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Berchtenbreiter K, Innes K, Watterson J, Nickson CP, Wong P. Intensive care unit nurses' perceptions of debriefing after critical incidents: A qualitative descriptive study. Aust Crit Care 2024; 37:288-294. [PMID: 37537123 DOI: 10.1016/j.aucc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 05/22/2023] [Accepted: 06/03/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Intensive care unit (ICU) nurses are exposed to critical incidents daily at their workplace, which may have long-term physical and psychological impacts. Despite the growing evidence supporting clinical debriefing in health care to prevent these impacts, a scarcity of literature exists to support its use in the adult intensive care setting. OBJECTIVES The objective of this study was to explore nurses' perceptions of clinical debriefing after critical incidents in an adult ICU. METHODS A qualitative descriptive design was utilised. Thematic analysis of data from individual semistructured interviews with six ICU nurses was undertaken. FINDINGS In this study, two themes were identified. Firstly, participants valued hot debriefing after critical incidents for the key reasons of having an opportunity to reflect on and learn from a critical incident and reduce normalisation of stressful situations. Secondly, when logistical factors such as communication, timing, and location were not considered, the attendance at debriefings was negatively influenced. Participants identified that ICU nurses commonly prioritised patient tasks over attending a debrief; therefore, teamwork and flexibility with logistics was crucial. CONCLUSIONS Hot debriefing, of a short duration and close to the time of the event, was valued and played an important role in staff wellbeing and self-care, contributing to preventing self-blame and normalisation of stressful situations. A clearer definition of the term along with greater recognition of types of events that could be considered critical incidents is required for staff support after critical incidents in the complex intensive care setting.
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Affiliation(s)
- Kristie Berchtenbreiter
- Alfred Health, 55 Commercial Road, Prahran, Victoria, 3004, Australia; Monash University, Monash Nursing and Midwifery, Wellington Road, Clayton, Victoria, 3800, Australia.
| | - Kelli Innes
- Monash University, Monash Nursing and Midwifery, Wellington Road, Clayton, Victoria, 3800, Australia.
| | - Jason Watterson
- Monash University, School of Public Health and Preventative Medicine, Wellington Road, Clayton, Victoria, 3800, Australia; Peninsula Health, 2 Hastings Rd, Frankston, VIC 3199 Australia.
| | - Christopher Peter Nickson
- Alfred Health, 55 Commercial Road, Prahran, Victoria, 3004, Australia; Monash University, School of Public Health and Preventative Medicine, Wellington Road, Clayton, Victoria, 3800, Australia.
| | - Pauline Wong
- Monash University, Monash Nursing and Midwifery, Wellington Road, Clayton, Victoria, 3800, Australia.
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Wong P, Brand G, Dix S, Choo D, Foley P, Lokmic-Tomkins Z. Pre-Registration Nursing Students' Perceptions of Digital Health Technology on the Future of Nursing: A Qualitative Exploratory Study. Nurse Educ 2023:00006223-990000000-00387. [PMID: 38151706 DOI: 10.1097/nne.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND Health informatics competencies, digital health education, and nursing students' perceptions of technology are critical to ensure a future digitally capable health care workforce. PURPOSE To explore preregistration students' perceptions of digital health technology impact on their role as nurses. METHODS Using a qualitative exploratory approach, students from 2 Australian universities were purposively sampled. Data were collected through photo-elicitation from 3 focus groups and thematically analyzed. Photo-elicitation provided reference points to encourage more in-depth exploration. RESULTS Themes included fear of the unknown and who am I? Nursing in a digital world. Human interaction was fundamental to their nursing role and digital health technology could depersonalize care, creating tension around their reason for choosing a nursing career. CONCLUSIONS Educators should prepare students to redefine their nursing identity by exploring how digital health technology augments their practice and critical thinking skills, while addressing fear of a perceived threat to the future of nursing.
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Affiliation(s)
- Pauline Wong
- Senior Lecturers (Dr Wong and Ms Dix), Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia; Associate Professor (Dr Brand), Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia; Lecturer/Research Fellow (Dr Choo), Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia; Lecturer (Ms Foley), Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia; and Associate Professor (Dr Lokmic-Tomkins), Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia. Dr Lokmic-Tomkins is now at Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
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Wong P, Dhivagaran T, Cheung R, Ito E, Chan KY, So N, Keller H, Cheung F, Rubinstein E, Tsang RW. Socio-Economic Status in Risk of Acute Adverse Events Following Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e75. [PMID: 37786170 DOI: 10.1016/j.ijrobp.2023.06.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Socio-economic status (SES) are known to influence cancer patient outcomes. The purpose of this study is to evaluate whether SES affected the short-term clinical experience of patients treated with radiotherapy (RT) during the pandemic. MATERIALS/METHODS This was a single institution, retrospective cohort quality improvement study. The primary endpoint consisted of adverse events (AEs) defined as an unplanned admission to a drop-in radiation-nursing clinic (RNC) or the institution's emergency department (ED) within 90 days of a radiation course. Adult cancer patients who received external beam RT from April 1, 2019, to March 31, 2022 were included. Patients were classified into two periods: treated prior to the pandemic (pre-COVID), and during the pandemic (COVID era), with a cutoff date of March 31, 2020. SES, age, RT intent (curative, palliative, SBRT), regimen (conventional fractionation and hypofractionation), disease site, and sex were included as co-variables. SES was obtained by matching a patient's postal code with a provincial data tool with four distinct dimensions: 1) residential instability, 2) material deprivation, 3) ethnic concentration, and 4) dependency. For each SES dimension, a score of 1-5 (best-worst) is assigned to individuals. A backward stepwise multivariable logistic regression analysis was performed to analyze the variables and identify the factors that were significantly associated (p<0.05) with increased risk of AEs. Institutional ethics review board exemption was obtained. RESULTS Across the 3-year period, 15715 patients (5499 pre-COVID and 10216 COVID era patients) were identified and included in the analyses, and 5756 AEs were observed. The analyses revealed that patient age (p<0.001), disease site (p<0.001), treatment intent (p<0.001) and treatment regimen (p = 0.005) were associated with the risk of developing AEs. AEs risk was correlated with the treatment period (pre-COVID vs. COVID era) (p<0.001) and material deprivation (p = 0.027). Adjusting for the other variables, patients who were least materially deprived were at lower risk (Odds Ratio (OR) = 0.88, 95% CI [0.78-0.98]) of developing AEs than patients who were most materially deprived. Patient sex (p>0.1), residential instability (p = 0.069), ethnic concentration (p>0.5) and dependency (p>0.5) were not associated with AEs risk. Patients with more (SES score 1-4 vs 5) residential instability (p<0.001; OR = 0.82, 95% CI [0.74-0.90]) and less (SES score 1 vs 2-5) material deprivations (p = 0.006; OR = 0.76, 95% CI [0.66-0.88]) were at reduced the risk of ED visits. SES was not associated with RNC visits. CONCLUSION In a universal health care system, SES (residential instability and material deprivation) were associated with the increased risk of ED within 90 days of RT. Proactive care and virtual monitoring during the 90-day period after RT in high-risk patients may reduce ED visits. ED visits beyond our tertiary institution are being gathered to address this study limitation.
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Affiliation(s)
- P Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - R Cheung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - E Ito
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - K Y Chan
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - N So
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - H Keller
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - F Cheung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - R W Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Chermat R, Refet-Mollof E, Kamio Y, Carrier JF, Wong P, Gervais T. Brachytherapy-on-Chip: A Microfluidic Setup for In Vitro Interrogation of Hypoxic Spheroids. Int J Radiat Oncol Biol Phys 2023; 117:e222-e223. [PMID: 37784906 DOI: 10.1016/j.ijrobp.2023.06.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Despite evidence of its advantages in many cancers, brachytherapy (BT) remains clinically underused and understudied in the pre-clinical setting due to a lack of versatile RT-compatible in vitro tools that can emulate the tumor microenvironment and radiobiology of various cancers. Microfluidic devices use conventional cell culture methods in 3D-tumor models, are radiocompatible and can integrate radiobioassays. However, they are seldom used in pre-clinical BT research. This project engineered the first microfluidic tool for in vitro testing of BT, with applications in translational radiobiology. MATERIALS/METHODS PDMS microfluidic chips were engineered to grow and culture concentric rows of hypoxic spheroids, and to allow the insertion of a clinical iodine-125 BT seed at the center of the device. FaDu (hypopharyngeal squamous cell carcinoma), SK-LMS-1 (leiomyosarcoma) and HCT116 (colorectal carcinoma) cell lines were selected for their clinical relevance and ability to form spheroids. Presence of hypoxia in spheroids was assessed by immunofluorescence (IF) staining for hypoxic protein CAIX. On-chip dose distribution was calculated using clinical TG-43 parameters and compared to EBT-XD radiographic film. Target dose criteria was fixed at 8 Gy in the center of the first row of spheroids. Treatment response was quantified by DNA damages (γH2AX IF, comet assay) and cell survival (clonogenic assay). Response of hypoxic and normoxic regions of spheroids will be compared in IF. RESULTS A total of 15 spheroids that are 750µm or larger can be cultured in our device, arranged as 5 rows of 3 spread from 1.5mm to 7.5mm away from a central iodine-125 seed. 48h after cell seeding, hypoxic cores were observed in spheroids derived from FaDu (50 ± 4% of cross-section, N = 3) and SK-LMS-1 (46 ± 4% of cross-section, N = 3) cells, results are pending for HCT116. TG-43 formula predicts that the center of each row receives 8 Gy, 2.6 Gy, 1.2 Gy, 0.7 Gy and 0.4 Gy respectively. Radiographic film analysis confirms on-chip TG-43 calculated doses (N = 5, R2 = 0.999). Similarly, tail moment from comet assays follows predicted dose trends (n>60, N = 3). There was no statistical difference between 8 Gy BT and 8 Gy GammaCell (8 Gy BT vs 8 Gy GammaCell, p = 0.8758), with a statistical difference between 8 Gy BT (8 Gy BT vs 2.6 Gy BT,1.2 Gy BT,0.7 Gy BT,0.4 Gy BT,0 Gy, p < 0.0001), 2.6 Gy BT (2.6 Gy BT vs 1.2 Gy BT,0.7 Gy BT,0.4 Gy BT,0 Gy, p < 0.05) or 8 Gy GammaCell (8 Gy GammaCell vs 2.6 Gy BT,1.2 Gy BT,0.7 Gy BT,0.4 Gy BT,0 Gy, p < 0.0001) and other lower BT doses. CONCLUSION For the first time, brachytherapy can be easily integrated on-chip and its effects evaluated on relevant 3D-tumor models. Our system allows simultaneous quantification of BT efficacy on normoxic and hypoxic cells treated at various doses. On-chip combination of BT with antitumor drug will be explored in future work. We hope this device will serve as further proof of the potential of BT/RT-on-chip systems for better drug development, treatment planification and theranostics.
