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Lee JW, Andersen SAW, Hittle B, Powell KA, Al-Fartoussi H, Banks L, Brannen Z, Lahchich M, Wiet GJ. Variability in Manual Segmentation of Temporal Bone Structures in Cone Beam CT Images. Otol Neurotol 2024; 45:e137-e141. [PMID: 38361290 DOI: 10.1097/mao.0000000000004119] [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: 02/17/2024]
Abstract
PURPOSE Manual segmentation of anatomical structures is the accepted "gold standard" for labeling structures in clinical images. However, the variability in manual segmentation of temporal bone structures in CBCT images of the temporal bone has not been systematically evaluated using multiple reviewers. Therefore, we evaluated the intravariability and intervariability of manual segmentation of inner ear structures in CBCT images of the temporal bone. METHODS Preoperative CBCTs scans of the inner ear were obtained from 10 patients who had undergone cochlear implant surgery. The cochlea, facial nerve, chorda tympani, mid-modiolar (MM) axis, and round window (RW) were manually segmented by five reviewers in two separate sessions that were at least 1 month apart. Interreviewer and intrareviewer variabilities were assessed using the Dice coefficient (DICE), volume similarity, mean Hausdorff Distance metrics, and visual review. RESULTS Manual segmentation of the cochlea was the most consistent within and across reviewers with a mean DICE of 0.91 (SD = 0.02) and 0.89 (SD = 0.01) respectively, followed by the facial nerve with a mean DICE of 0.83 (SD = 0.02) and 0.80 (SD = 0.03), respectively. The chorda tympani had the greatest amount of reviewer variability due to its thin size, and the location of the centroid of the RW and the MM axis were also quite variable between and within reviewers. CONCLUSIONS We observed significant variability in manual segmentation of some of the temporal bone structures across reviewers. This variability needs to be considered when interpreting the results in studies using one manual reviewer.
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Affiliation(s)
- Julian W Lee
- Ohio State University College of Medicine, Columbus, Ohio
| | - Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Bradley Hittle
- Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kimerly A Powell
- Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Hagar Al-Fartoussi
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Laura Banks
- Ohio State University College of Medicine, Columbus, Ohio
| | | | - Mariam Lahchich
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
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2
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Banks L, Kelly NA, Onwuka A, Althubaiti A, Damilano C, Hoffman RP, Aldrink JH, Jatana KR, Walz P. Does preoperative calcium and 1, 25 OH vitamin D supplementation impact postoperative hypocalcemia and length of stay following pediatric thyroidectomy? Int J Pediatr Otorhinolaryngol 2024; 178:111895. [PMID: 38422761 DOI: 10.1016/j.ijporl.2024.111895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/24/2024] [Accepted: 02/10/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To investigate whether perioperative calcium and 1,25 OH vitamin D supplementation (PCDS) influences the rates of postoperative hypocalcemia and length of stay (LOS) following pediatric thyroidectomy. STUDY DESIGN Retrospective Cohort Review. SETTING Tertiary children's hospital. METHODS 94 patients who underwent completion or total thyroidectomy with or without concomitant neck dissection from 2010 to 2020 at a single institution were included. Patients with pre-existing hypocalcemia or preoperative vitamin D insufficiency were excluded. Rates of postoperative hypocalcemia and LOS were compared for patients receiving PCDS to those receiving no supplementation. RESULTS Thirty percent of patients with PCDS had documented postoperative hypocalcemia compared to 64% of patients without PCDS (p = 0.01). Patients with PCDS had a median LOS of 30 h compared to 36 h (p = 0.002). Multivariable analyses confirmed that patients with PCDS had lower odds of postoperative hypocalcemia (OR: 0.32, CI: 0.11, 0.89) and shorter LOS by 17 h (SE: 8, p = 0.04) after adjustment for confounders. CONCLUSION PCDS is associated with significantly lower risk of hypocalcemia and shorter LOS. Standardizing preoperative care for pediatric patients undergoing thyroidectomy may decrease variability and improve outcomes following surgery.
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Affiliation(s)
- Laura Banks
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Natalie A Kelly
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | | | - Abdulrahman Althubaiti
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Cecilia Damilano
- Divison of Endocrinology, Department of Pediatrics, Nationwide Children's Hosp., Columbus, OH, USA
| | - Robert P Hoffman
- Divison of Endocrinology, Department of Pediatrics, Nationwide Children's Hosp., Columbus, OH, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kris R Jatana
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Nationwide Children's Hosp., Columbus, OH, USA; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Patrick Walz
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Nationwide Children's Hosp., Columbus, OH, USA; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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3
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Ghisi GLDM, Banks L, Cotie LM, Pakosh M, Pollock C, Nerenberg K, Gagliardi A, Smith G, Colella TJ. Women's Knowledge of Future Cardiovascular Risk Associated With Complications of Pregnancy: A Systematic Review. CJC Open 2024; 6:182-194. [PMID: 38487070 PMCID: PMC10935684 DOI: 10.1016/j.cjco.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 03/17/2024] Open
Abstract
Background Several common pregnancy conditions significantly increase a woman's risk of future cardiovascular diseases (CVD). Patient education and interventions aimed at awareness and self-management of cardiovascular risk factors may help modify future cardiovascular risk. The aim of this systematic review was to examine education interventions for cardiovascular risk after pregnancy, clinical measures/scales, and knowledge outcomes in published qualitative and quantitative studies. Methods Five databases were searched (from inception to June 2023). Studies including interventions and validated and nonvalidated measures of awareness/knowledge of future cardiovascular risk among women after complications of pregnancy were considered. Quality was rated using the Mixed Methods Appraisal Tool. Results were analyzed using the Synthesis Without Meta-analysis reporting guideline. Characteristics of interventions were reported using the Template for Intervention Description and Replication. Fifteen studies were included; 3 were randomized controlled trials. Results In total, 1623 women had a recent or past diagnosis of hypertensive disorders of pregnancy, gestational diabetes mellitus, and/or premature birth. Of the 7 studies that used online surveys or questionnaires, 2 reported assessing psychometric properties of tools. Four studies used diverse educational interventions (pamphlets, information sheets, in-person group sessions, and an online platform with health coaching). Overall, women had a low level of knowledge about their future CVD risk. Interventions were effective in increasing this knowledge. Conclusions In conclusion, women have a low level of knowledge of risk of CVD after pregnancy complications. To increase this level of knowledge and self-management, this population has a strong need for psychometrically validated tailored education interventions.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Laura Banks
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Lisa M. Cotie
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, KITE, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Courtney Pollock
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Departments of Medicine, Obstetrics & Gynecology, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anna Gagliardi
- Toronto General Hospital Research Institute and University of Toronto, Toronto, Ontario, Canada
| | - Graeme Smith
- Department of Obstetrics & Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Tracey J.F. Colella
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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Sheikh H, Walczak N, Rana H, Tseng NW, Syed MK, Collier C, Rezk M, Gong IY, Tan NS, Ali SH, Yan AT, Randhawa VK, Banks L. Temporal Trends of Enrollment by Sex and Race in Major Cardiovascular Randomized Clinical Trials. CJC Open 2024; 6:454-462. [PMID: 38487060 PMCID: PMC10935985 DOI: 10.1016/j.cjco.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/24/2023] [Indexed: 03/17/2024] Open
Abstract
Background Women and racialized minorities continue to be underrepresented in cardiovascular (CV) trial outcomes data, despite comprising a significant global burden of CV disease. This study evaluated the impact of trial characteristics on the temporal enrollment of women and racialized minorities in prominent CV trials published in the period 1986-2023. Methods MEDLINE was searched for CV trials published in The Lancet, the Journal of the American Medical Association, and the New England Journal of Medicine. Participant and investigator demographics, types of interventions, clinical indications, and funding sources were compared according to the enrollment of women or racialized minorities. Results From 799 studies, including 4,071,921 patients, the enrollment of women and racialized minorities significantly increased from 1986 to 2023 (both P ≤ 0.001). Although the enrollment of women varied by trial indication, comprising 25.0% of coronary artery disease, 35.2% of noncoronary and/or vascular disease, 13.8% of heart failure, 17.0% of arrhythmia, and 28.7% of other CV trials (P ≤ 0.001), it did not differ by peer-reviewed vs industry funding. First authors who were women were more likely than first authors who were men to enroll significantly more women (P = 0.01). Conclusions Active efforts to increase diverse enrollment, along with improved reporting, including of sex and race, in future CV trials may increase the generalizability of their findings and applicability to global populations.
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Affiliation(s)
- Hassan Sheikh
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Walczak
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Haaris Rana
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas W.H. Tseng
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad K. Syed
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Chris Collier
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Moemin Rezk
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Inna Y. Gong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nigel S. Tan
- Division of Cardiology, Niagara Health System, Niagara, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sammy H. Ali
- Department of Medicine, St Mary’s General Hospital, Toronto, Ontario, Canada
| | - Andrew T. Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Terrence Donnelly Heart Centre, St. Michael’s Hospital, Kitchener, Ontario, Canada
| | - Varinder K. Randhawa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura Banks
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Knowledge, Innovation, Talent, Everywhere (KITE), Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Bentley RF, Dorian P, Vecchiarelli E, Banks L, Connelly KA, Yan AT, Osman W, Goodman JM. The effect of chronic exercise training and acute exercise on power spectral analysis of heart rate variability. Appl Physiol Nutr Metab 2024; 49:148-156. [PMID: 37751466 DOI: 10.1139/apnm-2023-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Moderate to vigorous physical activity performed regularly is cardioprotective and reduces all-cause mortality, concomitant with increased resting heart rate variability (HRV). However, there are contradictory reports regarding the effects of chronic and acute exercise on nocturnal HRV in those performing exercise well-beyond physical activity guidelines. Therefore, the purpose of this study was to compare the power spectral analysis components of HRV in middle-aged endurance athletes (EA) and recreationally active individuals (REC) and explore acute exercise effects in EA. A total of 119 EA (52, 49-57 years) and 32 REC (56, 52-60 years) were recruited to complete 24 h Holter monitoring (GE SEER 1000) in the absence of exercise. Fifty one EA (52, 49-57 years) then underwent 24 h Holter monitoring following an intense bout of endurance exercise. Power spectral HRV analysis was completed hourly and averaged to quantify morning (1000-1200 h), evening (1900-2100 h), and nocturnal (0200-0400 h) HRV. EA had greater very low frequency (VLF) and low frequency (LF) (both p < 0.001) compared to REC. LF/high frequency (HF) was greater in EA at 0200-0400 h (p = 0.04). Among all participants, the change in HR and HF from 1000-1200 to 0200-0400 h was negatively correlated (r = -0.47, p < 0.001). Following acute exercise in EA, only nocturnal HRV was assessed. VLF (p < 0.001) and HF (p = 0.008) decreased, while LF/HF increased (p = 0.02). These results suggest that in EA, both long-term and acute exercises increase nocturnal sympathovagal activity through an increase in LF and decrease in HF, respectively. Further work is required to understand the mechanism underlying reduced nocturnal HRV in middle-aged EA and the long-term health implications.
