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Yeung KCY, Kapitany C, Chargé S, Callum J, Cserti-Gazdewich C, D'Empaire PP, Khandelwal A, Lieberman L, Lee C, Pavenski K, Pendergrast J, Shehata N, Hsia CC, Lavoie M, Murphy MF, Prokopchuk-Gauk O, Rahmani M, Trudeau J, Zeller MP, Lin Y. Transfusion camp: A retrospective study of self-reported impact on postgraduate trainee transfusion practice. Transfusion 2023; 63:839-848. [PMID: 36811164 DOI: 10.1111/trf.17278] [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] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The optimal method of postgraduate transfusion medicine (TM) education remains understudied. One novel approach is Transfusion Camp, a longitudinal 5-day program that delivers TM education to Canadian and international trainees. The purpose of this study was to determine the self-reported impact of Transfusion Camp on trainee clinical practice. STUDY DESIGN AND METHODS A retrospective analysis of anonymous survey evaluations from Transfusion Camp trainees over three academic years (2018-2021) was conducted. Trainees were asked, "Have you applied any of your learning from Transfusion Camp into your clinical practice?". Through an iterative process, responses were categorized into topics according to program learning objectives. The primary outcome was the rate of self-reported impact of Transfusion Camp on clinical practice. Secondary outcomes were to determine impact based on specialty and postgraduate year (PGY). RESULTS Survey response rate was 22%-32% over three academic years. Of 757 survey responses, 68% of respondents indicated that Transfusion Camp had an impact on their practice, increasing to 83% on day 5. The most frequent areas of impact included transfusion indications (45%) and transfusion risk management (27%). Impact increased as PGY increased with 75% of PGY-4+ trainees reporting impact. In multivariable analysis, the impact of specialty and PGY varied depending on the objective. DISCUSSION The majority of trainees report applying learnings from Transfusion Camp to their clinical practice with variations based on PGY and specialty. These findings support Transfusion Camp as an effective means of TM education and help identify high-yield areas and gaps for future curriculum planning.
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Affiliation(s)
- Katie C Y Yeung
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | | | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada.,Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada
| | - Christine Cserti-Gazdewich
- Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Blood Transfusion Laboratory (Laboratory Medicine Program) and Blood Disorders Clinic (Division of Medical Oncology and Hematology), University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Perez D'Empaire
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aditi Khandelwal
- Canadian Blood Services, Ottawa, Ontario, Canada.,Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.,Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christie Lee
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Jacob Pendergrast
- Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Blood Transfusion Laboratory (Laboratory Medicine Program) and Blood Disorders Clinic (Division of Medical Oncology and Hematology), University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Nadine Shehata
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Marianne Lavoie
- Department of Medicine, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Michael F Murphy
- NHS Blood & Transplant and the Oxford University Hospitals, Oxford, UK.,Department of Medicine, University of Oxford, Oxford, UK
| | - Oksana Prokopchuk-Gauk
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Mahboubeh Rahmani
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Pathology and Lab Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.,Beatrice Hunter Cancer Research Institute Halifax, Nova Scotia, Canada
| | - Jacqueline Trudeau
- Departments of Anesthesiology, Pharmacology and Therapeutics and Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle P Zeller
- Canadian Blood Services, Ottawa, Ontario, Canada.,McMaster McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Yulia Lin
- Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Shopsowitz KE, Lim C, Shih AW, Fishbane N, Berry BR, Bigham M, Petraszko T, Trudeau J, Wyatt M, Yan MTS, Morrison D. Impacts of COVID-19 and elective surgery cancellations on platelet supply and utilization in the Canadian Province of British Columbia. Vox Sang 2021; 117:251-258. [PMID: 34309031 PMCID: PMC8447158 DOI: 10.1111/vox.13180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 01/02/2023]
Abstract
