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Alexander GC, Budnitz D, Hughes C, Maas R, Mair A, McDonald EG, Meid AD, Payne R, Seidling HM, Shakir S, Suissa S, Tannenbaum C, Schneeweiss S, Dreischulte T. Proceedings of the International Ambulatory Drug Safety Symposium: Munich, Germany, June 2023. Drug Saf 2024; 47:103-111. [PMID: 37917316 DOI: 10.1007/s40264-023-01362-9] [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: 10/05/2023] [Indexed: 11/04/2023]
Affiliation(s)
- G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street W6035, Baltimore, MD, 21205, USA.
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Daniel Budnitz
- Kenvue, Fort Washington, PA, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
- United States Public Health Service (Retired), Atlanta, GA, USA
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, UK
| | - Emily G McDonald
- Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rupert Payne
- Exeter Collaboration for Academic Primary Care (APEx), Exeter Medical School, University of Exeter, Exeter, UK
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Saad Shakir
- Drug Safety Research Unit, University of Portsmouth, Southampton, UK
| | - Samy Suissa
- Department of Epidemiology and Biostatistics, and Department of Medicine, McGill University, Montreal, QC, Canada
| | - Cara Tannenbaum
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | | | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
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Davies J, Read J, Kruger D, Crisp N, Lamb N, Dixon M, Everington S, Hollins S, Moncrieff J, Giurca BC, van Tulleken C, Chouinard G, Dooley M, Guy A, Horowitz M, Kinderman P, Johnstone L, Montagu L, Nardi AE, Stacey S, Bell M, Tresidder A, Watson J, Lewis S, Spada M, Payne R, Akhtar N, Buckland C, Levett J, Whitcombe S, Marshall-Andrews L. Politicians, experts, and patient representatives call for the UK government to reverse the rate of antidepressant prescribing. BMJ 2023; 383:2730. [PMID: 38052460 DOI: 10.1136/bmj.p2730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
| | - John Read
- International Institute for Psychiatric Drug Withdrawal, London, UK
| | - Danny Kruger
- Beyond Pills All Party Parliamentary Group, Houses of Parliament, London, UK
| | - Nigel Crisp
- Beyond Pills All Party Parliamentary Group, Houses of Parliament, London, UK
| | | | | | | | - Sheila Hollins
- St George's, University of London, UK
- House of Lords, London, UK
| | | | | | | | | | | | - Anne Guy
- Beyond Pills All Party Parliamentary Group, Houses of Parliament, London, UK
| | | | | | | | - Luke Montagu
- Council for Evidence Based Psychiatry, London, UK
| | | | - Sarah Stacey
- College of Medicine Beyond Pills Campaign, London, UK
| | - Martin Bell
- British Association for Counselling and Psychotherapy, UK
| | | | | | - Stevie Lewis
- Lived and Professional Experience Advisory Panel for Prescribed Drug Dependence, UK
| | | | | | - Naveed Akhtar
- Integrated Medicine Alliance, UK
- College of Medicine, London, UK
| | | | - Jon Levett
- UK Council for Psychotherapy, London, UK
| | - Sue Whitcombe
- Division of Counselling Psychology, British Psychological Society
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Heuvelman H, Davies NM, Ben-Shlomo Y, Emond A, Evans J, Gunnell D, Liebling R, Morris R, Payne R, Storey C, Viner M, Rai D. Antidepressants in pregnancy: applying causal epidemiological methods to understand service-use outcomes in women and long-term neurodevelopmental outcomes in exposed children. Health Technol Assess 2023; 27:1-83. [PMID: 37842916 DOI: 10.3310/aqtf4490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background Antidepressants are commonly prescribed during pregnancy, despite a lack of evidence from randomised trials on the benefits or risks. Some studies have reported associations of antidepressants during pregnancy with adverse offspring neurodevelopment, but whether or not such associations are causal is unclear. Objectives To study the associations of antidepressants for depression in pregnancy with outcomes using multiple methods to strengthen causal inference. Design This was an observational cohort design using multiple methods to strengthen causal inference, including multivariable regression, propensity score matching, instrumental variable analysis, negative control exposures, comparison across indications and exposure discordant pregnancies analysis. Setting This took place in UK general practice. Participants Participants were pregnant women with depression. Interventions The interventions were initiation of antidepressants in pregnancy compared with no initiation, and continuation of antidepressants in pregnancy compared with discontinuation. Main outcome measures The maternal outcome measures were the use of primary care and secondary mental health services during pregnancy, and during four 6-month follow-up periods up to 24 months after pregnancy, and antidepressant prescription status 24 months following pregnancy. The child outcome measures were diagnosis of autism, diagnosis of attention deficit hyperactivity disorder and intellectual disability. Data sources UK Clinical Practice Research Datalink. Results Data on 80,103 pregnancies were used to study maternal primary care outcomes and were linked to 34,274 children with at least 4-year follow-up for neurodevelopmental outcomes. Women who initiated or continued antidepressants during pregnancy were more likely to have contact with primary and secondary health-care services during and after pregnancy and more likely to be prescribed an antidepressant 2 years following the end of pregnancy than women who did not initiate or continue antidepressants during pregnancy (odds ratioinitiation 2.16, 95% confidence interval 1.95 to 2.39; odds ratiocontinuation 2.40, 95% confidence interval 2.27 to 2.53). There was little evidence for any substantial association with autism (odds ratiomultivariableregression 1.10, 95% confidence interval 0.90 to 1.35; odds ratiopropensityscore 1.06, 95% confidence interval 0.84 to 1.32), attention deficit hyperactivity disorder (odds ratiomultivariableregression 1.02, 95% confidence interval 0.80 to 1.29; odds ratiopropensityscore 0.97, 95% confidence interval 0.75 to 1.25) or intellectual disability (odds ratiomultivariableregression 0.81, 95% confidence interval 0.55 to 1.19; odds ratiopropensityscore 0.89, 95% confidence interval 0.61 to 1.31) in children of women who continued antidepressants compared with those who discontinued antidepressants. There was inconsistent evidence of an association between initiation of antidepressants in pregnancy and diagnosis of autism in offspring (odds ratiomultivariableregression 1.23, 95% confidence interval 0.85 to 1.78; odds ratiopropensityscore 1.64, 95% confidence interval 1.01 to 2.66) but not attention deficit hyperactivity disorder or intellectual disability; however, but results were imprecise owing to smaller numbers. Limitations Several causal-inference analyses lacked precision owing to limited numbers. In addition, adherence to the prescribed treatment was not measured. Conclusions Women prescribed antidepressants during pregnancy had greater service use during and after pregnancy than those not prescribed antidepressants. The evidence against any substantial association with autism, attention deficit hyperactivity disorder or intellectual disability in the children of women who continued compared with those who discontinued antidepressants in pregnancy is reassuring. Potential association of initiation of antidepressants during pregnancy with offspring autism needs further investigation. Future work Further research on larger samples could increase the robustness and precision of these findings. These methods applied could be a template for future pharmaco-epidemiological investigation of other pregnancy-related prescribing safety concerns. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (15/80/19) and will be published in full in Health Technology Assessment; Vol. 27, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hein Heuvelman
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Neil M Davies
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Alan Emond
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Jonathan Evans
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - David Gunnell
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Rachel Liebling
- Fetal Medicine Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Richard Morris
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Rupert Payne
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Dheeraj Rai
- Department of Population Health Sciences, University of Bristol, Bristol, UK
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Clark C, McDonagh S, Cross R, Masoli J, Konya J, Abel G, Sheppard J, Jakubowski B, Bhanu C, Fordham J, Turner K, Lamb S, Payne R, McManus R, Campbell J. Understanding Measurement of postural hypotension: a nationwide survey of primary care practice in England. Br J Gen Pract 2023; 73:bjgp23X733857. [PMID: 37479289 DOI: 10.3399/bjgp23x733857] [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: 07/23/2023] Open
Abstract
BACKGROUND Postural hypotension (PH), the drop in blood pressure (BP) on standing, is associated with falls, all-cause mortality and cognitive decline. PH diagnostic criteria require lying-to-standing BP measurements. PH Prevalence in older adults is 20%, however, it is infrequently recorded in primary care records, suggesting PH testing and/or recording is under-utilised in this setting. AIM To understand current PH measurement and management by primary care practitioners in England. METHOD Clinical Research Networks circulated an online survey to primary care clinicians involved in measurement of BP. Demographics and responses were summarised as percentages, or median and inter-quartile ranges (IQR), as appropriate. The survey remains open until 30 November 2022; full results will be presented at the conference. RESULTS To date, there are 669 replies (341 doctors, 179 nurses, 70 healthcare assistants, 23 pharmacists, 56 other roles); median age 45 (IQR 38 to 53), 72% female. Overall, 597 (89%) responders check for PH, predominantly when symptoms are present (98%). Less common reasons to check include patients being over 80 (24%), Parkinson's disease (21%), hypertension reviews (18%), medication reviews (12%) or diabetes reviews (11%). Sitting-to-standing BP measurements are common (77%); only 22% use lying-to-standing. Only 64% ensure a rest period before sitting or lying BP measurement and only 1 (IQR 1 to 2) standing BP measurement is made, usually (66%) within the first minute of standing. CONCLUSION Interim findings suggest that most PH assessments in primary care do not meet current guideline criteria. Full findings from this survey are expected to inform and influence future national guidelines.
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Affiliation(s)
- Chris Clark
- Primary Care Research Group, University of Exeter Medical School
| | - Sinéad McDonagh
- Primary Care Research Group, University of Exeter Medical School
| | - Rosina Cross
- Primary Care Research Group, University of Exeter Medical School
| | - Jane Masoli
- Primary Care Research Group, University of Exeter Medical School
| | - Judit Konya
- Primary Care Research Group, University of Exeter Medical School
| | - Gary Abel
- Primary Care Research Group, University of Exeter Medical School
| | - James Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Beth Jakubowski
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Cini Bhanu
- Primary Care & Population Health, University College London
| | | | - Katrina Turner
- Centre for Academic Primary Care, university of Bristol Medical School
| | - Sallie Lamb
- Primary Care Research Group, University of Exeter Medical School
| | - Rupert Payne
- Primary Care Research Group, University of Exeter Medical School
| | - Richard McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - John Campbell
- Primary Care Research Group, University of Exeter Medical School
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McCahon D, Duncan P, Payne R, Horwood J. Patient perceptions and experiences of medication review: qualitative study in general practice. BMC Prim Care 2022; 23:293. [PMID: 36418986 PMCID: PMC9682692 DOI: 10.1186/s12875-022-01903-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Clinical medication reviews are a recognised strategy to address polypharmacy, a key part of general practice and positively associated with patient safety and clinical effectiveness. To date there has been little investigation of the patient perspective of medication reviews. OBJECTIVE To explore patient experiences of medication review including the processes and activities that led up to and shaped the review. METHODS Qualitative interview study within 10 general practices in Bristol. Participants were adults with polypharmacy (≥ 4 medications) and ≥ 2 long-term conditions who had a record of medication review with either a GP or pharmacist. Interviews were transcribed verbatim and analysed thematically using a data driven approach. Co-design work was undertaken with four patient and public involvement advisers to design and develop resources to support patient preparation for medication review. RESULTS Twenty-one patients were interviewed (10 female, mean age 73 years, range 59-88 years). Medication review was viewed as an opportunity to assess the effectiveness and need for medications. Participants expected the review to focus upon medication related concerns, side-effects and symptoms. Those who were newer to review, were uncertain of the intended purpose, and described their review as a box-ticking exercise. Some participants were unfamiliar with the role of the pharmacist and expressed a lack of confidence in their clinical skills and knowledge. Face-to-face consultation and relationship continuity were considered important for efficient and effective medication review. Results informed co-production of a patient information leaflet to facilitate greater patient engagement and involvement in medication review. CONCLUSIONS A lack of understanding of the rationale for medication review can limit the value patients attach to these healthcare encounters. Improved prior communication and information around the intended purpose and potential benefits of medication review may enhance patient engagement and improve patient experience and outcomes.
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Affiliation(s)
- Deborah McCahon
- grid.5337.20000 0004 1936 7603Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS UK
| | - Polly Duncan
- grid.5337.20000 0004 1936 7603Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS UK
| | - Rupert Payne
- grid.5337.20000 0004 1936 7603Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS UK
| | - Jeremy Horwood
- grid.5337.20000 0004 1936 7603Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS UK
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Jowett S, Kodabuckus S, Ford GA, Hobbs FDR, Lown M, Mant J, Payne R, McManus RJ, Sheppard JP. Cost-Effectiveness of Antihypertensive Deprescribing in Primary Care: a Markov Modelling Study Using Data From the OPTiMISE Trial. Hypertension 2022; 79:1122-1131. [PMID: 35266409 PMCID: PMC8997697 DOI: 10.1161/hypertensionaha.121.18726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Deprescribing of antihypertensive medications for older patients with normal blood pressure is recommended by some clinical guidelines, where the potential harms of treatment may outweigh the benefits. This study aimed to assess the cost-effectiveness of this approach. METHODS A Markov patient-level simulation was undertaken to model the effect of withdrawing one antihypertensive compared with usual care, over a life-time horizon. Model population characteristics were estimated using data from the OPTiMISE antihypertensive deprescribing trial, and the effects of blood pressure changes on outcomes were derived from the literature. Health-related quality of life was modeled in Quality-Adjusted Life Years (QALYs) and presented as costs per QALY gained. RESULTS In the base-case analysis, medication reduction resulted in lower costs than usual care (mean difference £185), but also lower QALYs (mean difference 0.062) per patient over a life-time horizon. Usual care was cost-effective at £2975 per QALY gained (more costly, but more effective). Medication reduction resulted more heart failure and stroke/TIA events but fewer adverse events. Medication reduction may be the preferred strategy at a willingness-to-pay of £20 000/QALY, where the baseline absolute risk of serious drug-related adverse events was ≥7.7% a year (compared with 1.7% in the base-case). CONCLUSIONS Although there was uncertainty around many of the assumptions underpinning this model, these findings suggest that antihypertensive medication reduction should not be attempted in many older patients with controlled systolic blood pressure. For populations at high risk of adverse effects, deprescribing may be beneficial, but a targeted approach would be required in routine practice.
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Affiliation(s)
- Sue Jowett
- Institute of Applied Health Research, University of Birmingham, United Kingdom (S.J., S.K.)
| | - Shahela Kodabuckus
- Institute of Applied Health Research, University of Birmingham, United Kingdom (S.J., S.K.)
| | - Gary A Ford
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, United Kingdom (G.A.F.)
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (F.D.R.H., R.J.M., J.P.S.)
| | - Mark Lown
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom (M.L.)
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, United Kingdom (J.M.)
| | - Rupert Payne
- Population Health Sciences, University of Bristol, United Kingdom (R.P.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (F.D.R.H., R.J.M., J.P.S.)
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (F.D.R.H., R.J.M., J.P.S.)
