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Mathews M, Hedden L, Lukewich J, Marshall EG, Meredith L, Moritz L, Ryan D, Spencer S, Brown JB, Gill PS, Wong EKW. Adapting care provision in family practice during the COVID-19 pandemic: a qualitative study exploring the impact of primary care reforms in four Canadian regions. BMC Prim Care 2024; 25:109. [PMID: 38582824 PMCID: PMC10998349 DOI: 10.1186/s12875-024-02356-x] [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] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Over the past two decades, Canadian provinces and territories have introduced a series of primary care reforms in an attempt to improve access to and quality of primary care services, resulting in diverse organizational structures and practice models. We examine the impact of these reforms on family physicians' (FPs) ability to adapt their roles during the COVID-19 pandemic, including the provision of routine primary care. METHODS As part of a larger case study, we conducted semi-structured qualitative interviews with FPs in four Canadian regions: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. During the interviews, participants were asked about their personal and practice characteristics, the pandemic-related roles they performed over different stages of the pandemic, the facilitators and barriers they experienced in performing these roles, and potential roles FPs could have filled. Interviews were transcribed and a thematic analysis approach was applied to identify recurring themes in the data. RESULTS Sixty-eight FPs completed an interview across the four regions. Participants described five areas of primary care reform that impacted their ability to operate and provide care during the pandemic: funding models, electronic medical records (EMRs), integration with regional entities, interdisciplinary teams, and practice size. FPs in alternate funding models experienced fewer financial constraints than those in fee-for-service practices. EMR access enhanced FPs' ability to deliver virtual care, integration with regional entities improved access to personal protective equipment and technological support, and team-based models facilitated the implementation of infection prevention and control protocols. Lastly, larger group practices had capacity to ensure adequate staffing and cover additional costs, allowing FPs more time to devote to patient care. CONCLUSIONS Recent primary care system reforms implemented in Canada enhanced FPs' ability to adapt to the uncertain and evolving environment of providing primary care during the pandemic. Our study highlights the importance of ongoing primary care reforms to enhance pandemic preparedness and advocates for further expansion of these reforms.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Judith B Brown
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Eric K W Wong
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
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Mathews M, Liu T, Ryan D, Hedden L, Lukewich J, Marshall EG, Buote R, Meredith L, Moritz LR, Spencer S, Asghari S, Brown JB, Freeman TR, Gill PS, Sibbald S. Practice- and System-Based Interventions to Reduce COVID-19 Transmission in Primary Care Settings: A Qualitative Study. Healthc Policy 2023; 19:63-78. [PMID: 38105668 PMCID: PMC10751755 DOI: 10.12927/hcpol.2023.27232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Using qualitative interviews with 68 family physicians (FPs) in Canada, we describe practice- and system-based approaches that were used to mitigate COVID-19 exposure in primary care settings across Canada to ensure the continuation of primary care delivery. Participants described how they applied infection prevention and control procedures (risk assessment, hand hygiene, control of environment, administrative control, personal protective equipment) and relied on centralized services that directed patients with COVID-19 to settings outside of primary care, such as testing centres. The multi-layered approach mitigated the risk of COVID-19 exposure while also conserving resources, preserving capacity and supporting supply chains.
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Affiliation(s)
- Maria Mathews
- Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Tiffany Liu
- Research Assistant, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Dana Ryan
- Research Assistant, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Lindsay Hedden
- Assistant Professor, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Julia Lukewich
- Associate Professor, Faculty of Nursing, Memorial University, St. John's, NL
| | - Emily Gard Marshall
- Professor, Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS
| | - Richard Buote
- Research Assistant, Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS
| | - Leslie Meredith
- Research Manager, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Lauren R. Moritz
- Research Associate, Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS
| | - Sarah Spencer
- Research Coordinator, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Shabnam Asghari
- Professor, Discipline of Family Medicine, Memorial University, St. John's, NL
| | - Judith B. Brown
- Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Thomas R. Freeman
- Professor Emeritus, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Paul S. Gill
- Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Lecturer, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Shannon Sibbald
- Associate Professor, School of Health Studies, Faculty of Health Sciences, Western University, Associate Professor, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
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Hedden L, Spencer S, Mathews M, Marshall EG, Lukewich J, Asghari S, Brown JB, Gill PS, Freeman TR, McCracken RK, Ryan BL, Vaughan C, Wong E, Buote R, Meredith L, Moritz L, Ryan D, McKay M, Schacter G. "There's nothing like a good crisis for innovation": a qualitative study of family physicians' experiences with virtual care during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:338. [PMID: 37016330 PMCID: PMC10072815 DOI: 10.1186/s12913-023-09256-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/07/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians' perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic. METHODS We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes. RESULTS We identified three prominent themes throughout participants' reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers. CONCLUSION Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rita K McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Mathews M, Ryan D, Hedden L, Lukewich J, Marshall EG, Asghari S, Terry AL, Buote R, Meredith L, Moritz L, Spencer S, Brown JB, Christian E, Freeman TR, Gill PS, Sibbald SL, Wong E. Family physicians' responses to personal protective equipment shortages in four regions in Canada: a qualitative study. BMC Prim Care 2023; 24:56. [PMID: 36849904 PMCID: PMC9969942 DOI: 10.1186/s12875-022-01958-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/23/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. METHODS As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. RESULTS A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. CONCLUSIONS During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Amanda Lee Terry
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Richard Buote
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Judith B Brown
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Erin Christian
- Nova Scotia Health, 78 Lovett Lake Ct, Halifax, NS, B3S 1B8, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Shannon L Sibbald
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Thames Valley Family Health Team, 1385 North Routledge Park, Unit 6, London, ON, N6H 5N5, Canada.,St. Joseph's Health Care London, Family Medical Centre, PO Box 5777, Stn B, London, ON, N6A 4V2, Canada
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Mathews M, Meredith L, Ryan D, Hedden L, Lukewich J, Marshall EG, Buote R, Moritz L, Spencer S, Asghari S, Brown JB, Freeman TR, Gill PS, McCracken RK, McKay M, Ryan B, Sibbald SL, Wetmore S, Wong E. The roles of family physicians during a pandemic. Healthc Manage Forum 2023; 36:30-35. [PMID: 35848444 PMCID: PMC9297067 DOI: 10.1177/08404704221112311] [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] [Indexed: 12/15/2022]
Abstract
Family physicians play important roles throughout all stages of a pandemic response; however, actionable descriptions outlining these roles are absent from current pandemic plans. Using a multiple case study design, we conducted a document analysis and interviewed 68 family physicians in four Canadian regions. We identified roles performed by family physicians in five distinct stages of pandemic response: pre-pandemic, phased closure and re-opening, acute care crisis, vaccination, and pandemic recovery. In addition to adopting public health guidance to ensure continued access to primary care services, family physicians were often expected to operationalize public health roles (eg, staffing assessment centres), modulate access to secondary/tertiary services, help provide surge capacity in acute care facilities, and enhance supports and outreach to vulnerable populations. Future pandemic plans should include family physicians in planning, explicitly incorporate family physician roles, and ensure needed resources are available to allow for an effective primary care response.
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Affiliation(s)
- Maria Mathews
- Western University, London, Ontario, Canada.,Maria Mathews, Western University, London, Ontario, Canada. E-mail:
| | | | - Dana Ryan
- Western University, London, Ontario, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julia Lukewich
- Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | | | | | | | - Sarah Spencer
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Shabnam Asghari
- Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | | | | | - Paul S. Gill
- Western University, London, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Eric Wong
- Western University, London, Ontario, Canada.,Thames Valley Family Health Team, London, Ontario, Canada.,St. Joseph’s Health Care London, London, Ontario, Canada
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Hall JN, Ackery AD, Dainty KN, Gill PS, Lim R, Masood S, McLeod SL, Mehta S, Nijmeh L, Rosenfield D, Rutledge G, Verma A, Mondoux S. Designs, facilitators, barriers, and lessons learned during the implementation of emergency department led virtual urgent care programs in Ontario, Canada. Front Digit Health 2022; 4:946734. [PMID: 36093385 PMCID: PMC9448924 DOI: 10.3389/fdgth.2022.946734] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionVirtual patient care has seen incredible growth since the beginning of the COVID-19 pandemic. To provide greater access to safe and timely urgent care, in the fall of 2020, the Ministry of Health introduced a pilot program of 14 virtual urgent care (VUC) initiatives across the province of Ontario. The objective of this paper was to describe the overall design, facilitators, barriers, and lessons learned during the implementation of seven emergency department (ED) led VUC pilot programs in Ontario, Canada.MethodsWe assembled an expert panel of 13 emergency medicine physicians and researchers with experience leading and implementing local VUC programs. Each VUC program lead was asked to describe their local pilot program, share common facilitators and barriers to adoption of VUC services, and summarize lessons learned for future VUC design and development.ResultsModels of care interventions varied across VUC pilot programs related to triage, staffing, technology, and physician remuneration. Common facilitators included local champions to guide program delivery, provincial funding support, and multi-modal marketing and promotions. Common barriers included behaviour change strategies to support adoption of a new service, access to high-quality information technology to support new workflow models that consider privacy, risk, and legal perspectives, and standardized data collection which underpin overall objective impact assessments.ConclusionsThese pilot programs were rapidly implemented to support safe access to care and ED diversion of patients with low acuity issues during the COVID-19 pandemic. The heterogeneity of program implementation respects local autonomy yet may present challenges for sustainability efforts and future funding considerations.