Background and Objectives The coronavirus disease 2019 (COVID‐19) pandemic raised concerns about the vulnerability of platelet supply and the uncertain impact of the resumption of elective surgery on utilization. We report the impact of COVID‐19 on platelet supply and utilization across a large, integrated healthcare system in the Canadian province of British Columbia (BC). Materials and Methods Historical platelet use in BC by indication was compiled for fiscal year 2010/2011–2019/2020. Platelet collections, initial daily inventory and disposition data were assessed pre‐COVID‐19 (1 April 2018–15 March 2020) and for two COVID‐19 time periods in BC: a shutdown phase with elective surgeries halted (16 March–17 May, 2020) and a renewal phase when elective surgeries resumed (18 May–27 September 2020); comparisons were made provincially and for individual health authorities. Results Historically, elective surgeries accounted for 10% of platelets transfused in BC. Initial daily supplier inventory increased from baseline during both COVID‐19 periods (93/90 units vs. 75 units pre‐COVID‐19). During the shutdown phase, platelet utilization decreased 10.4% (41 units/week; p < 0.0001), and remained significantly decreased during the ensuing renewal period. Decreased platelet utilization was attributed to fewer transfusions during the shutdown phase followed by a decreased discard/expiry rate during the renewal phase compared to pre‐COVID‐19 (15.2% vs. 18.9% pre‐COVID‐19; p < 0.0001). Differences in COVID‐19 platelet utilization patterns were noted between health authorities. Conclusion Decreased platelet utilization was observed in BC compared to pre‐COVID‐19, likely due to a transient reduction in elective surgery as well as practice and policy changes triggered by pandemic concerns.
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Affiliation(s)
- Kevin E Shopsowitz
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Lim
- BC Provincial Blood Coordinating Office, Vancouver, British Columbia, Canada
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Fishbane
- BC Provincial Blood Coordinating Office, Vancouver, British Columbia, Canada
| | - Brian R Berry
- Department of Pathology, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Mark Bigham
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Tanya Petraszko
- Canadian Blood Services, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Trudeau
- Department of Anesthesia, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen Wyatt
- Department of Pathology and Laboratory Medicine, Interior Health Authority, Kelowna, British Columbia, Canada
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Fraser Health Authority, New Westminster, British Columbia, Canada
| | - Douglas Morrison
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,BC Provincial Blood Coordinating Office, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of BC, Vancouver, British Columbia, Canada
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3
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Al Moosawi M, Trudeau J, Smith T, Lefebvre A, Shih AW. ROTEM in the setting of liver transplant surgery reduces frozen plasma transfusion. Transfus Apher Sci 2021; 60:103125. [PMID: 33775554 DOI: 10.1016/j.transci.2021.103125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/28/2021] [Accepted: 03/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND INR is traditionally used as a marker of clinical coagulopathy, but is suboptimal in liver disease patients due to rebalanced hemostasis and its ineffectiveness to predict bleeding. Rotational thromboelastometry (ROTEM) testing evaluates whole blood hemostasis, which may provide more accurate assessments with the EXTEM CT parameter than INR. Thus, in end-stage liver disease (ESLD) patients, we hypothesized that elevated INRs are associated with normal EXTEM CT values. METHODS A retrospective study assessing adult (>18) patients with ESLD and elevated INRs undergoing liver transplantation, was performed to assess correlations between INR and EXTEM CT. This included patients post-ROTEM implementation where all had pre-operative ROTEM testing; and patients up to one year pre-ROTEM implementation to compare transfusion utilization. Data abstracted also included patient demographics, coagulation testing results, liver disease etiology, and MELD score. RESULTS The study included 138 patients in the post-ROTEM group and 59 patients in the pre-ROTEM group. Normal EXTEM CT was observed in 95.3 % and 93 % of patients with INR of 1.3-1.8 and up to 3 respectively. There was no correlation between INR of 1.3-1.8 and EXTEM CT (⍴ = 0.239), and only moderate correlation was observed with higher INRs (⍴ = 0.617 with INRs >1.8). ROTEM-guided transfusion in liver transplant surgeries was associated with reduced plasma transfusion (OR 0.27, 95 % CI 0.12-0.58, p = 0.001) after adjusting for red cell utilization and coagulation testing. CONCLUSION Our study suggests ROTEM may be advantageous for evaluating coagulopathy in patients with liver disease and ROTEM-guided transfusion reduces plasma transfusion.
