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Chu D, Lessard D, Laymouna MA, Engler K, Schuster T, Ma Y, Kronfli N, Routy JP, Hijal T, Lacombe K, Sheehan N, Rougier H, Lebouché B. Understanding the Risks and Benefits of a Patient Portal Configured for HIV Care: Patient and Healthcare Professional Perspectives. J Pers Med 2022; 12:jpm12020314. [PMID: 35207803 PMCID: PMC8880024 DOI: 10.3390/jpm12020314] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Like other chronic viral illnesses, HIV infection necessitates consistent self-management and adherence to care and treatment, which in turn relies on optimal collaboration between patients and healthcare professionals (HCPs), including physicians, nurses, pharmacists, and clinical care coordinators. By providing people living with HIV (PLHIV) with access to their personal health information, educational material, and a communication channel with HCPs, a tailored patient portal could support their engagement in care. Our team intends to implement a patient portal in HIV-specialized clinics in Canada and France. We sought to understand the perceived risks and benefits among PLHIV and HCPs of patient portal use in HIV clinical care. Methods: This qualitative study recruited PLHIV and HIV-specialized HCPs, through maximum variation sampling and purposeful sampling, respectively. Semi-structured focus group discussions (FGDs) were held separately with PLHIV and HCPs between August 2019 and January 2020. FGDs were recorded, transcribed, coded using NVivo 12 software, and analyzed using content analysis. Results: A total of twenty-eight PLHIV participated in four FGDs, and thirty-one HCPs participated in six FGDs. PLHIV included eighteen men, nine women, and one person identifying as other; while, HCPs included ten men, twenty women, and one person identifying as other. A multi-disciplinary team of HCPs were included, involving physicians, nurses, pharmacists, social workers, and clinical coordinators. Participants identified five potential risks: (1) breach of confidentiality, (2) stress or uncertainty, (3) contribution to the digital divide, (4) dehumanization of care, and (5) increase in HCPs’ workload. They also highlighted four main benefits of using a patient portal: (1) improvement in HIV self-management, (2) facilitation of patient visits, (3) responsiveness to patient preferences, and (4) fulfillment of current or evolving patient needs. Conclusion: PLHIV and HCPs identified both risks and benefits of using a patient portal in HIV care. By engaging stakeholders and understanding their perspectives, the configuration of a patient portal can be optimized for end-users and concerns may be mitigated during its implementation.
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Affiliation(s)
- Dominic Chu
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (M.A.L.); (T.S.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
| | - David Lessard
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
| | - Moustafa A. Laymouna
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (M.A.L.); (T.S.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
| | - Kim Engler
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (M.A.L.); (T.S.)
| | - Yuanchao Ma
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, QC H3C 3A7, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
| | - Jean-Pierre Routy
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Karine Lacombe
- Faculté de Médecine, Sorbonne Université, Inserm IPLESP, Hôpital St Antoine, APHP, 75012 Paris, France;
| | - Nancy Sheehan
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
- Faculté de Pharmacie, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Hayette Rougier
- IMEA, Institut de Médecine et d’Épidémiologie Appliquée, F75018 Paris, France;
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (M.A.L.); (T.S.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
- Correspondence: ; Tel.: +1-514-843-2090
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Isnard S, Fombuena B, Ouyang J, Royston L, Lin J, Bu S, Sheehan N, Lakatos PL, Bessissow T, Chomont N, Klein M, Lebouché B, Costiniuk CT, Routy B, Marette A, Routy JP. Camu Camu effects on microbial translocation and systemic immune activation in ART-treated people living with HIV: protocol of the single-arm non-randomised Camu Camu prebiotic pilot study (CIHR/CTN PT032). BMJ Open 2022; 12:e053081. [PMID: 35039291 PMCID: PMC8765027 DOI: 10.1136/bmjopen-2021-053081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/12/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Despite the success of antiretroviral therapy (ART) in transforming HIV disease into a chronic infection, people living with HIV (PLWH) remain at risk for various non-AIDS inflammatory comorbidities. Risk of non-AIDS comorbidities is associated with gut dysbiosis, epithelial gut damage and subsequent microbial translocation, and increased activation of both circulating CD4+ and CD8+ T-cells. Therefore, in addition to ART, novel gut microbiota-modulating therapies could aid in reducing inflammation and immune activation, gut damage, and microbial translocation. Among various gut-modulation strategies under investigation, the Amazonian fruit Camu Camu (CC) presents itself as a prebiotic candidate based on its anti-inflammatory and antioxidant properties in animal models and tobacco smokers. METHOD AND ANALYSIS A total of 22 PLWH on ART for more than 2 years, with a viral load <50 copies/mL, a CD4 +count >200 and a CD4+/CD8 +ratio <1 (suggesting increased inflammation and risk for non-AIDS comorbidities), will be recruited in a single arm, non-randomised, interventional pilot trial. We will assess tolerance and effect of supplementation with CC in ART-treated PLWH on reducing gut damage, microbial translocation, inflammation and HIV latent reservoir by various assays. ETHICS AND DISSEMINATION The Canadian Institutes of Health Research (CIHR)/Canadian HIV Trials Network (CTN) pilot trial protocol CTNPT032 was approved by the Natural and Non-prescription Health Products Directorate of Health Canada and the research ethics board of the McGill university Health Centre committee (number 2020-5903). Results will be made available as free access through publications in peer-reviewed journals and through the CIHR/CTN website. TRIAL REGISTRATION NUMBER NCT04058392.
