1
|
Ebrahimi BS, Khwaounjoo P, Argus F, Chan HF, Nash MP, McGiffin D, Kaye D, Doi A, Joseph T, Whitford H, Tawhai MH. Predicting Patient Status in Chronic Thromboembolic Pulmonary Hypertension Using a Biophysical Model. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083065 DOI: 10.1109/embc40787.2023.10340433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) involves abnormally high blood pressure in the pulmonary vessels and is associated with small vessel vasculopathy and pre-capillary proximal occlusions. Management of CTEPH disease is challenging, therefore accurate diagnosis is crucial in ensuring effective treatment and improved patient outcomes. The treatment of choice for CTEPH is pulmonary endarterectomy, which is an invasive surgical intervention to remove thrombi. Following PEA, a number of patients experience poor outcomes or worse-than-expected improvements, which may indicate that they have significant small vessel disease. A method that can predict the extent of distal remodelling may provide useful clinical information to plan appropriate CTEPH patient treatment. Here, a novel biophysical modelling approach has been developed to estimate and quantify the extent of distal remodelling. This method includes a combination of mathematical modelling and computed tomography pulmonary angiography to first model the geometry of the pulmonary arteries and to identify the under-perfused regions in CTEPH. The geometric model is then used alongside haemodynamic measurements from right heart catheterisation to predict distal remodelling. In this study, the method is tested and validated using synthetically generated remodelling data. Then, a preliminary application of this technique to patient data is shown to demonstrate the potential of the approach for use in the clinical setting.Clinical relevance- Patient-specific modelling can help provide useful information regarding the extent of distal vasculopathy on a per-patient basis, which remains challenging. Physicians can be unsure of outcomes following pulmonary endarterectomy. Therefore, the predictive aspect of the patient's response to surgery can help with clinical decision-making.
Collapse
|
2
|
Findakly S, Zia A, Kavnoudias H, Mathew J, Varma D, Di Muzio B, Lee R, Moriarty HK, Joseph T, Clements W. The use of whole-body trauma CT should be based on mechanism of injury: A risk analysis of 3920 patients at a tertiary trauma centre. Injury 2023:110828. [PMID: 37225543 DOI: 10.1016/j.injury.2023.05.059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Mechanism of injury (MOI) plays a significant role in a decision to perform whole-body computed tomography (CT) imaging for trauma patients. Various mechanisms have unique patterns of injury and therefore form an important variable in decision making. METHODS Retrospective cohort study including all patients >18 years old who received a whole-body CT scan between 1 January 2019 and 19 February 2020. The outcomes were divided into CT 'positive' if any internal injuries were detected and CT 'negative' if no internal injuries were detected. The MOI, vital sign parameters, and other relevant clinical examination findings at presentation were recorded. RESULTS 3920 patients met the inclusion criteria, of which 1591 (40.6%) had a positive CT. The most common MOI was fall from standing height (FFSH), accounting for 23.0%, followed by motor vehicle accident (MVA), accounting for 22.4%. Covariates significantly associated with a positive CT included age, MVA >60 km/h, motor bike, bicycle, or pedestrian accident >30 km/h, prolonged extrication >30 min, fall from height above standing, penetrating chest or abdominal injury, as well as hypotension, neurological deficit, or hypoxia on arrival. FFSH was shown to reduce the risk of a positive CT overall, however, sub-analysis of FFSH in patients >65 years showed a significant association with a positive CT (OR 2.34, p < 0.001) compared to <65 years. CONCLUSIONS Pre-arrival information including MOI and vital signs have significant impact on identifying subsequent injuries with CT imaging. In high energy trauma, we should consider the need for whole-body CT based on MOI alone regardless of the clinical examination findings. However, for low-energy trauma, including FFSH, in the absence of clinical examination findings which support an internal injury, a screening whole-body CT is unlikely to yield a positive result, particularly in the age group <65yo.
Collapse
Affiliation(s)
- Salam Findakly
- Department of Radiology, Alfred Health, Melbourne, Australia. https://twitter.com/https//twitter.comSalamfindalky
| | - Adil Zia
- Department of Radiology, Alfred Health, Melbourne, Australia. https://twitter.com/https//twitter.comAdilFZia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia; Department of Trauma, Alfred Health, Melbourne, Australia. https://twitter.com/https//twitter.comtrauma_jm
| | - Dinesh Varma
- Department of Radiology, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Australia; National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia
| | - Bruno Di Muzio
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Robin Lee
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Heather K Moriarty
- Department of Radiology, Cork University Hospital, Cork, Ireland. https://twitter.com/https//twitter.comHeatherKateIR
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Australia; National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.
| |
Collapse
|
3
|
Clements W, Marshall E, Lukies M, Joseph T, Tran H, Ban EJ, Koukounaras J. A retrospective cohort study assessing the incidence of inferior vena cava (IVC) occlusion following prophylactic IVC filter insertion: Is anticoagulation necessary during filter dwell? Injury 2022; 53:2763-2767. [PMID: 35773022 DOI: 10.1016/j.injury.2022.06.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inferior vena cava (IVC) filters play a role in preventing venous thromboembolism after major trauma where deep venous thrombosis (DVT) risk is up to 80%. It has been suggested that IVC filters are thrombogenic and many patients are therefore placed on therapeutic anticoagulation during IVC filter dwell citing concern of in situ IVC thrombosis, even in the absence of existing DVT. METHODS Between 1 June 2018 and 31 December 2021, this retrospective study assessed the incidence of IVC thrombosis following prophylactic IVC filter insertion. Groups were defined according to the presence or absence of therapeutic anticoagulation during filter dwell. The primary outcome was the presence or absence of IVC thrombus at retrieval. RESULTS A total of 124 patients were included. Anticoagulation was prescribed in 29 and anticoagulation was not prescribed in 63. A further 32 patients developed a new thrombosis episode after the prophylactic IVC filter was placed, and 29 were prescribed anticoagulation part-way during filter dwell as a result of this diagnosis. No cases of IVC occlusion were observed in any patient group. CONCLUSIONS Caval thrombosis was not observed after prophylactic filter placement, with or without the prescription of anticoagulation. While prospective trials are needed to increase the level of evidence, based on these results the use of therapeutic anticoagulation during IVC filter dwell should not be dictated by the presence of an IVC filter alone but rather by the presence of a related thrombosis event.
Collapse
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Australia; National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.
| | - Elissa Marshall
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Matthew Lukies
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Huyen Tran
- Australian Centre for Blood Diseases, Clinical Haematology Department, Monash University, Melbourne, Australia
| | - Ee Jun Ban
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia; Department of Trauma, Alfred Health, Melbourne, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Australia
| |
Collapse
|
4
|
Clements W, Venn G, McGiffin D, Moriarty HK, Joseph T, Goh GS, Whitford H, Keating D. Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and massive hemoptysis: The rationale for bronchial artery embolization. Respir Med 2022; 195:106784. [DOI: 10.1016/j.rmed.2022.106784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/16/2022] [Accepted: 02/20/2022] [Indexed: 11/26/2022]
|
5
|
Doi A, Gajera J, Niewodowski D, Gangahanumaiah S, Whitford H, Snell G, Kaye D, Joseph T, McGiffin D. Surgical management of giant pulmonary artery aneurysms in patients with severe pulmonary arterial hypertension. J Card Surg 2022; 37:1019-1025. [PMID: 35040512 DOI: 10.1111/jocs.16235] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM Giant aneurysm of the pulmonary artery (PAA) is an extremely rare condition that may develop in patients with pulmonary arterial hypertension (PAH) which may be complicated by rupture, dissection or intravascular thrombus formation. The aim of this study was to examine available literature with regard to surgical strategies in patients undergoing transplantation for PAH with PAA. RESULTS These patients were traditionally considered for heart-lung transplantation but more recently, there have been reports of successful lung transplantation with reconstruction of the pulmonary artery. CONCLUSIONS Unless there is a mandatory indication for heart-lung transplantation, patients with PAH and PAA can undergo lung transplantation and reconstruction of the pulmonary artery without compromising the outcome.
Collapse
Affiliation(s)
- Atsuo Doi
- Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| | - Jay Gajera
- Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| | | | | | - Helen Whitford
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Greg Snell
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - David Kaye
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| |
Collapse
|
6
|
Slater SJ, Lukies M, Kavnoudias H, Zia A, Lee R, Bosco JJ, Joseph T, Clements W. Immune function and the role of vaccination after splenic artery embolization for blunt splenic injury. Injury 2022; 53:112-115. [PMID: 34565618 DOI: 10.1016/j.injury.2021.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 02/02/2023]
Abstract
The spleen is the most commonly injured solid organ following blunt abdominal trauma. Over recent decades, splenic artery embolization (SAE) has become the mainstay treatment for haemodynamically stable patients with high-grade blunt splenic trauma, with splenectomy the mainstay of treatment for unstable patients. Splenic function is complex but the spleen has an important role in immune function, particularly in protection against encapsulated bacteria. Established evidence suggests that following splenectomy immune function is impaired resulting in increased susceptibility to overwhelming post-splenectomy infection, however, immune function may be preserved following SAE. This review will discuss the current state of the literature on immune function following different treatments of blunt splenic injury, and the controversies surrounding what constitutes a quantitative test of splenic immune function.
