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Findlater CK, Gerges S, Litynsky J, Robson K. Implementation of a Meds to Beds Medication Use Program and Parent Experience at the Time of Transition From a Neonatal Intensive Care Unit to Home. J Pediatr Pharmacol Ther 2022; 27:300-305. [DOI: 10.5863/1551-6776-27.4.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
This study aims to describe the overall experience of the neonatal intensive care unit (NICU) parent at time of transition home related to discharge medication use, following implementation of a Meds to Beds program.
METHODS
A descriptive, qualitative study was used to explore parent experiences around medication use during transition home. Eleven parents whose infants required medications at the time of transition home from the NICU participated in a semi-structured telephone interview post-discharge. The data were coded and analyzed for themes.
RESULTS
Major themes nested within the key stages of medication use in preparation for transition home from the NICU were identified: in-hospital preparation (practice early and often, Meds to Beds, and relationship with clinical pharmacist), transition home (schedule and routine, strategies for medication administration) and post-discharge (refills and long-term medication management). Strategies based on parent experiences to improve the process and ameliorate anxiety are presented.
CONCLUSIONS
Parents expressed how effective the Meds to Beds program was on the transition home by increasing parental confidence and knowledge around medications and reducing stress around the acquisition of medications for home. They also reported comfort in having a relationship with the NICU clinical pharmacist, providing a tailored approach to coordinating care both in hospital and during the transition home. Regardless of implementation of a Meds to Beds program, great opportunities remain to refine the transition home. Implementing the suggested improvement strategies could provide significant positive effects with respect to patient care and parental stress during the transition home.
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Affiliation(s)
- Carla K. Findlater
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacy (CKF, SG), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sandra Gerges
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacy (CKF, SG), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jacklyn Litynsky
- Department of Pharmacy (JL), Windsor Regional Hospital, Windsor, ON, Canada
| | - Kate Robson
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Milette AA, Richter L, Bourque CJ, Janvier A, Robson K, Church PT, Synnes A, Luu T. 75 Parental perspective about the health and development of their extremely preterm child. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.060] [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: 11/12/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Preterm birth outcome studies and clinical follow-up have traditionally focused on neurodevelopment. We previously showed in a selected sample of parents that they also valued other types of outcomes.
Objectives
This study aimed to validate these findings in a more diverse cohort by examining parental perspectives about the positive and negative aspects of their very preterm child’s health and development in relation to level of neurodevelopment impairment (NDI).
Design/Methods
Parents of children born < 29 weeks gestational age in 2016-2018 and seen at two Canadian neonatal follow-up clinics were invited to complete an online survey about their level of agreement with statements about their child’s health, development, and well-being. Parental responses in relation to their child’s level of NDI were examined using Kruskal-Wallis and chi-square for trends tests.
Results
199 parental responses were obtained for 165 children (65% of eligible children). Of these children, 52%, 27% and 21% had, respectively, no, mild to moderate, and severe NDI. Development was the most common source of concerns (49%), followed by the child’s future (35%), and physical health (35%). Parents of children with severe NDI were more likely to express concerns than those with mild to moderate or no NDI. Parents rated their child’s health relatively high with a median score of 8/10 (range 3-10). Children with no NDI were given higher scores than those with NDI (p = 0.004). Regardless of level of NDI, almost all parents agreed with their child being happy (p = 1.000) and having a positive personality (p = 0.207). Figure 1 shows that parental concerns increased with level of NDI.
Conclusion
Parents of preterm children have a balanced perspective on their child’s outcome. Integrating their views when developing core sets of important outcomes for neonatal follow-up is critical.
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Orkin J, Major N, Esser K, Parmar A, Couture E, Daboval T, Kieran E, Ly L, O'Brien K, Patel H, Synnes A, Robson K, Barreira L, Smith WL, Rizakos S, Willan AR, Yaskina M, Moretti ME, Ungar WJ, Ballantyne M, Church PT, Cohen E. Coached, Coordinated, Enhanced Neonatal Transition (CCENT): protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants. BMJ Open 2021; 11:e046706. [PMID: 34233983 PMCID: PMC8264914 DOI: 10.1136/bmjopen-2020-046706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Having an infant admitted to the neonatal intensive care unit (NICU) is associated with increased parental stress, anxiety and depression. Enhanced support for parents may decrease parental stress and improve subsequent parent and child outcomes. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) programme is a novel bundled intervention of psychosocial support delivered by a nurse navigator that includes Acceptance and Commitment Therapy-based coaching, care coordination and anticipatory education for parents of high-risk infants in the NICU through the first year at home. The primary objective is to evaluate the impact of the intervention on parent stress at 12 months. METHODS AND ANALYSIS This is a multicentre pragmatic randomised controlled superiority trial with 1:1 allocation to the CCENT model versus control (standard neonatal follow-up). Parents of high-risk infants (n=236) will be recruited from seven NICUs across three Canadian provinces. Intervention participants are assigned a nurse navigator who will provide the intervention for 12 months. Outcomes are measured at baseline, 6 weeks, 4, 12 and 18 months. The primary outcome measure is the total score of the Parenting Stress Index Fourth Edition Short Form at 12 months. Secondary outcomes include parental mental health, empowerment and health-related quality of life for calculation of quality-adjusted life years (QALYs). A cost-effectiveness analysis will examine the incremental cost of CCENT versus usual care per QALY gained. Qualitative interviews will explore parent and healthcare provider experiences with the intervention. ETHICS AND DISSEMINATION Research ethics approval was obtained from Clinical Trials Ontario, Children's Hospital of Eastern Ontario Research Ethics Board (REB), The Hospital for Sick Children REB, UBC Children's and Women's REB and McGill University Health Centre REB. Results will be shared with Canadian level III NICUs, neonatal follow-up programmes and academic forums. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03350243).
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Affiliation(s)
- Julia Orkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nathalie Major
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kayla Esser
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arpita Parmar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elise Couture
- Division of Neonatology, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Thierry Daboval
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Emily Kieran
- Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Linh Ly
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karel O'Brien
- Division of Neonatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Hema Patel
- Division of General Pediatrics, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Anne Synnes
- Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Kate Robson
- Neonatal Follow Up Clinic, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Barreira
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wanda L Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sara Rizakos
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew R Willan
- Clinical Research Services, SickKids Research Institute, Toronto, Ontario, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Myla E Moretti
- Clinical Trials Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Ballantyne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Paige Terrien Church
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eyal Cohen
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Louro LF, Maddox T, Robson K, Alderson B. Pre-anaesthetic clinical examination influences anaesthetic protocol in dogs undergoing general anaesthesia and sedation. J Small Anim Pract 2021; 62:737-743. [PMID: 33988250 DOI: 10.1111/jsap.13348] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Identify whether pre-anaesthetic clinical examination influences anaesthetic and analgesic agents and techniques protocol in dogs presented for general anaesthesia and sedation at a large referral hospital. MATERIALS AND METHODS In this prospective clinical audit, 554 dogs, undergoing general anaesthesia or sedation for surgical, diagnostic or imaging procedures were included. Multiple attending anaesthetists completed a questionnaire divided into four sections (American Society of Anesthesiologists physical status classification, anaesthetic and analgesic agents and techniques protocol, pre-anaesthetic clinical examination findings and changes made to the anaesthetic protocol). The attending anaesthetist was able to review the patient's history before planning the anaesthetic and analgesic agents and techniques protocol. The patients were examined and changes in American Society of Anesthesiologists physical status classification or anaesthetic protocol were recorded. RESULTS The initial anaesthetic and analgesic agents and techniques protocol was altered in 23.3% (n=129/554) of cases following a pre-anaesthetic clinical examination, but American Society of Anesthesiologists physical status reclassification occurred in only 8.0% (n=37/464) of cases. Multivariable logistic regression analysis showed that pre-anaesthetic clinical examination performed by European College of Veterinary Anaesthesia and Analgesia diplomates (odds ratio 5.8, 95% confidence interval 2.0 to 17.2), compared to anaesthesia interns, and the presence of an audible heart murmur (odds ratio 2.4, 95% confidence interval 1.4 to 4.4) were factors linked to changes in anaesthetic and analgesic agents and techniques protocol, whereas for each one kilogram increase in patient's weight, the odds of a change in anaesthetic and analgesic agents and techniques protocol to occur decreased by 1.7% (odds ratio 0.98, 95% confidence interval 0.97 to 1.0). CLINICAL SIGNIFICANCE Pre-anaesthetic clinical examination has impact on American Society of Anesthesiologists physical status classification, therefore estimation of patient's anaesthetic risk, and influences anaesthetic and analgesic agents and techniques protocol choice.