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Affiliation(s)
- Justin N. Hall
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Correspondence: Justin N. Hall
| | - Alun D. Ackery
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
| | - Katie N. Dainty
- Department of Research and Innovation, North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Paul S. Gill
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
| | - Rodrick Lim
- Department of Paediatrics and Medicine, Western University, London, ON, Canada
| | - Sameer Masood
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Services, University Health Network, Toronto, ON, Canada
| | - Shelley L. McLeod
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
- Schwartz/Reisman Emergency Medicine Institute (SREMI), Mount Sinai Hospital, Toronto, ON, Canada
| | - Shaun D. Mehta
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
| | - Larry Nijmeh
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, Lakeridge Health, Oshawa, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
| | - Daniel Rosenfield
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Greg Rutledge
- Department of Emergency Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Aikta Verma
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shawn Mondoux
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Mathews M, Ryan D, Hedden L, Lukewich J, Marshall EG, Brown JB, Gill PS, McKay M, Wong E, Wetmore SJ, Buote R, Meredith L, Moritz L, Spencer S, Alexiadis M, Freeman TR, Letto A, Ryan BL, Sibbald SL, Terry AL. Family physician leadership during the COVID-19 pandemic: roles, functions and key supports. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [PMID: 35877594 DOI: 10.1108/lhs-03-2022-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans. DESIGN/METHODOLOGY/APPROACH This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes. FINDINGS Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships. PRACTICAL IMPLICATIONS Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles. ORIGINALITY/VALUE The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study's findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Stephen J Wetmore
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Richard Buote
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maria Alexiadis
- Department of Family Practice, Nova Scotia Health Authority, Halifax, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Aimee Letto
- Newfoundland and Labrador Medical Association, St. John's, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Shannon L Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Amanda Lee Terry
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University London, Canada, and Department of Epidemiology and Biostatistics, Schulich School of Western University Medicine and Dentistry, Western University, London, Canada
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Yong AS, Gill PS, Shalimar A, Sapuan J. Mistaking a Tumour for an Infection - Acrometastasis of the Finger from Endocervical Adenosquamous Carcinoma: A Case Report. Malays Orthop J 2021; 15:115-117. [PMID: 34966504 PMCID: PMC8667245 DOI: 10.5704/moj.2111.017] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 07/11/2021] [Indexed: 11/29/2022] Open
Abstract
Acrometastasis is rare with a very low incidence of all bone metastasis. It can present with swelling, pain and warmth with erythema that may mimic an infection especially in the distal phalanx. Due to its rarity and subtle clinical presentation, it can be misdiagnosed as an infection causing the treatment to be delayed. We report a 42-year-old female with an acrometastasis to the distal phalanx of the left middle finger which we mistook as an infection thus delaying her treatment. It was a terminal presentation of her endocervical adenosquamous carcinoma. We would like to highlight that acrometastasis has an indistinct presentation and in cases where the lesion does not respond to treatment, acrometastasis should be included as one of the differential diagnoses. Thus, physicians need to have a high level of suspicion in patients with a primary malignant tumour.
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Affiliation(s)
- A S Yong
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - P S Gill
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - A Shalimar
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - J Sapuan
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Khan A, Singh R, Sharma S, Singh V, Sheoran A, Soni A, Dhull V, Gill PS, Yadav A, Chaudhary D, Gupta MC, Mehta PK. Diagnosis of osteoarticular tuberculosis by immuno-PCR assay based on mycobacterial antigen 85 complex detection. Lett Appl Microbiol 2021; 74:17-26. [PMID: 34592012 DOI: 10.1111/lam.13567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 01/22/2023]
Abstract
Diagnosis of osteoarticular tuberculosis (OATB) exhibits serious challenges owing to paucibacillary nature of specimens and localization of disease at sites that are difficult to access. We recently developed indirect immuno-PCR (I-PCR) and real-time I-PCR (RT-I-PCR) assays for the detection of mycobacterial antigen 85 complex (Ag85) in OATB patients. Detection limits for the purified Ag85 protein were found to be 1 and 41 fg ml-1 by I-PCR and RT-I-PCR, respectively, which were at least 105 -fold lower than respective ELISA. While spiking synovial fluids of non-TB control subjects with the purified Ag85 protein, LODs of 100 and 120 fg ml-1 were obtained by I-PCR and RT-I-PCR, respectively, thus demonstrating the sample matrix effect. Sensitivities of 87·5 and 70·5% were observed in bodily fluids of confirmed (n = 8) and clinically suspected (n = 51) OATB cases, respectively, by I-PCR, with a specificity of 93·9% (n = 33). Markedly, the sensitivities obtained by I-PCR/RT-I-PCR were significantly higher (P < 0·05-0·01) than ELISA and GeneXpert assay (n = 30). However, no substantial difference in sensitivity was observed between the I-PCR and RT-I-PCR assays. After further improving the accuracy of I-PCR, this test may lead to development of an attractive diagnostic kit.
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Affiliation(s)
- A Khan
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak, India
| | - R Singh
- Department of Orthopaedics, University of Health Sciences (UHS), Rohtak, India
| | - S Sharma
- Department of Microbiology, UHS, Rohtak, India
| | - V Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - A Sheoran
- Department of Statistics, Ramanujan College, University of Delhi, New Delhi, India
| | - A Soni
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak, India.,Department of Biotechnology, Deenbandhu Chhotu Ram University of Science and Technology Murthal, Sonepat, India
| | - V Dhull
- Department of Biotechnology Engineering, University Institute of Engineering & Technology, MDU, Rohtak, India
| | - P S Gill
- Department of Microbiology, UHS, Rohtak, India
| | - A Yadav
- Department of Microbiology, UHS, Rohtak, India
| | - D Chaudhary
- Pulmonary and Critical Care Medicine, UHS, Rohtak, India
| | - M C Gupta
- Department of Pharmacology, UHS, Rohtak, India
| | - P K Mehta
- Centre for Biotechnology, Maharshi Dayanand University (MDU), Rohtak, India
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10
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Mathews M, Spencer S, Hedden L, Marshall EG, Lukewich J, Meredith L, Ryan D, Buote R, Liu T, Volpe E, Gill PS, Ryan B, Schacter G, Wickett J, Freeman TR, Sibbald SL, Wong E, McKay M, McCracken R, Brown JB. Development of a primary care pandemic plan informed by in-depth policy analysis and interviews with family physicians across Canada during COVID-19: a qualitative case study protocol. BMJ Open 2021; 11:e048209. [PMID: 34301660 PMCID: PMC8300554 DOI: 10.1136/bmjopen-2020-048209] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/05/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Given the recurrent risk of respiratory illness-based pandemics, and the important roles family physicians play during public health emergencies, the development of pandemic plans for primary care is imperative. Existing pandemic plans in Canada, however, do not adequately incorporate family physicians' roles and perspectives. This policy and planning oversight has become increasingly evident with the emergence of the novel coronavirus disease, COVID-19, pandemic. This study is designed to inform the development of pandemic plans for primary care through evidence from four provinces in Canada: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. METHODS AND ANALYSIS We will employ a multiple-case study of regions in four provinces. Each case consists of a mixed methods design which comprises: (1) a chronology of family physician roles in the COVID-19 pandemic response; (2) a provincial policy analysis; and (3) qualitative interviews with family physicians. Relevant policy and guidance documents will be identified through targeted, snowball and general search strategies. Additionally, these policy documents will be analysed to identify gaps and/or emphases in existing policies and policy responses. Interviews will explore family physicians' proposed, actual and potential roles during the pandemic, the facilitators and barriers they have encountered throughout and the influence of gender on their professional roles. Data will be thematically analysed using a content analysis framework, first at the regional level and then through cross-case analyses. ETHICS AND DISSEMINATION Approval for this study has been granted by the Research Ethics of British Columbia, the Health Research Ethics Board of Newfoundland and Labrador, the Nova Scotia Health Authority Research Ethics Board and the Western University Research Ethics Board. Findings will be disseminated via conferences and peer-reviewed publications. Evidence and lessons learnt will be used to develop tools for government ministries, public health units and family physicians for improved pandemic response plans for primary care.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Academic Health Science Network, Vancouver, British Columbia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Richard Buote
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Tiffany Liu
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Emily Volpe
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Paul S Gill
- University of Toronto, Goderich, Ontario, Canada
- Gateway Rural Health Institute, Goderich, Ontario, Canada
| | - Bridget Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Jamie Wickett
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Shannon L Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- School of Health Studies, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Thames Valley Family Health Team, London, Ontario, Canada
| | - Maddi McKay
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Doctors Nova Scotia, Dartmouth, Nova Scotia, Canada
| | - Rita McCracken
- Department of Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
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McArdle PD, Greenfield SM, Rilstone SK, Narendran P, Haque MS, Gill PS. Carbohydrate restriction for glycaemic control in Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2019; 36:335-348. [PMID: 30426553 DOI: 10.1111/dme.13862] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 01/05/2023]
Abstract
AIM To conduct a systematic review and meta-analysis to evaluate the effect of carbohydrate restriction on glycaemic control in Type 2 diabetes. METHODS We searched Medline, EMBASE and CINAHL for the period between 1976 and April 2018. We included randomized controlled trials comparing carbohydrate restriction with a control diet which aimed to maintain or increase carbohydrate intake, and that reported HbA1c as an outcome and reported the amount of carbohydrate consumed during or at the end of the study, with outcomes reported at ≥3 months. RESULTS We identified 1402 randomized controlled trials, 25 of which met the inclusion criteria, incorporating 2132 participants for the main outcome. Definitions of low carbohydrate varied among the studies. The pooled effect estimate from meta-analysis was a weighted mean difference of -0.09% [95% CI -0.27, 0.08 (P = 0.30); I2 72% (P <0.001)], suggesting no effect on HbA1c of restricting the quantity of carbohydrate. A subgroup analysis of diets containing 50-130 g carbohydrate resulted in a pooled effect estimate of -0.49% [95% CI -0.75, -0.23 (P <0.001); I2 0% (P = 0.56)], suggesting a clinically and statistically significant effect on HbA1c in favour of low-carbohydrate diets in studies of ≤6 months' duration. CONCLUSIONS There was no overall pooled effect on HbA1c in favour of restricting carbohydrate; however, restriction of carbohydrate to 50-130 g per day had beneficial effects on HbA1c in trials up to 6 months. Future randomized controlled trials should be of >12 months' duration, assess pre-study carbohydrate intake, use recognized definitions of low-carbohydrate diets and examine reasons for non-adherence to prescribed diets in greater detail.