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Affiliation(s)
- Stéphane Isnard
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Canadian HIV Trials Network, Canadian Institutes for Health Research, Vancouver, British Columbia, Canada
| | - Brandon Fombuena
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jing Ouyang
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Chongqing Public Health Medical Center, Chongqing, People's Republic of China
| | - Léna Royston
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Canadian HIV Trials Network, Canadian Institutes for Health Research, Vancouver, British Columbia, Canada
| | - John Lin
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Simeng Bu
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nancy Sheehan
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter L Lakatos
- Division of Gastroentrology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Talat Bessissow
- Division of Gastroentrology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicolas Chomont
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marina Klein
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cecilia T Costiniuk
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Routy
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - André Marette
- Insitute of Nutrition and Functional food, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Cardiology Axis of the Quebec Heart and Lung Institute, Laval University, Quebec city, Quebec, Canada
| | - Jean-Pierre Routy
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Hematology, McGill University Health Centre, Montreal, Quebec, Canada
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3
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Pelzek C, Kellihan HB, Sheehan N, Powers A, Peek SF. Aortopulmonary window, left coronary artery aneurysm, and redundant aortic valve leaflet in a calf: the use of multimodal imaging to diagnose congenital heart disease. J Vet Cardiol 2021; 34:48-54. [PMID: 33561812 DOI: 10.1016/j.jvc.2021.01.003] [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: 08/27/2020] [Revised: 12/20/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
A 2-month-old male Holstein calf was presented for evaluation of a continuous systolic murmur. A grade V/VI left basilar continuous murmur and a grade IV/VI right basilar continuous murmur was auscultated upon evaluation with increased respiratory effort, wheezes, and crackles. Multimodality diagnostics were performed on this patient for further workup and included transthoracic and transesophageal echocardiography, fluoroscopy guided angiography, and gross necropsy with histopathology. An aortopulmonary window with continuous left-to-right shunting was identified at the level of the left aortic sinus of Valsalva with a severely dilated left coronary artery and left-sided congestive heart failure. This case report outlines the diagnostic workup of a rare congenital heart defect and secondary cardiac abnormalities not previously identified in veterinary literature.
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Affiliation(s)
- C Pelzek
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA
| | - H B Kellihan
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA.
| | - N Sheehan
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA
| | - A Powers
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA
| | - S F Peek
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA
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4
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Kronfli N, Linthwaite B, Sheehan N, Cox J, Hardy I, Lebouché B, de Pokomandy A, Frenette C, Roger M, Klein MB. Delayed linkage to HIV care among asylum seekers in Quebec, Canada. BMC Public Health 2019; 19:1683. [PMID: 31842822 PMCID: PMC6916083 DOI: 10.1186/s12889-019-8052-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada. Methods We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral. Results Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation. Conclusions While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada. .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nancy Sheehan
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Faculté de Pharmacie, Université de Montréal, Montreal, Quebec, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Hardy
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra de Pokomandy
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Charles Frenette
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada
| | - Michel Roger
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
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5
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Sanche S, Sheehan N, Mesplède T, Wainberg MA, Li J, Nekka F. A Mathematical Model to Predict HIV Virological Failure and Elucidate the Role of Lymph Node Drug Penetration. CPT Pharmacometrics Syst Pharmacol 2017; 6:469-476. [PMID: 28556627 PMCID: PMC5706346 DOI: 10.1002/psp4.12200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/28/2017] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
Abstract
Preventing virological failure following HIV treatment remains a difficult task that is further complicated by the emergence of drug resistance. We have developed a mathematical model able to explain and predict HIV virological outcomes for various compounds and patients' drug intake patterns. Compared to current approaches, this model considers, altogether, drug penetration into lymph nodes, a refined adherence representation accounting for the propensity for long drug holidays, population pharmacokinetic and pharmacodynamic variability, drug interaction, and crossresistance. In silico results are consistent with clinical observations for treatment with efavirenz, efavirenz in association with tenofovir DF and emtricitabine, or boosted darunavir. Our findings indicate that limited lymph node drug penetration can account for a large proportion of cases of virological failure and drug resistance. Since a limited amount of information is required by the model, it can be of use in the process of drug discovery and to guide clinical treatment strategies.