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Affiliation(s)
- Robert F Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Cardiology, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, University of Toronto
| | - Emily Vecchiarelli
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Laura Banks
- University Health Network/Toronto Rehabilitation Institute, Cardiovascular Prevention and Rehabilitation Program, Toronto, ON M5G 2A2, Canada
| | - Kim A Connelly
- Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Cardiology, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, University of Toronto
| | - Andrew T Yan
- Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Cardiology, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
| | - Wesseem Osman
- Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
- University Health Network/Toronto Rehabilitation Institute, Cardiovascular Prevention and Rehabilitation Program, Toronto, ON M5G 2A2, Canada
- Division of Cardiology, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, University of Toronto
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6
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Buma S, Banks L, Onwuka A, Althubaiti A, Wiet G. Maternal infant bonding in tracheostomy dependent infants: A cross sectional study. Int J Pediatr Otorhinolaryngol 2023; 168:111549. [PMID: 37079946 DOI: 10.1016/j.ijporl.2023.111549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES To report the current state of maternal infant bonding (MIB) in mothers of tracheostomy-dependent infants and identify demographic factors associated with MIB. METHODS A cross-sectional study was conducted at a pediatric tertiary care hospital. Mothers of tracheostomy-dependent children below the age of two, seen during the 24 months prior to June 2021, were recruited to participate. The exclusion criteria consisted of clinical instability of the infant at the time of recruitment or lack of custody. The Maternal Infant Bonding Questionnaire (MIBQ) was administered to biological mothers. The possible range of scores was 0-24 with higher scores indicating poorer bonding. Mean MIBQ scores, as well as elevated MIBQ scores (greater than 0), were evaluated with respect to patient demographic and clinical characteristics. RESULTS Of 46 eligible participants, the response rate was 6 7% (n = 31). The median maternal age was 30 (IQR:8.5), and the median infant age was 15 months (IQR: 7.5). The mean MIBQ score in the tracheostomy-dependent infant population was 1.38 (SD: 1.96), and 45% had a score greater than 0. The mean MIBQ of our cohort was not statistically different from the control group of healthy infants. Elevated MIBQ scores signaling poorer bonding were seen in caregivers of infants with bronchopulmonary dysplasia and older caregivers. Preliminary evidence suggests that caregivers of infants with mechanical ventilation and neurologic comorbidities may have improved bonding compared to other tracheostomized infants. MIBQ scores were not associated with other sociodemographic or clinical characteristics, such as gestational age at birth, previous history of psychiatric illness, admission status or sociodemographic characteristics. CONCLUSION We observe a mean MIBQ score of 1.38 in mothers of tracheostomy-dependent infants. Efforts to improve bonding may aid infant development and maternal affect.
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Affiliation(s)
- Stephen Buma
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Laura Banks
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Abdulrahman Althubaiti
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Gregory Wiet
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
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7
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Jeyanathan J, Bootland D, Al-Rais A, Leung J, Wijesuriya J, Banks L, Breen T, DeCoverly R, Curtis L, McHenry A, Wright D, Griggs JE, Lyon RM. Lessons learned from the first 50 COVID-19 critical care transfer missions conducted by a civilian UK Helicopter Emergency Medical Service team. Scand J Trauma Resusc Emerg Med 2022; 30:6. [PMID: 35033171 PMCID: PMC8760584 DOI: 10.1186/s13049-022-00994-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed exceptional demand on Intensive Care Units, necessitating the critical care transfer of patients on a regional and national scale. Performing these transfers required specialist expertise and involved moving patients over significant distances. Air Ambulance Kent Surrey Sussex created a designated critical care transfer team and was one of the first civilian air ambulances in the United Kingdom to move ventilated COVID-19 patients by air. We describe the practical set up of such a service and the key lessons learned from the first 50 transfers. METHODS Retrospective review of air critical care transfer service set up and case review of first 50 transfers. RESULTS We describe key elements of the critical care transfer service, including coordination and activation; case interrogation; workforce; training; equipment; aircraft modifications; human factors and clinical governance. A total of 50 missions are described between 18 December 2020 and 1 February 2021. 94% of the transfer missions were conducted by road. The mean age of these patients was 58 years (29-83). 30 (60%) were male and 20 (40%) were female. The mean total mission cycle (time of referral until the time team declared free at receiving hospital) was 264 min (range 149-440 min). The mean time spent at the referring hospital prior to leaving for the receiving unit was 72 min (31-158). The mean transfer transit time between referring and receiving units was 72 min (9-182). CONCLUSION Critically ill COVID-19 patients have highly complex medical needs during transport. Critical care transfer of COVID-19-positive patients by civilian HEMS services, including air transfer, can be achieved safely with specific planning, protocols and precautions. Regional planning of COVID-19 critical care transfers is required to optimise the time available of critical care transfer teams.
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Affiliation(s)
- J Jeyanathan
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - D Bootland
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - A Al-Rais
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J Leung
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J Wijesuriya
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - L Banks
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - T Breen
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R DeCoverly
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - L Curtis
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - A McHenry
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - D Wright
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J E Griggs
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
- University of Surrey, Guildford, UK
| | - R M Lyon
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.
- University of Surrey, Guildford, UK.
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McKay B, Tseng NWH, Sheikh HI, Syed MK, Pakosh M, Caterini JE, Sharma A, Colella TJF, Konieczny KM, Connelly KA, Graham MM, McDonald M, Banks L, Randhawa VK. Sex, Race, and Age Differences of Cardiovascular Outcomes in Cardiac Resynchronization Therapy RCTs: A Systematic Review and Meta-analysis. CJC Open 2022; 3:S192-S201. [PMID: 34993449 PMCID: PMC8712541 DOI: 10.1016/j.cjco.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is beneficial in patients who have heart failure with reduced ejection fraction or arrhythmic events. However, most randomized controlled trials (RCTs) showing survival benefits primarily enrolled older white men. This study aims to evaluate CRT efficacy by sex, race, and age in RCTs. Methods Five electronic databases (CINAHL, Embase, Emcare, Medline, and PubMed) were searched from inception to July 12, 2021 for RCTs with CRT in adult patients. Data were analyzed for clinical outcomes including all-cause or cardiovascular (CV) death, worsening heart failure (HF), and HF hospitalization (HFH) according to sex, race, and age. Results Among six RCTs with up to moderate risk of bias, 54% (n = 3,630 of 6,682; mean age 64 years, 22% female, 8% black patients) had CRT device implantation. All-cause death (odds ratio [OR], 0.51; P = 0.053) was reduced in female versus male CRT patients, whereas CV death, HFH, or all-cause death with worsening HF or HFH did not differ significantly. No difference was seen in CRT patients for all-cause death and worsening HF (OR, 1.32; P = 0.46) among white vs black patients or for all-cause death and HFH (OR, 1.19; P = 0.55) among ≥ 65 versus < 65 years. Conclusions Whereas all-cause death was lower in female CRT patients, other reported outcomes did not significantly differ by sex, race, or age. Only 6 studies partially reported outcomes. Thus, enhanced reporting and analyses are required to overcome such paucity of data to evaluate the impact of these factors on clinical outcomes in distinct patient cohorts with CRT indication.
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Affiliation(s)
- Bradley McKay
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Hassan I Sheikh
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Mohammad K Syed
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Abhinav Sharma
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tracey J F Colella
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, Faculty of Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Kaja M Konieczny
- Department of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle M Graham
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael McDonald
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Laura Banks
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Varinder Kaur Randhawa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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9
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Dorian D, Chatterjee D, Connelly KA, Goodman JM, Yan AT, Bentley RF, Banks L, Hamilton RM, Dorian P. A Novel Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) Biomarker—Anti-DSG2—Is Absent in Athletes With Right Ventricular Enlargement. CJC Open 2021; 3:1413-1418. [PMID: 34993452 PMCID: PMC8712542 DOI: 10.1016/j.cjco.2021.07.002] [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] [Received: 04/21/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022] Open
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10
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Syed MK, Sheikh HI, McKay B, Tseng N, Pakosh M, Caterini JE, Sharma A, Colella TJ, Konieczny KM, Connelly KA, Graham MM, McDonald M, Banks L, Randhawa VK. Sex, Race, and Age Differences in Cardiovascular Outcomes in Implantable Cardioverter–Defibrillator Randomized Controlled Trials: A Systematic Review and Meta-analysis. CJC Open 2021; 3:S209-S217. [PMID: 34993451 PMCID: PMC8712708 DOI: 10.1016/j.cjco.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mohammad K. Syed
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Hassan I. Sheikh
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Bradley McKay
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Nicholas Tseng
- Faculty of Biomedical Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Abhinav Sharma
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tracey J.F. Colella
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Faculty of Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Kaja M. Konieczny
- Department of Cardiology, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Kim A. Connelly
- Department of Cardiology, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Michelle M. Graham
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael McDonald
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Laura Banks
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Corresponding author: Dr Laura Banks, Affiliate Scientist, University Health Network, Assistant Teaching Professor, Faculty of Health Sciences, Ontario Tech University, KITE, Toronto Rehabilitation Institute, Cardiovascular Prevention & Rehabilitation Program, 347 Rumsey Rd, Toronto, Ontario M4G 1R7, Canada. Tel.: +1-416-597-3422; fax: +1-416-425-0301.