Collapse
Affiliation(s)
- Samuel J Slater
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Matthew Lukies
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University Central Clinical School, Australia
| | - Adil Zia
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Robin Lee
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Julian J Bosco
- Department of Respiratory medicine, Allergy, asthma and Clinical Immunology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University Central Clinical School, Australia; National Trauma Research Institute, Monash University Central Clinical School, Melbourne, Australia.
| |
Collapse
|
7
|
Joseph T, Ghorbani-Asl M, Batzill M, Krasheninnikov AV. Water dissociation and association on mirror twin boundaries in two-dimensional MoSe 2: insights from density functional theory calculations. Nanoscale Adv 2021; 3:6992-7001. [PMID: 36132369 PMCID: PMC9419107 DOI: 10.1039/d1na00429h] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/21/2021] [Indexed: 06/07/2023]
Abstract
The adsorption and dissociation of water molecules on two-dimensional transition metal dichalcogenides (TMDs) is expected to be dominated by point defects, such as vacancies, and edges. At the same time, the role of grain boundaries, and particularly, mirror twinboundaries (MTBs), whose concentration in TMDs can be quite high, is not fully understood. Using density functional theory calculations, we investigate the interaction of water, hydroxyl groups, as well as oxygen and hydrogen molecules with MoSe2 monolayers when MTBs of various types are present. We show that the adsorption of all species on MTBs is energetically favorable as compared to that on the basal plane of pristine MoSe2, but the interaction with Se vacancies is stronger. We further assess the energetics of various surface chemical reactions involving oxygen and hydrogen atoms. Our results indicate that water dissociation on the basal plane should be dominated by vacancies even when MTBs are present, but they facilitate water clustering through hydroxyl groups at MTBs, which can anchor water molecules and give rise to the decoration of MTBs with water clusters. Also, the presence of MTBs affects oxygen reduction reaction (ORR) on the MoSe2 monolayer. Unlike Se vacancies which inhibit ORR due to a high overpotential, it is found that the ORR process on MTBs is more efficient, indicating their important role in the catalytic activity of MoSe2 monolayer and likely other TMDs.
Collapse
Affiliation(s)
- T Joseph
- Institute of Ion Beam Physics and Materials Research Helmholtz-Zentrum Dresden-Rossendorf 01328 Dresden Germany
| | - M Ghorbani-Asl
- Department of Physics, University of South Florida Tampa FL 33620 USA
| | - M Batzill
- Department of Applied Physics, Aalto University P.O. Box 11100 00076 Aalto Finland
| | - Arkady V Krasheninnikov
- Institute of Ion Beam Physics and Materials Research Helmholtz-Zentrum Dresden-Rossendorf 01328 Dresden Germany
| |
Collapse
|
8
|
Erskine B, Bradley P, Joseph T, Yeh S, Clements W. Comparing the accuracy and complications of peripherally inserted central catheter (PICC) placement using fluoroscopic and the blind pushing technique. J Med Radiat Sci 2021; 68:349-355. [PMID: 34343419 PMCID: PMC8655624 DOI: 10.1002/jmrs.533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Peripherally inserted central catheters (PICCs) offer a convenient long-term intravenous access option. Different methods exist for insertion including the use of continuous fluoroscopy for guidance, or bedside insertion techniques. The blind pushing technique is a bedside approach which involves advancing a PICC through the access sheath without imaging guidance, before taking a mobile chest radiograph to confirm tip position. Obtaining optimal position is a critical aim of PICC placement as malpositioned lines have been associated with higher complications including death. We aimed to assess the accuracy of PICC placement by comparing the tip position and complications for lines placed under fluoroscopic guidance to those placed without fluoroscopic guidance. METHODS The Radiology Information System was used to identify 100 continuous PICC insertions in each group (fluoroscopic and blind pushing) between 1 January and 12 May 2019. Patients were excluded if there was a known history of central venous occlusion/stenosis. RESULTS In the fluoroscopic-guided group, 0% of the lines were malpositioned compared with 60% of the lines placed using the blind pushing technique, P < 0.001. Fluoroscopic-guided PICC insertions were in place for a total of 2446 days and demonstrated 6 complications (2.45 complications per 1000 catheter days). This compared with blind pushing technique PICC insertions which were in place for a total of 1521 days and demonstrated 18 complications (11.83 complications per 1000 catheter days), P = 0.004. CONCLUSION The use of fluoroscopy for PICC placement leads to significant improvements in tip accuracy than for PICCs placed using the blind pushing technique. While the use of these imaging resources incurs cost and time, these factors should be balanced in order to offer patients the safest and most accurate method of line insertion.
Collapse
Affiliation(s)
- Brendan Erskine
- Department of RadiologyAlfred HospitalMelbourneVictoriaAustralia
| | - Pierre Bradley
- Department of Anaesthesia and Perioperative MedicineAlfred HospitalMelbourneVictoriaAustralia
- Department of Anaesthesia Teaching and ResearchMonash University Central Clinical SchoolMelbourneVictoriaAustralia
| | - Tim Joseph
- Department of RadiologyAlfred HospitalMelbourneVictoriaAustralia
| | - Sabrina Yeh
- Department of RadiologyAlfred HospitalMelbourneVictoriaAustralia
| | - Warren Clements
- Department of RadiologyAlfred HospitalMelbourneVictoriaAustralia
- Department of SurgeryMonash University Central Clinical SchoolMelbourneVictoriaAustralia
- National Trauma Research InstituteAlfred HospitalMelbourneVictoriaAustralia
| |
Collapse
|
9
|
Schlegel RN, Clements W, Koukounaras J, Goh GS, Joseph T, Phan T, Moriarty HK. A 10-year retrospective review of management and outcomes of pseudoaneurysms at a tertiary referral centre. J Med Imaging Radiat Oncol 2021; 66:603-608. [PMID: 34490983 DOI: 10.1111/1754-9485.13325] [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: 06/15/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pseudoaneurysms are uncommon but potentially life-threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound-guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on management. This study aimed to provide evidence for guiding clinical decisions regarding visceral artery pseudoaneurysm and peripheral artery pseudoaneurysm management. METHODS Retrospective single-centre review of patients diagnosed with visceral and peripheral artery pseudoaneurysms at a tertiary hospital (2010-2020). RESULTS There were 285 patients included in this study. A total of 86 patients were diagnosed with a visceral artery pseudoaneurysm, and 49 of these (57%) were caused by trauma. A total of 199 patients were identified with a peripheral pseudoaneurysm; 76 of these (38%) were caused by trauma and 69 (35%) were due to access site complication during an endovascular procedure. Initial technical success was achieved in 266 patients (93.3%) with 19 requiring an additional treatment to achieve success. Conservative treatment (100% success), endovascular treatment (98.1%) and surgery (100%) were more successful than ultrasound-guided compression (63.6%) and thrombin injection (83.8%). The median time from diagnosis to intervention was <9 h for visceral artery pseudoaneurysms and 24 h for peripheral artery pseudoaneurysms. There was no change in survival outcomes with respect to time from diagnosis and intervention. CONCLUSION In this study, pseudoaneurysms were treated with a high degree of success by observation or by using an endovascular approach, and those requiring endovascular intervention did not need to be treated immediately in an emergent setting.
Collapse
Affiliation(s)
- Richard N Schlegel
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerard S Goh
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Heather K Moriarty
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Clements W, McMahon GA, Joseph T, Goh GS, Kuang RJ, Smit DV, Varma D. Risk stratification of emergency department patients with acute pulmonary thromboembolism: Is chest pain a reason to investigate? J Med Imaging Radiat Oncol 2021; 65:864-868. [PMID: 34132053 DOI: 10.1111/1754-9485.13262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to risk-stratify chest pain as a presenting symptom in patients with a diagnosis of pulmonary thromboembolism (PE) to assess for any association. In addition, this study aimed to assess traditionally acknowledged PE risk factors in an Australian population. METHODS This was a retrospective single-centre cohort study assessing patients who presented to our emergency department during the period of 1 January 2019 to 1 January 2020. 730 consecutive patients who went on to computed tomography pulmonary angiography (CTPA) examination after presentation were included. RESULTS The rate of CTPA being positive in this study was 11.6% (85/730). Chest pain was associated with a non-significant reduction in the odds of PE (OR 0.774, P = 0.327). Univariate analysis showed significantly increased odds of a diagnosis of PE with presentation for leg pain/swelling (OR 6.670, P < 0.001). Multivariate analysis showed increasing age (OR 1.018, 95% CI 1.002-1.034, P = 0.024), clinical signs of a DVT (OR 3.194, 95% CI 1.803-5.657, P < 0.001) and positive D-dimer (OR 1.762, 95% CI 1.011-3.071, P = 0.046) were associated with increased odds of PE. CONCLUSION In this study, Emergency Department presentation with chest pain, whilst the most common reason to perform a CTPA, resulted in reduced odds with regard to the diagnosis of pulmonary thromboembolism. The use of CTPA in this setting may be rationalised according to other factors such as localised leg pain as a symptom, signs of DVT, increasing age or positive D-dimer.