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Zhou AY, Zghebi SS, Hodkinson A, Hann M, Grigoroglou C, Ashcroft DM, Esmail A, Chew-Graham CA, Payne R, Little P, de Lusignan S, Cherachi-Sohi S, Spooner S, Zhou AK, Kontopantelis E, Panagioti M. Investigating the links between diagnostic uncertainty, emotional exhaustion, and turnover intention in General Practitioners working in the United Kingdom. Front Psychiatry 2022; 13:936067. [PMID: 35958644 PMCID: PMC9360551 DOI: 10.3389/fpsyt.2022.936067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job satisfaction and turnover intention have not been previously examined. OBJECTIVES To examine associations between diagnostic uncertainty, emotional exhaustion (EE), depersonalization (DP), job satisfaction, and turnover intention in GPs. METHODS Seventy general practices in England were randomly selected through the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP-RSC). A total of 348 GPs within 67 these practices completed a 10-item online questionnaire which included questions on GP characteristics, work-life balance, job satisfaction, sickness presenteeism, diagnostic uncertainty, turnover intention as well as EE and DP. Associations between diagnostic uncertainty and each of EE, DP, job satisfaction, and turnover intention were evaluated in multivariate mixed-effect ordinal logistic regressions whilst adjusting for covariates, to account for the correlation in the three outcomes of interest. RESULTS Almost one-third of GPs (n = 101; 29%) reported experiencing >10% of diagnostic uncertainty in their day-to-day practice over the past year. GPs reporting greater diagnostic uncertainty had higher levels of EE [OR = 3.90; 95% CI = (2.54, 5.99)], job dissatisfaction [OR = 2.01; 95% CI = (1.30, 3.13)] and turnover intention [OR = 4.51; 95% CI = (2.86, 7.11)]. GPs with no sickness presenteeism had lower levels of EE [OR = 0.53; 95% CI = (0.35, 0.82)], job dissatisfaction [OR = 0.56; 95% CI = (0.35, 0.88)], and turnover intention [OR = 0.61; 95% CI = (0.41, 0.91)]. CONCLUSION Diagnostic uncertainty may not only negatively impact on the wellbeing of GPs, but could also have adverse implications on workforce retention in primary care.
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Affiliation(s)
- Anli Yue Zhou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Salwa S Zghebi
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Mark Hann
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christos Grigoroglou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Institute for Health Policy and Organisation (IHPO), Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Darren M Ashcroft
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
| | - Aneez Esmail
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Rupert Payne
- Centre for Academic Primary Care Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Simon de Lusignan
- Medical Sciences Division, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
| | - Sudeh Cherachi-Sohi
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sharon Spooner
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Andrew K Zhou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Gangannagaripalli J, Porter I, Davey A, Ricci Cabello I, Greenhalgh J, Anderson R, Briscoe S, Hughes C, Payne R, Cockcroft E, Harris J, Bramwell C, Valderas JM. STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09230] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background
Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults.
Objectives
To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts.
Design
A realist synthesis.
Setting
Primary care, hospital care and nursing homes.
Patients
Patients aged ≥ 65 years.
Interventions
Any intervention based on the use of the STOPP/START tools.
Review methods
Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies.
Results
We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs.
Limitations
None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse.
Conclusions
No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings.
Study registration
This study is registered as PROSPERO CRD42018110795.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Ignacio Ricci Cabello
- Gerència d’Atenció Primària de Mallorca, Fundació Institut d’Investigació Sanitària Illes Balears – IdISBa, Mallorca, Spain
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Rob Anderson
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
- Evidence Synthesis & Modelling for Health Improvement (ESMI) Research Group, University of Exeter Medical School, Exeter, UK
| | - Simon Briscoe
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Carmel Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Rupert Payne
- Population Health Sciences, University of Bristol, Bristol Medical School, Bristol, UK
| | - Emma Cockcroft
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jim Harris
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Charlotte Bramwell
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
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9
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Alam F, Farooq D, Theofilis A, Wooler H, Payne R. 269 Outcomes of Modified Karydakis Flap in The Surgical Management of Sacrococcygeal Pilonidal Disease: A Single Surgeon’s Experience. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.408] [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: 11/14/2022]
Abstract
Abstract
Aim
To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 months follow up.
Method
It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol (fig. 1). Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they only had excision without closure. Pre, per and post-operative management of the remaining 87 patients was according to a standardised protocol (fig. 1). Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway).
Results
Primary outcomes:
Secondary outcome:
Conclusions
Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad-spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.
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Affiliation(s)
- F Alam
- Great Western Hospital, Swindon, United Kingdom
| | - D Farooq
- Great Western Hospital, Swindon, United Kingdom
| | - A Theofilis
- Great Western Hospital, Swindon, United Kingdom
| | - H Wooler
- Great Western Hospital, Swindon, United Kingdom
| | - R Payne
- Great Western Hospital, Swindon, United Kingdom
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10
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Fisk M, Zecharia A, Payne R, Okorie M, Alexander S, Baker E, Cremers S. Sustainable medicines development and use: Our collective responsibility for action to mitigate the natural world crisis. Br J Clin Pharmacol 2021; 88:3013-3015. [PMID: 34486160 DOI: 10.1111/bcp.15067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Marie Fisk
- Department of Experimental Medicine & Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | | | - Rupert Payne
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Stephen Alexander
- Department of Pharmacology, University of Nottingham, Nottingham, UK
| | - Emma Baker
- British Pharmacology Society, London, UK.,St Georges University of London, London, UK
| | - Serge Cremers
- Department of Pathology & Cell Biology, Division of Laboratory Medicine, Columbia University, New York, New York, USA
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11
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Aguirre-Portoles C, Payne R, Trautz A, Foskett J, Natale C, Seykora J, Ridky T. 056 Testosterone signaling through ZIP9 renders melanoma more aggressive in males than in females. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Sheppard JP, Lown M, Burt J, Temple E, Lowe R, Ashby H, Todd O, Allen J, Ford GA, Fraser R, Heneghan C, Hobbs FR, Jowett S, Little P, Mant J, Mollison J, Payne R, Williams M, Yu L, McManus RJ. Generalizability of Blood Pressure Lowering Trials to Older Patients: Cross‐Sectional Analysis. J Am Geriatr Soc 2020; 68:2508-2515. [DOI: 10.1111/jgs.16749] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/17/2022]
Affiliation(s)
- James P. Sheppard
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Mark Lown
- Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine University of Southampton Southampton UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute, University of Cambridge Cambridge UK
| | - Eleanor Temple
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Rebecca Lowe
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Hannah Ashby
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Oliver Todd
- Academic Unit of Elderly Care and Rehabilitation University of Leeds Leeds UK
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Gary A. Ford
- Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Rosalyn Fraser
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham Birmingham UK
| | - Paul Little
- Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine University of Southampton Southampton UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - Jill Mollison
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Rupert Payne
- Centre for Academic Primary Care University of Bristol Bristol UK
| | | | - Ly‐Mee Yu
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK
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13
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Morey-Matamalas A, Corbetta D, Waine K, Payne R, Grau-Roma L, Baiker K. Exercise-induced Acute Abdominal Haemorrhage due to Iliopsoas Trauma in Racing Greyhounds. J Comp Pathol 2020; 177:42-46. [PMID: 32505239 DOI: 10.1016/j.jcpa.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
Post-mortem examination of 74 racing greyhounds with sudden, unexpected death was undertaken at the Veterinary School, University of Nottingham, UK, from 2015 to 2019. These investigations revealed severe, acute haemoabdomen with extensive retroperitoneal haemorrhage and an underlying severe, unilateral iliopsoas tear in four cases (5.4%). In all four cases, unilateral trauma and haemorrhage affecting the right iliopsoas muscle was common near the caudal insertion. Despite the acute clinical event, three cases demonstrated histological evidence of previous muscle damage with muscular regeneration, fibrosis and evidence of chronic haemorrhage. To our knowledge, this is the first detailed description of exercise-induced trauma to the iliopsoas muscle leading to extensive haemoretroperitoneum and haemoabdomen with subsequent hypovolaemic shock and death in racing greyhounds.
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Affiliation(s)
- A Morey-Matamalas
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK.
| | - D Corbetta
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - K Waine
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - R Payne
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - L Grau-Roma
- Institute of Animal Pathology, University of Bern, Bern, Switzerland
| | - K Baiker
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
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14
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Zhu Y, Edwards D, Kiddle S, Payne R. Characteristics and outcomes of clusters of multimorbid patients in UK general practice. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.662] [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] Open
Abstract
Abstract
Background
Current clinical specialities, guidelines and quality of care metrics are organised around single diseases and treatments of multiple conditions are rarely coordinated, resulting in insufficient or even conflicting care. This study uses large scale English general practice (GP) records to identify and characterise clusters of patients based on their multimorbidity to allow better design of health services and highlight groups that require additional interventions.
Methods
This is a retrospective cohort study that includes multimorbid adult patients (N = 113,211), from a random sample of 391,669 English patients with valid GP records in 2012 where 38 long-term conditions were defined. Latent class analysis, stratified by age groups, was used to identify multimorbidity clusters. Class solutions are validated and associations between multimorbidity clusters, patient characteristics, public health service utilisation and mortality are assessed.
Results
Poor socioeconomic status is associated with clusters with higher service use and mortality risk. Physical-mental health co-morbidity is a major component of multimorbidity across all age strata. The clusters with highest age-stratified mortality risk in under 65 year olds were linked to alcohol and substance misuse, whereas in over 65 year olds they were linked to cardiovascular disease. The largest cluster in the 85+ years strata (58%) has the lowest number of morbidities, a low degree of service use and mortality. Consistency was seen across identification and validation data.
Conclusions
We find a clear distinction between morbidity clusters, both in the prevalence of long term conditions within them, and in their associations with outcomes (service use and mortality). Specific health services and interventions might be more effective when targeted on the distinct types of multimorbidity we have identified, with a particular focus on the morbidity clusters associated with the worst patient outcomes.
Key messages
The first study to derive age stratified multimorbidity clusters from a large GP record system, whose patients are representative of the English population. Knowledge about particularly dangerous clusters of multimorbidity, such as those involving alcohol and drug use in 18–64 years old, and cardiovascular disease in those 65 years or older.
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Affiliation(s)
- Y Zhu
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - D Edwards
- The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - S Kiddle
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - R Payne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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15
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Sheppard J, Burt J, Lown M, Temple E, Lowe R, Todd O, Ford G, Hobbs FDR, Little P, Mant J, Mollison J, Payne R, Williams M, Yu LM, McManus RJ. P2649Do these data apply to me? Examining the applicability of trials assessing strategies for optimal management of blood pressure to older patients in UK primary care. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is debate as to what extent older patients (≥80 years) should be treated for high blood pressure. Existing trials show that blood pressure lowering in this population is effective at preventing stroke and heart failure but also results in an increased risk of adverse events. However, it has been suggested that these studies enrolled healthier patients, who are less representative of the general population and more likely to benefit from treatment.
Purpose
This study aimed to compare the characteristics of patients eligible for three blood pressure management trials and assess the likelihood of eligibility for each trial based on common characteristics of older patients.
Methods
Cross-sectional study of data extracted from the medical records of 15,376 patients aged ≥80 years, registered to 24 general practices in the south of England. Anonymised patient data relating to the eligibility criteria for two previous medication intensification trials (HYVET, SPRINT) and one medication reduction trial (OPTiMISE) were extracted. Patients eligible for each trial were defined according to criteria specified in each trial protocol. Descriptive statistics were used to define the characteristics of each trial population. A logistic regression model was constructed to estimate predictors of eligibility for each trial, with practice included as a random effect.
Results
Approximately 268 (1.7%), 5,290 (34.4%) and 3,940 (25.6%) patients were eligible for HYVET, SPRINT and OPTiMISE trials respectively. There was little overlap in eligibility for each trial (1.0% were eligible for HYVET and SPRINT; 0% were eligible for HYVET and OPTiMISE; 10.2% were eligible for SPRINT and OPTiMISE). Patients eligible for OPTiMISE were comparable to the general population in terms of frailty (eFI 0.12 [OPTiMISE] vs 0.11 [general population]), but had more morbidities (4 vs 3) and cardiovascular medications prescribed (4 vs 2). Patients in HYVET and SPRINT were less frail, multi-morbid and prescribed less cardiovascular medications. Overall, increasing frailty and a history of cardiovascular disease reduced the likelihood of being eligible for any trial.
Conclusions
Patients eligible for OPTiMISE appear to best represent the population aged ≥80 years attending UK primary care. Increasing frailty and/or multi-morbidity reduce the likelihood of eligibility for all three blood pressure trials. Caution should be exercised when applying the results from randomised controlled trials to management of blood pressure in frail and multi-morbid patients.
Acknowledgement/Funding
This study was funded by the National Institute for Health Research (NIHR) SPCR and Oxford CLAHRC
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Affiliation(s)
- J Sheppard
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - J Burt
- University of Cambridge, Cambridge, United Kingdom
| | - M Lown
- University of Southampton, Southampton, United Kingdom
| | - E Temple
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - R Lowe
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - O Todd
- Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - G Ford
- University of Oxford, Oxford, United Kingdom
| | - F D R Hobbs
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - P Little
- University of Southampton, Southampton, United Kingdom
| | - J Mant
- University of Cambridge, Cambridge, United Kingdom
| | - J Mollison
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - R Payne
- University of Bristol, Bristol, United Kingdom
| | - M Williams
- Patient representative, London, United Kingdom
| | - L M Yu
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - R J McManus
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
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16
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Denholm R, Morris R, Payne R. Polypharmacy patterns in the last year of life in patients with dementia. Eur J Clin Pharmacol 2019; 75:1583-1591. [PMID: 31346649 DOI: 10.1007/s00228-019-02721-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/11/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE To describe prescribing of medicines in primary care in the last year of life in patients with dementia. METHOD A retrospective cohort analysis in UK primary care using routinely collected data from the Clinical Practice Research Datalink. Number of medications and potentially inappropriate medication prescribed one year prior to, and including death, was ascertained. RESULTS Dementia patients (n = 6923) aged 86.6 ± 7.3 years (mean ± SD) were prescribed 4.8 ± 4.0 drugs 1 year prior to death, increasing to 5.6 ± 4.0 2 months prior, before falling to 4.9 ± 4.1 at death. One year prior to death, 50% of patients were prescribed a potentially inappropriate medication, falling to 41% at death. Cardiovascular medications were the most common, with decreases in drug count only occurring in the last month prior to death. Prescriptions for gastrointestinal and central nervous system medication increased throughout the year, particularly laxatives/analgaesics, antidepressants and hypnotic/antipsychotics. Women (vs. men) and patients with Alzheimer's (vs. vascular dementia) were prescribed 4.7% (95% CI 2.3%-7%) and 14.6% (11.7-17.3%) fewer medications, respectively. Prescribing decreased with age and increased with additional comorbidities. CONCLUSIONS Dementia patients are prescribed high levels of medication, many potentially inappropriate, during their last year of life, with reductions occurring relatively late. Improvements to medication optimisation guidelines are needed to inform decision-making around deprescribing of long-term medications in patients with limited life-expectancy.