| | - Varinder Kaur Randhawa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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11
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Marzolini S, Banks L, Oh PI. Sex Differences in Predictors of Completion of a 6-month Adapted Cardiac Rehabilitation Program for People with Type 2 Diabetes and No Known Cardiac Disease. Can J Diabetes 2021; 46:277-286.e1. [DOI: 10.1016/j.jcjd.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/19/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022]
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12
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Glibbery M, Banks L, Altaha MA, Bentley RF, Konieczny K, Yan AT, Dorian P, Deva DP, Goodman JM, Connelly KA. Atrial structure and function in middle-aged, physically-active males and females: A cardiac magnetic resonance study. Clin Cardiol 2021; 44:1467-1474. [PMID: 34469002 PMCID: PMC8495091 DOI: 10.1002/clc.23707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/29/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022] Open
Abstract
Recent studies have reported on an association between endurance sport, atrial enlargement and the development of lone atrial fibrillation in younger, male cohorts. The atrial morphology and function of middle‐aged, physically‐active males and females have not been well studied. We hypothesized that middle‐aged males would demonstrate larger left atrium (LA) and right atrium (RA) volumes compared to females, but atrial function would not differ. LA and RA volume and function were evaluated at rest in healthy adults, using a standardized 3.0Tesla cardiac magnetic resonance protocol. Physical activity, medical history, and maximal oxygen consumption (V˙O2peak) were also assessed. Physically‐active, middle‐aged men (n = 60; 54 ± 5 years old) and women (n = 30; 54 ± 5 years old) completed this study. Males had a higher body mass index, systolic blood pressure, and V˙O2peak than females (p < .05 for all), despite similar reported physical activity levels. Absolute and BSA and height‐indexed LA and RA maximum volumes were higher in males relative to females, despite no differences in ejection fractions (p < .05 for all). In multivariable regression, male sex p < .001) and V˙O2peak (p = .004) were predictors of LA volume (model R2 = 0.252), whereas V˙O2peak (p < .001), male sex (p = .03), and RV EF (p < .05) were predictors of RA volume (model R2 = 0.377). While middle‐aged males exhibited larger atrial volumes relative to females, larger, prospective studies are needed to explore the magnitude of physiologic atrial remodeling and functional adaptations in relation to phenotypic factors.
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Affiliation(s)
- Meghan Glibbery
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Laura Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Mustafa A Altaha
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Robert F Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Kaja Konieczny
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Andrew T Yan
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Paul Dorian
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Djeven P Deva
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.,Mount Sinai Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| | - Kim A Connelly
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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13
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Banks L, Sparrow L, Sandison N, Oh P, Colella TJF. The effect of insulin on post-exercise hypoglycemia in adults with type 2 diabetes participating in outpatient exercise-based cardiac rehabilitation. Eur J Appl Physiol 2021; 121:3361-3367. [PMID: 34468859 DOI: 10.1007/s00421-021-04781-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Few studies have reported on self-monitored blood glucose changes following acute exercise, particularly in patients with type 2 diabetes prescribed oral sulfonylureas and insulin medication. This study sought to determine the magnitude of post-exercise blood glucose changes and incidence of hypoglycemia (blood glucose < 4.0 mmol/L) in relation to medication regimen. METHODS A retrospective chart review was conducted in adults with type 2 diabetes attending a 6-month rehabilitation program. Demographics, medications, exercise prescription and patient-reported pre/post-BG values were collected at program initiation. It was hypothesized that patients with type 2 diabetes will experience a post-exercise capillary blood glucose reduction (ΔcapBG), and that incidents of hypoglycemia (< 4.0 mmol/L) will be strongly associated with insulin or oral secretagogue class of medication. RESULTS A chart review was conducted (n = 52, 46.2% males, mean age: 62.7 ± 8.3 years, A1c: 7.7 ± 1.6%, body mass index, BMI: 34.4 ± 7.8 kg/m2) in patients with type 2 diabetes (9.0 ± 7.7 years since diagnosis). A greater reduction in BG was related to a greater pre-exercise BG (beta [95% CI]: - 0.46 [- 0.54, - 0.37] mmol, p < 0.0001), independent of BMI and exercise duration. Post-exercise hypoglycemia (< 4.0 mmol) was associated with prescribed insulin use (vs. non-users: 14.5% vs. 3.0%, p < 0.05). Among insulin users, pre-mixed insulin had the highest incidence of hypoglycemia (vs. non-users: 50% vs. 3%, p < 0.0001) and insulin (bolus and basal; vs. non-users: 11.1% vs. 3%, p = 0.04). CONCLUSIONS These findings may suggest a low post-exercise hypoglycemia occurrence in patients with type 2 diabetes, except when taking insulin. Self-management strategies should be considered, especially for patients on insulin medications.
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Affiliation(s)
- Laura Banks
- KITE - University Health Network - Toronto Rehabilitation Cardiovascular Prevention and Rehabilitation Program, 347 Rumsey Road, Toronto, ON, M4G 1R7, Canada
| | - Lisa Sparrow
- KITE - University Health Network - Toronto Rehabilitation Cardiovascular Prevention and Rehabilitation Program, 347 Rumsey Road, Toronto, ON, M4G 1R7, Canada
| | - Nicole Sandison
- KITE - University Health Network - Toronto Rehabilitation Cardiovascular Prevention and Rehabilitation Program, 347 Rumsey Road, Toronto, ON, M4G 1R7, Canada
| | - Paul Oh
- KITE - University Health Network - Toronto Rehabilitation Cardiovascular Prevention and Rehabilitation Program, 347 Rumsey Road, Toronto, ON, M4G 1R7, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Tracey J F Colella
- KITE - University Health Network - Toronto Rehabilitation Cardiovascular Prevention and Rehabilitation Program, 347 Rumsey Road, Toronto, ON, M4G 1R7, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
- Rehabilitation Science Institute, University of Toronto, Toronto, Canada.
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14
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Currie KD, Bentley RF, Banks L, Dorian P, Connelly KA, Yan AT, Goodman JM. Exaggerated Blood Pressure Responses To Exercise: Assessment Of Criteria In Middle-aged Male Endurance Athletes. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000759140.28492.8c] [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: 11/21/2022]
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15
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Banks L, Altaha MA, Yan AT, Dorian P, Konieczny K, Deva DP, LA Gerche A, Akhavein F, Bentley RF, Connelly KA, Goodman JM. Left Ventricular Fibrosis in Middle-Age Athletes and Physically Active Adults. Med Sci Sports Exerc 2021; 52:2500-2507. [PMID: 32472930 DOI: 10.1249/mss.0000000000002411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) and T1 mapping techniques enable the quantification of focal and diffuse myocardial LGE, respectively. Studies have shown evidence of fibrosis in middle-age athletes, but not relative to physically active (PA) adults who perform recommended physical activity levels. Therefore, we examined cardiac remodeling and presence of left ventricular (LV) LGE and T1 values in both recreational middle-age endurance athletes (EA) and PA adults. METHODS Healthy EA and PA adults (45-65 yr) completed a standardized 3-T CMR protocol with ventricular volumetry, LV LGE, and T1 mapping. RESULTS Seventy-two EA and 20 PA participants (mean age, 53 ± 5 vs 56 ± 4 yr; P < 0.01; V˙O2peak = 50 ± 7 vs 37 ± 9 mL·kg·min, P < 0.0001) were examined, with CMR data available in 89/92 participants. Focal LV LGE was observed in 30% of participants (n = 27/89): 33% of EA (n = 23/69; 33%) and 20% of PA (n = 4/20; 20%). LGE was present at the right ventricular hinge point (n = 21/89; 23.5%) or identified as ischemic (n = 2/89; 2%) or nonischemic (n = 4/89; 4%). Focal LV LGE was observed similarly in both EA and PA (P = 0.25). EA had larger LV chamber sizes and T1 native values (1169 ± 35 vs 1190 ± 26, P = 0.02) compared with PA, with similar LV ejection fraction. Global extracellular volume (ECV) was similar in both EA and PA (22.6% ± 3.5% vs 21.5% ± 2.6%, P = 0.26), with no relationship between global ECV and LV mass (r = -0.16, P = 0.19). CONCLUSIONS Focal LGE at the right ventricular hinge point was detected at the same frequency in both groups, was unrelated to demographic or clinical indices, and was found without evidence of global ECV expansion in EA, suggesting a physiologic remodeling response. The long-term clinical implications of hinge-point LGE require clarification using prospective, long-term follow-up studies.
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Affiliation(s)
- Laura Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, CANADA
| | | | | | | | | | | | | | - Farhad Akhavein
- Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, CANADA
| | - Robert F Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, CANADA
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16
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Banks L, Worobetz N, Hamersley E, Onwuka A, Shepherd E, Wiet G. Evaluation of Short-term Outcomes of Tracheostomy Procedures in a NICU Population With High Ventilator Settings. Otolaryngol Head Neck Surg 2021; 165:881-886. [PMID: 33687280 DOI: 10.1177/0194599821996226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether tracheostomy placement in infants requiring high ventilator pressure is safe and effective. STUDY DESIGN Case series with chart review. SETTING Tertiary children's hospital. METHODS Fifty ventilator-dependent neonatal intensive care unit patients who underwent tracheotomy from 2009 to 2018 were included. Patients requiring high ventilator pressures were compared to those requiring low ventilator pressures. Demographics, comorbidities, and surgical and clinical data were recorded. RESULTS Thirty-two percent (n = 16) had low ventilator settings at the time of tracheostomy tube placement, and 68% (n = 34) had high ventilator settings. The median peak inspiratory pressure of the high ventilator group was 29.5 cm H2O, positive end-expiratory pressure (PEEP) was 8 cm H2O, mean airway pressure was 13 cm H2O, pressure support (PS) was 14 cm H2O, PS above PEEP was 6 cm H2O, and inspiratory time was 0.65 seconds. The high ventilator cohort had a higher median age at the time of surgery compared to the low ventilator group (P = .02). Female patients were more likely to have high ventilator settings (P = .02). There were no intraoperative complications or deaths within the first 7 days of tracheostomy tube placement. Pneumonia incidence and rate of mortality during admission did not vary by ventilator settings (P = .92 and P = .94, respectively). CONCLUSION Few differences in tracheostomy tube placement outcomes were observed for patients with high ventilator settings compared to low ventilator settings. These data demonstrate that patients requiring high ventilator pressures can benefit from tracheostomy tube placement with no additional short-term risks.