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Affiliation(s)
- R Chermat
- Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Institut du Cancer de Montréal, Axe Cancer, Montreal, QC, Canada
| | - E Refet-Mollof
- Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Institut du Cancer de Montréal, Axe Cancer, Montreal, QC, Canada
| | - Y Kamio
- Centre Hospitalier de l'Université de Montréal (CHUM), Département de Radio-Oncologie, Montreal, QC, Canada
| | - J F Carrier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Institut du Cancer de Montréal, Axe Cancer, Montreal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Département de Radio-Oncologie, Montreal, QC, Canada
| | - P Wong
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Institut du Cancer de Montréal, Axe Cancer, Montreal, QC, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - T Gervais
- Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Institut du Cancer de Montréal, Axe Cancer, Montreal, QC, Canada
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Kitsel Y, Wong P, Hollmann T, Vakiani E, Zadeh MZ, Kunin H, Petre N, Kirov A, Erinjeri J, Sotirchos V, Sofocleous C. Abstract No. 123 Immunological Changes in the Peripheral Blood after Yttrium-90 Radioembolization. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Joynes E, Wong P. PUMA guidelines for preventing unrecognised oesophageal intubation: don't forget the oxygen. Anaesthesia 2023; 78:399-400. [PMID: 36371528 DOI: 10.1111/anae.15915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 11/15/2022]
Affiliation(s)
- E Joynes
- Te Whatu Ora Health New Zealand, Waikato, New Zealand
| | - P Wong
- Te Whatu Ora Health New Zealand, Waikato, New Zealand
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Chen R(T, Truong M, Watterson JR, Burrell A, Wong P. The impact of the intensive care unit family liaison nurse role on communication during the COVID-19 pandemic: A qualitative descriptive study of healthcare professionals' perspectives. Aust Crit Care 2023; 36:127-132. [PMID: 36351854 PMCID: PMC9510056 DOI: 10.1016/j.aucc.2022.09.004] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 09/11/2022] [Accepted: 09/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has deeply impacted patient and family communication and patient- and family-centred care in the intensive care unit (ICU). A new role-the ICU Family Liaison Nurse (FLN)-was introduced in an Australian metropolitan hospital ICU to facilitate communication between patient and family and ICU healthcare professionals, although there is limited knowledge about the impact of this from the ICU healthcare professionals' perspectives. OBJECTIVE The aim of this study was to explore the impact of the ICU FLN role on communication with patients and their family during the COVID-19 pandemic, from the ICU healthcare professionals' perspectives. METHODS A qualitative descriptive study was conducted. Seven participants including ICU FLNs, ICU doctors, nurses, and social workers who worked with the ICU FLNs were interviewed. Thematic analysis was used to analyse the data. RESULTS Two main themes related to the ICU FLN role were identified. First, the COVID-19 pandemic posed challenges to patient and family communication, but it also created opportunities to improve patient and family communication. Second, the ICU FLN role brought beneficial impacts to the ICU healthcare professionals' workflow and work experience, as well as patient and family communication. The ICU FLN role has potential benefits that extend beyond the pandemic. CONCLUSION We found that during the COVID-19 pandemic, the ICU FLN role was acceptable, beneficial, and appreciated from the ICU healthcare professionals' perspectives. Further research should continue the evaluation of the ICU FLN role during and post the pandemic.
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Affiliation(s)
- Ruofei (Trophy) Chen
- Nursing and Midwifery, Monash University, Australia,Corresponding author at. Nursing and Midwifery, Monash University, Clayton Campus, VIC, 3800, Australia
| | - Mandy Truong
- Nursing and Midwifery, Monash University, Australia
| | - Jason R. Watterson
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Australia,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Aidan Burrell
- Department of Intensive Care Medicine, The Alfred Hospital, Australia
| | - Pauline Wong
- Nursing and Midwifery, Monash University, Australia
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Dainichi T, Nakano Y, Doi H, Nakamizo S, Nakajima S, Farkas T, Wong P, Narang V, Traspas RM, Kawakami E, Guttman-Yassky E, Dreesen O, Litman T, Reversade B, Kabashima K. 176 C10orf99/2610528A11Rik induces keratinocyte proinflammatory response and regulates lipid metabolism and barrier formation of the skin. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wong P, Cheung R, Ito E, Lopez M, Rubinstein E, Keller H, Cheung F, Liu Z, Liu F. Evaluating the Short-Term Environmental and Clinical Effects of a Radiation Oncology Department's Response to the COVID-19 Pandemic (STEER COVID-19). Int J Radiat Oncol Biol Phys 2022. [PMCID: PMC9595451 DOI: 10.1016/j.ijrobp.2022.07.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose/Objective(s) During the COVID-19 pandemic, hypofractionated regimens and virtual care was adopted by our institution to preserve hospital capacity and reduce foot traffic. This study's primary objective was to assess the collective environmental impact of these strategic changes by identifying sources of carbon dioxide equivalents (CO2e). As sustainable healthcare is only justifiable if the quality of the care is maintained, we also evaluated the rate of radiation-related acute adverse event. Materials/Methods All patients treated with external beam radiation therapy from April 1, 2019 to March 31, 2021 at our single institution were identified (n=10,175) along with their radiotherapy visits (176,423 fractions), and visits to the radiation nursing clinic (RNC) or emergency (ER) department. A treatment regimen was considered hypofractionated if the dose per fraction was ≥ 240 cGy. If the dose per fraction was ≥ 600 cGy and the total dose of the treatment regimen was > 2000 cGy, then the treatment regimen was classified as SBRT. Out-patient hospital and virtual visits (n=75,853) during this same period were also analyzed. Environmental impact measures, including linear accelerator power usage, patient travel distances, and personal protection equipment (PPE) consumption were all converted into CO2e. A waiver of individual patient consent was granted for this study by our institution's Research Ethics Board (REB). Results The use of curative hypofractionated regimens increased from 17% to 27% during the pandemic year. Twelve out of 15 cancer sites increased their use of hypofractionated regimens. Carbon footprint was reduced by 39% during the pandemic year (1,332,388 kg CO2e) as compared to the pre-pandemic year (2,024,823 kg CO2e). For comparison, the 744 tonnes of CO2e saved during the pandemic year equates to the CO2e produced by the annual energy consumption of 182 Canadian households or the CO2e sequestered by 12,000 seedling trees planted and grown for 10 years. On average 121 kg CO2e and 100 kg CO2e were emitted per radiation regimen delivered during the pre-pandemic and pandemic year, respectively. Comparing patients in the pre-pandemic vs. pandemic year, there was a significant reduction in the proportion of hypofractionated patients who needed a visit to either the RNC (39% vs. 25%; p<0.001) or ER (6% vs. 2%; p<0.001) during and within 90 days of radiotherapy. Conclusion This study demonstrated the environmental benefits of increased use of hypofractionated regimens and virtual care, while assuring that there was no added acute radiation-related adverse event. Our findings support their continued use as one of many long-term strategies to reduce the environmental footprint of healthcare delivery. Treatment efficacy and side-effects will need to be assessed in subsequent years to further support the sustainability of these strategies.
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Thaw D, Chen A, Song S, Morbeck D, Wong P. Development of an in-house algorithm to predict the formation of viable blastocyst from cleavage stage embryo. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wong P, Gamble A, Jaspers R, Pope N, Endacott R. Experiences of health care professionals in intensive care when families participate in clinician handovers: a qualitative systematic review protocol. JBI Evid Synth 2022; 20:2048-2054. [DOI: 10.11124/jbies-21-00310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lokmic-Tomkins Z, Choo D, Foley P, Dix S, Wong P, Brand G. Pre-registration nursing students' perceptions of their baseline digital literacy and what it means for education: A prospective COHORT survey study. Nurse Educ Today 2022; 111:105308. [PMID: 35240398 DOI: 10.1016/j.nedt.2022.105308] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 08/15/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To build complex digital skills and capability required by digitally-driven work environments, we must first understand nursing students' baseline digital literacy if educators are to develop a fit for purpose curriculum underpinned by digital health technologies. OBJECTIVE To determine first-year pre-registration nursing students' perceived baseline digital literacy before their first clinical placement. DESIGN Prospective cohort study. SETTINGS Two universities in Australia in 2020. PARTICIPANTS Students enrolled in pre-registration nursing programs at Bachelor's and Master's level. METHODS Participants (N = 205) completed an online 27-item survey composed of a Likert-type scale, forced-choice items, and open-ended questions. Data were analyzed with descriptive statistics. RESULTS Participants engaged with digital technology early in life, with 49.75% students using some form of digital technology before ten years of age. Students reported the highest daily use of technology to search the internet for information (92%), online social networking (68.3%) and watching videos (67%). Most students expressed the least confidence in identifying different types of portable storage devices (24.1% Master's students; 41.7% Bachelor's students), describing the advantages of a digital camera (39.3% Master's students; 48.3% Bachelor's students), and totaling numbers in spreadsheets (22.8% Masters students; 48.3% Bachelor's students). No statistical differences were observed between the two universities or the two cohorts in terms of perceived confidence in using technology and software applications to support their learning. Interestingly, 24.7% of participants expressed high confidence in using electronic medical records without prior training, which may reflect positive attitude towards engaging with unknown digital technologies. CONCLUSIONS Nursing students are frequent internet and social media users. However, despite positive attitudes to digital technology and widespread presence of digital technology in students' lives, deficits in students' confidence in using digital technology and software required for learning persist. Targeted digital literacy education interventions are needed as part of foundational nursing studies to improve nursing students' baseline digital literacy before commencing clinical placement. These should be scaffolded across the program to ensure an effective transition to nursing practice in evolving digitally-driven healthcare environments.
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Affiliation(s)
- Zerina Lokmic-Tomkins
- Department of Nursing, Centre for Digital Transformation of Health, The University of Melbourne, Victoria 3010, Australia.
| | - Dawn Choo
- Centre for Digital Transformation of Health, The University of Melbourne, Victoria 3010, Australia.
| | - Pieternella Foley
- School of Nursing and Midwifery, Monash University, Victoria 3800, Australia.
| | - Samantha Dix
- School of Nursing and Midwifery, Monash University, Victoria 3800, Australia.
| | - Pauline Wong
- School of Nursing and Midwifery, Monash University, Victoria 3800, Australia.
| | - Gabrielle Brand
- School of Nursing and Midwifery, Monash Centre for Scholarship in Health Education, Clayton, Victoria 3800, Australia.
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Smith MK, Chow J, Huang R, Omar M, Ebadi M, Wong P, Huard G, Yoshida EM, Peretz D, Brahmania M, Montano-Loza AJ, Bhanji R. A224 COVID-19 INFECTION IN LIVER TRANSPLANT RECIPIENTS: CLINICAL FEATURES, HOSPITALIZATION, AND MORTALITY FROM A CANADIAN MULTICENTRE COHORT. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859339 DOI: 10.1093/jcag/gwab049.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic has brought significant challenges to clinicians caring for liver transplant (LT) recipients. Researchers have sought to better understand the risk and clinical outcomes of LT recipients infected with COVID-19 globally, however, there is a paucity of data from within Canada.
