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Barrett K, Gallagher HL. The role of the radiographer in promoting health: A qualitative examination of diagnostic radiographer perspectives at a Scottish Major Trauma hospital. Radiography (Lond) 2024; 30:531-537. [PMID: 38271795 DOI: 10.1016/j.radi.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Publication of Government directives and initiatives have signalled a shift in healthcare priorities, with growing emphasis on prevention and early intervention. In comparison to other allied health professions, perceptions of Diagnostic Radiographers of their contribution to addressing these initiatives and role in promoting health, has not been explored. There is limited evidence on current practices, knowledge and confidence in providing health promotion advice to patients within this professional group. This study aimed to investigate the perceptions of Diagnostic Radiographers of their role in promoting health. METHODS Semi-structured focus groups were conducted with 20 Diagnostic Radiographers recruited via convenience sampling from a Scottish Major Trauma Hospital. Focus groups were transcribed and analysed using thematic analysis. RESULTS Findings demonstrated a lack of awareness and understanding of government initiatives and professional body recommendations surrounding health promotion. Diagnostic radiographers felt ill-equipped to provide appropriate and impactful health promotion advice and reported lack of time as a barrier to contributing to such activities. CONCLUSION Diagnostic Radiographers noted a willingness to undertake additional training to enable them to participate and were able to identify areas where they could adopt health promotion activities in their clinical practice. Addressing the barriers to participation is essential to empower Diagnostic Radiographers to contribute to the health promotion agenda. IMPLICATIONS FOR PRACTICE There is a need to address profession specific education at pre-registration and post-qualification levels, to ensure Diagnostic Radiographers are equipped with the knowledge, skills and confidence to promote health to their patients. Strong leadership is essential for creating a positive environment to facilitate education, training and the acceptance of health promotion as a key part of a diagnostic radiographer's role.
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Affiliation(s)
- K Barrett
- Queen Elizabeth University Hospital, Glasgow. 1345 Govan Road, Glasgow, Scotland G514TF, UK.
| | - H L Gallagher
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
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Sheikh F, Chechulina V, Daneman N, Garber GE, Hendrick K, Kissoon N, Loubani O, Russell K, Fox-Robichaud A, Schwartz L, Barrett K. Sepsis policy, guidelines and standards in Canada: a jurisdictional scoping review protocol. BMJ Open 2024; 14:e077909. [PMID: 38307532 PMCID: PMC10836367 DOI: 10.1136/bmjopen-2023-077909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION To our knowledge, this study is the first to identify and describe current sepsis policies, clinical practice guidelines, and health professional training standards in Canada to inform evidence-based policy recommendations. METHODS AND ANALYSIS This study will be designed and reported according to the Arksey and O'Malley framework for scoping reviews and the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews. EMBASE, CINAHL, Medline, Turning Research Into Practice and Policy Commons will be searched for policies, clinical practice guidelines and health professional training standards published or updated in 2010 onwards, and related to the identification, management or reporting of sepsis in Canada. Additional sources of evidence will be identified by searching the websites of Canadian organisations responsible for regulating the training of healthcare professionals and reporting health outcomes. All potentially eligible sources of evidence will be reviewed for inclusion, followed by data extraction, independently and in duplicate. The included policies will be collated and summarised to inform future evidence-based sepsis policy recommendations. ETHICS AND DISSEMINATION The proposed study does not require ethics approval. The results of the study will be submitted for publication in a peer-reviewed journal and presented at local, national and international forums.
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Affiliation(s)
- Fatima Sheikh
- Department of Health Research Methods, Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Nick Daneman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Gary E Garber
- Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ontario, Canada
- School of Public Health and Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- The Centre for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Osama Loubani
- Departments of Critical Care Medicine and Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristine Russell
- Department of Critical Care, University of Calgary, Calgary, Alberta, Canada
| | - Alison Fox-Robichaud
- Medicine, McMaster University, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute (TaARI), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kali Barrett
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Centre for Critical Care, University Health Network, Toronto, Ontario, Canada
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Barrett K, Oxenford C, Canfield P, Armstrong S, Malik R. Vale Dave McGavin. Aust Vet J 2024; 102:48. [PMID: 38302107 DOI: 10.1111/avj.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 02/03/2024]
Affiliation(s)
- K Barrett
- Launceston Veterinary Hospital, South Launceston, 7249, Tasmania, Australia
| | - C Oxenford
- WHO Lyon, 24 Rue Jean Baldassini, Lyon, F-69007, France
| | - P Canfield
- Sydney School of Veterinary Science, University of Sydney, Camperdown, New South Wales, 2006, Australia
| | - S Armstrong
- Zoetis, Springfield Drive, Surrey, KT22 7LP, United Kingdom of Great Britain and Northern Ireland
| | - R Malik
- Centre for Veterinary Education, University of Sydney, Camperdown, New South Wales, 2006, Australia
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R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Peel JK, Pullenayegum EM, Naimark D, Aversa M, Liu M, Del Sorbo L, Barrett K, Sander B, Keshavjee S. Evaluating the Impact of Ex-Vivo Lung Perfusion on Organ Transplantation: A Retrospective Cohort Study. Ann Surg 2023:00000658-990000000-00441. [PMID: 37073734 DOI: 10.1097/sla.0000000000005887] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Ex-vivo lung perfusion (EVLP) sustains and allows advanced assessment of potentially useable donor lungs prior to transplantation, potentially relieving resource constraints. OBJECTIVE We sought to characterize the effect of EVLP on organ utilization and patient outcomes. METHODS We performed a retrospective, before-after cohort study using linked institutional data sources of adults wait-listed for lung transplant and donor organs transplanted in Ontario, Canada between 2005-2019. We regressed the annual number of transplants against year, EVLP use, and organ characteristics. Time-to-transplant, waitlist mortality, primary graft dysfunction, tracheostomy insertion, in-hospital mortality, and chronic lung allograft dysfunction (CLAD) were evaluated using propensity score-weighted regression. RESULTS EVLP availability (P=0.01 for interaction) and EVLP use (P<0.001 for interaction) were both associated with steeper increases in transplantation than expected by historical trends. EVLP was associated with more donation after circulatory death (DCD) and extended-criteria donors transplanted, while the numbers of standard-criteria donors remained relatively stable. Significantly faster time-to-transplant was observed after EVLP was available (hazard ratio [HR] 1.64 [1.41-1.92]; P<0.001). Fewer patients died on the waitlist after EVLP was available, but no difference in the hazard of waitlist mortality was observed (HR 1.19 [0.81-1.74]; P=0.176). We observed no difference in the likelihood of CLAD before versus after EVLP was available. CONCLUSIONS We observed a significant increase in organ transplantation since EVLP was introduced into practice, predominantly from increased acceptance of DCD and extended-criteria lungs. Our findings suggest that EVLP-associated increases in organ availability meaningfully alleviated some barriers to transplant.
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Affiliation(s)
- John K Peel
- Department of Anesthesiology, University Health Network, University of Toronto
- Toronto Lung Transplant Program, University Health Network, University of Toronto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto
| | - Eleanor M Pullenayegum
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto
| | - David Naimark
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto
- Division of Nephrology, Sunnybrook Health Sciences Centre
| | - Meghan Aversa
- Toronto Lung Transplant Program, University Health Network, University of Toronto
| | - Mingyao Liu
- Toronto Lung Transplant Program, University Health Network, University of Toronto
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- Toronto Lung Transplant Program, University Health Network, University of Toronto
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto
| | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto
- Interdepartmental Division of Critical Care Medicine, University of Toronto
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, ON, Canada
- Public Health Ontario, ON, Canada
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, University of Toronto
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
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Reinmuth N, Cho B, Luft A, Alexander JA, Geater SL, Laktionov K, Kim SW, Ursol G, Hussein M, Lim F, Yang CT, Araujo L, Saito H, Barrett K, Lowery C, Tattersfield R, Peters S, Garon E, Mok T, Johnson M. 12MO Patterns of response in metastatic (m) NSCLC after 2 and 4 cycles of chemotherapy (CT), alone or with durvalumab (D) ± tremelimumab (T), in the phase III POSEIDON study. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00266-6] [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: 04/04/2023]
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Peel JK, Keshavjee S, Naimark D, Liu M, Del Sorbo L, Cypel M, Barrett K, Pullenayegum EM, Sander B. Determining the impact of ex-vivo lung perfusion on hospital costs for lung transplantation: A retrospective cohort study. J Heart Lung Transplant 2023; 42:356-367. [PMID: 36411188 DOI: 10.1016/j.healun.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Ex-vivo lung perfusion (EVLP) has improved organ utilization for lung transplantation, but it is not yet known whether the benefits of this technology offset its additional costs. We compared the institutional costs of lung transplantation before vs after EVLP was available to identify predictors of costs and determine the health-economic impact of EVLP. METHODS We performed a retrospective, before-after, propensity-score weighted cohort study of patients wait-listed for lung transplant at University Health Network (UHN) in Ontario, Canada, between January 2005 and December 2019 using institutional administrative data. We compared costs, in 2019 Canadian Dollars ($), between patients referred for transplant before EVLP was available (Pre-EVLP) to after (Modern EVLP). Cumulative costs were estimated using a novel application of multistate survival models. Predictors of costs were identified using weighted log-gamma generalized linear regression. RESULTS A total of 1,199 patients met inclusion criteria (352 Pre-EVLP; 847 Modern EVLP). Mean total costs for the transplant hospitalization were $111,878 ($94,123-$130,767) in the Pre-EVLP era and $110,969 ($87,714-$136,000) in the Modern EVLP era. Cumulative five-year costs since referral were $278,777 ($82,575-$298,135) in the Pre-EVLP era and $293,680 ($252,832-$317,599) in the Modern EVLP era. We observed faster progression to transplantation when EVLP was available. EVLP availability was not a predictor of waitlist (cost ratio [CR] 1.04 [0.81-1.37]; p = 0.354) or transplant costs (CR 1.02 [0.80-1.29]; p = 0.425) but was associated with lower costs during posttransplant years 1&2 (CR 0.75 [0.58-1.06]; p = 0.05) and posttransplant years 3+ (CR 0.43 [0.26-0.74]; p = 0.001). CONCLUSIONS At our center, EVLP availability was associated with faster progression to transplantation at no significant marginal cost.