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Affiliation(s)
- P D McArdle
- Birmingham Community Nutrition, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - S M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S K Rilstone
- Imperial College Healthcare NHS Trust, London, UK
| | - P Narendran
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M S Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - P S Gill
- Warwick Medical School, University of Warwick, Coventry, UK
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12
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Chawhan P, Singh B, Sharma R, Gill PS. Prevalence and molecular epidemiology of porcine cysticercosis in naturally infected pigs (Sus scrofa) in Punjab, India. REV SCI TECH OIE 2016; 34:953-60. [PMID: 27044164 DOI: 10.20506/rst.34.3.2408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Porcine cysticercosis is a serious zoonosis in resource-poor countries. Despite the evidence showing that the disease is endemic in the Punjab region of India, molecular characterisation of Taenia solium cysticercosis from naturally infected pigs has not been carried out. The authors examined a total of 519 pigs slaughtered in small slaughter shops (shops that sell meat from animals that are slaughtered on the premises as the customer waits) in the urban slums of Punjab state in northern India. The expected polymerase chain reaction products with molecular sizes of 286 bp, 420 bp, 1150 bp and 333 bp corresponding to the targeted large subunit ribosomal RNA (rRNA), cytochrome oxidase 1, internal transcribed spacer 1, and diagnostic antigen Ts14 genes, respectively, were amplified from the cysts collected from all 22 infected carcasses. The detection limits for the respective primers (except those targeting the Ts14 gene) were estimated. The analytical sensitivities of both the TBR and JB primers (targeting the rRNA and cytochrome oxidase genes, respectively) were found to be higher (10 pg) than that of the internal transcribed spacer 1 gene (1 ng) primers. Ten representative samples from cytochrome oxidase 1 gene amplified products were sequenced in both directions for phylogenetic analysis. Sequencing demonstrated that all cysticerci were of the Asian genotype of T. solium and not of the African/Latin American genotype or T. asiatica. The results confirm the presence of T. solium porcine cysticercosis in Punjab state and there is therefore an urgent need for science-based policies for prevention and control of this serious zoonosis.
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13
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Verma R, Behera BK, Jain RB, Arora V, Chayal V, Gill PS. Hepatitis C, a silent threat to the community of Haryana, India: a community-based study. Australas Med J 2014; 7:11-6. [PMID: 24567761 DOI: 10.4066/amj.2014.1883] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/09/2022]
Abstract
BACKGROUND Hepatitis C is a global public health problem. As many as 12 million people may be chronically infected in India and most are unaware of it. AIMS To determine the incidence of hepatitis C in the Ratia block of the Fatehabad district, Haryana, India. METHOD This cross-sectional study was carried out by house-tohouse visits over 2 weeks. After obtaining written consent, a blood sample was drawn from suspected cases by a laboratory technician maintaining all necessary safety precautions and sterilization. RESULTS Of the samples, 1,630 (22.3 per cent) were found to be positive for hepatitis C by ELISA, 253 (15.5 per cent) patients were previously hepatitis C positive, and adults (21-60 years) were affected maximally (70.0 per cent). CONCLUSION The study emphasises the need for public awareness campaigns at various levels and prevention of HCV infection. It also suggests the need to develop and strengthen evaluation methodology for the Integrated Disease Surveillance Project (IDSP).
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Affiliation(s)
| | | | - R B Jain
- Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | | | | | - P S Gill
- Pt B D Sharma PGIMS, Rohtak, Haryana, India
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14
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Abstract
BACKGROUND Endothelial progenitor cells (EPCs) are known to be altered in heart failure (HF), but monocyte-derived EPCs in HF have not been assessed. We aimed to characterize monocyte-derived EPCs in systolic HF. METHODS AND RESULTS We recruited 128 subjects with systolic HF: 50 South Asian (SA), 50 white, and 28 African-Caribbean (AC), for interethnic comparisons. Additionally, SAs with HF were compared with 40 SAs with coronary artery disease (CAD) without HF (disease controls [DCs]) and 40 SA healthy controls (HCs). Counts of CD34(+) and kinase domain receptor (KDR)(+) monocytes attributed to specific monocyte subsets (CD14(++) /CD16(-) [Mon1], CD14(++)/CD16(+) [Mon2], and CD14(+)/CD16(++) [Mon3]) and monocyte expression of vascular endothelial growth factor (VEGF) receptor 1 were analyzed by flow cytometry. We also enumerated CD34(+)/KDR(+) EPCs derived from mononuclear cells ('classic' EPC definition). RESULTS SAs with HF had significantly reduced counts of CD34(+) monocytes, attributed to the Mon1 and Mon2 subsets. KDR(+) Mon1 counts were 4.5-fold increased in DCs as compared with HCs, but significantly reduced in HF subjects vs. DCs. VEGF receptor type 1 expression on Mon1 and Mon2 cells was significantly reduced in HF patients as compared with DCs. Also, CD34(+)/KDR(+) EPC numbers were reduced in HF subjects. Whites had significantly fewer KDR(+) Mon3 cells than ACs, but significantly more CD34(+) Mon2 cells than SAs and ACs. VEGF receptor type 1 expression by Mon1 cells was predictive for left ventricular ejection fraction after adjustment for ethnicity (β = - 0.25. P = 0.039). CD34(+) Mon2 counts correlated with measures of microvascular endothelial function, and were predictive of the future risk of hospital admission. CONCLUSIONS Circulating counts of monocyte-derived EPCs are significantly altered in HF, with significant ethnic differences in the levels of monocyte-derived EPCs.
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Affiliation(s)
- E Shantsila
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
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15
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Patel JV, Lip GY, Prabharkaran D, Reddy KS, Gill PS, Hughes EA. Anthropometric discriminators of the risk of high blood pressure amongst public schoolchildren in Gujarat, India. Int J Clin Pract 2012; 66:418-20. [PMID: 22420501 DOI: 10.1111/j.1742-1241.2011.02875.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Affiliation(s)
- J V Patel
- Sandwell Medical Research Unit & University of Birmingham Centre for Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
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17
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Abstract
Heart failure (HF) is a common condition leading to an unfavourable prognosis and impaired quality of life. In this review, we provide an overview of published literature on possible epidemiological and pathophysiological differences between patients with systolic HF of South Asian origin and those from other ethnic groups (mainly White). Systolic HF tends to manifest earlier among South Asians and with frequent hospital admissions. However, survival for such patients appears to be significantly better compared with the White group, which might be associated with different patterns of HF. For example, this could be attributed to a lower prevalence of left ventricular systolic dysfunction in South Asian subjects. Indeed, the high prevalence of hypertension and diabetes among South Asians may predispose to diastolic HF with preserved systolic function. In addition, because of underrepresentation of South Asians in clinical trials, there are little data on optimal management of this ethnic group.
