1
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Adi-Wauran E, Clausen M, Shickh S, Gagliardi AR, Denburg A, Oldfield LE, Sam J, Reble E, Krishnapillai S, Regier DA, Baxter NN, Dawson L, Penney LS, Foulkes W, Basik M, Sun S, Schrader KA, Karsan A, Pollett A, Pugh TJ, Kim RH, Bombard Y. "I just wanted more": Hereditary cancer syndromes patients' perspectives on the utility of circulating tumour DNA testing for cancer screening. Eur J Hum Genet 2024; 32:176-181. [PMID: 37821757 PMCID: PMC10853540 DOI: 10.1038/s41431-023-01473-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
Hereditary cancer syndromes (HCS) predispose individuals to a higher risk of developing multiple cancers. However, current screening strategies have limited ability to screen for all cancer risks. Circulating tumour DNA (ctDNA) detects DNA fragments shed by tumour cells in the bloodstream and can potentially detect cancers early. This study aimed to explore patients' perspectives on ctDNA's utility to help inform its clinical adoption and implementation. We conducted a qualitative interpretive description study using semi-structured phone interviews. Participants were purposively sampled adult HCS patients recruited from a Canadian HCS research consortium. Thirty HCS patients were interviewed (n = 19 women, age range 20s-70s, n = 25 were white). Participants were highly concerned about developing cancers, particularly those without reliable screening options for early detection. They "just wanted more" than their current screening strategies. Participants were enthusiastic about ctDNA's potential to be comprehensive (detect multiple cancers), predictive (detect cancers early) and tailored (lead to personalized clinical management). Participants also acknowledged ctDNA's potential limitations, including false positives/negatives risks and experiencing additional anxiety. However, they saw ctDNA's potential benefits outweighing its limitations. In conclusion, participants' belief in ctDNA's potential to improve their care overshadowed its limitations, indicating patients' support for using ctDNA in HCS care.
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Affiliation(s)
- Ella Adi-Wauran
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Marc Clausen
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Salma Shickh
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Anna R Gagliardi
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Avram Denburg
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Leslie E Oldfield
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jordan Sam
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Emma Reble
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Suvetha Krishnapillai
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Dean A Regier
- BC Cancer, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- University of Toronto, Toronto, Canada
| | - Lesa Dawson
- Memorial University, St. John's, Canada
- Eastern Health Authority, St. John's, Canada
| | | | - William Foulkes
- McGill University, Montréal, Canada
- Jewish General Hospital, Montréal, Canada
| | - Mark Basik
- McGill University, Montréal, Canada
- Jewish General Hospital, Montréal, Canada
| | - Sophie Sun
- BC Cancer, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | | | - Aly Karsan
- BC Cancer, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | | | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Raymond H Kim
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
- University of Toronto, Toronto, Canada.
- Mount Sinai Hospital, Toronto, Canada.
- Ontario Institute for Cancer Research, Toronto, Canada.
| | - Yvonne Bombard
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
- Ontario Institute for Cancer Research, Toronto, Canada.
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2
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Hynes J, Dawson L, Seal M, Green J, Woods M, Etchegary H. "There should be one spot that you can go:" BRCA mutation carriers' perspectives on cancer risk management and a hereditary cancer registry. J Community Genet 2024; 15:49-58. [PMID: 37864742 PMCID: PMC10858006 DOI: 10.1007/s12687-023-00685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023] Open
Abstract
Individuals who carry BRCA1 or BRCA2 pathogenic variants are recommended to have extensive cancer prevention screening and risk-reducing surgeries. Uptake of these recommendations is variable, and there remains room for improvement in the risk management of BRCA carriers. This paper explores female BRCA carriers' experiences with the current model of care and their perspectives on (and interest in) an inherited cancer registry. Findings can inform the development of a dedicated high-risk screening and management program for these patients. Quantitative and qualitative data were gathered through a provincial descriptive survey and semi-structured qualitative interviews to assess BRCA carriers' opinions toward risk management services in the province of Newfoundland and Labrador (NL), Canada. Survey (n = 69) and interview data (n = 15) revealed continuity and coordination challenges with the current system of care of high-risk individuals. Respondents suggested an inherited cancer registry would help identify high-risk individuals and provide a centralized system of risk management for identified carriers. Respondents identified concerns about the privacy of their registry data, including who could access it. Findings suggest BRCA carriers see great value in an inherited cancer registry. Specifically, participants noted it could provide a centralized system to help improve the coordination of burdensome, life-long risk management. Important patient concerns about protecting their privacy and their health data confidentiality must be addressed in patient and public information and informed consent documents about a registry.
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Affiliation(s)
- J Hynes
- Faculty of Medicine, Memorial University, Craig L. Dobbin Centre for Genetics, Rm 4M210, St. John's, NL, A1B 3V6, Canada
| | - L Dawson
- Department Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M Seal
- Cancer Care Program, Eastern Regional Health Authority, St. John's, NL, Canada
| | - J Green
- Faculty of Medicine, Memorial University, Craig L. Dobbin Centre for Genetics, Rm 4M210, St. John's, NL, A1B 3V6, Canada
| | - M Woods
- Faculty of Medicine, Memorial University, Craig L. Dobbin Centre for Genetics, Rm 4M210, St. John's, NL, A1B 3V6, Canada
| | - H Etchegary
- Faculty of Medicine, Memorial University, Craig L. Dobbin Centre for Genetics, Rm 4M210, St. John's, NL, A1B 3V6, Canada.
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3
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Zadabedini Masouleh T, Etchegary H, Hodgkinson K, Wilson BJ, Dawson L. Beyond Sterilization: A Comprehensive Review on the Safety and Efficacy of Opportunistic Salpingectomy as a Preventative Strategy for Ovarian Cancer. Curr Oncol 2023; 30:10152-10165. [PMID: 38132373 PMCID: PMC10742942 DOI: 10.3390/curroncol30120739] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Ovarian cancer (OC) is Canada's third most common gynecological cancer, with an estimated 3000 new cases and 1950 deaths projected in 2022. No effective screening has been found to identify OC, especially the most common subtype, high-grade serous carcinoma (HGSC), at an earlier, curable stage. In patients with hereditary predispositions such as BRCA mutations, the rates of HGSC are significantly elevated, leading to the use of risk-reducing salpingo-oophorectomy as the key preventative intervention. Although surgery has been shown to prevent HGSC in high-risk women, the associated premature menopause has adverse long-term sequelae and mortality due to non-cancer causes. The fact that 75% of HGSCs are sporadic means that most women diagnosed with HGSC will not have had the option to avail of either screening or prevention. Recent research suggests that the fimbrial distal fallopian tube is the most likely origin of HGSC. This has led to the development of a prevention plan for the general population: opportunistic salpingectomy, the removal of both fallopian tubes. This article aims to compile and review the studies evaluating the effect of opportunistic salpingectomy on surgical-related complications, ovarian reserve, cost, and OC incidence when performed along with hysterectomy or instead of tubal ligation in the general population.
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Affiliation(s)
- Tahereh Zadabedini Masouleh
- Clinical Epidemiology Program, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada;
| | - Holly Etchegary
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
| | - Kathleen Hodgkinson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
- Division of Biomedical Sciences, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Brenda J. Wilson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
| | - Lesa Dawson
- Discipline of Obstetrics and Gynecology, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
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4
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Roebothan A, Smith KN, Seal M, Etchegary H, Dawson L. Specialty Care and Counselling about Hereditary Cancer Risk Improves Adherence to Cancer Screening and Prevention in Newfoundland and Labrador Patients with BRCA1/2 Pathogenic Variants: A Population-Based Retrospective Cohort Study. Curr Oncol 2023; 30:9367-9381. [PMID: 37887578 PMCID: PMC10605144 DOI: 10.3390/curroncol30100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Pathogenic variants (PVs) in BRCA1 and BRCA2 increase the lifetime risks of breast and ovarian cancer. Guidelines recommend breast screening (magnetic resonance imaging (MRI) and mammogram) or risk-reducing mastectomy (RRM) and salpingo-oophorectomy (RRSO). We sought to (1) characterize the population of BRCA1/2 PV carriers in Newfoundland and Labrador (NL), (2) evaluate risk-reducing interventions, and (3) identify factors influencing screening and prevention adherence. We conducted a retrospective study from a population-based provincial cohort of BRCA1/2 PV carriers. The eligibility criteria for risk-reducing interventions were defined for each case and patients were categorized based on their level of adherence with recommendations. Chi-squared and regression analyses were used to determine which factors influenced uptake and level of adherence. A total of 276 BRCA1/2 PV carriers were identified; 156 living NL biological females composed the study population. Unaffected females were younger at testing than those with a cancer diagnosis (44.4 years versus 51.7 years; p = 0.002). Categorized by eligibility, 61.0%, 61.6%, 39.0%, and 75.7% of patients underwent MRI, mammogram, RRM, and RRSO, respectively. Individuals with breast cancer were more likely to have RRM (64.7% versus 35.3%; p < 0.001), and those who attended a specialty hereditary cancer clinic were more likely to be adherent to recommendations (73.2% versus 13.4%; p < 0.001) and to undergo RRSO (84.1% versus 15.9%; p < 0.001). Nearly 40% of the female BRCA1/2 PV carriers were not receiving breast surveillance according to evidence-based recommendations. Cancer risk reduction and uptake of breast imaging and prophylactic surgeries are significantly higher in patients who receive dedicated specialty care. Organized hereditary cancer prevention programs will be a valuable component of Canadian healthcare systems and have the potential to reduce the burden of disease countrywide.