Collapse
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - George Al McMahon
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerard S Goh
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ronny Jd Kuang
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - De Villiers Smit
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Dinesh Varma
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Clements W, Joseph T, Koukounaras J. UK NICE Guidelines for EVAR: Cost Implications for Post-COVID Australian Public Health. Cardiovasc Intervent Radiol 2021; 44:1286-1288. [PMID: 33884459 DOI: 10.1007/s00270-021-02832-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Surgery, Monash University Central Clinical School, Melbourne, 3004, Australia. .,National Trauma Research Institute, Melbourne, 3004, Australia.
| | - Tim Joseph
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Surgery, Monash University Central Clinical School, Melbourne, 3004, Australia
| |
Collapse
|
12
|
Clements W, Kuang R, Majeed A, Joseph T. Percutaneous Transjejunal Retrograde Cholangiogram as Alternative Biliary Access in Patients with Previous Roux-en-Y Surgery. Journal of Gastrointestinal and Abdominal Radiology 2021. [DOI: 10.1055/s-0041-1722812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, VIC, Australia
- National Trauma Research Institute, Monash University, Melbourne, VIC, Australia
| | - Ronny Kuang
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia
- Department of Gastroenterology, Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| |
Collapse
|
13
|
Clements W, Shvarts Y, Koukounaras J, Phan TD, Goh GS, Joseph T, Kuang R, Murnane L. Radiologically Inserted Gastrostomy (RIG) at a Tertiary Center: Periprocedural Safety including Rationalization of Antibiotic Prophylaxis. Journal of Clinical Interventional Radiology ISVIR 2021. [DOI: 10.1055/s-0041-1723098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Introduction Long-term percutaneous enteral nutrition forms an important part of treatment for patients with an inability to meet nutrient requirements orally. Radiologically inserted gastrostomy (RIG) is an alternative to the traditionally performed percutaneous endoscopic gastrostomy technique. However, there is marked heterogeneity in the way that RIG is performed. In addition, the role for antibiotic prophylaxis during RIG insertion is not clearly established. This study aimed to assess the safety of RIG insertion using our technique including the role of antibiotics in RIG insertion.
Method Retrospective study over 5 years at a tertiary teaching hospital. Periprocedural or early complications within the first 2 weeks of the procedure were collected and correlated with the use of prophylactic antibiotics.
Results A total of 116 patients met the inclusion criteria. 18-French tube was used in 96.6%. Note that 58.6% of procedures were done with intravenous sedation. Prophylactic 1 g cefazolin was used in 70 patients with 1 case of infection. Procedures were performed without antibiotics in 46 patients with 3 infections, p = 0.20.There were two major complications (1.7%) consisting of right gastric artery injury requiring embolization and gastric wall injury requiring laparotomy. There were 12 minor complications (10.3%) including 4 cases of infection, 3 of severe pain, 1 of minor bleeding, 2 of early dislodgement, and 2 of leak/bypass of gastric contents around the tube.
Conclusion The technique used for RIG insertion at our institution results in a low complication rate. In addition, this study shows no significant difference in early peristomal infection rate with the use of antibiotic prophylaxis.
Collapse
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Yasmin Shvarts
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Tuan D. Phan
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerard S. Goh
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ronny Kuang
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Lisa Murnane
- Department of Nutrition and Dietetics, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Clements W, Joseph T, Koukounaras J, Goh GS, Moriarty HK, Mathew J, Phan TD. SPLEnic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study. CVIR Endovasc 2020; 3:92. [PMID: 33283253 PMCID: PMC7719586 DOI: 10.1186/s42155-020-00185-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As an adjunct to non-operative management, splenic artery embolization (SAE) has been increasingly utilized throughout the world and is now the standard of care for hemodynamically stable patients. This study aimed to retrospectively assess the rate of splenic salvage and complications after SAE for blunt trauma at a level 1 trauma center using the 2018 update to the AAST criteria, and further sub-stratify the role of angiography in AAST grade III injuries with significant hemoperitoneum. All patients between 1 January 2009 and 1 January 2019 who underwent blunt trauma and proceeded to embolization were included. Data was collected concerning initial injury grade, location of embolization, type of embolic material used, complications, and need for subsequent splenectomy. Technical success was defined as successful angiographic occlusion of the target artery at the conclusion of embolization. Clinical success was defined as splenic salvage at discharge. Vascular lesions were characterized including those with active bleeding, pseudoaneurysm, and arterio-venous fistula. RESULTS Two hundred thirty-two patients were included in the study. Treatments were performed at a median of 0 days (range 0-28 days) and the median AAST grade was IV (range III-V). Technical success was achieved in all patients. There were 13 complications (5.6%) consisting of re-bleed (9, 3.9%), infarction (3, 1.3%), and access site haematoma (1, 0.43%). Clinical success was achieved in 97% of patients with 7 patients requiring splenectomy after SAE (3.0%) at a median time of 4 days (range 0-17 days). Angiography in patients with grade III injuries identified 18 occult vascular injuries not identified at initial CT (p < 0.0001). CONCLUSIONS The SPLEEN-IN study shows that treatment of intermediate-high grade blunt force traumatic splenic injuries using SAE resulted in a low rate of complication and splenic salvage in 97% of patients, providing a safe and effective treatment in stable patients. In addition, angiography of grade III injuries identified occult vascular lesions and may warrant treatment of select patients in this cohort. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Surgery, Monash University, Melbourne, Australia. .,National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.
| | - Tim Joseph
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Gerard S Goh
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Surgery, Monash University, Melbourne, Australia.,National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia
| | - Heather K Moriarty
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.,Department of Trauma, Alfred Health, Melbourne, Victoria, Australia
| | - Tuan D Phan
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| |
Collapse
|
15
|
Lukies M, Kavnoudias H, Zia A, Lee R, Bosco JJ, Joseph T, Clements W. Long-Term Immune Function Following Splenic Artery Embolisation for Blunt Abdominal Trauma. Cardiovasc Intervent Radiol 2020; 44:167-169. [PMID: 32875434 DOI: 10.1007/s00270-020-02627-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew Lukies
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Adil Zia
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Robin Lee
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Julian J Bosco
- Department of Respiratory Medicine-Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Surgery, Monash University, Melbourne, VIC, Australia. .,National Trauma Research Institute, Monash University Central Clinical School, Melbourne, VIC, Australia.
| |
Collapse
|
16
|
Moriarty HK, Clements W, Koukounaras J, S Goh G, Joseph T, Phan T. ArtVentive endoluminal occlusion system for proximal splenic artery embolization. Diagn Interv Radiol 2020; 26:488-491. [PMID: 32673205 DOI: 10.5152/dir.2020.19417] [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: 11/22/2022]
Abstract
We aimed to discuss and evaluate the technical success and efficacy of the ArtVentive endoluminal occlusion system (EOS) device for splenic embolization. A retrospective review was undertaken for all patients in whom the EOS device was deployed for the purpose of splenic embolization. Data was collected by a search of splenic artery embolization procedures in the hospital computer database. Data was reviewed for all patients in whom an EOS plug was deployed. Patient demographics, technical aspects of the procedure and follow-up at one month were reviewed. We review the technical success and efficacy of this occlusion device. Six patients underwent splenic embolization with the EOS plug. There were 5 male and 1 female patients; age range was 24-88 years. Five 8 mm and one 5 mm EOS plugs were deployed for the occlusion of the splenic artery. The technical success rate was 100% occurring in all 6 splenic arteries. One patient underwent a second angiogram and subsequent splenectomy for persistent splenic hemorrhage. One patient had a subsequent splenectomy for bacteremia with the spleen as the suspected source. This early data supports the efficacy of the EOS plug for the embolization of the proximal splenic artery.