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Affiliation(s)
- Laura Banks
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Noah Worobetz
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Erin Hamersley
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Edward Shepherd
- The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Neonatology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Gregory Wiet
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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17
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Banks L, Randhawa V, Caterini J, Colella T, Connelly K, Robinson L, Straus S, Graham M. Women in cardiovascular medicine and science in Canada: challenges successes and opportunities for change. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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18
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Caterini JE, Adreak N, Cheung CC, Gupta S, Randhawa VK, Banks L. Opportunities for Advancing Mentorship: Highlighting Early Career Transitions for Women in Cardiovascular Medicine and Science. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Banks L, Randhawa VK, Colella TJF, Dhanvantari S, Connelly KA, Robinson L, Mak S, Ouzounian M, Mulvagh SL, Straus S, Allan K, Yin Yip CY, Graham MM. Cardiovascular Physicians, Scientists, and Trainees Balancing Work and Caregiving Responsibilities in the COVID-19 Era: Sex and Race-Based Inequities. CJC Open 2021; 3:627-630. [PMID: 34027367 PMCID: PMC8134915 DOI: 10.1016/j.cjco.2020.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/30/2020] [Indexed: 11/14/2022] Open
Abstract
Background The ongoing COVID-19 pandemic has exposed a work-life (im)balance that has been present but not openly discussed in medicine, surgery, and science for decades. The pandemic has exposed inequities in existing institutional structure and policies concerning clinical workload, research productivity, and/or teaching excellence inadvertently privileging those who do not have significant caregiving responsibilities or those who have the resources to pay for their management. Methods We sought to identify the challenges facing multidisciplinary faculty and trainees with dependents, and highlight a number of possible strategies to address challenges in work-life (im)balance. Results To date, there are no Canadian-based data to quantify the physical and mental effect of COVID-19 on health care workers, multidisciplinary faculty, and trainees. As the pandemic evolves, formal strategies should be discussed with an intersectional lens to promote equity in the workforce, including (but not limited to): (1) the inclusion of broad representation (including equal representation of women and other marginalized persons) in institutional-based pandemic response and recovery planning and decision-making; (2) an evaluation (eg, institutional-led survey) of the effect of the pandemic on work-life balance; (3) the establishment of formal dialogue (eg, workshops, training, and media campaigns) to normalize coexistence of work and caregiving responsibilities and to remove stigma of gender roles; (4) a reevaluation of workload and promotion reviews; and (5) the development of formal mentorship programs to support faculty and trainees. Conclusions We believe that a multistrategy approach needs to be considered by stakeholders (including policy-makers, institutions, and individuals) to create sustainable working conditions during and beyond this pandemic.
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Affiliation(s)
- Laura Banks
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Ontario, Canada
| | - Varinder K Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tracey J F Colella
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Kim A Connelly
- Department of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Lisa Robinson
- University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susanna Mak
- University of Toronto, Toronto, Ontario, Canada.,Department of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Maral Ouzounian
- University of Toronto, Toronto, Ontario, Canada.,Department of Cardiothoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Sharon L Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Ontario, Canada
| | - Sharon Straus
- University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Katherine Allan
- Department of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Cindy Ying Yin Yip
- Project Management Institute, Toronto, Ontario, Canada.,HeartLife Foundation, British Columbia, Canada
| | - Michelle M Graham
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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20
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Banks L, Al-Mousawy S, Altaha MA, Konieczny KM, Osman W, Currie KD, Connelly KA, Yan AT, Sasson Z, Mak S, Goodman JM, Dorian P. Cardiac remodeling in middle-aged endurance athletes: relation between signal-averaged electrocardiogram and LV mass. Am J Physiol Heart Circ Physiol 2020; 320:H316-H322. [PMID: 33124882 DOI: 10.1152/ajpheart.00602.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The relationship between structural and electrical remodeling in the heart, particularly after long-standing endurance training, remains unclear. Signal-averaged electrocardiogram (SAECG) may provide a more sensitive method to evaluate cardiac remodeling than a 12-lead electrocardiogram (ECG). Accurate measures of electrical function (SAECG filtered QRS duration (fQRSd) and late potentials (LP) and left-ventricular (LV) mass (cardiac magnetic resonance, CMR) can allow an assessment of structural remodeling and QRS prolongation. Endurance athletes (45-65 yr old, >10 yr of endurance sport), screened to exclude cardiac disease, had standardized 12-lead ECG, SAECG, resting echocardiogram (ECHO), and CMR performed. SAECG fQRSd was correlated with QRS duration on the 12-lead ECG, and ECHO and CMR-derived LV mass. Participants (n = 82, 67% male, mean age: 54 ± 6 yr, mean V̇o2max: 50 ± 7 mL/kg/min) had a CMR-derived LV mass of 118 ± 28 g/m2 and a fQRSd of 112 ± 8 ms (46% had abnormal fQRSd (>114 ms), and 51% met clinical threshold for abnormal SAECG). fQRSd was positively correlated with the 12-lead ECG QRS duration (r = 0.83), ECHO-derived LV mass (r = 0.60), CMR-derived LV mass (r = 0.58) and LV end-diastolic volume (r = 0.63, P < 0.001 for all). fQRSd had higher correlations with ECHO and CMR-derived LV mass than 12-lead ECG (P < 0.0008 and P < 0.0005, respectively). In conclusion, in a healthy cohort of middle-aged endurance athletes, the SAECG is often abnormal by conventional criteria, and is correlated with structural remodeling, but CMR evaluation does not indicate pathologic structural remodeling. SAECG fQRSd is superior to the 12-lead ECG for the electrocardiographic evaluation of LV mass.NEW & NOTEWORTHY Study findings indicate that a positive correlation exists between electrical (SAECG fQRSd) and structural indices (LV mass) in middle-aged endurance athletes with normal physiological LV adaptation, in the absence of known cardiac pathology. SAECG fQRSd may also provide an alternative, superior method for identifying increased LV mass compared to other 12-lead ECG criteria.
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Affiliation(s)
- Laura Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Saif Al-Mousawy
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mustafa A Altaha
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kaja M Konieczny
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Wesseem Osman
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katharine D Currie
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrew T Yan
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zion Sasson
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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21
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Banks L, Randhawa VK, Caterini J, Colella TJF, Dhanvantari S, McMurtry S, Connelly KA, Robinson L, Anand SS, Ouzounian M, Zieroth S, Mak S, Straus S, Graham MM. Sex, Gender, and Equity in Cardiovascular Medicine, Surgery, and Science in Canada : Challenges, Successes, and Opportunities for Change. CJC Open 2020; 2:522-529. [PMID: 33305212 PMCID: PMC7711008 DOI: 10.1016/j.cjco.2020.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/29/2020] [Indexed: 01/01/2023] Open
Abstract
Background A previous review of sex, gender, and equity within cardiovascular (CV) medicine, surgery, and science in Canada has revealed parity during medical and graduate school training. The purpose of this study was to explore sex and gendered experiences within the Canadian CV landscape, and their impact on career training and progression. Methods An environmental scan was conducted of the Canadian CV landscape, which included an equity survey using Qualtrics software. Results The environmental scan revealed that women remain underrepresented within CV training programs as trainees (12%–30%), program directors (33%), in leadership roles at the divisional level (21%), and in other professional or career-related activities (< 30%). Our analysis also showed improvements of career engagement at these levels of women at over time. The thematic analysis of the equity survey responses (n = 71 respondents; 83% female; 9.7% response rate among female Canadian Cardiovascular Society members) identified the following themes reported within the socio-ecological framework: desire to report inequities vs staying the course (individual level); desire for social support and mentorship and challenges of dual responsibilities (interpersonal level); concerns over exclusionary cliques and desire for respect and opportunity (organizational level); and increasing awareness and actions to overcome institutional barriers and accountability (societal level). Conclusions Although women face challenges and remain underrepresented in CV medicine, surgery, and science, this study highlights potential opportunities for improving access of female medical, surgical, and research trainees and professionals to specialized cardiovascular training, career advancement, leadership, and research.