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Affiliation(s)
- Aimee Roebothan
- Faculty of Medicine, Memorial University, St. John’s, NL 1AB 3V6, Canada;
| | - Kerri N. Smith
- Centre for Translational Genomics, NL Health Services, St. John’s, NL 1AB 3V6, Canada
- Discipline of Laboratory Medicine, Faculty of Medicine, Memorial University, St. John’s, NL 1AB 3V6, Canada
| | - Melanie Seal
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John’s, NL 1AB 3V6, Canada;
| | - Holly Etchegary
- Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, NL 1AB 3V6, Canada;
| | - Lesa Dawson
- Division of Gynecologic Oncology, Faculty of Medicine, Memorial University, St. John’s, NL 1AB 3V6, Canada
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5
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Farncombe KM, Wong D, Norman ML, Oldfield LE, Sobotka JA, Basik M, Bombard Y, Carile V, Dawson L, Foulkes WD, Malkin D, Karsan A, Parkin P, Penney LS, Pollett A, Schrader KA, Pugh TJ, Kim RH. Current and new frontiers in hereditary cancer surveillance: Opportunities for liquid biopsy. Am J Hum Genet 2023; 110:1616-1627. [PMID: 37802042 PMCID: PMC10577078 DOI: 10.1016/j.ajhg.2023.08.014] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 10/08/2023] Open
Abstract
At least 5% of cancer diagnoses are attributed to a causal pathogenic or likely pathogenic germline genetic variant (hereditary cancer syndrome-HCS). These individuals are burdened with lifelong surveillance monitoring organs for a wide spectrum of cancers. This is associated with substantial uncertainty and anxiety in the time between screening tests and while the individuals are awaiting results. Cell-free DNA (cfDNA) sequencing has recently shown potential as a non-invasive strategy for monitoring cancer. There is an opportunity for high-yield cancer early detection in HCS. To assess clinical validity of cfDNA in individuals with HCS, representatives from eight genetics centers from across Canada founded the CHARM (cfDNA in Hereditary and High-Risk Malignancies) Consortium in 2017. In this perspective, we discuss operationalization of this consortium and early data emerging from the most common and well-characterized HCSs: hereditary breast and ovarian cancer, Lynch syndrome, Li-Fraumeni syndrome, and Neurofibromatosis type 1. We identify opportunities for the incorporation of cfDNA sequencing into surveillance protocols; these opportunities are backed by examples of earlier cancer detection efficacy in HCSs from the CHARM Consortium. We seek to establish a paradigm shift in early cancer surveillance in individuals with HCSs, away from highly centralized, regimented medical screening visits and toward more accessible, frequent, and proactive care for these high-risk individuals.
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Affiliation(s)
- Kirsten M Farncombe
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Derek Wong
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Maia L Norman
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Leslie E Oldfield
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Julia A Sobotka
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mark Basik
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Victoria Carile
- Jewish General Hospital Stroll Cancer Prevention Centre, Montreal, QC, Canada
| | - Lesa Dawson
- Memorial University, St. John's, NL, Canada; Eastern Health Authority, St. John's, NL, Canada
| | - William D Foulkes
- Jewish General Hospital Stroll Cancer Prevention Centre, Montreal, QC, Canada; Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - David Malkin
- Division of Hematology-Oncology, Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | | | - Patricia Parkin
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Kasmintan A Schrader
- BC Cancer, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Trevor J Pugh
- Ontario Institute for Cancer Research, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
| | - Raymond H Kim
- Ontario Institute for Cancer Research, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Sinai Health System, Toronto, ON, Canada; Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
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6
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Hambäck PA, Dawson L, Geranmayeh P, Jarsjö J, Kačergytė I, Peacock M, Collentine D, Destouni G, Futter M, Hugelius G, Hedman S, Jonsson S, Klatt BK, Lindström A, Nilsson JE, Pärt T, Schneider LD, Strand JA, Urrutia-Cordero P, Åhlén D, Åhlén I, Blicharska M. Tradeoffs and synergies in wetland multifunctionality: A scaling issue. Sci Total Environ 2023; 862:160746. [PMID: 36513236 DOI: 10.1016/j.scitotenv.2022.160746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/31/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Wetland area in agricultural landscapes has been heavily reduced to gain land for crop production, but in recent years there is increased societal recognition of the negative consequences from wetland loss on nutrient retention, biodiversity and a range of other benefits to humans. The current trend is therefore to re-establish wetlands, often with an aim to achieve the simultaneous delivery of multiple ecosystem services, i.e., multifunctionality. Here we review the literature on key objectives used to motivate wetland re-establishment in temperate agricultural landscapes (provision of flow regulation, nutrient retention, climate mitigation, biodiversity conservation and cultural ecosystem services), and their relationships to environmental properties, in order to identify potential for tradeoffs and synergies concerning the development of multifunctional wetlands. Through this process, we find that there is a need for a change in scale from a focus on single wetlands to wetlandscapes (multiple neighboring wetlands including their catchments and surrounding landscape features) if multiple societal and environmental goals are to be achieved. Finally, we discuss the key factors to be considered when planning for re-establishment of wetlands that can support achievement of a wide range of objectives at the landscape scale.
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Affiliation(s)
- P A Hambäck
- Dept of Ecology, Environment and Plant Sciences, Stockholm University, Stockholm, Sweden.
| | - L Dawson
- School of Forest Management, Swedish University of Agricultural Sciences, Skinnskatteberg, Sweden
| | - P Geranmayeh
- Dept of Aquatic Sciences and Assessment, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - J Jarsjö
- Dept of Physical Geography, Stockholm University, Stockholm, Sweden
| | - I Kačergytė
- Dept of Ecology, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - M Peacock
- Dept of Aquatic Sciences and Assessment, Swedish University of Agricultural Sciences, Uppsala, Sweden; Dept of Geography and Planning, School of Environmental Sciences, University of Liverpool, UK
| | - D Collentine
- Dept of Aquatic Sciences and Assessment, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - G Destouni
- Dept of Physical Geography, Stockholm University, Stockholm, Sweden
| | - M Futter
- Dept of Aquatic Sciences and Assessment, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - G Hugelius
- Dept of Physical Geography, Stockholm University, Stockholm, Sweden
| | - S Hedman
- The Rural Economy and Agricultural Society, Eldsberga, Sweden
| | - S Jonsson
- Dept of Environmental Science, Stockholm University, Stockholm, Sweden
| | - B K Klatt
- The Rural Economy and Agricultural Society, Eldsberga, Sweden; Dept of Biology, Lund University, Lund, Sweden
| | - A Lindström
- National Veterinary Institute, Uppsala, Sweden
| | - J E Nilsson
- Dept of Environmental and Biosciences, Halmstad University, Halmstad, Sweden; Dept of Ecology and Genetics, Uppsala University, Uppsala, Sweden
| | - T Pärt
- Dept of Ecology, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - L D Schneider
- The Rural Economy and Agricultural Society, Eldsberga, Sweden
| | - J A Strand
- The Rural Economy and Agricultural Society, Eldsberga, Sweden
| | | | - D Åhlén
- Dept of Ecology, Environment and Plant Sciences, Stockholm University, Stockholm, Sweden
| | - I Åhlén
- Dept of Physical Geography, Stockholm University, Stockholm, Sweden
| | - M Blicharska
- Natural Resources and Sustainable Development, Dept of Earth Sciences, Uppsala University, Uppsala, Sweden
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7
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Etchegary H, Pike A, Puddester R, Watkins K, Warren M, Francis V, Woods M, Green J, Savas S, Seal M, Gao Z, Avery S, Curtis F, McGrath J, MacDonald D, Burry TN, Dawson L. Cancer prevention in cancer predisposition syndromes: A protocol for testing the feasibility of building a hereditary cancer research registry and nurse navigator follow up model. PLoS One 2022; 17:e0279317. [PMID: 36548287 PMCID: PMC9778977 DOI: 10.1371/journal.pone.0279317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Monogenic, high penetrance syndromes, conferring an increased risk of malignancies in multiple organs, are important contributors to the hereditary burden of cancer. Early detection and risk reduction strategies in patients with a cancer predisposition syndrome can save their lives. However, despite evidence supporting the benefits of early detection and risk reduction strategies, most Canadian jurisdictions have not implemented programmatic follow up of these patients. In our study site in the province of Newfoundland and Labrador (NL), Canada, there is no centralized, provincial registry of high-risk individuals. There is no continuity or coordination of care providing cancer genetics expertise and no process to ensure that patients are referred to the appropriate specialists or risk management interventions. This paper describes a study protocol to test the feasibility of obtaining and analyzing patient risk management data, specifically patients affected by hereditary breast ovarian cancer syndrome (HBOC; BRCA 1 and BRCA 2 genes) and Lynch syndrome (LS; MLH1, MSH2, MSH6, and PMS2 genes). Through a retrospective cohort study, we will describe these patients' adherence to risk management guidelines and test its relationship to health outcomes, including cancer incidence and stage. Through a qualitative interviews, we will determine the priorities and preferences of patients with any inherited cancer mutation for a follow up navigation model of risk management. Study data will inform a subsequent funding application focused on creating and evaluating a research registry and follow up nurse navigation model. It is not currently known what proportion of cancer mutation carriers are receiving care according to guidelines. Data collected in this study will provide clinical uptake and health outcome information so gaps in care can be identified. Data will also provide patient preference information to inform ongoing and planned research with cancer mutation carriers.