Collapse
Affiliation(s)
| | - Warren Clements
- Department of Radiology, Alfred hospital, Melbourne, Australia;Department of Surgery, Monash University, Clayton, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred hospital, Melbourne, Australia;Department of Surgery, Monash University, Clayton, Australia
| | - Gerard S Goh
- Department of Radiology, Alfred hospital, Melbourne, Australia;Department of Surgery, Monash University, Clayton, Australia
| | - Tim Joseph
- Department of Radiology, Alfred hospital, Melbourne, Australia
| | - Tuan Phan
- Department of Radiology, Alfred hospital, Melbourne, Australia
| |
Collapse
|
17
|
Harisis GN, Lee JTL, Clements W, Joseph T, Goh GS. Accuracy of dual‐bolus CT in the diagnosis of active arterial bleeding in adult pelvic trauma. J Med Imaging Radiat Oncol 2020; 64:326-330. [DOI: 10.1111/1754-9485.13030] [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] [Received: 08/19/2019] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- George N Harisis
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
| | - Jonathan TL Lee
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
| | - Warren Clements
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
- Monash University Clayton Victoria Australia
| | - Tim Joseph
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
| | - Gerard S Goh
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
- Monash University Clayton Victoria Australia
| |
Collapse
|
18
|
Clements W, Goh GS, Lukies MW, Joseph T, Jhamb A, O’Brien A, Koukounaras J. What is a modern Interventional Radiologist in Australia and New Zealand? J Med Imaging Radiat Oncol 2020; 64:361-365. [DOI: 10.1111/1754-9485.13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Warren Clements
- Department of Radiology Alfred Health Melbourne Victoria Australia
- Department of Surgery Monash University Melbourne Victoria Australia
| | - Gerard S Goh
- Department of Radiology Alfred Health Melbourne Victoria Australia
- Department of Surgery Monash University Melbourne Victoria Australia
| | - Matthew W Lukies
- Department of Radiology Alfred Health Melbourne Victoria Australia
| | - Tim Joseph
- Department of Radiology Alfred Health Melbourne Victoria Australia
| | - Ashu Jhamb
- Department of Radiology St Vincent's Hospital Melbourne Victoria Australia
| | - Andrew O’Brien
- Department of Radiology Alfred Health Melbourne Victoria Australia
| | - Jim Koukounaras
- Department of Radiology Alfred Health Melbourne Victoria Australia
- Department of Surgery Monash University Melbourne Victoria Australia
| |
Collapse
|
19
|
Menzies R, Heron L, Lampard J, McMillan M, Joseph T, Chan J, Storken A, Marshall H. A randomised controlled trial of SMS messaging and calendar reminders to improve vaccination timeliness in infants. Vaccine 2020; 38:3137-3142. [PMID: 32147296 DOI: 10.1016/j.vaccine.2020.02.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effectiveness of SMS reminders in improving vaccination coverage has been assessed previously, with effectiveness varying between settings. However, there are very few studies on their effect on the timeliness of vaccination. DESIGN Unblinded, randomised controlled trial with blocked sampling. METHODS 1594 Australian infants and young children were recruited to assess the impact of (1) SMS reminders only, (2) a personalised calendar, (3) SMS reminder and personalised calendar and (4) no intervention, on receipt of vaccine within 30 days of the due date. Outcomes were measured for receipt of vaccines due at 2, 4, 6, 12 and 18 months of age. A post-hoc assessment was also conducted of the impact of a new national "No jab No Pay" policy introduced during the trial, which removed philosophical objections as an exemption for financial penalties for non-vaccination. RESULTS There was a statistically significant improvement in on-time vaccination only at the 12 month schedule point amongst infants who received SMS reminders alone (RR 1.09, 95% CI 1.01-1.18) or in combination with a personalised calendar (1.11, CI 1.03-1.20) compared to controls. This impact was limited to participants who had received one or more previous doses late. No statistically significant impacts of calendar interventions alone were seen. There was a high rate of on-time compliance amongst control participants - 95%, 86%, 80%, 74% at the 4, 6, 12 and 18 month schedule points respectively, which increased more than 10 percentage points after implementation of the "No Jab, No Pay" policy. CONCLUSIONS SMS reminders are more effective in improving timeliness where pre-existing compliance is lower, but the 18 month schedule point appeared to be less amenable to intervention. Australia and New Zealand Clinical Trial Registration No. ACTRN12614000970640.
Collapse
Affiliation(s)
- R Menzies
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
| | - L Heron
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - J Lampard
- Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - M McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - T Joseph
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - J Chan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - A Storken
- Department of Health, South Australia, Adelaide, SA, Australia
| | - H Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
20
|
Clements W, Moriarty HK, Koukounaras J, Joseph T, Phan T, Goh GS. The cost to perform uterine fibroid embolisation in the Australian public hospital system. J Med Imaging Radiat Oncol 2019; 64:18-22. [PMID: 31793208 DOI: 10.1111/1754-9485.12982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/13/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Uterine fibroids have the potential to cause morbidity, and there is a substantial cost to both the healthcare system and society. There is support for minimally invasive intervention, and uterine fibroid embolisation (UFE) is an established cost-effective option for women wishing for an alternative to surgery. There is a lack of local Australian costing data to compliment use in the public hospital system, and we offer a costing analysis of running a public hospital service. METHODS We reviewed the costs for 10 sequential uterine fibroid embolisation cases, by assessing the direct and indirect hospital costs. RESULTS The total cost of providing a uterine fibroid embolisation service using our model in a public hospital including initial outpatient assessment, procedure costs, overnight hospital ward stay and outpatient follow-up is $3995 per admission. CONCLUSION Using our model, the overall cost to perform this procedure is low, and lower than prior estimates for surgical alternatives. We encourage government and regulatory bodies to support UFE through guidelines and remuneration models, and encourage more public Australian interventional radiology departments to offer this service.
Collapse
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Clayton, Victoria, Australia
| | | | - Jim Koukounaras
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Gerard S Goh
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
21
|
Moriarty HK, Charalabidis P, Musicki K, Phan T, Joseph T, Clements W. Hybrid Management of an Ulnar Artery Pseudoaneurysm Postphlebotomy. J Clin Interv Radiol ISVIR 2019. [DOI: 10.1055/s-0039-3401306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractThe purpose of this case report is to describe the occurrence and management of an ulnar artery pseudoaneurysm post phlebotomy. A 36-year-old worker with progressively painful nondominant forearm swelling was referred at 4 weeks postphlebotomy. Serial imaging showed an expanding proximal ulnar pseudoaneurysm. This was managed with a covered stent in the ulnar artery and coiling of the interosseous artery. The hematoma was evacuated, and the neurovascular bundle was protected with muscle coverage. At follow-up, the stent was patent, and there was no distal ischemia. Pseudoaneurysms post phlebotomy are rare. We demonstrate successful treatment of an ulnar artery pseudoaneurysm with stent graft and coiling of the interosseous branch.
Collapse
Affiliation(s)
| | - Peter Charalabidis
- Department of Vascular Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Korana Musicki
- Department of Vascular Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
22
|
Joseph T, Ghorbani-Asl M, Kvashnin AG, Larionov KV, Popov ZI, Sorokin PB, Krasheninnikov AV. Nonstoichiometric Phases of Two-Dimensional Transition-Metal Dichalcogenides: From Chalcogen Vacancies to Pure Metal Membranes. J Phys Chem Lett 2019; 10:6492-6498. [PMID: 31589053 DOI: 10.1021/acs.jpclett.9b02529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Two-dimensional (2D) membranes consisting of a single layer of Mo atoms were recently manufactured [ Adv. Mater. 2018 , 30 , 1707281 ] from MoSe2 sheets by sputtering Se atoms using an electron beam in a transmission electron microscope. This is an unexpected result as formation of Mo clusters should energetically be more favorable. To get microscopic insights into the energetics of realistic Mo membranes and nonstoichiometric phases of transition-metal dichalcogenides (TMDs) MaXb, where M = Mo and W and X = S, Se, and Te, we carry out first-principles calculations and demonstrate that the membranes, which can be referred to as metallic quantum dots embedded into a semiconducting matrix, can be stabilized by charge transfer. We also show that an ideal neutral 2D Mo or W sheet is not flat but a corrugated structure, with a square lattice being the lowest-energy configuration. We further demonstrate that several intermediate nonstoichiometric phases of TMDs are possible as they have lower formation energies than pure metal membranes. Among them, the orthorhombic metallic 2D M4X4 phase is particularly stable. Finally, we study the properties of this phase in detail and discuss how it can be manufactured by the top-down approaches.
Collapse
Affiliation(s)
- T Joseph
- Institute of Ion Beam Physics and Materials Research , Helmholtz-Zentrum Dresden-Rossendorf , 01328 Dresden , Germany
| | - M Ghorbani-Asl
- Institute of Ion Beam Physics and Materials Research , Helmholtz-Zentrum Dresden-Rossendorf , 01328 Dresden , Germany
| | - A G Kvashnin
- Skolkovo Institute of Science and Technology , Skolkovo Innovation Center , 3 Nobel Street , Moscow 121205 , Russia
| | - K V Larionov
- National University of Science and Technology "MISIS" , Leninsky prospect 4 , Moscow 119049 , Russia
- Moscow Institute of Physics and Technology , Institutsky lane 9 , Dolgoprudny , Moscow region , 141700 , Russian Federation
| | - Z I Popov
- National University of Science and Technology "MISIS" , Leninsky prospect 4 , Moscow 119049 , Russia
- Emanuel Institute of Biochemical Physics RAS , Moscow 119334 , Russia
| | - P B Sorokin
- National University of Science and Technology "MISIS" , Leninsky prospect 4 , Moscow 119049 , Russia
- Moscow Institute of Physics and Technology , Institutsky lane 9 , Dolgoprudny , Moscow region , 141700 , Russian Federation
- Emanuel Institute of Biochemical Physics RAS , Moscow 119334 , Russia
| | - Arkady V Krasheninnikov
- Institute of Ion Beam Physics and Materials Research , Helmholtz-Zentrum Dresden-Rossendorf , 01328 Dresden , Germany
- Department of Applied Physics , Aalto University , P.O. Box 11100, 00076 Aalto , Finland
| |
Collapse
|
23
|
Danchin N, Puymirat E, Ducrocq G, Henry P, Collet JP, Genee O, Joseph T, Belle L, Naccache N, Ferrieres J, Schiele F, Simon T. P4569Differential prognostic impact of blood glucose levels at the acute stage of myocardial infarction according to HbA1c. The FAST-MI programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0959] [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
Hyperglycemia is a well-known prognostic marker in patients with acute myocardial infarction (AMI), associated with higher mortality compared with normoglycemia. Whether the prognostic impact of glycemic status at the acute stage of AMI is similar in patients with chronic dysglycemia has not been extensively explored.