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Affiliation(s)
- Rachel Denholm
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Richard Morris
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rupert Payne
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
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17
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Miani C, Martin A, Exley J, Doble B, Wilson E, Payne R, Avery A, Meads C, Kirtley A, Jones MM, King S. Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling. Health Technol Assess 2019; 21:1-128. [PMID: 29268843 DOI: 10.3310/hta21780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. OBJECTIVE To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. DESIGN/DATA SOURCES The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios. REVIEW METHODS In the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available. RESULTS An exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean difference -0.45, 95% confidence interval -0.65 to -0.26). The cost analysis showed that a statistically significant increase in medication waste was associated with longer prescription lengths. However, when accounting for dispensing fees and prescriber time, longer prescriptions were found to be cost saving compared with shorter prescriptions. Prescriber time was the largest component of the calculated cost savings to the NHS. The decision modelling suggested that, in all three clinical scenarios, longer prescription lengths were associated with lower costs and higher quality-adjusted life-years. LIMITATIONS The available evidence was found to be at a moderate to serious risk of bias. All of the studies were conducted in the USA, which was a cause for concern in terms of generalisability to the UK. No evidence of the direct impact of prescription length on health outcomes was found. The cost study could investigate prescriptions issued only; it could not assess patient adherence to those prescriptions. Additionally, the cost study was based on products issued only and did not account for underlying patient diagnoses. A lack of good-quality evidence affected our decision modelling strategy. CONCLUSIONS Although the quality of the evidence was poor, this study found that longer prescriptions may be less costly overall, and may be associated with better adherence than 28-day prescriptions in patients with chronic conditions being treated in primary care. FUTURE WORK There is a need to more reliably evaluate the impact of differing prescription lengths on adherence, on patient health outcomes and on total costs to the NHS. The priority should be to identify patients with particular conditions or characteristics who should receive shorter or longer prescriptions. To determine the need for any further research, an expected value of perfect information analysis should be performed. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027042. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Céline Miani
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Adam Martin
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK.,Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Josephine Exley
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Brett Doble
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ed Wilson
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rupert Payne
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Anthony Avery
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Catherine Meads
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK.,School of Nursing and Midwifery, Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK
| | - Anne Kirtley
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK.,Strategy Division, Wellcome Trust, London, UK
| | - Molly Morgan Jones
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Sarah King
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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18
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Qiao Y, Zhu X, Zhai L, Payne R, Li T. PSXVI-42 Dietary soybean meal level and β-mannanase supplementation affected serum biochemical constituents in nursery pigs. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Qiao
- Elanco Animal Health,Beijing, China (People’s Republic)
| | - X Zhu
- Institute of Subtropical Agriculture, Chinese Academy of Sciences,Hunan, China (People’s Republic)
| | - L Zhai
- Elanco Animal Health,Beijing, China (People’s Republic)
| | - R Payne
- Elanco Animal Health,Sunset, LA, United States
| | - T Li
- Elanco Animal Health,Beijing, China (People’s Republic)
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19
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Qiao Y, Zhu X, Zhai L, Payne R, Li T. 192 Dietary β-mannanase supplementation improved growth and health of nursery pigs fed high soybean meal diet. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Qiao
- Elanco Animal Health,Beijing, China (People’s Republic)
| | - X Zhu
- Institute of Subtropical Agriculture, Chinese Academy of Sciences,Hunan, China (People’s Republic)
| | - L Zhai
- Elanco Animal Health,Beijing, China (People’s Republic)
| | - R Payne
- Elanco Animal Health,Sunset, LA, United States
| | - T Li
- Institute of Subtropical Agriculture, Chinese Academy of Sciences,Hunan, China (People’s Republic)
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20
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Qiao Y, Zhu X, Zhai L, Payne R, Li T. PSIII-36 Dietary soybean meal level and β-mannanase supplementation affected immunoproteins in carotid artery and morphology and aquaporin water channels in small intestine of nursery pigs. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Qiao
- Elanco Animal Health,Beijing, China (People’s Republic)
| | - X Zhu
- Institute of Subtropical Agriculture, Chinese Academy of Sciences,Hunan, China (People’s Republic)
| | - L Zhai
- Elanco Animal Health,Beijing, China (People’s Republic)
| | - R Payne
- Elanco Animal Health,Kennesaw, GA, United States
| | - T Li
- Institute of Subtropical Agriculture, Chinese Academy of Sciences,Hunan, China (People’s Republic)
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21
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Sheppard JP, Burt J, Lown M, Temple E, Benson J, Ford GA, Heneghan C, Hobbs FDR, Jowett S, Little P, Mant J, Mollison J, Nickless A, Ogburn E, Payne R, Williams M, Yu LM, McManus RJ. OPtimising Treatment for MIld Systolic hypertension in the Elderly (OPTiMISE): protocol for a randomised controlled non-inferiority trial. BMJ Open 2018; 8:e022930. [PMID: 30287610 PMCID: PMC6173263 DOI: 10.1136/bmjopen-2018-022930] [Citation(s) in RCA: 10] [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: 03/13/2018] [Revised: 08/10/2018] [Accepted: 08/18/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Recent evidence suggests that larger blood pressure reductions and multiple antihypertensive drugs may be harmful in older people, particularly frail individuals with polypharmacy and multimorbidity. However, there is a lack of evidence to support deprescribing of antihypertensives, which limits the practice of medication reduction in routine clinical care. The aim of this trial is to examine whether antihypertensive medication reduction is possible in older patients without significant changes in blood pressure control at follow-up. METHODS AND ANALYSIS This trial will use a primary care-based, open-label, randomised controlled trial design. A total of 540 participants will be recruited, aged ≥80 years, with systolic blood pressure <150 mm Hg and receiving ≥2 antihypertensive medications. Participants will have no compelling indication for medication continuation and will be considered to potentially benefit from medication reduction due to existing polypharmacy, comorbidity and frailty. Following a baseline appointment, individuals will be randomised to a strategy of medication reduction (intervention) with optional self-monitoring or usual care (control). Those in the intervention group will have one antihypertensive medication stopped. The primary outcome will be to determine if a reduction in medication can achieve a proportion of participants with clinically safe blood pressure levels at 12-week follow-up (defined as a systolic blood pressure <150 mm Hg), which is non-inferior (within 10%) to that achieved by the usual care group. Qualitative interviews will be used to understand the barriers and facilitators to medication reduction. The study will use economic modelling to predict the long-term effects of any observed changes in blood pressure and quality of life. ETHICS AND DISSEMINATION The protocol, informed consent form, participant information sheet and all other participant facing material have been approved by the Research Ethics Committee (South Central-Oxford A; ref 16/SC/0628), Medicines and Healthcare products Regulatory Agency (ref 21584/0371/001-0001), host institution(s) and Health Research Authority. All research outputs will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER EudraCT 2016-004236-38; ISRCTN97503221; Pre-results.
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Affiliation(s)
- James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Mark Lown
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Eleanor Temple
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Benson
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Gary A Ford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jill Mollison
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emma Ogburn
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rupert Payne
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | | | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Coughlan L, Sridhar S, Payne R, Edmans M, Milicic A, Venkatraman N, Lugonja B, Clifton L, Qi C, Folegatti PM, Lawrie AM, Roberts R, de Graaf H, Sukhtankar P, Faust SN, Lewis DJM, Lambe T, Hill AVS, Gilbert SC. Corrigendum to "Heterologous Two-dose Vaccination with Simian Adenovirus and Poxvirus Vectors Elicits Long-lasting Cellular Immunity to Influenza Virus A in Healthy Adults" [EBioMedicine 29 (2018) 146-154]. EBioMedicine 2018; 31:321. [PMID: 29735416 PMCID: PMC6014575 DOI: 10.1016/j.ebiom.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- L Coughlan
- Icahn School of Medicine at Mount Sinai, Department of Microbiology, Annenberg Building, Room 16.30, One Gustave Levy Place, New York 10029, United States
| | - S Sridhar
- Sanofi Pasteur, MARCY l'ETOILE 69280, France
| | - R Payne
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - M Edmans
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - A Milicic
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - N Venkatraman
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - B Lugonja
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - L Clifton
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
| | - C Qi
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
| | - P M Folegatti
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - A M Lawrie
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - R Roberts
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - H de Graaf
- NIHR Wellcome Trust Clinical Research Facility, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - P Sukhtankar
- NIHR Wellcome Trust Clinical Research Facility, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S N Faust
- NIHR Wellcome Trust Clinical Research Facility, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D J M Lewis
- Clinical Research Centre, University of Surrey, Guildford GU2 7AX, UK
| | - T Lambe
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - A V S Hill
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - S C Gilbert
- The Jenner Institute, University of Oxford, ORCRB, Roosevelt Drive, Oxford OX3 7DQ, UK.
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Cassell A, Edwards D, Harshfield A, Rhodes K, Brimicombe J, Payne R, Griffin S. The epidemiology of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract 2018; 68:e245-e251. [PMID: 29530918 PMCID: PMC5863678 DOI: 10.3399/bjgp18x695465] [Citation(s) in RCA: 284] [Impact Index Per Article: 47.3] [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] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/09/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available. AIM To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation. DESIGN AND SETTING Retrospective cohort study, undertaken in England. METHOD The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients' medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified. RESULTS In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical-mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18-44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions. CONCLUSION Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.
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Affiliation(s)
- Anna Cassell
- School of Medicine, University of Utah, Salt Lake City, US
| | - Duncan Edwards
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amelia Harshfield
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kirsty Rhodes
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rupert Payne
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Begen FM, Barnett J, Payne R, Gowland MH, DunnGalvin A, Lucas JS. Eating out with a food allergy in the UK: Change in the eating out practices of consumers with food allergy following introduction of allergen information legislation. Clin Exp Allergy 2018; 48:317-324. [PMID: 29220107 DOI: 10.1111/cea.13072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Strict allergen avoidance is important in day-to-day management of food allergy and avoidance when eating outside the home can present particular difficulties. EU legislation (EU FIC) introduced in December 2014 aimed to improve food allergen information provision for customers by requiring retailers of non-prepacked foods to provide information related to the content of one or more of 14 specified food allergens within their foods. OBJECTIVES To investigate the impact of EU FIC on the behaviours, experiences and attitudes of consumers with food allergy when eating out. METHODS As part of longitudinal research, participants with food allergy from across the UK took part in either (A) pre and post legislation in-depth interviews, or (B) pre and post legislation surveys. In-depth interviews were carried out with 28 participants pre and post legislation and analysed using the framework approach. Self-report surveys were completed by 129 participants pre and post legislation, and responses were subject to quantitative analyses. RESULTS Improvements in allergen information provision and raised awareness of food allergy in eating out venues were reported following introduction of EU FIC. Whilst participants favoured written allergen information, they expressed greater confidence in communicating with eating out staff and in trusting the allergen information that they provided. Improvements were judged to be gradual, sporadic or inconsistent in implementation. CONCLUSION & CLINICAL RELEVANCE For many participants, the "ideal" eating out experience was one in which a range of information resources were available and where written allergen information was complemented by proactive and accommodating staff within an allergy-aware environment. Whilst the onus is on legislators and food providers to ensure that adequate allergen information is provided, clinicians play an important role in encouraging patients with food allergy to pursue their legal right to make allergen enquiries to avoid accidental allergen ingestion when eating out.
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Affiliation(s)
- F M Begen
- Department of Psychology, University of Bath, Bath, UK
| | - J Barnett
- Department of Psychology, University of Bath, Bath, UK
| | - R Payne
- Creative Research Ltd, Bishops Castle, UK
| | | | - A DunnGalvin
- School of Applied Psychology, University College Cork, Cork City, Ireland
| | - J S Lucas
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Doble B, Payne R, Harshfield A, Wilson ECF. Retrospective, multicohort analysis of the Clinical Practice Research Datalink (CPRD) to determine differences in the cost of medication wastage, dispensing fees and prescriber time of issuing either short (<60 days) or long (≥60 days) prescription lengths in primary care for common, chronic conditions in the UK. BMJ Open 2017; 7:e019382. [PMID: 29208621 PMCID: PMC5719293 DOI: 10.1136/bmjopen-2017-019382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To investigate patterns of early repeat prescriptions and treatment switching over an 11-year period to estimate differences in the cost of medication wastage, dispensing fees and prescriber time for short (<60 days) and long (≥60 days) prescription lengths from the perspective of the National Health Service in the UK. SETTING Retrospective, multiple cohort study of primary care prescriptions from the Clinical Practice Research Datalink. PARTICIPANTS Five random samples of 50 000 patients each prescribed oral drugs for (1) glucose control in type 2 diabetes mellitus (T2DM); (2) hypertension in T2DM; (3) statins (lipid management) in T2DM; (4) secondary prevention of myocardial infarction; and (5) depression. PRIMARY AND SECONDARY OUTCOME MEASURES The volume of medication wastage from early repeat prescriptions and three other types of treatment switches was quantified and costed. Dispensing fees and prescriber time were also determined. Total unnecessary costs (TUC; cost of medication wastage, dispensing fees and prescriber time) associated with <60 day and ≥60 day prescriptions, standardised to a 120-day period, were then compared. RESULTS Longer prescription lengths were associated with more medication waste per prescription. However, when including dispensing fees and prescriber time, longer prescription lengths resulted in lower TUC. This finding was consistent across all five cohorts. Savings ranged from £8.38 to £12.06 per prescription per 120 days if a single long prescription was issued instead of multiple short prescriptions. Prescriber time costs accounted for the largest component of TUC. CONCLUSIONS Shorter prescription lengths could potentially reduce medication wastage, but they may also increase dispensing fees and/or the time burden of issuing prescriptions.