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Affiliation(s)
- Holly Etchegary
- Clinical Epidemiology, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
- * E-mail:
| | - April Pike
- Faculty of Nursing, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Rebecca Puddester
- Faculty of Nursing, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Kathy Watkins
- Centre for Nursing and Health Studies, Eastern Health, St. John’s, Newfoundland, Canada
| | - Mike Warren
- Patient Partner, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Vanessa Francis
- Patient Partner, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Michael Woods
- Division of Biomedical Sciences, Discipline of Oncology, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Jane Green
- Division of Biomedical Sciences, Discipline of Oncology, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Sevtap Savas
- Division of Biomedical Sciences, Discipline of Oncology, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Melanie Seal
- Discipline of Oncology, Faculty of Medicine, Memorial University of Newfoundland, Cancer Care Program, Eastern Health, St. John’s, Newfoundland, Canada
| | - Zhiwei Gao
- Clinical Epidemiology, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Susan Avery
- Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Fiona Curtis
- Provincial Medical Genetics Program, Eastern Health, St. John’s, Newfoundland, Canada
| | - Jerry McGrath
- Gastroenterology, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Donald MacDonald
- Newfoundland and Labrador Centre for Health Information, St. John’s, Newfoundland, Canada
| | - T. Nadine Burry
- Clinical Epidemiology, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Lesa Dawson
- Obstetrics and Gynecology, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
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8
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Dawson L, Andrew E, Nehme Z, Bloom J, Cox S, Anderson D, Stephenson M, Lefkovits J, Taylor AJ, Kaye D, Guo Y, Smith K, Stub D. Temperature-related chest pain presentations and future projections with climate change. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Climate change has led to increased interest in studying adverse health effects relating to ambient temperatures. It is unclear whether incident chest pain is associated with non-optimal temperatures and how chest pain presentation rates might be affected by climate change.
Methods
The study included ambulance data of chest pain presentations in Melbourne, Australia from 1/1/2015 to 30/6/2019 with linkage to hospital and emergency discharge diagnosis data. A time series quasi-Poisson regression with a distributed lag nonlinear model was fitted to assess the temperature-chest pain presentation associations, after adjusting for season, day of the week and long-term trend. Future excess chest pain presentations associated with cold and heat were projected under six general circulation models under medium and high emission scenarios.
Results
In 206,789 chest pain presentations, mean (SD) age was 61.2 (18.9) years and 50.3% were female. Significant heat- and cold-related increased risk of chest pain presentations were observed for mean air temperatures above and below 20.8°C, respectively (Figure 1). Excess chest pain presentations related to heat were observed in all subgroups, but appeared to be attenuated for older patients (≥70 years) and patients of higher socioeconomic status (SES). We projected no significant change in net temperature-related chest pain presentations with climate change under medium- and high-emission scenarios, with increases in heat-related chest pain presentations offset by decreases in chest pain presentations related to cold temperatures.
Conclusions
Heat- and cold-exposure appear to increase risk of chest pain presentations, especially among younger patients and patients of lower SES. In Melbourne, Australia, chest pain presentations overall were not projected to increase with climate change, but increases in heat-related chest pain presentations highlight the importance of risk mitigation strategies to minimise adverse health impacts on hotter days.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Alfred Health.
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Affiliation(s)
- L Dawson
- Royal Melbourne Hospital , Melbourne , Australia
| | - E Andrew
- Monash University , Melbourne , Australia
| | - Z Nehme
- Monash University , Melbourne , Australia
| | - J Bloom
- The Alfred Hospital , Melbourne , Australia
| | - S Cox
- Monash University , Melbourne , Australia
| | - D Anderson
- The Alfred Hospital , Melbourne , Australia
| | | | - J Lefkovits
- Royal Melbourne Hospital , Melbourne , Australia
| | - A J Taylor
- The Alfred Hospital , Melbourne , Australia
| | - D Kaye
- The Alfred Hospital , Melbourne , Australia
| | - Y Guo
- Monash University , Melbourne , Australia
| | - K Smith
- Monash University , Melbourne , Australia
| | - D Stub
- The Alfred Hospital , Melbourne , Australia
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Dawson L, Andrew E, Stephenson M, Nehme Z, Bloom J, Cox S, Anderson D, Lefkovits J, Taylor AJ, Kaye D, Smith K, Stub D. Impact of ambulance off-load delays on mortality in patients with chest pain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ambulance off-load delays in transferring patient care to emergency departments (EDs) are increasingly common, but it is unclear whether clinical outcomes are impacted.
Methods
Population-based cohort study of ambulance attendances for non-traumatic chest pain transported to ED in Victoria, Australia (1/1/2015–30/6/2019) excluding patients transported to hospital with “lights and sirens” or triaged as ED category 1. Multivariable models were used to assess the relationship between ambulance off-load times and 30-day mortality and ambulance re-attendance for chest pain.
Results
The study included 213,544 ambulance attendances for chest pain (mean age 62 [SD 18] years; 51% female). Median ambulance off-load times increased across the study period from 21 minutes (interquartile range [IQR] 15–30) in 2015 to 24 minutes (IQR 17–37) in 2019. Patients were divided into tertiles according to off-load times with 69,247 patients included in tertile 1 (0–17 minutes), 73,109 patients in tertile 2 (18–28 minutes), and 71,188 patients in tertile 3 (>28 minutes). In multivariable models, ambulance off-load delays were associated with higher unadjusted and adjusted rates of 30-day mortality (1.57% tertile 3 vs. 1.29% tertile 1, adjusted risk difference 0.28% [95% CI 0.16% - 0.42%], p<0.001) and ambulance re-attendance for chest pain (9.89% tertile 3 vs. 8.59% tertile 1, adjusted risk difference 1.30% [95% CI 1.00% - 1.61%], p<0.001). Similarly, in analysis using off-load times as a continuous variable with restricted cubic splines, a non-linear increase in adjusted odds ratio for mortality was observed (Figure 1).
Conclusions
Delays in ambulance off-load times appear to be associated with increased mortality and ambulance re-attendance risk among chest pain cohorts. This study has important policy implications given the increasing frequency of off-load delays in many healthcare settings.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Alfred health
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Affiliation(s)
- L Dawson
- Royal Melbourne Hospital , Melbourne , Australia
| | - E Andrew
- Monash University , Melbourne , Australia
| | | | - Z Nehme
- Monash University , Melbourne , Australia
| | - J Bloom
- The Alfred Hospital , Melbourne , Australia
| | - S Cox
- Monash University , Melbourne , Australia
| | - D Anderson
- The Alfred Hospital , Melbourne , Australia
| | - J Lefkovits
- Royal Melbourne Hospital , Melbourne , Australia
| | - A J Taylor
- The Alfred Hospital , Melbourne , Australia
| | - D Kaye
- The Alfred Hospital , Melbourne , Australia
| | - K Smith
- Monash University , Melbourne , Australia
| | - D Stub
- The Alfred Hospital , Melbourne , Australia
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Navani RV, Dawson L, Andrew E, Nehme Z, Bloom J, Cox S, Anderson D, Stephenson M, Lefkovits J, Taylor A, Kaye D, Smith K, Stub D. Variation in health-care quality and outcomes according to time of chest pain presentation: a state-wide prospective cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies examining temporal variation in cardiovascular care have largely been limited to assessing weekend and after-hours effects whereby those presenting on the weekend or after-hours have a poorer outcome. However, emerging evidence suggests more complex patterns in patterns and outcomes may exist.
Purpose
We aimed to determine patterns of temporal variation in chest pain presentations and subsequent health-care quality and outcomes.
Methods
This was an observational, prospective-cohort study of adult patients aged 18 and over who were attended by emergency medical services for non-traumatic chest pain between 1 January 2015 and 30 June 2019 in Victoria, Australia. Major exclusion criteria included pre-hospital diagnosis of ST elevation myocardial infarction or an out of hospital cardiac arrest. The exposure variable was time of day and day of week stratified into 168 hourly time periods. The primary outcome measure was 30-day mortality.
Results
The study cohort comprised 196,365 ambulance attendances for acute non-traumatic chest pain; mean age 62.4 years (SD 18.3) and 99,497 (50.7%) females. Three temporal patterns were observed for chest pain presentations (Figure 1): (1) a diurnal pattern with a sharp increase in presentations from 8 am, peaking around midday, before decreasing into late evening with a nadir between 3–4 am, (2) a weekend effect where Saturday and Sunday had a relatively lower rate of presentations compared to during the week, and (3) a Monday – Sunday gradient where more presentations were likely earlier in the week, than later. Six patterns were identified across pre-hospital and hospital key performance indicators (KPI) (diurnal, in/after-hours, weekend effect, Monday – Sunday gradient, a peak period and morning vs afternoon/evening effect. Risk of 30-day mortality was associated with weekend presentation (OR 1.15, 95% CI 1.06–1.24, p=0.001) and morning presentation between midnight and midday (OR 1.17, 95% CI 1.09–1.25, p<0.001) (Figure 2).