Aims
Our multi-center study aims to examine the characteristics and clinical outcomes of LT patients with COVID-19 in Canada.
Methods
We identified a retrospective cohort of adult LT recipients with RT-PCR confirmed COVID-19 from 7 Canadian tertiary care centers between March 2020 and June 2021. Demographic and clinical data were compiled by clinicians within those centers. We identified liver enzyme profile at the time of COVID-19 infection, immunosuppression type and post-infection adjustments, rate of hospitalization, ICU admission, mechanical ventilation, and death.
Results
A total of 49 patients with a history of LT and COVID-19 infection were identified. Twenty nine patients (59%) were male, the median time from LT was 66 months (1, 128) and the median age at COVID-19 infection was 59 years (52, 65). At COVID-19 diagnosis, the median ALT was 37 U/L (21, 41), AST U/L was 34 (20, 37), ALP U/L was 156 (88, 156), Total Bilirubin was 11 umol/L (7, 14), and INR was 1.1 (1.0, 1.1). The majority of patients (92%) were on tacrolimus monotherapy or a combination of tacrolimus and mycophenolate mofetil (MMF); median tacrolimus level at COVID-19 diagnosis was 5.3 ug/L (4.0, 8.1). Immunosuppression was modified in 8 (16%) patients post-infection; either the tacrolimus dose was reduced or MMF was held. One patient developed acute cellular rejection which recovered after re-initiation of the prior regimen. Eighteen patients (37%) required hospitalization, 6 (12%) were treated with dexamethasone, and 3 (6%) required ICU admission and mechanical ventilation. Four patients (8%) died due to complications of COVID-19. On univariate analysis, neither age, sex, co-morbidities nor duration post-transplant were associated with risk of hospitalization.
Conclusions
In our national retrospective study, approximately 40% of patients required hospitalization with a mortality rate of < 10%. Previous studies have shown proximity to LT as an independent factor for mortality with COVID-19; the median time from LT for our patients was 5 years, which may explain the lower mortality rate. Of note, the median tacrolimus levels were much lower in comparison to the target of 8–10 ug/L used in the first year post-transplant. As the landscape of COVID-19 changes with vaccination, evolving treatments, and increasing rates of variant transmission, additional studies are required to continue identifying trends in clinical outcomes.
Funding Agencies
None
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Affiliation(s)
- M K Smith
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - J Chow
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - R Huang
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - M Omar
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - M Ebadi
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - P Wong
- Gastroenterology, McGill University, Brossard, QC, Canada
| | - G Huard
- Liver diseases, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - D Peretz
- University of Manitoba, Winnipeg, MB, Canada
| | | | - A J Montano-Loza
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - R Bhanji
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
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14
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Rahman SH, Scharr Y, Jeyaparan J, Manko A, Coffin CS, Congly SE, Ramji A, Fung S, Cooper C, Ma M, Bailey R, Minuk G, Wong A, Doucette K, Elkhashab M, Wong P, Brahmania M. A217 TREATMENT ADHERENCE OF CHRONIC HEPATITIS B PATIENTS WITH HEPATOCELLULAR CARCINOMA FROM THE CANHEPB NETWORK. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859274 DOI: 10.1093/jcag/gwab049.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Chronic hepatitis B (CHB) is the most common cause of hepatocellular carcinoma (HCC) worldwide. Aims The primary aim of this study is to explore the degree of treatment adherence to the American Association For The Study of Liver Disease (AASLD) HCC treatment guidelines for patients with CHB-HCC. Methods This is a retrospective, cross-sectional study of available data (2005–2020) in patients mono-infected with CHB collected from the Canadian HBV Network; a national consortium across 8 Canadian provinces. We analyzed data using descriptive statistics along with parametric and nonparametric statistical methods with a significance level of p < 0.05. Results Of the 6500 patients, 132 (2.0%) patients met inclusion criteria. The median age was 64 (IQR: 53.5- 71.5) with 101 (76%) being male. The median ALT was 40 (IQR: 26–59.5) and the median tumor number was 1(IQR: 1- 2) with a median tumor size of 2.6 cm (IQR: 1.9- 4.5). 98 (74.5%) patients were HBeAg negative with a median viral load of 3.8 logs (IQR 1.9 – 5.8). 58 (43%) patients had cirrhosis at diagnosis. 36% of patients were diagnosed with HCC on their first screening imaging whereas 39% were found to have HCC on repeated surveillance imaging. 116 (87.9%) were on treatment at the time of diagnosis or after (70 (60.3%) NA and 46 (39%) Combination therapy with double NA or NA plus interferon). Out of the 132 patients, BCLC stage 0, A, B, and C represented 30 (23%), 42 (32%), 17 (13%), and 5 (4%) patients, respectively, with 38 (28%) patients with unknown BCLC stage. The overall adherence to AASLD guidelines was 61%. The HCC treatment adherence rate for patients with BCLC stage 0, A, B were 63%, 97.5%, and 23.5%, respectively. BCLC stages C and D did not have a sufficient sample size for analysis. The adherence rate ranged from 53% (Eastern Canada) to 71% (Western Canada) across Canada. Conclusions In this retrospective nationwide cohort study of patients with CHB-related HCC, the overall treatment adherence rate to AASLD guidelines was low with notable regional differences. Further analysis will determine the cause of regional differences. Funding Agencies None
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Affiliation(s)
- S H Rahman
- internal medicine, Western University, London, ON, Canada
| | - Y Scharr
- internal medicine, Western University, London, ON, Canada
| | - J Jeyaparan
- internal medicine, Western University, London, ON, Canada
| | - A Manko
- Biological sciences, University of Calgary, Calgary, AB, Canada
| | - C S Coffin
- Medicine, University of Calgary, Calgary, AB, Canada
| | - S E Congly
- Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - A Ramji
- Gastrointestinal Research Institute, Vancouver, BC, Canada
| | - S Fung
- Toronto General Hospital, Toronto, ON, Canada
| | - C Cooper
- University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - M Ma
- University of Alberta, Edmonton, AB, Canada
| | - R Bailey
- Royal Alexandra Hospital, Edmonton, AB, Canada
| | - G Minuk
- University of Manitoba, Winnipeg, MB, Canada
| | - A Wong
- University of Saskatchewan, Saskatoon, SK, Canada
| | - K Doucette
- University of Alberta, Edmonton, AB, Canada
| | | | - P Wong
- Gastroenterology, McGill University, Brossard, QC, Canada
| | - M Brahmania
- internal medicine, Western University, London, ON, Canada
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15
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Zhao X, Chen Y, Deschenes M, Wong P, Sebastiani G, Chen T, Benmassaoud A. A110 FEASIBILITY OF EUS-GUIDED PORTAL PRESSURE GRADIENT MEASUREMENT WITHOUT DEEP SEDATION: A PATH TO ACCURATE PORTAL PRESSURE DETERMINATION. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859132 DOI: 10.1093/jcag/gwab049.109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims Hepatic venous pressure gradient (HVPG) is the gold standard for the diagnosis and staging of portal hypertension. Previous studies have shown that it underestimates pre-sinusoidal portal hypertension. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) can safely measure direct portal vein pressure (PVP) and bridge this diagnostic gap. However, EUS-PPG has so far been performed with patients under deep sedation which can alter HVPG measurement and lead to misclassification of portal hypertension. Ketamine, a conscious sedation agent, has minimal effect on portal hemodynamics. We present our center’s experience with EUS-PPG under ketamine and low dose midazolam. Methods We retrospectively reviewed consecutive patients undergoing EUS-PPG with conscious sedation using ketamine and low-dose midazolam (<0.02 mg/kg) at the McGill University Health Centre from February to May 2021. Patients were placed in the left lateral position. Hepatic vein and portal vein were located through EUS via a trans-gastric/hepatic approach. A through the scope 25-gauge needle attached to a manometer was advanced through the liver to measure hepatic vein pressure (HVP) and portal vein pressure (PVP). Three measurements were sampled per vessel and mean pressure differences calculated to obtain PPG. PPG was considered reliable if the differences between the values was no more than 1mmHg. Results Three patients underwent EUS-PPG for evaluation of pre-sinusoidal portal hypertension. Cirrhosis was excluded in all patients based on recent liver biopsy or transient elastography. The first patient is a 69-year-old man with splenomegaly and recanalization of the paraumbilical vein on imaging. He received 80 mg of ketamine and no midazolam. HVPG measured was 1 mmHg. EUS-PPG was successful with PPG of 6 mmHg (HVP= 7 mmHg, and PVP= 13 mmHg). The second patient is a 42-year-old woman with previous sleeve gastrectomy and known with portal cavernoma. She received 120 mg of ketamine and 1 mg of midazolam. EUS-PPG was technically difficult due to respiratory movements. The measurement was not considered reliable as differences in PPG were as high as 2mmHg. In this case, PPG was 0mmHg (HVP= 15mmHg, and PVP= 15mmHg). The third patient, a 74-year-old man with hepatic steatosis and splenomegaly received 70 mg of ketamine and 1 mg of midazolam. EUS-PPG was successful (HVP= 3mmHg, PVP= 3mmHg) yielding a PPG 0mmHg. All patients tolerated the procedure well with no procedural or sedation-related complications Conclusions Our early experience suggests that EUS-PPG can be successfully and safely performed in patients under conscious sedation with ketamine and low-dose midazolam. This combination may avoid deep sedation with high dose midazolam or propofol which are known to alter accuracy of HVPG. ![]()
Measurement of HVP (left) and PVP (right) Funding Agencies None
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Affiliation(s)
- X Zhao
- Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada
| | - Y Chen
- Divison of Gastroenterology and Hepatology, McGill University Health Centre, Outremont, QC, Canada
| | | | - P Wong
- Gastroenterology, McGill University, Brossard, QC, Canada
| | - G Sebastiani
- Royal Victoria Hospital, McGill University Health Center, Montreal, QC, Canada
| | - T Chen
- McGill University Health Centre, Montreal, QC, Canada
| | - A Benmassaoud
- McGill University Health Center, Montreal, QC, Canada
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16
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Truong M, Yeganeh L, Cook O, Crawford K, Wong P, Allen J. OUP accepted manuscript. J Am Med Inform Assoc 2022; 29:970-982. [PMID: 35150266 PMCID: PMC9006681 DOI: 10.1093/jamia/ocac015] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/17/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The COVID-19 pandemic has seen a rapid adoption of telehealth consultations, potentially creating new barriers to healthcare access for racial/ethnic minorities. This systematic review explored the use of telehealth consultations for people from racial/ethnic minority populations in relation to health outcomes, access to care, implementation facilitators and barriers, and satisfaction with care. Materials and Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Joanna Briggs Institute Manual for Evidence Synthesis. Five major databases were searched to identify relevant studies. Screening, full-text review, quality appraisal, and data extraction were all completed independently and in duplicate. A convergent integrated approach to data synthesis was applied with findings reported narratively. Results A total of 28 studies met the inclusion criteria. Telehealth-delivered interventions were mostly effective for the treatment/management of physical and mental health conditions including depression, diabetes, and hypertension. In several studies, telehealth improved access to care by providing financial and time benefits to patients. Technological difficulties were the main barriers to effective telehealth consultation, although overall satisfaction with telehealth-delivered care was high. Discussion Telehealth-delivered care for racial/ethnic minorities offers promise across a range of conditions and outcomes, particularly when delivered in the patient’s preferred language. However, telehealth may be problematic for some due to cost and limited digital and health literacy. Conclusion The development and implementation of guidelines, policies, and practices in relation to telehealth consultations for racial/ethnic minorities should consider the barriers and facilitators identified in this review to ensure existing health disparities are not exacerbated.