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Affiliation(s)
- Brett Doble
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rupert Payne
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
- Department of Population Health Sciences, Bristol Medical School, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Amelia Harshfield
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Edward C F Wilson
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
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Mughal Z, Payne R, Zaidi H. Evaluating Weekend Handover in General Surgery Using a Bespoke Proforma Tool. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.312] [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: 10/18/2022]
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Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
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Payne R, Halik L, Ma J, Zhang H, Zhang J, Conklin J, Gaylord M, Yokoyama K, Bahrainy Y, Ozgen N, Balderson J, Chase A, Gorman R, Plouffe B, Deflippi C. P2754Performance evaluation of the siemens advia centaur high sensitivity troponin i assay. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bond S, Payne R, Wilson E, Chowdry A, Caskey F, Wheeler D, Hiemstra T. Using the UK renal registry for a clinical trial in dialysis patients: the example of SIMPLIFIED. Trials 2015. [PMCID: PMC4658783 DOI: 10.1186/1745-6215-16-s2-o15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Achutha M, Slagle-Webb B, Rizk E, Payne R, Harbaugh K, Connor J. MS-01 * DEVELOPMENT OF MALIGNANT PERIPHERAL NERVE TUMOR MODEL FOR EVALUATING A TUMOR TARGETED LIPOSOME-BASED THERAPY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou260.1] [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: 11/13/2022] Open
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Adamson J, Thorne D, Errington G, Fields W, Li X, Payne R, Krebs T, Dalrymple A, Fowler K, Dillon D, Xie F, Meredith C. An inter-machine comparison of tobacco smoke particle deposition in vitro from six independent smoke exposure systems. Toxicol In Vitro 2014; 28:1320-8. [PMID: 24997294 DOI: 10.1016/j.tiv.2014.06.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 04/03/2014] [Revised: 06/09/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
There are several whole smoke exposure systems used to assess the biological and toxicological impact of tobacco smoke in vitro. One such system is the Vitrocell® VC 10 Smoking Robot and exposure module. Using quartz crystal microbalances (QCMs) installed into the module, we were able to assess tobacco smoke particle deposition in real-time. We compared regional deposition across the module positions and doses delivered by six VC 10s in four independent laboratories: two in the UK, one in Germany and one in China. Gauge R&r analysis was applied to the total data package from the six VC 10s. As a percentage of the total, reproducibility (between all six VC 10s) and repeatability (error within an individual VC 10) accounted for 0.3% and 7.4% respectively. Thus Gauge R&r was 7.7%, less than 10% overall and considered statistically fit for purpose. The dose-responses obtained from the six machines across the four different locations demonstrated excellent agreement. There were little to no positional differences across the module at all airflows as determined by ANOVA (except for one machine and at three airflows only). These results support the on-going characterisation of the VC 10 exposure system and suitability for tobacco smoke exposure in vitro.
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Affiliation(s)
- J Adamson
- British American Tobacco, Group R&D, Southampton SO15 8TL, UK.
| | - D Thorne
- British American Tobacco, Group R&D, Southampton SO15 8TL, UK.
| | - G Errington
- British American Tobacco, Group R&D, Southampton SO15 8TL, UK.
| | - W Fields
- R.J. Reynolds Tobacco Co., P.O. Box 1487, Winston-Salem, NC 27102, USA.
| | - X Li
- Zhengzhou Tobacco Research Institute of China National Tobacco Corporation, No.2 Fengyang Street, High-Tech Zone, Zhengzhou, PR China.
| | - R Payne
- Covance Laboratories Ltd., Otley Road, Harrogate HG3 1PY, UK.
| | - T Krebs
- Vitrocell® Systems GmbH, Fabrik Sonntag 3, 79183 Waldkirch, Germany.
| | - A Dalrymple
- British American Tobacco, Group R&D, Southampton SO15 8TL, UK.
| | - K Fowler
- R.J. Reynolds Tobacco Co., P.O. Box 1487, Winston-Salem, NC 27102, USA.
| | - D Dillon
- British American Tobacco, Group R&D, Southampton SO15 8TL, UK.
| | - F Xie
- Zhengzhou Tobacco Research Institute of China National Tobacco Corporation, No.2 Fengyang Street, High-Tech Zone, Zhengzhou, PR China.
| | - C Meredith
- British American Tobacco, Group R&D, Southampton SO15 8TL, UK.
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Korim MT, Payne R, Bhatia M. A case–control study of surgical site infection following operative fixation of fractures of the ankle in a large UK trauma unit. Bone Joint J 2014; 96-B:636-40. [DOI: 10.1302/0301-620x.96b5.33143] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 11/05/2022]
Abstract
Most of the literature on surgical site infections following the surgical treatment of fractures of the ankle is based on small series of patients, focusing on diabetics or the elderly. None have described post-operative functional scores in those patients who develop an infection. We performed an age- and gender-matched case–control study to identify patient- and surgery-related risk factors for surgical site infection following open reduction and internal fixation of a fracture of the ankle. Logistic regression analysis was used to identify significant risk factors for infection and to calculate odds ratios (OR). Function was assessed using the Olerud and Molander Ankle Score. The incidence of infection was 4% (29/717) and 1.1% (8/717) were deep infections. The median ankle score was significantly lower in the infection group compared with the control group (60 vs 90, Mann–Whitney test p < 0.0001). Multivariate regression analysis showed that diabetes (OR = 15, p = 0.031), nursing home residence (OR = 12, p = 0.018) and Weber C fractures (OR = 4, p = 0.048) were significant risk factors for infection. A low incidence of infection following open reduction and internal fixation of fractures of the ankle was observed. Both superficial and deep infections result in lower functional scores. Cite this article: Bone Joint J 2014;96-B:636–40.
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Affiliation(s)
- M. T. Korim
- University Hospitals of Leicester, Gwendolen
Road, Leicester LE5 4PW, UK
| | - R. Payne
- University Hospitals of Leicester, Gwendolen
Road, Leicester LE5 4PW, UK
| | - M. Bhatia
- University Hospitals of Leicester, Gwendolen
Road, Leicester LE5 4PW, UK
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Aaberg-Jessen C, Fogh L, Halle B, Jensen V, Brunner N, Kristensen BW, Abe T, Momii Y, Watanabe J, Morisaki I, Natsume A, Wakabayashi T, Fujiki M, Aldaz B, Fabius AWM, Silber J, Harinath G, Chan TA, Huse JT, Anai S, Hide T, Nakamura H, Makino K, Yano S, Kuratsu JI, Balyasnikova IV, Prasol MS, Kanoija DK, Aboody KS, Lesniak MS, Barone T, Burkhart C, Purmal A, Gudkov A, Gurova K, Plunkett R, Barton K, Misuraca K, Cordero F, Dobrikova E, Min H, Gromeier M, Kirsch D, Becher O, Pont LB, Kloezeman J, van den Bent M, Kanaar R, Kremer A, Swagemakers S, French P, Dirven C, Lamfers M, Leenstra S, Pont LB, Balvers R, Kloezeman J, Kleijn A, Lawler S, Leenstra S, Dirven C, Lamfers M, Gong X, Andres A, Hanson J, Delashaw J, Bota D, Chen CC, Yao NW, Chuang WJ, Chang C, Chen PY, Huang CY, Wei KC, Cheng Y, Dai Q, Morshed R, Han Y, Auffinger B, Wainwright D, Zhang L, Tobias A, Rincon E, Thaci B, Ahmed A, He C, Lesniak M, Choi YA, Pandya H, Gibo DM, Fokt I, Priebe W, Debinski W, Chornenkyy Y, Agnihotri S, Buczkowicz P, Rakopoulos P, Morrison A, Barszczyk M, Becher O, Hawkins C, Chung S, Decollogne S, Luk P, Shen H, Ha W, Day B, Stringer B, Hogg P, Dilda P, McDonald K, Moore S, Hayden-Gephart M, Bergen J, Su Y, Rayburn H, Edwards M, Scott M, Cochran J, Das A, Varma AK, Wallace GC, Dixon-Mah YN, Vandergrift WA, Giglio P, Ray SK, Patel SJ, Banik NL, Dasgupta T, Olow A, Yang X, Mueller S, Prados M, James CD, Haas-Kogan D, Dave ND, Desai PB, Gudelsky GA, Chow LML, LaSance K, Qi X, Driscoll J, Driscoll J, Ebsworth K, Walters MJ, Ertl LS, Wang Y, Berahovic RD, McMahon J, Powers JP, Jaen JC, Schall TJ, Eroglu Z, Portnow J, Sacramento A, Garcia E, Raubitschek A, Synold T, Esaki S, Rabkin S, Martuza R, Wakimoto H, Ferluga S, Tome CL, Debinski W, Forde HE, Netland IA, Sleire L, Skeie B, Enger PO, Goplen D, Giladi M, Tichon A, Schneiderman R, Porat Y, Munster M, Dishon M, Weinberg U, Kirson E, Wasserman Y, Palti Y, Giladi M, Porat Y, Schneiderman R, Munster M, Weinberg U, Kirson E, Palti Y, Gramatzki D, Staudinger M, Frei K, Peipp M, Weller M, Grasso C, Liu L, Becher O, Berlow N, Davis L, Fouladi M, Gajjar A, Hawkins C, Huang E, Hulleman E, Hutt M, Keller C, Li XN, Meltzer P, Quezado M, Quist M, Raabe E, Spellman P, Truffaux N, van Vurden D, Wang N, Warren K, Pal R, Grill J, Monje M, Green AL, Ramkissoon S, McCauley D, Jones K, Perry JA, Ramkissoon L, Maire C, Shacham S, Ligon KL, Kung AL, Zielinska-Chomej K, Grozman V, Tu J, Viktorsson K, Lewensohn R, Gupta S, Mladek A, Bakken K, Carlson B, Boakye-Agyeman F, Kizilbash S, Schroeder M, Reid J, Sarkaria J, Hadaczek P, Ozawa T, Soroceanu L, Yoshida Y, Matlaf L, Singer E, Fiallos E, James CD, Cobbs CS, Hashizume R, Tom M, Ihara Y, Ozawa T, Santos R, Torre JDL, Lepe E, Waldman T, Prados M, James D, Hashizume R, Ihara Y, Huang X, Yu-Jen L, Tom M, Mueller S, Gupta N, Solomon D, Waldman T, Zhang Z, James D, Hayashi T, Adachi K, Nagahisa S, Hasegawa M, Hirose Y, Gephart MH, Moore S, Bergen J, Su YS, Rayburn H, Scott M, Cochran J, Hingtgen S, Kasmieh R, Nesterenko I, Figueiredo JL, Dash R, Sarkar D, Fisher P, Shah K, Horne E, Diaz P, Stella N, Huang C, Yang H, Wei K, Huang T, Hlavaty J, Ostertag D, Espinoza FL, Martin B, Petznek H, Rodriguez-Aguirre M, Ibanez C, Kasahara N, Gunzburg W, Gruber H, Pertschuk D, Jolly D, Robbins J, Hurwitz B, Yoo JY, Bolyard C, Yu JG, Wojton J, Zhang J, Bailey Z, Eaves D, Cripe T, Old M, Kaur B, Serwer L, Yoshida Y, Le Moan N, Santos R, Ng S, Butowski N, Krtolica A, Ozawa T, Cary SPL, James CD, Johns T, Greenall S, Donoghue J, Adams T, Karpel-Massler G, Westhoff MA, Kast RE, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Karpel-Massler G, Kast RE, Westhoff MA, Merkur N, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Kievit F, Stephen Z, Wang K, Kolstoe D, Silber J, Ellenbogen R, Zhang M, Kitange G, Schroeder M, Sarkaria J, Kleijn A, Haefner E, Leenstra S, Dirven C, Lamfers M, Knubel K, Pernu BM, Sufit A, Pierce AM, Nelson SK, Keating AK, Jensen SS, Kristensen BW, Lachowicz J, Demeule M, Regina A, Tripathy S, Curry JC, Nguyen T, Castaigne JP, Le Moan N, Serwer L, Yoshida Y, Ng S, Davis T, Santos R, Davis A, Tanaka K, Keating T, Getz J, Kapp GT, Romero JM, Ozawa T, James CD, Krtolica A, Cary SPL, Lee S, Ramisetti S, Slagle-Webb B, Sharma A, Connor J, Lee WS, Maire C, Kluk M, Aster JC, Ligon K, Sun S, Lee D, Ho ASW, Pu JKS, Zhang ZQ, Lee NP, Day PJR, Leung GKK, Liu Z, Liu X, Madhankumar AB, Miller P, Webb B, Connor JR, Yang QX, Lobo M, Green S, Schabel M, Gillespie Y, Woltjer R, Pike M, Lu YJ, Torre JDL, Waldman T, Prados M, Ozawa T, James D, Luchman HA, Stechishin O, Nguyen S, Cairncross JG, Weiss S, Lun X, Wells JC, Hao X, Zhang J, Grinshtein N, Kaplan D, Luchman A, Weiss S, Cairncross JG, Senger D, Robbins S, Madhankumar A, Slagle-Webb B, Rizk E, Payne R, Park A, Pang M, Harbaugh K, Connor J, Wilisch-Neumann A, Pachow D, Kirches E, Mawrin C, McDonell S, Liang J, Piao Y, Nguyen N, Yung A, Verhaak R, Sulman E, Stephan C, Lang F, de Groot J, Mizobuchi Y, Okazaki T, Kageji T, Kuwayama K, Kitazato KT, Mure H, Hara K, Morigaki R, Matsuzaki K, Nakajima K, Nagahiro S, Kumala S, Heravi M, Devic S, Muanza T, Nelson SK, Knubel KH, Pernu BM, Pierce AM, Keating AK, Neuwelt A, Nguyen T, Wu YJ, Donson A, Vibhakar R, Venkatamaran S, Amani V, Neuwelt E, Rapkin L, Foreman N, Ibrahim F, New P, Cui K, Zhao H, Chow D, Stephen W, Nozue-Okada K, Nagane M, McDonald KL, Ogawa D, Chiocca E, Godlewski J, Ozawa T, Yoshida Y, Santos R, James D, Pang M, Liu X, Madhankumar AB, Slagle-Webb B, Patel A, Miller P, Connor J, Pasupuleti N, Gorin F, Valenzuela A, Leon L, Carraway K, Ramachandran C, Nair S, Quirrin KW, Khatib Z, Escalon E, Melnick S, Phillips A, Boghaert E, Vaidya K, Ansell P, Shalinsky D, Zhang Y, Voorbach M, Mudd S, Holen K, Humerickhouse R, Reilly E, Huang T, Parab S, Diago O, Espinoza FL, Martin B, Ibanez C, Kasahara N, Gruber H, Pertschuk D, Jolly D, Robbins J, Ryken T, Agarwal S, Al-Keilani M, Alqudah M, Sibenaller Z, Assemolt M, Sai K, Li WY, Li WP, Chen ZP, Saito R, Sonoda Y, Kanamori M, Yamashita Y, Kumabe T, Tominaga T, Sarkar G, Curran G, Jenkins R, Scharnweber R, Kato Y, Lin J, Everson R, Soto H, Kruse C, Kasahara N, Liau L, Prins R, Semenkow S, Chu Q, Eberhart C, Sengupta R, Marassa J, Piwnica-Worms D, Rubin J, Serwer L, Kapp GT, Le Moan N, Yoshida Y, Romero JM, Ng S, Davis A, Ozawa T, Krtolica A, James CD, Cary SPL, Shai R, Pismenyuk T, Moshe I, Fisher T, Freedman S, Simon A, Amariglio N, Rechavi G, Toren A, Yalon M, Shen H, Decollogne S, Dilda P, Chung S, Luk P, Hogg P, McDonald K, Shimazu Y, Kurozumi K, Ichikawa T, Fujii K, Onishi M, Ishida J, Oka T, Watanabe M, Nasu Y, Kumon H, Date I, Sirianni RW, McCall RL, Spoor J, van der Kaaij M, Kloezeman J, Geurtjens M, Dirven C, Lamfers M, Leenstra S, Stephen Z, Veiseh O, Kievit F, Fang C, Leung M, Ellenbogen R, Silber J, Zhang M, Strohbehn G, Atsina KK, Patel T, Piepmeier J, Zhou J, Saltzman WM, Takahashi M, Valdes G, Inagaki A, Kamijima S, Hiraoka K, Micewicz E, McBride WH, Iwamoto KS, Gruber HE, Robbins JM, Jolly DJ, Kasahara N, Warren K, McCully C, Bacher J, Thomas T, Murphy R, Steffen-Smith E, McAllister R, Pastakia D, Widemann B, Wei K, Yang H, Huang C, Chen P, Hua M, Liu H, Woolf EC, Abdelwahab MG, Fenton KE, Liu Q, Turner G, Preul MC, Scheck AC, Yoshida Y, Ozawa T, Butowski N, Shen W, Brown D, Pedersen H, James D, Zhang J, Hariono S, Yao TW, Sidhu A, Hashizume R, James CD, Weiss WA, Nicolaides TP, Olusanya T. EXPERIMENTAL THERAPEUTICS AND PHARMACOLOGY. Neuro Oncol 2013; 15:iii37-iii61. [PMCID: PMC3823891 DOI: 10.1093/neuonc/not176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
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Hassenbusch SJ, Satterfield WC, Gradert TL, Binhazim AW, Ahad G, Mokhtarzadeh M, Schapiro SJ, Payne R. Preclinical toxicity study of intrathecal administration of the pain relievers dextrorphan, dextromethorphan, and memantine in the sheep model. Neuromodulation 2012; 2:230-40. [PMID: 22151256 DOI: 10.1046/j.1525-1403.1999.00230.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives To determine the toxicity window for the continuous intrathecal administration of dextrorphan, dextromethorphan, and memantine via an implanted delivery pump. Materials and Methods Using 48 sheep with programmable continuous intrathecal infusion systems we determined the behavioral, motor, neurological, and histopathological changes produced by a 43-day continuous infusion study of dextrorphan, dextromethorphan, and memantine dissolved in 0.9% NaCl. Daily doses of each N-methyl-D-aspartate (NMDA) antagonist were 0.013, 0.051, 0.203, 0.510, 0.811, and 2.533 mg/kg/day, flow rates ranged from 13.25 ml/day to 0.051 ml/day at a concentration of 10 mg/ml. Control animals received saline in the range of 7.9985 ml/day to 1 ml/day. Conclusions Infusion of saline in the control animals produced no behavioral or motor changes. However, infusion of dextrorphan, dextromethorphan, and memantine at the higher doses (> 0.051 mg/kg/day) produced dose-dependent negative behavioral, motor, and histopathologic changes as indicated by a series of nonparametric statistical analyses. The minimal toxic doses were dextrorphan dose 3, dextromethorphan dose 1 and memantine dose 1. This study suggests that continuous intrathecal infusion of dextrorphan, dextromethorphan, and memantine via an implantable pump system can cause significant toxicities at the higher doses studied.