Aims and methods
Using data from the nationwide French FAST-MI cohorts (2005, 2010 and 2015), we analysed the association between glycemia at entry and 30-day death, according to HbA1c level. From the 13,130 patients included, 5,452 had both glycemia and HbA1c assessed at entry. Of those, 1173 (21.5%) had an HbA1c ≥7%.
Results
In patients with HbA1c <7%, LVEF was inversely correlated with glycemic levels (55±11% for glycemia <100, 52±11% for glycemia 100–140, 50±12% for glycemia 140–160 and 49±12% for glycemia >180 mg/dl); a graded association between admission glycemia and 30-day mortality was observed, ranging from 0.7% in normoglycemic patients to 6.3% in patients with admission glycemia >180 mg/dl. In contrast, in patients with HbA1c ≥7%, LVEF was not correlated with glycemia (<100 mg/dl: 49±14%, >180 mg/dl 49±12%), and mortality was the highest in patients with normoglycemia (9.2%) and the lowest in patients with glycemia between 140 and 180 mg/dl (3.1%) (Figure). In multivariate analyses adjusting for baseline characteristics and early management, normoglycemia was associated with a decreased risk of 30-day mortality in patients with HbA1c <7% (HR 0.27, 95% confidence interval 0.10–0.73, P=0.01), while it was associated with a two-fold increase in mortality in patients with HbA1c ≥7% (HR 2.49, 95% confidence interval 1.02–6.09, P=0.046).
Figure 1. 30-day death
Conclusion
In AMI patients with high HbA1c levels on admission, normoglycemia is associated with higher early mortality than hyperglycemia. In contrast, a graded correlation is observed between admission glycemia and early mortality in patients with HbA1c <7%. Management of glycemia at the acute stage of MI might require different measures according to the initial HbA1c level.
Acknowledgement/Funding
Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier
Collapse
Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Henry
- Hospital Lariboisiere, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
| | - O Genee
- Clinique de la Reine Blanche, Orleans, France
| | - T Joseph
- Centre Hospitalier, Quimper, France
| | - L Belle
- Hospital of Annecy, Annecy, France
| | - N Naccache
- French Society of Cardiology, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
| |
Collapse
|
24
|
Moriarty HK, Clements W, Joseph T, Madan A, Phan T. Complex Renal Arteriovenous Malformation (AVM) Embolization using Ethylene Vinyl Alcohol (EVOH) Copolymer and a Balloon Microcatheter. J Clin Interv Radiol ISVIR 2019. [DOI: 10.1055/s-0039-1694094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
AbstractOccurrence of a symptomatic renal arteriovenous malformation (AVM) is rare. The authors present the case of a patient with a background of Turner's syndrome, hemophilia B, and horseshoe kidney, who presented with hematuria and was successfully treated with endovascular embolization. The use of a microballoon catheter Scepter XC (Microvention, Inc.) to safely embolize the feeding arterial supply, using ethylene vinyl alcohol (EVOH) copolymer (Onyx; Medtronic/ev3) has not, to the authors’ knowledge, previously been described for the treatment of renal AVM. This novel use of an occlusal balloon catheter is permitted by the precipitation rate of Onyx, and allowed a safe and effective procedure, reducing the risk of reflux, allowing a forward push of embolic material in a controlled manner.
Collapse
Affiliation(s)
| | - Warren Clements
- Department of Radiology, Alfred hospital, Melbourne, Australia
- Department of Surgery, Monash University, Clayton, Australia
| | - Tim Joseph
- Department of Radiology, Alfred hospital, Melbourne, Australia
| | - Anoop Madan
- Department of Radiology, Alfred hospital, Melbourne, Australia
| | - Tuan Phan
- Department of Radiology, Alfred hospital, Melbourne, Australia
| |
Collapse
|
25
|
Clements W, Scicchitano M, Koukounaras J, Joseph T, Goh GS. Use of the Magellan Robotic System for Conventional Transarterial Chemoembolization (cTACE): A 6-Patient Case Series Showing Safety and Technical Success. J Clin Interv Radiol ISVIR 2019. [DOI: 10.1055/s-0039-1694093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
AbstractRobotic endovascular technology is an emerging concept, and is being developed to allow more precise navigation of anatomy in challenging endovascular cases. The Magellan Endovascular System allows either direct or remote steerability of a 2-point articulating robotic platform with the ability to place a conventional microcatheter through the catheter tip. Such flexibility may help to reach an otherwise difficult anatomic location, especially in variant anatomy. To date, this platform has been shown to be technically successful in a small number of different settings. This case series shows another potential platform for such technology and explores the technical use and overall safety in conventional transarterial chemoembolization (cTACE). The study retrospectively assessed 6 patients undergoing selective cTACE. Treatments were performed in a single center by two experienced interventional radiologists. Fluoroscopy time, radiation dose, anatomic target, and adverse events were logged. In spite of a longer than expected average fluoroscopy time, which can be expected for a first-generation technology, the average radiation dose was comparable to literature and technical success was able to be shown in all 6 patients with no adverse events. This technology has wide scope for future use and once overcoming a learning curve, may allow us to avoid repeat procedure attempts thus reducing fluoroscopy time and leading to earlier successful treatment. Providing a platform of interest and usability in the interventional radiology world may also lead to further development of smaller, cheaper, and more widely-accessible devices.
Collapse
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
| | | | - Jim Koukounaras
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerard S. Goh
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
26
|
Ang MT, Wong GR, Wong DR, Clements W, Joseph T. Diagnostic yield of computed tomography‐guided biopsy and aspiration for vertebral osteomyelitis. J Med Imaging Radiat Oncol 2019; 63:589-595. [DOI: 10.1111/1754-9485.12923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Megan T Ang
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
| | - Geoffrey R Wong
- Department of Medicine Royal Melbourne Hospital Melbourne Victoria Australia
| | - Davy R Wong
- Department of Medicine University of Notre Dame Sydney New South Wales Australia
| | - Warren Clements
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
- Department of Surgery Monash University Melbourne Victoria Australia
| | - Tim Joseph
- Department of Radiology Alfred Hospital Melbourne Victoria Australia
| |
Collapse
|
27
|
Sanderson T, Joseph T, Haq T, Lefebvre P, Gantier R. Platform for the growth and propogation of HEK293 cells and adenovirus viral vector amplification. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.332] [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: 12/01/2022]
|
28
|
Clements W, Sneddon D, Kavnoudias H, Joseph T, Goh GS, Koukounaras J, Snow T. Randomized and controlled study comparing patient controlled and radiologist controlled intra-procedural conscious sedation, using midazolam and fentanyl, for patients undergoing insertion of a central venous line. J Med Imaging Radiat Oncol 2018; 62:781-788. [DOI: 10.1111/1754-9485.12817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/04/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Warren Clements
- Department of Radiology; Alfred Hospital; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - David Sneddon
- Department of Radiology; Alfred Hospital; Melbourne Victoria Australia
| | - Helen Kavnoudias
- Department of Radiology; Alfred Hospital; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - Tim Joseph
- Department of Radiology; Alfred Hospital; Melbourne Victoria Australia
| | - Gerard S Goh
- Department of Radiology; Alfred Hospital; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - Jim Koukounaras
- Department of Radiology; Alfred Hospital; Melbourne Victoria Australia
| | - Thomas Snow
- Queensland Diagnostic Imaging; Holy Spirit Northside Hospital; Brisbane Queensland Australia
| |
Collapse
|
29
|
Clements W, Goh GS, Nguyen J, Vrazas J, Rogan C, Lau G, Joseph T. Establishing a Platform for Interest and Education in Interventional Radiology Amongst Radiology Trainees. Cardiovasc Intervent Radiol 2018; 42:95-100. [PMID: 30238333 DOI: 10.1007/s00270-018-2080-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/17/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Over recent times, procedural Radiologists have begun to establish themselves as the distinct subspecialty of Interventional Radiology (IR). The Interventional Radiology Society of Australasia (IRSA) was established in 1982 to share collaborative ideas, encourage research, and promote education. IRSA developed a weekend registrar workshop attended by Radiology Registrars from Australia and New Zealand. In the 2018 event, we surveyed the Registrars to identify their interest in IR training before and after the workshop. MATERIALS AND METHODS The event was held over a weekend and consisted of both lectures and hands-on workshops. A survey was handed to all 67 registrants of the workshop and there was a 55% response rate including 78% of females in attendance. RESULTS Before the workshop, trainees rated their interest in IR training at a mean of 3.7 out of 5. After the workshop, trainees rated their interest in IR training as an average of 4.4 out of 5 (p < 0.001). The difference in interest between males and females before the workshop (4.0 vs. 3.1) was significant (p = 0.003), however after the workshop (4.5 vs. 4.1) was not significant (p = 0.07). The change in interest from attending the workshop was significant between genders, p = 0.03 (male interest increased mean 0.5, female increased mean 1.0). CONCLUSION We show that a program of lectures and workshops designed to generate interest in IR leads to a significant increase in training interest, particularly amongst females. Other subspecialty groups should consider this type of intervention and promote ongoing education and inspiration. LEVEL OF EVIDENCE Cross-sectional study, Level IV.