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Affiliation(s)
- E Shantsila
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
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18
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Patel JV, Gill PS, Chackathayil J, Ojukwu H, Stemman P, Sheldon L, Meelu S, Lane DA, Tracey I, Lip GYH, Hughes EA. Short-term effects of screening for cardiovascular risk in the deaf community: a pilot study. Cardiol Res Pract 2011; 2011:493546. [PMID: 21559268 PMCID: PMC3087949 DOI: 10.4061/2011/493546] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 01/26/2011] [Indexed: 11/20/2022] Open
Abstract
There is limited information on the risk of cardiovascular disease amongst the Deaf community. Given that the access of Deaf people to mainstream health promotion is likely to be hindered by language barriers, we were interested to assess the short-term impact of cardiovascular health promotion within this group. Using a pilot study we investigated changes in cardiovascular risk factors amongst Deaf people identified to be at high cardiovascular risk, who received standard health promotion by a medical team specializing in cardiovascular health promotion. The short-term impact of cardiovascular health promotion in this group did not reduce estimates of cardiovascular risk. The reasons for this are likely to relate to the design and delivery of health promotion to Deaf people, which deserves further study.
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Affiliation(s)
- J V Patel
- Sandwell Medical Research Unit, Sandwell and West Birmingham Hospitals NHS Trust, West Midlands B17 4HJ, UK
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Bennett PC, Gill PS, Silverman S, Blann AD, Chackathayil J, Lip GYH. Hemostatic cardiovascular risk factors, common carotid-intima medial thickness and peripheral arterial disease in South Asians and African Caribbeans: a substudy to the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study. J Thromb Haemost 2011; 9:645-52. [PMID: 21232010 DOI: 10.1111/j.1538-7836.2011.04190.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether ethnic differences exist in inflammatory (interleukin-6 and C-reactive protein) and hemostatic biomarkers (soluble P-selectin [sP-sel], von Willebrand factor [VWF], and fibrin D-dimer) between South Asian (people originating from India, Pakistan, and Bangladesh) and African Caribbean (Black Caribbean and Black African) groups, the two largest minority ethnic groups in the UK; and to determine associations between these biomarkers and common carotid intima-media thickness and peripheral artery disease (PAD). PATIENTS AND METHODS We recruited 572 subjects (356 South Asian and 216 Black) aged ≥ 45 years as a substudy to a community screening project, the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study. All subjects completed an interviewer-led questionnaire, anthropometric measurements were taken, and blood sampling was performed if consent was granted. Ankle brachial pressure index (ABPI) was calculated, and the common carotid intima-media thickness (CCIMT) was measured. PAD was defined as ABPI < 0.9. ELISA was used to quantify inflammatory and hemostatic biomarkers. RESULTS The incidence of hypertension (> 70%) and diabetes (> 27%) was high, but non-significantly different between the two ethnic groups. South Asians had higher platelet count and sP-sel levels than African Caribbeans (P < 0.0001 for both), despite there being no significant difference in antiplatelet medication. African Caribbeans had higher D-dimer levels (P = 0.0052). Among South Asians, VWF correlated with ABPI (P = 0.047) and mean (P = 0.002) and maximum CCIMT (P = 0.011) on univariate analysis, and remained an independent predictor of mean and maximum CCIMT on multivariate analysis with traditional cardiovascular risk factors (P = 0.034 and P = 0.046, respectively). In African Caribbeans, D-dimer levels were was higher in PAD than in normal ABPI participants (P = 0.04), and was associated with ABPI in both univariate analysis (P = 0.014) and multivariate analysis (P < 0.0001) with traditional cardiovascular risk factors. CONCLUSION Ethnic differences are evident in inflammatory and hemostatic factors, as well as in their associations with CCIMT and PAD. These may reflect differences in cardiovascular risk factors or pathophysiologic processes that characterize each ethnic group.
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Affiliation(s)
- P C Bennett
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
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20
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Bennett PC, Gill PS, Silverman S, Blann AD, Lip GYH. Ethnic differences in common carotid intima-media thickness, and the relationship to cardiovascular risk factors and peripheral arterial disease: the Ethnic-Echocardiographic Heart of England Screening Study. QJM 2011; 104:245-54. [PMID: 20956456 DOI: 10.1093/qjmed/hcq187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To compare the mean and maximum common carotid intima-media thickness (CCIMT) in Blacks (Black Caribbean and Black African) and South Asians (People originating from India, Pakistan and Bangladesh) in a population survey and make associations with established cardiovascular risk factors and peripheral arterial disease (PAD). PATIENTS AND METHODS A subset of 492 (293 South Asians and 199 Blacks) out of 572 participants aged ≥ 45 years recruited in a sub-study to the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) epidemiological study had mean and maximum CCIMT measured. A questionnaire, anthropometric measurements and Ankle Brachial Pressure Index (ABPI) and Intermittent Claudication assessments were made. RESULTS Black participants had greater mean but not maximum CCIMT when compared to South Asians overall (P = 0.022), in men (P = 0.04) and in women (P = 0.044). Black ethnicity was an independent predictor of CCIMT even after adjustment for traditional cardiovascular risk factors (P < 0.05). After adjustment for age, ethnicity and traditional cardiovascular risk factors, the presence of PAD remained independently predictive of mean (P = 0.019) and maximum (P = 0.012) CCIMT. CONCLUSION Black ethnicity is related to greater mean and maximum CCIMT when compared to South Asians, even after adjusting for traditional cardiovascular risk factors. The presence of PAD independently predicts mean and maximum CCIMT adjusting for ethnicity, age and cardiovascular risk factors.
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Affiliation(s)
- P C Bennett
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK
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21
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Bennett PC, Lip GYH, Silverman S, Blann AD, Gill PS. The contribution of cardiovascular risk factors to peripheral arterial disease in South Asians and Blacks: a sub-study to the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study. QJM 2010; 103:661-9. [PMID: 20576717 DOI: 10.1093/qjmed/hcq102] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether differences exist in prevalence of peripheral arterial disease (PAD) between South Asians (people originating from India, Pakistan and Bangladesh) and Blacks (Black Caribbean and Black African), the two largest minority ethnic groups in the UK. To determine if associations with cardiovascular risk factors and this disease differ between these two ethnic groups. PATIENTS AND METHODS We recruited 572 patients (356 South Asian and 216 Blacks) > or = 45 years as a sub-study to a community screening project, the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study. All subjects completed an interviewer-led questionnaire, anthropometric measurements and blood sampling. Ankle brachial pressure index (ABPI) was calculated and intermittent claudication was assessed using the Edinburgh Claudication Questionnaire. The presence of PAD was defined as ABPI <0.9. RESULTS The mean age was 62 years overall with no difference between the two ethnic groups. The prevalence of PAD was 13.2% [95% confidence interval (CI) 9.7-16.7] in South Asians and 10.2% (95% CI 6.2-14.2) in Blacks with no significant difference between the two ethnic groups. The prevalence of PAD was higher in South Asian women than Black women (16.3 vs. 6.1%; P = 0.011). No difference in prevalence was found in men (11 vs. 14% P = 0.47, in South Asians and Blacks, respectively). The prevalence of intermittent claudication was 0.9% (95% CI 0.11-1.63). On multivariate logistic regression, mean systolic blood pressure, diabetes, smoking and male sex were independently associated with PAD in South Asians (P = 0.016, 0.022, 0.037 and 0.008, respectively). In Blacks, only age remained independently associated with PAD on multivariate logistic regression (P = 0.003). CONCLUSION The prevalence of PAD is similar in South Asians and Blacks, and similar to levels reported in pre-dominantly White populations. South Asian women had a higher prevalence of PAD than Black women, which is not explained by traditional cardiovascular risk factors.
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Affiliation(s)
- P C Bennett
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, B18 7QH, UK
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Abstract
Peripheral arterial disease (PAD) is an important healthcare problem and is an indicator of widespread atherosclerosis in other vascular territories, such as the cerebral and coronary circulations. PAD is associated with considerable morbidity and mortality. Most population-based studies investigating PAD prevalence and risk factors for its development and progression have been based on predominantly White ethnic groups. Much less is known about the characteristics of this disease in other ethnic groups. Understanding the epidemiology of PAD amongst ethnic minority groups is relevant, given that the population of minority ethnic groups in countries such as the United Kingdom rose by 53% between 1991 and 2001 and is expected to rise further in the future. This article aims to provide an overview of possible pathophysiological differences between ethnic groups for PAD, focussing predominantly on South Asians (people originating from India, Bangladesh and Pakistan) and Blacks (people of Black Caribbean and Black African descent) as these groups comprise the majority of all ethnic minorities in the United Kingdom.