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Affiliation(s)
- L F Louro
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, UK
| | - T Maddox
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, UK
| | - K Robson
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, UK
| | - B Alderson
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, UK
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Abstract
A 530-g girl born at 22 weeks and 6 days' gestation (determined by an ultrasound at 11 weeks) was admitted to the NICU. Her mother had received prenatal steroids. At 12 hours of age, she was stable on low ventilator settings. Her blood pressure was fine. Her urine output was good. After counseling, her parents voiced understanding of the risks and wanted all available life-supporting measures. Many nurses were distressed that doctors were trying to save a "22-weeker." In the past, 4 infants born at 22 weeks' gestation had been admitted to that NICU, and all had died. The attending physician on call had to deal with many sick infants and the nurses' moral distress.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics and Bureau de l'Éthique Clinique, Université de Montréal, Montréal, Canada.,Palliative Care Specialty, Mother and Child Clinical Ethics Unit, Division of Neonatology, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Trisha Prentice
- Division of Neonatology, The Royal Children's Hospital, Melbourne, Australia
| | | | - Kate Robson
- NICU, Sunnybrook Health Sciences Centre, Toronto, Canada; and
| | - Paul Mann
- Division of Neonatology, The University of Iowa, Iowa City, Iowa
| | - John D Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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6
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Janvier A, Bourque CJ, Dahan S, Robson K, Barrington KJ. Integrating Parents in Neonatal and Pediatric Research. Neonatology 2019; 115:283-291. [PMID: 30799397 DOI: 10.1159/000492502] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Parents and their infants are the beneficiaries of neonatal and pediatric research, but in the past they have been excluded from most stages of research projects. As a result, many projects may fail to produce the most worthwhile information for parents and families. Lately, veteran resource parents and patients have been increasingly integrated in research initiatives. METHODS Benchmarking of neonatal and pediatric research initiatives where resource parents and/or ex neonatal patients have helped to optimize pediatric research. We review ways in which resource parents/patients can be involved in research, with examples and practical ideas of how to proceed. RESULTS Resource parents/patients can be collaborators in research and be integrated in many steps: prioritizing research projects, designing trials, determining the outcomes of interest, ethics review, developing and improving consent procedures, collection and interpretation of data, participation in data safety monitoring committees, publication of results, and presentation to peer groups. Some of the strategies for integration of stakeholders in clinical research are more complex, may involve risk and require more training than others. CONCLUSION We suggest that groups wanting to involve parents in their research endeavors start with simpler tasks that entail less risk and develop teams of resource parents who have differing interests and abilities. Quality control of programs is essential, such as frequently giving and obtaining feedback from resource parents/patients and researchers. In the future, integration of resource parents/patients into every step of clinical research will be essential to ensure that parent and family important outcomes are examined.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada, .,Division of Neonatology, Hôpital Sainte-Justine, Montréal, Québec, Canada, .,CHU Sainte-Justine Research Center, Montréal, Québec, Canada, .,Bureau de l'Éthique Clinique, Université de Montréal, Montréal, Québec, Canada, .,Unité d'Éthique Clinique, Hôpital Sainte-Justine, Montréal, Québec, Canada, .,Unité de Soins Palliatifs, Hôpital Sainte-Justine, Montréal, Québec, Canada, .,Unité de Recherche en Éthique Clinique et Partenariat Famille (UREPAF), Montréal, Québec, Canada,
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Unité d'Éthique Clinique, Hôpital Sainte-Justine, Montréal, Québec, Canada.,Unité de Recherche en Éthique Clinique et Partenariat Famille (UREPAF), Montréal, Québec, Canada
| | - Sonia Dahan
- Division of Neonatology, Hôpital Sainte-Justine, Montréal, Québec, Canada.,Unité d'Éthique Clinique, Hôpital Sainte-Justine, Montréal, Québec, Canada
| | - Kate Robson
- Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Keith James Barrington
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.,Division of Neonatology, Hôpital Sainte-Justine, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
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Jacobson GA, Raidal S, Robson K, Narkowicz CK, Nichols DS, Walters EH. Salmeterol undergoes enantioselective bronchopulmonary distribution with receptor localisation a likely determinant of duration of action. J Pharm Biomed Anal 2018; 154:102-107. [PMID: 29544104 DOI: 10.1016/j.jpba.2018.02.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Salmeterol (a long acting beta2-agonist) is a chiral molecule. (RR)-salmeterol is responsible for pharmacological effect, but basic knowledge of enantioselective pulmonary pharmacodynamics and pharmacokinetics of salmeterol remains unknown. There are safety concerns with (S)-enantiomers of beta2-agonists, with suggestions that these enantiomers may increase bronchial hyperresponsivneness in asthma patients. METHODOLOGY Horses (n = 12) received racemic (rac-) salmeterol 250 μg via inhalation. Enantioselective UPLC-MS/MS was used to determine (R)- and (S)-salmeterol concentrations in pulmonary epithelial lining fluid (PELF) sampled 2, 5, 10 and 15 min after administration, in central lung (endoscopic bronchial biopsy) and peripheral lung (percutaneous pulmonary biopsy) tissues (at 20 and 25 min respectively), and in plasma samples. RESULTS Physiologically relevant tissue concentrations were found for both enantiomers, with median levels greater in central than peripheral lung (equivalent to 32 and 5 mM (R)-salmeterol for central and peripheral lung respectively). Levels in PELF decreased around 50% over 15 min and enantioselective distribution was observed in the central lung with levels of (R)-salmeterol around 30% higher than (S)-salmeterol. CONCLUSION Salmeterol distribution is enantioselective in the central lung. This suggests duration of action is more likely associated with specific B2ADR localisation effects rather than non-specific physiochemical factors which would not be enantioselective.
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Affiliation(s)
- Glenn A Jacobson
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
| | - Sharanne Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Kate Robson
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | | | - David S Nichols
- Central Science Laboratory, University of Tasmania, Hobart, Tasmania, Australia
| | - E Haydn Walters
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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O'Brien K, Robson K, Bracht M, Cruz M, Lui K, Alvaro R, da Silva O, Monterrosa L, Narvey M, Ng E, Soraisham A, Ye XY, Mirea L, Tarnow-Mordi W, Lee SK. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health 2018; 2:245-254. [PMID: 30169298 DOI: 10.1016/s2352-4642(18)30039-7] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite evidence suggesting that parent involvement was beneficial for infant and parent outcomes, the Family Integrated Care (FICare) programme was one of the first pragmatic approaches to enable parents to become primary caregivers in the neonatal intensive care unit (NICU). We aimed to analyse the effect of FICare on infant and parent outcomes, safety, and resource use. METHODS In this multicentre, cluster-randomised controlled trial, we stratified 26 tertiary NICUs from Canada, Australia, and New Zealand by country and size, and assigned them, using a computer-generated random allocation sequence, to provide FICare or standard NICU care. Eligible infants were born at 33 weeks' gestation or earlier, and had no or low-level respiratory support; parents gave written informed consent for enrolment. To be eligible, parents in the FICare group had to commit to be present for at least 6 h a day, attend educational sessions, and actively care for their infant. The primary outcome, analysed at the individual level, was infant weight gain at day 21 after enrolment. Secondary outcomes were weight gain velocity, high frequency breastfeeding (≥6 times a day) at hospital discharge, parental stress and anxiety at enrolment and day 21, NICU mortality and major neonatal morbidities, safety, and resource use (including duration of oxygen therapy and hospital stay). This trial is registered with ClinicalTrials.gov, number NCT01852695. FINDINGS From Oct 1, 2012, 26 sites were randomly assigned to provide FICare (n=14) or standard care (n=12). One site assigned to FICare discontinued because of poor site enrolment. Parents and infants were enrolled between April 1, 2013, and Aug 31, 2015, with 895 infants being eligible in the FICare group and 891 in the standard care group. At day 21, weight gain was greater in the FICare group than in the standard care group (mean change in Z scores -0·071 [SD 0·42] vs -0·155 [0·42]; p<0·0002). Average daily weight gain was significantly higher in infants receiving FICare than those receiving standard care (mean daily weight gain 26·7 g [SD 9·4] vs 24·8 g [9·5]; p<0·0001). The high-frequency exclusive breastmilk feeding rate at discharge was higher for infants in the FICare group (279 [70%] of 396) than those in the standard care group (394 [63%] of 624; p=0·016). At day 21, parents in the FICare group had lower mean stress scores than did parents in the standard care group (2·3 [SD 0·8] vs 2·5 [0·8]; p<0·00043), and lower mean anxiety scores (70·8 [20·1] vs 74·2 [19·9]; p=0·0045). There were no significant differences between groups in the rates of the secondary outcomes of mortality, major morbidity, duration of oxygen therapy, and duration of hospital stay. Although the safety assessment was not completed, there were no adverse events. INTERPRETATION FICare improved infant weight gain, decreased parent stress and anxiety, and increased high-frequency exclusive breastmilk feeding at discharge, which together suggest that FICare is an important advancement in neonatal care. Further research is required to examine if these results translate into better long-term outcomes for families. FUNDING Canadian Institutes of Health Research Partnerships for Health System Improvement, and Ontario Ministry of Health and Long-Term Care.
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Affiliation(s)
- Karel O'Brien
- Department of Paediatrics, Sinai Health System, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Kate Robson
- Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Marianne Bracht
- Department of Paediatrics, Sinai Health System, Toronto, ON, Canada
| | - Melinda Cruz
- Miracle Babies Foundation, Chipping Norton, NSW, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ruben Alvaro
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Orlando da Silva
- Department of Paediatrics, Western University, London, ON, Canada
| | - Luis Monterrosa
- Department of Pediatrics, Neonatal Division, Dalhousie University, Halifax, NS, Canada
| | - Michael Narvey
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Eugene Ng
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Amuchou Soraisham
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Lucia Mirea
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Phoenix Children's Hospital, Phoenix, AZ, USA
| | - William Tarnow-Mordi
- WINNER Centre for Newborn Research, NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Shoo K Lee
- Department of Paediatrics, Sinai Health System, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
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9
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Shah PS, McDonald SD, Barrett J, Synnes A, Robson K, Foster J, Pasquier JC, Joseph KS, Piedboeuf B, Lacaze-Masmonteil T, O'Brien K, Shivananda S, Chaillet N, Pechlivanoglou P. The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families. CMAJ Open 2018; 6:E44-E49. [PMID: 29348260 PMCID: PMC5878956 DOI: 10.9778/cmajo.20170128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. METHODS Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems. Three broad clusters of projects will be undertaken. Cluster 1 will focus on quality-improvement efforts that use the Evidence-based Practice for Improving Quality method to evaluate information from the CPTBN database and review the current literature, then identify potentially better health care practices and implement identified strategies. Cluster 2 will assess the impact of current practices and practice changes in maternal, perinatal and neonatal care on maternal, neonatal and neurodevelopmental outcomes. Cluster 3 will evaluate the effect of preterm birth on babies, their families and the health care system by integrating CPTBN data, parent feedback, and national and provincial database information in order to identify areas where more parental support is needed, and also generate robust estimates of resource use, cost and cost-effectiveness around preterm neonatal care. INTERPRETATION These collaborative efforts will create a flexible, transdisciplinary, evaluable and informative research and quality-improvement platform that supports programs, projects and partnerships focused on improving outcomes of preterm neonates.