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Affiliation(s)
- S Sanche
- Faculté de Pharmacie de l'Université de Montréal, Montréal, Québec, Canada
| | - N Sheehan
- Faculté de Pharmacie de l'Université de Montréal, Montréal, Québec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montréal, Québec, Canada.,McGill University AIDS Centre, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - T Mesplède
- McGill University AIDS Centre, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - M A Wainberg
- McGill University AIDS Centre, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - J Li
- Faculté de Pharmacie de l'Université de Montréal, Montréal, Québec, Canada
| | - F Nekka
- Faculté de Pharmacie de l'Université de Montréal, Montréal, Québec, Canada
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Kreutzwiser D, Sheehan N, Dayneka N, Lemire B, Wong A, Samson L, Brophy J. Therapeutic drug monitoring guided raltegravir dosing for prevention of vertical transmission in a premature neonate born to a woman living with perinatally acquired HIV. Antivir Ther 2017; 22:545-549. [PMID: 28198351 DOI: 10.3851/imp3139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
We report a case of therapeutic drug monitoring guided raltegravir use for the prevention of vertical HIV transmission in a premature neonate born to a woman living with perinatally acquired HIV and documented resistance to multiple HIV drugs. Maternal viral load was above 1,000 copies/ml at delivery. This case demonstrates delayed raltegravir elimination in a neonate born at 33 weeks gestational age and a need for less frequent raltegravir dosing than is used in older infants and children.
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Affiliation(s)
- Denise Kreutzwiser
- McGill University Health Centre, Chronic Viral Illness Service, Montréal, QC, Canada.,Toronto General Hospital, University Health Network, Immunodeficiency Clinic, Toronto, ON, Canada.,University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, ON, Canada
| | - Nancy Sheehan
- McGill University Health Centre, Chronic Viral Illness Service, Montréal, QC, Canada.,McGill University Health Centre, Québec Antiretroviral Therapeutic Drug Monitoring Program, Montréal, QC, Canada.,Université de Montréal, Faculté de Pharmacie, Montréal, QC, Canada
| | | | - Benoît Lemire
- McGill University Health Centre, Chronic Viral Illness Service, Montréal, QC, Canada.,McGill University Health Centre, Québec Antiretroviral Therapeutic Drug Monitoring Program, Montréal, QC, Canada
| | - Alison Wong
- McGill University Health Centre, Chronic Viral Illness Service, Montréal, QC, Canada.,McGill University Health Centre, Québec Antiretroviral Therapeutic Drug Monitoring Program, Montréal, QC, Canada
| | - Lindy Samson
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada
| | - Jason Brophy
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada
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7
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Daher Z, Thibeault D, Blank D, Sheehan N. Simplified off-line sample preparation method combined with on-line trapping technique on LC–MS/MS for antiretroviral drug measurement. Clin Biochem 2012. [DOI: 10.1016/j.clinbiochem.2012.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Tseng A, Foisy M, Hughes CA, Kelly D, Chan S, Dayneka N, Giguère P, Higgins N, Hills-Nieminen C, Kapler J, la Porte CJL, Nickel P, Park-Wyllie L, Quaia C, Robinson L, Sheehan N, Stone S, Sulz L, Yoong D. Role of the Pharmacist in Caring for Patients with HIV/AIDS: Clinical Practice Guidelines. Can J Hosp Pharm 2012; 65:125-45. [PMID: 22529405 PMCID: PMC3329905 DOI: 10.4212/cjhp.v65i2.1120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alice Tseng
- , BScPhm, PharmD, FSCHP, AAHIVP, is with the Immunodeficiency Clinic of the Toronto General Hospital, Toronto, Ontario
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Carvalhal A, Baril JG, Crouzat F, De Wet J, Junod P, Kovacs C, Sheehan N. Recognizing cognitive and psychiatric changes in the post-highly active antiretroviral therapy era. Can J Infect Dis Med Microbiol 2012; 23:209-15. [PMID: 24294277 PMCID: PMC3597400 DOI: 10.1155/2012/652131] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Amid numerous complications that plague the health and quality of life of people living with HIV, neurocognitive and psychiatric illnesses pose unique challenges. While there remains uncertainty with respect to the pathophysiology surrounding these disorders, their adverse implications are increasingly recognized. Left undetected, they have the potential to significantly impact patient well being, adherence to