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Affiliation(s)
- Laura Banks
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Ontario, Canada
| | - Varinder K Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Tracey J F Colella
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Savita Dhanvantari
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Sean McMurtry
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Kim A Connelly
- Department of Cardiology, St Michaels Hospital, Toronto, Ontario, Canada
| | - Lisa Robinson
- University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sonia S Anand
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maral Ouzounian
- University of Toronto, Toronto, Ontario, Canada.,Department of Cardiothoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Shelley Zieroth
- Section of Cardiology, St Boniface Hospital, and University of Manitoba, Winnipeg, Canada
| | - Susanna Mak
- University of Toronto, Toronto, Ontario, Canada.,Department of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Sharon Straus
- Department of Medicine, St Michaels Hospital, Toronto, Ontario, Canada
| | - Michelle M Graham
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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22
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Rodman C, Kelly N, Niermeyer W, Banks L, Onwuka A, Mason E, Chiang T. Quantitative Assessment of Surgical Ergonomics in Otolaryngology. Otolaryngol Head Neck Surg 2020; 163:1186-1193. [DOI: 10.1177/0194599820932851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives Objective evaluation of the ergonomic risk of common otolaryngology procedures and assessment of work-related musculoskeletal pain and injury. Study Design Cross-sectional intraoperative assessment and survey. Setting Department of Otolaryngology at a tertiary children’s hospital. Subjects and Methods Sixteen otolaryngology attendings, fellows, and residents participated in a blinded study. Intraoperative ergonomics was assessed for tonsillectomies, adenoidectomies, and tympanostomy tube insertions using the Rapid Upper Limb Assessment (RULA). Follow-up surveys were sent to all participating surgeons to determine the prevalence of musculoskeletal pain and formal ergonomic training. Results Zero percent (N = 0/275) of intraoperative observations were found to have a negligible level of ergonomic risk, with 47% low risk, 37% high risk, and 16% very high risk. Tympanostomy tube insertions conferred less risk than tonsillectomy and adenoidectomy, while the use of headlamp or loupes conferred increased risk. Eighty percent of respondents reported having musculoskeletal pain and 40% reported experiencing pain while operating within the past year. The most common area of pain was the cervical spine. No surgeons reported formal ergonomic training. Conclusions Our study demonstrates an unacceptable level of ergonomic risk for common procedures in otolaryngology. Furthermore, most participants reported experiencing musculoskeletal pain despite the duration of examined procedures being relatively short. The high prevalence of work-related musculoskeletal pain and the lack of ergonomic training in our cohort highlight the need for increased awareness of ergonomics as well as the development of formal ergonomic curricula.
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Affiliation(s)
- Cole Rodman
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Natalie Kelly
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Weston Niermeyer
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Laura Banks
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Eric Mason
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tendy Chiang
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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23
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Lee LS, Banks L, Oh PI, Brooks D, Colella TJF. Capturing the perspectives of women with coronary artery disease regarding interval training or continuous exercise in cardiac rehabilitation. Disabil Rehabil 2020; 44:68-78. [PMID: 32343623 DOI: 10.1080/09638288.2020.1756469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Motivators and barriers to exercise participation in women with coronary artery disease remain poorly understood. With evidence suggesting that women with coronary artery disease are less likely to adhere to exercise during cardiac rehabilitation and are more likely to drop out, it is important to understand these factors in order to optimize cardiac rehabilitation programs for women.Methods: We contribute to the discussion by presenting findings from a qualitative study using two focus groups with nine women with coronary artery disease sharing their experiences with attending cardiac rehabilitation and exercising in this setting, in addition to their perceived motivators and barriers to performing aerobic interval training. Focus group transcripts were analysed using a deductive thematic approach with Bandura's Social Cognitive Theory as the guiding conceptual framework.Results: Four themes were identified regarding the attitudes and experiences of attending and exercising at cardiac rehabilitation, while five themes capturing the motivators and barriers for these women to perform aerobic interval training were identified for the first time. These novel themes encompassed the daunting nature of it, the physical discomfort associated with it, and conversely, the potential sense of enjoyment and accomplishment that it could bring.Conclusion: This study demonstrates the complexity of implementation of aerobic interval training into clinical practice, and suggests that further research is warranted to explore this domain.IMPLICATIONS FOR REHABILITATIONDespite challenges in feasibility of conducting a randomised controlled trial in female patients with coronary artery disease examining the effects of aerobic interval training versus moderate-intensity continuous exercise on aerobic exercise capacity, there was a significant per protocol treatment effect of 0.95 ml·kg-1·min-1 in favour of aerobic interval training.The cardiac rehabilitation environment provides key facilitators and perceived benefits for exercising and attending cardiac rehabilitation for women, and thus emphasises the need for improving referral and enrolment processes specifically for women into cardiac rehabilitation programs.Aerobic interval training may elicit feelings of fear and physical discomfort, or may be precluded by comorbid conditions, therefore, judicious consideration must be taken in examining the suitability of implementation into clinical practice for each female patient.
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Affiliation(s)
- Leanna S Lee
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada
| | - Laura Banks
- Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada
| | - Paul I Oh
- Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada
| | - Dina Brooks
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Tracey J F Colella
- Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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24
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Bentley RF, Vecchiarelli E, Banks L, Gonçalves PEO, Thomas SG, Goodman JM. Heart rate variability and recovery following maximal exercise in endurance athletes and physically active individuals. Appl Physiol Nutr Metab 2020; 45:1138-1144. [PMID: 32294393 DOI: 10.1139/apnm-2020-0154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to determine potential adverse cardiac effects of chronic endurance training by comparing sympathovagal modulation via heart rate variability (HRV) and heart rate recovery (HRR) in middle-aged endurance athletes (EA) and physically active individuals (PA) following maximal exercise. Thirty-six (age, 53 ± 5 years) EA and 19 (age, 56 ± 5 years) PA were recruited to complete a 2-week exercise diary and graded exercise to exhaustion. Time domain and power spectral HRV analyses were completed on recorded R-R intervals. EA had a greater HRR slope following exercise (95% confidence interval, 0.0134-0.0138 vs. 0.0101-0.0104 beats/s; p < 0.001). While EA had greater HRR at 1-5 min after exercise (all p < 0.01), PA and EA did not differ when expressed as a percentage of baseline heart rate (130 ± 19 vs. 139 ± 19; p = 0.2). Root mean square of successive differences in R-R intervals (rest and immediately after exercise) were elevated in EA (p < 0.05). Low-frequency (LF) and high-frequency (HF) spectral components were nonsignificantly elevated after exercise (p = 0.045-0.147) in EA while LF/HF was not different (p = 0.529-0.986). This data suggests greater HRR in EA may arise in part due to a lower resting HR. While nonsignificant elevations in HF and LF in EA produces a LF/HF similar to PA, absolute spectral component modulation differed. These observations require further exploration. Novelty Acute effects of exercise on HRV in EA compared with a relevant control group, PA, are unknown. EA had greater HRR and nonsignificant elevations in LF and HF compared with PA, yet LF/HF was not different. Future work should explore the implications of this observation.
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Affiliation(s)
- Robert F Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Emily Vecchiarelli
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Laura Banks
- University Health Network/Toronto Rehabilitation Institute, Cardiovascular Prevention and Rehabilitation Program, Toronto, ON M5G 2A2, Canada
| | - Patric E O Gonçalves
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Scott G Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada.,Division of Cardiology, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
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25
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Banks L, Bentley RF, Currie KD, Vecchiarelli E, Aslam A, Connelly KA, Yan AT, Konieczny KM, Dorian P, Mak S, Sasson Z, Goodman JM. Cardiac Remodeling in Middle-Aged Endurance Athletes and Recreationally Active Individuals: Challenges in Defining the “Athlete's Heart”. J Am Soc Echocardiogr 2020; 33:247-249. [DOI: 10.1016/j.echo.2019.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
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26
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Osman W, Banks L, Lee S, Connelly K, Yan A, Konieczny K, Aves T, Goodman J, Dorian P. DOES PHYSIOLOGIC CARDIAC REMODELING IN ENDURANCE ATHLETES ALTER REPOLARIZATION OR QT DYNAMICS? Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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27
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Banks L, Glibbery M, Selam M, Lee S, Bentley R, Konieczny K, Yan A, Dorian P, Goodman J, Connelly K. PHYSIOLOGIC CARDIAC REMODELING IN MIDDLE-AGED ATHLETES IS INDEPENDENT OF ENDURANCE SPORT DISCIPLINE: A CARDIAC MAGNETIC RESONANCE STUDY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.552] [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: 10/25/2022] Open
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28
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Konieczny K, Banks L, Osman W, Glibbery M, Connelly KA, Yan AT, Goodman JM, Dorian P. Prolonged P wave duration is associated with right atrial dimensions, but not atrial arrhythmias, in middle-aged endurance athletes. J Electrocardiol 2019; 56:115-120. [PMID: 31394411 DOI: 10.1016/j.jelectrocard.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/28/2019] [Accepted: 07/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrial arrhythmias occur at a higher than expected prevalence amongst endurance athletes. Few studies have examined both atrial structure and arrhythmias in middle-aged endurance athletes. We examined the relationship between P-wave duration, atrial dimensions, and the presence of atrial ectopy in long-standing, middle-aged endurance athletes. METHODS Middle-aged athletes with a minimum of 10 years of competitive endurance sport history and no history of structural heart disease or clinical atrial arrhythmias, had 12-lead ECGs to assess P-wave duration, signal-averaged ECGs (SAECG) to assess filtered P-wave duration, a 24 h Holter monitor to assess atrial ectopy, and echocardiography and cardiac magnetic resonance imaging to assess atrial structural characteristics. RESULTS Amongst endurance athletes (n = 104; mean age = 54 ± 5 years; 63% male), filtered P-wave duration on SAECG was correlated with P-wave duration on 12-lead ECG (r = 0.36, p, 0.0001), as well as with larger CMR-derived RA areas (r = 0.30, p = 0.01) and volumes (r = 0.24, p < 0.05). There was no correlation between filtered P-wave duration and any LA measures on imaging (p > 0.05). There was no correlation between the incidence of atrial ectopy (premature atrial contractions or atrial tachycardia) and any electrocardiographic or structural measures. CONCLUSION Longer filtered P-wave duration was associated with larger RA areas and volumes, without an increase in atrial ectopy.