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Affiliation(s)
- Prakesh S Shah
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Sarah D McDonald
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Jon Barrett
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Anne Synnes
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Kate Robson
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Jonathan Foster
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Jean-Charles Pasquier
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - K S Joseph
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Bruno Piedboeuf
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Thierry Lacaze-Masmonteil
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Karel O'Brien
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Sandesh Shivananda
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Nils Chaillet
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Petros Pechlivanoglou
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
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Hicks D, Rafiee G, Schwalbe E, Howell C, Lindsey J, Hill R, Smith A, Crosier S, Joshi A, Robson K, Wharton S, Jacques T, Williamson D, Bailey S, Clifford S. MEDU-09. SUBGROUP-DIRECTED STRATIFICATION OF DISEASE RISK IN INFANT MEDULLOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.160] [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: 11/14/2022] Open
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Haward MF, Gaucher N, Payot A, Robson K, Janvier A. Personalized Decision Making: Practical Recommendations for Antenatal Counseling for Fragile Neonates. Clin Perinatol 2017; 44:429-445. [PMID: 28477670 DOI: 10.1016/j.clp.2017.01.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Emphasis has been placed on engaging parents in processes of shared decision making for delivery room management decisions of critically ill neonates whose outcomes are uncertain and unpredictable. The goal of antenatal consultation should rather be to adapt to parental needs and empower them through a personalized decision-making process. This can be done by acknowledging individuality and diversity while respecting the best interests of neonates. The goal is for parents to feel like they have agency and ability and are good parents, before birth, at birth, and after, either in the NICU or until the death of their child.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, New York, NY 10467, USA
| | - Nathalie Gaucher
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada
| | - Antoine Payot
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada; Palliative Care Unit, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Unité d'Éthique Clinique et de Partenariat Famille, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada
| | - Kate Robson
- Canadian Premature Babies Foundation, Toronto, Ontario M4N 3M5, Canada
| | - Annie Janvier
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada; Palliative Care Unit, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Unité d'Éthique Clinique et de Partenariat Famille, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Department of Pediatrics and Clinical Ethics, Sainte-Justine Hospital, University of Montreal, 3175 Chemin Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
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12
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Jacobson GA, Raidal S, Robson K, Narkowicz CK, Nichols DS, Haydn Walters E. Bronchopulmonary pharmacokinetics of (R)-salbutamol and (S)-salbutamol enantiomers in pulmonary epithelial lining fluid and lung tissue of horses. Br J Clin Pharmacol 2017; 83:1436-1445. [PMID: 28061018 DOI: 10.1111/bcp.13228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/20/2016] [Accepted: 12/21/2016] [Indexed: 01/11/2023] Open
Abstract
AIMS Salbutamol is usually administered as a racemic mixture but little is known about the enantioselectivity of salbutamol pharmacokinetics in the lung. This study was designed to investigate enantiomer concentrations in lung tissue after inhaled dosing. METHODS Horses (n = 12) received racemic salbutamol 1000 μg via inhalation. Enantioselective ultra performance liquid chromatography-tandem mass spectrometry was used to determine salbutamol concentrations in pulmonary epithelial lining fluid (PELF) sampled 2, 5, 10 and 15 min after administration, in central lung (endoscopic bronchial biopsy) and peripheral lung (percutaneous pulmonary biopsy) tissues (at 20 and 25 min respectively), and in plasma samples. RESULTS Mean ± 95% confidence interval (CI) yield of PELF was 57 ± 10 mg. Initial mean ± 95%CI (R)- and (S)-salbutamol PELF concentrations were 389 ± 189 ng g-1 and 378 ± 177 ng g-1 respectively, and both reduced approximately 50% by 15 min. Mean ± 95%CI central lung levels of drug were higher than peripheral lung tissue for both (R)-salbutamol (875 ± 945 vs. 49.5 ± 12 ng g-1 ) and (S)-salbutamol (877 ± 955 vs. 50.9 ± 12 ng g-1 ) respectively. There was no evidence of enantioselectivity in PELF or central lung but minor (~2%) enantioselectivity was observed in the peripheral lung. Enantioselectivity was clearly evident in plasma with (S):(R) ratio of 1.25 and 1.14 for both area under the concentration-time curve (0-25 min) and Cmax respectively. CONCLUSIONS PELF sampling in horses offers sufficient yield allowing direct detection of drug and, combined with tissue sampling, is a valuable model to investigate bronchopulmonary pharmacokinetics. Salbutamol did not demonstrate enantioselectivity in PELF or central lung tissue uptake following acute dosing, however, enantioselective plasma concentrations were demonstrated, with minor enantioselectivity in the peripheral lung.
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Affiliation(s)
- Glenn A Jacobson
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Sharanne Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Kate Robson
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | | | - David S Nichols
- Central Science Laboratory, University of Tasmania, Hobart, Tasmania, Australia
| | - E Haydn Walters
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Robson K, MacMillan-York E, Dunn MS. Celebration in the Face of Trauma: Supporting NICU Families through Compassionate Facility Design. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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McMurtry CM, Taddio A, Noel M, Antony MM, Chambers CT, Asmundson GJG, Pillai Riddell R, Shah V, MacDonald NE, Rogers J, Bucci LM, Mousmanis P, Lang E, Halperin S, Bowles S, Halpert C, Ipp M, Rieder MJ, Robson K, Uleryk E, Votta Bleeker E, Dubey V, Hanrahan A, Lockett D, Scott J. Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research. Cogn Behav Ther 2016; 45:217-35. [PMID: 27007463 PMCID: PMC4867871 DOI: 10.1080/16506073.2016.1157204] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/09/2016] [Indexed: 12/20/2022]
Abstract
Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.
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Affiliation(s)
- C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Canada
- Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, Canada
- Children’s Health Research Institute, London, Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Canada
| | | | - Christine T. Chambers
- Department of Pediatrics, Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- The Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | | | - Rebecca Pillai Riddell
- The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Vibhuti Shah
- Mount Sinai Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Noni E. MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
- Canadian Center for Vaccinology, Halifax, Canada
| | - Jess Rogers
- Centre for Effective Practice, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Lucie M. Bucci
- Immunize Canada, Ottawa, Canada
- Canadian Public Health Association, Ottawa, Canada
| | | | - Eddy Lang
- Alberta Health Services and the Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott Halperin
- Department of Pediatrics, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
- Canadian Center for Vaccinology, Halifax, Canada
- Department of Microbiology & Immunology, Dalhousie University, Halifax, Canada
| | - Susan Bowles
- College of Pharmacy, Dalhousie University, Halifax, Canada
| | - Christine Halpert
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, Canada
| | - Moshe Ipp
- The Hospital for Sick Children, Toronto, Canada
- Faculty of Medicine, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Michael J. Rieder
- Departments of Paediatrics, Physiology & Pharmacology and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Kate Robson
- Canadian Family Advisory Network, Toronto, Canada
| | | | | | | | - Anita Hanrahan
- Communicable Disease Control, Alberta Health Services, Edmonton, Canada
| | - Donna Lockett
- Bodhi Seed Center for Healing and Conscious Living, Milton, Canada
| | - Jeffrey Scott
- Department of Emergency Medicine, IWK Health Centre, Halifax, Canada
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Robson K, Hill P, Langsford D, Dwyer K, Goodman D, Langham R. Galactose therapy reduces proteinuria in patients with recurrent focal segmental glomerulosclerosis after kidney transplantation. Nephrology (Carlton) 2015; 20 Suppl 1:13-6. [PMID: 25807852 DOI: 10.1111/nep.12422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 12/13/2022]
Abstract
Primary focal segmental glomerulosclerosis is an important cause of end-stage kidney disease with a high rate of recurrent disease after kidney transplantation. Current therapy achieves remission in only half of patients. Recent interest has focused on the potential role of galactose in binding and inactivating the putative circulating permeability factor, supported by in vitro and clinical case report studies. Orally active and without major adverse effects, galactose has a favourable treatment profile compared with current immunosuppressive treatment options. We describe our experience using galactose therapy in two patients with recurrent focal segmental glomerulosclerosis after renal transplantation. Galactose was associated with symptomatic improvement and stabilization of graft function in one case; the other case was complicated by concurrent malignancy. In both cases, we observed a marked reduction in proteinuria with galactose treatment.
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O'Brien K, Bracht M, Robson K, Ye XY, Mirea L, Cruz M, Ng E, Monterrosa L, Soraisham A, Alvaro R, Narvey M, Da Silva O, Lui K, Tarnow-Mordi W, Lee SK. Evaluation of the Family Integrated Care model of neonatal intensive care: a cluster randomized controlled trial in Canada and Australia. BMC Pediatr 2015; 15:210. [PMID: 26671340 PMCID: PMC4681024 DOI: 10.1186/s12887-015-0527-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/09/2015] [Indexed: 11/27/2022] Open
Abstract
Background Admission to the neonatal intensive care unit (NICU) may disrupt parent-infant interaction with adverse consequences for infants and their families. Several family-centered care programs promote parent-infant interaction in the NICU; however, all of these retain the premise that health-care professionals should provide most of the infant’s care. Parents play a mainly supportive role in the NICU and continue to feel anxious and unprepared to care for their infant after discharge. In the Family Integrated Care (FICare) model, parents provide all except the most advanced medical care for their infants with support from the medical team. Our hypothesis is that infants whose families complete the FICare program will have greater weight gain and better clinical and parental outcomes compared with infants provided with standard NICU care. Methods/Design FICare is being evaluated in a cluster randomized controlled trial among infants born at ≤ 33 weeks’ gestation admitted to 19 Canadian, 6 Australian, and 1 New Zealand tertiary-level NICU. Trial enrollment began in April, 2013, with a target sample size of 675 infants in each arm, to be completed by August, 2015. Participating sites were stratified by country, and by NICU size within Canada, for randomization to either the FICare intervention or control arm. In intervention sites, parents are taught how to provide most of their infant’s care and supported by nursing staff, veteran parents, a program coordinator, and education sessions. In control sites standard NICU care is provided. The primary outcome is infants’ weight gain at 21 days after enrollment, which will be compared between the FICare and control groups using Student’s t-test adjusted for site-level clustering, and multi-level hierarchical models accounting for both clustering and potential confounders. Similar analyses will examine secondary outcomes including breastfeeding, clinical outcomes, safety, parental stress and anxiety, and resource use. The trial was designed, is being conducted, and will be reported according to the CONSORT 2010 guidelines for cluster randomized controlled trials. Discussion By evaluating the impact of integrating parents into the care of their infant in the NICU, this trial may transform the delivery of neonatal care. Trial registration NCT01852695, registered December 19, 2012
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Affiliation(s)
- Karel O'Brien
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada. .,Department of Paediatrics, University of Toronto, Toronto, ON, Canada. .,Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue Rm 19-231A, Toronto, ON, M5G 1X5, Canada.
| | - Marianne Bracht
- Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue Rm 19-231A, Toronto, ON, M5G 1X5, Canada.
| | - Kate Robson
- Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Lucia Mirea
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Melinda Cruz
- Miracle Babies Foundation, Chipping Norton, NSW, Australia.
| | - Eugene Ng
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada. .,Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Luis Monterrosa
- Department of Pediatrics, Neonatal Division, Dalhousie University, Halifax, NS, Canada.
| | - Amuchou Soraisham
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
| | - Ruben Alvaro
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
| | - Michael Narvey
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
| | - Orlando Da Silva
- Department of Paediatrics, Western University, London, ON, Canada.
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women and Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - William Tarnow-Mordi
- WINNER Centre for Newborn Research, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia. .,Department of Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, Australia.
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada. .,Department of Paediatrics, University of Toronto, Toronto, ON, Canada. .,Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue Rm 19-231A, Toronto, ON, M5G 1X5, Canada.