Collapse
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Surgery, Monash University, Clayton, VIC, Australia.
| | - Gerard S Goh
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Surgery, Monash University, Clayton, VIC, Australia
| | - Julian Nguyen
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Radiology, Western Health, St Albans, VIC, Australia
| | - John Vrazas
- Melbourne Institute of Vascular and Interventional Radiology, Collingwood, VIC, Australia
| | - Chris Rogan
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Gabriel Lau
- Pacific Radiology, Otago/Southland, Dunedin, New Zealand.,Department of Radiology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Tim Joseph
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| |
Collapse
|
30
|
Clements W, Kassamali R, Joseph T. Retrieval of an embedded suprarenal inferior vena cava filter using the Hangman technique. J Med Imaging Radiat Oncol 2018; 62:806-809. [PMID: 29974622 DOI: 10.1111/1754-9485.12761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/30/2017] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Abstract
Inferior vena cava filters should be ideally placed in the infrarenal caval segment to maintain renal vein outflow and thereby patency; however, in certain circumstances a suprarenal position may be required. Suprarenal filters are subject to the same risks as for infrarenal filters including tilt. While many advanced techniques have been used for infrarenal filter retrievals, there is a paucity of evidence supporting the use of these retrieval techniques in the suprarenal segment. We show a case of successful retrieval of a suprarenal filter using the Hangman technique.
Collapse
Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Rahil Kassamali
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| |
Collapse
|
31
|
Lee JTL, Goh GS, Joseph T, Koukounaras J, Phan T, Clements W. Prolonged balloon tamponade in the initial management of inferior vena cava injury following complicated filter retrieval, without the need for surgery. J Med Imaging Radiat Oncol 2018; 62:810-813. [DOI: 10.1111/1754-9485.12758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan TL Lee
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
| | - Gerard S Goh
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - Tim Joseph
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
| | - Jim Koukounaras
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
| | - Tuan Phan
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
| | - Warren Clements
- Department of Radiology; Alfred Health; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| |
Collapse
|
32
|
Affiliation(s)
- T Joseph
- Wexham Park Hospital, Slough, UK.
| | | |
Collapse
|
33
|
Udupa KS, Rajendranath R, Sagar TG, Sundersingh S, Joseph T. Dual surrogate markers for rapid prediction of epidermal growth factor receptor mutation status in advanced adenocarcinoma of the lung: A novel approach in resource-limited setting. Indian J Cancer 2016; 52:266-8. [PMID: 26905105 DOI: 10.4103/0019-509x.176693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Tyrosine kinase inhibitors have revolutionized the treatment of metastatic lung cancer in patients with epidermal growth factor receptor (EGFR) mutations. Amplified refractory mutation system (ARMS)-reverse transcription-polymerase chain reaction (RT-PCR), the current standard for detecting EGFR mutation status is time-consuming and highly expensive. Consequently any surrogate test which are cheaper, faster and as accurate as the PCR method will help in early diagnosis and management of patients with lung cancer, especially in resource-limited settings. MATERIALS AND METHODS Eighty-five patients, all of South Indian origin, with adenocarcinoma of lung, registered between October 2009 and January 2013, were evaluated for EGFR mutation status by using scorpion probe based ARMS RT-PCR method. Immunohistochemical (IHC) was performed using the phosphorylated AKT (P-AKT) and thyroid transcription factor-1 (TTF-1) on above patient's sample, and the results were compared with EGFR mutation tests. RESULTS EGFR mutation was positive in 34 of 85 patients (40%). P-AKT and TTF-1 were positive in 50 (58.8%) and 68 (80%) patients respectively. Both P-AKT and TTF-1 had statistically significant correlation with EGFR mutation status. Positive and negative predictive value of P-AKT in diagnosing EGFR mutation was 58% and 85.5% and that for TTF-1 was 48.5% and 94.1%, respectively. The problem of low positive predictive value can partly be overcome by testing P-AKT and TTF-1 simultaneously. CONCLUSION P-AKT and TTF-1 using IHC had statistically significant correlation with EGFR mutation with high negative predictive value. In the case of urgency of starting treatment, EGFR mutation testing may be avoided in those patients who are negative for these IHC markers and can be started on chemotherapy.
Collapse
Affiliation(s)
- K S Udupa
- Department of Medical Oncology, K M C, Manipal, Karnataka, India
| | | | | | | | | |
Collapse
|
34
|
Sonis J, Mort E, Natsui S, Goldsmith A, Joseph T, White B, Raja A, Aaronson E. 18 Listening to Our Patients' Concerns: A Call to Focus Experience Efforts on Communication and Compassion. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
35
|
|
36
|
Lung O, Ohene-Adjei S, Buchanan C, Joseph T, King R, Erickson A, Detmer S, Ambagala A. Multiplex PCR and Microarray for Detection of Swine Respiratory Pathogens. Transbound Emerg Dis 2015; 64:834-848. [PMID: 26662640 PMCID: PMC7169873 DOI: 10.1111/tbed.12449] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Indexed: 12/26/2022]
Abstract
Porcine respiratory disease complex (PRDC) is one of the most important health concerns for pig producers and can involve multiple viral and bacterial pathogens. No simple, single‐reaction diagnostic test currently exists for the simultaneous detection of major pathogens commonly associated with PRDC. Furthermore, the detection of most of the bacterial pathogens implicated in PRDC currently requires time‐consuming culture‐based methods that can take several days to obtain results. In this study, a novel prototype automated microarray that integrates and automates all steps of post‐PCR microarray processing for the simultaneous detection and typing of eight bacteria and viruses commonly associated with PRDC is described along with associated multiplex reverse transcriptase PCR. The user‐friendly assay detected and differentiated between four viruses [porcine reproductive and respiratory syndrome virus (PRRSV), influenza A virus, porcine circovirus type 2, porcine respiratory corona virus], four bacteria (Mycoplasma hyopneumoniae, Pasteurella multocida, Salmonella enterica serovar Choleraesuis, Streptococcus suis), and further differentiated between type 1 and type 2 PRRSV as well as toxigenic and non‐toxigenic P. multocida. The assay accurately identified and typed a panel of 34 strains representing the eight targeted pathogens and was negative when tested with 34 relevant and/or closely related non‐target bacterial and viral species. All targets were also identified singly or in combination in a panel of clinical lung samples and/or experimentally inoculated biological material.
Collapse
Affiliation(s)
- O Lung
- Lethbridge Laboratory, National Centres for Animal Disease, Canadian Food Inspection Agency, Lethbridge, AB, Canada
| | - S Ohene-Adjei
- Lethbridge Laboratory, National Centres for Animal Disease, Canadian Food Inspection Agency, Lethbridge, AB, Canada
| | - C Buchanan
- Lethbridge Laboratory, National Centres for Animal Disease, Canadian Food Inspection Agency, Lethbridge, AB, Canada
| | - T Joseph
- Animal Health Centre, BC Ministry of Agriculture, Abbotsford, BC, Canada
| | - R King
- Animal Health and Assurance Division, Alberta Agriculture and Rural Development, Edmonton, AB, Canada
| | - A Erickson
- Lethbridge Laboratory, National Centres for Animal Disease, Canadian Food Inspection Agency, Lethbridge, AB, Canada
| | - S Detmer
- Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - A Ambagala
- Lethbridge Laboratory, National Centres for Animal Disease, Canadian Food Inspection Agency, Lethbridge, AB, Canada
| |
Collapse
|
37
|
De Boo DW, Joseph T, Phan T, Thomson KR. Blunt traumatic celiac axis pseudoaneurysm: Multi detector computed tomography findings and endovascular management. Trauma 2015. [DOI: 10.1177/1460408614567704] [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: 11/15/2022]
Abstract
Blunt trauma to the abdomen resulting in celiac axis injury is uncommon, and we present the case of a 28-year-old male pedestrian hit by a car. Whole body multi detector computed tomography revealed a non-bleeding celiac axis pseudoaneurysm. The subsequent successful endovascular management is described.