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Affiliation(s)
- S J Hassenbusch
- Departments of Neurosurgery and Pain and Symptom Management, The University of Texas M. D. Anderson Cancer Center, Houston, Texas and Department of Veterinary Sciences, The University of Texas M. D. Anderson Cancer Center-Science Park, Bastrop, Texas
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Kløverpris HN, Payne R, Sacha JB, Chen F, Rasaiyaah J, Towers G, Goulder P, Prado JG. Early presentation of HIV-1 KF11Gag and KK10Gag protective epitopes facilitate rapid CD8+ T cell activation and killing of virus infected cells. Retrovirology 2012. [PMCID: PMC3441270 DOI: 10.1186/1742-4690-9-s2-p255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Ignatiadis M, Pierga JY, Campion M, Fehm T, Payne R, Rack B, Mavroudis D, Riethdorf S, Rothe F, Bessi S, Aura CM, Sandri MT, Borgen E, Kraan J, Terstappen LWMM, Piccart M, Sotiriou C, Michiels S, Pantel K. P4-07-14: Circulating Tumor Cells (CTCs) Detection and HER2 Profiling by CellSearch® in Non-Metastatic Breast Cancer: An International Ring Study To Assess Inter-Reader Variability. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-07-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Preliminary results from the Success and Remagus trials showed that CTC detection by CellSearch® has adverse prognostic value in non-metastatic breast cancer. Moreover, several investigators have characterized HER2 expression on CTCs in early breast cancer. Since the majority of CTC-positive women with non-metastatic breast cancer have only 1 CTC detected / blood volume analyzed, we wanted to evaluate the inter-reader variability in this setting. This is a crucial step before moving forward with multi-lab/multi-center prospective testing of the clinical utility of the CellSearch® technology in non-metastatic breast cancer.
Methods: Five galleries of CellSearch® images from 3 European and one US institution (a total of 307 images) were mailed to 22 independent readers from 14 European and US academic laboratories and 8 readers from two CellSearch® Veridex laboratories in a blinded fashion. These images came mainly from studies on CTC and/or HER2−positive CTC detection in breast cancer and included healthy women (negative controls), women with metastatic (positive controls) and non-metastatic disease (Pierga et al SABCS 2010, Pierga et al ASCO 2011, Riedthorf et al CCR 2010, Ignatiadis et al PLoS ONE 2011). Each reader reported the images as either CTC-negative or CTC-positive/HER2−negative or CTC-positive/HER2−positive. Kappa statistics were used to assess inter-reader agreement. The 8 Veridex readers were summarized by a majority voting system to derive a gold standard in order to compare each independent reader using discordance rates.
Results: Kappa statistics showed moderate to good agreement between independent readers depending on the gallery evaluated (gallery 1 K: 0.55, gallery 2 K:0.57 gallery 3 K:0.64, gallery 4 K:0.72, gallery 5 K:0.85). These differences were attributed to differences in scoring difficulty of each gallery. Discordances in CTC-positive vs CTC-negative events between each reader and the gold standard ranged from 2.3%-31.3% with 7 readers showing discordance rates <5%, 11 readers between 5–10%, 10 readers between 10–14% and only 2 readers showing discordance rates >14% as compared to the gold standard (median discordance rate: 9.3%). Image analysis showed that investigators with high discordance rates compared to the Veridex gold standard were not always taking into account “morphological characteristics” for defining an event as CTC-positive. Discordant results between readers were mainly due to discordance in CTC definition and to a lesser extent in the definition of HER2−positivity. Indeed, discordances in assigning a CTC-positive event as either HER2−negative or HER2−positive ranged from 0.3−13.7% with 19 readers showing discordance rates <5%, 7 readers between 5–10% and 4 readers with discordance rates >10% (median discordance rate: 3.9%).
Conclusion: In non-metastatic breast cancer, we observed low discordance between most independent readers and the gold standard for defining a CellSearch® event as CTC with very few readers showing high discordance rates. Concordance can be improved through appropriate training and the use of all the tools provided by the CellSearch® system for image interpretation.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-07-14.
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Affiliation(s)
- M Ignatiadis
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - J-Y Pierga
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - M Campion
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - T Fehm
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - R Payne
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - B Rack
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - D Mavroudis
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - S Riethdorf
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - F Rothe
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - S Bessi
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - CM Aura
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - MT Sandri
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - E Borgen
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - J Kraan
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - LWMM Terstappen
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - M Piccart
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - C Sotiriou
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - S Michiels
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
| | - K Pantel
- 1Institut Jules Bordet, Brussels, Belgium; Institut Curie, Paris, France; Mayo Clinic, Rochester; Universitaets-Frauenklinik, Tubingen, Germany; Hammersmith Hospital, Imperial College, London, United Kingdom; Ludwig-Maximilians-Universitat, Munchen, Germany; University of Crete, Crete, Greece; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hospital of Prato, Prato, Italy; Vall d'Hebron, Barcelona, Spain; European Institute of Oncology, Milan, Italy; Oslo University Hospital, Oslo, Norway; Erasmus Medical Center, Rotterdam, Netherlands; University of Twente, Twente, Netherlands
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El Turabi A, Payne R. Ethnicity and hypertension: not as black and white as NICE makes out. BMJ 2011; 343:d6501; author reply d6506. [PMID: 21994305 DOI: 10.1136/bmj.d6501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Payne R, Spencer K. The effect of a dietetic/speech and language therapy assistant practitioner on compliance with nutrition screening targets on an acute stroke unit. J Hum Nutr Diet 2011. [DOI: 10.1111/j.1365-277x.2011.01177_35.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Matthews A, Kidd D, Neilson L, Dillon D, Payne R, Bowen R, Meredith C. Use of the Epioral™ tissue model to determine the irritation potential of Swedish snus. Toxicol Lett 2011. [DOI: 10.1016/j.toxlet.2011.05.583] [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: 10/18/2022]
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Chiu JC, Shi X, Karmali S, Birch DW, Apriasz I, Alkhamesi NA, Lal A, Schlachta CM, Christou NV, Elkassem S, Lindsay D, Smith L, Sullivan P, Sockalingam S, Hawa R, Wnuk S, Jackson T, Okrainec A, Fayez R, Christou NV, Court O, Mueller C, Okrainec A, Sockalingham S, Jackson T, Mueller C, Swanson T, Daigle C, Okrainec A, Pitzul K, Penner T, Urbach DR, Jackson T, Sandhu L, Maciver A, McCall M, Edgar R, Thiesen A, Bigam D, Churchill T, Shapiro AMJ, Luu S, Regehr G, Murnaghan ML, Gallinger S, Moulton CA, Palter V, Grantcharov T, Dath D, Hoogenes J, Matsumoto E, Szalay D, Fox A, Pitzul K, Bhojani F, Kaplan M, Wei A, McGilvray I, Cleary SP, Okrainec A, Alqahtani A, Parsyan A, Payne R, Tabah R, Anantha R, Vogt K, Crawford S, Parry N, Leslie K, Ochs A, Matthew K, Khadaroo R, Churchill T, Lavoie JM, Zalai C, Vasilevsky CA, Booy J, Takata J, Tomlinson G, Urbach DR, Lim D, Tomlinson C, LaBossiere J, Rommens K, Birch DW, Brenneman F, MacLellan S, Simpson J, Asai K, Elgadi K, Ali S, Sawyer J, Helewa R, Turner D, Wirtzfeld D, Park J, Czaykowski P, Mak G, Hochman D, McKay A, Gill R, Al-Adra D, Shi X, Sample C, Armstrong J, Lester L, Vogt K, Brackstone M, Lee L, Kaneva P, Liberman S, Charlebois P, Stein B, Fried G, Feldman L, Kanji A, Sharon E, Asai K, Jacks L, McCready D, Ghazarian D, Leong WL, Wu R, Okrainec A, Penner T, Ball C, Kirkpatrick A, Vasquez A, Balakrishnan L, Miller G, Awan S, Azadeh NR, Hoogenes J, Dath D, Jain V, Busato GM, Cristea O, Landau J, Moreland R, Johnson M, Ramage D, Browning D, Ullah S, Cristea O, Bodrogi A, Johnson M, McAlister V, Palisoc J, Anderson J, Kiladze R, Ciar J, Bancel I, Pitzul K, Leake PA, Okrainec A, Dalvi A, McLean R, Stephen W, Loeb M, Smith R, Christoffersen E, Forbes S, Kidane B, Vogt K, Vinden C, Ahmadi N, Dubois L, McKenzie M, Baxter N, Brown C, Chaudhury P, Dixon E, Fitzgerald W, Henteleff H, Kirkpatrick A, Latosinsky S, MacLean A, McLeod R, Pearsall E, Aarts MA, Meghji Z, McLeod R, Okrainec A, Tran T, Kaneva P, Fried G, Mayo N, Feldman L, Newman D, Bergman S, Cummings BA, Delisle M, Whitehead V, Chertkow H, Chan T, Cicero M, Perampaladas K, Bandukwala T, Struble J, Moser M, Young P, Groeneveld A, Chan P, Smith S, Khadaroo R, Buczkowski A, Hameed M, Tan-Tam C, Meneghetti A, Simons R, Panton N, Elnahas A, Ghaderi I, Madani A, de Gara C, Schlachta CM, Kalechstein S, Pitzul K, Henao O, Okrainec A, Paskar D, Croome K, Hernandez R, Knapp G, Howatt N, Foster S, Cameron B, Austin J, Mack L, Temple W, Puloski S, Schachar N, Gill T, Doris P, Tecson A, Kolozsvari N, Andalib A, Kaneva P, Cao J, Vassiliou M, Fried G, Feldman L, Kolozsvari N, Kaneva P, Vassiliou M, Fried G, Feldman L, Kolozsvari N, Kaneva P, Brace C, Chartrand G, Vaillancourt M, Cao J, Banaszek D, Vassiliou M, Fried G, Feldman L, Fraser S, Bergman S, Deobald R, Chad J, Di Gregorio C, Johnstone J, Kenyon C, Lees M, Auger-Dufour E, Fried G, Feldman L, Ferri L, Vassiliou M, Alqahtani A, Perlman R, Holcroft C, Gordon PH, Szilagyi A, Iradukunda D, Moser MAJ, Rodych N, Shaw JM, Ahmed N, Chiu M, Kurabi B, Qureshi A, Nathens A, Conn LG, Pandya A, Kitto S, Ma G, Pooni A, Forbes S, Eskicioglu C, Pearsall E, Brenneman F, McLeod R, Rockx MA, McAlister V, Roberts D, Ouellet J, Kirkpatrick A, Lall R, Sutherland F, Ball C, Chackungal S, Knowlton LM, Dahn B, McQueen K, Morrison JA, Lent B, Brown J, Fluit M, Herbert C, Deen S, Deutschmann M, McFadden S, Gelfand G, Bosch D, Grimmer L, Milman S, Ng T, Gill R, Perry T, Abele J, Bedard E, Schiller D, Coughlin S, Stewart TC, Parry N, Gray D, Williamson J, Malthaner R, Bottoni D, Perri M, Trejos AL, Naish M, Patel R, Malthaner R, Ashrafi A, Bond J, Ong S, Yamashita M, Ahmadi S, Abdulmosen M, Miller J, Finley C, Ostrander K, Shargall Y, Lee L, Hanley S, Robineau C, Sirois C, Mulder D, Ferri L, Humphrey R, Inculet R, Fortin D, Arab A, Malthaner R, Ashrafi A, Bond J, Ong S, Yamashita M, Ahmadi S, McGuire A, Reid K, Petsikas D, Hopman W, Basi A, Basi S, Irshad K, Hanna W, Croome KP, Marotta P, McAlister V, Quan D, Wall W, Hernandez-Alejandro R, de Mestral C, Zagorski B, Rotstein O, Gomez D, Haas B, Laupacis A, Sharma S, Bridge J, Nathens A, Bhojani F, Fox A, Pitzul K, Moulton CA, Wei A, Okrainec A, Cleary S, Bertens K, Croome KP, Mujoomdar A, Peck D, Rankin R, Quan D, Kakani N, Hernandez-Alejandro R, Suri R, Marcaccio M, Ruo L, Jamal M, Khalil JA, Simoneau-Beaudry E, Dumitra S, Edwards M, Yousef Y, Jiffry MA, Metrakos P, Tchervenkov J, Doi S, Barkun J, Obayan A, Meiers S, Keith R, Elkassem S, Church N, Mitchell P, Turbide C, Dixon E, Debru E, Shum J, Wall WJ, Maniar R, Hochman D, Wirtzfeld D, Yaffe C, Yip B, McKay A, Silverman R, Park J, Francescutti V, Rivera L, Kane JM, Skitzki JJ, Lovrics P, Hodgson N, O'Brien MA, Thabane L, Cornacchi S, Heller B, Reid S, Sanders K, Kittmer T, Simunovic M, Duhaime S, Fong B, Deria M, Acton C, El-Maadawy M, Lad S, Arnaout A, Omole M, Pemberton J, Lovrics P, Bischof D, Stotland P, Hagen J, Swallow C, Klein L, Van Koughnett JA, Ahmad T, Ainsworth P, Brackstone M, Kanagaratnam S, Groot G, VanderBeek L, Francescutti V, Farrokhyar F, Strang B, Kahnamoui K, MacLellan S, MacKay H, Ringash J, Jacks L, Kassam Z, Khalili I, Conrad T, Okrainec A, Chagpar R, Xing Y, You N, Yi-Ju C, Feig B, Chang G, Cormie J, Gervais MK, Sideris L, Drolet P, Mitchell A, Leblanc G, Dubé P, Merchant S, Knowling M, Cheifetz R, Raval M, Heidary B, Kalikias S, Raval D, Phang T, Brown C, Scheer A, O'Connor A, Chan B, Moloo H, Poulin E, Mamazza J, Auer R, Boushey R, Hardy K, Vergis A, Sullivan P, Musselman R, Gomes T, Chan B, Auer R, Moloo H, Poulin E, Mamazza J, Al-Khayal K, Al-Omran M, Mamdani M, AlObeed O, Boushey R, Martel G, Crawford A, Barkun J, Ramsay C, Fergusson D, Boushey R, Williams L, Crawford A, McLaughlin K, Mackey M, Moloo H, Mamazza J, Poulin E, Friedlich M, Boushey R, Auer R, Bellolio F, Cohen Z, MacRae H, O'Connor B, Huang H, Victor JC, McLeod R, Hardy K, Pitzul K, Kwong J, Vergis A, Urbach D, Okrainec A, Vogt K, Dubois L, Vinden C, Chan B, Scheer A, Menezes A, Moloo H, Poulin E, Boushey R, Mamazza J, Bellolio F, MacRae H, Cohen Z, O'Connor B, Huang H, McLeod R, Godbout-Simard C, Azar J, Psaradellis F, Sampalis J, Morin N, Brown C, Kalikias S, Heidary B, Raval D, Phang PT, Raval M, Archibald A, Hurlbut D, Vanner S, Zalai C, Vasilevsky CA, Simunovic M, Cadeddu M, Forbes S, Kelly S, Stephen W, Grubac V, Marcinow M, Coates A, Aslani N, Phang PT, Raval M, Brown C, Scheer A, Carrier M, Boushey R, Asmis T, Wells P, Jonker D, Auer R, Azer N, Gill R, de Gara C, Birch DW, Karmali S, Roxin G, Drolet S, MacLean A, Buie WD, Heine J, Agzarian J, Forbes S, Stephen W, Kelly S, Churchill P, Corner T, Kelly S, Forbes S, Lindsay L, Stephen W, Scheer A, O'Connor A, Chan B, Moloo H, Poulin E, Mamazza J, Auer R, Boushey R, Denis J, Hochman D, Recsky M, Phang PT, Raval M, Cheung W, Brown C, Alkhamesi N, Schlachta CM, Tiwari T, Brown C, Raval MJ, Phang PT. Canadian Surgery Forum: Abstracts of presentations to the Annual Meetings of the Canadian Association of Bariatric Physicians and Surgeons, Canadian Association of General Surgeons, Canadian Association of Thoracic Surgeons, Canadian Hepato-Pancreato-Biliary Society, Canadian Society of Surgical Oncology, Canadian Society of Colon and Rectal Surgeons, London, Ont. Sept. 15-18, 2011. Can J Surg 2011; 54:S57-S104. [PMID: 35488394 PMCID: PMC3191910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- J C Chiu
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - X Shi
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - I Apriasz
- From the Schulich School of Medicine and Dentistry and the London Health Sciences Centre, London, Ont
| | - N A Alkhamesi
- From the Schulich School of Medicine and Dentistry and the London Health Sciences Centre, London, Ont
| | - A Lal
- From the Schulich School of Medicine and Dentistry and the London Health Sciences Centre, London, Ont
| | - C M Schlachta
- From the Schulich School of Medicine and Dentistry and the London Health Sciences Centre, London, Ont
| | | | - S Elkassem
- From the University of Toronto, Toronto, Ont
| | - D Lindsay
- From the University of Toronto, Toronto, Ont
| | - L Smith
- From the University of Toronto, Toronto, Ont
| | - P Sullivan
- From the University of Toronto, Toronto, Ont
| | - S Sockalingam
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - R Hawa
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - S Wnuk
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - T Jackson
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - R Fayez
- From the McGill University Health Centre, Montréal, Que
| | - N V Christou
- From the McGill University Health Centre, Montréal, Que
| | - O Court
- From the McGill University Health Centre, Montréal, Que
| | - C Mueller
- From the Division of General Surgery and Division of Psychiatry, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the Division of General Surgery and Division of Psychiatry, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - S Sockalingham
- From the Division of General Surgery and Division of Psychiatry, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - T Jackson
- From the Division of General Surgery and Division of Psychiatry, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - C Mueller
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - T Swanson
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - C Daigle
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - K Pitzul
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - T Penner
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - T Jackson
- From the Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ont
| | - L Sandhu
- From the University of Toronto, Toronto, Ont
| | - A Maciver
- From the University of Alberta, Edmonton, Alta
| | - M McCall
- From the University of Alberta, Edmonton, Alta
| | - R Edgar
- From the University of Alberta, Edmonton, Alta
| | - A Thiesen
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - T Churchill
