Arnold G, Wang W, Abboud RJ. Comparison of gait kinetics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl 2018; 100:267-274. [PMID: 29484928 PMCID: PMC5958845 DOI: 10.1308/rcsann.2017.0226] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to compare kinetical data from gait analysis of patients who have undergone total and uni-condylar knee replacement. Materials and methods Thirteen patients with unilateral total knee arthroplasty (TKA) and 13 unicondylar knee arthroplasty (UKA), were included, all performed by the same surgeon more than one year prior. The Vicon gait analysis system was used. Statistical power was calculated using SPSS. Results No significant difference was found in the spatiotemporal parameters of gait and survival years of the knee prosthesis between the two groups. The UKA group was found to have significantly larger moments than the TKA group in knee adduction on the operated side and knee flexion moment on the unoperated side during the loading phase. The maximum and minimum sagittal plane moments of the operated sides in the TKA group were significantly lower than the unoperated side. The difference was most significant at pre-swing. The maximum and minimum moments on the operated sides in the UKA group were significantly lower for the knee flexion and adduction moments when compared with the unoperated side and were most prevalent during the loading phase. Conclusions These results are relevant in terms of prosthesis wear. The TKA knees had smaller magnitude moments than the UKA knees in the sagittal and coronal planes. This could explain the higher revision rates for UKA. In both groups, the non-operated knees had significantly larger moments than the operated knees, which implies that after unilateral knee replacement of either type, the non-operated knee is being put under greater stress.
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Affiliation(s)
- S Miller
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - A Agarwal
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - WB Haddon
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - L Johnston
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - G Arnold
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - W Wang
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - RJ Abboud
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
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Affiliation(s)
- Lynn Johnston
- Linking Generations Northern Ireland, Newtownards, Northern Ireland; Part of the Beth Johnson Foundation, Stoke-on-Trent, United Kingdom
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Johnston L, Terp D. SUPPORT IS COMPLICATED: HOW INCREASED SUPPORT AFTER CRITICAL ILLNESS CAN CREATE INCREASED ANXIETY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L. Johnston
- Social Sciences, Cal Poly University, San Luis Obispo, California,
| | - D. Terp
- Curry Senior Center, San Francisco, California
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Cheng L, Tahim A, Ali S, Blanchard J, Johnston L, Leung H, Jones A, Grant C. The use of TissuePatch™, a self-adhesive sealant film to prevent postoperative vascular leakage after thyroid surgery. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.1153] [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: 11/25/2022]
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Cheng L, Tahim A, Ali S, Blanchard J, Johnston L, Leung H, Jones A, Grant C. The use of TissuePatch™, a self-adhesive sealant film to prevent postoperative vascular leakage after head and neck surgery. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Diffin J, Spence K, Naranian T, Badawi N, Johnston L. Stress and distress in parents of neonates admitted to the neonatal intensive care unit for cardiac surgery. Early Hum Dev 2016; 103:101-107. [PMID: 27565126 DOI: 10.1016/j.earlhumdev.2016.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parents of infants admitted to the Neonatal Intensive Care Unit (NICU) are at risk of psychological distress and NICU-related stress. However, parents of infants admitted to NICU for cardiac surgery are an under-researched population. AIMS Identify levels of NICU-related stress, and levels of psychological distress, reported by parents of infants admitted to the NICU for cardiac surgery. STUDY DESIGN Observational study. SUBJECTS 69 parents of infants admitted to the NICU for cardiac surgery (cardiac group) and 142 parents of healthy infants (control group). OUTCOME MEASURES Questionnaire packs provided to parents prior to discharge (time-point 1), and at six and 12months corrected age included: Hospital Anxiety and Depression Scale, Coping Inventory for Stressful Situations, and Family Support Scale. The Parental Stressor Scale:NICU was administered to the cardiac group at time-point 1. RESULTS The cardiac group reported (i) that parental role alteration was the most stressful aspect of the NICU and (ii) higher scores for anxiety and depression than the control group at all three time-points, with the highest levels reported during the NICU stay. Correlation analyses indicated (i) stress associated with the sights and sounds of the NICU, and the appearance and behaviour of the infant in the NICU, had a significant positive association with anxiety and depression, and (ii) a significant negative relationship between anxiety and task-focused coping. CONCLUSIONS An individualised parent-targeted intervention aimed at reducing stress associated with the NICU and enhancing task-focused coping style may help to reduce levels of anxiety and depression within this group of parents.