Collapse
Affiliation(s)
- Diederick W De Boo
- Department of Radiology, Alfred Health, Melbourne, Australia
- Department of Radiology, AMC, Amsterdam, the Netherlands
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - KR Thomson
- Department of Radiology, Alfred Health, Melbourne, Australia
| |
Collapse
|
38
|
Britton AP, Redford T, Bidulka JJ, Scouras AP, Sojonky KR, Zabek E, Schwantje H, Joseph T. Beyond Rabies: Are Free-Ranging Skunks (Mephitis mephitis) in British Columbia Reservoirs of Emerging Infection? Transbound Emerg Dis 2015; 64:603-612. [DOI: 10.1111/tbed.12426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Indexed: 12/01/2022]
Affiliation(s)
- A. P. Britton
- Animal Health Centre; BC Ministry of Agriculture; Abbotsford BC Canada
| | - T. Redford
- Department of Veterinary Pathology; Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - J. J. Bidulka
- Animal Health Centre; BC Ministry of Agriculture; Abbotsford BC Canada
| | - A. P. Scouras
- Animal Health Centre; BC Ministry of Agriculture; Abbotsford BC Canada
| | - K. R. Sojonky
- Animal Health Centre; BC Ministry of Agriculture; Abbotsford BC Canada
| | - E. Zabek
- Animal Health Centre; BC Ministry of Agriculture; Abbotsford BC Canada
| | - H. Schwantje
- Ministry of Forests, Lands and Natural Resources; Nanaimo BC Canada
| | - T. Joseph
- Animal Health Centre; BC Ministry of Agriculture; Abbotsford BC Canada
| |
Collapse
|
39
|
Marty GD, Morrison DB, Bidulka J, Joseph T, Siah A. Piscine reovirus in wild and farmed salmonids in British Columbia, Canada: 1974-2013. J Fish Dis 2015; 38:713-28. [PMID: 25048977 DOI: 10.1111/jfd.12285] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 05/18/2023]
Abstract
Piscine reovirus (PRV) was common among wild and farmed salmonids in British Columbia, western Canada, from 1987 to 2013. Salmonid tissues tested for PRV by real-time rRT-PCR included sections from archived paraffin blocks from 1974 to 2008 (n = 363) and fresh-frozen hearts from 2013 (n = 916). The earliest PRV-positive sample was from a wild-source steelhead trout, Oncorhynchus mykiss (Walbaum), from 1977. By histopathology (n = 404), no fish had lesions diagnostic for heart and skeletal muscle inflammation (HSMI). In some groups, lymphohistiocytic endocarditis affected a greater proportion of fish with PRV than fish without PRV, but the range of Ct values among affected fish was within the range of Ct values among unaffected fish. Also, fish with the lowest PRV Ct values (18.4-21.7) lacked endocarditis or any other consistent lesion. From 1987 to 1994, the proportion of PRV positives was not significantly different between farmed Atlantic salmon, Salmo salar L. (44% of 48), and wild-source salmonids (31% of 45). In 2013, the proportion of PRV positives was not significantly different between wild coho salmon, Oncorhynchus kisutch (Walbaum), sampled from British Columbia (5.0% of 60) or the reference region, Alaska, USA (10% of 58).
Collapse
Affiliation(s)
- G D Marty
- Animal Health Centre, Ministry of Agriculture, Abbotsford, BC, Canada
| | - D B Morrison
- Marine Harvest Canada, Campbell River, BC, Canada
| | - J Bidulka
- Animal Health Centre, Ministry of Agriculture, Abbotsford, BC, Canada
| | - T Joseph
- Animal Health Centre, Ministry of Agriculture, Abbotsford, BC, Canada
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - A Siah
- British Columbia Centre for Aquatic Health Sciences, Campbell River, BC, Canada
| |
Collapse
|
40
|
Whitcroft K, Loh W, Joseph T. Cross-speciality cover at the junior level: A national survey. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.07.191] [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: 10/24/2022]
|
41
|
Retterath L, Zhan J, Bicker E, Ardary C, Joseph T, Law J, Jones J. 302 Prevalence of Sexually Transmitted Infection in Symptomatic Adolescents Presenting to the Emergency Department. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
Retterath L, Bicker E, Zhan J, Law J, Joseph T, Ardary C, Jones J. 98 Diagnostic Usefulness of Endocervical Gram Stain Smears in Adolescents With Genitourinary Complaints. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
43
|
Wysong A, Kim D, Joseph T, MacFarlane DF, Tang JY, Gladstone HB. Quantifying soft tissue loss in the aging male face using magnetic resonance imaging. Dermatol Surg 2014; 40:786-93. [PMID: 25111352 DOI: 10.1111/dsu.0000000000000035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Quantitative data on soft tissue aging of the face are scarce, particularly in men. OBJECTIVE Magnetic resonance imaging (MRI) was used to quantify and compare facial soft tissue loss in men. MATERIALS AND METHODS Two thousand thirty-seven MRIs were screened and 30 male subjects were divided into young, middle, and old-aged groups. A blinded radiologist measured temporal, infraorbital, and medial and lateral cheek areas. RESULTS The mean thickness of the subcutaneous tissue in the temporal area was 12.5, 10.9, and 9.6 mm in the young, middle, and older age groups, respectively (p < .001). A 40% reduction in the skin thickness was seen in the infraorbital areas. Finally, a decrease of 1.5 and 2.7 mm in medial cheeks (p < .001), and 0.9 and 1.6 mm (p = .03) in lateral cheeks were measured in middle and old age groups. CONCLUSION A steady and significant decline in the soft tissue thickness was noted at all measured sites in men over time. These findings are in contrast to our recently study in women showing dramatic loss of soft tissue between the ages of 30 and 60 with no significant differences between the middle and old-aged groups. These results have implications for volume correction and maintenance of a youthful appearance in the aging male face.
Collapse
Affiliation(s)
- Ashley Wysong
- *Department of Dermatology, Stanford University School of Medicine, Redwood City, California; †Department of Dermatology, Mohs/Dermatologic Surgery Division, Scripps Clinic, La Jolla, California; ‡Department of Radiology, UCLA School of Medicine, Los Angeles, California; §Department of Dermatology, MD Anderson Cancer Center, Houston, Texas; ‖Berman Gladstone Skin Institute, Palo Alto, California
| | | | | | | | | | | |
Collapse
|
44
|
Joseph T, Manz J, Mohan V, Schreier HJ. Local versus Hyperspherical Modes of Formaldehyde I. Model Hamiltonian and Decay of the CH2-Fragment. ACTA ACUST UNITED AC 2014. [DOI: 10.1002/bbpc.198800081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
45
|
Berhane Y, Joseph T, Kehler H, Hisanaga T, Embury-Hyatt C, Diederich S, McGreevy KH, Handel K, Cottam-Birt C, Pasick J. Characterization of a Low Pathogenic Avian Influenza H5N2 Virus Isolated from a Turkey Breeder Flock in Manitoba, Canada. Avian Dis 2014; 58:1-7. [DOI: 10.1637/10591-061213-reg.1] [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: 11/05/2022]
|
46
|
Affiliation(s)
- N Foden
- Royal National Throat Nose and Ear Hospital, London, UK
| | - M Ellis
- Royal National Throat Nose and Ear Hospital, London, UK
| | | | - T Joseph
- Royal National Throat Nose and Ear Hospital, London, UK
| |
Collapse
|
47
|
Wysong A, Joseph T, Kim D, Tang JY, Gladstone HB. Quantifying Soft Tissue Loss in Facial Aging: A Study in Women Using Magnetic Resonance Imaging. Dermatol Surg 2013; 39:1895-902. [DOI: 10.1111/dsu.12362] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
Sohail I, Jonker L, Stanton A, Walker M, Joseph T. Physiological POSSUM as an Indicator for Long-term Survival in Vascular Surgery. Eur J Vasc Endovasc Surg 2013; 46:223-6. [DOI: 10.1016/j.ejvs.2013.05.018] [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] [Received: 02/25/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
|
49
|