Conclusion
Chest pain presentations, care quality and outcomes demonstrate complex temporal variation beyond the already established weekend and after-hours effect. Such relationships should be considered during resource allocation and quality improvement programs in order to improve treatment quality across all days and times of the week.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R V Navani
- The Alfred Hospital, Department of Cardiology , Melbourne , Australia
| | - L Dawson
- The Alfred Hospital, Department of Cardiology , Melbourne , Australia
| | - E Andrew
- Ambulance Victoria , Melbourne , Australia
| | - Z Nehme
- Ambulance Victoria , Melbourne , Australia
| | - J Bloom
- The Alfred Hospital, Department of Cardiology , Melbourne , Australia
| | - S Cox
- Ambulance Victoria , Melbourne , Australia
| | - D Anderson
- Ambulance Victoria , Melbourne , Australia
| | | | - J Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University , Melbourne , Australia
| | - A Taylor
- The Alfred Hospital, Department of Cardiology , Melbourne , Australia
| | - D Kaye
- The Alfred Hospital, Department of Cardiology , Melbourne , Australia
| | - K Smith
- Ambulance Victoria , Melbourne , Australia
| | - D Stub
- The Alfred Hospital, Department of Cardiology , Melbourne , Australia
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Karki D, Dawson L, Muthukumar V, Aggarwal N. Blood Indices In Adult Acute Burn: A Window Into Milieu Interieur - The Future Biomarkers? Ann Burns Fire Disasters 2022; 35:46-54. [PMID: 35582086 PMCID: PMC9020846] [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] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/23/2021] [Indexed: 06/15/2023]
Abstract
Optimal treatment of sepsis in burned patients depends on early diagnosis and includes prompt administration of antimicrobials as well as management of hemodynamic alterations and other organ dysfunctions. The role of red blood cell distribution width (RDW) and platelet indices in prognosticating and identifying sepsis in acute burn patients is studied. This study was done as a prospective study over 18 months, including patients in the age group >18 or <60 years, with burns >20% and <70% TBSA, burn time to resuscitation time 24 hours or less and with thermal and scald burns. Data of 157 patients were analyzed and the following observations were made. The mean age of the study population was 31.36 years (18-59 years). RDW values were higher in the non-survivor group. Platelet count and plateletcrit were higher in the survivor group and the no sepsis group. Positive rising trends of platelet count and plateletcrit were seen in the survivor group. Day 1, 3, 7 values of RDW, platelet count and plateletcrit were significant in determining the outcome of the patient on mortality and sepsis related morbidity of the patient. RDW, platelet count and plateletcrit in combination can predict mortality and sepsis as early as the third day, thus giving a clinical advantage of initiating targeted treatment to the at-risk burn population before sepsis is detected clinically. This could better the outcomes in treatment of burn patients.
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Affiliation(s)
- D Karki
- Dr. Durga Karki MS, MCh, DNB, MNAMS, FACS
Dept. of Plastic, Burns & Maxillofacial Surgery, V.M. Medical College & Safdarjung HospitalDelhi 110029India+91 1126122903; +91 9910649386
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Grim CCA, van der Wal LI, Helmerhorst HJF, van Westerloo DJ, Pelosi P, Schultz MJ, de Jonge E, del Prado MR, Wigbers J, Sigtermans MJ, Dawson L, van der Heijden PLJ, den Berg EYSV, Loef BG, Reidinga AC, de Vreede E, Qualm J, Boerma EC, Rijnhart-de Jong H, Koopmans M, Cornet AD, Krol T, Rinket M, Vermeijden JW, Beishuizen A, Schoonderbeek FJ, van Holten J, Tsonas AM, Botta M, Winters T, Horn J, Paulus F, Loconte M, Battaglini D, Ball L, Brunetti I. ICONIC study—conservative versus conventional oxygenation targets in intensive care patients: study protocol for a randomized clinical trial. Trials 2022; 23:136. [PMID: 35152909 PMCID: PMC8842972 DOI: 10.1186/s13063-022-06065-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Oxygen therapy is a widely used intervention in acutely ill patients in the intensive care unit (ICU). It is established that not only hypoxia, but also prolonged hyperoxia is associated with poor patient-centered outcomes. Nevertheless, a fundamental knowledge gap remains regarding optimal oxygenation for critically ill patients. In this randomized clinical trial, we aim to compare ventilation that uses conservative oxygenation targets with ventilation that uses conventional oxygen targets with respect to mortality in ICU patients. Methods The “ConservatIve versus CONventional oxygenation targets in Intensive Care patients” trial (ICONIC) is an investigator-initiated, international, multicenter, randomized clinical two-arm trial in ventilated adult ICU patients. The ICONIC trial will run in multiple ICUs in The Netherlands and Italy to enroll 1512 ventilated patients. ICU patients with an expected mechanical ventilation time of more than 24 h are randomized to a ventilation strategy that uses conservative (PaO2 55–80 mmHg (7.3–10.7 kPa)) or conventional (PaO2 110–150 mmHg (14.7–20 kPa)) oxygenation targets. The primary endpoint is 28-day mortality. Secondary endpoints are ventilator-free days at day 28, ICU mortality, in-hospital mortality, 90-day mortality, ICU- and hospital length of stay, ischemic events, quality of life, and patient opinion of research and consent in the emergency setting. Discussion The ICONIC trial is expected to provide evidence on the effects of conservative versus conventional oxygenation targets in the ICU population. This study may guide targeted oxygen therapy in the future. Trial registration Trialregister.nl NTR7376. Registered on 20 July, 2018.
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Shickh S, Oldfield LE, Clausen M, Mighton C, Sebastian A, Calvo A, Baxter NN, Dawson L, Penney LS, Foulkes W, Basik M, Sun S, Schrader KA, Regier DA, Karsan A, Pollett A, Pugh TJ, Kim RH, Bombard Y. OUP accepted manuscript. Oncologist 2022; 27:e393-e401. [PMID: 35385106 PMCID: PMC9075003 DOI: 10.1093/oncolo/oyac039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background We explored health professionals’ views on the utility of circulating tumor DNA (ctDNA) testing in hereditary cancer syndrome (HCS) management. Materials and Methods A qualitative interpretive description study was conducted, using semi-structured interviews with professionals across Canada. Thematic analysis employing constant comparison was used for analysis. 2 investigators coded each transcript. Differences were reconciled through discussion and the codebook was modified as new codes and themes emerged from the data. Results Thirty-five professionals participated and included genetic counselors (n = 12), geneticists (n = 9), oncologists (n = 4), family doctors (n = 3), lab directors and scientists (n = 3), a health-system decision maker, a surgeon, a pathologist, and a nurse. Professionals described ctDNA as “transformative” and a “game-changer”. However, they were divided on its use in HCS management, with some being optimistic (optimists) while others were hesitant (pessimists). Differences were driven by views on 3 factors: (1) clinical utility, (2) ctDNA’s role in cancer screening, and (3) ctDNA’s invasiveness. Optimists anticipated ctDNA testing would have clinical utility for HCS patients, its role would be akin to a diagnostic test and would be less invasive than standard screening (eg imaging). Pessimistic participants felt ctDNA testing would add limited utility; it would effectively be another screening test in the pathway, likely triggering additional investigations downstream, thereby increasing invasiveness. Conclusions Providers anticipated ctDNA testing will transform early cancer detection for HCS families. However, the contrasting positions on ctDNA’s role in the care pathway raise potential practice variations, highlighting a need to develop evidence to support clinical implementation and guidelines to standardize adoption.