- From the University of Alberta, Edmonton, Alta
| | | | - S Luu
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - G Regehr
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - M L Murnaghan
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - S Gallinger
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - C-A Moulton
- From the Wilson Centre, University Health Network, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ont., and the Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC
| | - V Palter
- From St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - T Grantcharov
- From St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - D Dath
- From McMaster University, Hamilton, Ont
| | | | | | - D Szalay
- From McMaster University, Hamilton, Ont
| | - A Fox
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - K Pitzul
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - F Bhojani
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - M Kaplan
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - A Wei
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - I McGilvray
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - S P Cleary
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | - A Okrainec
- From University of Toronto, Toronto Western Hospital, Toronto, Ont
| | | | - A Parsyan
- From McGill University, Montréal, Que
| | - R Payne
- From McGill University, Montréal, Que
| | - R Tabah
- From McGill University, Montréal, Que
| | - R Anantha
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - K Vogt
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - S Crawford
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - N Parry
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - K Leslie
- From the Division of General Surgery, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Ochs
- From the University of Alberta, Edmonton, Alta
| | - K Matthew
- From the University of Alberta, Edmonton, Alta
| | - R Khadaroo
- From the University of Alberta, Edmonton, Alta
| | - T Churchill
- From the University of Alberta, Edmonton, Alta
| | | | - C Zalai
- From McGill University, Montréal, Que
| | | | - J Booy
- From the University Health Network, Toronto, Ont
| | - J Takata
- From the University Health Network, Toronto, Ont
| | - G Tomlinson
- From the University Health Network, Toronto, Ont
| | - D R Urbach
- From the University Health Network, Toronto, Ont
| | - D Lim
- From the University of Alberta, Edmonton, Alta
| | - C Tomlinson
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - J LaBossiere
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - K Rommens
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - F Brenneman
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - S MacLellan
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - J Simpson
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - K Asai
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - K Elgadi
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - S Ali
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - J Sawyer
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - R Helewa
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - D Turner
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - D Wirtzfeld
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - P Czaykowski
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - G Mak
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - D Hochman
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - A McKay
- From the University of Manitoba, CancerCare Manitoba, Winnipeg, Man
| | - R Gill
- From the University of Alberta, Edmonton, Alta
| | - D Al-Adra
- From the University of Alberta, Edmonton, Alta
| | - X Shi
- From the University of Alberta, Edmonton, Alta
| | - C Sample
- From the University of Alberta, Edmonton, Alta
| | - J Armstrong
- From the University of Western Ontario, London, Ont
| | - L Lester
- From the University of Western Ontario, London, Ont
| | - K Vogt
- From the University of Western Ontario, London, Ont
| | - M Brackstone
- From the University of Western Ontario, London, Ont
| | - L Lee
- From the McGill University Health Centre, Montréal, Que
| | - P Kaneva
- From the McGill University Health Centre, Montréal, Que
| | - S Liberman
- From the McGill University Health Centre, Montréal, Que
| | - P Charlebois
- From the McGill University Health Centre, Montréal, Que
| | - B Stein
- From the McGill University Health Centre, Montréal, Que
| | - G Fried
- From the McGill University Health Centre, Montréal, Que
| | - L Feldman
- From the McGill University Health Centre, Montréal, Que
| | - A Kanji
- From the University of Toronto, University Health Network, Toronto, Ont
| | - E Sharon
- From the University of Toronto, University Health Network, Toronto, Ont
| | - K Asai
- From the University of Toronto, University Health Network, Toronto, Ont
| | - L Jacks
- From the University of Toronto, University Health Network, Toronto, Ont
| | - D McCready
- From the University of Toronto, University Health Network, Toronto, Ont
| | - D Ghazarian
- From the University of Toronto, University Health Network, Toronto, Ont
| | - W-L Leong
- From the University of Toronto, University Health Network, Toronto, Ont
| | - R Wu
- From The Ottawa Hospital, Ottawa and Toronto Western Hospital, Toronto, Ont
| | - A Okrainec
- From The Ottawa Hospital, Ottawa and Toronto Western Hospital, Toronto, Ont
| | - T Penner
- From The Ottawa Hospital, Ottawa and Toronto Western Hospital, Toronto, Ont
| | - C Ball
- From the University of Calgary, Calgary, Alta
| | | | - A Vasquez
- From the University of Saskatchewan, Saskatoon, Sask
| | | | - G Miller
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Awan
- From the University of Saskatchewan, Saskatoon, Sask
| | | | | | - D Dath
- From McMaster University, Hamilton, Ont
| | - V Jain
- From the University of Western Ontario, London, Ont
| | - G-M Busato
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - O Cristea
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - J Landau
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - R Moreland
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - M Johnson
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - D Ramage
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - D Browning
- From the Schulich School of Medicine and Dentistry, and Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - S Ullah
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - O Cristea
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - A Bodrogi
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - M Johnson
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - V McAlister
- From the Canadian Forces Medical Service and University of Western Ontario, London, Ont
| | - J Palisoc
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - J Anderson
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - R Kiladze
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - J Ciar
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - I Bancel
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - K Pitzul
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - P-A Leake
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont
| | - A Dalvi
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - R McLean
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - W Stephen
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - M Loeb
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - R Smith
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - E Christoffersen
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - S Forbes
- From the Department of Surgery, Department of Pathology and Molecular Medicine, McMaster University and Hamilton Health Sciences Hamilton, Ont
| | - B Kidane
- From the University of Western Ontario, London, Ont
| | - K Vogt
- From the University of Western Ontario, London, Ont
| | - C Vinden
- From the University of Western Ontario, London, Ont
| | - N Ahmadi
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - L Dubois
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - M McKenzie
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - N Baxter
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - C Brown
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - P Chaudhury
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - E Dixon
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - W Fitzgerald
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - H Henteleff
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - A Kirkpatrick
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - S Latosinsky
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - A MacLean
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - R McLeod
- From the University of Toronto, Toronto, the University of Western Ontario, London, Ont., the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, McGill University, Montréal, Que., the University of Calgary, Calgary, Alta., Charles S. Curtis Memorial Hospital, St. Anthony, NL, and Dalhousie University, Halifax, NS
| | - E Pearsall
- From the University of Toronto, Toronto, Ont
| | - M-A Aarts
- From the University of Toronto, Toronto, Ont
| | - Z Meghji
- From the University of Toronto, Toronto, Ont
| | - R McLeod
- From the University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University of Toronto, Toronto, Ont
| | - T Tran
- From McGill University, Montréal, Que
| | - P Kaneva
- From McGill University, Montréal, Que
| | - G Fried
- From McGill University, Montréal, Que
| | - N Mayo
- From McGill University, Montréal, Que
| | - L Feldman
- From McGill University, Montréal, Que
| | - D Newman
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - S Bergman
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - B-A Cummings
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - M Delisle
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - V Whitehead
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - H Chertkow
- From McGill University and the Jewish General Hospital, Montréal, Que
| | - T Chan
- From McMaster University, Hamilton, Ont
| | - M Cicero
- From McMaster University, Hamilton, Ont
| | | | | | - J Struble
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - M Moser
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - P Young
- From the University of Alberta, Edmonton, Alta
| | | | - P Chan
- From the University of Alberta, Edmonton, Alta
| | - S Smith
- From the University of Alberta, Edmonton, Alta
| | - R Khadaroo
- From the University of Alberta, Edmonton, Alta
| | - A Buczkowski
- From the University of British Columbia, Vancouver, BC
| | - M Hameed
- From the University of British Columbia, Vancouver, BC
| | - C Tan-Tam
- From the University of British Columbia, Vancouver, BC
| | - A Meneghetti
- From the University of British Columbia, Vancouver, BC
| | - R Simons
- From the University of British Columbia, Vancouver, BC
| | - N Panton
- From the University of British Columbia, Vancouver, BC
| | - A Elnahas
- From McMaster University, Hamilton, Ont
| | - I Ghaderi
- From the University of Western Ontario, London, Ont., and the University of Alberta, Edmonton, Alta
| | - A Madani
- From the University of Western Ontario, London, Ont., and the University of Alberta, Edmonton, Alta
| | - C de Gara
- From the University of Western Ontario, London, Ont., and the University of Alberta, Edmonton, Alta
| | - C M Schlachta
- From the University of Western Ontario, London, Ont., and the University of Alberta, Edmonton, Alta
| | - S Kalechstein
- From McMaster University, Hamilton University Health Network, Hamilton, University of Toronto, Toronto, Ont., and the Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - K Pitzul
- From McMaster University, Hamilton University Health Network, Hamilton, University of Toronto, Toronto, Ont., and the Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - O Henao
- From McMaster University, Hamilton University Health Network, Hamilton, University of Toronto, Toronto, Ont., and the Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - A Okrainec
- From McMaster University, Hamilton University Health Network, Hamilton, University of Toronto, Toronto, Ont., and the Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - D Paskar
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - K Croome
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - R Hernandez
- From the Department of General Surgery, University of Western Ontario, London, Ont
| | - G Knapp
- From McMaster University, Hamilton, Ont., and Centro Evangelico de Medicina (CEML) Hospital, Lubango, Angola
| | - N Howatt
- From McMaster University, Hamilton, Ont., and Centro Evangelico de Medicina (CEML) Hospital, Lubango, Angola
| | - S Foster
- From McMaster University, Hamilton, Ont., and Centro Evangelico de Medicina (CEML) Hospital, Lubango, Angola
| | - B Cameron
- From McMaster University, Hamilton, Ont., and Centro Evangelico de Medicina (CEML) Hospital, Lubango, Angola
| | - J Austin
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - L Mack
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - W Temple
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - S Puloski
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - N Schachar
- From the Foothills Medical Centre and Tom Baker Cancer Centre, Calgary, Alta
| | - T Gill
- From the Surrey Memorial Hospital, New Westminster and Surrey, BC
| | - P Doris
- From the Surrey Memorial Hospital, New Westminster and Surrey, BC
| | - A Tecson
- From the Surrey Memorial Hospital, New Westminster and Surrey, BC
| | - N Kolozsvari
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - A Andalib
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - P Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - J Cao
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - M Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - G Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - L Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - N Kolozsvari
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - P Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - M Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - G Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - L Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - N Kolozsvari
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - P Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - C Brace
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - G Chartrand
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - M Vaillancourt
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - J Cao
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - D Banaszek
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - M Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - G Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - L Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que., and Simon Fraser University, Burnaby, BC
| | - S Fraser
- From the Jewish General Hospital, Montréal, Que
| | - S Bergman
- From the Jewish General Hospital, Montréal, Que
| | - R Deobald
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - J Chad
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - C Di Gregorio
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - J Johnstone
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - C Kenyon
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - M Lees
- From the Department of General Surgery and West Winds Primary Health Centre, University of Saskatchewan, Saskatoon, Sask
| | - E Auger-Dufour
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - G Fried
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - L Feldman
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - L Ferri
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - M Vassiliou
- From the McGill University Health Centre, McGill University, Montréal, Que
| | - A Alqahtani
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - R Perlman
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - C Holcroft
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - P H Gordon
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - A Szilagyi
- From the Division of Colorectal Surgery, Department of Epidemiology, Division of Gastroenterology of the Jewish General Hospital, McGill University School of Medicine, Montréal, Que
| | - D Iradukunda
- From the University of Saskatchewan, Saskatoon, Sask
| | - M A J Moser
- From the University of Saskatchewan, Saskatoon, Sask
| | - N Rodych
- From the University of Saskatchewan, Saskatoon, Sask
| | - J M Shaw
- From the University of Saskatchewan, Saskatoon, Sask
| | - N Ahmed
- From the University of Toronto, Toronto, Ont
| | - M Chiu
- From the University of Toronto, Toronto, Ont
| | - B Kurabi
- From the University of Toronto, Toronto, Ont
| | - A Qureshi
- From the University of Toronto, Toronto, Ont
| | - A Nathens
- From the University of Toronto, Toronto, Ont
| | | | - A Pandya
- From the University of Toronto, Toronto, Ont
| | - S Kitto