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Affiliation(s)
- Mandy Truong
- Corresponding Author: Mandy Truong, PhD, MPH, BOptom, Monash Nursing and Midwifery, Monash University, Level 3, Building 13D, 35 Rainforest Walk, Clayton, VIC 3800, Australia;
| | - Ladan Yeganeh
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Olivia Cook
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Kimberley Crawford
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Pauline Wong
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jacqueline Allen
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
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17
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Lin R, Ritter E, Flynn J, Ho C, Ruiz J, Jakubowski A, Papadopoulos E, Shaffer B, Castro-Malaspina H, Cho C, Ponce D, Barker J, Tamari R, Sauter C, Gyurkocza B, van den Brink M, Young J, Perales M, Devlin S, Wong P, Giralt S. Aging-related, Senescence-associated Secretory Phenotype and Allogeneic Hematopoietic Cell Transplantation Outcomes in Older Adults. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Masucci G, Boucher O, Marie F, Plourde M, Panet-Raymond V, Pavic M, Owen S, Masson-Cote L, Menard C, Routy B, Tehfe M, Blais N, Roberge D, Wong P. Prospective Neurocognitive Functions of Patients Treated With Concurrent Nivolumab and Stereotactic Brain Radiosurgery for NSCLC and RCC Brain Metastases. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Priskorn F, Wong P, Daultrey C. 665 Management of Epistaxis Patients After Nasal Pack Removal - Quality Improvement Project. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Epistaxis is a common emergency and treatments include cautery and nasal packing. NICE guidelines recommend Naseptin® (chlorhexidine and neomycin) and routine practice is to perform cautery if bleeding point identified following pack removal.
Method
Retrospective analysis of electronic records over a 9-month period identified 114 patients admitted with epistaxis.
Results
Demographics: 65 male, 49 females (roughly 13:10 ratio), an average age of 72.5 and median age: 76. 8 patients had 2 presentations with epistaxis (3 had SPA ligation on repeat admission). 97 patients were packed, 17 no packing performed. Reasons for admission without packing was observation after cautery (7), observation without cautery (5) and admission under medics for non-epistaxis issue (5). Of patients with discharge summaries, 90% had naseptin prescribed. Of patient admitted under medics, only 60% discharged with naseptin. 70 patients (61.4%) were cauterized, 16 patients (14%) examined, but no cautery required, and 28 patients (24.5%) had no documentation of examination or cautery attempt.
Conclusions
The majority of patients are receiving naseptin on discharge but room for improvement. Although small sample size of 5, greater portion medical patients discharged without naseptin, better handover required. Almost a quarter of patients (24.5%) did not have any documentation of cautery attempts.
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Affiliation(s)
- F Priskorn
- Worcester Royal Hospital, Worcester, United Kingdom
| | - P Wong
- Worcester Royal Hospital, Worcester, United Kingdom
| | - C Daultrey
- Worcester Royal Hospital, Worcester, United Kingdom
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20
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Wong P, Kumar CM, Seet E. Recommendations for standards of monitoring during anaesthesia and recovery 2021: caveats regarding neuromuscular monitoring. Anaesthesia 2021; 76:1425. [PMID: 34131908 DOI: 10.1111/anae.15529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 12/17/2022]
Affiliation(s)
- P Wong
- Waikato District Health Board, Hamilton, New Zealand
| | - C M Kumar
- Khoo Teck Puat Hospital, National Healthcare Group, Singapore, Singapore
| | - E Seet
- Khoo Teck Puat Hospital, National Healthcare Group, Singapore, Singapore
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21
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Zoughlami A, Serero J, Sebastiani G, Deschenes M, Wong P, Khan AQ. A72 NON-INVASIVE PREDICTION OF ESOPHAGEAL VARICES BY TRANSIENT ELASTOGRAPHY AND PLATELET COUNT IN PATIENTS WITH HEPATITIS B AND ADVANCED CHRONIC LIVER DISEASE: VALIDATION OF BAVENO VI AND EXPANDED BAVENO VI CRITERIA. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with compensated advanced chronic liver disease (cACLD) are at higher risk of developing complications from portal hypertension, including esophageal varices (EV). Baveno VI and expanded Baveno VI criteria, based on liver stiffness measurement (LSM) by transient elastography combined with platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for large esophageal varices needing treatment (EVNT). This approach has not been validated in patients with chronic hepatitis B virus (HBV) infection, who have etiology-specific cut-off of LSM for liver fibrosis.
Aims
We aimed to validate the Baveno VI and expanded Baveno VI criteria for EVNT in HBV patients with cACLD.
Methods
We performed a retrospective analysis of HBV patients who underwent LSM in 2014–2020. Inclusion criteria were: a) diagnosis of cACLD, defined as LSM >9 kPa; b) availability of EGD and platelets within 1 year of LSM. Baveno VI (LSM <20 kPa and platelets >150,000) and expanded Baveno VI criteria (LSM <25 kPa and platelets >110,000) were tested for EGD sparing. Diagnostic performance of these criteria against gold standard (EGD) was computed and compared to patients with hepatitis C virus (HCV) infection and nonalcoholic steatohepatitis (NASH) etiologies, where these criteria have been widely validated. In these patients, the threshold for cACLD definition was >10 kPa.
Results
A total of 287 patients (mean age 56, 95% Child A) were included, comprising of 43 HBV (58% on antiviral therapy), 134 HCV and 110 NASH patients. The prevalence of any grade EV and EVNT was 25% and 8% in the whole cohort, with 19% and 5% in HBV patients, respectively. Table 1 reports diagnostic performance, spared EGD and missed EVNT according to non-invasive criteria and cACLD etiology. Both Baveno VI and expanded Baveno VI criteria performed well in patients with HBV-related cACLD. There was no significant difference on diagnostic performance of these non-invasive criteria across the cACLD etiologies.
Conclusions
These results support use of non-invasive criteria based on LSM and platelets to spare unnecessary EGD in patients with HBV and cACLD. Baveno VI and expanded Baveno VI criteria can improve resource utilization and avoid invasive testing in context of screening EGD for patients with HBV-related cACLD.
Funding Agencies
None
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Affiliation(s)
- A Zoughlami
- McGill University Faculty of Medicine, Montreal, QC, Canada
| | - J Serero
- McGill University Faculty of Medicine, Montreal, QC, Canada
| | - G Sebastiani
- McGill University Faculty of Medicine, Montreal, QC, Canada
| | - M Deschenes
- McGill University Faculty of Medicine, Montreal, QC, Canada
| | - P Wong
- McGill University Faculty of Medicine, Montreal, QC, Canada
| | - A Q Khan
- McGill University Faculty of Medicine, Montreal, QC, Canada
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22
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Valenzano MC, Rybakovsky E, Chen V, Leroy K, Lander J, Richardson E, Yalamanchili S, McShane S, Mathew A, Mayilvaganan B, Connor L, Urbas R, Huntington W, Corcoran A, Trembeth S, McDonnell E, Wong P, Newman G, Mercogliano G, Zitin M, Etemad B, Thornton J, Daum G, Raines J, Kossenkov A, Fong LY, Mullin JM. Zinc Gluconate Induces Potentially Cancer Chemopreventive Activity in Barrett's Esophagus: A Phase 1 Pilot Study. Dig Dis Sci 2021; 66:1195-1211. [PMID: 32415564 PMCID: PMC7677901 DOI: 10.1007/s10620-020-06319-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/02/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chemopreventive effects of zinc for esophageal cancer have been well documented in animal models. This prospective study explores if a similar, potentially chemopreventive action can be seen in Barrett's esophagus (BE) in humans. AIMS To determine if molecular evidence can be obtained potentially indicating zinc's chemopreventive action in Barrett's metaplasia. METHODS Patients with a prior BE diagnosis were placed on oral zinc gluconate (14 days of 26.4 mg zinc BID) or a sodium gluconate placebo, prior to their surveillance endoscopy procedure. Biopsies of Barrett's mucosa were then obtained for miRNA and mRNA microarrays, or protein analyses. RESULTS Zinc-induced mRNA changes were observed for a large number of transcripts. These included downregulation of transcripts encoding proinflammatory proteins (IL32, IL1β, IL15, IL7R, IL2R, IL15R, IL3R), upregulation of anti-inflammatory mediators (IL1RA), downregulation of transcripts mediating epithelial-to-mesenchymal transition (EMT) (LIF, MYB, LYN, MTA1, SRC, SNAIL1, and TWIST1), and upregulation of transcripts that oppose EMT (BMP7, MTSS1, TRIB3, GRHL1). miRNA arrays showed significant upregulation of seven miRs with tumor suppressor activity (-125b-5P, -132-3P, -548z, -551a, -504, -518, and -34a-5P). Of proteins analyzed by Western blot, increased expression of the pro-apoptotic protein, BAX, and the tight junctional protein, CLAUDIN-7, along with decreased expression of BCL-2 and VEGF-R2 were noteworthy. CONCLUSIONS When these mRNA, miRNA, and protein molecular data are considered collectively, a cancer chemopreventive action by zinc in Barrett's metaplasia may be possible for this precancerous esophageal tissue. These results and the extensive prior animal model studies argue for a future prospective clinical trial for this safe, easily-administered, and inexpensive micronutrient, that could determine if a chemopreventive action truly exists.
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Affiliation(s)
- M C Valenzano
- The Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - E Rybakovsky
- The Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - V Chen
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - K Leroy
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - J Lander
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - E Richardson
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - S Yalamanchili
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - S McShane
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - A Mathew
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - B Mayilvaganan
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - L Connor
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - R Urbas
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - W Huntington
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - A Corcoran
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - S Trembeth
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - E McDonnell
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - P Wong
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - G Newman
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - G Mercogliano
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - M Zitin
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - B Etemad
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - J Thornton
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA
| | - G Daum
- The Department of Pathology, Lankenau Medical Center, Wynnewood, USA
| | - J Raines
- The Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA
| | | | - L Y Fong
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - J M Mullin
- The Division of Gastroenterology, Lankenau Medical Center, Wynnewood, USA.
- The Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA.