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Affiliation(s)
- Salma Shickh
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Leslie E Oldfield
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Marc Clausen
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Chloe Mighton
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Agnes Sebastian
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Alessia Calvo
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Nancy N Baxter
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Lesa Dawson
- Memorial University, St. John’s, NL, Canada
- Eastern Health Authority, St. John’s, NL, Canada
| | | | - William Foulkes
- McGill University, Montréal, QC, Canada
- Jewish General Hospital, Montréal, QC, Canada
| | - Mark Basik
- McGill University, Montréal, QC, Canada
- Jewish General Hospital, Montréal, QC, Canada
| | - Sophie Sun
- BC Cancer, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Kasmintan A Schrader
- BC Cancer, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Dean A Regier
- BC Cancer, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Aly Karsan
- BC Cancer, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | | | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Raymond H Kim
- University of Toronto, Toronto, ON, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Yvonne Bombard
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Corresponding author: Yvonne Bombard, University of Toronto, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Toronto, ON, Canada M5B 1W8. Tel: +1 416 864 6060, 77378;
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14
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Navani R, Dawson L, Andrew E, Nehme Z, Bloom J, Cox S, Anderson D, Stephenson M, Lefkovits J, Taylor A, Kaye D, Smith K, Stub D. Variation in Health-Care Quality and Outcomes According to Time of Chest Pain Presentation: A State-Wide Prospective Cohort Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.402] [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: 11/26/2022]
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15
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Dawson L, Andrew E, Stephenson M, Nehme Z, Bloom J, Cox S, Anderson D, Lefkovits J, Taylor A, Kaye D, Smith K, Stub D. Impact of Ambulance Off-Load Delays on Mortality in Patients With Chest Pain. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.338] [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]
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do Valle HA, Kaur P, Kwon JS, Cheifetz R, Dawson L, Hanley GE. Bone health after RRBSO among BRCA1/2 mutation carriers: a population-based study. J Gynecol Oncol 2022; 33:e51. [PMID: 35557034 PMCID: PMC9250858 DOI: 10.3802/jgo.2022.33.e51] [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: 12/03/2021] [Revised: 01/28/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Examine the risks of fractures and osteoporosis after risk-reducing bilateral salpingo-oophorectomy (RRBSO) among women with BRCA1/2 mutations. Methods In this retrospective population-based study in British Columbia, Canada, between 1996 to 2017, we compared risks of osteoporosis and fractures among women with BRCA1/2 mutations who underwent RRBSO before the age of 50 (n=329) with two age-matched groups without known mutations: 1) women who underwent bilateral oophorectomy (BO) (n=3,290); 2) women with intact ovaries who had hysterectomy or salpingectomy (n=3,290). Secondary outcomes were: having dual-energy X-ray absorptiometry (DEXA) scan, and bisphosphonates use. Results The mean age at RRBSO was 42.4 years (range, 26–49) and the median follow-up for women with BRCA1/2 mutations was 6.9 years (range, 1.1–19.9). There was no increased hazard of fractures for women with BRCA1/2 mutations (adjusted hazard ratio [aHR]=0.80; 95% confidence interval [CI]=0.56–1.14 compared to women who had BO; aHR=1.02; 95% CI=0.65–1.61 compared to women with intact ovaries). Among women who had DEXA-scan, those with BRCA1/2 mutations had higher risk of osteoporosis (aHR=1.60; 95% CI=1.00–2.54 compared to women who had BO; aHR=2.49; 95% CI=1.44–4.28 compared to women with intact ovaries). Women with BRCA1/2 mutations were more likely to get DEXA-scan than either control groups, but only 46% of them were screened. Of the women with BRCA1/2 mutations diagnosed with osteoporosis, 36% received bisphosphonates. Conclusion Women with BRCA1/2 mutations had higher risk of osteoporosis after RRBSO, but were not at increased risk of fractures during our follow-up. Low rates of DEXA-scan and bisphosphonates use indicate we can improve prevention of bone loss. BRCA mutations carriers had higher osteoporosis risk after risk-reducing bilateral salpingo-oophorectomy (RRBSO) than the groups without mutations. However, they were not at increased risk of fractures during the study period. Only 46% of BRCA mutations carriers were screened for bone loss after RRBSO. The rate of bisphosphonates use was also low.
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Affiliation(s)
- Helena Abreu do Valle
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
| | - Paramdeep Kaur
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
| | - Janice S. Kwon
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
| | - Rona Cheifetz
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- High-Risk Clinic, Hereditary Cancer Program, BC Cancer Agency, Vancouver, BC, Canada
| | - Lesa Dawson
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Gillian E. Hanley
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
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Xiao X, Bloom J, Andrew E, Dawson L, Nehme Z, Stephenson M, Anderson D, Fernando H, Noaman S, Cox S, Chan W, Kaye D, Smith K, Stub D. Age as a Predictor of Clinical Outcomes and Determinant of Therapeutic Measures for Emergency Medical Services Treated Cardiogenic Shock. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Dawson L, Quinn S, Tong D, Boyle A, Hamilton-Craig C, Adams H, Layland J. Colchicine and quality of life in patients with acute coronary syndromes: results from the COPS randomized trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Recent data suggest that colchicine may reduce cardiovascular events among patients presenting with acute coronary syndromes. This sub-study of the Australian COPS trial aimed to assess whether colchicine affects health status outcomes.
Methods
Health status was assessed at baseline and 12-months using the EuroQol-5 Dimension 5-level (EQ-5D-5L) score and the full 19-question Seattle Angina Questionnaire (SAQ). Data were available for 786 patients (388 randomized to colchicine, 398 to placebo).
Results
Baseline characteristics were well matched between groups; mean age was 60.1 (SD 14.8) years, and 20% were female. Baseline health status scores were impaired, and most parameters demonstrated significant improvement from baseline to 12-months (EQ-5D-5L Visual Analogue Score [VAS] 69.3 to 77.7; SAQ angina frequency score 83.0 to 95.3, both p<0.001). No significant differences in adjusted mean score change among any of the EQ-5D-5L or SAQ dimensions were observed between treatment groups in either intention-to-treat or per-protocol analysis. There were borderline interactions in EQ-5D-5L scores for those with previous MI vs not, and in SAQ scores for those with obesity vs not. In categorical analysis using observed data, patients treated with colchicine were more likely to have clinically significant improvement in physical limitation score over the period (36% improved vs. 28%, P<0.05). Baseline health status scores were not associated with the primary endpoint at 12 months.
Conclusions
Treatment with colchicine did not appear to affect change in measures of health status following acute coronary syndromes, but it did lead to a greater likelihood of improvement in physical limitation scores.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Peninsula Health, Monash University
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Affiliation(s)
- L Dawson
- Royal Melbourne Hospital, Melbourne, Australia
| | - S Quinn
- Swinburne University of Technology, Department of Health Science and Biostatistics, Melbourne, Australia
| | - D Tong
- Peninsula Health, Department of Cardiology, Melbourne, Australia
| | - A Boyle
- University of Newcastle, Newcastle, Australia
| | | | - H Adams
- Royal Hobart Hospital, Hobart, Australia
| | - J Layland
- Peninsula Health, Department of Cardiology, Frankston, Australia
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do Valle HA, Kaur P, Kwon JS, Cheifetz R, Dawson L, Hanley GE. Risk of cardiovascular disease among women carrying BRCA mutations after risk-reducing bilateral salpingo-oophorectomy: A population-based study. Gynecol Oncol 2021; 162:707-714. [PMID: 34217543 DOI: 10.1016/j.ygyno.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Examine the risk of cardiovascular disease (CVD) following risk reducing bilateral salpingo-oophorectomy (RRBSO) among women with BRCA mutations. METHODS In this retrospective population-based study in British Columbia, Canada, between 1996 and 2017, we compared the risk of CVD among women with known BRCA mutations who underwent RRBSO before the age of 50 (n = 360) with two groups of age-matched women without known BRCA mutations: 1) women who underwent bilateral oophorectomy (BO) for benign conditions (n = 3600); and, 2) women with intact ovaries who had hysterectomy or salpingectomy (n = 3600). Our primary outcome was CVD (a composite (any of) myocardial infarction, heart failure, and/or cerebrovascular disease). Secondary outcomes included a diagnostic code for predisposing conditions (hypertension, dyslipidemia, and/or diabetes mellitus), and use of cardioprotective medications (statins and/or beta-blockers). RESULTS We report no significant increased risk for CVD between women with BRCA mutations and women who underwent BO (aHR = 1.08, 95%CI: 0.72-1.62), but women with BRCA mutations were less likely to be diagnosed with predisposing conditions (aHR = 0.69, 95%CI: 0.55-0.85). Compared to women without BRCA mutations with intact ovaries who underwent hysterectomy or salpingectomy, women with BRCA mutations had significantly increased risk for CVD (aHR = 1.82, 95%CI: 1.18-2.79) and were less likely to be diagnosed with predisposing conditions (aHR = 0.78, 95%CI: 0.62-0.97) and to fill cardioprotective medications (aHR = 0.88, 95%CI: 0.64-1.22). CONCLUSION Our results suggest an opportunity for improved prevention of CVD in women with BRCA mutations after prophylactic oophorectomy. Despite the observed lower prevalence of predisposing conditions for CVD and lesser use of cardioprotective medications, this population did not have a lower rate of CVD.
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Affiliation(s)
- Helena Abreu do Valle
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Paramdeep Kaur
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Janice S Kwon
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Rona Cheifetz
- Department of Surgery, University of British Columbia, Canada; BC Cancer Agency Hereditary Cancer Program High-Risk Clinic, Canada
| | - Lesa Dawson
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC, Canada; Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology Memorial University St. John's NL, Canada
| | - Gillian E Hanley
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, BC, Canada.
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Calle M, Dawson L, Rojas M, Loetz E. 110 Pregnancy rate and embryo viability in response to chorionic gonadotrophins given for oestrus induction and gonadotrophin-releasing hormone 5 days after timed laparoscope-aided insemination of lactating and non-lactating goats. Reprod Fertil Dev 2021. [DOI: 10.1071/rdv33n2ab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gonadotrophins are included in oestrous/ovulation synchronization (E/OS) regimens when breeding early in the transitional phase to promote follicular development. However, the time of use has been a matter of debate. Hence, the objective of this study was to determine whether equine and human chorionic gonadotrophins (eCG and hCG, respectively) given 24h before or 24h after concurrent removal of intravaginal progestagen (P4) and prostaglandin (PGF2α) delivery influences pregnancy rate (PR) and/or embryo viability (EV). Relatedly, the influence of gonadotrophin-releasing hormone (GnRH) 5 days post-breeding (dpb) on PR and/or EV was also considered. A prospective randomised control trial was conducted using lactating and non-lactating Alpine breed goats of different parity, average±s.e. age, and bodyweight (3.7±2.6), and (52.5±7), respectively. Goats were time-bred at 48h after P4 removal by laparoscopy (LAI; n=75) or by natural service (NS; n=29) during the early transitional breeding phase in mid-September through mid-December (corresponding to 12:12h daylight/darkness). E/OS used an intravaginal device containing 300mg of P4 for 12±1d. At P4 removal, 2mL of PGF2α was administered IM. Twenty-four hours before (E) or 24h after (L) P4 removal, an IM dose of 1.5mL containing 120IU of eCG and 60IU of hCG was given. A third control (C) group (n=38) was not exposed to gonadotrophins. GnRH analogue was given (n=51) 5 days after insemination, and the remaining goats (n=53) received an IM dose of 2mL of saline solution. PR was evaluated at 18 to 24 (dpb) by non-return to oestrus (NRE), at 30 dpb by pregnancy-specific protein B (PSPB), and at 40 dpb by ultrasound imaging (UI). EV was determined from the difference between pregnancy outcomes for NRE and PSPB, and PSPB and UI. Statistical analysis (JMP/SAS vs.11; SAS Institute Inc.) were obtained using logistic regression. All concomitant variables (i.e. parity, bodyweight, days of P4 exposure, and lactation were not influenced by PR or EV; P>0.07). The overall PR was 71% for LAI and 69% for NS and, as shown in Table 1, was similar (P>0.49) at all times (at 18 to 24, 30, and 40 dpb). Likewise, the breeding procedure did not influence the levels of EV at 30 or 40 dpb. E/OS protocol or the use of GnRH 5 dpb did not affect PR or EV at any of the time points evaluated.