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Affiliation(s)
- John Kenneth Peel
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - David Naimark
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mingyao Liu
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Lorenzo Del Sorbo
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eleanor M Pullenayegum
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Ontario, Canada; Public Health Ontario, Ontario, Canada.
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Quinn KL, Abdel‐Qadir H, Barrett K, Bartsch E, Beaman A, Biering‐Sørensen T, Colacci M, Cressman A, Detsky A, Gosset A, Lassen MH, Kandel C, Khaykin Y, Lapointe‐Shaw L, Lovblom E, MacFadden DR, Perkins B, Rothman KJ, Skaarup KG, Stall N, Tang T, Yarnell C, Zipursky J, Warkentin MT, Fralick M. Variation in the risk of death due to COVID-19: An international multicenter cohort study of hospitalized adults. J Hosp Med 2022; 17:793-802. [PMID: 36040111 PMCID: PMC9539016 DOI: 10.1002/jhm.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is wide variation in mortality among patients hospitalized with COVID-19. Whether this is related to patient or hospital factors is unknown. OBJECTIVE To compare the risk of mortality for patients hospitalized with COVID-19 and to determine whether the majority of that variation was explained by differences in patient characteristics across sites. DESIGN, SETTING, AND PARTICIPANTS An international multicenter cohort study of hospitalized adults with laboratory-confirmed COVID-19 enrolled from 10 hospitals in Ontario, Canada and 8 hospitals in Copenhagen, Denmark between January 1, 2020 and November 11, 2020. MAIN OUTCOMES AND MEASURES Inpatient mortality. We used a multivariable multilevel regression model to compare the in-hospital mortality risk across hospitals and quantify the variation attributable to patient-level factors. RESULTS There were 1364 adults hospitalized with COVID-19 in Ontario (n = 1149) and in Denmark (n = 215). In Ontario, the absolute risk of in-hospital mortality ranged from 12.0% to 39.8% across hospitals. Ninety-eight percent of the variation in mortality in Ontario was explained by differences in the characteristics of the patients. In Denmark, the absolute risk of inpatients ranged from 13.8% to 20.6%. One hundred percent of the variation in mortality in Denmark was explained by differences in the characteristics of the inpatients. CONCLUSION There was wide variation in inpatient COVID-19 mortality across hospitals, which was largely explained by patient-level factors, such as age and severity of presenting illness. However, hospital-level factors that could have affected care, including resource availability and capacity, were not taken into account. These findings highlight potential limitations in comparing crude mortality rates across hospitals for the purposes of reporting on the quality of care.
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Affiliation(s)
- Kieran L. Quinn
- Department of Medicine, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Internal Medicine, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Interdepartmental Division of Palliative Care, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Husam Abdel‐Qadir
- Department of Medicine, Division of CardiologyWomen's College HospitalTorontoOntarioCanada
- Department of MedicineUniversity Health NetworkTorontoOntarioCanada
| | - Kali Barrett
- Department of MedicineUniversity Health NetworkTorontoOntarioCanada
- Department of Medicine, Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoOntarioCanada
| | - Emily Bartsch
- Department of Medicine, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Andrea Beaman
- Department of PharmacyTrillium Health PartnersMississaugaOntarioCanada
| | | | - Michael Colacci
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Alex Cressman
- Division of Internal Medicine, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Allan Detsky
- Department of Medicine, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Alexi Gosset
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Mats H. Lassen
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Chris Kandel
- Department of MedicineMichael Garron HospitalTorontoOntarioCanada
| | - Yaariv Khaykin
- Department of MedicineSouthlake Regional Health CentreNewmarketOntarioCanada
| | | | - Erik Lovblom
- Department of Medicine, Lunenfeld‐Tanenbaum Research InstituteMount Sinai HospitalTorontoOntarioCanada
| | - Derek R. MacFadden
- Department of MedicineThe Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Bruce Perkins
- Department of MedicineUniversity Health NetworkTorontoOntarioCanada
| | - Kenneth J Rothman
- Department of Epidemiology, School of Public HealthBoston UniversityMassachusettsBostonUSA
| | | | - Nathan Stall
- Department of Medicine, Division of General Internal Medicine and GeriatricsSinai Health and the University Health NetworkTorontoOntarioCanada
| | - Terence Tang
- Department of Medicine, Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoOntarioCanada
| | - Chris Yarnell
- Department of Medicine, Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoOntarioCanada
| | - Jonathan Zipursky
- Department of MedicineSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Matthew T. Warkentin
- Department of Medicine, Lunenfeld‐Tanenbaum Research InstituteMount Sinai HospitalTorontoOntarioCanada
| | - Mike Fralick
- Department of Medicine, Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
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Lau VI, Johnson JA, Bagshaw SM, Rewa OG, Basmaji J, Lewis KA, Wilcox ME, Barrett K, Lamontagne F, Lauzier F, Ferguson ND, Oczkowski SJW, Fiest KM, Niven DJ, Stelfox HT, Alhazzani W, Herridge M, Fowler R, Cook DJ, Rochwerg B, Xie F. Health-related quality-of-life and health-utility reporting in critical care. World J Crit Care Med 2022; 11:236-245. [PMID: 36051941 PMCID: PMC9305682 DOI: 10.5492/wjccm.v11.i4.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/16/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Mortality is a well-established patient-important outcome in critical care studies. In contrast, morbidity is less uniformly reported (given the myriad of critical care illnesses and complications of each) but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life (HRQoL). Survival with a poor quality-of-life may not be acceptable depending on individual patient values and preferences. Hence, as mortality decreases within critical care, it becomes increasingly important to measure intensive care unit (ICU) survivor HRQoL. HRQoL measurements with a preference-based scoring algorithm can be converted into health utilities on a scale anchored at 0 (representing death) and 1 (representing full health). They can be combined with survival to calculate quality-adjusted life-years (QALY), which are one of the most widely used methods of combining morbidity and mortality into a composite outcome. Although QALYs have been use for health-technology assessment decision-making, an emerging and novel role would be to inform clinical decision-making for patients, families and healthcare providers about what expected HRQoL may be during and after ICU care. Critical care randomized control trials (RCTs) have not routinely measured or reported HRQoL (until more recently), likely due to incapacity of some patients to participate in patient-reported outcome measures. Further differences in HRQoL measurement tools can lead to non-comparable values. To this end, we propose the validation of a gold-standard HRQoL tool in critical care, specifically the EQ-5D-5L. Both combined health-utility and mortality (disaggregated) and QALYs (aggregated) can be reported, with disaggregation allowing for determination of which components are the main drivers of the QALY outcome. Increased use of HRQoL, health-utility, and QALYs in critical care RCTs has the potential to: (1) Increase the likelihood of finding important effects if they exist; (2) improve research efficiency; and (3) help inform optimal management of critically ill patients allowing for decision-making about their HRQoL, in additional to traditional health-technology assessments.
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Affiliation(s)
- Vincent Issac Lau
- Department of Critical Care Medicine, University of Alberta, Edmonton T6G 2B7, AB, Canada
| | - Jeffrey A Johnson
- School of Public Health, Inst Hlth Econ, University of Alberta, Edmonton T6G 2B7, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta, Edmonton T6G 2B7, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, University of Alberta, Edmonton T6G 2B7, AB, Canada
| | - John Basmaji
- Department of Medicine, Division of Critical Care, Western University, London N6A 5W9, Canada
| | - Kimberley A Lewis
- Division of Critical Care, McMaster University, Hamilton L8N 4A6, Canada
| | - M Elizabeth Wilcox
- Interdepartmental Division of Critical Care, University of Toronto, Toronto M5T 2S8, Canada
| | - Kali Barrett
- Interdepartmental Division of Critical Care, University of Toronto, Toronto M5T 2S8, Canada
| | | | - Francois Lauzier
- Departments of Medicine and Anesthesiology, University Laval, Laval G1V 4G2, Canada
| | - Niall D Ferguson
- Department Critical Care Medicine, University of Toronto, Toronto M5G 2C4, Canada
| | - Simon J W Oczkowski
- Department of Medicine, McMaster Clin, Hamilton Gen Hosp, McMaster University, Hamilton L8N 4A6, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences & Institute for Public Health, University of Calgary, Calgary T2N 2T9, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University Calgary, Calgary T2N 2T9, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary T2N 2T9, Canada
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton L8N 4A6, Canada
| | - Margaret Herridge
- Indepartmental Division of Critical Care, University Health Network, Toronto M5G 2C4, Canada
| | - Robert Fowler
- Departments of Medicine and Critical Care Medicine, Sunnybrook Health Sciences Center, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto M4N 3M5, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton L8N 4A6, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton L8N 4A6, Canada
| | - Feng Xie
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton L8N 3Z5, Canada
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Robinson C, Xing L, Tanaka H, Tasaka S, Badiyan S, Nasrallah H, Biswas T, Shtivelband M, Schuette W, Shi A, Hepner A, Barrett K, Rigas J, Jiang H, Lin S. 122TiP Phase III study of durvalumab with SBRT for unresected stage I/II, lymph-node negative NSCLC (PACIFIC-4/RTOG 3515). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Lucas LN, Barrett K, Kerby RL, Zhang Q, Cattaneo LE, Stevenson D, Rey FE, Amador-Noguez D. Dominant Bacterial Phyla from the Human Gut Show Widespread Ability To Transform and Conjugate Bile Acids. mSystems 2021; 6:e0080521. [PMID: 34463573 DOI: 10.1128/msystems.00805-21] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Gut bacteria influence human physiology by chemically modifying host-synthesized primary bile acids. These modified bile acids, known as secondary bile acids, can act as signaling molecules that modulate host lipid, glucose, and energy metabolism and affect gut microbiota composition via selective antimicrobial properties. However, knowledge regarding the bile acid-transforming capabilities of individual gut microbes remains limited. To help address this knowledge gap, we screened 72 bacterial isolates, spanning seven major phyla commonly found in the human gut, for their ability to chemically modify unconjugated bile acids. We found that 43 isolates, representing 41 species, were capable of in vitro modification of one or more of the three most abundant unconjugated bile acids in humans: cholic acid, chenodeoxycholic acid, and deoxycholic acid. Of these, 32 species have not been previously described as bile acid transformers. The most prevalent bile acid transformations detected were oxidation of 3α-, 7α-, or 12α-hydroxyl groups on the steroid core, a reaction catalyzed by hydroxysteroid dehydrogenases. In addition, we found 7α-dehydroxylation activity to be distributed across various bacterial genera, and we observed several other complex bile acid transformations. Finally, our screen revealed widespread bacterial conjugation of primary and secondary bile acids to glycine, a process that was thought to only occur in the liver, and to 15 other amino acids, resulting in the discovery of 44 novel microbially conjugated bile acids. IMPORTANCE Our current knowledge regarding microbial bile acid transformations comes primarily from biochemical studies on a relatively small number of species or from bioinformatic predictions that rely on homology to known bile acid-transforming enzyme sequences. Therefore, much remains to be learned regarding the variety of bile acid transformations and their representation across gut microbial species. By carrying out a systematic investigation of bacterial species commonly found in the human intestinal tract, this study helps better define the gut bacteria that impact composition of the bile acid pool, which has implications in the context of metabolic disorders and cancers of the digestive tract. Our results greatly expand upon the list of bacterial species known to perform different types of bile acid transformations. This knowledge will be vital for assessing the causal connections between the microbiome, bile acid pool composition, and human health.