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
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23
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Wong P, Redley B, Bucknall T. Families' control preference for participation in patient care in adult intensive care. Intensive Crit Care Nurs 2020; 62:102953. [PMID: 33189518 DOI: 10.1016/j.iccn.2020.102953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 07/28/2020] [Accepted: 08/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Understand families' preferences and observed participation in patient care in an adult ICU. RESEARCH METHODOLOGY The mixed-methods design used survey and naturalistic observation to collect data from a convenience sample of 30 family members of critically ill patients. SETTING Two public hospital intensive care units in Australia. MAIN OUTCOME MEASURES 1) Families' preferences for participation in decision-making and physical patient care activities in the adult intensive care unit, measured using a modified Control Preference Scale; 2) the type and frequency of family participation in patient care activities in the intensive care unit. RESULTS Almost half (47%) reported a preference to share in decision-making about care for their relative with healthcare professionals; 17% reported a preference for active participation in decision-making. Alternatively, most families preferred a passive (60%) role in the physical care of their relative ; 33% preferred shared participation with staff and very few (3%) preferred active participation with little involvement of staff. Of the 193 activities observed, family participation in physical care was the least frequent (24%). CONCLUSION Differences emerged in family preferences for participation in physical care compared to their involvement in decision-making about care for their relative. The findings indicate a need for tailored interventions to support family participation aligned with their preferences.
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Affiliation(s)
- Pauline Wong
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, 1 Gheringhap Street, Geelong, Victoria 3220, Australia.
| | - Bernice Redley
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, 1 Gheringhap Street, Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research-Monash Health Partnership, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | - Tracey Bucknall
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, 1 Gheringhap Street, Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, The Alfred, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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24
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Abstract
Abstract
Background
Atrial fibrillation (AF) is a common arrhythmia with significant morbidity due to an increased risk of ischemic stroke. Outpatient electrocardiogram (ECG) monitoring is an integral part of the diagnosis of AF. Conventional 24 hour Holter monitoring can be cumbersome and often fails to diagnose patients with paroxysmal AF. Spyder ECG is a non-invasive ECG monitoring device that allows wireless transmission of ECG information for analysis. It is small and comfortable, allowing for easy application for the screening and detection of AF over a mid-term duration.
Purpose
This study aims to evaluate the incidence of AF in patients with no prior AF and CHADsVASC score of at least 1 with the use of the Spyder ECG mid-term ECG monitoring device.
Methods
Patients aged 21 to 85 years old with no prior history of AF and CHADsVASC score of at least 1 were recruited from outpatient clinics of 3 large tertiary hospitals in Singapore from December 2016 to April 2019. Patients wore the Spyder ECG device for up to 2 weeks, during which continuous ECG information was uploaded onto a central cloud database and analysed.
Results
There were 363 patients recruited. The mean age was 61±10.0 years and 65.1% were male. There were 80.3% Chinese, 11.6% Malay, 7.5% Indian and 20.6% of other races. 68.3% of the patients were non-smokers and 74.0% of them were non-alcohol drinkers. The mean BMI of 25.5±4.7 kg/m2. The patient population had significant co-morbidities. 76.3% of the patients had hypertension, 69.4% of them had hyperlipidemia and 40.5% of them had diabetes mellitus. 10.0% of them had congestive cardiac failure and 56.7% had ischaemic heart disease. 11.3% of patients had a previous stroke and 20.4% had a prior myocardial infarction. 7.8% of the patients had asthma, 5.8% of them had thyroid disease and 9.9% of them had chronic kidney disease. They were monitored for a mean of 5.4±2.9 days each. There were 15 (4.1%) patients in whom AF was detected. The patients with AF wore the device for a mean of 5.7±2.0 SD days. The mean burden of AF was 9.0% of monitored time. 46.7% of the patients with AF had detection of AF on the first day, 26.7% on the second day, 13.3% on the third day and 13.3% on the seventh day. The mean duration of the first episode of AF was 251±325 minutes. 7 out of 15 (46.7%) of patients had first episodes of AF lasting less than 10 minutes.
Conclusion
Continuous mid-term ECG monitoring was able to detect AF in 15 (4.1%) of a population of 363 patients with no prior AF and CHADsVASC score of at least one, monitored for a mean of 5.4 days. Most episodes (53.3%) of AF were detected after the first day of ECG monitoring.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Duke-NUS Medical School Singapore
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Affiliation(s)
- J Cai
- National Heart Centre Singapore (NHCS), Singapore, Singapore
| | - K.K Yeo
- National Heart Centre Singapore (NHCS), Singapore, Singapore
| | - P Wong
- National Heart Centre Singapore (NHCS), Singapore, Singapore
| | - C.K Ching
- National Heart Centre Singapore (NHCS), Singapore, Singapore
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Agarwal A, Galer B, Wong P, Farfel G, Keane M, Lai W. Identification of the intermittent nature of trace mitral and/or aortic regurgitation: long-term longitudinal echocardiogram study in children with Dravet syndrome treated with fenfluramine. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Previous studies have identified the presence of trace valvular regurgitation; however, these studies are typically cross-sectional assessments at a single point in time and provide no information regarding the natural history of trace aortic or mitral regurgitation (AR, MR). To our knowledge no study has assessed valve function in growing children with longitudinal echocardiogram (ECHO) assessments.
Purpose
To monitor cardiac valve function with regular, standardized ECHOs in patients with Dravet syndrome (DS) treated with fenfluramine for up to 3 years.
Methods
Patients with DS who completed either of two double-blind Phase 3 clinical trials were eligible to enroll in the open label extension (OLE) study. Patients were to be excluded from entry into the double-blind trials if they exhibited any degree of AR or MR, including trace; or pulmonary artery hypertension (PAH). However, trace MR or AR were not exclusion criteria for continuation into the OLE study. All patients had an ECHO prior to initiation of treatment in the double-blind study, after 6 to 8 weeks of treatment, and at the end of that study. In the OLE study, ECHOs were performed at study week 4, 5, or 6, and every 3 months thereafter. Valve morphology was also examined.
Results
As of September 1, 2019 a total of 330 patients had enrolled in the OLE study and received at least one dose of fenfluramine. The average age of patients at enrollment was 9.0±4.6 years, 27.6% were <6 years old, and 54.5% were male. The median duration of treatment with fenfluramine in the OLE study was 631 days (min, max; 7, 1086 days), and a total of 2,691 ECHOs had been performed. The point prevalence of trace MR was 10.6% at OLE study entry and ranged from 2.8% to 12.9% thereafter. All instances of trace MR were transient events that reverted to absent or oscillated between trace and absent at later study visits. Four patients demonstrated trace AR at one or more visits and all had reverted to absent at their most recent examination. No changes in valve morphology were observed.
Conclusions
In this long-term longitudinal ECHO study in DS children treated with fenfluramine, we identified that trace MR and AR were intermittent and not predictive of future valve disease. In all cases trace reverted to absent regurgitation at subsequent ECHOs. No valve morphological changes were seen. The intermittent and transient nature of trace regurgitation observed in this study is consistent with current ECHO guidelines, which consider trace regurgitation to be a normal physiologic phenomenon.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Zogenix, Inc.
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Affiliation(s)
- A Agarwal
- Zogenix, Inc., Emeryville, United States of America
| | - B Galer
- Zogenix, Inc., Emeryville, United States of America
| | - P Wong
- Children's Hospital Los Angeles, Los Angeles, United States of America
| | - G Farfel
- Zogenix, Inc., Emeryville, United States of America
| | - M.G Keane
- Temple University Hospital, Philadelphia, United States of America
| | - W.W Lai
- Children's Hospital of Orange County, Orange, United States of America
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Wong P, Banville J, Wexler R, Priestley E, Marinier A, Bouvier M, Gordon D, Yang J. Favorable therapeutic index of an orally-active small-molecule antagonist of the platelet protease-activated receptor-4, BMS-986141, compared with the P2Y12 antagonist ticagrelor in cynomolgus monkeys. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
BMS-986141 is an orally-active small-molecule platelet thrombin receptor antagonist selective for the protease-activated receptor-4 (PAR4), a human platelet thrombin receptor.
Purpose
This study assessed effects of BMS-986141 vs. the P2Y12 antagonist ticagrelor, a standard of care antiplatelet agent, on arterial thrombosis (AT), mesenteric bleeding time (MBT) and platelet aggregation in monkeys.
Methods
Studies were conducted in models of electrically-mediated carotid artery thrombosis and MBT in anesthetized monkeys. Monkeys were given a single oral dose of BMS-986141 (0.05, 0.1, 0.5 mg/kg) or vehicle (n=8/group). At 2 hr post-dose, in vivo AT, MBT as well as ex vivo platelet aggregation were monitored in the same animal. Ticagrelor was studied as a comparator and given as IV bolus plus infusion at 0.0023+0.017 to 0.075+0.6 (mg/kg+mg/kg/h) (n=5–6/group). Thrombus weight reduction, MBT increase over vehicle, and platelet aggregation inhibition were determined. Peak platelet aggregation responses to activation peptides selective for PAR4 (PAR4-AP, 12.5 μM) and PAR1 (PAR1-AP, 18 μM), to collagen (5 μg/ml) and to ADP (20 μM) were determined by whole blood aggregometry.
Results
BMS-986141 inhibited platelet aggregation induced by PAR4-AP in human and monkey blood in vitro with comparable IC50 of 1.8±0.3 and 1.2±0.3 nM, respectively. BMS-986141 at 0.5 mg/kg completely inhibited platelet aggregation induced by PAR4-AP but not PAR1-AP, ADP and collagen, suggesting PAR4 receptor selectivity. In the AT model, BMS-986141 at 0.05, 0.1 and 0.5 mg/kg reduced thrombus weight by 36±7*, 63±8*, and 88±3%*, respectively (*P<0.05 vs. vehicle). BMS-986141 increased MBT by up to 1.2-fold. In a separate study, ticagrelor at 0.0023+0.017, 0.0068+0.055, 0.0255+0.18 and 0.075+0.6 (mg/kg+mg/kg/h IV) reduced thrombus weight by 19±8, 36±5*, 76±6* and 89±1%*, and increased MBT by respectively by 1.7-, 6.4-*, >10-*, and >10-fold*, respectively (*P<0.05 vs. vehicle).