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Taddio A, McMurtry CM, Shah V, Riddell RP, Chambers CT, Noel M, MacDonald NE, Rogers J, Bucci LM, Mousmanis P, Lang E, Halperin SA, Bowles S, Halpert C, Ipp M, Asmundson GJG, Rieder MJ, Robson K, Uleryk E, Antony MM, Dubey V, Hanrahan A, Lockett D, Scott J, Bleeker EV. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015; 187:975-982. [PMID: 26303247 DOI: 10.1503/cmaj.150391] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont.
| | - C Meghan McMurtry
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Vibhuti Shah
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Rebecca Pillai Riddell
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Christine T Chambers
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Melanie Noel
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Noni E MacDonald
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Jess Rogers
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Lucie M Bucci
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Patricia Mousmanis
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Eddy Lang
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Scott A Halperin
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Susan Bowles
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Christine Halpert
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Moshe Ipp
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Gordon J G Asmundson
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Michael J Rieder
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Kate Robson
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Elizabeth Uleryk
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Martin M Antony
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Vinita Dubey
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Anita Hanrahan
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Donna Lockett
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Jeffrey Scott
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
| | - Elizabeth Votta Bleeker
- Leslie Dan Faculty of Pharmacy (Taddio), University of Toronto, and The Hospital for Sick Children, Toronto, Ont.; Department of Psychology (McMurtry), University of Guelph, Children's Health Research Institute, and Department of Paediatrics, Western University, London, Ont.; Mount Sinai Hospital (Shah), and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Pillai Riddell), York University, Toronto, Ont.; Departments of Pediatrics (Chambers), and Psychology and Neuroscience, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS; Center for Child Health, Behavior and Development (Noel), Seattle Children's Research Institute, Seattle, Wash.; Department of Pediatrics (MacDonald), Dalhousie University, IWK Health Centre and Canadian Center for Vaccinology, Halifax, NS; Centre for Effective Practice (Rogers), and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Child and Adolescent Health Program Committee (Mousmanis), The College of Family Physicians of Canada, Mississauga, Ont.; Alberta Health Services (Lang), and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Departments of Pediatrics (Halperin), and Microbiology and Immunology, and Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, NS; College of Pharmacy (Bowles), Dalhousie University, Halifax, NS; Immunization Programs and Vaccine Preventable Diseases Service (Halpert), BC Centre for Disease Control, Vancouver, BC; Department of Paediatrics (Ipp), The Hospital for Sick Children, and Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Asmundson), Faculty of Arts, University of Regina, Regina, Sask.; Departments of Paediatrics (Rieder), Physiology and Pharmacology, and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Canadian Family Advisory Network (Robson), Toronto, Ont.; E.M. Uleryk Consulting (Uleryk), Mississauga, Ont.; Department of Psychology (Antony), Ryerson University, Toronto, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Communicable Disease Control (Hanrahan), Alberta Health Services, Edmonton, Alta.; Bodhi Seed Center for Healing and Conscious Living (Lockett), Milton, Ont.; Department of Emergency Medicine (Scott), IWK Health Centre, Halifax, NS; Science Directorate (Votta Bleeker), Canadian Psychological Association, Ottawa, Ont
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Robson K, Ngu K, Stanley M, Langham R. SP698NOCTURNAL IN-CENTRE HAEMODIALYSIS: AN AUSTRALIAN COHORT EXPERIENCE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv200.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yusuff H, Malagon I, Robson K, Parmar J, Hamilton P, Falter F. Extracorporeal membrane oxygenation for Life-threatening ANCA-positive pulmonary capillaritis. A review of UK experience. Heart Lung Vessel 2015; 7:159-67. [PMID: 26157742 PMCID: PMC4476770] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Anti-neutrophil cytoplasmic antibody positive pulmonary capillaritis complicated by diffuse alveolar hemorrhage is a potentially fatal condition for which extracorporeal membrane oxygenation can facilitate improved outcomes and potential cure. Diffuse alveolar hemorrhage can be the initial presentation of an autoimmune disorder. The management is centered on the use of immunosuppressive therapy, which requires time, with fatality often occurring for these patients. We showed two very young patients with no previous history of vasculitis presenting with life threatening pulmonary hemorrhage due to anti-neutrophil cytoplasmic antibody positive vasculitis, whose management was facilitated with extracorporeal membrane oxygenation. METHODS We reviewed the clinical presentation and course of the first two patients with diffuse alveolar hemorrhage for anti-neutrophil cytoplasmic antibody positive vasculitis managed with veno-venous extracorporeal membrane oxygenation. We highlighted and analysed the unique challenges encountered in managing these patients. RESULTS The two patients were referred for extracorporeal membrane oxygenation since conventional ventilation was inadequate to provide physiologic support for respiratory failure. Clinical improvement was achieved without exacerbation of the pulmonary hemorrhage despite the use of anticoagulants. This provided time for the immunosuppressants to take effect. Both patients were discharged and were cured of the underlying condition. CONCLUSIONS Extracorporeal membrane oxygenation has a role in the management of patients with severe respiratory failure due to anti-neutrophil cytoplasmic antibody positive capillaritis. Early recognition and referral for extracorporeal membrane oxygenation are vital to achieve a favourable outcome.
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Affiliation(s)
- Hakeem Yusuff
- Department of Cardiothoracic Intensive Care, Papworth Hospital, Cambridge, UK
| | - Ignacio Malagon
- Department of Cardiothoracic Anaesthesia and Intensive Care, University Hospital of South Manchester, Manchester, UK
| | - Kate Robson
- Department of Cardiothoracic Intensive Care, Papworth Hospital, Cambridge, UK
| | - Jas Parmar
- Department of Respiratory Medicine and Transplantation, Papworth Hospital, Cambridge, UK
| | - Patrick Hamilton
- Department of Cardiothoracic Anaesthesia and Intensive Care, University Hospital of South Manchester, Manchester, UK
| | - Florian Falter
- Department of Cardiothoracic Intensive Care, Papworth Hospital, Cambridge, UK
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Robson K, Nagakumar P, Collins N, Davies J, Fleming L, Balfour-Lynn I, Rosenthal M, Hogg C, Jochmann A, Bush A, Saglani S. P105 Safety, Feasibility And Quality Of Sputum Induction In Preschool Children With Obstructive Airways Disease. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.246] [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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Collins N, Robson K, Nagakumar P, Saglani S, Voase N, Davies J. P106 Sputum Induction Reduces The Need For Bronchoscopy In School-aged Children With Cystic Fibrosis. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.247] [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: 11/03/2022]
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Vaidyanathan G, Gururangan S, Bigner D, Zalutsky M, Morfouace M, Shelat A, Megan J, Freeman BB, Robinson S, Throm S, Olson JM, Li XN, Guy KR, Robinson G, Stewart C, Gajjar A, Roussel M, Sirachainan N, Pakakasama S, Anurathapan U, Hansasuta A, Dhanachai M, Khongkhatithum C, Hongeng S, Feroze A, Lee KS, Gholamin S, Wu Z, Lu B, Mitra S, Cheshier S, Northcott P, Lee C, Zichner T, Lichter P, Korbel J, Wechsler-Reya R, Pfister S, Project IPT, Li KKW, Xia T, Ma FMT, Zhang R, Zhou L, Lau KM, Ng HK, Lafay-Cousin L, Chi S, Madden J, Smith A, Wells E, Owens E, Strother D, Foreman N, Packer R, Bouffet E, Wataya T, Peacock J, Taylor MD, Ivanov D, Garnett M, Parker T, Alexander C, Meijer L, Grundy R, Gellert P, Ashford M, Walker D, Brent J, Cader FZ, Ford D, Kay A, Walsh R, Solanki G, Peet A, English M, Shalaby T, Fiaschetti G, Baulande S, Gerber N, Baumgartner M, Grotzer M, Hayase T, Kawahara Y, Yagi M, Minami T, Kanai N, Yamaguchi T, Gomi A, Morimoto A, Hill R, Kuijper S, Lindsey J, Schwalbe E, Barker K, Boult J, Williamson D, Ahmad Z, Hallsworth A, Ryan S, Poon E, Robinson S, Ruddle R, Raynaud F, Howell L, Kwok C, Joshi A, Nicholson SL, Crosier S, Wharton S, Robson K, Michalski A, Hargrave D, Jacques T, Pizer B, Bailey S, Swartling F, Petrie K, Weiss W, Chesler L, Clifford S, Kitanovski L, Prelog T, Kotnik BF, Debeljak M, Fiaschetti G, Shalaby T, Baumgartner M, Grotzer MA, Gevorgian A, Morozova E, Kazantsev I, Iukhta T, Safonova S, Kumirova E, Punanov Y, Afanasyev B, Zheludkova O, Grajkowska W, Pronicki M, Cukrowska B, Dembowska-Baginska B, Lastowska M, Murase A, Nobusawa S, Gemma Y, Yamazaki F, Masuzawa A, Uno T, Osumi T, Shioda Y, Kiyotani C, Mori T, Matsumoto K, Ogiwara H, Morota N, Hirato J, Nakazawa A, Terashima K, Fay-McClymont T, Walsh K, Mabbott D, Smith A, Wells E, Madden J, Chi S, Owens E, Strother D, Packer R, Foreman N, Bouffet E, Lafay-Cousin L, Sturm D, Northcott PA, Jones DTW, Korshunov A, Lichter P, Pfister SM, Kool M, Hooper C, Hawes S, Kees U, Gottardo N, Dallas P, Siegfried A, Bertozzi AI, Sevely A, Loukh N, Munzer C, Miquel C, Bourdeaut F, Pietsch T, Dufour C, Delisle MB, Kawauchi D, Rehg J, Finkelstein D, Zindy F, Phoenix T, Gilbertson R, Pfister S, Roussel M, Trubicka J, Borucka-Mankiewicz M, Ciara E, Chrzanowska K, Perek-Polnik M, Abramczuk-Piekutowska D, Grajkowska W, Jurkiewicz