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Affiliation(s)
- K Konieczny
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - L Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - W Osman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Glibbery
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - K A Connelly
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A T Yan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - P Dorian
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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29
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Banks L, Cacoilo J, Carter J, Oh PI. Age-Related Improvements in Peak Cardiorespiratory Fitness among Coronary Heart Disease Patients Following Cardiac Rehabilitation. J Clin Med 2019; 8:jcm8030310. [PMID: 30841541 PMCID: PMC6463044 DOI: 10.3390/jcm8030310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 11/16/2022] Open
Abstract
While cardiorespiratory fitness (VO₂peak) can be improved with exercise and training, it is unclear whether older age is associated with an attenuated VO₂peak improvement among patients with coronary artery disease (CAD) who complete a cardiac rehabilitation (CR) program. A retrospective review of patient demographics and VO₂peak data from January 2012 to December 2017 was performed. CAD patients were included if they had successfully completed the supervised 6-month CR program (>75% of exercise prescription) and two VO₂peak assessments (respiratory exchange ratio (RER) >1.0). Among all patients, there was an improvement in VO₂peak from 21.1 ± 6.3 mL/kg/min to 26.5 ± 7.9 mL/kg/min (+26% ΔVO₂peak). Patients in the younger age category (age category 1: 30⁻39 years old) tended to have a greater percent of relative VO₂peak improvement when compared to all other age categories (e.g., adults 50 years of age and older). In the regression analysis, VO₂peak improvement was associated with younger age (β = -0.286, p < 0.0001), after adjustment for the baseline VO₂peak (β = -0.456, p < 0.0001), final prescribed exercise speed at CR program completion (β = 0.254, p < 0.0001), body mass index (β = -0.172, p < 0.0001), and male sex (β = 0.153, p < 0.0001). Nonetheless, the study findings indicate that older adults who complete CR may be able to obtain clinically relevant improvements in VO₂peak of greater than 20%, and therefore, should be referred for CR.
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Affiliation(s)
- Laura Banks
- Cardiac Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 1R7, Canada.
| | - Joseph Cacoilo
- Cardiac Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 1R7, Canada.
| | - Jasmine Carter
- Cardiac Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 1R7, Canada.
| | - Paul I Oh
- Cardiac Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 1R7, Canada.
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30
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Liu C, Herrmann N, Gallagher D, Rajji T, Oh P, Marzolini S, Banks L, Vieira D, Lanctot K. Designing a randomized, sham-controlled, parallel-design trial to investigate the effects of a combined exercise priming and transcranial direct current stimulation intervention in mild cognitive impairment and alzheimer’s disease. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.378] [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: 11/17/2022] Open
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31
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West SL, Banks L, Schneiderman JE, Caterini JE, Stephens S, White G, Dogra S, Wells GD. Physical activity for children with chronic disease; a narrative review and practical applications. BMC Pediatr 2019; 19:12. [PMID: 30621667 PMCID: PMC6325687 DOI: 10.1186/s12887-018-1377-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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] [Received: 11/02/2017] [Accepted: 12/18/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical activity (PA) is associated with a diverse range of health benefits. International guidelines suggest that children should be participating in a minimum of 60 min of moderate to vigorous intensity PA per day to achieve these benefits. However, current guidelines are intended for healthy children, and thus may not be applicable to children with a chronic disease. Specifically, the dose of PA and disease specific exercise considerations are not included in these guidelines, leaving such children with few, if any, evidence-based informed suggestions pertaining to PA. Thus, the purpose of this narrative review was to consider current literature in the area of exercise as medicine and provide practical applications for exercise in five prevalent pediatric chronic diseases: respiratory, congenital heart, metabolic, systemic inflammatory/autoimmune, and cancer. METHODS For each disease, we present the pathophysiology of exercise intolerance, summarize the pediatric exercise intervention research, and provide PA suggestions. RESULTS Overall, exercise intolerance is prevalent in pediatric chronic disease. PA is important and safe for most children with a chronic disease, however exercise prescription should involve the entire health care team to create an individualized program. CONCLUSIONS Future research, including a systematic review to create evidence-based guidelines, is needed to better understand the safety and efficacy of exercise among children with chronic disease.
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Affiliation(s)
- Sarah L. West
- Department of Biology, Trent/Fleming School of Nursing, Trent University, Toronto, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Canada
| | | | - Jane E. Schneiderman
- Translational Medicine, The Hospital for Sick Children, Toronto, Canada
- Faculty of Kinesiology and Physical Education, The University of Toronto, Toronto, Canada
| | - Jessica E. Caterini
- Translational Medicine, The Hospital for Sick Children, Toronto, Canada
- Faculty of Kinesiology and Physical Education, The University of Toronto, Toronto, Canada
| | - Samantha Stephens
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy Management and Evaluation, The University of Toronto, Toronto, Canada
| | - Gillian White
- Translational Medicine, The Hospital for Sick Children, Toronto, Canada
- Faculty of Kinesiology and Physical Education, The University of Toronto, Toronto, Canada
| | - Shilpa Dogra
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Oshawa, Canada
| | - Greg D. Wells
- Translational Medicine, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 10th floor, 686 Bay St., Toronto, ON M5G 0A4 Canada
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32
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de Caestecker L, Banks L, Bell E, Sethi M, Arulkumaran S. Planning and implementation of a FIGO postpartum intrauterine device initiative in six countries. Int J Gynaecol Obstet 2018; 143 Suppl 1:4-12. [PMID: 30225869 DOI: 10.1002/ijgo.12598] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe the process of planning and implementing a program of counselling and delivery of postpartum intrauterine devices (PPIUD) in 48 hospitals across six countries in Africa and Asia. METHODS The process of planning the FIGO PPIUD initiative, selection of countries and hospitals, model of implementation, and lessons for the future are described. RESULTS Country-level and hospital-based leadership were essential and training-the-trainer models were successful. There was a need for consistency of competency standards allowing for national variations. As the project progressed, additional steps were necessary for steady implementation of the initiative, specifically: establishment of a project steering committee and a data safety monitoring committee, audits of structure and process, and regular feedback of each center's performance to stimulate maintenance and enhancement of activities. Postnatal follow-up was challenging in many countries with fragmented maternity systems. CONCLUSION The importance of professional leadership and commitment backed by robust data for monitoring and feedback are essential for success.
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Affiliation(s)
| | - Laura Banks
- International Federation of Gynecology and Obstetrics, London, UK
| | - Eliza Bell
- International Federation of Gynecology and Obstetrics, London, UK
| | - Maya Sethi
- International Federation of Gynecology and Obstetrics, London, UK
| | - Sabaratnam Arulkumaran
- International Federation of Gynecology and Obstetrics, London, UK.,St George's, University of London, London, UK
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33
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Banks L, Goodman JM, Dorian P. Letter by Banks et al Regarding Article, "Does High-Intensity Endurance Training Increase the Risk of Atrial Fibrillation? A Longitudinal Study of Left Atrial Structure and Function". Circ Arrhythm Electrophysiol 2018; 11:e006645. [PMID: 30354315 DOI: 10.1161/circep.118.006645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Laura Banks
- Faculty of Kinesiology and Physical Education (L.B., J.M.G.)
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education (L.B., J.M.G.)
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, St Michael's Hospital (P.D.), University of Toronto, Ontario, Canada
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34
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Bonsignore A, Banks L. Defining lifelong exercise frequency and arterial stiffness changes in older adults: considerations for sex differences and exercise dose. J Physiol 2018; 596:3459-3460. [PMID: 29917240 DOI: 10.1113/jp276617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Alis Bonsignore
- University Health Network, Toronto Rehabilitation Institute, Cardiac Prevention and Rehabilitation Program, Toronto, M4G 2V6, Ontario, Canada.,University of Toronto, Faculty of Kinesiology and Physical Education, Toronto, M5S 2C9, Ontario, Canada
| | - Laura Banks
- University Health Network, Toronto Rehabilitation Institute, Cardiac Prevention and Rehabilitation Program, Toronto, M4G 2V6, Ontario, Canada
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35
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Goodman JM, Banks L, Connelly KA, Yan AT, Backx PH, Dorian P. Excessive exercise in endurance athletes: Is atrial fibrillation a possible consequence? Appl Physiol Nutr Metab 2018; 43:973-976. [PMID: 29842800 DOI: 10.1139/apnm-2017-0764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Moderate physical activity levels are associated with increased longevity and lower risk of atrial fibrillation (AF). However, the relative risk of lone AF is 3-5-fold higher in intensive endurance-trained athletes compared with healthy adults. There is growing concern that "excessive" endurance exercise may promote cardiac remodelling, leading to long-term adverse consequences. The pathogenesis of exercise-induced AF is thought to arise from an interplay of multiple acute and chronic factors, including atrial enlargement, pro-fibrotic tendency, high vagal tone, and genotypic profile, which collectively promote adverse atrial remodelling. Clinical management of athletes with AF, while challenging, can be achieved using various strategies that may allow continued, safe exercise. Based on the overall risk-benefit evidence, it is premature to suggest that excessive exercise is unsafe or should be curtailed. Evidence-based assessment and treatment guidelines are required to ensure optimal and safe exercise among the growing number of endurance athletes with AF.