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Affiliation(s)
- P C Bennett
- University Department of Medicine, City Hospital, Birmingham B187QH, UK
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Bridgewater D, Cox B, Cain J, Lau A, Athaide V, Gill PS, Kuure S, Sainio K, Rosenblum ND. Canonical WNT/β-catenin signaling is required for ureteric branching. Dev Biol 2008; 317:83-94. [DOI: 10.1016/j.ydbio.2008.02.010] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 01/30/2008] [Accepted: 02/05/2008] [Indexed: 12/23/2022]
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Sharobeem KM, Patel JV, Ritch AES, Lip GYH, Gill PS, Hughes EA. Elevated lipoprotein (a) and apolipoprotein B to AI ratio in South Asian patients with ischaemic stroke. Int J Clin Pract 2007; 61:1824-8. [PMID: 17935546 DOI: 10.1111/j.1742-1241.2007.01521.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Stroke is a continuing cause of excess cardiovascular disease (CVD) mortality amongst migrants from the Indian subcontinent (South Asians) living in Britain. However, little is known about the dyslipidaemia associated with stroke in South Asians. In particular, the highly atherogenic lipoprotein (a) [Lp(a)] and high apolipoprotein (Apo) B to AI ratio are emerging risk factors for CVD. METHODS Using a case-control study, we investigated features of the dyslipidaemia in South Asian patients with stroke compared with South Asian subjects with no history of clinically detectable stroke. We studied 55 consecutive South Asian patients with ischaemic stroke (confirmed on computerised scan of the brain) and 85 controls. RESULTS The stroke patients were significantly older than controls (65.2 vs. 59.8 years, p = 0.001), but were similarly matched for male gender (63.6 vs. 61.2%), smoking habit (20.7 vs. 18.1%) and presence of type 2 diabetes (25.5 vs. 19.3%). There were no differences between serum total cholesterol (p = 0.07) and high-density lipoprotein cholesterol (p = 0.08) between the groups, but stroke patients had higher serum triglycerides (p = 0.005). Mean [95% confidence interval (CI)] Apo B to AI ratio was higher amongst stroke patients [1.0 (0.9-1.0) vs. 0.7 (0.7-0.75), p < 0.001]. Similarly, geometric mean serum Lp(a) was significantly higher (p = 0.037) in stroke patients [19.9 mg/dl (14.0-28.5)] vs. controls [15.1 mg/dl (11.4-20.1)]. On logistic regression, stroke was independently associated with age and Apo B to AI ratio (p < 0.01). CONCLUSION The present study suggests that Lp(a) and the Apo B to AI ratio are associated with ischaemic stroke in South Asians. A prospective analysis is needed to elucidate the role of Lp(a), Apo B and AI as risk factors for ischaemic stroke in this population, as well as the effects of intervention.
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Affiliation(s)
- K M Sharobeem
- Department of Geriatric Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Edgbaston, Birmingham, UK.
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25
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Gill PS, Arora DR, Arora B, Gill M, Gautam V, Karan J, Chaudhary U, Garg N. Lymphadenopathy--An Important Guiding Tool for Detecting Hidden HIV-Positive Cases: A 6-Year Study. ACTA ACUST UNITED AC 2007; 6:269-72. [PMID: 17873248 DOI: 10.1177/1545109707304298] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lymphadenopathy is one of the leading and persistent signs during the progression of human immunodeficiency virus (HIV) infection. Lymphadenopathy, as a clinical sign, can become one of the important guiding tools for detecting hidden HIV-positive cases. The present study was conducted to assess the incidence of HIV positivity in previously undiagnosed patients of HIV presenting with lymphadenopathy, comparing it with the current trends of HIV infection in the community, and to ascertain the etiology of lymphadenopathy in HIV-positive and HIV-negative cases. Over a period of 6 years, a total of 1082 cases of extra-inguinal lymphadenopathy were screened for HIV infection. Simultaneously, fine needle aspiration cytology of the enlarged lymph nodes was performed to know the etiology. The incidence of HIV positivity was found to be 2.3% among the patients presenting with lymphadenopathy. Among the HIV-positive cases, tuberculous lymphadenopathy was found in 60% of cases as compared to 28% of cases in HIV-negative cases. Alarmingly high incidence of HIV infection among the lymphadenopathy cases has been observed. This necessitates the importance of exercising vigilance, caution, and a high degree of suspicion while dealing with patients of lymphadenopathy, to protect ourselves as well as a much larger population at risk from this scourge.
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Affiliation(s)
- P S Gill
- Department of Microbiology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India.
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Gunarathne A, Patel JV, Potluri R, Gill PS, Hughes EA, Lip GYH. Secular trends in the cardiovascular risk profile and mortality of stroke admissions in an inner city, multiethnic population in the United Kingdom (1997–2005). J Hum Hypertens 2007; 22:18-23. [PMID: 17673899 DOI: 10.1038/sj.jhh.1002265] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 11/09/2022]
Abstract
Our objective was to study ethnic differences in the cardiovascular risk profile and mortality of stroke admissions to an inner city teaching hospital serving a multiethnic population in Birmingham, UK, over a 9-year period (1997-2005). Hospital case notes and registry data of 3083 patients admitted with a first onset stroke were reviewed. Secular trends in the prevalence of risk factors (hypertension, diabetes, hyperlipidaemia, atrial fibrillation and myocardial infarction), hospital admission rates and 30-day mortality among Afro-Caribbean, European Caucasian and South Asian ethnic groups were analysed. Between 1997 and 2005, there were 3083 first onset strokes, of whom 47.6% (1595) were men, 9.3% Afro-Caribbean, 57.8% European Caucasian and 15.1% South Asian. There was a significant trend towards a reduction in non-haemorrhagic stroke admissions over the study period (P<0.001), with no ethnic variation (P=0.07). Increases in hypertension and hyperlipidaemia were observed (P<0.001), whereas myocardial infarction showed a decline (P<0.001). Compared to other ethnic groups, South Asian patients were younger on admission (P<0.001), had more hyperlipidaemia (P<0.05) and poorer survival at 30 days (P=002). We conclude that cardiovascular risk profiles among patients admitted with non-haemorrhagic stroke have changed over the last decade. In particular, hyperlipidaemia has increased, especially among South Asians. The reduced decline in stroke admissions and 30-day survival of stroke in South Asians in recent years warrants further investigation and highlights the importance of a targeted health-care approach in the migrant ethnic minorities.