Table 1.
Main effect mean comparisons and logistic model probabilities for pregnancy rate (PR) and embryo viability (EV) by main treatment effect
Response variable (days post-breeding)
Breeding procedure
E/OS Protocol
Gonadotrophin
LAI
NS
P>
Control
Early
Late
P>
GnRH
Placebo
P>
PR at 18–24
77
72
0.49
76
73
78
0.83
78
74
0.49
PR at 30
68
66
0.65
66
65
70
0.82
71
64
0.43
PR at 40
69
69
0.78
66
69
73
0.77
73
66
0.43
EV at 30
89
90
0.94
86
94
90
0.65
92
87
0.46
EV at 40
88
95
0.42
86
89
94
0.73
92
87
0.43
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21
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Encinas F, Rojas M, Dawson L, Loetz E. 111 Use of gonadotrophin-releasing hormone (GnRH) or equine and human chorionic gonadotrophins for oestrus synchronization and their influence on embryo viability and progesterone levels on day 16 and 30 of goats receiving GnRH 5 days after intrauterine insemination or natural service. Reprod Fertil Dev 2021. [DOI: 10.1071/rdv33n2ab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gonadotrophin-releasing hormone (GnRH) or equine and human chorionic gonadotrophins (eCG and hCG) were evaluated for oestrus/ovulation synchronization (E/OS), as well as the influence of GnRH 5 days post-breeding (dpb) on embryo viability (EV), and progesterone (P4) levels on Day 16 and 30 after laparoscopic AI (LAI) or natural service (NS). Fifty-four lactating/non-lactating Alpine breed goats (average of 3.82±1.2s.d. years of age) of mixed parity were E/OS during the early transitional breeding phase using 12±1 day of 300mg of P4 and 2mL of prostaglandin F2α analogue given at P4 removal. The experiment included a sub-group from a larger study in which a completely randomised design was used. The germane data were arranged as a 2×2×2 factorial. This study focused on goats receiving 120IU of eCG and 60IU of hCG (n=40), or GnRH analogue (n=14) 24h after P4 removal. At 5 dpb, 25 goats received 1mL (IM) of GnRH and the control (n=29) received 1mL of physiologic saline. Goats were time-bred 48h after P4 withdrawal by LAI (n=33) or NS (n=21). Pregnancy was diagnosed at 18 to 24, 30, and 40 dpb by non-return to oestrus, pregnancy-specific protein B, and ultrasound, respectively. EV was evaluated as the difference between pregnancy diagnosis results. Blood serum P4 was evaluated at 5, 16, and 30 dpb. A logistic regression model was used for statistical analysis. Pregnancy rate (PR) for LAI or NS, at 18–24, 30, and 40 days was 73 vs. 76%, 67 vs. 62%, and 64 vs. 67%, respectively (P>0.72). In contrast, when GnRH was used for E/OS, the 5 dpb GnRH influenced EV at 30 days (95 vs. 81%; P=0.06) but not at 40 days (89 vs. 86%; P>0.35), compared with placebo. Similarly, with the exception of PR at 40 days (43 vs. 72%; P=0.05), for the GnRH and eCG/hCG E/OS groups, respectively, PR was not affected (P>0.12) by either E/OS or GnRH 5 dpb or their interaction (P>0.35) at any pregnancy diagnosis (i.e. 18–24, 30, or 40 dpb). Likewise, levels of P4 at 5, 16, and 30 dpb did not affect PR at 18–24, 30, and 40 dpb (P>0.92, 0.71, and 0.11). As shown in Table 1, the level of P4 was not influenced for goats receiving GnRH or placebo at 5, 16, or 30 dpb. The baseline mean P4 blood serum level for goats receiving GnRH 5 dpb differed at 16 but not at 30 dpb (P<0.001).
Table 1
Blood serum progesterone (P4, ng mL−1) in response to gonadotrophin-releasing hormone (GnRH) or placebo given 5 days post-breeding
Sampling day
GnRH
Placebo
P >1
Mean
±SE
Mean
±SE
5 (baseline)
6.2a
0.83
5.7a
0.72
0.66
16
11.7b
1.11
11.0b
1.05
0.65
30
6.2a
0.89
7.6c
0.84
0.26
a–cMean values with different superscripts within a column signify statistical difference for GnRH (P<0.001) and placebo (P<0.02).
1Probability for mean differences in the same row.
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22
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O'Brien J, Dawson L, Chowdhury E, Tran L, Baker R, Newcomb A, Smith J, Reid C, Duffy S. Long-term Outcomes in Indigenous Australians Following Coronary Artery Bypass Surgery. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Dawson L, Bloom J, Lefkovits J, Taylor A, Duffy S, Stub D. Timing of Oral P2Y12 Inhibitors in Non-ST-Elevation Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of Randomised Trials. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Gladding P, Hewitt W, Walsh H, Parata M, Dawson L, Flay L, Ayar Z, Bohot K. First Experience With a Rapid Cardiac Screening Clinic Augmented by Artificial Intelligence. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.047] [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: 10/21/2022]
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25
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Bloom J, Andrew E, Nehme Z, Dinh D, Shi W, Vriesendorp P, Nanayakarra S, Fernando H, Dawson L, Brennan A, Noaman S, Layland J, William J, Al-Fiadh A, Brookes M, Freeman M, Hutchinson A, McGaw D, Van GW, Wilson W, White A, Prakash R, Reid C, Lefkovits J, Duffy S, Chan W, Kaye D, Stephenson M, Bernard S, Smith K, Stub D. Pre-Hospital Heparin Use for ST-Elevation Myocardial Infarction is Safe and Improves Angiographic Outcomes. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Javor J, Robbins M, Rosewall T, Craig T, Villafuerte CJ, Cummings B, Dawson L. Corrigendum to 'Can Conformity-Based Volumetric Modulated Arc Therapy Improve Dosimetry and Speed of Delivery in Radiation Therapy to Lumbosacral Spine Compared with Conventional Techniques?' [Journal of Medical Imaging and Radiation Sciences Volume 51 Issue 3 (2020) 404-410/814]. J Med Imaging Radiat Sci 2020; 51:700. [PMID: 33334501 DOI: 10.1016/j.jmir.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- J Javor
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - M Robbins
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - T Rosewall
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - T Craig
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - C J Villafuerte
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - B Cummings
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - L Dawson
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
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27
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Dawson L, Biswas S, Stub D, Lefkovits J, Burchill L, Reid C, Eccleston D. National cardiac registries: a systematic review. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Over the last thirty years, there has been exponential growth in the number and scale of national cardiovascular disease registries. We aimed to provide a comprehensive outline of contemporary national cardiac registries across all subspecialties.
Methods
We performed a systematic literature review by searching OvidMedline in August 2019 to identify registries relating to six pre-specified domains (Table). For inclusion, registries had to be national in nature, actively collecting data, and publishing either peer-reviewed publications or online reports.
Results
A total of 24,076 records were identified from six domain-specific Medline searches; 24,057 abstracts were screened with 19,435 non-relevant records excluded; 4,624 full texts were screened with 4,473 non-relevant texts excluded; and 151 registries met inclusion criteria representing 51 countries. Of these, 15 related to cardiac surgery, 27 to arrhythmia (17 device, 5 ablation, 7 atrial fibrillation), 21 to congenital heart disease (14 general, 2 interventional, 4 surgical, and 1 disease specific), 43 to coronary disease or percutaneous coronary intervention (22 PCI, 21 CAD), 27 to heart failure (13 heart failure, 5 transplant, 2 mechanical support, 7 disease specific), and 18 related to structural intervention (3 any, 13 transcatheter aortic valve replacement, 2 mitral intervention). Nine national registries (USA, Sweden, Finland, Denmark, UK, Portugal, Norway, Taiwan, and Singapore) covered multiple domains. Quality scoring using the Monash University Clinical Quality Registry Grading System (a composite score of recruitment, and data completeness, definitions, reliability and validation), demonstrated marked heterogeneity in quality between registries.