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Affiliation(s)
- L N Lucas
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - K Barrett
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - R L Kerby
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Q Zhang
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - L E Cattaneo
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - D Stevenson
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - F E Rey
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - D Amador-Noguez
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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13
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Knoerr MD, Tutterow AM, Graeter GJ, Pittman SE, Barrett K. Population models reveal the importance of early life‐stages for population stability of an imperiled turtle species. Anim Conserv 2021. [DOI: 10.1111/acv.12718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. D. Knoerr
- Department of Forestry and Environmental Conservation Clemson University Clemson SC USA
| | | | - G. J. Graeter
- North Carolina Wildlife Resources Commission Raleigh NC USA
| | - S. E. Pittman
- College of Arts and Sciences Athens State University Athens AL USA
| | - K. Barrett
- Department of Forestry and Environmental Conservation Clemson University Clemson SC USA
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14
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Naimark D, Mishra S, Barrett K, Khan YA, Mac S, Ximenes R, Sander B. Simulation-Based Estimation of SARS-CoV-2 Infections Associated With School Closures and Community-Based Nonpharmaceutical Interventions in Ontario, Canada. JAMA Netw Open 2021; 4:e213793. [PMID: 33787909 PMCID: PMC8013816 DOI: 10.1001/jamanetworkopen.2021.3793] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/06/2021] [Indexed: 12/22/2022] Open
Abstract
Importance Resurgent COVID-19 cases have resulted in the reinstitution of nonpharmaceutical interventions, including school closures, which can have adverse effects on families. Understanding the associations of school closures with the number of incident and cumulative COVID-19 cases is critical for decision-making. Objective To estimate the association of schools being open or closed with the number of COVID-19 cases compared with community-based nonpharmaceutical interventions. Design, Setting, and Participants This decision analytical modelling study developed an agent-based transmission model using a synthetic population of 1 000 000 individuals based on the characteristics of the population of Ontario, Canada. Members of the synthetic population were clustered into households, neighborhoods, or rural districts, cities or rural regions, day care facilities, classrooms (ie, primary, elementary, or high school), colleges or universities, and workplaces. Data were analyzed between May 5, 2020, and October 20, 2020. Exposures School reopening on September 15, 2020, vs schools remaining closed under different scenarios for nonpharmaceutical interventions. Main Outcomes and Measures Incident and cumulative COVID-19 cases between September 1, 2020, and October 31, 2020. Results Among 1 000 000 simulated individuals, the percentage of infections among students and teachers acquired within schools was less than 5% across modeled scenarios. Incident COVID-19 case numbers on October 31, 2020, were 4414 (95% credible interval [CrI], 3491-5382) cases in the scenario with schools remaining closed and 4740 (95% CrI, 3863-5691) cases in the scenario for schools reopening, with no other community-based nonpharmaceutical intervention. In scenarios with community-based nonpharmaceutical interventions implemented, the incident case numbers on October 31 were 714 (95% CrI, 568-908) cases for schools remaining closed and 780 (95% CrI, 580-993) cases for schools reopening. When scenarios applied the case numbers observed in early October in Ontario, the cumulative case numbers were 777 (95% CrI, 621-993) cases for schools remaining closed and 803 (95% CrI, 617-990) cases for schools reopening. In scenarios with implementation of community-based interventions vs no community-based interventions, there was a mean difference of 39 355 cumulative COVID-19 cases by October 31, 2020, while keeping schools closed vs reopening them yielded a mean difference of 2040 cases. Conclusions and Relevance This decision analytical modeling study of a synthetic population of individuals in Ontario, Canada, found that most COVID-19 cases in schools were due to acquisition in the community rather than transmission within schools and that the changes in COVID-19 case numbers associated with school reopenings were relatively small compared with the changes associated with community-based nonpharmaceutical interventions.
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Affiliation(s)
- David Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharmistha Mishra
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada
| | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Yasin A. Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Escola de Matemática Aplicada, Fundação Getúlio Vargas, Rio de Janeiro, Brasil
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
- ICES, Toronto, Canada
- Public Health Ontario, Toronto, Canada
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15
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Mac S, Barrett K, Khan YA, Naimark DMJ, Rosella L, Ximenes R, Sander B. Demographic characteristics, acute care resource use and mortality by age and sex in patients with COVID-19 in Ontario, Canada: a descriptive analysis. CMAJ Open 2021; 9:E271-E279. [PMID: 33757964 PMCID: PMC8096409 DOI: 10.9778/cmajo.20200323] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Understanding resource use for coronavirus disease 2019 (COVID-19) is critical. We conducted a descriptive analysis using public health data to describe age- and sex-specific acute care use, length of stay (LOS) and mortality associated with COVID-19. METHODS We conducted a descriptive analysis using Ontario's Case and Contact Management Plus database of individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ontario from Mar. 1 to Sept. 30, 2020, to determine age- and sex-specific hospital admissions, intensive care unit (ICU) admissions, use of invasive mechanical ventilation, LOS and mortality. We stratified analyses by month of infection to study temporal trends and conducted subgroup analyses by long-term care residency. RESULTS During the observation period, 56 476 individuals testing positive for SARS-CoV-2 were reported; 41 049 (72.7%) of these were younger than 60 years, and 29 196 (51.7%) were female. Proportion of cases shifted from older populations (> 60 yr) to younger populations (10-39 yr) over time. Overall, 5383 (9.5%) of individuals were admitted to hospital; of these, 1183 (22.0%) were admitted to the ICU, and 712 (60.2%) of these received invasive mechanical ventilation. Mean LOS for individuals in the ward, ICU without invasive mechanical ventilation and ICU with invasive mechanical ventilation was 12.8 (standard deviation [SD] 15.4), 8.5 (SD 7.8) and 20.5 (SD 18.1) days, respectively. Among patients receiving care in the ward, ICU without invasive mechanical ventilation and ICU with invasive mechanical ventilation, 911/3834 (23.8%), 124/418 (29.7%) and 287/635 (45.2%) died, respectively. All outcomes varied by age and decreased over time, overall and within age groups. INTERPRETATION This descriptive study shows use of acute care and mortality varying by age and decreasing between March and September 2020 in Ontario. Improvements in clinical practice and changing risk distributions among those infected may contribute to fewer severe outcomes.