Conclusion
Comparable antithrombotic efficacy was observed between BMS-986141 and ticagrelor in monkeys. BMS-986141 exhibited lower MBT compared with ticagrelor at equivalent antithrombotic doses. This study suggests that PAR4 antagonism provides a potentially safer antiplatelet therapy.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Research was supported by Bristol-Myers Squibb
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Affiliation(s)
- P Wong
- Bristol Myers Squibb, Princeton, United States of America
| | - J Banville
- Universite de Montreal, Institute for Research in Immunology and Cancer, Montreal, Canada
| | - R Wexler
- Bristol Myers Squibb, Princeton, United States of America
| | - E Priestley
- Bristol Myers Squibb, Princeton, United States of America
| | - A Marinier
- Universite de Montreal, Institute for Research in Immunology and Cancer, Montreal, Canada
| | - M Bouvier
- Universite de Montreal, Institute for Research in Immunology and Cancer, Montreal, Canada
| | - D Gordon
- Bristol Myers Squibb, Princeton, United States of America
| | - J Yang
- Bristol Myers Squibb, Princeton, United States of America
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Menard C, Delouya G, Wong P, Beauchemin M, Barkati M, Taussky D, Duplan D, Igidbashian L, Mok G, Clavel S, Gauthier-Pare A, Bahary J, Key K, Vallee E, Roberge D, DaSilva J, Saad F, Juneau D. Randomized Controlled Trial of PSMA PET/CT Guided Intensification of Radiotherapy for Prostate Cancer: Detection Rates and Impact on Radiotherapeutic Management. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Lee ST, Muralidharan V, Tebbutt N, Wong P, Fang C, Liu Z, Gan H, Sachinidis J, Pathmaraj K, Christophi C, Scott AM. Prevalence of hypoxia and correlation with glycolytic metabolism and angiogenic biomarkers in metastatic colorectal carcinoma. Eur J Nucl Med Mol Imaging 2020; 48:1585-1592. [PMID: 33125527 DOI: 10.1007/s00259-020-05074-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Hypoxia is associated with aggressive tumour behaviour and can influence response to systemic therapy and radiotherapy. The prevalence of hypoxia in metastatic colorectal cancer is poorly understood, and the relationship of hypoxia to patient outcomes has not been clearly established. The aims of the study were to evaluate hypoxia in metastatic colorectal cancer with [18F]Fluoromisonidazole ([18F]FMISO PET) and correlate these findings with glycolytic metabolism ([18F]FDG PET) and angiogenic blood biomarkers and patient outcomes. METHODS Patients with metastatic colorectal cancer received routine staging investigations and both [18F] FMISO PET and [18F] FDG PET scans. Correlative blood specimens were also obtained at the time of the [18F] FMISO PET scan. Patient follow-up was performed to establish progression-free survival. RESULTS A total of 40 patients were recruited into the trial. [18F]FMISO and [18F]FDG PET scans showed a significant correlation of SUVmax (p = 0.003). A significant correlation of progression-free survival and [18F] FMISO TNR (p = 0.02) and overall survival with [18F]FMISO TNR (p = 0.003) and [18F]FDG TGV (p = 0.02) was observed. Serum levels of osteopontin, but not VEGF, correlated with [18F] FMISO and [18F]FDG PET scan parameters. CONCLUSION [18F]FMISO PET uptake in metastatic colorectal cancer significantly correlates with glycolytic metabolism and is predictive of progression-free and overall survival. These findings have implications for the assessment and treatment of metastatic colorectal cancer patients with novel therapies which affect tumour angiogenesis and hypoxia.
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Affiliation(s)
- S T Lee
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia. .,Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia. .,School of Cancer Medicine, La Trobe University, Melbourne, Australia. .,Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Australia.
| | - V Muralidharan
- Department of Surgery, Austin Health, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Australia
| | - N Tebbutt
- Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Australia.,Department of Medical Oncology, Austin Health, Melbourne, Australia
| | - P Wong
- Department of Surgery, Austin Health, Melbourne, Australia
| | - C Fang
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia
| | - Z Liu
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia
| | - H Gan
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia.,School of Cancer Medicine, La Trobe University, Melbourne, Australia.,Department of Medical Oncology, Austin Health, Melbourne, Australia
| | - J Sachinidis
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
| | - K Pathmaraj
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
| | - C Christophi
- Department of Surgery, Austin Health, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Australia
| | - A M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia.,Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia.,School of Cancer Medicine, La Trobe University, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Australia
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Wong P, Redley B, Digby R, Correya A, Bucknall T. Families’ perspectives of participation in patient care in an adult intensive care unit: A qualitative study. Aust Crit Care 2020; 33:317-325. [DOI: 10.1016/j.aucc.2019.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022] Open
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Ng B, Wong P, Hassett G, Gibson K. FRI0354 FACTORS AFFECTING SELF-REPORTED PHYSICAL CTIVITY IN PATIENTS WITH PSORIATIC ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Despite the known benefits of exercise1, patients with osteoarthritis (OA) and rheumatoid arthritis (RA) are reported to have low levels of physical activity2. Exercise participation is not well studied in psoriatic arthritis (PsA) cohorts. This study aims to explore which factors predict exercise participation across cohorts and specifically in the PsA cohort.Objectives:The primary aim of this study was to determine which clinical factors were predictive of self- reported physical activity levels in patients with PsA. A secondary aim was to explore differences in self-reported physical activity levels amongst patients with PsA, OA and RA.Methods:Patients with the diagnosis of PsA, RA or OA are recruited prospectively at two tertiary hospital rheumatology clinics over 12 months. Demographic data is captured by the multi-dimensional health assessment questionnaire, the international physical activity questionnaire short form captures self-reported physical activity and self-efficacy for exercise (SEE) is assessed using the SEE scale. Clinical data including joint count, body mass index and co-morbidities including fibromyalgia are collected for all patients, in addition to PsA specific data including skin and enthesitis indices.Results:205 patients (PsA n=62, RA n=83, OA n=60) were recruited across two sites. There was no significant difference in self-reported physical activity between OA, RA and PsA cohorts. Fibromyalgia was present in 30% of each cohort. In patients with PsA, univariate analysis showed that co-existent fibromyalgia, age and self-efficacy for exercise were predictors of physical activity levels. Skin disease and enthesitis were not predictors of physical activity in the PsA cohort.Table 1.Univariate Analyses of effect of Clinical Features on Physical Activity levels in PsANon-exercisers versus ExercisersOR (95% CI)P-valueLEI1.35 (0.92-1.97)0.127PASI0.8 (0.6-1.07)0.133DLQI1.03 (0.92-1.16)0.589BMI0.97 (0.91-1.04)0.415DAS280.79 (0.55-1.14)0.205Concurrent Fibromyalgia4.46 (1.37-14.49)0.012Age1.05 (1.00-1.10)0.013Self-efficacy for exercise0.97 (0.95-0.99)0.019Pain1.17 (0.99-1.37)0.061Function1.3 (1.02-1.65)0.031Patient global1.14 (0.96-1.34)0.128Depression0.97 (0.51-1.84)0.930Table 2.Multivariable Analysis on Physical Activity in PsANon-exercisers vs ExercisersOR (95% CI)P-valueConcurrent fibromyalgia5.1 (1.44-18.08)0.0117Age1.05 (1.00-1.11)0.0342Conclusion:In the PsA cohort, fibromyalgia and age were associated with lower levels of physical activity. DLQI, PASI, LEI did not predict physical activity in PsA. Multivariate analysis showed higher pain levels and lower self-efficacy scores were associated with lower physical activity across arthritis groups.References:[1]Der Ananian C, Wilcox S, Watkins K, Saunders RP, Evans AE. (2008). Factors Associated with Exercise Participation in Adults with Arthritis.Journal of Aging and Physical Activity, 16: 125-143[2]Wilcox S, Der Ananian C, Abbott J, Vrazel J, Ramsey C, Sharpe PA, Brady T. (2006). Perceived Exercise Barriers, Enablers, and Benefits Among Exercising and Nonexercising Adults With Arthritis: Results from a Qualitative Study.Arthritis & Rheumatism, 55(4): 616-627Acknowledgments:Joseph DescallarDana GeorgevskyDr Michael OliffeDr Diana ChessmanDepartment of Rheumatology, Liverpool Hospital NSW AustraliaDepartment of Rheumatology, Westmead Hospital NSW AustraliaDisclosure of Interests:None declared
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Wu D, Griffith JF, Lam SHM, Wong P, Yue J, Shi L, Li EK, Cheng IT, Li TK, Hung VW, Qin L, Tam LS. Comparison of bone structure and microstructure in the metacarpal heads between patients with psoriatic arthritis and healthy controls: an HR-pQCT study. Osteoporos Int 2020; 31:941-950. [PMID: 31938819 DOI: 10.1007/s00198-020-05298-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/10/2020] [Indexed: 01/01/2023]
Abstract
UNLABELLED Human cadaveric study has indicated that the metacarpal head (MCH) is intracapsular in location. We hypothesized that exposure to the intra-articular inflammatory milieu in psoriatic arthritis (PsA) will lead to bone loss in the MCH. INTRODUCTION To compare the bone structure and microstructure in the MCH between patients with PsA and healthy controls by high-resolution peripheral quantitative CT (HR-pQCT), and to ascertain factors associated with bone loss in PsA patients. METHODS Sixty-two PsA patients without joint destruction and 62 age-, gender-, and body mass index-matched healthy subjects underwent HR-pQCT imaging of the second and third MCH (MCH 2&3). The number and volume of bone erosion and enthesiophytes, as well as volumetric bone mineral density (vBMD) and microstructure at the MCH 2&3, were recorded. Correlation analysis and multivariable linear regression models were used to determine the association of demographic and disease-specific variables with compromised bone structure and microstructure in PsA. RESULTS At the MCH 2&3, bone erosion (p = 0.003) and enthesiophyte (p = 0.000) volumes in PsA patients were significantly larger than healthy controls. In PsA patients, older age was associated with a larger erosion and enthesiophyte volume. Concerning the mean vBMD and microstructure at the MCH 2&3, PsA patients had significantly lower mean vBMD (average vBMD - 6.9%, trabecular vBMD - 8.8%, peri-trabecular vBMD - 7.7%, meta-trabecular vBMD - 9.8%), trabecular bone volume fraction (- 8.8%), and trabecular thickness (- 8.1%) compared with control subjects. Multivariable regression analysis revealed that older age and a higher C-reactive protein level were associated with trabecular bone loss. CONCLUSIONS PsA patients had a higher burden of bone damages (erosions and enthesiophytes) and trabecular bone loss compared with healthy control at the MCH. Inflammation contributed to the deterioration in trabecular microstructure in these patients.