D, Luczak S, Kowalski P, Krajewska-Walasek M, Lastowska M, Sheila C, Lee S, Foster C, Manoranjan B, Pambit M, Berns R, Fotovati A, Venugopal C, O'Halloran K, Narendran A, Hawkins C, Ramaswamy V, Bouffet E, Taylor M, Singhal A, Hukin J, Rassekh R, Yip S, Northcott P, Singh S, Duhman C, Dunn S, Chen T, Rush S, Fuji H, Ishida Y, Onoe T, Kanda T, Kase Y, Yamashita H, Murayama S, Nakasu Y, Kurimoto T, Kondo A, Sakaguchi S, Fujimura J, Saito M, Arakawa T, Arai H, Shimizu T, Lastowska M, Jurkiewicz E, Daszkiewicz P, Drogosiewicz M, Trubicka J, Grajkowska W, Pronicki M, Kool M, Sturm D, Jones DTW, Hovestadt V, Buchhalter I, Jager NN, Stuetz A, Johann P, Schmidt C, Ryzhova M, Landgraf P, Hasselblatt M, Schuller U, Yaspo ML, von Deimling A, Korbel J, Eils R, Lichter P, Korshunov A, Pfister S, Modi A, Patel M, Berk M, Wang LX, Plautz G, Camara-Costa H, Resch A, Lalande C, Kieffer V, Poggi G, Kennedy C, Bull K, Calaminus G, Grill J, Doz F, Rutkowski S, Massimino M, Kortmann RD, Lannering B, Dellatolas G, Chevignard M, Lindsey J, Kawauchi D, Schwalbe E, Solecki D, McKinnon P, Olson J, Hayden J, Grundy R, Ellison D, Williamson D, Bailey S, Roussel M, Clifford S, Buss M, Remke M, Lee J, Caspary T, Taylor M, Castellino R, Lannering B, Sabel M, Gustafsson G, Fleischhack G, Benesch M, Doz F, Kortmann RD, Massimino M, Navajas A, Reddingius R, Rutkowski S, Miquel C, Delisle MB, Dufour C, Lafon D, Sevenet N, Pierron G, Delattre O, Bourdeaut F, Ecker J, Oehme I, Mazitschek R, Korshunov A, Kool M, Lodrini M, Deubzer HE, von Deimling A, Kulozik AE, Pfister SM, Witt O, Milde T, Phoenix T, Patmore D, Boulos N, Wright K, Boop S, Gilbertson R, Janicki T, Burzynski S, Burzynski G, Marszalek A, Triscott J, Green M, Foster C, Fotovati A, Berns R, O'Halloran K, Singhal A, Hukin J, Rassekh SR, Yip S, Toyota B, Dunham C, Dunn SE, Liu KW, Pei Y, Wechsler-Reya R, Genovesi L, Ji P, Davis M, Ng CG, Remke M, Taylor M, Cho YJ, Jenkins N, Copeland N, Wainwright B, Tang Y, Schubert S, Nguyen B, Masoud S, Gholamin S, Lee A, Willardson M, Bandopadhayay P, Bergthold G, Atwood S, Whitson R, Cheshier S, Qi J, Beroukhim R, Tang J, Wechsler-Reya R, Oro A, Link B, Bradner J, Cho YJ, Vallero SG, Bertin D, Basso ME, Milanaccio C, Peretta P, Cama A, Mussano A, Barra S, Morana G, Morra I, Nozza P, Fagioli F, Garre ML, Darabi A, Sanden E, Visse E, Stahl N, Siesjo P, Cho YJ, Vaka D, Schubert S, Vasquez F, Weir B, Cowley G, Keller C, Hahn W, Gibbs IC, Partap S, Yeom K, Martinez M, Vogel H, Donaldson SS, Fisher P, Perreault S, Cho YJ, Guerrini-Rousseau L, Dufour C, Pujet S, Kieffer-Renaux V, Raquin MA, Varlet P, Longaud A, Sainte-Rose C, Valteau-Couanet D, Grill J, Staal J, Lau LS, Zhang H, Ingram WJ, Cho YJ, Hathout Y, Brown K, Rood BR, Sanden E, Visse E, Stahl N, Siesjo P, Darabi A, Handler M, Hankinson T, Madden J, Kleinschmidt-Demasters BK, Foreman N, Hutter S, Northcott PA, Kool M, Pfister S, Kawauchi D, Jones DT, Kagawa N, Hirayama R, Kijima N, Chiba Y, Kinoshita M, Takano K, Eino D, Fukuya S, Yamamoto F, Nakanishi K, Hashimoto N, Hashii Y, Hara J, Taylor MD, Yoshimine T, Wang J, Guo C, Yang Q, Chen Z, Perek-Polnik M, Lastowska M, Drogosiewicz M, Dembowska-Baginska B, Grajkowska W, Filipek I, Swieszkowska E, Tarasinska M, Perek D, Kebudi R, Koc B, Gorgun O, Agaoglu FY, Wolff J, Darendeliler E, Schmidt C, Kerl K, Gronych J, Kawauchi D, Lichter P, Schuller U, Pfister S, Kool M, McGlade J, Endersby R, Hii H, Johns T, Gottardo N, Sastry J, Murphy D, Ronghe M, Cunningham C, Cowie F, Jones R, Sastry J, Calisto A, Sangra M, Mathieson C, Brown J, Phuakpet K, Larouche V, Hawkins C, Bartels U, Bouffet E, Ishida T, Hasegawa D, Miyata K, Ochi S, Saito A, Kozaki A, Yanai T, Kawasaki K, Yamamoto K, Kawamura A, Nagashima T, Akasaka Y, Soejima T, Yoshida M, Kosaka Y, Rutkowski S, von Bueren A, Goschzik T, Kortmann R, von Hoff K, Friedrich C, Muehlen AZ, Gerber N, Warmuth-Metz M, Soerensen N, Deinlein F, Benesch M, Zwiener I, Faldum A, Kuehl J, Pietsch T, KRAMER K, -Taskar NP, Zanzonico P, Humm JL, Wolden SL, Cheung NKV, Venkataraman S, Alimova I, Harris P, Birks D, Balakrishnan I, Griesinger A, Remke M, Taylor MD, Handler M, Foreman NK, Vibhakar R, Margol A, Robison N, Gnanachandran J, Hung L, Kennedy R, Vali M, Dhall G, Finlay J, Erdrich-Epstein A, Krieger M, Drissi R, Fouladi M, Gilles F, Judkins A, Sposto R, Asgharzadeh S, Peyrl A, Chocholous M, Holm S, Grillner P, Blomgren K, Azizi A, Czech T, Gustafsson B, Dieckmann K, Leiss U, Slavc I, Babelyan S, Dolgopolov I, Pimenov R, Mentkevich G, Gorelishev S, Laskov M, Friedrich C, Warmuth-Metz M, von Bueren AO, Nowak J, von Hoff K, Pietsch T, Kortmann RD, Rutkowski S, Mynarek M, von Hoff K, Muller K, Friedrich C, von Bueren AO, Gerber NU, Benesch M, Pietsch T, Warmuth-Metz M, Ottensmeier H, Kwiecien R, Faldum A, Kuehl J, Kortmann RD, Rutkowski S, Mynarek M, von Hoff K, Muller K, Friedrich C, von Bueren AO, Gerber NU, Benesch M, Pietsch T, Warmuth-Metz M, Ottensmeier H, Kwiecien R, Faldum A, Kuehl J, Kortmann RD, Rutkowski S, Yankelevich M, Laskov M, Boyarshinov V, Glekov I, Pimenov R, Ozerov S, Gorelyshev S, Popa A, Dolgopolov I, Subbotina N, Mentkevich G, Martin AM, Nirschl C, Polanczyk M, Bell R, Martinez D, Sullivan LM, Santi M, Burger PC, Taube JM, Drake CG, Pardoll DM, Lim M, Li L, Wang WG, Pu JX, Sun HD, Remke M, Taylor MD, Ruggieri R, Symons MH, Vanan MI, Bandopadhayay P, Bergthold G, Nguyen B, Schubert S, Gholamin S, Tang Y, Bolin S, Schumacher S, Zeid R, Masoud S, Yu F, Vue N, Gibson W, Paolella B, Mitra S, Cheshier S, Qi J, Liu KW, Wechsler-Reya R, Weiss W, Swartling FJ, Kieran MW, Bradner JE, Beroukhim R, Cho YJ, Maher O, Khatua S, Tarek N, Zaky W, Gupta T, Mohanty S, Kannan S, Jalali R, Kapitza E, Denkhaus D, Muhlen AZ, Rutkowski S, Pietsch T, von Hoff K, Pizer B, Dufour C, van Vuurden DG, Garami M, Massimino M, Fangusaro J, Davidson TB, da Costa MJG, Sterba J, Benesch M, Gerber NU, Mynarek M, Kwiecien R, Clifford SC, Kool M, Pietsch T, Finlay JL, Rutkowski S, Pietsch T, Schmidt R, Remke M, Korshunov A, Hovestadt V, Jones DT, Felsberg J, Goschzik T, Kool M, Northcott PA, von Hoff K, von Bueren A, Skladny H, Taylor M, Cremer F, Lichter P, Faldum A, Reifenberger G, Rutkowski S, Pfister S, Kunder R, Jalali R, Sridhar E, Moiyadi AA, Goel A, Goel N, Shirsat N, Othman R, Storer L, Korshunov A, Pfister SM, Kerr I, Coyle B, Law N, Smith ML, Greenberg M, Bouffet E, Taylor MD, Laughlin S, Malkin D, Liu F, Moxon-Emre I, Scantlebury N, Mabbott D, Nasir A, Othman R, Storer L, Onion D, Lourdusamy A, Grabowska A, Coyle B, Cai Y, Othman R, Bradshaw T, Coyle B, de Medeiros RSS, Beaugrand A, Soares S, Epelman S, Jones DTW, Hovestadt V, Wang W, Northcott PA, Kool M, Sultan M, Landgraf P, Reifenberger G, Eils R, Yaspo ML, Wechsler-Reya RJ, Korshunov A, Zapatka M, Radlwimmer B, Pfister SM, Lichter P, Alderete D, Baroni L, Lubinieki F, Auad F, Gonzalez ML, Puya W, Pacheco P, Aurtenetxe O, Gaffar A, Gros L, Cruz O, Calvo C, Navajas A, Shinojima N, Nakamura H, Kuratsu JI, Hanaford A, Eberhart C, Archer T, Tamayo P, Pomeroy S, Raabe E, De Braganca K, Gilheeney S, Khakoo Y, Kramer K, Wolden S, Dunkel I, Lulla RR, Laskowski J, Fangusaro J, Goldman S, Gopalakrishnan V, Ramaswamy V, Remke M, Shih D, Wang X, Northcott P, Faria C, Raybaud C, Tabori U, Hawkins C, Rutka J, Taylor M, Bouffet E, Jacobs S, De Vathaire F, Diallo I, Llanas D, Verez C, Diop F, Kahlouche A, Grill J, Puget S, Valteau-Couanet D, Dufour C, Ramaswamy V, Thompson E, Taylor M, Pomeroy S, Archer T, Northcott P, Tamayo P, Prince E, Amani V, Griesinger A, Foreman N, Vibhakar R, Sin-Chan P, Lu M, Kleinman C, Spence T, Picard D, Ho KC, Chan J, Hawkins C, Majewski J, Jabado N, Dirks P, Huang A, Madden JR, Foreman NK, Donson AM, Mirsky DM, Wang X, Dubuc A, Korshunov A, Ramaswamy V, Remke M, Mack S, Gendoo D, Peacock J, Luu B, Cho YJ, Eberhart C, MacDonald T, Li XN, Van Meter T, Northcott P, Croul S, Bouffet E, Pfister S, Taylor M, Laureano A, Brugmann W, Denman C, Singh H, Huls H, Moyes J, Khatua S, Sandberg D, Silla L, Cooper L, Lee D, Gopalakrishnan V. MEDULLOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou074] [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: 11/14/2022] Open
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O'Brien K, Bracht M, Macdonell K, McBride T, Robson K, O'Leary L, Christie K, Galarza M, Dicky T, Levin A, Lee SK. A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy Childbirth 2013; 13 Suppl 1:S12. [PMID: 23445639 PMCID: PMC3561192 DOI: 10.1186/1471-2393-13-s1-s12] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background We have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents. The objective of this pilot prospective cohort analytic study was to explore the feasibility, safety, and potential outcomes of implementing this model in a Canadian NICU. Methods Infants born ≤35 weeks gestation, receiving continuous positive airway pressure or less respiratory support, with a primary caregiver willing and able to spend ≥8 hours a day with their infant were eligible. Families attended daily education sessions and were mentored at the bedside by nurses. The primary outcome was weight gain, as measured by change in z-score for weight 21 days after enrolment. For each enrolled infant, we identified two matched controls from the previous year’s clinical database. Differences in weight gain between the two groups were analyzed using a linear mixed effects multivariable regression model. We also measured parental stress levels using the Parental Stress Survey: NICU, and interviewed parents and nurses regarding their experiences with FIC. Results This study included 42 mothers and their infants. Of the enrolled infants, matched control data were available for 31 who completed the study. The rate of change in weight gain was significantly higher in FIC infants compared with control infants (p < 0.05). There was also a significant increase in the incidence of breastfeeding at discharge (82.1 vs. 45.5%, p < 0.05). The mean Parental Stress Survey: NICU score for FIC mothers was 3.06 ± 0.12 at enrolment, which decreased significantly to 2.30 ± 0.13 at discharge (p < 0.05). Feedback from the parents and nurses indicated that FIC was feasible and appropriately implemented. Conclusions This study suggests that the FIC model is feasible and safe in a Canadian healthcare setting and results in improved weight gain among preterm infants. In addition, this innovation has the potential to improve other short and long-term infant and family outcomes. A multi-centre randomized controlled trial is needed to further evaluate the efficacy of FIC in the Canadian context.