- From the University of Toronto, Toronto, Ont
| | - G Ma
- From the University of Toronto, Toronto, Ont
| | - A Pooni
- From the University of Toronto, Toronto, Ont
| | - S Forbes
- From the University of Toronto, Toronto, Ont
| | | | - E Pearsall
- From the University of Toronto, Toronto, Ont
| | - F Brenneman
- From the University of Toronto, Toronto, Ont
| | - R McLeod
- From the University of Toronto, Toronto, Ont
| | - M A Rockx
- From the Alberta Medical Association Locum Services and the University of Western Ontario, London, Ont
| | - V McAlister
- From the Alberta Medical Association Locum Services and the University of Western Ontario, London, Ont
| | - D Roberts
- From the University of Calgary, Calgary, Alta
| | - J Ouellet
- From the University of Calgary, Calgary, Alta
| | | | - R Lall
- From the University of Calgary, Calgary, Alta
| | | | - C Ball
- From the University of Calgary, Calgary, Alta
| | - S Chackungal
- From the University of Western Ontario, London, Ont., the University of British Columbia, Vancouver, BC, the Ministry of Health Liberia, Monrovia, Liberia, and Harvard Humanitarian Initiative, Cambridge, Mass
| | - L M Knowlton
- From the University of Western Ontario, London, Ont., the University of British Columbia, Vancouver, BC, the Ministry of Health Liberia, Monrovia, Liberia, and Harvard Humanitarian Initiative, Cambridge, Mass
| | - B Dahn
- From the University of Western Ontario, London, Ont., the University of British Columbia, Vancouver, BC, the Ministry of Health Liberia, Monrovia, Liberia, and Harvard Humanitarian Initiative, Cambridge, Mass
| | - K McQueen
- From the University of Western Ontario, London, Ont., the University of British Columbia, Vancouver, BC, the Ministry of Health Liberia, Monrovia, Liberia, and Harvard Humanitarian Initiative, Cambridge, Mass
| | - J A Morrison
- From the Chatham Kent Health Alliance, Chatham, Ont
| | - B Lent
- From the University of Western Ontario, London, Ont
| | - J Brown
- From the University of Western Ontario, London, Ont
| | - M Fluit
- From the University of Western Ontario, London, Ont
| | - C Herbert
- From the University of Western Ontario, London, Ont
| | - S Deen
- From the University of Calgary, Calgary, Alta
| | | | - S McFadden
- From the University of Calgary, Calgary, Alta
| | - G Gelfand
- From the University of Calgary, Calgary, Alta
| | - D Bosch
- From the University of Calgary, Calgary, Alta
| | - L Grimmer
- From the Brown University School of Medicine, Providence, RI
| | - S Milman
- From the Brown University School of Medicine, Providence, RI
| | - T Ng
- From the Brown University School of Medicine, Providence, RI
| | - R Gill
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - T Perry
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - J Abele
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - E Bedard
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - D Schiller
- From the University of Alberta, the Cross Cancer Institute, Edmonton, Alta
| | - S Coughlin
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - T Charyk Stewart
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - N Parry
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - D Gray
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - J Williamson
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - R Malthaner
- From the University of Western Ontario, London Health Sciences Centre, London, Ont
| | - D Bottoni
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - M Perri
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - A L Trejos
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - M Naish
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - R Patel
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - R Malthaner
- From the London Health Sciences Centre and CSTAR, London, Ont
| | - A Ashrafi
- From the Surrey Memorial Hospital, Surrey, BC
| | - J Bond
- From the Surrey Memorial Hospital, Surrey, BC
| | - S Ong
- From the Surrey Memorial Hospital, Surrey, BC
| | - M Yamashita
- From the Surrey Memorial Hospital, Surrey, BC
| | - S Ahmadi
- From the Surrey Memorial Hospital, Surrey, BC
| | | | - J Miller
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | | | | | - L Lee
- From the McGill University Health Centre, Montréal, Que
| | - S Hanley
- From the McGill University Health Centre, Montréal, Que
| | - C Robineau
- From the McGill University Health Centre, Montréal, Que
| | - C Sirois
- From the McGill University Health Centre, Montréal, Que
| | - D Mulder
- From the McGill University Health Centre, Montréal, Que
| | - L Ferri
- From the McGill University Health Centre, Montréal, Que
| | - R Humphrey
- From the University of Western Ontario, Woodstock, and London, Ont
| | - R Inculet
- From the University of Western Ontario, Woodstock, and London, Ont
| | - D Fortin
- From the University of Western Ontario, Woodstock, and London, Ont
| | - A Arab
- From the University of Western Ontario, Woodstock, and London, Ont
| | - R Malthaner
- From the University of Western Ontario, Woodstock, and London, Ont
| | - A Ashrafi
- From the Surrey Memorial Hospital, Surrey, BC
| | - J Bond
- From the Surrey Memorial Hospital, Surrey, BC
| | - S Ong
- From the Surrey Memorial Hospital, Surrey, BC
| | - M Yamashita
- From the Surrey Memorial Hospital, Surrey, BC
| | - S Ahmadi
- From the Surrey Memorial Hospital, Surrey, BC
| | - A McGuire
- From Queen's University, Ottawa and Kingston, Ont
| | - K Reid
- From Queen's University, Ottawa and Kingston, Ont
| | - D Petsikas
- From Queen's University, Ottawa and Kingston, Ont
| | - W Hopman
- From Queen's University, Ottawa and Kingston, Ont
| | - A Basi
- From the University of Western Ontario, London, and the William Osler Health Centre, Brampton, Ont
| | - S Basi
- From the University of Western Ontario, London, and the William Osler Health Centre, Brampton, Ont
| | - K Irshad
- From the University of Western Ontario, London, and the William Osler Health Centre, Brampton, Ont
| | - W Hanna
- From the Toronto General Hospital, Toronto, Ont
| | - K P Croome
- From the University of Western Ontario, London, Ont
| | - P Marotta
- From the University of Western Ontario, London, Ont
| | - V McAlister
- From the University of Western Ontario, London, Ont
| | - D Quan
- From the University of Western Ontario, London, Ont
| | - W Wall
- From the University of Western Ontario, London, Ont
| | | | - C de Mestral
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - B Zagorski
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - O Rotstein
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - D Gomez
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - B Haas
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - A Laupacis
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - S Sharma
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - J Bridge
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - A Nathens
- From the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto and Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - F Bhojani
- From the University of Toronto, Toronto, Ont
| | - A Fox
- From the University of Toronto, Toronto, Ont
| | - K Pitzul
- From the University of Toronto, Toronto, Ont
| | - C-A Moulton
- From the University of Toronto, Toronto, Ont
| | - A Wei
- From the University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University of Toronto, Toronto, Ont
| | - S Cleary
- From the University of Toronto, Toronto, Ont
| | - K Bertens
- From the University of Western Ontario, London, Ont
| | - K P Croome
- From the University of Western Ontario, London, Ont
| | - A Mujoomdar
- From the University of Western Ontario, London, Ont
| | - D Peck
- From the University of Western Ontario, London, Ont
| | - R Rankin
- From the University of Western Ontario, London, Ont
| | - D Quan
- From the University of Western Ontario, London, Ont
| | - N Kakani
- From the University of Western Ontario, London, Ont
| | | | - R Suri
- From McMaster University, Hamilton, Ont
| | | | - L Ruo
- From McMaster University, Hamilton, Ont
| | - M Jamal
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - J Abou Khalil
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - E Simoneau-Beaudry
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - S Dumitra
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - M Edwards
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - Y Yousef
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - M Al Jiffry
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - P Metrakos
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - J Tchervenkov
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - S Doi
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - J Barkun
- From McGill University, Montréal, Que., and University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - A Obayan
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask., and the Regina General Hospital, Regina, Sask
| | - S Meiers
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask., and the Regina General Hospital, Regina, Sask
| | - R Keith
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask., and the Regina General Hospital, Regina, Sask
| | - S Elkassem
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - N Church
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - P Mitchell
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - C Turbide
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - E Dixon
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - E Debru
- From the University of Toronto, Toronto, Ont., and the University of Calgary, Calgary, Alta
| | - J Shum
- From the University of Western Ontario, London, Ont
| | - W J Wall
- From the University of Western Ontario, London, Ont
| | - R Maniar
- From the University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the University of Manitoba, Winnipeg, Man
| | - D Wirtzfeld
- From the University of Manitoba, Winnipeg, Man
| | - C Yaffe
- From the University of Manitoba, Winnipeg, Man
| | - B Yip
- From the University of Manitoba, Winnipeg, Man
| | - A McKay
- From the University of Manitoba, Winnipeg, Man
| | - R Silverman
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - V Francescutti
- From the Roswell Park Cancer Institute, Buffalo, New York, NY
| | - L Rivera
- From the Roswell Park Cancer Institute, Buffalo, New York, NY
| | - J M Kane
- From the Roswell Park Cancer Institute, Buffalo, New York, NY
| | - J J Skitzki
- From the Roswell Park Cancer Institute, Buffalo, New York, NY
| | - P Lovrics
- From McMaster University, Hamilton, Ont
| | - N Hodgson
- From McMaster University, Hamilton, Ont
| | | | - L Thabane
- From McMaster University, Hamilton, Ont
| | | | - B Heller
- From McMaster University, Hamilton, Ont
| | - S Reid
- From McMaster University, Hamilton, Ont
| | - K Sanders
- From McMaster University, Hamilton, Ont
| | - T Kittmer
- From McMaster University, Hamilton, Ont
| | | | - S Duhaime
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - B Fong
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - M Deria
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - C Acton
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - M El-Maadawy
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - S Lad
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - A Arnaout
- From the University of Ottawa, Ottawa, Ont., and The Ottawa Hospital, Ottawa, Ont
| | - M Omole
- From McMaster University, Hamilton, Ont
| | | | - P Lovrics
- From McMaster University, Hamilton, Ont
| | - D Bischof
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - P Stotland
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - J Hagen
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - C Swallow
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - L Klein
- From North York General Hospital, Mount Sinai Hospital, Humber River Regional Hospital and the University of Toronto, Toronto, Ont
| | - J A Van Koughnett
- From the Division of General Surgery, University of Western Ontario, and the London Regional Cancer Program, London, Ont
| | - T Ahmad
- From the Division of General Surgery, University of Western Ontario, and the London Regional Cancer Program, London, Ont
| | - P Ainsworth
- From the Division of General Surgery, University of Western Ontario, and the London Regional Cancer Program, London, Ont
| | - M Brackstone
- From the Division of General Surgery, University of Western Ontario, and the London Regional Cancer Program, London, Ont
| | | | - G Groot
- From the University of Saskatchewan, Saskatoon, Sask
| | | | | | | | - B Strang
- From McMaster University, Hamilton, Ont
| | | | - S MacLellan
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - H MacKay
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - J Ringash
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - L Jacks
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - Z Kassam
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - I Khalili
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - T Conrad
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - A Okrainec
- From the Department of Radiology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Cancer Care Ontario, Toronto, Ont
| | - R Chagpar
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - Y Xing
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - N You
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - C Yi-Ju
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - B Feig
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - G Chang
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - J Cormie
- From the University of Western Ontario, London, Ont., and the MD Anderson Cancer Center, Houston, Tex
| | - M-K Gervais
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - L Sideris
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - P Drolet
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - A Mitchell
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - G Leblanc
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - P Dubé
- From Hôpital Maisonneuve-Rosemont, Montréal, Que
| | - S Merchant
- From the University of British Columbia, General Surgery, and the BC Cancer Agency, Vancouver, BC
| | - M Knowling
- From the University of British Columbia, General Surgery, and the BC Cancer Agency, Vancouver, BC
| | - R Cheifetz
- From the University of British Columbia, General Surgery, and the BC Cancer Agency, Vancouver, BC
| | - M Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - B Heidary
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - S Kalikias
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - D Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - T Phang
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C Brown
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - A Scheer
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A O'Connor
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Chan
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man., and the University of Toronto, Toronto, Ont
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man., and the University of Toronto, Toronto, Ont
| | - P Sullivan
- From the University of Manitoba, Winnipeg, Man., and the University of Toronto, Toronto, Ont
| | - R Musselman
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - T Gomes
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - B Chan
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - R Auer
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - E Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - K Al-Khayal
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - M Al-Omran
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - M Mamdani
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - O AlObeed
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - R Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Institute for Clinical Evaluative Sciences, Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ont., and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - G Martel
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - A Crawford
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - J Barkun
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - C Ramsay
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - D Fergusson
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - R Boushey
- From the University of Ottawa, Ottawa, Ont., McGill University, Montréal, Que., and the University of Aberdeen, Aberdeen, Great Britain
| | - L Williams
- From the University of Ottawa, Ottawa, Ont
| | - A Crawford
- From the University of Ottawa, Ottawa, Ont
| | | | - M Mackey
- From the University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the University of Ottawa, Ottawa, Ont
| | - E Poulin
- From the University of Ottawa, Ottawa, Ont
| | | | - R Boushey
- From the University of Ottawa, Ottawa, Ont
| | - R Auer
- From the University of Ottawa, Ottawa, Ont
| | - F Bellolio
- From the University of Toronto, Toronto, Ont
| | - Z Cohen