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Affiliation(s)
- D Wu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - S H M Lam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - P Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - J Yue
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L Shi
- Research Centre for Medical Image Computing, Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - E K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - I T Cheng
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - T K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - V W Hung
- Bone Quality and Health Centre of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L Qin
- Bone Quality and Health Centre of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L-S Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Martel G, Baker L, Wherrett C, Fergusson DA, Saidenberg E, Workneh A, Saeed S, Gadbois K, Jee R, McVicar J, Rao P, Thompson C, Wong P, Abou Khalil J, Bertens KA, Balaa FK. Phlebotomy resulting in controlled hypovolaemia to prevent blood loss in major hepatic resections (PRICE-1): a pilot randomized clinical trial for feasibility. Br J Surg 2020; 107:812-823. [PMID: 31965573 DOI: 10.1002/bjs.11463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/28/2019] [Accepted: 11/15/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Major liver resection is associated with blood loss and transfusion. Observational data suggest that hypovolaemic phlebotomy can reduce these risks. This feasibility RCT compared hypovolaemic phlebotomy with the standard of care, to inform a future multicentre trial. METHODS Patients undergoing major liver resections were enrolled between June 2016 and January 2018. Randomization was done during surgery and the surgeons were blinded to the group allocation. For hypovolaemic phlebotomy, 7-10 ml per kg whole blood was removed, without intravenous fluid replacement. Co-primary outcomes were feasibility and estimated blood loss (EBL). RESULTS A total of 62 patients were randomized to hypovolaemic phlebotomy (31) or standard care (31), at a rate of 3·1 patients per month, thus meeting the co-primary feasibility endpoint. The median EBL difference was -111 ml (P = 0·456). Among patients at high risk of transfusion, the median EBL difference was -448 ml (P = 0·069). Secondary feasibility endpoints were met: enrolment, blinding and target phlebotomy (mean(s.d.) 7·6(1·9) ml per kg). Blinded surgeons perceived that parenchymal resection was easier with hypovolaemic phlebotomy than standard care (16 of 31 versus 10 of 31 respectively), and guessed that hypovolaemic phlebotomy was being used with an accuracy of 65 per cent (20 of 31). There was no significant difference in overall complications (10 of 31 versus 15 of 31 patients), major complications or transfusion. Among those at high risk, transfusion was required in two of 15 versus three of nine patients (P = 0·326). CONCLUSION Endpoints were met successfully, but no difference in EBL was found in this feasibility study. A multicentre trial (PRICE-2) powered to identify a difference in perioperative blood transfusion is justified. Registration number: NCT02548910 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- G Martel
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - L Baker
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - C Wherrett
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - D A Fergusson
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - E Saidenberg
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - A Workneh
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - S Saeed
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - K Gadbois
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - R Jee
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - J McVicar
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - P Rao
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - C Thompson
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - P Wong
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - J Abou Khalil
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - K A Bertens
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - F K Balaa
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Wong P, Sng BL, Lim WY. Rescue supraglottic airway devices at caesarean delivery: What are the options to consider? Int J Obstet Anesth 2019; 42:65-75. [PMID: 31843342 DOI: 10.1016/j.ijoa.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/17/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Tracheal intubation is considered the gold standard means of securing the airway in obstetric general anaesthesia because of the increased risk of aspiration. Obstetric failed intubation is relatively rare. Difficult airway guidelines recommend the use of a supraglottic airway device to maintain the airway and to allow rescue ventilation. Failed intubation is associated with a further increased risk of aspiration, therefore there is an argument for performing supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI). The technique of SAGFBI has a high success rate in the non-obstetric population, it protects the airway and it minimises task fixation on repeated attempts at laryngoscopic tracheal intubation. However, after failed intubation via laryngoscopy, there is a lack of specific recommendations or indications for SAGFBI in current obstetric difficult airway guidelines in relation to achieving tracheal intubation. Our narrative review explores the issues pertaining to airway management in these cases: the use of supraglottic airway devices and the techniques of, and technical issues related to, SAGFBI. We also discuss the factors involved in the decision-making process as to whether to proceed with surgery with the airway maintained only with a supraglottic airway device, or to proceed only after SAGFBI.
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Affiliation(s)
- P Wong
- Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore.
| | - B L Sng
- Department of Women's Anaesthesia, KK Women's & Children's Hospital, Singapore
| | - W Y Lim
- Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore
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Budacan AM, Tan G, Cheeseman M, Mofidi R, Wong P. Patients Turned Down for Non-Emergency Abdominal Aortic Aneurysm (AAA) Surgery: Are We Doing The Right Thing? Factors that Influence Decision Making and the Long-term outcome – A Single Centre Experience. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Loh K, Poh L, Yao Y, Wong P, Chan Z, Teo C, Ng Y, Pang A. MEDICATION THERAPY MANAGEMENT (MTM) IN ELDERLY CANCER PATIENTS: A PILOT STUDY. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lim WY, Loh L, Desai SR, Tien SL, Goh BK, Wong P. Major liver surgery in a Jehovah’s Witness patient: challenges for safe surgery. South Afr J Anaesth Analg 2019. [DOI: 10.36303/sajaa.2019.25.3.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Jehovah’s Witnesses presenting for major surgery run the risk of major bleeding, which is complicated by the refusal to accept blood transfusion. We present a case of a 63-year-old woman, a Jehovah’s Witness, who was diagnosed with hepatocellular carcinoma and advised for curative laparoscopic liver segmentectomy. Due to the risk of significant intraoperative haemorrhage, her perioperative care was coordinated in a multidisciplinary manner. Informed consent requires the physician to advise on the material risks of undertaking major surgery without blood transfusion and the possible alternatives. Conflicting ethical issues of patient autonomy and beneficence related to refusal of blood products also arise. Perioperative strategies to minimise blood loss, maximise haematopoiesis and tolerance of anaemia to facilitate safe surgery in such patients are also presented. Written patient consent obtained.
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Affiliation(s)
- WY Lim
- Singapore General Hospital
| | - L Loh
- Singapore General Hospital
| | | | | | - BK Goh
- Singapore General Hospital
| | - P Wong
- Singapore General Hospital
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Wudhikarn K, Bunworasate U, Julamanee J, Lekhakula A, Ekwattanakit S, Khuhapinant A, Norasetthada L, Nawarawong W, Laoruangroj C, Numbenjapon T, Niparuck P, Chancharunee S, Kanitsap N, Wongkhantee S, Makruasi N, Wong P, Sirijerachai C, Chansung K, Suwanban T, Praditsuktavorn P, Intragumtornchai T. EVENT FREE SURVIVAL AT 12 MONTHS AND 24 MONTHS AS PREDICTORS FOR OUTCOME OF SYSTEMIC PERIPHERAL T CELL LYMPHOMA: ANALYSIS OF NATIONWIDE THAI LYMPHOMA STUDY GROUP. Hematol Oncol 2019. [DOI: 10.1002/hon.88_2630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K. Wudhikarn
- Medicine; Faculty of Medicine Chulalongkorn University; Bangkok Thailand
| | - U. Bunworasate
- Medicine; Faculty of Medicine Chulalongkorn University; Bangkok Thailand
| | - J. Julamanee
- Medicine; Faculty of Medicine Prince of Songkla University; Songkhla Thailand
| | - A. Lekhakula
- Medicine; Faculty of Medicine Prince of Songkla University; Songkhla Thailand
| | - S. Ekwattanakit
- Medicine; Faculty of Medicine Siriraj Hospital Mahidol University; Bangkok Thailand
| | - A. Khuhapinant
- Medicine; Faculty of Medicine Siriraj Hospital Mahidol University; Bangkok Thailand
| | - L. Norasetthada
- Medicine; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - W. Nawarawong
- Medicine; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - C. Laoruangroj
- Medicine; Faculty of Medicine, Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - T. Numbenjapon
- Medicine; Faculty of Medicine, Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - P. Niparuck
- Medicine; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - S. Chancharunee
- Medicine; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - N. Kanitsap
- Medicine; Faculty of Medicine, Thammasat University; Pathum Thani Thailand
| | - S. Wongkhantee
- Medicine; Khon Kaen Regional Hospital; Khon Kaen Thailand
| | - N. Makruasi
- Medicine; Faculty of Medicine, Srinakharinwirot University; Nakhon Nayok Thailand
| | - P. Wong
- Medicine; Faculty of Medicine, Naresuan University; Phitsanulok Thailand
| | - C. Sirijerachai
- Medicine; Faculty of Medicine, Khon Kaen University; Khon Kaen Thailand
| | - K. Chansung
- Medicine; Faculty of Medicine, Khon Kaen University; Khon Kaen Thailand
| | - T. Suwanban
- Medicine; Rajavithi Hospital; Bangkok Thailand
| | - P. Praditsuktavorn
- Medicine; Faculty of Medicine, HRH Princess Chulabhorn College of Medical Science; Bangkok Thailand
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Tomaszewski M, Strohl M, Wong P. A245 TRANSHEPATIC PEG-TUBE INSERTION: A CASE REPORT AND REVIEW OF THE LITERATURE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Tomaszewski
- Internal Medicine, McGill University, Montreal, QC, Canada
| | - M Strohl
- Gastroenterology, McGill University , Montreal, QC, Canada
| | - P Wong
- Gastroenterology, McGill University , Montreal, QC, Canada
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Masckauchan M, Wong P, Valenti D. A200 UNUSUAL PERIANAL MASS IN A CIRRHOTIC PATIENT: A CASE REPORT. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Masckauchan
- McGill University Health Centre, Montreal, QC, Canada
| | - P Wong
- McGill University Health Centre, Montreal, QC, Canada
| | - D Valenti
- McGill University Health Centre, Montreal, QC, Canada
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AL-Bahlani AM, Wong P, Ahmed N. A201 GASTRIC VARICEAL BLEED AS A FIRST PRESENTATION OF AUTOIMMUNE HEPATITIS. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A M AL-Bahlani
- Pediatric gastroenterology, McGill University, Montreal, QC, Canada
| | - P Wong
- Gastroenterology, McGill University, Brossard, QC, Canada
| | - N Ahmed
- Pediatrics, McGill University Health Centre, Montreal, QC, Canada
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Wong P, Redley B, Digby R, Correya A, Bucknall T. Families' Perspectives of Participation in Patient Care in Adult ICU: A Descriptive Study. Aust Crit Care 2019. [DOI: 10.1016/j.aucc.2018.11.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
CONTEXT Bone fragility in cerebral palsy (CP) is secondary to a complex interplay of functional, hormonal, and nutritional factors that affect bone remodelling. A greater understanding of bone microarchitectural changes seen in CP should assist therapeutic decision making. OBJECTIVE To examine the relationship between trabecular bone score (TBS), BMD and fractures in adults with CP; the influence of clinical factors and body composition on bone microarchitecture were explored. DESIGN Retrospective cross-sectional study. SETTING AND PARTICIPANTS 43 adults (25 male) with CP of median age 25 years (interquartile range 21.4-33.9) who had evaluable dual-energy X-ray absorptiometry imaging of the lumbar spine from a single tertiary hospital between 2005-March 2018. RESULTS 24/43 (55.8%) of patients had TBS values indicating intermediate or high risk of fracture (<1.31). TBS correlated with areal BMD at the lumbar spine, femoral neck and total body. TBS was significantly associated with arm and leg lean mass, with adjustment for age, gender and height (adjusted R2 = 0.18, p = 0.042 for arm lean mass; adjusted R2 = 0.19, p = 0.036 for leg lean mass). There was no difference in TBS when patients were grouped by fracture status, anticonvulsant use, gonadal status or use of PEG feeding. TBS was lower in non-ambulatory patients compared with ambulatory patients (1.28 vs 1.37, p = 0.019). CONCLUSIONS Abnormal bone microarchitecture, as measured by TBS, was seen in >50% of young adults with CP. TBS correlated with both areal BMD and appendicular lean mass. Maintaining muscle function is likely to be important for bone health in young adults with CP and needs to be confirmed in further studies.