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Affiliation(s)
- Karel O'Brien
- Department of Paediatrics, University of Toronto, Toronto M5G 1X5, Canada.
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Khatua S, Brown R, Pearlman M, Vats T, Satge D, Stiller C, Rutkowski S, von Bueren AO, Lacour B, Sommelet D, Nishi M, Massimino M, Garre ML, Moreno F, Hasle H, Jakab Z, Greenberg M, von der Weid N, Kuehni C, Zurriaga O, Vicente ML, Peris-Bonet R, Benesch M, Vekemans M, Sullivan S, Rickert C, Fisher PG, Von Behren J, Nelson DO, Reynolds P, Fukuoka K, Yanagisawa T, Suzuki T, Koga T, Wakiya K, Adachi JI, Mishima K, Fujimaki T, Matsutani M, Nishikawa R, Gidding C, Schieving J, Wesseling P, Ligtenberg M, Hoogerbrugge N, Jongmans M, Crosier S, Nicholson SL, Robson K, Jacques T, Wharton S, Bown N, Michalski A, Pizer B, Clifford S, Sanden E, Visse E, Siesjo P, Darabi A, Nousome D, Lupo PJ, Scheurer ME, Nulman I, Barrera M, Maxwell C, Koren G, Gorelyshev S, Matuev K, Lubnin A, Laskov M, Lemeneva N, Mazerkina N, Khuhlaeva E, Muller K, Bruns F, Pietsch T, Rutkowski S, Kortmann RD, Krishnatry R, Shirsat N, Kunder R, Epari S, Gupta T, Kurkure P, Vora T, Arora B, Moiyadi A, Jalali R, Swieszkowska E, Dembowska-Baginska B, Drogosiewicz M, Filipek I, Perek-Polnik M, Grajkowska W, Perek D, Johnston D, Cyr J, Strother D, Lafay-Cousin L, Fryer C, Scheinemann K, Carret AS, Fleming A, Larouche V, Bouffet E, Friedrich C, Gnekow AK, Fleischhack G, Kramm CM, Fruehwald MC, Muller HL, Calaminus G, Kordes U, Faldum A, Pietsch T, Warmuth-Metz M, Kortmann RD, Jung I, Kaatsch P, Rutkowski S, Caretti V, Bugiani M, Boor I, Schellen P, Vandertop WP, Noske DP, Kaspers G, Wurdinger T, Wesseling P, Robinson G, Chingtagumpala M, Adesina A, Dalton J, Santi M, Sievert A, Wright K, Armstrong G, Boue D, Olshefski R, Scott S, Huang A, Cohn R, Gururangan S, Bowers D, Gilbertson R, Gajjar A, Ellison D, Chick E, Donson A, Owens E, Smith AA, Madden JR, Foreman NK, Bakry D, Aronson M, Durno C, Hala R, Farah R, Amayiri N, Alharbi Q, Shamvil A, Ben-Shachar S, Constantini S, Rina D, Ellise J, Keiles S, Pollet A, Qaddoumi I, Gallinger S, Malkin D, Bouffet E, Hawkins C, Tabori U, Trivedi M, Goodden J, Chumas P, Tyagi A, O'kane R, Trivedi M, Goodden J, Chumas P, Tyagi A, O'Kane R, Crimmins D, Picton S, Elliott M. EPIDEMIOLOGY. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Luck NL, Thomas KC, Morin-Adeline VE, Barwick S, Chong AY, Carpenter EL, Wan L, Willet CE, Langford-Salisbury SM, Abdelsayd M, Ang RA, Atkinson SJ, Barcelo FG, Booth ME, Bradbury EJ, Branighan TL, Brown J, Castillo LE, Chandler ND, Chong JY, Collits KJ, Cook E, Cruz RE, Farrugia CA, Fletcher JL, Fletcher S, Gamaliel NS, Gurr JF, Hallett NJ, Hargreaves G, Harris T, Hollings S, Hopcroft RL, Johinke D, Kern PL, Kiddell JL, Kilby KE, Kragic B, Kwan JH, Lee JI, Liang JM, Lillie MC, Lui BC, Luk SW, Lun KH, Marshall KL, Marzec JA, Masters KT, Mazurkijevic LJ, Medlock J, Meoli C, Morris KM, Noh YH, Okazaki H, Orourke TJ, Payne EM, Powell DJ, Quinlivan AR, Reeves TJ, Robson K, Robson KL, Royle LJ, Stevenson R, Sellens T, Sun Z, Sutton AL, Swan A, Tang JM, Tinker JE, Tomlinson SC, Wilkin T, Wright AL, Xiao ST, Yang J, Yee C, Jaratlerdsiri W, Isberg SR, Miles L, Higgins D, Lane A, Gongora J. Mitochondrial DNA analyses of the saltwater crocodile (Crocodylus porosus) from the Northern Territory of Australia. AUST J ZOOL 2012. [DOI: 10.1071/zo12008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The saltwater crocodile is distributed throughout south-east Asia and Australia. In Australia, it is most abundant in the Northern Territory and Queensland, where it is sustainably farmed for its skins and meat. The aim of this study was to elucidate the relationships and genetic structure among saltwater crocodiles from the Northern Territory of Australia using mitochondrial control region sequences from 61 individuals, representing nine river basins and six of unknown origin, as well as published sequences from other regions. Eight mitochondrial control region haplotypes were identified among both published and novel sequences. Three of the haplotypes appear to be restricted to specimens from northern Australia, with a single haplotype being the most widely dispersed across all river basins. Although Analysis of Molecular Variance provides some support for differentiation among river basins, the frequency of shared haplotypes among these geographical units and median-joining network analysis do not support a clear genetic structure or phylogeographic pattern for saltwater crocodiles in the Northern Territory. The results of this study will assist in furthering our understanding of the genetic diversity of wild saltwater crocodile populations used for ranching in the Northern Territory, as well as providing a framework for assessing the origin of unknown specimens in the future.
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Affiliation(s)
- K Robson
- Small Animal Teaching Hospital, University of Liverpool, Leahurst, Chester High Road, Neston, Cheshire CH64 7TE
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Naisby GP, Harris H, Robson K. HILINA: minimising the breast compression time at stereoguided biopsy. Breast Cancer Res 2008. [PMCID: PMC3332621 DOI: 10.1186/bcr2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Robson K, Wojtczak H, Matteucci M, Griffith E. 90: Can One Hospital Quality Team Make a Difference in the Emergency Department Pediatric Asthma Population? Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Simpson MA, Verbesey JE, Khettry U, Morin DS, Gordon FD, Burns DL, Robson K, Pomposelli JJ, Jenkins RL, Pomfret EA. Successful algorithm for selective liver biopsy in the right hepatic lobe live donor (RHLD). Am J Transplant 2008; 8:832-8. [PMID: 18261175 DOI: 10.1111/j.1600-6143.2007.02135.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Routine versus selective predonation liver biopsy (LBx) remains controversial for assuring the safety of right hepatic lobe live donor (RHLD). Between December 1999 and March 2007, 403 potential RHLD were evaluated; 142 donated. Indications for selective LBx were: abnormal liver function tests or imaging studies, body mass index (BMI) >28, history of substance abuse or family history of immune mediated liver disease. All donors had a LBx at the time of surgery. Of 403 potential RLD, 149(36.9%) were accepted as donors, 25(6.3%) had their recipient receive a deceased donor graft, 94(23.4%) were rejected, 52(12.9%) stopped the evaluation process, 76(18.8%) withdrew from the process and 7(1.7%) are currently completing evaluation. Eighty-seven (21.5%) met criteria and were biopsied. Seventy-three (83.9%) had either normal (n = 24) or macrosteatosis <10% (n = 49); 51 of these donated. Abnormal LBx eliminated 15 potential donors. No significant abnormalities were found in donation biopsies of donors not meeting algorithm criteria. Three of 87 (3.4%) had complications requiring overnight admission (2 for pain, 1 for bleeding; transfusion not required). Use of this algorithm resulted in 78% of potential donors avoiding biopsy and potential complications. No significant liver pathology was identified in donors not meeting criteria for evaluation LBx. Routine predonation LBx is unnecessary in potential RHLD.