Conclusions
Cardiac registries have seen rapid growth, however the use and quality among various subspecialties differs markedly across world regions. Given the multiple benefits, clinicians, funders and health bureaucrats should be encouraged to focus on the range, quality and uptake of national registries.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Dawson
- Royal Melbourne Hospital, Melbourne, Australia
| | - S Biswas
- Monash University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - J Lefkovits
- Royal Melbourne Hospital, Melbourne, Australia
| | - L Burchill
- Royal Melbourne Hospital, Melbourne, Australia
| | - C Reid
- Monash University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - D Eccleston
- Royal Melbourne Hospital, Melbourne, Australia
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28
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Dawson L, Dinh D, Duffy S, Brennan A, Guymer E, Clark D, Oqueli E, Freeman M, Hiew C, Reid C, Ajani A. Long-term outcomes following percutaneous coronary intervention for patients with rheumatoid arthritis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis (RA) is the most common inflammatory arthritis and is associated with increased risk of cardiovascular events and mortality. Despite this, data regarding long-term outcomes following percutaneous coronary intervention (PCI) are limited.
Methods
We identified 756 patients with RA from the Melbourne Interventional Group PCI registry (2005–2018) and compared outcomes to the remaining cohort (N=38,579). Cox regression analysis was performed to assess risk of adverse cardiac events including long-term mortality (derived from linkage with the National Death Index [NDI]).
Results
Patients with RA were older (68.9±10.0 vs. 64.6±12.0 years) and more often female (40% vs. 23%), with higher rates of hypertension (70% vs 67%), previous stroke (9% vs 6%), peripheral vascular disease (9% vs 6%), obstructive sleep apnoea (10% vs 5%), chronic lung disease (22% vs 12%), prior myocardial infarction (32% vs 27%), and impaired renal function (eGFR<60 ml/min/1.73m2 in 31% vs 24%), while rates of current smoking were lower (20% vs. 25%), all p<0.05. Lesions were more frequently complex (ACC/AHA type B2/C in 61% vs 57%), required longer stents (>20mm in 39% vs 35%), and rates of no reflow were higher (5% vs 3%), all p<0.05. 30-day mortality was higher (4.4% vs. 3.3%, p=0.04) mainly owing to higher non-cardiac mortality (1.6% vs. 0.8%, p=0.01). National Death Index-linked long-term mortality was 28% vs. 19% (p<0.01) with mean follow-up 4.6 vs. 5.4 years. Risk of 30-day and long-term mortality (including by indication subgroup) are presented in the Table.
Conclusions
Patients with RA undergoing PCI have more comorbidities and longer, more complex coronary lesions. After adjustment, risk of short-term adverse outcomes are similar, while risk of long-term mortality is higher, particularly among patients with acute coronary syndromes.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Dawson
- Royal Melbourne Hospital, Melbourne, Australia
| | - D Dinh
- Monash University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - S.J Duffy
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - A Brennan
- Monash University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - E Guymer
- Monash Health, Rheumatology, Melbourne, Australia
| | - D Clark
- Austin Hospital, Cardiology, Melbourne, Australia
| | - E Oqueli
- Deakin University, Melbourne, Australia
| | - M Freeman
- Box Hill Hospital, Cardiology, Melbourne, Australia
| | - C Hiew
- Geelong Hospital, Cardiology, Geelong, Australia
| | - C Reid
- Monash University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - A.E Ajani
- Royal Melbourne Hospital, Melbourne, Australia
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29
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Huo M, Morley L, Dawson L, Bissonnette J, Helou J, Giuliani M, Berlin A, Shultz D, Hosni A, Shessel A, Barry A. PO-1757: Peer Review in Stereotactic Body Radiotherapy: The Impact of Case Volume. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01775-8] [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: 11/28/2022]
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30
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Subramonian A, Smith D, Dicks E, Dawson L, Borgaonkar M, Etchegary H. Universal tumor screening for lynch syndrome: perspectives of patients regarding willingness and informed consent. Per Med 2020; 17:373-387. [PMID: 32875945 DOI: 10.2217/pme-2020-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Lynch Syndrome is associated with a significant risk of colorectal carcinoma (CRC) and other cancers. Universal tumor screening is a strategy to identify high-risk individuals by testing all CRC tumors for molecular features suggestive of Lynch Syndrome. Patient interest in screening and preferences for consent have been underexplored. Methods: A postal survey was administered to CRC patients in a Canadian province. Results: Most patients (81.4%) were willing to have tumors tested if universal tumor screening were available and were willing to discuss test results with family members and healthcare professionals. The majority (62.6%) preferred informed consent be obtained prior to screening. Conclusion: Patients were supportive of universal screening. They expected consent to be obtained, contrary to current practice across Canada and elsewhere.
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Affiliation(s)
- Anusree Subramonian
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | | | - Elizabeth Dicks
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Lesa Dawson
- Gynecologic Oncology, Women's Health & Genetics, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Women's Health and Genetics, Eastern Health, St John's NL, Canada
| | - Mark Borgaonkar
- Gastroenterology, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St John's, NL, Canada
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31
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Markovitz M, Lambert N, Dawson L, Hoots G. 3:36 PM Abstract No. 259 Safety and efficacy of the Inari FlowTriever device for mechanical thrombectomy in patients with acute submassive pulmonary embolism and contraindication to thrombolysis. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.306] [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: 11/26/2022] Open
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32
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Hynes J, MacMillan A, Fernandez S, Jacob K, Carter S, Predham S, Etchegary H, Dawson L. Group plus "mini" individual pre-test genetic counselling sessions for hereditary cancer shorten provider time and improve patient satisfaction. Hered Cancer Clin Pract 2020; 18:3. [PMID: 32099586 PMCID: PMC7029530 DOI: 10.1186/s13053-020-0136-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genetic counselling (GC) is an integral component in the care of individuals at risk for hereditary cancer predisposition syndromes (CPS). In many jurisdictions, access to timely counselling and testing is limited by financial constraints, by the shortage of genetics professionals and by labor-intensive traditional models of individual pre and post-test counselling. There is a need for further research regarding alternate methods of GC service delivery and implementation. This quality improvement project was initiated to determine if pretest group GC followed immediately by a 'mini' individual session, would be acceptable to patients at risk for hereditary breast and colon cancer. METHODS Patients on waitlists for GC at the Provincial Medical Genetics Program in St. John's, NL, Canada (n = 112), were contacted by telephone and offered the option of a group counselling session (GGC), followed by a "mini" individual session, versus (TGC) traditional private appointments. GGC sessions consisted of a cancer genetics information session given to groups of 6-20 followed by brief 20 min "mini" individual sessions with the patient and genetic specialist. TGC individual appointments provided the same cancer genetics information and counselling to one patient at a time in the classic model. All but 2 participants selected group+mini session. A de-identified confidential 12-item, Likert scale survey was distributed at the conclusion of mini-sessions to measure perceptions of GGC and satisfaction with this counselling model. RESULTS Sixty participants completed questionnaires. The majority of participants strongly agreed that they were comfortable with the group session (58/60); the explanation of cancer genetics was clear (54/59); they understood their cancer risks (50/60); and they would recommend such a session to others (56/59). 38/53 respondents disagreed or strongly disagreed that they would prefer to wait for a traditional private appointment. All 5 participating genetic counselors reported a preference for this model. At the end of the pilot project, the waitlist for counselling/testing was reduced by 12 months. CONCLUSIONS Group pre-test genetic counselling combined with immediate "mini" individual session is strongly supported by patients and reduces wait times. Additional formal investigation of this approach in larger numbers of patients is warranted.
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Affiliation(s)
- Jaclyn Hynes
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador Canada
| | - Andrée MacMillan
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Sara Fernandez
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Karen Jacob
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Shannon Carter
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Sarah Predham
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Holly Etchegary
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador Canada
| | - Lesa Dawson
- Gynecologic Oncology, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador Canada
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33
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Bekooij T, Gilhuis H, Dawson L, Niks E. Dysautonomia as the Presenting Symptom in Anti-Muscle-Specific Kinase Antibody Myasthenia Gravis. J Neuromuscul Dis 2020; 7:47-50. [DOI: 10.3233/jnd-190411] [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: 11/15/2022]
Affiliation(s)
- T.J.S. Bekooij
- Department of Neurology, Haaglanden Medical Centre Westeinde, The Hague, The Netherlands
| | - H.J. Gilhuis
- Department of Neurology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - L. Dawson
- Department of Neurology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - E.H. Niks
- Department of Neurology, Leiden University Medical Centre, The Netherlands
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34
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Dawson L, Biswas S, Stub D, Lefkovits J, Burchill L, Reid C, Eccleston D. 514 National Cardiac Registries: A Systematic Review. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.521] [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: 10/23/2022]
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35
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Dawson L, Biswas S, Burchill L, Stub D, Lefkovits J, Reid C, Eccleston D. 664 Heterogeneity of Design and Quality Among National Congenital Heart Disease Registries. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.671] [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: 11/16/2022]
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36
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Calle M, Dawson L, Rojas M, Loetz E. 151 Influence of chorionic gonadotrophin, breeding procedure, and gonadotrophin-releasing hormone on pregnancy, embryo viability, and kidding rate of lactating Alpine goats time inseminated during the early transitional reproductive phase. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Oestrus and ovulation synchronisation (E/OS) regimens containing equine chorionic gonadotrophin (ECG) are used for follicular stimulation during the early transitional reproductive phase and goat anestrus. However, the effects of ECG when applied at different times are unknown. Thus, the objective was to evaluate the influence of ECG, breeding procedure, and gonadotrophin-releasing hormone (GnRH) on pregnancy, embryonic viability, and kidding rate in dairy goats. We used 41 alpine goats (mean±standard deviation: 3.82±1.2 years old; 57.0±6.0kg of bodyweight; 1.75-2.25 body condition score; 195±16.7 days in milk; range of 1-4 kiddings). This study took place during the transitional phase (12h of daylight, 12h of dark) in September (35.9° N, 97.3° W) using controlled internal drug release intravaginal inserts (300mg of progestagen; P4) for 11, 12, or 13 days with a 2-mL intramuscular dose containing 10mg of dinoprost tromethamine at P4 removal. The E/OS protocols differed on the time when the 1-mL intramuscular dose of P.G. 600© (Merck Animal Health; 120 and 60IU of ECG and human chorionic gonadotrophin, respectively) was given (i.e. early=24h before P4 removal; late=24h after P4 removal), and the traditional control group did not receive P.G. 600. Time breeding, either by laparoscopic-aided insemination using frozen-thawed semen (n=28) or natural (n=13), was scheduled 48h after P4 removal. To improve embryo survival, 5 days post-breeding (dpb) 21 goats received 1mL of GnRH analogue intramuscularly as 50µgmL−1 gonadorelin diacetate tetrahydrate, and 20 control goats received 1mL of placebo intramuscularly. Pregnancy rate (PR) was evaluated at d 18-24 by non-return to oestrus, d 30 by pregnancy-specific protein B, and d 40 by ultrasound. Kidding rate was determined for females with at least one newborn. Logistic regression was used to establish statistical significance. Days of P4 exposure did not influence any response variable (P>0.20). Table 1 summarises the results; age influenced all PR evaluations. The number of kiddings and administration of GnRH at 5 dpb had a significant effect on PR, whereas bodyweight, days in milk, E/OS protocol, and breeding procedure were not influential. Embryo viability and kidding rate were not influenced by any variable. In short, P.G. 600 had no bearing on any response variable analysed. Late-lactating goats can be evaluated early in the transitional breeding phase using PR at 18-24, 30, or 40 dpb. As indicated by the lack of effect on embryo viability at 30 and 40 days, the mechanism by which GnRH increases PR was not by decreasing embryo mortality.