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Affiliation(s)
- Stephen Mac
- Institute of Health Policy, Management and Evaluation (Mac, Barrett, Khan, Naimark, Sander), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mac, Ximenes, Sander), University Health Network; University Health Network (Barrett, Khan); Sunnybrook Health Sciences Centre (Naimark); Dalla Lana School of Public Health (Rosella), University of Toronto, Toronto, Ont.; Escola de Matemática Aplicada (Ximenes), Fundação Getúlio Vargas, Rio de Janeiro, Brazil; ICES Central (Rosella, Sander); Public Health Ontario (Rosella), Toronto, Ont.
| | - Kali Barrett
- Institute of Health Policy, Management and Evaluation (Mac, Barrett, Khan, Naimark, Sander), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mac, Ximenes, Sander), University Health Network; University Health Network (Barrett, Khan); Sunnybrook Health Sciences Centre (Naimark); Dalla Lana School of Public Health (Rosella), University of Toronto, Toronto, Ont.; Escola de Matemática Aplicada (Ximenes), Fundação Getúlio Vargas, Rio de Janeiro, Brazil; ICES Central (Rosella, Sander); Public Health Ontario (Rosella), Toronto, Ont
| | - Yasin A Khan
- Institute of Health Policy, Management and Evaluation (Mac, Barrett, Khan, Naimark, Sander), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mac, Ximenes, Sander), University Health Network; University Health Network (Barrett, Khan); Sunnybrook Health Sciences Centre (Naimark); Dalla Lana School of Public Health (Rosella), University of Toronto, Toronto, Ont.; Escola de Matemática Aplicada (Ximenes), Fundação Getúlio Vargas, Rio de Janeiro, Brazil; ICES Central (Rosella, Sander); Public Health Ontario (Rosella), Toronto, Ont
| | - David M J Naimark
- Institute of Health Policy, Management and Evaluation (Mac, Barrett, Khan, Naimark, Sander), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mac, Ximenes, Sander), University Health Network; University Health Network (Barrett, Khan); Sunnybrook Health Sciences Centre (Naimark); Dalla Lana School of Public Health (Rosella), University of Toronto, Toronto, Ont.; Escola de Matemática Aplicada (Ximenes), Fundação Getúlio Vargas, Rio de Janeiro, Brazil; ICES Central (Rosella, Sander); Public Health Ontario (Rosella), Toronto, Ont
| | - Laura Rosella
- Institute of Health Policy, Management and Evaluation (Mac, Barrett, Khan, Naimark, Sander), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mac, Ximenes, Sander), University Health Network; University Health Network (Barrett, Khan); Sunnybrook Health Sciences Centre (Naimark); Dalla Lana School of Public Health (Rosella), University of Toronto, Toronto, Ont.; Escola de Matemática Aplicada (Ximenes), Fundação Getúlio Vargas, Rio de Janeiro, Brazil; ICES Central (Rosella, Sander); Public Health Ontario (Rosella), Toronto, Ont
| | - Raphael Ximenes
- Institute of Health Policy, Management and Evaluation (Mac, Barrett, Khan, Naimark, Sander), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mac, Ximenes, Sander), University Health Network; University Health Network (Barrett, Khan); Sunnybrook Health Sciences Centre (Naimark); Dalla Lana School of Public Health (Rosella), University of Toronto, Toronto, Ont.; Escola de Matemática Aplicada (Ximenes), Fundação Getúlio Vargas, Rio de Janeiro, Brazil; ICES Central (Rosella, Sander); Public Health Ontario (Rosella), Toronto, Ont
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation (Mac, Barrett, Khan, Naimark, Sander), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mac, Ximenes, Sander), University Health Network; University Health Network (Barrett, Khan); Sunnybrook Health Sciences Centre (Naimark); Dalla Lana School of Public Health (Rosella), University of Toronto, Toronto, Ont.; Escola de Matemática Aplicada (Ximenes), Fundação Getúlio Vargas, Rio de Janeiro, Brazil; ICES Central (Rosella, Sander); Public Health Ontario (Rosella), Toronto, Ont
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Mac S, Mishra S, Ximenes R, Barrett K, Khan YA, Naimark DMJ, Sander B. Modeling the coronavirus disease 2019 pandemic: A comprehensive guide of infectious disease and decision-analytic models. J Clin Epidemiol 2020; 132:133-141. [PMID: 33301904 PMCID: PMC7837043 DOI: 10.1016/j.jclinepi.2020.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada
| | - Sharmistha Mishra
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada; Escola de Matemática Aplicada, Fundação Getúlio Vargas, Rio de Janeiro, Brazil
| | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada
| | - Yasin A Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada
| | - David M J Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada; Public Health Ontario, Toronto, Canada; ICES, Toronto, Canada.
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Ogunbameru A, Barrett K, Joda A, Khan YA, Pechlivanoglou P, Mac S, Naimark D, Ximenes R, Sander B. Estimating healthcare resource needs for COVID-19 patients in Nigeria. Pan Afr Med J 2020; 37:293. [PMID: 33654515 PMCID: PMC7881931 DOI: 10.11604/pamj.2020.37.293.26017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION continuous assessment of healthcare resources during the COVID-19 pandemic will help in proper planning and to prevent an overwhelming of the Nigerian healthcare system. In this study, we aim to predict the effect of COVID-19 on hospital resources in Nigeria. METHODS we adopted a previously published discrete-time, individual-level, health-state transition model of symptomatic COVID-19 patients to the Nigerian healthcare system and COVID-19 epidemiology in Nigeria by September 2020. We simulated different combined scenarios of epidemic trajectories and acute care capacity. Primary outcomes included the expected cumulative number of cases, days until depletion resources and the number of deaths associated with resource constraints. Outcomes were predicted over a 60-day time horizon. RESULTS in our best-case epidemic trajectory, which implies successful implementation of public health measures to control COVID-19 spread, assuming all three resource scenarios, hospital resources would not be expended within the 60-days time horizon. In our worst-case epidemic trajectory, assuming conservative resource scenario, only ventilated ICU beds would be depleted after 39 days and 16 patients were projected to die while waiting for ventilated ICU bed. Acute care resources were only sufficient in the three epidemic trajectory scenarios when combined with a substantial increase in healthcare resources. CONCLUSION substantial increase in hospital resources is required to manage the COVID-19 pandemic in Nigeria, even as the infection growth rate declines. Given Nigeria's limited health resources, it is imperative to focus on maintaining aggressive public health measures as well as increasing hospital resources to reduce COVID-19 transmission further.
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Affiliation(s)
- Adeteju Ogunbameru
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Arinola Joda
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Lagos, Nigeria
| | - Yasin Azim Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids) Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - David Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Escola de Matemática Aplicada, Fundação Getúlio Vargas, Rio de Janeiro, Brazil
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
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18
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Barrett K, Khan YA, Mac S, Ximenes R, Naimark DMJ, Sander B. Estimation de l’épuisement des ressources hospitalières attribuable à la COVID-19 en Ontario, au Canada. CMAJ 2020; 192:E1474-E1481. [PMID: 33199458 DOI: 10.1503/cmaj.200715-f] [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] [Accepted: 05/04/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kali Barrett
- Institut des politiques, de la gestion et de l'évaluation de la santé (K. Barrett, Y. Khan, S. Mac, D. Naimark, B. Sander), Université de Toronto; Réseau universitaire de santé (K. Barrett, Y. Khan, R. Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (S. Mac, R. Ximenes, B. Sander), Réseau universitaire de santé; Hôpital Sunnybrook (D. Naimark), Toronto, Ont
| | - Yasin A Khan
- Institut des politiques, de la gestion et de l'évaluation de la santé (K. Barrett, Y. Khan, S. Mac, D. Naimark, B. Sander), Université de Toronto; Réseau universitaire de santé (K. Barrett, Y. Khan, R. Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (S. Mac, R. Ximenes, B. Sander), Réseau universitaire de santé; Hôpital Sunnybrook (D. Naimark), Toronto, Ont
| | - Stephen Mac
- Institut des politiques, de la gestion et de l'évaluation de la santé (K. Barrett, Y. Khan, S. Mac, D. Naimark, B. Sander), Université de Toronto; Réseau universitaire de santé (K. Barrett, Y. Khan, R. Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (S. Mac, R. Ximenes, B. Sander), Réseau universitaire de santé; Hôpital Sunnybrook (D. Naimark), Toronto, Ont
| | - Raphael Ximenes
- Institut des politiques, de la gestion et de l'évaluation de la santé (K. Barrett, Y. Khan, S. Mac, D. Naimark, B. Sander), Université de Toronto; Réseau universitaire de santé (K. Barrett, Y. Khan, R. Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (S. Mac, R. Ximenes, B. Sander), Réseau universitaire de santé; Hôpital Sunnybrook (D. Naimark), Toronto, Ont
| | - David M J Naimark
- Institut des politiques, de la gestion et de l'évaluation de la santé (K. Barrett, Y. Khan, S. Mac, D. Naimark, B. Sander), Université de Toronto; Réseau universitaire de santé (K. Barrett, Y. Khan, R. Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (S. Mac, R. Ximenes, B. Sander), Réseau universitaire de santé; Hôpital Sunnybrook (D. Naimark), Toronto, Ont
| | - Beate Sander
- Institut des politiques, de la gestion et de l'évaluation de la santé (K. Barrett, Y. Khan, S. Mac, D. Naimark, B. Sander), Université de Toronto; Réseau universitaire de santé (K. Barrett, Y. Khan, R. Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (S. Mac, R. Ximenes, B. Sander), Réseau universitaire de santé; Hôpital Sunnybrook (D. Naimark), Toronto, Ont.
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McGowan CP, Angeli NF, Beisler WA, Snyder C, Rankin NM, Woodrow JO, Wilson JK, Rivenbark E, Schwarzer A, Hand CE, Anthony R, Griffin RK, Barrett K, Haverland AA, Roach NS, Schnieder T, Smith AD, Smith FM, Tolliver JDM, Watts BD. Linking monitoring and data analysis to predictions and decisions for the range-wide eastern black rail status assessment. ENDANGER SPECIES RES 2020. [DOI: 10.3354/esr01063] [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] [Indexed: 11/23/2022] Open
Abstract
The US Fish and Wildlife Service (USFWS) has initiated a re-envisioned approach for providing decision makers with the best available science and synthesis of that information, called the Species Status Assessment (SSA), for endangered species decision making. The SSA report is a descriptive document that provides decision makers with an assessment of the current and predicted future status of a species. These analyses support all manner of decisions under the US Endangered Species Act, such as listing, reclassification, and recovery planning. Novel scientific analysis and predictive modeling in SSAs could be an important part of rooting conservation decisions in current data and cutting edge analytical and modeling techniques. Here, we describe a novel analysis of available data to assess the current condition of eastern black rail Laterallus jamaicensis jamaicensis across its range in a dynamic occupancy analysis. We used the results of the analysis to develop a site occupancy projection model where the model parameters (initial occupancy, site persistence, colonization) were linked to environmental covariates, such as land management and land cover change (sea-level rise, development, etc.). We used the projection model to predict future status under multiple sea-level rise and habitat management scenarios. Occupancy probability and site colonization were low in all analysis units, and site persistence was also low, suggesting low resiliency and redundancy currently. Extinction probability was high for all analysis units in all simulated scenarios except one with significant effort to preserve existing habitat, suggesting low future resiliency and redundancy. With the results of these data analyses and predictive models, the USFWS concluded that protections of the Endangered Species Act were warranted for this subspecies.