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Affiliation(s)
- M A Simpson
- Department of Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic, Burlington, MA, USA.
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Pevalin DJ, Robson K. Social determinants of health inequalities in Bosnia and Herzegovina. Public Health 2007; 121:588-95. [PMID: 17475296 DOI: 10.1016/j.puhe.2007.01.012] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 12/11/2006] [Accepted: 01/16/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the social determinants of inequalities in health in Bosnia and Herzegovina in the post-conflict period, and to test if the relative effects vary across the two entities of the Federation of Bosnia and Herzegovina and the Republika Srpska. STUDY DESIGN Cross-sectional data come from the first wave of the Bosnia and Herzegovina Household Panel Study conducted in 2001, which collected data from 7482 respondents aged 17 years and older based on over 3000 households. METHODS Distributions and odds ratios for physical limitations and poor mental well-being were calculated over a number of known social determinants. Multivariate logistic regression and t-tests were used to compare risks across entities within the state of Bosnia and Herzegovina. RESULTS The prevalence of poor mental well-being and physical limitations was significantly higher in the Republika Srpska. Significant differences in poor mental well-being and physical limitations were observed across most determinants within each entity, but only a few of these relative effects differed between entities. CONCLUSIONS Efforts to tackle absolute differences in poor health between the entities within Bosnia and Herzegovina should be pursued, along with reducing social inequalities.
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Affiliation(s)
- D J Pevalin
- Department of Health and Human Sciences, University of Essex, Colchester, Essex CO4 3SQ, UK.
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Grill J, Lowis S, Frappaz D, Michalski A, Picton S, Jouvet A, Robson K, Jaspan T, Couanet D, Le Deley M. Phase II study of the combination of cisplatin + temozolomide in malignant glial tumours in children and adolescents at diagnosis or in relapse (cistem2/nct00147160). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9543 Background: Temozolomide has been shown moderately effective in pediatric high-grade glioma (HGG). By decreasing the activity of MGMT, principal mechanism of resistance to temozolomide, cisplatin may increase the activity of this alkylating agent. Methods: Patients aged 4 to 21y with HGG outside the brainstem were treated at diagnosis or at relapse every 28 days with a combination of cisplatin 80 mg/m2 intravenously on day-1 and temozolomide 200 mg/m2 orally on days 2–6, according to the pediatric phase I recommendations. Patients treated at diagnosis had to proceed to involved field radiotherapy after the chemotherapy window. According to initial response, patients were offered additional courses, up to seven. We considered that this combination would be of interest if the response rate was superior or equal to 20%, using a two-stage Simon design in 3 cohorts: evaluable non measurable (infiltrative) at diagnosis (cohort A1); measurable disease (nodular) at diagnosis (A2); recurrent disease (B). The primary endpoint was complete or partial response after two courses, confirmed by central review. Up to 29 evaluable pts were to be entered in each cohort. If fewer than 4/29 responses were observed, it would be concluded that the combination is ineffective. Results: 56 pts were entered from 10/2003 through 07/2006 in 25 centers. One was excluded after central pathology review and 3 due to insufficient radiology work-out. 42 had grade III and 13 grade IV gliomas, including 21 tumors with oligodendroglial features. No response was observed in the first 11 pts in cohort A1 and in the first 12 pts in cohort B. Two partial and 4 minor responses were confirmed in 29 pts of cohort A2 leading to a 7% response rate (95% CI, 1–23%). Median time to progression was 1.7, 7.1 and 6.9 months in cohorts A1, A2 and B, respectively. Toxicity was manageable except in pts with large infiltrative lesions who did not tolerate hydration. Conclusion: CISTEM combination has insufficient efficacy in pediatric compared to adult HGG despite efficient down-regulation of MGMT activity. To overcome resistance to temozolomide in children and adolescents, one may need to target other known resistance mechanisms such as mismatch-repair deficiency. [Table: see text]
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Affiliation(s)
- J. Grill
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - S. Lowis
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - D. Frappaz
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - A. Michalski
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - S. Picton
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - A. Jouvet
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - K. Robson
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - T. Jaspan
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - D. Couanet
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - M. Le Deley
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
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Schuman SI, Lambrou N, Robson K, Glück S, Myriounis N, Pearson J, Alvarez E, Crisp MP, Twiggs LB, Lucci JA. Safety and efficacy of pegfilgrastim administration on the same day as myelosuppressive chemotherapy (CT) in women with ovarian or primary peritoneal cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16009 Background: According to prescribing information, pegfilgrastim should not be administered within 14 days prior to, or within 24 hours after, the administration of cytotoxic CT. However, little data exist to support this recommendation. The purpose of the current study is to determine the safety and efficacy of administering pegfilgrastim on the same day as myelosuppressive CT in patients with ovarian or primary peritoneal carcinoma. Methods: A retrospective review was conducted of all ovarian and primary peritoneal cancer patients that received prophylactic pegfilgrastim on the same day as CT from May 2003 to June 2006. Results: Forty-six patients (mean age: 57, range: 21–82) were treated for the following malignancies: 35 (76%) epithelial ovarian, 6 (13%) primary peritoneal, and 5 (11.0%) ovarian germ cell or stromal cell carcinoma. Twenty-six patients (56%) had primary cancers and 20 (44 %) had recurrent disease. All patients met the ASCO or NCCN recommendations of using colony-stimulating factors for prophylaxis against febrile neutropenia (FN) (Risk of FN > 20%). A total of 269 cycles of CT were administered including 125 cycles (46.5%) docetaxel + carboplatin, 39 cycles (14.5%) gemcitabine + platinum, 30 cycles (11.1%) intravenous paclitaxel + carboplatin, 28 cycles (10.4%) liposomal doxorubicin, 19 cycles (7.1%) paclitaxel + intraperitoneal platinum, 6 cycles (2.2%) docetaxel, 6 cycles (2.2%) liposomal doxorubicin + cisplatin, 5 cycles (2%) bleomycin + etoposide + cisplatin, 4 cycles (1.5%) topotecan, 3 cycles (1.1%) of paclitaxel, 2 cycles (0.7%) vincristine + actinomycin-D + cyclophosphamide, and 2 cycles (0.7%) docetaxel + gemcitabine. All patients received pegfilgrastim within one hour of the completion of CT administration. Grade 1 or 2 neutropenia developed in 10 cycles (3.7%) out of the 269 cycles, mean absolute neutrophil count = 4926 (range, 1293 -24300). No patients had FN episodes, hospitalizations or antibiotic use secondary to neutropenia, or dose-reductions and CT delays due to neutropenia. Conclusions: Administration of pegfilgrastim on the same day as CT in ovarian and primary peritoneal cancer patients is more convenient to the patient and appears safe and effective. No significant financial relationships to disclose.
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Affiliation(s)
- S. I. Schuman
- University of Miami - Jackson Memorial Hospital, Miami, FL
| | - N. Lambrou
- University of Miami - Jackson Memorial Hospital, Miami, FL
| | - K. Robson
- University of Miami - Jackson Memorial Hospital, Miami, FL
| | - S. Glück
- University of Miami - Jackson Memorial Hospital, Miami, FL
| | - N. Myriounis
- University of Miami - Jackson Memorial Hospital, Miami, FL
| | - J. Pearson
- University of Miami - Jackson Memorial Hospital, Miami, FL
| | - E. Alvarez
- University of Miami - Jackson Memorial Hospital, Miami, FL
| | - M. P. Crisp
- University of Miami - Jackson Memorial Hospital, Miami, FL
| | - L. B. Twiggs
- University of Miami - Jackson Memorial Hospital, Miami, FL
| | - J. A. Lucci
- University of Miami - Jackson Memorial Hospital, Miami, FL
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Dolo A, Poudiougo B, Modiano D, Camara F, Kouriba B, Diallo M, Bosman A, Crisanti A, Robson K, Doumbo O. [Epidemiology of malaria in a village of Sudanese savannah in Mali (Bancoumana). Anti-TRAP and anti-CS humoral immunity response]. Bull Soc Pathol Exot 2003; 96:287-90. [PMID: 14717043] [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] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Vaccine development research is an important component of malaria control strategies. Thrombospondin related anonymous protein (TRAP) and the circumsporozoite (CS) protein are two antigens of sporozoite surface. Immune response to these two antigens may contribute to the development of anti-sporozoite vaccine. Recent studies suggest that antibodies anti-TRAP may partially block sporozoites penetration in hepatocyte, and thereby reducing malaria morbidity. We carried out a study to assess the seroprevalence of anti-TRAP and anti-CS antibodies and to identify a possible role of these antibodies on malaria morbidity in children 1-9 years old living in a rural hyperendemic village. We performed 5 cross sectional surveys and a longitudinal follow up in 1993 and 1994. During each cross sectional study, children were examined for fever and splenomegaly; all febrile children received thick film examination, and serologic analysis was performed in one third of these, randomly selected. The results show that the seroprevalence of anti-TRAP and anti-CS varied with age and season (p < 0.05). Association between the prevalence of anti-TRAP and splenomegaly was observed during two cross sectional surveys (June and October 1993). The presence of anti-TRAP antibody was associated with Plasmodium falciparum infection at the beginning of the transmission season (June 1993 and July 1994). A negative association between the level of anti-TRAP title and parasitemia was observed (March and October 1994). These findings suggest no clear evidence of the protective role of anti-TRAP antibodies in uncomplicated malaria, possibly due to the limited persistence of these antibodies under natural situations.
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Affiliation(s)
- A Dolo
- Département d'épidémiologie des affections parasitaires, Faculté de médecine, de pharmacie et d'odonto-stomalogie, BP 1805, Bamako, Mali.