- From the University of Toronto, Toronto, Ont
| | - H MacRae
- From the University of Toronto, Toronto, Ont
| | - B O'Connor
- From the University of Toronto, Toronto, Ont
| | - H Huang
- From the University of Toronto, Toronto, Ont
| | - J C Victor
- From the University of Toronto, Toronto, Ont
| | - R McLeod
- From the University of Toronto, Toronto, Ont
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - K Pitzul
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - J Kwong
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - D Urbach
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - A Okrainec
- From the University of Manitoba, Winnipeg, Man., the University of Toronto, Toronto, and Queen's University, Kingston, Ont
| | - K Vogt
- From the London Health Sciences Centre, London, Ont
| | - L Dubois
- From the London Health Sciences Centre, London, Ont
| | - C Vinden
- From the London Health Sciences Centre, London, Ont
| | - B Chan
- From the University of Ottawa, Ottawa, Ont
| | - A Scheer
- From the University of Ottawa, Ottawa, Ont
| | - A Menezes
- From the University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the University of Ottawa, Ottawa, Ont
| | - E Poulin
- From the University of Ottawa, Ottawa, Ont
| | - R Boushey
- From the University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the University of Ottawa, Ottawa, Ont
| | - F Bellolio
- From the University of Toronto, Toronto, Ont
| | - H MacRae
- From the University of Toronto, Toronto, Ont
| | - Z Cohen
- From the University of Toronto, Toronto, Ont
| | - B O'Connor
- From the University of Toronto, Toronto, Ont
| | - H Huang
- From the University of Toronto, Toronto, Ont
| | - R McLeod
- From the University of Toronto, Toronto, Ont
| | - C Godbout-Simard
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - J Azar
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - F Psaradellis
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - J Sampalis
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - N Morin
- From the McGill Medical School, JSS Medical Research, Jewish General Hospital, Montréal, Que
| | - C Brown
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - S Kalikias
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - B Heidary
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - D Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - A Archibald
- From the Department of Pathology and the Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ont
| | - D Hurlbut
- From the Department of Pathology and the Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ont
| | - S Vanner
- From the Department of Pathology and the Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ont
| | - C Zalai
- From McGill University, Montréal, Que
| | | | - M Simunovic
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - S Forbes
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - S Kelly
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - W Stephen
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - V Grubac
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - M Marcinow
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - A Coates
- From the Juravinski Cancer Centre, McMaster University, Hamilton, Ont
| | - N Aslani
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - P T Phang
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - M Raval
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - C Brown
- From the University of British Columbia, Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - A Scheer
- From The Ottawa Hospital, Ottawa, Ont
| | - M Carrier
- From The Ottawa Hospital, Ottawa, Ont
| | - R Boushey
- From The Ottawa Hospital, Ottawa, Ont
| | - T Asmis
- From The Ottawa Hospital, Ottawa, Ont
| | - P Wells
- From The Ottawa Hospital, Ottawa, Ont
| | - D Jonker
- From The Ottawa Hospital, Ottawa, Ont
| | - R Auer
- From The Ottawa Hospital, Ottawa, Ont
| | - N Azer
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - R Gill
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - C de Gara
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Royal Alexandra Hospital, Edmonton, Alta
| | - G Roxin
- From the University of Calgary, Calgary, Alta
| | - S Drolet
- From the University of Calgary, Calgary, Alta
| | - A MacLean
- From the University of Calgary, Calgary, Alta
| | - W D Buie
- From the University of Calgary, Calgary, Alta
| | - J Heine
- From the University of Calgary, Calgary, Alta
| | - J Agzarian
- From McMaster University Hamilton, Ont., and the Harvard School of Public Health, Boston, Mass
| | - S Forbes
- From McMaster University Hamilton, Ont., and the Harvard School of Public Health, Boston, Mass
| | - W Stephen
- From McMaster University Hamilton, Ont., and the Harvard School of Public Health, Boston, Mass
| | - S Kelly
- From McMaster University Hamilton, Ont., and the Harvard School of Public Health, Boston, Mass
| | - P Churchill
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - T Corner
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - S Kelly
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - S Forbes
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - L Lindsay
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - W Stephen
- From McMaster University, Hamilton Health Sciences Hamilton, Ont
| | - A Scheer
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - A O'Connor
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - B Chan
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E Poulin
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R Auer
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R Boushey
- From The University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Denis
- From the Winnipeg Regional Health Authority, University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the Winnipeg Regional Health Authority, University of Manitoba, Winnipeg, Man
| | - M Recsky
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - M Raval
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - W Cheung
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - C Brown
- From the Department of Surgery, St. Paul's Hospital, University of British Columbia, and the BC Cancer Agency, Vancouver, BC
| | - N Alkhamesi
- From Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - C M Schlachta
- From Canadian Surgical Technologies and Advanced Robotics, London, Ont
| | - T Tiwari
- From the Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - C Brown
- From the Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, Vancouver, BC
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Shaw JA, Page K, Blighe K, Hava N, Guttery D, Ward B, Brown J, Ruangpratheep C, Payne R, Palmieri C, Cleator S, Walker R, Coombes C. A molecular portrait of circulating free DNA of patients with breast cancer: High-resolution analysis using SNP 6.0 arrays. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.555] [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: 11/20/2022] Open
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Watson J, Payne R, Chamberlain A, Jones R, Sellers WI. The kinematics of load carrying in humans and great apes: implications for the evolution of human bipedalism. ACTA ACUST UNITED AC 2009; 80:309-28. [PMID: 19923843 DOI: 10.1159/000258646] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 07/07/2009] [Indexed: 11/19/2022]
Abstract
We present a comparison of loaded and unloaded carrying kinematics in humans, common chimpanzees (Pan troglodytes), bonobos (Pan paniscus), western lowland gorillas (Gorilla gorilla gorilla) and Bornean and Sumatran orang-utans (Pongo pygmaeus and Pongo abelii). Human hindlimb joint and segment angles were collected during treadmill locomotion using infrared motion analysis cameras. Non-human primate fore- and hindlimb joint and segment angles were collected at zoos during free-ranging locomotion using a standard video camera. In quadrupedal locomotion there were small but potentially important changes associated with load carriage leading to a more upright trunk and a shift in shoulder excursion. These changes were exacerbated as locomotion shifts from quadrupedal to tripedal and bipedal gaits when carrying more awkward loads suggesting a possible adaptive sequence. However, food carrying may favour a highly flexed bent-hip bent-knee bipedal gait since it allows simultaneous foraging and hoarding. In bipedal humans no changes in limb kinematics were seen associated with type of load, although asymmetric loads may lead to lateral postural shifts. Carrying may therefore be an important component of the evolutionary shift to habitual bipedalism, although further work is needed to understand the full biomechanical implications.
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Affiliation(s)
- J Watson
- University of Manchester, Oxford Road, Manchester, UK
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Cann HM, Kidd KK, Lisker R, Radvany R, Payne R. Genetic structure of the HL-A system in a Nahua Indian population in Mexico. Tissue Antigens 2008; 3:364-72. [PMID: 4771177 DOI: 10.1111/j.1399-0039.1973.tb00505.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Pham DQ, Pham AQ, Ullah E, McFarlane SI, Payne R. Evaluating the appropriateness of thromboprophylaxis in an acute care setting using a computerised reminder, through order-entry system. Int J Clin Pract 2008; 62:134-7. [PMID: 17892471 DOI: 10.1111/j.1742-1241.2007.01578.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS Evidence suggests that thromboprophylaxis is still significantly underutilised across the United States despite its relationship with morbidity, mortality and resource expenditure. Previous randomised trials that have incorporated computerised reminders, through order-entry systems, have resulted in increased rates of thromboprophylaxis and lower incidences of clinically diagnosed deep-vein thrombosis or pulmonary embolism. The primary purpose of this prospective, observational study is to evaluate the use and appropriateness of preset computerized thromboprophylaxis regimens for patients in a major county metropolitan hospital over a 1-month period by evaluating the proportion of patients actually receiving recommended thromboprophylaxis according to established hospital guidelines. METHODS This prospective, observational study was conducted in a large county hospital that recently established an evidence-based routine computerised policy to decrease risk of venous thromboembolism. Physicians, residents, medical interns, medical students, pharmacy students, and nurses were the targets of the investigation. Data were randomly collected between 10 internal medicine teams from 10 October 2006 to 10 November 2006. Investigators completed one DVT/PE risk assessment form for each patient reviewed and compared this to actual prescribed therapy to determine appropriateness of therapy. RESULTS Pharmacological or non-pharmacological thromboprophylaxis was administered to 100% of patients evaluated. Eighty-six patients received recommended DVT/PE prophylaxis based on established hospital guidelines. DISCUSSION Reported values seem to indicate that computerized reminders are capable of providing venous thromboprophylaxis for medically ill (non-surgical) patients relative to published norms. CONCLUSION Results of this observational study reinforces the evidence that computerized, reminders, through order-entry systems might increase the delivery of thromboprophylaxis for hospitalized patients.
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Affiliation(s)
- D Q Pham
- Western University of Health Sciences, College of Pharmacy, Fountain Valley Regional Hospital and Medical Center, Orange County, Pomona, CA 91766-1854, USA.
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Frater AJ, Brown H, Oxenius A, Günthard HF, Hirschel B, Robinson N, Leslie AJ, Payne R, Crawford H, Prendergast A, Brander C, Kiepiela P, Walker BD, Goulder PJR, McLean A, Phillips RE. Effective T-cell responses select human immunodeficiency virus mutants and slow disease progression. J Virol 2007; 81:6742-51. [PMID: 17409157 PMCID: PMC1900110 DOI: 10.1128/jvi.00022-07] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The possession of some HLA class I molecules is associated with delayed progression to AIDS. The mechanism behind this beneficial effect is unclear. We tested the idea that cytotoxic T-cell responses restricted by advantageous HLA class I molecules impose stronger selection pressures than those restricted by other HLA class I alleles. As a measure of the selection pressure imposed by HLA class I alleles, we determined the extent of HLA class I-associated epitope variation in a cohort of European human immunodeficiency virus (HIV)-positive individuals (n=84). We validated our findings in a second, distinct cohort of African patients (n=516). We found that key HIV epitopes restricted by advantageous HLA molecules (B27, B57, and B51 in European patients and B5703, B5801, and B8101 in African patients) were more frequently mutated in individuals bearing the restricting HLA than in those who lacked the restricting HLA class I molecule. HLA alleles associated with clinical benefit restricted certain epitopes for which the consensus peptides were frequently recognized by the immune response despite the circulating virus's being highly polymorphic. We found a significant inverse correlation between the HLA-associated hazard of disease progression and the mean HLA-associated prevalence of mutations within epitopes (P=0.028; R2=0.34). We conclude that beneficial HLA class I alleles impose strong selection at key epitopes. This is revealed by the frequent association between effective T-cell responses and circulating viral escape mutants and the rarity of these variants in patients who lack these favorable HLA class I molecules, suggesting a significant pressure to revert.
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Affiliation(s)
- A J Frater
- Nuffield Department of Medicine, John Radcliffe Hospital and Peter Medawar Building for Pathogen Research, Oxford University, OX1 3SY, United Kingdom
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Watson J, Payne R, Chamberlain A, Jones R, Sellers W. The role of load carrying in the evolution of bipedal locomotion. Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Edge A, Shillingford S, Smith C, Payne R, Wilson I. Temperature as a variable in liquid chromatography: Development and application of a model for the separation of model drugs using water as the eluent. J Chromatogr A 2006; 1132:206-10. [DOI: 10.1016/j.chroma.2006.07.081] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 07/26/2006] [Accepted: 07/31/2006] [Indexed: 11/25/2022]
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Cleeland CS, Portenoy RK, Rue M, Mendoza TR, Weller E, Payne R, Kirshner J, Atkins JN, Johnson PA, Marcus A. Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group. Ann Oncol 2005; 16:972-80. [PMID: 15821119 DOI: 10.1093/annonc/mdi191] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer pain is highly prevalent and commonly undertreated. This study was designed to determine whether dissemination of a clinical protocol for pain management would improve outcomes in community oncology practices. PATIENTS AND METHODS A pain management protocol was developed based on accepted guidelines. After baseline assessment, oncology practices were randomly assigned to 'analgesic protocol' (AP) sites, where oncologists implemented the guidelines in a group of lung or prostate cancer patients, or to 'physician discretion' (PD) sites, where customary treatment was continued. Patients treated on protocol and a comparison group of patients with pain due to breast cancer or myeloma were monitored for change in pain using the Brief Pain Inventory, and for change in other symptoms or mood. RESULTS The protocol terminated early because of poor accrual. We compared groups using proportions of patients who had no or mild pain at follow-up. Although measures of protocol adherence did not suggest the occurrence of major practice change, the proportion of lung or prostate cancer patients with no or mild pain increased significantly from baseline for those treated at AP sites compared with those treated at PD sites. There was no significant difference between the breast and myeloma patients treated at AP sites versus those treated at PD sites. CONCLUSION A protocol for cancer pain management can improve pain control. Diffusion of these benefits to other patients was not confirmed. Given the small sample size, these findings require confirmation in a larger trial.
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Affiliation(s)
- C S Cleeland
- The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Madsen PT, Kerr I, Payne R. Source parameter estimates of echolocation clicks from wild pygmy killer whales (Feresa attenuata). J Acoust Soc Am 2004; 116:1909-1912. [PMID: 15532623 DOI: 10.1121/1.1788726] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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