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Affiliation(s)
- A Gunarathne
- University Department of Medicine, City Hospital, Birmingham, UK
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27
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Kumar SR, Masood R, Spannuth WA, Singh J, Scehnet J, Kleiber G, Jennings N, Deavers M, Krasnoperov V, Dubeau L, Weaver FA, Sood AK, Gill PS. The receptor tyrosine kinase EphB4 is overexpressed in ovarian cancer, provides survival signals and predicts poor outcome. Br J Cancer 2007; 96:1083-91. [PMID: 17353927 PMCID: PMC2360128 DOI: 10.1038/sj.bjc.6603642] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [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] [Indexed: 11/17/2022] Open
Abstract
EphB4 is a member of the largest family of transmembrane receptor tyrosine kinases and plays critical roles in axonal pathfinding and blood vessel maturation. We wanted to determine the biological role of EphB4 in ovarian cancer. We studied the expression of EphB4 in seven normal ovarian specimens and 85 invasive ovarian carcinomas by immunohistochemistry. EphB4 expression was largely absent in normal ovarian surface epithelium, but was expressed in 86% of ovarian cancers. EphB4 expression was significantly associated with advanced stage of disease and the presence of ascites. Overexpression of EphB4 predicted poor survival in both univariate and multivariate analyses. We also studied the biological significance of EphB4 expression in ovarian tumour cells lines in vitro and in vivo. All five malignant ovarian tumour cell lines tested expressed higher levels of EphB4 compared with the two benign cell lines. Treatment of malignant, but not benign, ovarian tumour cell lines with progesterone, but not oestrogen, led to a 90% reduction in EphB4 levels that was associated with 50% reduction in cell survival. Inhibition of EphB4 expression by specific siRNA or antisense oligonucleotides significantly inhibited tumour cell viability by inducing apoptosis via activation of caspase-8, and also inhibited tumour cell invasion and migration. Furthermore, EphB4 antisense significantly inhibited growth of ovarian tumour xenografts and tumour microvasculature in vivo. Inhibition of EphB4 may hence have prognostic and therapeutic utility in ovarian carcinoma.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Animals
- Apoptosis
- Caspases/metabolism
- Cell Line, Tumor
- Cell Movement
- Cystadenocarcinoma, Serous/metabolism
- Cystadenocarcinoma, Serous/pathology
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Mice
- Mice, Inbred BALB C
- Mice, Nude
- Middle Aged
- Neoplasm Invasiveness
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/pathology
- Progesterone/pharmacology
- Progestins/pharmacology
- RNA, Small Interfering/therapeutic use
- Receptor, EphB4/antagonists & inhibitors
- Receptor, EphB4/metabolism
- Survival Rate
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Affiliation(s)
- S R Kumar
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - R Masood
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - W A Spannuth
- Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Singh
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J Scehnet
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - G Kleiber
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - N Jennings
- Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Deavers
- Department of Pathology and Laboratory Medicine, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - L Dubeau
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - F A Weaver
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - A K Sood
- Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Cancer Biology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P S Gill
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
- USC/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, NOR 6330, Los Angeles, CA 90033, USA. E-mail:
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Lip GYH, Barnett AH, Bradbury A, Cappuccio FP, Gill PS, Hughes E, Imray C, Jolly K, Patel K. Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management. J Hum Hypertens 2007; 21:183-211. [PMID: 17301805 DOI: 10.1038/sj.jhh.1002126] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [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: 01/12/2023]
Abstract
The United Kingdom is a diverse society with 7.9% of the population from black and minority ethnic groups (BMEGs). The causes of the excess cardiovascular disease (CVD) and stroke morbidity and mortality in BMEGs are incompletely understood though socio-economic factors are important. However, the role of classical cardiovascular (CV) risk factors is clearly important despite the patterns of these risk factors varying significantly by ethnic group. Despite the major burden of CVD and stroke among BMEGs in the UK, the majority of the evidence on the management of such conditions has been based on predominantly white European populations. Moreover, the CV epidemiology of African Americans does not represent well the morbidity and mortality experience seen in black Africans and black Caribbeans, both in Britain and in their native African countries. In particular, atherosclerotic disease and coronary heart disease are still relatively rare in the latter groups. This is unlike the South Asian diaspora, who have prevalence rates of CVD in epidemic proportions both in the diaspora and on the subcontinent. As the BMEGs have been under-represented in research, a multitude of guidelines exists for the 'general population.' However, specific reference and recommendation on primary and secondary prevention guidelines in relation to ethnic groups is extremely limited. This document provides an overview of ethnicity and CVD in the United Kingdom, with management recommendations based on a roundtable discussion of a multidisciplinary ethnicity and CVD consensus group, all of whom have an academic interest and clinical practice in a multiethnic community.
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Affiliation(s)
- G Y H Lip
- University Department of Medicine, City Hospital, Birmingham, UK.
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Abstract
Fibromyalgia syndrome and tension-type headache have multiple clinical features in common, and pathogenic mechanisms partly overlap. Significant differences need to be recognized as well. Studying the correlations of these often comorbid conditions represents a unique opportunity to gain insight into their pathophysiology and that of other chronic pain syndromes, to increase the accuracy of their diagnosis, and to improve the therapeutic armamentarium.
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Affiliation(s)
- Marc E Lenaerts
- Department of Neurology, Headache Section, Oklahoma University Health Sciences Center, 711 Stanton L. Young Boulevard #215, Oklahoma City, OK 73104, USA.
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Abstract
Sonic hedgehog (SHH) controls cell differentiation and morphogenesis in many tissues and species. The mammalian kidney is a paradigm for studying epithelial-mesenchymal interactions and growth factor signaling during embryogenesis. Here, we review our recent findings demonstrating that SHH is required for normal murine kidney development. During renal morphogenesis, SHH controls a hierarchy of genes including renal patterning genes, cell cycle modulators, and GLI family members. Our investigation of GLI protein processing and binding of GLI activators and repressor to SHH target genes provide insight into the molecular mechanisms by which SHH and its GLI family of effectors control renal embryogenesis. Further, we highlight the roles of BMP, WNT and FGF signaling during renal development and discuss possible interactions of these pathways with SHH signaling.
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Affiliation(s)
- Paul S Gill
- Program in Developmental Biology, The Hospital for Sick Children, Toronto, Canada
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Garg N, Gautam V, Gill PS, Arora B, Arora DR. Comparison of salivary and serum antibody detection in HIV-1 infection by ELISA and rapid methods in India. Trop Doct 2006; 36:108-9. [PMID: 16611447 DOI: 10.1258/004947506776593440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- N Garg
- Department of Microbiology, Pt BDS PGIMS, Rohtak, Haryana, India
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Xia G, Kumar SR, Stein JP, Singh J, Krasnoperov V, Zhu S, Hassanieh L, Smith DL, Buscarini M, Broek D, Quinn DI, Weaver FA, Gill PS. EphB4 receptor tyrosine kinase is expressed in bladder cancer and provides signals for cell survival. Oncogene 2006; 25:769-80. [PMID: 16205642 DOI: 10.1038/sj.onc.1209108] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [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] [Indexed: 11/09/2022]
Abstract
We sought to evaluate the biological function of the receptor tyrosine kinase EphB4 in bladder cancer. All of the nine bladder cancer cell lines examined express EphB4 and the receptor could be phosphorylated following stimulation with its cognate ligand, EphrinB2. Out of the 15 fresh bladder cancer specimens examined, 14 expressed EphB4 with a mean sevenfold higher level of expression compared to adjacent normal urothelium. EphB4 expression was regulated by several mechanisms: EPHB4 gene locus was amplified in 27% tumor specimens and 33% cell lines studied; inhibition of EGFR signaling downregulated EphB4 levels; and forced expression of wild-type p53 reduced EphB4 expression. EphB4 knockdown using specific siRNA and antisense oligodeoxynucleotides molecules led to a profound inhibition in cell viability associated with apoptosis via activation of caspase-8 pathway and downregulation of antiapoptotic factor, bcl-xl. Furthermore, EphB4 knockdown significantly inhibited tumor cell migration and invasion. EphB4 knockdown in an in vivo murine tumor xenograft model led to a nearly 80% reduction in tumor volume associated with reduced tumor proliferation, increased apoptosis and reduced tumor microvasculature. EphB4 is thus a potential candidate as a predictor of disease outcome in bladder cancer and as target for novel therapy.
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Affiliation(s)
- G Xia
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
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35
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Gill PS, Hunt JP, Guerra AB, Dellacroce FJ, Sullivan SK, Boraski J, Metzinger SE, Dupin CL, Allen RJ. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 2004; 113:1153-60. [PMID: 15083015 DOI: 10.1097/01.prs.0000110328.47206.50] [Citation(s) in RCA: 407] [Impact Index Per Article: 20.4] [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: 01/28/2023]
Abstract
This study examined 758 deep inferior epigastric perforator flaps for breast reconstruction, with respect to risk factors and associated complications. Risk factors that demonstrated significant association with any breast or abdominal complication included smoking (p = 0.0000), postreconstruction radiotherapy (p = 0.0000), and hypertension (p = 0.0370). Ninety-eight flaps (12.9 percent) developed fat necrosis. Associated risk factors were smoking (p = 0.0226) and postreconstruction radiotherapy (p = 0.0000). Interestingly, as the number of perforators increased, so did the incidence of fat necrosis. There were only 19 cases (2.5 percent) of partial flap loss and four cases (0.5 percent) of total flap loss. Patients with 45 flaps (5.9 percent) were returned to the operating room before the second-stage procedure. Patients with 29 flaps (3.8 percent) were returned to the operating room because of venous congestion. Venous congestion and any complication were observed to be statistically unrelated to the number of venous anastomoses. Overall, postoperative abdominal hernia or bulge occurred after only five reconstructions (0.7 percent). Complication rates in this large series were comparable to those in retrospective reviews of pedicle and free transverse rectus abdominis musculocutaneous flaps. Previous studies of the free transverse rectus abdominis musculocutaneous flap described breast complication rates ranging from 8 to 13 percent and abdominal complication rates ranging from 0 to 82 percent. It was noted that, with experience in microsurgical techniques and perforator selection, the deep inferior epigastric perforator flap offers distinct advantages to patients, in terms of decreased donor-site morbidity and shorter recovery periods. Mastery of this flap provides reconstructive surgeons with more extensive options for the treatment of postmastectomy patients.