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Affiliation(s)
- Muntadhar Al Moosawi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Trudeau
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler Smith
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandre Lefebvre
- Department of Cardiothoracic Anesthesiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.
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4
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McGinnis E, Guo RJ, Marcon KM, Berry B, Coupland R, Meneghetti V, Morrison D, Onell R, Steele L, Trudeau J, Wong M, Shih AW. Adaptations of transfusion systems to the COVID-19 pandemic in British Columbia, Canada: Early experiences of a large tertiary care center and survey of provincial activities. Transfusion 2021; 61:1102-1111. [PMID: 33452826 PMCID: PMC8014229 DOI: 10.1111/trf.16265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
Background In March 2020, a state of emergency was declared to facilitate organized responses to the coronavirus disease 2019 (COVID‐19) pandemic in British Columbia, Canada. Emergency blood management committees (EBMCs) were formed regionally and provincially to coordinate transfusion service activities and responses to possible national blood shortages. Study Design and Methods We describe the responses of transfusion services to COVID‐19 in regional health authorities in British Columbia through a collaborative survey, contingency planning meeting minutes, and policy documents, including early trends observed in blood product usage. Results Early strategic response policies were developed locally in collaboration with members of the provincial EBMC and focused on three key areas: utilization management strategies, stakeholder engagement (collaboration with frequent users of the transfusion service, advance notification of potential inventory shortage plans, and development of blood triage guidance documents), and laboratory staffing and infection control procedures. Reductions in transfusion volumes were observed beginning in mid‐March 2020 for red blood cells and platelets relative to the prepandemic baseline (27% and 26% from the preceding year, respectively). There was a slow gradual return toward baseline beginning one month later; no product shortage issues were experienced. Conclusion Provincial collaborative efforts facilitated the development of initiatives focused on minimizing potential COVID‐19–related disruptions in transfusion services in British Columbia. While there have been no supply issues to date, the framework developed early in the pandemic should facilitate timely responses to possible disruptions in future waves of infection.
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Affiliation(s)
- Eric McGinnis
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert J Guo
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krista M Marcon
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Brian Berry
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Robert Coupland
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Victor Meneghetti
- Department of Pathology, University Hospital of Northern British Columbia, Prince George, British Columbia, Canada
| | - Douglas Morrison
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Children's and Women's Health Center of BC, Vancouver, British Columbia, Canada
| | - Rodrigo Onell
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Lisa Steele
- Department of Pathology and Laboratory Medicine, Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Jacqueline Trudeau
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Wong
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
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5
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Peel JK, Trudeau J, Tano R, Jadunandan S, Callum J, Moussa F, Lin Y. Determining Optimal Treatment to Correct Preoperative Anemia and Reduce Perioperative Allogeneic Blood Transfusions in Cardiac Surgery: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2021; 35:2631-2639. [PMID: 33483268 DOI: 10.1053/j.jvca.2020.12.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Preoperative anemia management reduces red blood cell (RBC) transfusion and adverse outcomes, but how best to optimize the patient's hemoglobin (Hgb) before cardiac surgery remains unclear. The authors sought to determine the optimal treatment of anemia using iron and epoetin alfa before cardiac surgery. DESIGN Retrospective cohort study. SETTING Sunnybrook Health Sciences Centre, University of Toronto. PARTICIPANTS The study comprised 532 consecutive patients referred to the outpatient Blood Conservation Clinic and who underwent cardiac surgery between 2008 and 2018. INTERVENTIONS Of the 532 patients, 207 received oral iron, 84 received intravenous (IV) iron, 71 received epoetin alfa, 92 received combination therapy, and 78 received no treatment. MEASUREMENTS AND MAIN RESULTS Multivariate linear, logistic, and Poisson regressions modelled preoperative Hgb, the change from referral to preoperative Hgb (∆Hgb), the odds of transfusion, and the number of RBC units transfused, while accounting for baseline covariates. Higher ∆Hgb was associated with IV iron >600 mg (9.80 g/L [6.17-13.42]), epoetin alfa >80,000 U (5.80 g/L [2.20-9.40]), and higher referral Hgb (1.91 g/L [1.09-2.74] per 10 g/L). Higher preoperative Hgb (odds ratio 0.76 [0.64-0.90]; count ratio 0.84 [0.77-0.93] per 10 g/L) corresponded to a lower likelihood of being transfused and transfusion of fewer RBC units. CONCLUSIONS Preoperative IV iron >600 mg and epoetin alfa >80,000 U each was associated with significant increases in Hgb. Higher preoperative Hgb was associated with a lower likelihood of transfusion and transfusion of fewer RBC units. The authors recommend that cumulative preoperative doses of IV iron >600 mg and epoetin alfa >80,000 U be used for treatment of anemia before cardiac surgery.