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Affiliation(s)
- J Diffin
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
| | - K Spence
- Grace Centre for Newborn Care, Children's Hospital Westmead, Sydney, Australia; School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - T Naranian
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - N Badawi
- Grace Centre for Newborn Care, Children's Hospital Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - L Johnston
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Johnston L. Old School With the Hairy Bikers. Journal of Intergenerational Relationships 2016. [DOI: 10.1080/15350770.2016.1226636] [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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Dear BF, Staples LG, Terides MD, Fogliati VJ, Sheehan J, Johnston L, Kayrouz R, Dear R, McEvoy PM, Titov N. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for Social Anxiety Disorder and comorbid disorders: A randomized controlled trial. J Anxiety Disord 2016; 42:30-44. [PMID: 27261562 DOI: 10.1016/j.janxdis.2016.05.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/22/2016] [Accepted: 05/07/2016] [Indexed: 12/14/2022]
Abstract
Disorder-specific (DS-CBT) and transdiagnostic (TD-CBT) cognitive behaviour therapy have both been used to treat social anxiety disorder (SAD). This study compared internet-delivered DS-CBT and TD-CBT for SAD across clinician-guided (CG-CBT) and self-guided (SG-CBT) formats. Participants with SAD (n=233) were randomly allocated to receive internet-delivered TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of SAD (Cohen's d≥1.01; avg. reduction≥30%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d≥1.25; avg. reduction≥39%), generalised anxiety disorder (Cohen's d≥0.86; avg. reduction≥36%) and panic disorder (Cohen's d≥0.53; avg. reduction≥25%) were found immediately post-treatment and were maintained or further improved to 24-month follow-up. No marked differences were observed between TD-CBT and DS-CBT or CG-CBT and SG-CBT highlighting the potential of each for the treatment of SAD and comorbid disorders.
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Affiliation(s)
- B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Sheehan
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Kayrouz
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
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Sawyer T, French H, Ades A, Johnston L. Neonatal-perinatal medicine fellow procedural experience and competency determination: results of a national survey. J Perinatol 2016; 36:570-4. [PMID: 26938919 DOI: 10.1038/jp.2016.19] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Ensuring that neonatal-perinatal medicine (NPM) fellows attain competency in performing neonatal procedures is a requirement of training-competent neonatologists. STUDY DESIGN A survey of NPM fellows was performed to determine the procedural experience of current fellows, investigate techniques used to track procedural experience and examine the methods programs use to verify procedural competency. RESULTS One hundred and sixty-three fellows in 57 accredited training programs responded to the survey. Reported number of procedures provide contemporary normative data on procedural experience during training. The majority of fellows reported using an online reporting system to track experience. The most common technique to verify procedural competency was supervised practice until an arbitrary number of procedures had been performed. CONCLUSIONS NPM fellow procedural experience increases significantly for most, but not all, procedures duration training. We speculate that supplemental simulation training for rare neonatal procedures would help ensure the competency of graduating NPM fellows. Experience alone is insufficient to verify competency. Further work on the accurate tracking of experience and verification of procedural competency is needed.
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Affiliation(s)
- T Sawyer
- University of Washington School of Medicine, Division of Neonatology, Seattle, WA, USA
| | - H French
- Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA, USA
| | - A Ades
- Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA, USA
| | - L Johnston
- Yale School of Medicine, Division of Neonatology, New Haven, CT, USA
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Taylor G, Gravel D, Matlow A, Embree J, LeSaux N, Johnston L, Suh KN, John M, Embil J, Henderson E, Roth V, Wong A. Assessing the magnitude and trends in hospital acquired infections in Canadian hospitals through sequential point prevalence surveys. Antimicrob Resist Infect Control 2016; 5:19. [PMID: 27213039 PMCID: PMC4875760 DOI: 10.1186/s13756-016-0118-3] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/10/2016] [Indexed: 01/25/2023] Open
Abstract
Background Healthcare acquired infections (HAI) are an important public health problem in developed countries, but comprehensive data on trends over time are lacking. Prevalence surveys have been used as a surrogate for incidence studies and can be readily repeated. Methods The Canadian Nosocomial Infection Surveillance Program conducted prevalence surveys in 2002 and 2009 in a large network of major Canadian acute care hospitals. NHSN definitions of HAI were used. Use of isolation precautions on the survey day was documented. Results In 2009, 9,953 acute care inpatients were surveyed; 1,234 infections (124/1000) were found, compared to 111/1000 in 2002, (p < 0.0001). There was increased prevalence of urinary tract infection (UTI) and Clostridium difficile, offset by decreases in pneumonia and bloodstream infection. Use of isolation precautions increased from 77 to 148 per 1000 patients (p < 0.0001), attributable to increased use of contact precautions in patients infected or colonized with antimicrobial resistant organisms. Conclusion Between 2002 and 2009 HAI prevalence increased by 11.7 % in a network of major Canadian hospitals due to increases in Clostridium difficile and urinary tract infection. The use of isolation precautions increased by 92.2 % attributable to increased contact isolation. National prevalence surveys are useful tools to assess evolving trends in HAI.