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Affiliation(s)
- Jack M Goodman
- a Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada.,b Division of Cardiology, Mt. Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Laura Banks
- a Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Kim A Connelly
- c Division of Cardiology, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - Andrew T Yan
- c Division of Cardiology, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - Peter H Backx
- d Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Paul Dorian
- c Division of Cardiology, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
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36
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Millar BC, Banks L, Bourke TW, Cunningham M, Dooley JSG, Elshibly S, Goldsmith CE, Fairley D, Jackson K, Lamont S, Jessop L, McCrudden E, McConnell D, McAuley K, McKenna JP, Moore PJA, Smithson R, Stirling J, Shields M, Moore JE. Meningococcal Disease Section 4: Post Disease Complications, Charity Support and Future Perspectives: MeningoNI Forum. THE ULSTER MEDICAL JOURNAL 2018; 87:99-101. [PMID: 29867263 PMCID: PMC5974664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- BC Millar
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD,School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - L Banks
- Meningitis Now, Stroud, Gloucestershire GL5 3TJ
| | - TW Bourke
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - M Cunningham
- University Health Centre at Queen’s, 7 University Terrace, Belfast, BT7 1NP
| | - JSG Dooley
- School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - S Elshibly
- Department of Microbiology, Antrim Area Hospital, Antrim, BT41 2RL
| | - CE Goldsmith
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - D Fairley
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - K Jackson
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - S Lamont
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - L Jessop
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - E McCrudden
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - D McConnell
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - K McAuley
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - JP McKenna
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - PJA Moore
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - R Smithson
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - J Stirling
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - M Shields
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - JE Moore
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD,School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN,Correspondence to Professor John E. Moore, Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD. E-mail:
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Millar BC, Banks L, Bourke TW, Cunningham M, Dooley JSG, Elshibly S, Goldsmith CE, Fairley D, Jackson K, Lamont S, Jessop L, McCrudden E, McConnell D, McAuley K, McKenna JP, Moore PJA, Smithson R, Stirling J, Shields M, Moore JE. Meningococcal Disease Section 3: Diagnosis and Management: MeningoNI Forum. Ulster Med J 2018; 87:94-98. [PMID: 29867262 PMCID: PMC5974663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 10/29/2022]
Affiliation(s)
- BC Millar
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
- School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - L Banks
- Meningitis Now, Stroud, Gloucestershire GL5 3TJ
| | - TW Bourke
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - M Cunningham
- University Health Centre at Queen’s, 7 University Terrace, Belfast, BT7 1NP
| | - JSG Dooley
- School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - S Elshibly
- Department of Microbiology, Antrim Area Hospital, Antrim, BT41 2RL
| | - CE Goldsmith
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - D Fairley
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - K Jackson
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - S Lamont
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - L Jessop
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - E McCrudden
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - D McConnell
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - K McAuley
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - JP McKenna
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - PJA Moore
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - R Smithson
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - J Stirling
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - M Shields
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - JE Moore
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
- School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
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38
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Millar BC, Banks L, Bourke TW, Cunningham M, Dooley JSG, Elshibly S, Goldsmith CE, Fairley D, Jackson K, Lamont S, Jessop L, McCrudden E, McConnell D, McAuley K, McKenna JP, Moore PJA, Smithson R, Stirling J, Shields M, Moore JE. Meningococcal Disease in Northern Ireland - Past, Present & Future: MeningoNI Forum. Ulster Med J 2018; 87:83. [PMID: 29867259 PMCID: PMC5974660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/23/2022]
Abstract
Meningococcal disease has had devastating consequences in Northern Ireland since its first description locally in 1859. The incidence of this disease has significantly declined in recent years, however it is important to understand reasons for this changing epidemiology and to acknowledge the diagnostic and clinical management developments that have been made locally. This review aims to examine the changing face of this disease in Northern Ireland over the years, with particular reference to local disease prevention, epidemiology, diagnosis, clinical treatment and management, post-disease sequelae and the role of meningitis charities locally, in terms of patient support and research.
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Affiliation(s)
- BC Millar
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD,School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - L Banks
- Meningitis Now, Stroud, Gloucestershire GL5 3TJ
| | - TW Bourke
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - M Cunningham
- University Health Centre at Queen’s, 7 University Terrace, Belfast, BT7 1NP
| | - JSG Dooley
- School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - S Elshibly
- Department of Microbiology, Antrim Area Hospital, Antrim, BT41 2RL
| | - CE Goldsmith
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - D Fairley
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - K Jackson
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - S Lamont
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - L Jessop
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - E McCrudden
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - D McConnell
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - K McAuley
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - JP McKenna
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - PJA Moore
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - R Smithson
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - J Stirling
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - M Shields
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - JE Moore
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD,School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN,Correspondence to Professor John E. Moore, Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD,
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39
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Millar BC, Banks L, Bourke TW, Cunningham M, Dooley JSG, Elshibly S, Goldsmith CE, Fairley D, Jackson K, Lamont S, Jessop L, McCrudden E, McConnell D, McAuley K, McKenna JP, Moore PJA, Smithson R, Stirling J, Shields M, Moore JE. Meningococcal Disease Section 1: Microbiology And Historical Perspective: MeningoNI Forum. Ulster Med J 2018; 87:84-87. [PMID: 29867260 PMCID: PMC5974661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 12/05/2022]
Affiliation(s)
- BC Millar
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD,School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - L Banks
- Meningitis Now, Stroud, Gloucestershire GL5 3TJ
| | - TW Bourke
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - M Cunningham
- University Health Centre at Queen’s, 7 University Terrace, Belfast, BT7 1NP
| | - JSG Dooley
- School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - S Elshibly
- Department of Microbiology, Antrim Area Hospital, Antrim, BT41 2RL
| | - CE Goldsmith
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - D Fairley
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - K Jackson
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - S Lamont
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - L Jessop
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - E McCrudden
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - D McConnell
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - K McAuley
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - JP McKenna
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - PJA Moore
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - R Smithson
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - J Stirling
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - M Shields
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - JE Moore
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD,School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN,Correspondence to Professor John E. Moore, Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD. E-mail:
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40
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Millar BC, Banks L, Bourke TW, Cunningham M, Dooley JSG, Elshibly S, Goldsmith CE, Fairley D, Jackson K, Lamont S, Jessop L, McCrudden E, McConnell D, McAuley K, McKenna JP, Moore PJA, Smithson R, Stirling J, Shields M, Moore JE. Meningococcal Disease Section 2: Epidemiology and Vaccination of Meningococcal Disease in Northern Ireland: MeningoNI Forum. Ulster Med J 2018; 87:88-93. [PMID: 29867261 PMCID: PMC5974662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/23/2022]
Affiliation(s)
- BC Millar
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD,School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - L Banks
- Meningitis Now, Stroud, Gloucestershire GL5 3TJ
| | - TW Bourke
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - M Cunningham
- University Health Centre at Queen’s, 7 University Terrace, Belfast, BT7 1NP
| | - JSG Dooley
- School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA
| | - S Elshibly
- Department of Microbiology, Antrim Area Hospital, Antrim, BT41 2RL
| | - CE Goldsmith
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - D Fairley
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - K Jackson
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - S Lamont
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - L Jessop
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - E McCrudden
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE
| | - D McConnell
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - K McAuley
- Meningitis Research Foundation, 71 Botanic Avenue, Belfast, BT7 1JL
| | - JP McKenna
- Department of Medical Microbiology, The Royal Group of Hospitals Belfast, BT12 6BA
| | - PJA Moore
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - R Smithson
- Northern Ireland Public Health Agency, Belfast, BT2 8BS
| | - J Stirling
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD
| | - M Shields
- The Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN
| | - JE Moore
- Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD,School of Biomedical Science, Ulster University, Cromore Road, Coleraine, BT52 1SA,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, University Road, Belfast, BT7 1NN,Correspondence to Professor John E. Moore, Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AD. E-mail:
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Wan D, Cheung C, Tsirigotis D, Banks L. Facilitating Mentorship: The Canadian Cardiovascular Society Trainee Committee Experience. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Banks L, Buchan TA, Dizonno V. Aerobic exercise attenuates ageing of the athletic heart. J Physiol 2017; 594:3183-4. [PMID: 27302382 DOI: 10.1113/jp272099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/17/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- L Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, M5S 2C9, Canada
| | - T A Buchan
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, M5S 2C9, Canada
| | - V Dizonno
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, M5S 2C9, Canada
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Caterini JE, Banks L, Wells GD, Cifra B, Slorach C, McCrindle BW, Seed M. Magnetic resonance imaging reveals elevated aortic pulse wave velocity in obese and overweight adolescents. Clin Obes 2017; 7:360-367. [PMID: 28834246 DOI: 10.1111/cob.12206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/07/2017] [Accepted: 07/07/2017] [Indexed: 12/01/2022]
Abstract
The aortic pulse wave velocity (PWV) measured via cardiac magnetic resonance (CMR) can be used to non-invasively assess changes in arterial stiffness and potential underlying vascular dysfunction. This technique could unmask early arterial dysfunction in overweight and obese youth at risk for cardiovascular disease. We sought to determine the association between vascular stiffness, percentage body fat, body mass index (BMI), and cardiac function in adolescents across the weight spectrum through both CMR and standard applanation tonometry (AT)-based PWV measurements. PWV and left-ventricular cardiac function were assessed using 3.0 T CMR in obese and overweight (OB/OW) participants (n = 12) and controls (n = 7). PWV was also estimated via carotid-femoral AT. OB/OW participants did not differ from healthy-weight controls regarding cardiometabolic risk factors or physical activity levels, but there was a trend towards higher levels of triglycerides in obese/overweight participants (P = 0.07). Mean PWV was higher in obese participants when corrected for age and sex (P = 0.01), and was positively associated with BMI (β = 0.51, P = 0.02). PWV estimated through AT was not significantly different between groups. Cardiac function measured by left-ventricular ejection fraction z-score was inversely associated with mean PWV (β = -0.57, P = 0.026). Increasing arterial stiffness and decreasing cardiac function were evident among our overweight and obese cohort. PWV estimated by CMR could detect early increases in arterial stiffness vs. traditional AT measurements of PWV.