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Affiliation(s)
- John K Peel
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Trudeau
- Department of Anesthesia, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ruby Tano
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Saudia Jadunandan
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Quality in Utilization, Education and Safety Research Program, University of Toronto, Toronto, Ontario, Canada
| | - Fuad Moussa
- Department of Cardiac Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Quality in Utilization, Education and Safety Research Program, University of Toronto, Toronto, Ontario, Canada.
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6
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Uemura H, Lee J, Oudard S, Hadaschik B, Saad F, Cella D, Basch E, Graff J, Dibaj S, Li S, Brookman-May S, De Porre P, Bevans K, Trudeau J, Smith M, Small E. 221P Patient-reported sexual and urinary function in nonmetastatic castration-resistant prostate cancer (nmCRPC) when treated with apalutamide (APA) vs placebo (PBO) and ongoing androgen deprivation therapy (ADT) in SPARTAN. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.441] [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: 10/22/2022] Open
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7
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Lin Y, Tilokee E, Chargé S, Alam A, Cserti-Gazdewich C, Lau W, Lee C, Lieberman L, Nixon P, Owens W, Pavenski K, Pendergrast J, Saidenberg E, Shehata N, Skeate R, Yi QL, Conrad D, Dudebout J, Hsia CC, Murphy M, Prokopchuk-Gauk O, Shah A, Solh Z, Trudeau J, Zeller MP, Callum J. Transfusion Camp: a prospective evaluation of a transfusion education program for multispecialty postgraduate trainees. Transfusion 2019; 59:2141-2149. [PMID: 30946497 DOI: 10.1111/trf.15284] [Citation(s) in RCA: 5] [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: 12/17/2018] [Revised: 01/25/2019] [Accepted: 02/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The optimal method of providing transfusion medicine (TM) education has not been determined. Transfusion Camp was established in 2012 at the University of Toronto as a centrally delivered TM education program for postgraduate trainees. The impact of Transfusion Camp on knowledge, attitudes, and self-reported behavior was evaluated. METHODS Didactic lectures (delivered locally, by webinar, or recorded) and locally facilitated team-based learning seminars were delivered over 5 days during the academic year to 8 sites: 7 in Canada and 1 in the United Kingdom. Knowledge assessment using a validated 20-question multiple-choice exam was conducted before and after Transfusion Camp. Attitudes and self-reported behavior were collected through a survey. RESULTS Over 2 academic years (July 2016 to June 2018), 390 trainees from 16 different specialties (predominantly anesthesia, 41%; hematology, 14%; and critical care, 7%) attended at least 1 day of Transfusion Camp. The mean pretest score was 10.3 of 20 (±2.9; n = 286) compared with posttest score of 13.0 (±2.8; n = 194; p < 0.0001). Lower pretest score and greater attendance (4-5 days compared with 1-3 days) were associated with larger improvement in posttest score; delivery format, specialty, and postgraduate year were not. Trainees reported an improvement in self-rated abilities to manage TM scenarios; 95% rated TM knowledge as very or extremely important in providing patient care; and 81% indicated that they had applied learning from Transfusion Camp into clinical practice. CONCLUSIONS Transfusion Camp increased TM knowledge, fostered a positive attitude toward TM, and enabled a self-reported positive impact on transfusion practice in postgraduate trainees. It is a novel and scalable approach to delivering TM education.