antiretroviral treatment and overall health outcomes. As such, early identification of HIV-associated neurocognitive disorders (HAND) and psychiatric illnesses will be paramount in the proactive management of affected patients. The present review focuses on strategies to ensure optimal screening and detection of HAND, depression and substance abuse in routine practice. For each topic, currently available screening methods are discussed. These include identification of risk factors, recognition of relevant symptomatology and an update on validated screening tools that can be efficiently implemented in the clinical setting. Specifically addressed in the present review are the International HIV Dementia Scale, a novel screening equation and algorithm for HAND, as well as brief, validated, verbal questionnaires for detection of depression and substance abuse. Adequate understanding and usage of these screening mechanisms can ensure effective use of resources by distinguishing patients who require referral for more extensive diagnostic procedures from those who likely do not.
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Affiliation(s)
| | | | | | - Joss De Wet
- Spectrum Health, Department of Family and Community Medicine, University of British Columbia, Vancouver, British Columbia
| | | | - Colin Kovacs
- Maple Leaf Medical Clinic, Toronto, Ontario
- Department of Internal Medicine, University of Toronto, Toronto, Ontario
| | - Nancy Sheehan
- Immunodeficiency Service, Montréal Chest Institute, McGill University Health Centre and Faculté de pharmacie, Université de Montréal, Montréal, Québec
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10
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Abstract
Discrimination against people with experience of mental illness is a recognised problem, and there is a lack of information in New Zealand regarding the nature of this discrimination. The Like Minds, Like Mine project is a New Zealand initiative to combat the stigma and discrimination associated with mental illness. This paper reports on a study undertaken as part of this initiative, and describes the nature of discrimination that people with experience of mental illness face in New Zealand. A written survey was undertaken with people with experience of mental illness from throughout New Zealand, using a mixture of qualitative and quantitative questions. This questionnaire was distributed throughout the country in 2003, using a variety of distribution methods, and 785 responses were received and analysed from people self-identifying as having experienced mental illness. Respondents reported discrimination in all areas of their lives. The most commonly reported areas were discrimination by friends and family (59%), a fear of being discriminated against (46%), and discrimination in looking for employment (34%) and mental health services (34%). Discrimination can limit the participation of people with experience of mental illness in our society. We all need to examine our own attitudes and behaviours and take responsibility for discrimination.
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Affiliation(s)
- Deborah Peterson
- Mental Health Foundation of New Zealand, Wellington, New Zealand.
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11
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Boland M, Sayers G, Coleman T, Bergin C, Sheehan N, Creamer E, O'Connell M, Jones L, Zochowski W. A cluster of leptospirosis cases in canoeists following a competition on the River Liffey. Epidemiol Infect 2004; 132:195-200. [PMID: 15061493 PMCID: PMC2870094 DOI: 10.1017/s0950268803001596] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
On 6 November 2001, a possible case of leptospirosis was notified in a canoeist following a white-water event on the River Liffey. It emerged that a second race participant was also a possible case. An outbreak control team coordinated the epidemiological investigation, laboratory investigation, environmental assessment, communication and control measures. A cluster of six laboratory-confirmed cases of leptospirosis, serologically Leptospira interrogans serogroup Icterohaemorrhagiae was found. The attack rate was 9.2% (6/65). Fever, chills, red eyes and shortness of breath were significantly associated with being a confirmed case. Five cases were hospitalized. Swallowing more than one mouthful of water was associated with an increased risk of developing leptospirosis. Increased rainfall and release of hydroelectric water may have contributed to this outbreak. A multidisciplinary approach and use of the Internet and e-mail facilitated rapid and effective communication.