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Affiliation(s)
- CP McGowan
- U.S. Geological Survey, Alabama Cooperative Fish and Wildlife Research Unit, Auburn University, Auburn, AL 36849, USA Addresses for other authors are given in Supplement 1 at www.int-res.com/articles/suppl/n043p209_supp/
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20
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Iragorri N, Gómez-Restrepo C, Barrett K, Herrera S, Hurtado I, Khan Y, Mac S, Naimark D, Pechlivanoglou P, Rosselli D, Toro D, Villamizar P, Ximenes R, Zapata H, Sander B. COVID-19: Adaptation of a model to predicting healthcare resources needs in Valle del Cauca, Colombia. Colomb Med (Cali) 2020; 51:e204534. [PMID: 33402754 PMCID: PMC7744107 DOI: 10.25100/cm.v51i3.4534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 09/19/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Valle del Cauca is the region with the fourth-highest number of COVID-19 cases in Colombia (>50,000 on September 7, 2020). Due to the lack of anti-COVID-19 therapies, decision-makers require timely and accurate data to estimate the incidence of disease and the availability of hospital resources to contain the pandemic. METHODS We adapted an existing model to the local context to forecast COVID-19 incidence and hospital resource use assuming different scenarios: (1) the implementation of quarantine from September 1st to October 15th (average daily growth rate of 2%); (2-3) partial restrictions (at 4% and 8% growth rates); and (4) no restrictions, assuming a 10% growth rate. Previous scenarios with predictions from June to August were also presented. We estimated the number of new cases, diagnostic tests required, and the number of available hospital and intensive care unit (ICU) beds (with and without ventilators) for each scenario. RESULTS We estimated 67,700 cases by October 15th when assuming the implementation of a quarantine, 80,400 and 101,500 cases when assuming partial restrictions at 4% and 8% infection rates, respectively, and 208,500 with no restrictions. According to different scenarios, the estimated demand for reverse transcription-polymerase chain reaction tests ranged from 202,000 to 1,610,600 between September 1st and October 15th. The model predicted depletion of hospital and ICU beds by September 20th if all restrictions were to be lifted and the infection growth rate increased to 10%. CONCLUSION Slowly lifting social distancing restrictions and reopening the economy is not expected to result in full resource depletion by October if the daily growth rate is maintained below 8%. Increasing the number of available beds provides a safeguard against slightly higher infection rates. Predictive models can be iteratively used to obtain nuanced predictions to aid decision-making.
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Affiliation(s)
- Nicolas Iragorri
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment (THETA) collaborative, University Health Network, Toronto, Canada
| | | | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment (THETA) collaborative, University Health Network, Toronto, Canada
- University Health Network, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Socrates Herrera
- Comité Público Privado de Expertos en Salud COPESA, Cali, Colombia
- Centro de Investigación Científica Caucaseco, Cali, Colombia
| | | | - Yasin Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment (THETA) collaborative, University Health Network, Toronto, Canada
| | - David Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Sunnybrook Hospital, Toronto, Canada
| | - Petros Pechlivanoglou
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
| | - Diego Rosselli
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Dilian Toro
- Comité Público Privado de Expertos en Salud COPESA, Cali, Colombia
| | - Pedro Villamizar
- Facultad de Medicina, Pontificia Universidad Javeriana, Cali, Colombia
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment (THETA) collaborative, University Health Network, Toronto, Canada
- Escola de Matemática Aplicada, Fundação Getúlio Vargas, Rio de Janeiro, RJ, Brasil
| | - Helmer Zapata
- Centro de Investigación Científica Caucaseco, Cali, Colombia
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- Institute for Clinical Evaluative Sciences ICES, Toronto, Canada
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21
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Barrett K, Habib Bedwani N, Arya S, Bhargava A. Colorectal cancer referrals during the COVID-19 pandemic - a model for the faster diagnosis standard? Br J Surg 2020; 107:e531-e532. [PMID: 32871025 PMCID: PMC7929102 DOI: 10.1002/bjs.12008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Affiliation(s)
- K Barrett
- Department of Surgery, Digestive Diseases Centre, King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT), Barley Lane, Goodmayes, London, IG3 8YB
| | - N Habib Bedwani
- Department of Surgery, Digestive Diseases Centre, King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT), Barley Lane, Goodmayes, London, IG3 8YB
| | - S Arya
- Department of Surgery, Digestive Diseases Centre, King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT), Barley Lane, Goodmayes, London, IG3 8YB
| | - A Bhargava
- Department of Surgery, Digestive Diseases Centre, King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT), Barley Lane, Goodmayes, London, IG3 8YB
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Tam DY, Naimark D, Natarajan MK, Woodward G, Oakes G, Rahal M, Barrett K, Khan YA, Ximenes R, Mac S, Sander B, Wijeysundera HC. The Use of Decision Modelling to Inform Timely Policy Decisions on Cardiac Resource Capacity During the COVID-19 Pandemic. Can J Cardiol 2020; 36:1308-1312. [PMID: 32447059 PMCID: PMC7241392 DOI: 10.1016/j.cjca.2020.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022] Open
Abstract
In Ontario on March 16, 2020, a directive was issued to all acute care hospitals to halt nonessential procedures in anticipation of a potential surge in COVID-19 patients. This included scheduled outpatient cardiac surgical and interventional procedures that required the use of intensive care units, ventilators, and skilled critical care personnel, given that these procedures would draw from the same pool of resources required for critically ill COVID-19 patients. We adapted the COVID-19 Resource Estimator (CORE) decision analytic model by adding a cardiac component to determine the impact of various policy decisions on the incremental waitlist growth and estimated waitlist mortality for 3 key groups of cardiovascular disease patients: coronary artery disease, valvular heart disease, and arrhythmias. We provided predictions based on COVID-19 epidemiology available in real-time, in 3 phases. First, in the initial crisis phase, in a worst case scenario, we showed that the potential number of waitlist related cardiac deaths would be orders of magnitude less than those who would die of COVID-19 if critical cardiac care resources were diverted to the care of COVID-19 patients. Second, with better local epidemiology data, we predicted that across 5 regions of Ontario, there may be insufficient resources to resume all elective outpatient cardiac procedures. Finally in the recovery phase, we showed that the estimated incremental growth in waitlist for all cardiac procedures is likely substantial. These outputs informed timely data-driven decisions during the COVID-19 pandemic regarding the provision of cardiovascular care.
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Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Madhu K Natarajan
- Division of Cardiology, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | | | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Yasin A Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Raphael Ximenes
- COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; COVID-19 Modelling Collaborative, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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23
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Barrett K, Khan YA, Mac S, Ximenes R, Naimark DMJ, Sander B. Estimation of COVID-19-induced depletion of hospital resources in Ontario, Canada. CMAJ 2020; 192:E640-E646. [PMID: 32409519 DOI: 10.1503/cmaj.200715] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The global spread of coronavirus disease 2019 (COVID-19) continues in several jurisdictions, causing substantial strain to health care systems. The purpose of our study was to predict the effect of the COVID-19 pandemic on patient outcomes and use of hospital resources in Ontario, Canada. METHODS We developed an individual-level simulation to model the flow of patients with COVID-19 through the hospital system in Ontario. We simulated different combined scenarios of epidemic trajectory and hospital health care capacity. Our outcomes included the number of patients who needed admission to the ward or to the intensive care unit (ICU) with or without the need for mechanical ventilation, number of days to resource depletion, number of patients awaiting resources and number of deaths. RESULTS We found that with effective early public health measures, hospital system resources would not be depleted. For scenarios with late or ineffective implementation of physical distancing, hospital resources would be depleted within 14-26 days, and in the worst case scenario, 13 321 patients would die while waiting for needed resources. Resource depletion would be avoided or delayed with aggressive measures to increase ICU, ventilator and acute care hospital capacities. INTERPRETATION We found that without aggressive physical distancing measures, the Ontario hospital system would have been inadequately equipped to manage the expected number of patients with COVID-19 despite a rapid increase in capacity. This lack of hospital resources would have led to an increase in mortality. By slowing the spread of the disease using public health measures and by increasing hospital capacity, Ontario may have avoided catastrophic stresses to its hospitals.
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Affiliation(s)
- Kali Barrett
- Institute of Health Policy, Management and Evaluation (Barrett, Khan, Mac, Naimark, Sander), University of Toronto; University Health Network (Barrett, Khan, Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (Mac, Ximenes, Sander), University Health Network; Sunnybrook Hospital (Naimark), Toronto, Ont
| | - Yasin A Khan
- Institute of Health Policy, Management and Evaluation (Barrett, Khan, Mac, Naimark, Sander), University of Toronto; University Health Network (Barrett, Khan, Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (Mac, Ximenes, Sander), University Health Network; Sunnybrook Hospital (Naimark), Toronto, Ont
| | - Stephen Mac
- Institute of Health Policy, Management and Evaluation (Barrett, Khan, Mac, Naimark, Sander), University of Toronto; University Health Network (Barrett, Khan, Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (Mac, Ximenes, Sander), University Health Network; Sunnybrook Hospital (Naimark), Toronto, Ont
| | - Raphael Ximenes
- Institute of Health Policy, Management and Evaluation (Barrett, Khan, Mac, Naimark, Sander), University of Toronto; University Health Network (Barrett, Khan, Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (Mac, Ximenes, Sander), University Health Network; Sunnybrook Hospital (Naimark), Toronto, Ont
| | - David M J Naimark
- Institute of Health Policy, Management and Evaluation (Barrett, Khan, Mac, Naimark, Sander), University of Toronto; University Health Network (Barrett, Khan, Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (Mac, Ximenes, Sander), University Health Network; Sunnybrook Hospital (Naimark), Toronto, Ont
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation (Barrett, Khan, Mac, Naimark, Sander), University of Toronto; University Health Network (Barrett, Khan, Ximenes); Toronto Health Economics and Technology Assessment (THETA) collaborative (Mac, Ximenes, Sander), University Health Network; Sunnybrook Hospital (Naimark), Toronto, Ont.