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Affiliation(s)
- Geoffrey Taylor
- University of Alberta Hospital, 1-127 CSB, T6G 2G3 Edmonton, Alberta Canada
| | - Denise Gravel
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario Canada ; University of Alberta Hospital, Edmonton, Alberta Canada
| | - Anne Matlow
- The Hospital for Sick Children, Toronto, Ontario Canada
| | | | | | - Lynn Johnston
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia Canada
| | | | | | - John Embil
- Health Sciences Centre, Winnipeg, Manitoba Canada
| | | | | | - Alice Wong
- Royal University Hospital, Saskatoon, Saskatchewan Canada
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Gandy M, Fogliati V, Terides M, Johnston L, Nicholson Perry K, Newall C, Titov N, Dear B. Short message service prompts for skills practice in Internet-delivered cognitive behaviour therapy for chronic pain - are they feasible and effective? Eur J Pain 2016; 20:1288-98. [DOI: 10.1002/ejp.853] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 01/24/2023]
Affiliation(s)
- M. Gandy
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | - V.J. Fogliati
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | - M.D. Terides
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | - L. Johnston
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | | | - C. Newall
- Institute of Early Childhood; Macquarie University; Sydney NSW Australia
| | - N. Titov
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
| | - B.F. Dear
- eCentreClinic; Department of Psychology; Macquarie University; Sydney NSW Australia
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Alway Y, Gould KR, Johnston L, McKenzie D, Ponsford J. A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury. Psychol Med 2016; 46:1331-1341. [PMID: 26867715 DOI: 10.1017/s0033291715002986] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI. METHOD Participants were 161 individuals (78.3% male) with moderate (31.2%) or severe (68.8%) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors. RESULTS In the first 5 years post-injury, 75.2% received a psychiatric diagnosis, commonly emerging within the first year (77.7%). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5%) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6% over time, decreasing by 27% [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.65-0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95% CI 0.63-0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95% CI 1.41-4.25) and accident-related limb injury (OR 1.78, 95% CI 1.03-3.07). CONCLUSIONS Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders.
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Affiliation(s)
- Y Alway
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,Monash University,Melbourne,Australia
| | - K R Gould
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,Monash University,Melbourne,Australia
| | - L Johnston
- Monash-Epworth Rehabilitation Research Centre,Epworth Hospital,Melbourne,Australia
| | - D McKenzie
- Research Development and Governance,Epworth Healthcare,Melbourne,Australia
| | - J Ponsford
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences,Monash University,Melbourne,Australia
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Fogliati VJ, Dear BF, Staples LG, Terides MD, Sheehan J, Johnston L, Kayrouz R, Dear R, McEvoy PM, Titov N. Disorder-specific versus transdiagnostic and clinician-guided versus self-guided internet-delivered treatment for panic disorder and comorbid disorders: A randomized controlled trial. J Anxiety Disord 2016; 39:88-102. [PMID: 27003376 DOI: 10.1016/j.janxdis.2016.03.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022]
Abstract
Transdiagnostic cognitive behaviour therapy (TD-CBT) aims to target the symptoms of multiple disorders whereas disorder-specific CBT (DS-CBT) targets the symptoms of principal disorders. This study compared the relative benefits of internet-delivered TD-CBT and DS-CBT when provided in clinician-guided (CG-CBT) and self-guided (SG-CBT) formats for people with a principal diagnosis of Panic Disorder (PD). Participants (n=145) were randomly allocated to receive TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of PD (Cohen's d ≥ 0.71; avg. reduction ≥ 36%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d ≥ 0.71; avg. reduction ≥ 33%), generalised anxiety disorder (Cohen's d ≥ 0.91; avg. reduction ≥ 34%) and social anxiety disorder (Cohen's d ≥ 0.50; avg. reduction ≥ 15%) were found over the 24-month follow-up period. Highlighting their efficacy and acceptability, no marked and consistent differences were observed between TD-CBT and DS-CBT or CG-CBT and DS-CBT.