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Affiliation(s)
- Yulia Lin
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada
| | - Everad Tilokee
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Sophie Chargé
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Asim Alam
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Department of Anesthesia, North York General Hospital, Toronto, Canada
| | - Christine Cserti-Gazdewich
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - Wendy Lau
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Christie Lee
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - Paula Nixon
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada
| | - Wendy Owens
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Ontario Regional Blood Coordinating Network, Ontario, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,St. Michael's Hospital, Toronto, Canada
| | - Jacob Pendergrast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - Elianna Saidenberg
- University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,Hematology and Transfusion Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Nadine Shehata
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Department of Medicine, Division of Hematology, Mount Sinai Hospital, Toronto, Canada
| | - Robert Skeate
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada.,Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Qi-Long Yi
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - David Conrad
- Division of Hematopathology, Dalhousie University & Nova Scotia Health Authority Central Zone, Halifax, Canada
| | | | - Cyrus C Hsia
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - Oksana Prokopchuk-Gauk
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Akshay Shah
- Oxford University Hospitals, Oxford, United Kingdom
| | - Ziad Solh
- Department of Pathology & Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Jacqueline Trudeau
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Michelle P Zeller
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Canada.,Canadian Blood Services, Ancaster, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University of Toronto Transfusion Camp Planning Committee, Toronto, Canada.,University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Canada
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Abstract
The majority of heavy drinkers and users of illicit drugs are employed adults, yet there is a dearth of sophisticated substance abuse prevention efforts in the workplace. This article reviews the approaches to worksite-based substance abuse prevention and presents the results of a field test of a prevention program aimed at the individual worker. Based on these findings and other theoretical perspectives from the literature, an expanded conceptual model for workplace substance abuse prevention is presented.
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Affiliation(s)
- R F Cook
- ISA Associates, Inc., 201 N. Union St., Suite 360, 22314, Alexandria, VA
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Trudeau J, Turk D, Dworkin R, Benson C, Biondi D, Kim M, Mou J, Katz N. Validation of the revised short form McGill Pain Questionnaire (SF-MPQ-2) for self-report of pain qualities in patients with acute low back pain. The Journal of Pain 2012. [DOI: 10.1016/j.jpain.2012.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Stephens-Stidham S, Trudeau J, Istre G, Weir C, Johnson U, Anderson R. Using lay home educators to provide safety messages in Dallas, TX, USA. Inj Prev 2011. [DOI: 10.1136/ip.2010.029215.261] [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: 11/04/2022]
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11
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Katchamart W, Trudeau J, Phumethum V, Bombardier C. Efficacy and toxicity of methotrexate (MTX) monotherapy versus MTX combination therapy with non-biological disease-modifying antirheumatic drugs in rheumatoid arthritis: a systematic review and meta-analysis. Ann Rheum Dis 2008; 68:1105-12. [PMID: 19054823 PMCID: PMC2689526 DOI: 10.1136/ard.2008.099861] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective: To evaluate the efficacy and toxicity of methotrexate (MTX) monotherapy compared with MTX combination with non-biological disease-modifying antirheumatic drugs (DMARDs) in adults with rheumatoid arthritis. Method: A systematic review of randomised trials comparing MTX alone and in combination with other non-biological DMARDs was carried out. Trials were identified in Medline, EMBASE, the Cochrane Library and ACR/EULAR meeting abstracts. Primary outcomes were withdrawals for adverse events or lack of efficacy. Results: A total of 19 trials (2025 patients) from 6938 citations were grouped by the type of patients randomised. Trials in DMARD naive patients showed no significant advantage of the MTX combination versus monotherapy; withdrawals for lack of efficacy or toxicity were similar in both groups (relative risk (RR) = 1.16; 95% CI 0.70 to 1.93). Trials in MTX or non-MTX DMARD inadequate responder patients also showed no difference in withdrawal rates between the MTX combo versus mono groups (RR = 0.86; 95% CI 0.49 to 1.51 and RR = 0.75; 95% CI 0.41 to 1.35), but in one study the specific combination of MTX with sulfasalazine and hydroxychloroquine showed a better efficacy/toxicity ratio than MTX alone with RR = 0.3 (95% CI 0.14 to 0.65). Adding leflunomide to MTX non-responders improved efficacy but increased the risk of gastrointestinal side effects and liver toxicity. Withdrawals for toxicity were most significant with ciclosporin and azathioprine combinations. Conclusion: In DMARD naive patients the balance of efficacy/toxicity favours MTX monotherapy. In DMARD inadequate responders the evidence is inconclusive. Trials are needed that compare currently used MTX doses and combination therapies.