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Affiliation(s)
- Paul S Gill
- Division of Trauma and Critical Care and the Division of Plastic Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Quirke TP, Gill PS, Mant JW, Allan TF. The applicability of the Framingham coronary heart disease prediction function to black and minority ethnic groups in the UK. Heart 2003; 89:785-6. [PMID: 12807859 PMCID: PMC1767743 DOI: 10.1136/heart.89.7.785] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2003] [Indexed: 11/03/2022] Open
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Abstract
BACKGROUND AND OBJECTIVE Headache is a common and distressing morbidity associated with day case surgery. We undertook a prospective, observational study to identify risk factors associated with perioperative headache in a modern, day case surgery setting. METHODS Two hundred-and-thirty consecutive patients presenting for day case surgery were invited to complete a questionnaire about their previous experience of headache and various associated risk factors. Questionnaires were completed by 90% of patients. The presence of headache in the pre- or postoperative period was also documented. We used multivariate logistic regression to model perioperative headache. RESULTS Increased frequency of previous headache, odds ratio (95% confidence interval) 1.9 (1.2-2.8) (P = 0.004) and low alcohol consumption 0.90 (0.87-0.98) (P = 0.019) were significant predictors. A history of migraine showed a trend towards being predictive 1.9 (0.9-4.0) (P = 0.055). Some risk factors thought to be important such as caffeine withdrawal and duration of starvation and fluid deprivation were not associated with perioperative headache in this setting. CONCLUSIONS In this study of risk factors associated with perioperative headache in day case surgery, increased frequency of headache and low alcohol consumption were independent risk factors.
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Affiliation(s)
- P S Gill
- Leicester General Hospital, University Department of Anaesthesia, Leicester, UK.
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Gupta N, Gautam V, Sehgal R, Gill PS, Arora DR. Screening by VDRL test to detect hidden cases of syphilis. Indian J Med Microbiol 2003; 21:118-20. [PMID: 17642995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A total of 59,450 sera from January 1996 to December 2000 were subjected to VDRL testing. Overall VDRL positivity rate was 3.2% and downward trend was observed in the recent years, 1999 and 2000. Majority of the samples were from Gynaecology department, out of which 1.57% were VDRL positive. Out of 30,045 samples from antenatal females, 517(1.47%) were positive, while 304(1.8%) were positive out of 16,980 samples obtained from couples. Out of 304 samples from couples found positive, 17.4% wives had titre >R16; 27.9% wives had titre R1 to R8, out of which 15.3% husbands had titre of >R16. Also, 166 wives with nonreactive VDRL had 19.3% husbands with titre > R16. Thus, couple VDRL test plays an important role in detection of hidden cases of syphilis in the community and early detection and treatment of such cases will further reduce the perinatal morbidity and mortality.
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Affiliation(s)
- N Gupta
- Department of Microbiology, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana - 124 001, India
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Abstract
OBJECTIVE To investigate the contribution of patient and doctor characteristics in explaining observed variations in prescribing costs between individual doctors. METHOD Secondary analysis of data collected from general practitioners, Family Health Services Authorities, 1991 Census data set and the Prescription Pricing Authority. RESULTS A multiple regression model with four variables (social class, training status, generic prescribing and length of time in general practice) explained only 16.5% of the variation in costs/ASTRO-PU. CONCLUSION This study highlights that very little of the variation in prescribing costs can readily be explained. Further research is needed to document contributing factors.
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Affiliation(s)
- P S Gill
- Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK.
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Greenfield SM, Anderson P, Gill PS, Loudon R, Skelton J, Ross N, Parle J. Community voices: views on the training of future doctors in Birmingham, UK. Patient Educ Couns 2001; 45:43-50. [PMID: 11602367 DOI: 10.1016/s0738-3991(01)00142-2] [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: 05/23/2023]
Abstract
The United Kingdom (UK) population is diverse with nearly 6% minority ethnic communities. Both patients and doctors experience difficulties when dealing with someone from a different ethnic group. Medical education has failed to keep pace with the changing needs of the diverse population. We report a project in which 12 established (religious/cultural and specific interest) community groups expressed their views on what future doctors should learn about serving diverse populations. Data were obtained by group discussion and through the media using a structured format. Fifteen themes emerged which were grouped under three broad themes: firstly, the identification by group members of their perception of the 'differences' in social and cultural beliefs and behaviours of their individual community; secondly, the identification of characteristics of a culturally sensitive doctor; and lastly, recommendations for changes in medical training. New teaching has been introduced to the medical curriculum that incorporates the themes raised by the communities and which reflects consciousness raising and communication issues.
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Affiliation(s)
- S M Greenfield
- Department of Primary Care and General Practice, University of Birmingham, Edgbaston, UK
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Masood R, Cai J, Zheng T, Smith DL, Hinton DR, Gill PS. Vascular endothelial growth factor (VEGF) is an autocrine growth factor for VEGF receptor-positive human tumors. Blood 2001; 98:1904-13. [PMID: 11535528 DOI: 10.1182/blood.v98.6.1904] [Citation(s) in RCA: 264] [Impact Index Per Article: 11.5] [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] [Indexed: 12/12/2022] Open
Abstract
Angiogenesis is required for the progression of tumors from a benign to a malignant phenotype and for metastasis. Malignant tumor cells secrete factors such as vascular endothelial growth factor (VEGF), which bind to their cognate receptors on endothelial cells to induce angiogenesis. Here it is shown that several tumor types express VEGF receptors (VEGFRs) and that inhibition of VEGF (VEGF antisense oligonucleotide AS-3) or VEGFRs (neutralizing antibodies) inhibited the proliferation of these cell lines in vitro. Furthermore, this effect was abrogated by exogenous VEGF. Thus, VEGF is an autocrine growth factor for tumor cell lines that express VEGFRs. A modified form of VEGF AS-3 (AS-3m), in which flanking 4 nucleotides were substituted with 2-O-methylnucleosides (mixed backbone oligonucleotides), retained specificity and was active when given orally or systemically in vitro and in murine tumor models. In VEGFR-2-expressing tumors, VEGF inhibition may have dual functions: direct inhibition of tumor cell growth and inhibition of angiogenesis.
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Affiliation(s)
- R Masood
- Department of Medicine, University of Southern California School of Medicine, Los Angeles, CA, USA
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Masood R, Cai J, Tulpule A, Zheng T, Hamilton A, Sharma S, Espina BM, Smith DL, Gill PS. Interleukin 8 is an autocrine growth factor and a surrogate marker for Kaposi's sarcoma. Clin Cancer Res 2001; 7:2693-702. [PMID: 11555581] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Kaposi's sarcoma (KS) is the most common tumor associated with HIV-1 infection. Here, we report the expression, regulation, and biological effect of interleukin (IL)-8 in KS. AIDS-KS cell lines expressed higher levels of IL-8 than either human umbilical vein endothelial cells (HUVECs), human aortic smooth muscle (AoSM) cells or fibroblast cells (T1). The inflammatory cytokine IL-1beta up-regulated IL-8 expression in a time- and concentration-dependent manner in KS cell lines. IL-8 antisense oligonucleotides specifically reduced IL-8 mRNA and protein levels and inhibited KS cell growth in a dose-dependent manner. In addition, supernatant from a KS cell line induced the growth of HUVECs and angiogenesis in chicken chorioallantoic membrane assays, both of which were inhibited by IL-8 neutralizing antibody. Serum levels of IL-8 were also elevated in KS cases compared with matched controls. Modulation of IL-8 may thus be of therapeutic value in this disease.
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MESH Headings
- Animals
- Antibodies, Monoclonal/pharmacology
- Biomarkers, Tumor/analysis
- Cell Division/drug effects
- Cell Line
- Culture Media, Conditioned/pharmacology
- DNA, Antisense/pharmacology
- Dose-Response Relationship, Drug
- Gene Expression Regulation, Neoplastic/drug effects
- Growth Substances/genetics
- Growth Substances/metabolism
- Humans
- Immunohistochemistry
- Interleukin-1/pharmacology
- Interleukin-8/genetics
- Interleukin-8/immunology
- Interleukin-8/pharmacology
- Male
- Mice
- Mice, Inbred BALB C
- Mice, Nude
- Neovascularization, Physiologic/drug effects
- Oligonucleotides/pharmacology
- RNA, Messenger/drug effects
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Neoplasm/drug effects
- RNA, Neoplasm/genetics
- RNA, Neoplasm/metabolism
- Receptors, Interleukin-8A/analysis
- Receptors, Interleukin-8A/genetics
- Recombinant Proteins/pharmacology
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Kaposi/genetics
- Sarcoma, Kaposi/metabolism
- Sarcoma, Kaposi/prevention & control
- Tumor Cells, Cultured
- Up-Regulation/drug effects
- Xenograft Model Antitumor Assays
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Affiliation(s)
- R Masood
- University of Southern California Keck School of Medicine, Los Angeles, California 90089-9172, USA.
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Abstract
Almost 6% of Britain's population are of black or minority ethnic origin. There is increasing recognition that the health needs of such groups are not adequately met within the current health care system. One factor in reducing health inequalities is for health professionals to become culturally aware in order to serve these communities effectively. This literature review focuses on pre-registration nursing programmes that address cultural sensitivity as part of basic training. The studies were selected by a computerized search of a number of databases and a hand search of selected nursing journals. The papers were reviewed under the following headings: setting, programme design, conceptual framework, curricula content, student assessment, and course evaluation. The programmes presented were undertaken predominantly in the USA. Either few programmes exist in the UK, or the programme details have not been published. Although, in the UK, cultural sensitivity training appears in its infancy, there are positive signs of change.