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Affiliation(s)
- M Boland
- Department of Public Health, Eastern Regional Health Authority, Dublin
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12
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Jensen CS, Sheehan N. Problems with determination of noncommunicating classes for Monte Carlo Markov chain applications in pedigree analysis. Biometrics 1998; 54:416-25. [PMID: 9629636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Exact calculations for probabilities on complex pedigrees are computationally intensive and very often infeasible. Markov chain Monte Carlo methods are frequently used to approximate probabilities and likelihoods of interest. However, when a locus with more than two alleles is considered, the underlying Markov chain is not guaranteed to be irreducible and the results of such analyses are unreliable. A method for finding the noncommunicating classes of the Markov chain would be very useful in designing algorithms that can jump between these classes. In this paper, we will examine some existing work on this problem and point out its limitations. We will also comment on the difficulty of developing a useful algorithm.
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Affiliation(s)
- C S Jensen
- Department of Mathematics and Computer Science, Aalborg University, Denmark
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13
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Jensen CS, Sheehan N. Problems with Determination of Noncommunicating Classes for Monte Carlo Markov Chain Applications in Pedigree Analysis. Biometrics 1998. [DOI: 10.2307/3109752] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Bansal A, Cannings C, Sheehan N. An evaluation of the application of the genetic algorithm to the problem of ordering genetic loci on human chromosomes using radiation hybrid data. IMA J Math Appl Med Biol 1997; 14:161-87. [PMID: 9306673] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We consider the problem of ordering detectable genetic loci along a chromosome by minimizing the number of obligatory breaks that can be inferred from radiation hybrid data. The problem bears some resemblance to the travelling-salesman problem, for which genetic algorithms have been used with considerable success. We find that the results from other studies on closely related problems are not directly transferable, and although we did find a genetic algorithm that performed well in this application it would appear that this algorithm is highly sensitive to any changes in the problem. Moreover, a very simple stochastic algorithm performed almost as well as our much more complicated and computer-intensive genetic algorithm and it did so in a fraction of the time. While we do not dispute that genetic algorithms can work on large complicated problems, the various modifications and fine-tuning necessary for good performance tend to be highly problem specific and they are often only arrived at after an exhaustive exploration of possibilities. Thus, we would dispute any claim that genetic algorithms are robust in their form and range of applicability.
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Affiliation(s)
- A Bansal
- School of Mathematics and Statistics, University of Sheffield, UK
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15
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Healy M, O’Moore R, Keane EM, Coakley D, Walsh JB, Tully M, Swanwick G, Coen R, Bruce I, O’Mahony D, Radic A, O’Kelly F, O’Doherty M, Lawlor BA, Lee H, Conway J, Keane E, Ng K, Murphy S, Khaw KT, May H, Compston JE, Taggart H, Crawford V, Twomey C, Delaney L, Crowley M, Hyland M, Hegarty V, Donovan MC, Pye M, Reardon M, Coleman P, Hyland CM, Scott T, Keane CT, Farragher B, O’Connor A, Quinn E, Mahony D, Rowan M, Buggy F, Freyne A, Wrigley M, Passmore AP, Crawford VLS, Beringer TRO, Gilmore DH, Hussain A, Grant D, Montgomery A, Hemeryck L, McCormack PME, Sheehan N, Guely A, Leonard L, Caulfield D, Nic Cártaigh M, Feely J, Mulkerrin E, Clark BA, Epstein FH, Keane N, McCabe E, Shepherd M, O’Donnell MJ, Cooper RA, Nurzaman M, Brooks RW, Sinha SK, Kane D, McKiernan M, Crowe J, Lennon J, Sheehan J, Rearden M, Hyland M, Tracey F, Lawson JT, Stout RW, Williams H, Naguib M, O’Keefe S, Lavan J, Madigan SM, McNulty H, Eaton-Evans J, Strain JJ, Stanwick G, Horgan F, Keating D, Crowe M, McNamara A, Leahy P, Healy S, Moraes D, Tyrell J, Crawford VLS, O’Keeffe S, Glasgow R, Tormey W, Finucane P, Nair BK, McCann C, Coen RF, O’Boyle CA, Joyce CRB, Hiltbrunner B, Clarke R, Cooney J. Irish Gerontological Society. Ir J Med Sci 1994. [DOI: 10.1007/bf02940568] [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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Abstract
This paper demonstrates how the number of possible genotypic assignments consistent with the rules of Mendelian genetics and with any known phenotypes can be calculated for an arbitrary genealogy. This is of interest both in the contest of the uses of the Metropolis algorithm for pedigree analysis and in its own right. Bounds on the number of states for certain regular and random genealogies are also obtained, and further results will be given in a later paper.