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Affiliation(s)
- W Katchamart
- Rheumatology Division, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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12
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Visser K, Katchamart W, Loza E, Martinez-Lopez JA, Salliot C, Trudeau J, Bombardier C, Carmona L, van der Heijde D, Bijlsma JWJ, Boumpas DT, Canhao H, Edwards CJ, Hamuryudan V, Kvien TK, Leeb BF, Martín-Mola EM, Mielants H, Müller-Ladner U, Murphy G, Østergaard M, Pereira IA, Ramos-Remus C, Valentini G, Zochling J, Dougados M. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann Rheum Dis 2008; 68:1086-93. [PMID: 19033291 PMCID: PMC2689523 DOI: 10.1136/ard.2008.094474] [Citation(s) in RCA: 307] [Impact Index Per Article: 19.2] [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: 12/26/2022]
Abstract
Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007–8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005–7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroid-sparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use.
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Affiliation(s)
- K Visser
- Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands.
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13
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Abstract
Autoimmune (type 1) diabetes results from a loss of beta cells that is mediated by self-reactive T cells. Previous studies have shown that a single injection of CFA prevents diabetes in nonobese diabetic (NOD) mice, but the mechanism(s) of protection remain unknown. We show here that NOD mice immunized with CFA have a markedly reduced incidence of diabetes and that this reduced incidence is associated with a decrease in the number of beta cell-specific, autoreactive CTL. In addition, the adoptive transfer of diabetes into syngeneic NOD/SCID recipients was prevented by CFA immunization, and the protective effects of CFA were lost when cells expressing the NK cell marker, asialo GM1, were removed from both donor cells and recipient mice. Returning a population of CD3-DX5+ cells to the adoptive transfer restored the protective effects of CFA. Therefore, NK cells mediate the protective effects of CFA possibly through the down-regulation of autoreactive CTL and stimulation of NK cells represents a novel approach to the prevention of autoimmune diabetes.
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MESH Headings
- Adoptive Transfer
- Animals
- Cell Aggregation/immunology
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 1/prevention & control
- Down-Regulation/immunology
- Female
- Freund's Adjuvant/administration & dosage
- Freund's Adjuvant/immunology
- Interferon-gamma/metabolism
- Islets of Langerhans/immunology
- Islets of Langerhans/pathology
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Killer Cells, Natural/pathology
- Lymphocyte Count
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Prediabetic State/immunology
- Prediabetic State/pathology
- Spleen/cytology
- Spleen/immunology
- Spleen/transplantation
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/pathology
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Affiliation(s)
- I-Fang Lee
- Department of Pathology & Laboratory Medicine, British Columbia's Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC V6H 2V4, Canada
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14
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Zhang Y, O'Brien B, Trudeau J, Tan R, Santamaria P, Dutz JP. In situ beta cell death promotes priming of diabetogenic CD8 T lymphocytes. J Immunol 2002; 168:1466-72. [PMID: 11801690 DOI: 10.4049/jimmunol.168.3.1466] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CTLs are important mediators of pancreatic beta cell destruction in the nonobese diabetic mouse model of type 1 diabetes. Cross-presentation of Ag is one means of priming CTLs. The death of Ag-bearing cells has been implicated in facilitating this mode of priming. The role of beta cell death in facilitating the onset of spontaneous autoimmune diabetes is unknown. Here, we used an adoptive transfer system to determine the time course of islet-derived Ag presentation to naive beta cell-specific CD8 T cells in nonobese diabetic mice and to test the hypothesis that beta cell death enhances the presentation of beta cell autoantigen. We have determined that beta cell death enhances autoantigen presentation. Priming of diabetogenic CD8 T cells in the pancreatic lymph nodes was negligible before 4 wk, progressively increased until 8 wk of age, and was not influenced by gender. Administration of multiple low doses of the beta cell toxin streptozotocin augmented in situ beta cell apoptosis and accelerated the onset and magnitude of autoantigen presentation to naive CD8 T cells. Increasing doses of streptozotocin resulted in both increased pancreatic beta cell death and significantly enhanced T cell priming. These results indicate that in situ beta cell death facilitates autoantigen-specific CD8 T cell priming and can contribute to both the initiation and the ongoing amplification of an autoimmune response.