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Abstract
AIM To determine the contribution of various doctor and patient factors on the frequency of antibiotic prescribing. METHODS Secondary analyses of data on 155 single handed general practitioners. RESULTS Three variables explained 25% of variation in antibiotic prescribing. Doctors qualified from the Indian subcontinent issued more antibiotics than U.K.-qualified doctors. Patients from the non-manual social class were issued fewer antibiotics than those from the manual class and the most deprived patients received significantly more antibiotics. CONCLUSION Very little of prescribing of antibiotics by doctors is explained by these doctor-patient factors. Prescribing is a complex process and the search for factors must continue in order to address the rising antibiotic resistance.
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Affiliation(s)
- P S Gill
- Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, U.K.
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Gill PS, Shah J, Ogilvy A. Midazolam reduces the dose of propofol required for induction of anaesthesia and laryngeal mask airway insertion. Eur J Anaesthesiol 2001; 18:166-70. [PMID: 11298175 DOI: 10.1046/j.0265-0215.2000.00805.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Insertion of the laryngeal mask airway in the anaesthetized patient can sometimes be difficult and propofol has been advocated as the anaesthetic induction agent of choice because of its depressant effect on laryngeal reflexes compared with other intravenous anaesthetics. However, when used as the sole induction agent, relatively large doses of propofol are required to achieve successful laryngeal mask insertion. This has cost implications and may produce unwanted cardiorespiratory depression. METHODS One hundred and forty-two patients were randomized to receive either: fentanyl 1 microg kg(-1) and lidocaine 1.5 mg kg(-1) (group 1), or fentanyl 1 microg kg(-1) and midazolam 0.04 mg kg(-1) (group 2), or fentanyl 1 microg kg(-1), midazolam 0.04 mg kg(-1) and lidocaine 1.5 mg kg(-1) (group 3) or fentanyl 1 microg kg(-1) (group 4) 2 min before induction of anaesthesia. Anaesthesia was established with propofol infused at 33.3 mg min(-1). RESULTS Patients who were given midazolam required significantly less propofol to achieve satisfactory laryngeal mask insertion, median propofol doses: group 1, 1.63 mg kg(-1); group 2, 1.16 mg kg(-1); group 3, 1.01 mg kg(-1); group 4, 1.9 mg kg(-1), P < 0.0001 (analysis of variance). Patients given midazolam reported less pain on injection with propofol 13% and 3% groups (2 and 3) compared with 37.5% and 77% (groups 1 and 4) P = 0.002 (chi(2)). CONCLUSIONS Midazolam reduces the dose of propofol required for induction of anaesthesia and successful insertion of the laryngeal mask airway. There was no clinical benefit to be gained from the addition of lidocaine.
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Affiliation(s)
- P S Gill
- Department of Anaesthesia, Leicester General Hospital, Leicester LE5 4PW, UK
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46
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Levine AM, Seneviratne L, Espina BM, Wohl AR, Tulpule A, Nathwani BN, Gill PS. Evolving characteristics of AIDS-related lymphoma. Blood 2000; 96:4084-90. [PMID: 11110677] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Over time, the epidemiologic and demographic characteristics of AIDS have changed in the United States, while the use of highly active antiretroviral therapy has changed the natural history of the disease. The goal of the study was to ascertain any changes in the epidemiologic, immunologic, pathologic, or clinical characteristics of AIDS-related lymphoma (ARL) over the course of the AIDS epidemic. Records of 369 patients with ARL diagnosed or treated at a single institution from 1982 through 1998 were reviewed. Single institutional data were compared to population-based data from the County of Los Angeles. Significant changes in the demographic profile of patients with newly diagnosed ARL have occurred, with the later time intervals associated with a higher prevalence in women (P =.25), in Latino/Hispanic individuals (P <.0001), and in those who acquired human immunodeficiency virus (HIV) heterosexually (P =.01). These changes were similar in both countywide, population-based analyses and in those from the single institution. The median CD4(+) lymphocyte count at lymphoma diagnosis has decreased significantly over the years, from 177/dL in the earliest time period (1982-1986), to 53/dL in the last time period from 1995 to 1998 (P =.0006). The pathologic spectrum of disease has also changed, with a decrease in the prevalence of small noncleaved lymphoma (P =.0005) and an increase in diffuse large cell lymphoma (P <.0001). Despite changes in the use of antiretroviral or chemotherapy regimens, the median survival has not significantly changed.
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Affiliation(s)
- A M Levine
- Division of Hematology, Department of Medicine, and Division of Hematopathology, Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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47
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Masood R, Nagpal S, Zheng T, Cai J, Tulpule A, Smith DL, Gill PS. Kaposi sarcoma is a therapeutic target for vitamin D(3) receptor agonist. Blood 2000; 96:3188-94. [PMID: 11050002] [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: 02/18/2023] Open
Abstract
Kaposi sarcoma (KS) is responsive to a number of different steroid hormones, such as glucocorticoids and retinoids. An active metabolite of vitamin D, 1alpha,25 dihydroxyvitamin D(3), was used to study the effect of this steroid hormone in KS. Steroid hormones exert their effect through their cognate nuclear receptors, which for vitamin D metabolites is the vitamin D receptor (VDR). It was first shown that KS cell lines and primary tumor tissue express high levels of VDR, whereas endothelial cells had minimal expression and fibroblasts had no expression. Second, KS cell growth was inhibited by VDR agonist 1alpha,25 dihydroxyvitamin D(3) with a 50% inhibitory concentration of 5 x 10 -8 mol/L, whereas endothelial cells and fibroblast cells showed no response. Studies on the mechanism of KS tumor growth inhibition by 1alpha,25 dihydroxyvitamin D(3) showed that production of autocrine growth factors interleukin (IL)-6 and IL-8 was reduced in a dose-dependent manner, whereas no effect was observed on vascular endothelial growth factor and basic fibroblast growth factor. Transcription initiated at the IL-6 promoter was repressed by VDR agonist. The DNA sequences required to mediate this repression were localized to nucleotides -225/-110 in the 5'-flanking region. The antitumor activity of VDR agonists was also confirmed in KS tumor xenograft and after topical application in patients with KS. 1alpha,25 Dihydroxyvitamin D(3) and its analogs may thus be candidates for clinical development in KS.
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Affiliation(s)
- R Masood
- University of Southern California School of Medicine and Pathology, Norris Cancer Hospital and Research Institute, Los Angeles, CA, USA
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Gill PS. New series--Research Notes. The methodology of prescribing research. J Clin Pharm Ther 2000; 25:315-6. [PMID: 11123481 DOI: 10.1046/j.1365-2710.2000.00299.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ferrario A, von Tiehl KF, Rucker N, Schwarz MA, Gill PS, Gomer CJ. Antiangiogenic treatment enhances photodynamic therapy responsiveness in a mouse mammary carcinoma. Cancer Res 2000; 60:4066-9. [PMID: 10945611] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Photodynamic therapy (PDT) is a promising cancer treatment that induces localized tumor destruction via the photochemical generation of cytotoxic singlet oxygen. PDT-mediated oxidative stress elicits direct tumor cell damage as well as microvascular injury within exposed tumors. Reduction in vascular perfusion associated with PDT-mediated microvascular injury produces tumor tissue hypoxia. Using a transplantable BA mouse mammary carcinoma, we show that Photofrin-mediated PDT induced expression of the hypoxia-inducible factor-1alpha (HIF-1alpha) subunit of the heterodimeric HIF-1 transcription factor and also increased protein levels of the HIF-1 target gene, vascular endothelial growth factor (VEGF), within treated tumors. HIF-1alpha and VEGF expression were also observed following tumor clamping, which was used as a positive control for inducing tissue hypoxia. PDT treatment of BA tumor cells grown in culture resulted in a small increase in VEGF expression above basal levels, indicating that PDT-mediated hypoxia and oxidative stress could both be involved in the overexpression of VEGF. Tumor-bearing mice treated with combined antiangiogenic therapy (IM862 or EMAP-II) and PDT had improved tumoricidal responses compared with individual treatments. We also demonstrated that PDT-induced VEGF expression in tumors decreased when either IM862 or EMAP-II was included in the PDT treatment protocol. Our results indicate that combination procedures using antiangiogenic treatments can improve the therapeutic effectiveness of PDT.
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Affiliation(s)
- A Ferrario
- Clayton Center for Ocular Oncology, Childrens Hospital Los Angeles, California 90027, USA
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50
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Mihalcea AM, Smith DL, Monini P, Sgadari C, Ensoli B, Gill PS. Treatment update for AIDS-related Kaposi's sarcoma. AIDS 2000; 13 Suppl A:S215-25. [PMID: 10885778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- A M Mihalcea
- Westfalian Technical University, School of Medicine, Aachen, Germany
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