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24
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Fleischl W, Barrett K, Meredith I, Foster A. P11 Metastatic breast cancer in Wellington, New Zealand. How do we do? Breast 2020. [DOI: 10.1016/j.breast.2020.01.025] [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: 10/24/2022] Open
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Barrett K, O'Connor M, McHugh L. Investigating the psychometric properties of the Values Wheel with a clinical cohort: A preliminary validation study. Journal of Contextual Behavioral Science 2020. [DOI: 10.1016/j.jcbs.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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26
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Duong L, Rawson R, Bezryadina A, Manresa M, Newbury R, Dohil R, Liu Z, Barrett K, Kurten R, Aceves S. TGFβ1 single-nucleotide polymorphism C-509T alters mucosal cell function in pediatric eosinophilic esophagitis. Mucosal Immunol 2020; 13:110-117. [PMID: 31636346 PMCID: PMC6917872 DOI: 10.1038/s41385-019-0214-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023]
Abstract
Eosinophilic esophagitis (EoE) is a chronic Th2 antigen-driven disorder associated with tissue remodeling. Inflammation and remodeling lead to esophageal rigidity, strictures, and dysphagia. TGFβ1 drives esophageal remodeling including epithelial barrier dysfunction and subepithelial fibrosis. A functional SNP in the TGFβ1 gene that increases its transcription (C-509T) is associated with elevated numbers of esophageal TGFβ1-expressing cells. We utilized esophageal biopsies and fibroblasts from TT-genotype EoE children to understand if TGFβ1 influenced fibroblast and epithelial cell function in vivo. Genotype TT EoE esophageal fibroblasts had higher baseline TGFβ1, collagen1α1, periostin, and MMP2 (p < 0.05) gene expression and distinct contractile properties compared with CC genotype (n = 6 subjects per genotype). In vitro TGFβ1 exposure caused greater induction of target gene expression in genotype CC fibroblasts (p < 0.05). Esophageal biopsies from TT-genotype subjects had significantly less epithelial membrane-bound E-cadherin (p < 0.01) and wider cluster distribution at nanometer resolution. TGFβ1 treatment of stratified primary human esophageal epithelial cells and spheroids disrupted transepithelial resistance (p < 0.001) and E-cadherin localization (p < 0.0001). A TGFβ1-receptor-I inhibitor improved TGFβ1-mediated E-cadherin mislocalization. These data suggest that EoE severity can depend on genotypic differences that increase in vivo exposure to TGFβ1. TGFβ1 inhibition may be a useful therapy in subsets of EoE patients.
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Affiliation(s)
- L.D. Duong
- Division of Allergy & Immunology, University of California, San Diego and Rady Children’s Hospital San Diego,Department of Pediatrics, University of California, San Diego and Rady Children’s Hospital San Diego
| | - R. Rawson
- Division of Allergy & Immunology, University of California, San Diego and Rady Children’s Hospital San Diego,Department of Pediatrics, University of California, San Diego and Rady Children’s Hospital San Diego
| | - A. Bezryadina
- Department of Bioengineering, University of California, San Diego
| | - M.C. Manresa
- Division of Allergy & Immunology, University of California, San Diego and Rady Children’s Hospital San Diego,Department of Pediatrics, University of California, San Diego and Rady Children’s Hospital San Diego
| | - R.O. Newbury
- Department of Pathology, University of California, San Diego, Rady Children’s Hospital, San Diego
| | - R. Dohil
- Department of Pediatrics, University of California, San Diego and Rady Children’s Hospital San Diego,Division of Gastroenterology
| | - Z. Liu
- Department of Bioengineering, University of California, San Diego
| | - K. Barrett
- Division of Gastroenterology,Department of Medicine, University of California, San Diego
| | - R. Kurten
- Arkansas Children’s Research Institute and University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - S.S. Aceves
- Division of Allergy & Immunology, University of California, San Diego and Rady Children’s Hospital San Diego,Department of Pediatrics, University of California, San Diego and Rady Children’s Hospital San Diego,Department of Medicine, University of California, San Diego
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Barrett K, O’Connor M, McHugh L. A Systematic Review of Values-Based Psychometric Tools Within Acceptance and Commitment Therapy (ACT). Psychol Rec 2019. [DOI: 10.1007/s40732-019-00352-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Davey V, Raturaga T, Shirley R, Barrett K, Harvey V, Campbell I, Foster A, Harris G. PO6 Consolidation of the four New Zealand breast cancer registers. Breast 2018. [DOI: 10.1016/j.breast.2018.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Despite being recognised and reported in the literature for decades, subungual melanoma of the foot remains a diagnostic pitfall, with it commonly being mistaken for benign conditions. We present an interesting case of delayed diagnosis of subungual melanoma of the hallux that was misdiagnosed in the community for over one year. With melanoma being the fourth most commonly diagnosed cancer in Australia in 2013, this case serves as a reminder to all clinicians about the importance of maintaining a high index of suspicion for melanoma of the foot.
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Affiliation(s)
- B Finlay
- 1 Resident Medical Officer, Department of Vascular Surgery, Royal Adelaide Hospital, South Australia
| | - T Ramachandren
- 1 Resident Medical Officer, Department of Vascular Surgery, Royal Adelaide Hospital, South Australia
| | - K Hussey
- 3 Consultant Vascular Surgeon, Department of Vascular Surgery, Royal Adelaide Hospital, South Australia
| | - S Parkyn
- 4 Senior Podiatrist, Lyell McEwin Hospital, South Australia
| | - K Meyer
- 4 Senior Podiatrist, Lyell McEwin Hospital, South Australia
| | - K Barrett
- 4 Senior Podiatrist, Lyell McEwin Hospital, South Australia
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Barrett K, Sudharsan S. Service innovations: Is there a market for neuropsychiatry? A year in the life of a district-based neuropsychiatry service. Psychiatr bull 2018. [DOI: 10.1192/pb.29.12.465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodThis paper describes the clinical activity of a district neuropsychiatry service over a 1-year period. The data presented are drawn from a clinical database with individuals classified according to the following diagnostic groups: acquired brain injury, early-onset dementia, Huntington's disease, epilepsy, other neurological disorders, developmental disorders and non-organic disorders. Information is presented on out-patient case-load, new out-patient referrals, general hospital referrals and in-patient admissions.ResultsThe total out-patient case-load was 451; 189 new out-patient and 99 liaison referrals were seen and 90 individuals were admitted. Acquired brain injury was the most common neurological diagnosis in all groups.Clinical ImplicationsThe demand for this service indicates that there is a market for neuropsychiatry, even at a district level, and particularly in the management of the sequelae of acquired brain injury.
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Barrett K, Black L, Edwards K, Fortner K. 9: Antenatal compliance with ACIP guidelines during three subsequent years following guideline change. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.09.036] [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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Meredith IC, Popadich A, Mouat CH, Barrett K, King B. Abstract P2-12-03: Endofascial axillary lymphadenectomy – Towards a drainless protocol. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-12-03] [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
Background:
The pathogenesis of seroma formation following axillary dissection continues to be poorly understood, although it seems that the greater the surgical disruption of the axilla, the higher the incidence of seroma and lymphoedema. We have previously described the laminated, three-dimensional structure of the clavipectoral fascia (CPF) that is evident during axillary ultrasonography and dissection . We propose that reconstituting the CPF reduces dead space, partially restores pressure gradients and facilitates collateralization to improve lymphatic flow, thereby reducing the incidence of seromas. Herewith, is a description of our technique for reconstitution of the CPF and our experience thus far.
Method:
Technique:
Following mastectomy or breast conservation surgery, the lateral border of pectoralis major is defined. Here, the medial, anterior laminae of the CPF are identified but not incised. Once the anterior extent of the CPF is displayed, a longitudinal incision is made through the midpoint of the CPF to access the axillary contents. If there is a substantial axillary tail, then the CPF is incised along the perimeter of the tail to include intra-mammary lymph nodes. A loose areolar tissue plane is encountered; the edges of the CPF are grasped and elevated and this areolar tissue plane developed by blunt and sharp dissection. Medially, this loose areolar tissue plane leads directly to a posterior gutter, and the long thoracic nerve on serratus anterior is identified and preserved.
Superiorly, a deeper lamina of the CPF along the inferior border of the axillary vein has to be incised to find the thoracodorsal nerve. Identification of the intercostobrachial nerves is standard, as is the lateral dissection. Identification of the long thoracic nerve and thoracodorsal bundle results in definition of a vertical sheet, ‘the interneural tissue’. This can be grasped between the thumb and index finger and is excised en bloc. This tissue contains fat, lymph nodes and lymphatic vessels and is lined by thin fascial layers that we consider related to the CPF3.
At this stage, the anterior laminae of the CPF and axilla are carefully palpated for any residual nodes. After haemostasis, the CPF is reconstituted with a running, absorbable ‘lymphostatic’ suture. No drain is placed in the axilla.
Results:
Between 2012 – 2015, 64 patients have undergone axillary dissection with reconstitution of the CPF in our unit.. The average age was 54 years (range 29-87 years). An average of 12 nodes were procured (range 2-26 nodes). Only 5 women (8%) required seroma aspiration.