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Affiliation(s)
- Yiqun Zhang
- Department of Medicine, British Columbia Research Institute of Children and Women's Health, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Amen DG, Yantis S, Trudeau J, Stubblefield MS, Halverstadt JS. Visualizing the firestorms in the brain: an inside look at the clinical and physiological connections between drugs and violence using brain SPECT imaging. J Psychoactive Drugs 1997; 29:307-19. [PMID: 9460024 DOI: 10.1080/02791072.1997.10400557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The connection between drugs and violence has been well documented. Understanding the intricacies of this connection is essential to finding effective interventions. Much has been written about the psychosocial causes of these problems, but there have been few studies exploring the biophysiological interface between drug effects, violent behavior and brain metabolism. Over the past eight years, The Amen Clinic has been extensively involved in the clinical use of brain SPECT imaging to evaluate complicated neuropsychiatric problems, especially related to the issues of both violence and substance abuse. From this work several clinical patterns, as well as brain SPECT imaging patterns, have been recognized that may help further our understanding of these problems. In this article, following a brief review of the literature on drugs, violence and the brain, five clinical examples are explored; the authors show how these support the clinical utility of incorporating SPECT imaging into psychiatric assessment of drug abuse and violence. Finally, a model is proposed to help explain the complex interaction between the brain, violence and drug abuse.
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Affiliation(s)
- D G Amen
- Amen Clinic for Behavioral Medicine, Fairfield, California 94585, USA
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16
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Abstract
A program designed to prevent alcohol misuse among working adults was developed and presented in four sessions to employees of a medium-sized printing company. The Working People program, based on a social-learning model, was field-tested with 108 employees in the context of a quasi-experimental design. Members of the Program Group (n = 38) and two Comparison Groups (n = 26 and 44) were assessed before and after the program on a questionnaire containing measures of alcohol consumption, attitudes and intentions regarding alcohol use, problem consequences of alcohol use, and health beliefs. Program effects were demonstrated on alcohol consumption, motivation to reduce consumption, and problem consequences of drinking. No effects were found on health beliefs or self-efficacy to reduce drinking. Although the findings are qualified by the self-selected nature of the samples, the results suggest that alcohol consumption can be reduced among adults who participate in this type of worksite program.
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Affiliation(s)
- R F Cook
- ISA Associates, Alexandria, Virginia 22314, USA
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17
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Trudeau J. On the Entozoaria, Found in the Eye of Some Mammalia, and of Man in Particular. Med Exam (Phila) 1841; 4:405-407. [PMID: 38122724 PMCID: PMC10513636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
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18
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Trudeau J. On Stammering. Med Exam (Phila) 1841; 4:407. [PMID: 38122726 PMCID: PMC10513638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
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Trudeau J. On the Various Operations Performed for the Cure of Stammering. Med Exam (Phila) 1841; 4:392-393. [PMID: 38122772 PMCID: PMC10513688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
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