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Affiliation(s)
- A Trinh
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia.
| | - P Wong
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia
| | - M C Fahey
- Hudson Institute of Medical Research, Clayton, Australia; Departments of Paediatrics, Monash Health and Monash University, Clayton, Australia
| | - P R Ebeling
- Department of Endocrinology, Monash Health, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia
| | - P J Fuller
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia
| | - F Milat
- Department of Endocrinology, Monash Health, Clayton, Australia; Hudson Institute of Medical Research, Clayton, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Clayton, Australia
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Wong P, Liamputtong P, Koch S, Rawson H. The Impact of Social Support Networks on Family Resilience in an Australian Intensive Care Unit: A Constructivist Grounded Theory. J Nurs Scholarsh 2018; 51:68-80. [PMID: 30471184 DOI: 10.1111/jnu.12443] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This article discusses the findings of a grounded theory of family resilience in an Australian intensive care unit (ICU) with a specific focus on families' experiences of their interactions with other members within their own family, and the families of other patients in the ICU. DESIGN A constructivist grounded theory methodology was adopted. Data were collected using in-depth interviews with 25 family members of 21 critically ill patients admitted to a tertiary-level ICU in Australia. FINDINGS The core category regaining control represents the families' journey toward resilience when in ICU. The major categories represent facilitators for, and barriers to, regaining control. One of the main facilitators is drawing strength, and it explains the manner with which families receive social support from their own and other family members to help them cope. CONCLUSIONS This study offers a framework to improve patient- and family-centered care in the ICU by facilitating families' ability to manage their situation more effectively. Social support offered by family members facilitates the families' ability to regain control. An ICU family resilience theoretical framework, situated within the context of the Australian healthcare system, adds to what is currently known about the families' experiences in the ICU. CLINICAL RELEVANCE The relationships that develop between families in the ICU may provide a source of social support; however, not all families welcome interactions with other ICU families, and it may cause further emotional distress. Further research is warranted to determine whether families suffer a secondary stress reaction from incidental interactions with other patients' families in the ICU. Furthermore, when family members pull together and offer social support to each other, they are better able to regain control. This process contributes to an ICU family resilience framework.
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Affiliation(s)
- Pauline Wong
- Lecturer in Nursing, Deakin University, School of Nursing and Midwifery, Faculty of Health, Geelong, Australia
| | - Pranee Liamputtong
- Professor of Public Health, School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Susan Koch
- Conjoint Professor of Practice, Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia; Adjunct Associate Professor, University of Sydney Medical School, Hornsby Ku-ring-gai Hospital, New South Wales, Australia
| | - Helen Rawson
- Research Fellow, Deakin University, School of Nursing & Midwifery, Faculty of Health, Geelong, Australia
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Jurak E, Suzuki H, van Erven G, Gandier JA, Wong P, Chan K, Ho CY, Gong Y, Tillier E, Rosso MN, Kabel MA, Miyauchi S, Master ER. Dynamics of the Phanerochaete carnosa transcriptome during growth on aspen and spruce. BMC Genomics 2018; 19:815. [PMID: 30424733 PMCID: PMC6234650 DOI: 10.1186/s12864-018-5210-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/30/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The basidiomycete Phanerochaete carnosa is a white-rot species that has been mainly isolated from coniferous softwood. Given the particular recalcitrance of softwoods to bioconversion, we conducted a comparative transcriptomic analysis of P. carnosa following growth on wood powder from one softwood (spruce; Picea glauca) and one hardwood (aspen; Populus tremuloides). P. carnosa was grown on each substrate for over one month, and mycelia were harvested at five time points for total RNA sequencing. Residual wood powder was also analyzed for total sugar and lignin composition. RESULTS Following a slightly longer lag phase of growth on spruce, radial expansion of the P. carnosa colony was similar on spruce and aspen. Consistent with this observation, the pattern of gene expression by P. carnosa on each substrate converged following the initial adaptation. On both substrates, highest transcript abundances were attributed to genes predicted to encode manganese peroxidases (MnP), along with auxiliary activities from carbohydrate-active enzyme (CAZy) families AA3 and AA5. In addition, a lytic polysaccharide monooxygenase from family AA9 was steadily expressed throughout growth on both substrates. P450 sequences from clans CPY52 and CYP64 accounted for 50% or more of the most highly expressed P450s, which were also the P450 clans that were expanded in the P. carnosa genome relative to other white-rot fungi. CONCLUSIONS The inclusion of five growth points and two wood substrates was important to revealing differences in the expression profiles of specific sequences within large glycoside hydrolase families (e.g., GH5 and GH16), and permitted co-expression analyses that identified new targets for study, including non-catalytic proteins and proteins with unknown function.
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Affiliation(s)
- E Jurak
- Department of Bioproducts and Biosystems, Aalto University, Espoo, Finland.,Department of Aquatic Biotechnology and Bioproduct Engineering, Groningen, The Netherlands
| | - H Suzuki
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
| | - G van Erven
- Wageningen University, Laboratory of Food Chemistry, Bornse Weilanden 9, 6708, WG, Wageningen, The Netherlands
| | - J A Gandier
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
| | - P Wong
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - K Chan
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - C Y Ho
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Y Gong
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, Canada
| | - E Tillier
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - M-N Rosso
- Aix-Marseille Université, INRA, UMR1163, Biodiversité et Biotechnologie Fongiques, Marseille, France
| | - M A Kabel
- Wageningen University, Laboratory of Food Chemistry, Bornse Weilanden 9, 6708, WG, Wageningen, The Netherlands
| | - S Miyauchi
- Laboratory of Excellence ARBRE, INRA, Nancy, Lorraine, France.,Aix-Marseille Université, INRA, UMR1163, Biodiversité et Biotechnologie Fongiques, Marseille, France
| | - E R Master
- Department of Bioproducts and Biosystems, Aalto University, Espoo, Finland. .,Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada.
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Chmura S, Winter K, Salama J, Robinson C, Pisansky T, Borges V, Al-Hallaq H, Matuszak M, Park S, Gonzalez V, Hasan Y, Bazan J, Wong P, Yoon H, Horton J, Gan G, Milano M, Sigurdson E, Moughan J, White J. Phase I Trial of Stereotactic Body Radiation Therapy (SBRT) to Multiple Metastatic Sites: A NRG Oncology Study. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.187] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Quiroz CFA, Wong P, Nahmiash M, Shedid D, Donath D, Roberge D, Wang Z, Boubez G, Masucci G. Systemic Therapy as a Predictor of Pain and VCF after Spine SBRT. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wong P, Liamputtong P, Koch S, Rawson H. Searching for meaning: A grounded theory of family resilience in adult ICU. J Clin Nurs 2018; 28:781-791. [PMID: 30207613 DOI: 10.1111/jocn.14673] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/02/2018] [Accepted: 09/02/2018] [Indexed: 11/30/2022]
Abstract
AIM To explore families' experiences of their interactions in an Australian adult intensive care unit (ICU) to develop a grounded theory that can be used by critical care nurses to improve patient- and family-centred care (PFCC). BACKGROUND Families in ICU play an important role in the patient's recovery and outcomes. However, families are at risk of significant psychological morbidity due to their experiences in ICU. Although many ICU patients can make their own decisions, a large proportion are unconscious or chemically sedated and unable to contribute to decisions about their care, leaving the decision-making role to the family. Therefore, the families' psychosocial and emotional well-being must be supported by implementing evidence-based interventions that align with a PFCC approach. This study describes the findings of a grounded theory of family resilience in ICU, of which the core category is Regaining control. The focus of this paper is on the major category: Searching for meaning. METHODS We adopted a constructivist grounded theory method. Twenty-five adult family members (n = 25) of 21 patients admitted unexpectedly to an ICU in metropolitan Australia were recruited. In-depth interviews were used to collect the data, and the analytical processes of constructivist grounded theory underpinned the development of a core category and related subcategories. RESULTS When adult family members experience the unexpected admission of a relative to ICU, they move towards a state of being beyond emotional adversity and regaining control when facilitated to search for meaning in their situation. When families were able to make sense of their situation and find a purpose by contributing to their relative's recovery, it encouraged them to cope and be resilient. CONCLUSIONS Our findings can be used to promote PFCC in ICU, which considers a collaborative approach to meet the patient's needs while providing emotional and psychosocial support to their families.
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Affiliation(s)
- Pauline Wong
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
| | - Pranee Liamputtong
- School of Science and Health, Western Sydney University, Campbelltown Campus, Penrith, NSW, Australia
| | - Susan Koch
- Faculty of Health and Medicine, University of Newcastle, NSW, Australia.,University of Sydney Medical School, Hornsby Ku-ring-gai Hospital, NSW, Australia
| | - Helen Rawson
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
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O’Cearbhaill R, Wolfer A, Disilvestro P, O’Malley D, Sabbatini P, Shohara L, Schwarzenberger P, Ricciardi T, Macri M, Ryan A, Venhaus R, Bryan J, Wong P, Homicsko K, Kandalaft L, Rusakiewicz S, Harari A, Monk B, Coukos G. A phase I/II study of chemo-immunotherapy with durvalumab (durva) and pegylated liposomal doxorubicin (PLD) in platinum-resistant recurrent ovarian cancer (PROC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
It is proposed that the specific reversal by serum albumin of the erythrocyte echinocytosis in an inorganic phosphate buffer saline or in a saline, either after 24 h in blood or after a storage of 6-7 weeks in SGAM or PAGGSM media, is due to a cell dehydration by a decrease of the total NaCl and KCl concentrations favoring the stomatocytogenic slow outward transport of inorganic phosphate with a hydrogen ion by band 3 anion exchanger, which was previously proposed to control the erythrocyte shape. This proposal would indicate that the opposition of the erythrocyte echinocytosis by serum albumin is not limited to binding to echinocytogenic amphiphiles, supported by the ability of the band 3-based mechanism of control of the erythrocyte shape to explain a variety of observations on the erythrocyte shape. It would also imply that this mechanism is a determinant of the erythrocyte rheological properties since influenced by cell shape and volume. It is shown that the above process of stomatocytosis can explain stomatocytoses by different agents as well as a knizocytosis induced in vitro and occurring in acquired and inherited disorders and other situations. Lastly, it can also explain the opposition of hemolysis by mannitol in SGAM and PAGGSM media.
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Affiliation(s)
- P Wong
- Laboratoire de Chimie des Protéines, Montréal, QC, Canada
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50
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Aljudaibi B, Burak KW, Yoshida EM, Bilodeau M, Wong P, Benmassaoud A, Hussaini T, Thomas BS, Chen J, Teriaky A, Marotta P. A166 SOFOSBUVIR-BASED THERAPY IN THE PRE-LIVER TRANSPLANT SETTING: THE CANADIAN NATIONAL EXPERIENCE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Aljudaibi
- Gastroenterology, London Health Sciences Centre, London, ON, Canada
| | - K W Burak
- Liver Unit, Univ Calgary, Calgary, AB, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - M Bilodeau
- Liver Unit, CRCHUM, Montréal, QC, Canada
| | - P Wong
- Gastroenterology, McGill University, Brossard, QC, Canada
| | - A Benmassaoud
- McGill University Health Center, Montreal, QC, Canada
| | - T Hussaini
- University of British Columbia, Vancouver, BC, Canada
| | - B S Thomas
- Medicine, Western University, London, ON, Canada
| | - J Chen
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - A Teriaky
- Gastroenterology, London Health Sciences Centre, London, ON, Canada
| | - P Marotta
- London heatlh sciences Center, University of Western Ontario, London, ON, Canada
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