Conclusion:
We have dispensed with axillary drains in those who have had reconstitution of the CPF and only a minority of our patients required axillary seroma aspiration. We believe this technique should be given consideration to decrease the use of drains following axillary dissection.
Citation Format: Meredith IC, Popadich A, Mouat CH, Barrett K, King B. Endofascial axillary lymphadenectomy – Towards a drainless protocol. [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 P2-12-03.
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Affiliation(s)
- IC Meredith
- North Shore Hospital, Auckland, New Zealand; Wellington Hospital, Wellington, New Zealand; The Breast Centre, Wellington, New Zealand
| | - A Popadich
- North Shore Hospital, Auckland, New Zealand; Wellington Hospital, Wellington, New Zealand; The Breast Centre, Wellington, New Zealand
| | - CH Mouat
- North Shore Hospital, Auckland, New Zealand; Wellington Hospital, Wellington, New Zealand; The Breast Centre, Wellington, New Zealand
| | - K Barrett
- North Shore Hospital, Auckland, New Zealand; Wellington Hospital, Wellington, New Zealand; The Breast Centre, Wellington, New Zealand
| | - B King
- North Shore Hospital, Auckland, New Zealand; Wellington Hospital, Wellington, New Zealand; The Breast Centre, Wellington, New Zealand
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Sturman G, Barrett K, Carruthers N, Ennis M, Pearce FL, Bell D, Chazot PL, Gibbs B. The European Histamine Research Society 44th Annual Meeting, May 6-9, 2015 Malaga, Spain. Inflamm Res 2015; 64 Suppl 1:S1-50. [PMID: 26160655 DOI: 10.1007/s00011-015-0842-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ann Wy P, Rettiganti M, Li J, Yap V, Barrett K, Whiteside-Mansell L, Casey P. Impact of intraventricular hemorrhage on cognitive and behavioral outcomes at 18 years of age in low birth weight preterm infants. J Perinatol 2015; 35:511-5. [PMID: 25654365 DOI: 10.1038/jp.2014.244] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 09/23/2014] [Accepted: 12/23/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although high-grade intraventricular hemorrhage (IVH; grades III-IV) in preterm and low birth weight infants are clearly associated with increased risk of long-term adverse neurodevelopmental sequelae, the impact of low-grade IVH (grades I-II) has been less clear. Some studies have followed these infants through early school age and have shown some conflicting results regarding cognitive outcome. Such studies that assess children at younger ages may not accurately predict outcomes in later childhood, as it is known that fluid and crystallized intelligence peak at age 26 years. There is paucity of data in current medical literature, which correlates low-grade IVH with outcomes in early adulthood. To determine the link between the occurrence of low-grade IVH in low birth weight (birth weight ⩽2500 g) infants born prematurely (gestational age <37 weeks) and intellectual function, academic achievement, and behavioral problems to the age of 18 years. STUDY DESIGN This study is an analysis of data derived from the Infant Health and Development Program (IHDP), a multisite national collaborative study and a randomized controlled trial of education intervention for low birth weight infants from birth until 3 years of age with follow-up through 18 years of age. A total of 985 infants were enrolled in the IHDP. Of the 462 infants tested for IVH, 99 demonstrated sonographic evidence of low-grade IVH, whereas 291 showed no sonographic evidence of IVH. Several outcomes were compared between these two groups. Intelligence was assessed using Stanford-Binet Intelligence scales at age 3 years, Wechsler Intelligence Scale for Children (WISC-III) at age 8 years, Wechsler Abbreviated Scale of Intelligence (WASI) at age 18 years and Woodcock Johnson Tests of Achievement at age 8 and 18 years. Behavior was measured using the Achenbach Behavior Checklist at age 3 years and Child Behavior Checklist (CBCL) at age 8 and 18 years. Outcomes were compared between the IVH-positive and IVH-negative groups using analysis of covariance after adjusting for the presence or absence of intervention, birth weight, gestational age, gender, severity of neonatal course, race and maternal education. RESULTS No statistically significant difference in intelligence as measured by Stanford-Binet Intelligence scales, WISC-III, WASI and Woodcock-Johnson Tests of Achievement could be appreciated between IVH-positive patients and controls at any age group (36 months, 8 years and 18 years of age). In addition, there was no significant difference in problem behavior as assessed by the Achenbach Behavior Checklist and Child Behavior Checklist (CBCL) comparing IVH patients with controls. CONCLUSION Low-grade IVH was not demonstrated in our study to be an independent risk factor associated with lower outcomes in intelligence, academic achievement or problem behavior at age 3, 8 and 18 years.
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Affiliation(s)
- P Ann Wy
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Rettiganti
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Li
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - V Yap
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K Barrett
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - L Whiteside-Mansell
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - P Casey
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Piessevaux H, Corazziari E, Rey E, Simren M, Wiechowska-Kozlowska A, Kerstens R, Cools M, Barrett K, Levine A. A randomized, double-blind, placebo-controlled trial to evaluate the efficacy, safety, and tolerability of long-term treatment with prucalopride. Neurogastroenterol Motil 2015; 27:805-15. [PMID: 25808103 DOI: 10.1111/nmo.12553] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 10/16/2014] [Accepted: 02/24/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Randomized trials have confirmed the efficacy of prucalopride for the treatment of chronic constipation up to 12 weeks. This study aimed to assess the efficacy of prucalopride over a 24-week period (ClinicalTrials.gov: NCT01424228). METHODS Adults with chronic constipation and ≤2 spontaneous complete bowel movements (SCBMs)/week were randomized to receive prucalopride 2 mg or placebo daily for 24 weeks. The primary endpoint was the proportion of patients achieving a mean of ≥3 SCBMs/week over the treatment period, assessed using daily e-diaries. Secondary outcomes and safety parameters were assessed throughout the study. KEY RESULTS Overall, 361 patients were randomized and received prucalopride or placebo. Baseline characteristics were similar in the prucalopride (N = 181) and placebo (N = 180) groups. Mean age was 48.9 years (standard deviation, 16.0) and most patients were women. The proportion of participants achieving the primary endpoint was not statistically different between the prucalopride and placebo groups (25.1% vs 20.7%; p = 0.367). There was also no statistically significant difference between groups over the first 12-week period (prucalopride, 25.1%; placebo, 20.1%; p = 0.341). There were no statistically significant differences between groups for most secondary endpoints. No new safety concerns were identified. CONCLUSIONS & INFERENCES This trial did not show statistically significant improvements in primary or secondary outcomes with prucalopride compared with placebo over 24 or 12 weeks. This is in contrast to the results of four previous 12-week trials, which demonstrated prucalopride to be significantly more effective than placebo. An extensive evaluation did not provide an explanation for the null efficacy results of this study.
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Affiliation(s)
- H Piessevaux
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - E Corazziari
- Unità Operativa Complessa di Gastroenterologia, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - E Rey
- Department of Digestive Diseases, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - M Simren
- University of Gothenburg, Gothenburg, Sweden
| | | | | | - M Cools
- Shire Movetis NV, Turnhout, Belgium
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Hipp H, Loucks T, Barrett K, Yang G, Sidell N, Session D. Anti-MÜLLERIAN hormone (AMH) in peritoneal fluid and plasma in patients with endometriosis. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tawk R, Eidelman B, Hanel R, Meschia J, Barrett K. E-010 Prolonged Neurologic Deterioration Following Acetazolamide Testing in the Acute Phase Following Ischaemic Stroke. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Miller D, Tawk R, Barrett K. E-033 Bow Hunter's syndrome: an unusual cause of symptomatic vertebral artery stenosis. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carrigan W, Floyd J, Woessner H, Freeman W, Barrett K. Measuring Handover Communication during Transition of Care from the Neurointensive Care Unit to the General Neurology Ward (P07.238). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Singh A, Raper C, Mooney L, Shaw S, Meschia J, Barrett K. Multi-Modal CT Delays Initiation of Intravenous rt-PA for Acute Ischemic Stroke (P07.023). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chiota N, McCollum D, Mauricio E, Ditrapani R, Capobianco D, Barrett K. Assessment of Handover Communication among Neurology Residents: Utilization of a Handover OSCE and a Standardized Curriculum To Improve Transitions of Care (P07.237). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.237] [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: 11/15/2022] Open
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Barrett K, McGuire AD, Hoy EE, Kasischke ES. Potential shifts in dominant forest cover in interior Alaska driven by variations in fire severity. Ecol Appl 2011; 21:2380-2396. [PMID: 22073630 DOI: 10.1890/10-0896.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Large fire years in which >1% of the landscape burns are becoming more frequent in the Alaskan (USA) interior, with four large fire years in the past 10 years, and 79 000 km2 (17% of the region) burned since 2000. We modeled fire severity conditions for the entire area burned in large fires during a large fire year (2004) to determine the factors that are most important in estimating severity and to identify areas affected by deep-burning fires. In addition to standard methods of assessing severity using spectral information, we incorporated information regarding topography, spatial pattern of burning, and instantaneous characteristics such as fire weather and fire radiative power. Ensemble techniques using regression trees as a base learner were able to determine fire severity successfully using spectral data in concert with other relevant geospatial data. This method was successful in estimating average conditions, but it underestimated the range of severity. This new approach was used to identify black spruce stands that experienced intermediate- to high-severity fires in 2004 and are therefore susceptible to a shift in regrowth toward deciduous dominance or mixed dominance. Based on the output of the severity model, we estimate that 39% (approximately 4000 km2) of all burned black spruce stands in 2004 had <10 cm of residual organic layer and may be susceptible a postfire shift in plant functional type dominance, as well as permafrost loss. If the fraction of area susceptible to deciduous regeneration is constant for large fire years, the effect of such years in the most recent decade has been to reduce black spruce stands by 4.2% and to increase areas dominated or co-dominated by deciduous forest stands by 20%. Such disturbance-driven modifications have the potential to affect the carbon cycle and climate system at regional to global scales.