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Lashford LS, Thiesse P, Jouvet A, Jaspan T, Couanet D, Griffiths PD, Doz F, Ironside J, Robson K, Hobson R, Dugan M, Pearson ADJ, Vassal G, Frappaz D. Temozolomide in malignant gliomas of childhood: a United Kingdom Children's Cancer Study Group and French Society for Pediatric Oncology Intergroup Study. J Clin Oncol 2002; 20:4684-91. [PMID: 12488414 DOI: 10.1200/jco.2002.08.141] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.7] [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: 11/20/2022] Open
Abstract
PURPOSE To determine the response rate of the malignant gliomas of childhood to an oral, daily schedule of temozolomide. PATIENTS AND METHODS A multicenter, phase II evaluation of an oral, daily schedule of temozolomide (200 mg/m(2) on 5 consecutive days) was undertaken in children with relapsed or progressive, biopsy-proven, high-grade glioma (arm A) and progressive, diffuse, intrinsic brainstem glioma (arm B). Evidence of activity was defined by radiologic evidence of a sustained reduction in tumor size on serial magnetic resonance imaging scans. RESULTS Fifty-five patients were recruited (34 to arm A and 21 to arm B) and received 215 cycles of chemotherapy. Grade 3/4 thrombocytopenia was the most frequent toxic event (7% of cycles). Prolonged myelosuppression resulted in significant treatment delays and dose reductions (17% and 22% of cycles, respectively). Two toxic deaths were documented and were related to myelosuppression and sepsis in one patient and pneumonia in a second. The overall (best) response rate was 12% for arm A (95% confidence interval [CI], 3 to 28 in the study cohort, and 2 to 31 for eligible patients) and 5% and 6%, respectively, for arm B (95% CI, 0 to 26 in the study cohort, and 0 to 27 for eligible patients). Stabilization of disease was also documented and was most noteworthy for brainstem gliomas, where two patients achieved both radiologic static disease and discontinued steroid medication. CONCLUSION Despite moderate toxicity, objective response rates to temozolomide have been low, indicating that temozolomide has minimal activity in the high-grade gliomas of childhood.
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Affiliation(s)
- L S Lashford
- Christie National Health Service Trust, Manchester.
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Abstract
The performance of developmentally dyslexic children and adults was studied upon a range of tasks that involved executive functioning. Both adult and child samples of dyslexics were found to under-perform on the group-embedded figures test. This test required the identification of constituent parts from within complex visual arrays, with good performance necessitating the inhibition of the processing of the surrounding context. A general deficit on visual-spatial tasks was eliminated as an explanation as dyslexics performed normally upon a range of other non-verbal assessments. The dyslexics consistently demonstrated a deficit in digit span tasks, a decrement that was increased with distractors, again suggesting difficulties in inhibiting the processing of the surrounding context. A deficit was also identified upon a verbal fluency task without a deficit in vocabulary level. Additionally, a specific deficit in the recollection of the temporal order of the presentation of items was in evidence, without a deficit in the recognition of the items themselves. The findings taken as a whole suggest that dyslexic individuals show deficiencies in executive functions relating to inhibition of distractors and to sequencing of events, a set of tasks associated with left prefrontal cortex functioning in the acquired neuropsychology literature.
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Affiliation(s)
- Mark Brosnan
- Department of Psychology, School of Social Sciences and Law, University of Greenwich, London SE9 2UG, UK.
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Buxton N, Davis G, Robertson JA, Jaspan T, Lenthall RK, Cooper AD, Robson K. Third ventricular plasma-cell lesion with delayed intraventricular transudation of contrast medium. Neuroradiology 2001; 43:750-4. [PMID: 11594425 DOI: 10.1007/s002340100568] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a patient presenting with hydrocephalus secondary to a posterior third ventricular plasma-cell lesion which exhibited delayed transudation of contrast medium into the adjacent aqueduct and fourth ventricle.
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Affiliation(s)
- N Buxton
- Department of Neurosurgery, University Hospital, Nottingham, UK
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Marshall NW, Faulkner K, Kotre CJ, Robson K. Analysis of variations in contrast-detail measurements performed on image intensifier-television systems. Phys Med Biol 2000. [DOI: 10.1088/0031-9155/37/12/011] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
An unusual case of multiple intestinal atresias with multiple small bowel diverticulae is presented. To the best of our knowledge this is the first reported case of its kind in the literature.
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Affiliation(s)
- M U Shenoy
- Department of Paediatric Surgery, University Hospital, Queen's Medical Centre, Nottingham, England
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Abstract
The pathophysiology of achalasia is not completely understood. Several reports have suggested that esophageal motility disorders may progress from one type to another. We report a patient with symptoms and esophageal motility findings consistent with gastroesophageal reflux who subsequently developed a diffuse esophageal spasm and then achalasia. We believe this to be the first report showing such a progression in esophageal motility.
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Affiliation(s)
- K Robson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Affiliation(s)
- M U Shenoy
- Department of Paediatric Surgery, University Hospital, Queen's Medical Centre, Nottingham, United Kingdom.
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Capra ML, Walker DA, Mohammed WM, Kapila L, Barbor PR, Sokal M, Robson K, Hewitt M, Stewart R. Wilms' tumor: a 25-year review of the role of preoperative chemotherapy. J Pediatr Surg 1999; 34:579-82. [PMID: 10235327 DOI: 10.1016/s0022-3468(99)90078-7] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This 25-year population based, single institution review was conducted to investigate the impact of preoperative chemotherapy on surgical and histological staging in patients with Wilms' tumors. RESULTS Forty-nine patients under the age of 15 years were identified from case notes to have had histologically verified Wilms' tumors over the 25-year period from January 1972 to December 1996. Twenty-six patients were treated initially with preoperative chemotherapy, 23 with immediate surgery. Eleven had treatment randomized within the UKCCSG WT9101 trial (UKWT3), and the remainder received initial treatment according to unit policy. Surgical stages in the two groups (preoperative chemotherapy and immediate surgery) were respectively, stage 1:14(28.5%) and 11 (22.5%), stage II: one (2%) and eight (16.3%), stage III: 11 (22.5%) and four (8.2%). Seven patients had clinical stage IV disease at presentation. Histology results were favorable in 45 patients and unfavorable in four. All patients received chemotherapy during treatment, whereas 25 (51%) also received radiotherapy. No significant difference was evident in the two groups with respect to treatment-related morbidity. Five patients relapsed, three of whom died within the period of review, but a fourth has since died. CONCLUSIONS This study suggests that the use of preoperative chemotherapy does not put the patient at increased risk of postoperative morbidity or reduced survival. The distribution of surgical stages suggests that limited tumor downstaging may have occurred as a result of preoperative chemotherapy.
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Affiliation(s)
- M L Capra
- Department of Child Health, Queen's Medical Centre, University of Nottingham, England
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Robson K. Donkey work. Nurs Times 1999; 95:64-6. [PMID: 10085965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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43
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Bame KJ, Robson K. Heparanases produce distinct populations of heparan sulfate glycosaminoglycans in Chinese hamster ovary cells. J Biol Chem 1997; 272:2245-51. [PMID: 8999930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Once internalized, cell-associated heparan sulfate proteoglycans are degraded to short glycosaminoglycans by the action of endoglycosidases or heparanases. We have begun to address the question of how many heparanases are responsible for this process by analyzing short heparan sulfate chains produced in vivo by Chinese hamster ovary (CHO) cell heparanases. Short heparan sulfate chains were purified from CHO cells and labeled at the reducing end with [3H]NaBH4. Hydrolysis of the chains to monosaccharides and analysis of the 3H-sugar alcohols indicate that heparanase activities in CHO cells are endo-beta-glucuronidases. The modification state of the heparanase-derived glycosaminoglycans was examined by treating the [3H]heparan sulfate chains with nitrous acid or bacterial heparin lyases, which cut the chain at specific sequences, and analyzing the products by P2 gel filtration chromatography. Two populations of short chains were identified that differ in the extent of modification on the nonreducing side of the heparanase cleavage site. One class of chains is unmodified for at least 9 residues from the reducing end, while the other group has a modified domain within 3-7 residues from the heparanase cleavage site. Our results suggest a model of heparanase action where the enzymes recognize differences in sulfate content between modified and unmodified regions and bind to sites that encompass both domains. The enzymes then cleave the glycosaminoglycan at junctions between the modified and unmodified sequences to produce the different populations of short heparan sulfate chains.
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Affiliation(s)
- K J Bame
- Division of Molecular Biology and Biochemistry, School of Biological Sciences, University of Missouri, Kansas City, Missouri 64110, USA
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45
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46
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Abstract
Focal myositis is considered a rare self-limiting inflammatory swelling of skeletal muscle. Focal involvement of individual muscle or muscle groups with severe myopathic and inflammatory changes characterizes the histology. We report the development of progressive focal myositis in both upper eyelids of a 34 year old man that responded to immunosuppressive therapy.
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Affiliation(s)
- K L Lim
- Department of Immunology, University Hospital, Queen's Medical Centre, Nottingham, UK
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Robertson CS, Womack C, Robson K, Morris DL. A study of the local toxicity of agents used for variceal injection sclerotherapy. HPB Surg 1989; 1:149-52; discussion 153-4. [PMID: 2487061 PMCID: PMC2423512 DOI: 10.1155/1989/79120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Injection sclerotherapy is widely used in the treatment of oesophageal varices. However, few studies have compared the local toxicity of sclerosant agents which may be important if serious local complications are to be avoided. In this study the depth of injury caused by submucosal injection of increasing concentrations of sodium tetradecyl sulphate, polidocanol, 5% ethanolamine oleate and 5% varicosid in rabbits stomach, has been compared by histopathological examination. Macroscopic ulceration was seen in 14.6% of injection sites. Increasing concentrations of sodium tetradecyl sulphate and polidocanol produced increasingly extensive microscopic inflammation. Five percent varicosid caused more inflammation than 5% ethanolamine and only 3% polidocanol and 5% varicosid caused full thickness inflammation. Only 5% ethanolamine produced inflammation consistently confined to the mucosa and submucosa. On the basis of this study we feel that 5% ethanolamine is the most suitable agent for injection sclerotherapy.
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Affiliation(s)
- C S Robertson
- Department of Surgery, University Hospital, Nottingham, UK
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Robson K, Whitfield AG. Baldwin Hamey Junior--ninth Registrar. J R Coll Physicians Lond 1979; 13:189-92. [PMID: 393814 PMCID: PMC5373287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
One hundred and nineteen primiparae, who were routinely attending ante-natal clinics, were interviewed repeatedly between the 12th and 36th weeks of their pregnancies. The incidence of depression was highest in the first trimester and, overall, about a fifth of the sample was found to be suffering from clinically significant neurotic disturbances. In a proportion of these expectant mothers there was an association between depression and anxiety early in pregnancy and a previous history of induced abortion; this phenomenon may reflect a reactivation of mourning which was previously suppressed.
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