Table 1.Logistic model independent variable probabilities on response variables1
Response variable
Age (years)
BW
Kidding
DIM
E/OS protocol
GnRH
Breeding procedure
PR 18-24 d
0.02
0.65
0.15
0.52
0.37
0.21
0.30
PR 30 d
0.01
0.56
0.05
0.58
0.61
0.05
0.39
PR 40 d
0.001
0.12
0.01
0.60
0.62
0.02
0.35
EV 30 d
0.62
0.96
0.61
0.63
0.30
0.32
0.36
EV 40 d
0.44
0.90
0.26
0.36
0.46
0.17
0.40
KR
0.83
0.93
0.63
0.86
0.42
0.29
0.35
1BW=body weight; DIM=days in milk; E/OS=oestrus/ovulation synchronisation; GnRH=gonadotrophin-releasing hormone; PR=pregnancy rate; EV=embryo viability at 30 and 40 d; KR=kidding rate.
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Dawson L, Dinh D, Duffy S, Brennan A, Guymer E, Clark D, Oqueli E, Freeman M, Hiew C, Reid C, Ajani A. 861 Outcomes of Percutaneous Coronary Intervention Among Patients With Rheumatoid Arthritis. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.868] [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: 11/26/2022]
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Lukovic J, Kim J, Liu A, Ringash J, Brierley J, Wong R, Barry A, Dawson L, Cummings B, Krzyzanowska M, Chen E, Hedley D, Prince R, Quereshy F, Easson A, Swallow C, Gryfe R, Kennedy E, Hosni A. EP-1473 Anal adenocarcinoma: a comprehensive review of management practices and clinical outcomes. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Seal MD, Roebothan A, Gabriel A, Dawson L. Abstract P5-09-17: Risk reducing interventions among BRCA 1 and 2 female carriers in Newfoundland and Labrador: A provincial analysis. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Germline mutations in the tumour suppressor genes BRCA 1 and 2 result in a significant increase in cancer predisposition. Female carriers can have up to a 50-70% chance of developing a breast malignancy in their life time and a risk of 20-40% for ovarian cancer. Management options for women with a BRCA mutation include screening with annual mammography and magnetic resonance imaging (MRI), prophylactic surgery and chemoprevention. There is substantial evidence that preventative strategies may reduce the risk of developing breast and ovarian cancer and in some cases improve survival.
Newfoundland and Labrador (NL) is the most easterly province in Canada with a population of 525 983. It is geographically and genetically isolated with the majority of residents from English and Irish ancestry. While no one single founder effect has been identified, geographically distinct mutations for both BRCA 1 and 2 have been described. The objective of this study is to characterize the population of BRCA mutation carriers in NL and to evaluate their uptake of risk reducing interventions.
Methods
All BRCA 1 and 2 carriers tested through the Provincial Medical Genetics program between 1996 - 2018 were captured. Inclusion criteria for this study were females ≥ 18 years of age residing in the province. Demographic, clinical history and information on uptake of risk reducing interventions were abstracted from the electronic medical record. Descriptive statistical analysis was performed.
Results
One hundred and sixty one women were identified that met inclusion criteria (38% of patients had BRCA1 and 62% had BRCA 2 mutations). Of those unaffected carriers eligible for mammography and MRI screening, only 58% were adherent in the last 18 months. Consultation with a medical or gynecological oncologist increased mammogram screening within the last 18 months to 71% compared with 29% of women who did not see an oncologist. MRI screening increased to 80% for those assessed by oncology versus 20% who did not. For those women who underwent prophylactic surgeries, 27% had bilateral mastectomies with the majority having breast reconstruction (>70%). Fifty two percent of carriers had bilateral salpingo-oophorectomies (BSO) at a median age of 45 years in BRCA 1 and 51 years in BRCA 2.
Fifty-three women had a diagnosis of breast cancer and 8 had ovarian cancer. In this cohort, most underwent genetic testing after their diagnosis of cancer (>80%). Median age at presentation of breast cancer was 44 years versus 54 years for ovarian cancer.
Conclusion
This study demonstrates that women with BRCA 1 and 2 mutations are not adequately availing of risk reducing interventions for breast and ovarian cancer. Furthermore, most patients with malignancy did not undergo genetic testing until after they were diagnosed with cancer. Patient focused research designed to explore factors which may contribute is planned. Consultation with an oncologist increased the likelihood of adherence to breast cancer screening. This highlights the importance of specialty care for patients with a hereditary predisposition to breast and ovarian cancer.
Citation Format: Seal MD, Roebothan A, Gabriel A, Dawson L. Risk reducing interventions among BRCA 1 and 2 female carriers in Newfoundland and Labrador: A provincial analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-17.
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Affiliation(s)
- MD Seal
- Memorial University, St. John's, NL, Canada
| | | | - A Gabriel
- Memorial University, St. John's, NL, Canada
| | - L Dawson
- Memorial University, St. John's, NL, Canada
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Dagan M, Dawson L, Stehli J, Koh S, Quine E, Walton A, Stub D, Htun N, Duffy S. Incidence, Predictors and Outcomes of Myocardial Injury Following Transcatheter Aortic Valve Implantation (TAVI). Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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41
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Koh J, Stehli J, Martin C, Quine E, Dagan M, Dawson L, Dong M, Crawford C, Htun N, Stub D, Walton A, Duffy S. Impact of Left Ventricular Ejection Fraction on Outcomes Following Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.629] [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: 11/28/2022]
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42
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Pol D, Yao J, Deutscher E, Dawson L, Brooks M. Trends in Management of Dyslipidaemia in Australia Over the Last 5 Years. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Montalto S, Dawson L, Yao J, Velusamy R, Pol D, Blusztein D, Wong J, Grigg L, Wilson W, Brooks M, Gurvitch R. Impact of Pulmonary Hypertension on Outcome Following Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.632] [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: 11/26/2022]
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Koh J, Stehli J, Martin C, Quine E, Dagan M, Dawson L, Htun N, Stub D, Walton A, Duffy S. Predictors of Clinical Outcomes Following Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.669] [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: 11/26/2022]
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Dawson L, Cadden J, Pol D, Stephenson I. Learning Curve and Initial Experience of Implementing a HIS Bundle Pacing Program. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.198] [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: 11/27/2022]
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Dawson L, Dinh D, Duffy S, Brennan A, Clark D, Reid C, Blusztein D, Stub D, Andrianopoulos N, Freeman M, O’Queli E, Hutchison A, Ajani A. Percutaneous Coronary Intervention Outcomes Following Out-of-Hospital Cardiac Arrest For Patients With and Without ST-Elevation Myocardial Infarction. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pol D, Gurvitch R, Blusztein D, Dawson L, Wilson W. Outcomes of Tricuspid Valve in Valve Implantation Via Trans-jugular and Transfemoral Approach. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.663] [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]
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Dawson L, Yao J, Velusamy R, Montalto S, Pol D, Blusztein D, Wong J, Grigg L, Wilson W, Brooks M, Gurvitch R. Long-term Outcomes With Non-Femoral Access for Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Koh J, Stehli J, Martin C, Dagan M, Dawson L, Liew S, Htun N, Stub D, Walton A, Duffy S. Ten-year Trends in Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Blusztein D, Wilson W, Brooks M, Pol D, Dawson L, Montalto S, Gurvitch R. Transcatheter Aortic Valve Implantation in the Very Large Annulus – Beyond the “Recommended Retail”. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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