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Affiliation(s)
- K Barrett
- USGS Alaska Science Center, 4230 University Drive, Anchorage, Alaska 99508, USA.
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Hope A, Coate L, Massey C, Sacher A, Barrett K, Keshavjee S, Darling G, Leighl N, Bezjak A, Shepherd F. Outcomes of Bimodality and Trimodality Therapy in Patients with Stage III Non-small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1180] [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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Edmunds N, Barrett K, Solanki S, Cimolai M, Wong A. Prospects for Commercial Bitumen Recovery from the Grosmont Carbonate, Alberta. ACTA ACUST UNITED AC 2009. [DOI: 10.2118/09-09-26] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
The last few years have seen the end of the Athabasca land play and the revival of interest in Alberta's bitumen resources in carbonate reservoirs. Of these, the Grosmont Formation is the most promising in terms of resource size and concentration. It is also the best known, in terms of having been the subject of several in situ pilots operated in the late '70s and early '80s.
The data recorded from these early pilots is priceless in terms of having a touchstone of reality for new process concepts. On the other hand, the interpretations written in those days ('before gravity') are not necessarily as helpful. This paper looks at the Grosmont in terms of facts and fundamentals, and presents the case for Grosmont exploitation.
There is good evidence that the Grosmont has very high bulk permeability as a result of karst porosity development and fracturing. This bodes well for the use of modern gravity drainage methods in the Grosmont.
Introduction
Grosmont Piloting History
The Grosmont Formation in north-central Alberta is a dolomitized, karsted and fractured platform carbonate containing a massive bitumen accumulation. An excellent historical summary of various Grosmont pilots was recently provided by Alvarez et al.(1) Cyclic Steam Stimulation (CSS), steam drive and forward combustion were all attempted in the Grosmont during the '70s and '80s. CSS was the most widely and successfully piloted method. The best well, at 10A-5-88-19W4, recovered about 100,000 bbls of oil over 10 cycles, with a cumulative steam-oil ratio (CSOR) of about 6. Results of other tests were mixed, as were the operating procedures; most of these were based on horizontal flooding concepts. However, responses to well-executed CSS first cycles were reasonably similar at a number of widely-spaced wells. Notably, steam injectivity was generally sufficient so that a few hundred tonnes/day could be injected at pressures that were significantly below overburden pressure (ruling out geomechanical enhancement of permeability).
A degree of pessimism, or at least great caution, has been expressed with respect to the supposed complexity of the reservoir, and hence, prospects for commercial recovery. In particular, it is often said that the reservoir is very heterogenous, and that this explains the historical failure of attempted steam drive and fire flood processes.
Review of the Unocal Buffalo Creek and McLean scheme reports(2, 3) suggest that much of this originates in the interpretations of the contemporary operators, who largely explored conventional EOR concepts involving horizontal displacement. They expected to recover oil by means of horizontal, radial flow. When this failed, it was natural to assume that the problem lay in a failure to maintain the 'radial' part of the prescription, due to permeability heterogeneity.
Figure 1 presents the performance of the Buffalo Creek 10A-5 CSS test in perspective with a contemporary test and two modern-day, commercially-optimized CSS wells (the data is publicly available from the Alberta Energy Resources Conservation Board). It can be seen that the Grosmont well had comparable performance to a Clearwater CSS test of the same vintage.
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Affiliation(s)
| | | | | | | | - A. Wong
- Laricina Energy Ltd./University of Calgary
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Everich R, Schiller C, Whitehead J, Beavers M, Barrett K. Effects of captan on Apis mellifera brood development under field conditions in California almond orchards. J Econ Entomol 2009; 102:20-29. [PMID: 19253613 DOI: 10.1603/029.102.0104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Three almond field trials were conducted during 2003 and 2004 at two locations in central (Fresno County) and northern (Yolo County) California to evaluate the potential effects of commercial applications of Captan on honey bees, Apis mellifera L. Captan was applied at 5.0 kg (AI)/ha during bloom. Hives were evaluated for hive health and brood development parameters for approximately 2 mo after application. This study showed that the application of Captan was not harmful to foraging honey bees or their brood. No treatment-related effects were noted on hive weights, dead bee deformity, number of dead bees, survival of individual larvae, weight of individual emerging adults, and other hive health parameters.
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Affiliation(s)
- R Everich
- Makhteshim Agan of North America, 4515 Falls of Neuse Rd., Raleigh, NC 27609, USA.
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Kamm MA, Lichtenstein GR, Sandborn WJ, Schreiber S, Lees K, Barrett K, Joseph R. Randomised trial of once- or twice-daily MMX mesalazine for maintenance of remission in ulcerative colitis. Gut 2008; 57:893-902. [PMID: 18272546 PMCID: PMC2564831 DOI: 10.1136/gut.2007.138248] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM Maintenance treatment in ulcerative colitis should be as convenient as possible, to increase the chance of compliance. MMX mesalazine is a once-daily, high-strength (1.2 g/tablet) formulation of 5-aminosalicylic acid. This study evaluated the safety and efficacy of MMX mesalazine dosed once or twice daily as maintenance therapy in patients with ulcerative colitis. METHODS This multicentre, randomised, open-label trial enrolled patients with strictly defined clinical and endoscopic remission, immediately following an episode of mild to moderate ulcerative colitis. Patients were randomised to MMX mesalazine 2.4 g/day as a single (2x1.2 g tablet) or divided dose (1x1.2 g tablet twice daily) for 12 months. RESULTS 174 patients (37.9%; safety population n = 459) experienced 384 adverse events, the majority of which were mild or moderate in intensity. Eighteen patients (3.9%), nine in each group, experienced a total of 22 serious adverse events (10 in the once-daily and 12 in the twice-daily group). Most serious adverse events were gastrointestinal, experienced by 5 patients in the once-daily and 4 in the twice-daily group. At month 12, 64.4% (efficacy population, n = 451) of patients in the once-daily and 68.5% of patients in the twice-daily group were in clinical and endoscopic remission (p = 0.351). At month 12, 88.9% and 93.2% in each group, respectively, had maintained clinical remission (were relapse free). CONCLUSIONS MMX mesalazine 2.4 g/day administered as a single or divided dose demonstrated a good safety profile, was well tolerated and was effective as maintenance treatment. High clinical and endoscopic remission rates can be achieved with once-daily dosing. TRIAL REGISTRATION NUMBER NCT00151944.
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Affiliation(s)
- M A Kamm
- Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
| | - G R Lichtenstein
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, USA
| | - W J Sandborn
- Inflammatory Bowel Disease Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - S Schreiber
- First Department of Medicine, Christian-Albrechts-Universität, Kiel, Germany
| | - K Lees
- Shire Pharmaceuticals Inc., Wayne, Philadelphia, USA
| | - K Barrett
- Shire Pharmaceuticals Inc., Basingstoke, Hampshire, UK
| | - R Joseph
- Shire Pharmaceuticals Inc., Wayne, Philadelphia, USA
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Barrett K, Medlam G, Ditomasso A, Price J, Kelly V, Wong R, Warde P, Brierley J, Bissonnette JP. 439 DEVELOPMENT OF AN INTEGRATED PATIENT-SPECIFIC QUALITY ASSURANCE PROGRAM IN RADIATION THERAPY: A PILOT PROJECT BY THE GASTROINTESTINAL SITE GROUP. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Barrett K, Liakata E, Rao PV, Watson PF, Weetman AP, Lymberi P, Banga JP, Carayanniotis G. Induction of hyperthyroidism in mice by intradermal immunization with DNA encoding the thyrotropin receptor. Clin Exp Immunol 2004; 136:413-22. [PMID: 15147342 PMCID: PMC1809053 DOI: 10.1111/j.1365-2249.2004.02483.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intramuscular injection with plasmid DNA encoding the human thyrotropin receptor (TSHR) has been known to elicit symptoms of Graves' disease (GD) in outbred but not inbred mice. In this study, we have examined, firstly, whether intradermal (i.d.) injection of TSHR DNA can induce hyperthyroidism in BALB/c mice and, secondly, whether coinjection of TSHR- and cytokine-producing plasmids can influence the outcome of disease. Animals were i.d. challenged at 0, 3 and 6 weeks with TSHR DNA and the immune response was assessed at the end of the 8th or 10th week. In two experiments, a total of 10 (67%) of 15 mice developed TSHR-specific antibodies as assessed by flow cytometry. Of these, 4 (27%) mice had elevated thyroxine (TT4) levels and goitrous thyroids with activated follicular epithelial cells but no evidence of lymphocytic infiltration. At 10 weeks, thyroid-stimulating antibodies (TSAb) were detected in two out of the four hyperthyroid animals. Interestingly, in mice that received a coinjection of TSHR- and IL-2- or IL-4-producing plasmids, there was no production of TSAbs and no evidence of hyperthyroidism. On the other hand, coinjection of DNA plasmids encoding TSHR and IL-12 did not significantly enhance GD development since two out of seven animals became thyrotoxic, but had no goitre. These results demonstrate that i.d. delivery of human TSHR DNA can break tolerance and elicit GD in inbred mice. The data do not support the notion that TSAb production is Th2-dependent in murine GD but they also suggest that codelivery of TSHR and Th1-promoting IL-12 genes may not be sufficient to enhance disease incidence and/or severity in this model.
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Affiliation(s)
- K Barrett
- Division of Endocrinology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
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Barrett K. Prosecuting pregnant addicts for dealing to the unborn. Ariz Law Rev 2002; 33:221-37. [PMID: 12186069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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