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Affiliation(s)
- N Camp
- School of Mathematics and Statistics, University of Sheffield, UK
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17
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Sheehan N, Thomas A. On the irreducibility of a Markov chain defined on a space of genotype configurations by a sampling scheme. Biometrics 1993; 49:163-75. [PMID: 8513101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Techniques from image processing are now being considered for use in pedigree analysis. Although the method that we develop here was motivated by considering it as an analogue to the Gibbs sampler, we justify it independently using the ergodic theorem for aperiodic, irreducible, finite Markov chains. While it is trivial to show that aperiodicity holds, irreducibility is a more interesting condition. Proofs of irreducibility are provided for some special cases and counterexamples are provided for others. Where irreducibility does not hold, an alternative method using relaxed genetic parameters and rejection is recommended and justified.
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Affiliation(s)
- N Sheehan
- School of Mathematical Sciences, University of Bath, Claverton Down, England
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18
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Sheehan N. Sampling genotypes on complex pedigrees with phenotypic constraints: the origin of the B allele among the Polar Eskimos. IMA J Math Appl Med Biol 1992; 9:1-18. [PMID: 1500799 DOI: 10.1093/imammb/9.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Exact probability calculations are often infeasible on large complex pedigrees. Conditional independences, however, occurring as a natural consequence of Mendelian inheritance of genetic traits, define a locally dependent Markov random field on the state space of all genotypic configurations on the pedigree. The underlying Markov chain is irreducible for most traits determined by a diallelic locus. For a given pedigree and a known genetic model, the Gibbs sampler can be used to obtain good estimates of the posterior distribution of genotypes given the observed data. The areas of pedigree analysis to which such an approach would be most directly relevant include genetic counselling and selective animal breeding, together with questions about ancestral genotypes and the ancestral paths of rare alleles. The method is illustrated by tracing the ancestral paths of a rare allele in a simple diallelic system on a highly complex Eskimo pedigree.
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Affiliation(s)
- N Sheehan
- School of Mathematical Sciences, University of Bath, UK
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19
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Cook S, Gray WJ, Byrnes DP, McKinstry CS, O’Sullivan MGJ, Connolly EA, Buckley TF, Reid V, McCullagh PJ, Wallace WFM, McClelland RJ, Hutchinson M, Kirker S, Connolly S, Hawkins SA, Douglas J, McMillan SA, McNeill TA, Lyttle JA, O’Donovan C, Murphy S, Farrell MA, Phillips J, Devlin J, McLaughlin B, McCormack D, Stefani L, Bymes D, Mirakhur M, Coleman C, Eustace P, Fitzgerald J, Bouchier-Hayes D, Kui-Chung L, Patterson V, Roberts G, Trimble E, O’Donohoe NV, Forsythe I, Khan T, McKinstry CS, Bell KE, Young S, O’Neill P, Phillips J, Farrell MA, Keohane C, Galvin RJ, Buckley TF, McMenamin J, Norse C, Bolger C, Coakley D, Malone J, Martin E, Hutchinson M, Sheridan M, Sheehan N, Avaria MA, Patterson VH, Robinson F, Haller A, Patterson V, Kirker S, Browne P, Martin EA, Cotell E, Hutchinson M, Harrington MG. Irish Neurological association. Ir J Med Sci 1990. [DOI: 10.1007/bf02937243] [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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Asherson RA, Mercey D, Phillips G, Sheehan N, Gharavi AE, Harris EN, Hughes GR. Recurrent stroke and multi-infarct dementia in systemic lupus erythematosus: association with antiphospholipid antibodies. Ann Rheum Dis 1987; 46:605-11. [PMID: 3116954 PMCID: PMC1002208 DOI: 10.1136/ard.46.8.605] [Citation(s) in RCA: 136] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Four patients with recurrent stroke and multi-infarct dementia are presented in whom the dementia was progressive and severe. Three of the patients developed the dementia during the course of an illness which was punctuated by repeated episodes of cerebral infarction demonstrated by computed tomographic (CT) scans. The fourth patient presented with an illness dominated by progressive and deteriorating higher mental functions, which culminated in a major stroke 18 months later. Three patients fulfilled the American Rheumatism Association (ARA) criteria for the classification of systemic lupus erythematosus, the fourth had a 'lupus-like' disease. All had livedo reticularis, severe migraines, and also demonstrated antibodies to phospholipids. All four patients suffered deep vein thromboses.
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Affiliation(s)
- R A Asherson
- Lupus Arthritis Research Unit, Rayne Institute, St Thomas's Hospital, London
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21
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