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Affiliation(s)
- V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Sheehan
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Kayrouz
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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Johnston L, Chan A, Arieno A, Morgan R, Highnam R, Destounis S. Abstract P6-10-12: Volumetric breast density better predicts tumour characteristics associated with poor prognosis compared to visual BI-RADS. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-10-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:
Early detection of breast cancer through mammography screening reduces breast cancer mortality. To improve outcomes from screening, more than half of invasive cancers and a third of high grade cancers should be small at detection (<15mm), and more than 70% of all cancers should be node negative at diagnosis. Although breast density is associated with reduced mammographic sensitivity, it is unclear whether certain tumor characteristics associated with poorer prognosis are more prevalent in women with denser breasts. The study investigated associations between visually- or volumetrically-assessed breast density and tumor characteristics related to poor prognosis.
Methods:
Our IRB-approved study included 755 DCIS, invasive ductal or invasive lobular breast cancers diagnosed in women (aged over 40) between January 2009 and December 2012. Information on the patients' tumor characteristics including stage, size, receptor, grade and lymph node status was collected retrospectively. Women were excluded if they had a previous history of breast cancer or breast surgery, or if they were missing tumour size data or raw digital mammograms taken within 24 months of the cancer diagnosis. For women with multiple cancers, only the first diagnosed cancer was included. Breast density was assessed using visual BI-RADS density categories and Volpara Density Grades (VDG; an automated equivalent to 4th Edition BI-RADS, assigned using preset cut-offs of volumetric breast density: 4.5, 7.5, 15.5 and >15.5%). VDG was calculated from both breasts if the prior negative mammogram was available, and the contralateral breast for positive mammograms.
Results:
Overall, 55% of invasive tumors and 33% of grade 3 tumors were smaller than 15 mm and 83% were node negative. Mean tumor size increased significantly with increasing VDG (VDG 1 = 12.8, 2 = 14.7, 3 = 16.1, 4 = 20.4 mm, p<0.001) and increasing BI-RADS (1 = 12.2, 2 = 13.9, 3 = 16.8, 4 = 18.2 mm, p=0.01). The proportion of node positive tumors also increased significantly with increasing VDG (5.1%, 12.8%, 19.3%, 26.1%, p<0.001) and BI-RADS (0%, 10.6%, 19.5%, 26%, p=0.01). There was a significant increase in grade 3 tumors (11%, 16.1%, 21.7%, 21.7%, p =0.02) and HER-2 positive tumors (5.6%, 10.5%, 13.3%, 14.3%, p=0.02) with increasing VDG that was not seen with visual BI-RADS assessment (p=0.4). Increasing VDG was also significantly associated with increased proportions of larger (i.e. >15mm) node positive cancers (1.7%, 6.3%, 10.5%, 16%, p=0.004) that were not seen with BI-RADS (p=0.2).
Conclusion:
We found that tumour size and node status differed significantly with breast density as measured by VDG and visual BI-RADS. However, grade 3, HER-2 positive and large/node-positive cancers were all significantly associated with increasing VDG, but not BI-RADS density grade. Further research is needed to investigate whether automated volumetric breast density can be used to predict which women are more likely to be diagnosed with tumours that have poorer prognostic features.
Citation Format: Johnston L, Chan A, Arieno A, Morgan R, Highnam R, Destounis S. Volumetric breast density better predicts tumour characteristics associated with poor prognosis compared to visual BI-RADS. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-12.
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Affiliation(s)
- L Johnston
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - A Chan
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - A Arieno
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - R Morgan
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - R Highnam
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
| | - S Destounis
- Volpara Solutions, Wellington, New Zealand; Elizabeth Wende Breast Care, Rochester, NY
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