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Affiliation(s)
- J E Caterini
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - L Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada
| | - G D Wells
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
- Translational Medicine, Hospital for Sick Children, Toronto, Canada
| | - B Cifra
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada
| | - C Slorach
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada
| | - B W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - M Seed
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
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Randhawa VK, Banks L, Rayner-Hartley E, McIntyre WF, Belley-Côte E, Rampersad P, Graham MM. Canadian Women in Cardiovascular Medicine and Science: Moving Toward Parity. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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45
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Pearce EA, Farney AN, Banks L, Harrell AJ. Multi-Patient Rabies Exposure on a Colorado River Rafting Expedition: Urgent vs. Emergent Transport Decision Making in an Austere Setting. PREHOSP EMERG CARE 2017; 22:276-279. [DOI: 10.1080/10903127.2017.1367445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Banks L, Rosenthal S, Manlhiot C, Fan CPS, McKillop A, Longmuir PE, McCrindle BW. Exercise Capacity and Self-Efficacy are Associated with Moderate-to-Vigorous Intensity Physical Activity in Children with Congenital Heart Disease. Pediatr Cardiol 2017; 38:1206-1214. [PMID: 28608149 DOI: 10.1007/s00246-017-1645-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 04/07/2017] [Accepted: 05/29/2017] [Indexed: 01/02/2023]
Abstract
This study sought to determine whether exercise capacity, self-efficacy, and gross motor skills are associated with moderate-to-vigorous physical activity (MVPA) levels in children, and if these associations differ by congenital heart disease (CHD) type. Medical history was abstracted from chart review. We assessed MVPA levels (via accelerometry), percent-predicted peak oxygen consumption ([Formula: see text] cardiopulmonary exercise test), gross motor skill percentiles (test of gross motor development version-2), and self-efficacy [children's self-perceptions of adequacy and predilection for physical activity scale (CSAPPA scale)]. CHD patients (n = 137, range 4-12 years) included children with a repaired atrial septal defect (n = 31, mean ± standard deviation MVPA = 454 ± 246 min/week), transposition of the great arteries after the arterial switch operation (n = 34, MVPA = 423 ± 196 min/week), tetralogy of Fallot after primary repair (n = 37, MVPA = 389 ± 211 min/week), or single ventricle after the Fontan procedure (n = 35, MVPA = 405 ± 256 min/week). MVPA did not differ significantly between CHD groups (p = 0.68). Higher MVPA was associated with a higher percent-predicted [Formula: see text] (EST[95% CI] = 16.9[-0.2, 34] MVPA min/week per 10% increase in percent-predicted [Formula: see text] p = 0.05) and higher self-efficacy (EST[95% CI] = 5.2[1.0, 9.3] MVPA min/week per 1-unit increase in CSAPPA score, p = 0.02), after adjustment for age, sex, and testing seasonality, with no association with CHD type. Higher MVPA was not associated with gross motor skill percentile (p = 0.92). There were no significant interactions between CHD type and percent-predicted [Formula: see text] self-efficacy scores, and gross motor skill percentiles regarding their association with MVPA (p > 0.05 for all). Greater MVPA was associated with higher exercise capacity and self-efficacy, but not gross motor skills.
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Affiliation(s)
- Laura Banks
- Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Shelly Rosenthal
- Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Cedric Manlhiot
- Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Chun-Po Steve Fan
- Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Adam McKillop
- Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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47
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Wells GD, Banks L, Caterini JE, Thompson S, Noseworthy MD, Rayner T, Syme C, McCrindle BW, Hamilton J. The association among skeletal muscle phosphocreatine recovery, adiposity, and insulin resistance in children. Pediatr Obes 2017; 12:163-170. [PMID: 26916682 DOI: 10.1111/ijpo.12123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/17/2015] [Revised: 01/21/2016] [Accepted: 01/28/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity is associated with cardiometabolic disturbances, which may have significant implications for musculoskeletal health and exercise tolerance. OBJECTIVE We sought to determine the association between muscle structure, function, and metabolism in adolescents across the weight spectrum. METHODS This cross-sectional case-control study included overweight and obese participants (n = 24) 8-18 years of age with a body mass index (BMI) ≥ 85th percentile for age and gender, and non-obese participants (n = 24) with a BMI < 85th percentile. Body composition, physical activity, peak aerobic capacity, cardiometabolic blood markers and insulin resistance (measured by the homeostatic model assessment of insulin resistance, HOMA-IR), skeletal muscle mitochondrial oxidative capacity (via 31 Phosphorous-Magnetic Resonance Spectroscopy, 31 P-MRS, to assess phosphocreatine (PCr) recovery after exercise), and extramyocellular and intramyocellular lipid (IMCL) levels (via 1 Hydrogen-MRS) were assessed. Stepwise regression was performed to examine the factors associated with oxidative capacity. RESULTS bese and overweight patients had similar age, height, and physical activity to non-obese controls, but obese and overweight participants exhibited higher insulin resistance. Obese and overweight participants had longer PCr recovery than non-obese controls following 5x30s of moderate-intensity exercise (51.2 ± 20.1 s vs. 23.9 ± 7.5 s, p = 0.004). In univariate correlation analysis, impaired PCr recovery was associated with a higher BMI z-score (rs = 0.51, p < 0.001), circulating triglycerides (rs = 0.41, p = 0.005), and HOMA-IR (rs = 0.46, p = 0.001). In stepwise multivariate regression analysis, impaired PCr recovery was associated with a higher BMI z-score (β = 0.47, p = 0.002), but not insulin resistance (β = 0.07, p = 0.07) or circulating triglycerides (β = 0.16 p = 0.33). CONCLUSION A slower phosphocreatine recovery following aerobic exercise is strongly associated with increasing adiposity. A slower metabolic recovery following aerobic exercise stress suggests that endurance exercise training in obese adolescents may be an optimal strategy to target exercise intolerance in this cohort.
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Affiliation(s)
- Greg D Wells
- Physiology and Experimental Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8.,Faculty of Kinesiology and Physical Education, 100 Devonshire Place, Toronto, Ontario, M5S 2C9
| | - Laura Banks
- Physiology and Experimental Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8.,Faculty of Kinesiology and Physical Education, 100 Devonshire Place, Toronto, Ontario, M5S 2C9
| | - Jessica E Caterini
- Physiology and Experimental Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8.,Faculty of Kinesiology and Physical Education, 100 Devonshire Place, Toronto, Ontario, M5S 2C9
| | - Sara Thompson
- Physiology and Experimental Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8.,Faculty of Kinesiology and Physical Education, 100 Devonshire Place, Toronto, Ontario, M5S 2C9
| | - Michael D Noseworthy
- School of Biomedical Engineering, McMaster University, 1280 Main St. West, Hamilton.,Department of Electrical and Computer Engineering, McMaster University, 1280 Main St. West, Hamilton
| | - Tammy Rayner
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8
| | - Catriona Syme
- Division of Endocrinology, Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8
| | - Brian W McCrindle
- Division of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8.,Department of Pediatrics, University of Toronto, Toronto, M5S 1A8
| | - Jill Hamilton
- Physiology and Experimental Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8.,Division of Endocrinology, Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8.,Department of Pediatrics, University of Toronto, Toronto, M5S 1A8
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Vecchiarelli E, Banks L, Currie KD. Can a bout of exercise harm the human heart? J Physiol 2016; 594:7167-7168. [PMID: 27976391 DOI: 10.1113/jp273300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Laura Banks
- University of Toronto, Toronto, Ontario, Canada
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Rathbone AP, Todd A, Jamie K, Bonam M, Banks L, Husband AK. A systematic review and thematic synthesis of patients' experience of medicines adherence. Res Social Adm Pharm 2016; 13:403-439. [PMID: 27432023 DOI: 10.1016/j.sapharm.2016.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medicines non-adherence continues to be problematic in health care practice. After decades of research, few interventions have a robust evidence-based demonstrating their applicability to improve adherence. Phenomenology has a place within the health care research environment. OBJECTIVE To explore patients' lived experiences of medicines adherence reported in the phenomenonologic literature. METHODS A systematic literature search was conducted to identify peer-reviewed and published phenomenological investigations in adults that aimed to investigate patients' lived experiences of medicines adherence. Studies were appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Research Tool. Thematic synthesis was conducted using a combination of manual coding and NVivo10 [QSR International, Melbourne] coding to aid data management. RESULTS Descriptive themes identified included i) dislike for medicines, ii) survival, iii) perceived need, including a) symptoms and side-effects and b) cost, and iv) routine. Analytic themes identified were i) identity and ii) interaction. CONCLUSIONS This work describes adherence as a social interaction between the identity of patients and medicines, mediated by interaction with family, friends, health care professionals, the media and the medicine, itself. Health care professionals and policy makers should seek to re-locate adherence as a social phenomenon, directing the development of interventions to exploit patient interaction with wider society, such that patients 'get to know' their medicines, and how they can be taken, throughout the life of the patient and the prescription.
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Affiliation(s)
- A P Rathbone
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Queen's Campus, Stockton-on-Tees TS17 6BH, United Kingdom
| | - A Todd
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Queen's Campus, Stockton-on-Tees TS17 6BH, United Kingdom
| | - K Jamie
- School of Applied Social Sciences, Durham University, 32 Old Elvet, Durham DH1 3HN, United Kingdom
| | - M Bonam
- AstraZeneca PLC, Charter Way, Macclesfield SK10 2NA, United Kingdom
| | - L Banks
- AstraZeneca PLC, Charter Way, Macclesfield SK10 2NA, United Kingdom
| | - A K Husband
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Queen's Campus, Stockton-on-Tees TS17 6BH, United Kingdom.
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50
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Banks L, Wells GD, Clarizia NA, Jean-St-Michel E, McKillop AL, Redington AN, McCrindle BW. Short-term remote ischemic preconditioning is not associated with improved blood pressure and exercise capacity in young adults. Appl Physiol Nutr Metab 2016; 41:903-6. [PMID: 27439445 DOI: 10.1139/apnm-2016-0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We sought to determine whether a 9-day remote ischemic preconditioning (IPC) causes improvements in exercise performance, energetics, and blood pressure. Ten participants (mean age 24 ± 4 years) had no changes in aerobic capacity (preintervention: 38 ± 10 mL/(kg·min)(-1) vs. postintervention: 38 ± 10 mL/(kg·min)(-1)), blood pressure (preintervention: 112 ± 7/66 ± 6 mm Hg vs. postintervention: 112 ± 10/62 ± 5 mm Hg), cardiac phosphocreatinine-to-adenosine-triphosphate ratio (preintervention: 2.1 ± 0.5 vs. postintervention: 2.3 ± 0.4), and postexercise skeletal muscle phosphocreatine recovery (preintervention: 34 ± 11 s vs. postintervention: 31 ± 11 s). Short-term remote IPC may be ineffective in improving these outcomes.
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Affiliation(s)
- Laura Banks
- a Labatt Family Heart Centre, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Greg D Wells
- b Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,d Physiology and Experimental Medicine, the Hospital for Sick Children, Toronto, ON, Canada
| | - Nadia A Clarizia
- a Labatt Family Heart Centre, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Emilie Jean-St-Michel
- a Labatt Family Heart Centre, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Adam L McKillop
- a Labatt Family Heart Centre, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Andrew N Redington
- a Labatt Family Heart Centre, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.,c Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Brian W McCrindle
- a Labatt Family Heart Centre, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.,c Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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