Hoit G, Hinkewich C, Tiao J, Porgo V, Moore L, Moore L, Tiao J, Wang C, Moffatt B, Wheeler S, Gillman L, Bartens K, Lysecki P, Pallister I, Patel S, Bradford P, Bradford P, Kidane B, Holmes A, Trajano A, March J, Lyons R, Kao R, Rezende-Neto J, Leblanc Y, Rezende-Neto J, Vogt K, Alzaid S, Jansz G, Andrusiek D, Andrusiek D, Bailey K, Livingston M, Calthorpe S, Hsu J, Lubbert P, Boitano M, Leeper W, Williamson O, Reid S, Alonazi N, Lee C, Rezende-Neto J, Aleassa E, Jennings P, Jennings P, Mador B, Hoffman K, Riley J, Vu E, Alburakan A, Alburakan A, Alburakan A, Mckee J, Bobrovitz N, Gabbe B, Gabbe B, Hodgkinson J, Hodgkinson J, Ali J, Ali J, Grant M, Roberts D, Holodinsky J, Cooper C, Santana M, Kruger K, Hodgkinson J, Waggott M, Da Luz L, Banfield J, Santana M, Dorigatti A, Birn K, Bobrovitz N, Zakirova R, Davies D, Das D, Gamme G, Pervaiz F, Almarhabi Y, Brainard A, Brown R, Bell N, Bell N, Jowett H, Jowett H, Bressan S, Hogan A, Watson I, Woodford S, Hogan A, Boulay R, Watson I, Howlett M, Atkinson P, Chesters A, Hamadani F, Atkinson P, Azzam M, Fraser J, Doucet J, Atkinson P, Muakkassa F, Sathivel N, Chadi S, Joseph B, Takeuchi L, Bradley N, Al Bader B, Kidane B, Harrington A, Nixon K, Veigas P, Joseph B, O’Keeffe T, Bracco D, Rezende-Neto J, Azzam M, Lin Y, Bailey K, Bracco D, Nash N, Alhabboubi M, Slobogean G, Spicer J, Heidary B, Joos E, Berg R, Berg R, Sankarankutty A, Zakrison T, Babul S, Lockhart S, Faux S, Jackson A, Lee T, Bailey K, Pemberton J, Green R, Tallon J, Moore L, Turgeon A, Boutin A, Moore L, Reinartz D, Lapointe G, Turgeon A, Stelfox H, Turgeon A, Nathens A, Neveu X, Stelfox H, Turgeon A, Nathens A, Neveu X, Moore L, Turgeon A, Bratu I, Gladwin C, Voaklander D, Lewis M, Vogt K, Eckert K, Williamson J, Stewart TC, Parry N, Gray D, L’Heureux R, Ziesmann M, Kortbeek J, Brindley P, Hicks C, Fata P, Engels P, Ball C, Paton-Gay D, Widder S, Vogt K, Hernandez-Alejandro R, Gray D, Vanderbeek L, Forrokhyar F, Anatharajah R, Howatt N, Lamb S, Sne N, Kahnamoui K, Lyons R, Walters A, Brooks C, Pinder L, Rahman S, Walters A, Kidane B, Parry N, Donnelly E, Lewell M, Mellow R, Hedges C, Morassutti P, Bulatovic R, Morassutti P, Galbraith E, McKenzie S, Bradford D, Lewell M, Peddle M, Dukelow A, Eby D, McLeod S, Bradford P, Stewart TC, Parry N, Williamson O, Fraga G, Pereira B, Sareen J, Doupe M, Gawaziuk J, Chateau D, Logsetty S, Pallister I, Lewis J, O’Doherty D, Hopkins S, Griffiths S, Palmer S, Gabbe B, Xu X, Martin C, Xenocostas A, Parry N, Mele T, Rui T, Abreu E, Andrade M, Cruz F, Pires R, Carreiro P, Andrade T, Lampron J, Balaa F, Fortuna R, Issa H, Dias P, Marques M, Fernandes T, Sousa T, Inaba K, Smith J, Okoye O, Joos E, Shulman I, Nelson J, Parry N, Rhee P, Demetriades D, Ostrofsky R, Butler-Laporte G, Chughtai T, Khwaja K, Fata P, Mulder D, Razek T, Deckelbaum D, Bailey K, Pemberton J, Evans D, Anton H, Wei J, Randall E, Sobolev B, Scott BB, van Heest R, Frankfurter C, Pemberton J, McKerracher S, Stewart TC, Merritt N, Barber L, Kimmel L, Hodgson C, Webb M, Holland A, Gruen R, Harrison K, Hwang M, Hsee L, Civil I, Muizelaar A, Baillie F, Leeper T, Stewart TC, Gray D, Parry N, Sutherland A, Hart M, Gabbe B, Tuma F, Coates A, Farrokhyar F, Faidi S, Gastaldo F, Paskar D, Reid S, Faidi S, Petrisor B, Bhandari M, Loh WL, Ho C, Chong C, Rodrigues G, Gissoni M, Martins M, Andrade M, Cunha-Melo J, Rizoli S, Abu-Zidan F, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, Masci K, Gabbe B, Simpson P, Smith K, Cox S, Cameron P, Evans D, West A, Barratt L, Rozmovits L, Livingstone B, Vu M, Griesdale D, Schlamp R, Wand R, Alhabboubi M, Alrowaili A, Alghamdi H, Fata P, Essbaiheen F, Alhabboubi M, Fata P, Essbaiheen F, Chankowsky J, Razek T, Stephens M, Vis C, Belton K, Kortbeek J, Bratu I, Dufresne B, Guilfoyle J, Ibbotson G, Martin K, Matheson D, Parks P, Thomas L, Kirkpatrick A, Santana M, Kline T, Kortbeek J, Stelfox H, Lyons R, Macey S, Fitzgerald M, Judson R, Cameron P, Sutherland A, Hart M, Morgan M, McLellan S, Wilson K, Cameron P, Sorvari A, Chaudhry Z, Khawaja K, Ali A, Akhtar J, Zubair M, Nickow J, Sorvari A, Holodinsky J, Jaeschke R, Ball C, Blaser AR, Starkopf J, Zygun D, Kirkpatrick A, Roberts D, Ball C, Blaser AR, Starkopf J, Zygun D, Jaeschke R, Kirkpatrick A, Santana M, Stelfox H, Stelfox H, Rizoli S, Tanenbaum B, Stelfox H, Redondano BR, Jimenez LS, Zago T, de Carvalho RB, Calderan TA, Fraga G, Campbell S, Widder S, Paton-Gay D, Engels P, Ferri M, Santana M, Kline T, Kortbeek J, Stelfox H, Nathens A, Lashoher A, McFarlan A, Ahmed N, Booy J, McDowell D, Nasr A, Wales P, Roberts D, Mercado M, Vis C, Kortbeek J, Kirkpatrick A, Lall R, Stelfox H, Ball C, Niven D, Dixon E, Stelfox H, Kirkpatrick A, Kaplan G, Hameed M, Ball C, Qadura M, Sne N, Reid S, Coates A, Faidi S, Veenstra J, Hennecke P, Gardner R, Appleton L, Sobolev B, Simons R, van Heest R, Hameed M, Sobolev B, Simons R, van Heest R, Hameed M, Palmer C, Bevan C, Crameri J, Palmer C, Hogan D, Grealy L, Bevan C, Palmer C, Jowett H, Boulay R, Chisholm A, Beairsto E, Goulette E, Martin M, Benjamin S, Boulay R, Watson I, Boulay R, Watson I, Watson I, Savoie J, Benjamin S, Martin M, Hogan A, Woodford S, Benjamin S, Chisholm A, Ondiveeran H, Martin M, Atkinson P, Doody K, Fraser J, Leblanc-Duchin D, Strack B, Naveed A, vanRensburg L, Madan R, Atkinson P, Boulva K, Deckelbaum D, Khwaja K, Fata P, Razek T, Fraser J, Verheul G, Parks A, Milne J, Nemeth J, Fata P, Correa J, Deckelbaum D, Bernardin B, Al Bader B, Khwaja K, Razek T, Atkinson P, Benjamin S, Sproul E, Mehta A, Galarneau M, Mahadevan P, Bansal V, Dye J, Hollingsworth-Fridlund P, Stout P, Potenza B, Coimbra R, Madan R, Marley R, Salvator A, Pisciotta D, Bridge J, Lin S, Ovens H, Nathens A, Abdo H, Dencev-Bihari R, Parry N, Lawendy A, Ibrahim-Zada I, Pandit V, Tang A, O’Keeffe T, Wynne J, Gries L, Friese R, Rhee P, Hameed M, Simons R, Taulu T, Wong H, Saleem A, Azzam M, Boulva K, Razek T, Khwaja K, Mulder D, Deckelbaum D, Fata P, Plourde M, Chadi S, Forbes T, Parry N, Martin G, Gaunt K, Bandiera G, Bawazeer M, MacKinnon D, Ahmed N, Spence J, Sankarankutty A, Nascimento B, Rizoli S, Ibrahim-Zada I, Aziz H, Tang A, Friese R, Wynne J, O’keeffe T, Vercruysse G, Kulvatunyou N, Rhee P, Sakles J, Mosier J, Wynne J, Kulvatunyou N, Tang A, Joseph B, Rhee P, Khwaja K, Fata P, Deckelbaum D, Razek T, Dias P, Issa H, Fortuna R, Sousa T, Abreu E, Bracco D, Khwaja K, Fata P, Deckelbaum D, Razek T, Bracco D, Khwaja K, Fata P, Deckelbaum D, Razek T, Norman D, Li J, Pemberton J, Al-Oweis J, Khwaja K, Fata P, Deckelbaum D, Razek T, Albuz O, Karamanos E, Vogt K, Okoye O, Talving P, Inaba K, Demetriades D, Elhusseini M, Sudarshan M, Deckelbaum D, Fata P, Razek T, Khwaja K, MacPherson C, Sun T, Pelletier M, Hameed M, Khalil MA, Azzam M, Valenti D, Fata P, Deckelbaum D, Razek T, Brown R, Simons R, Evans D, Hameed M, Inaba K, Vogt K, Okoye O, Gelbard R, Moe D, Grabo D, Demetriades D, Inaba K, Karamanos E, Okoye O, Talving P, Demetriades D, Inaba K, Karamanos E, Pasley J, Teixeira P, Talving P, Demetriades D, Fung S, Alababtain I, Brnjac E, Luz L, Nascimento B, Rizoli S, Parikh P, Proctor K, Murtha M, Schulman C, Namias N, Goldman R, Pike I, Korn P, Flett C, Jackson T, Keith J, Joseph T, Giddins E, Ouellet J, Cook M, Schreiber M, Kortbeek J. Trauma Association of Canada (TAC) Annual Scientific Meeting. The Westin Whistler Resort & Spa, Whistler, BC, Thursday, Apr. 11 to Saturday, Apr. 13, 2013Testing the reliability of tools for pediatric trauma teamwork evaluation in a North American high-resource simulation settingThe association of etomidate with mortality in trauma patientsDefinition of isolated hip fractures as an exclusion criterion in trauma centre performance evaluations: a systematic reviewEstimation of acute care hospitalization costs for trauma hospital performance evaluation: a systematic reviewHospital length of stay following admission for traumatic injury in Canada: a multicentre cohort studyPredictors of hospital length of stay following traumatic injury: a multicentre cohort studyInfluence of the heterogeneity in definitions of an isolated hip fracture used as an exclusion criterion in trauma centre performance evaluations: a multicentre cohort studyPediatric trauma, advocacy skills and medical studentsCompliance with the prescribed packed red blood cell, fresh frozen plasma and platelet ratio for the trauma transfusion pathway at a level 1 trauma centreEarly fixed-wing aircraft activation for major trauma in remote areasDevelopment of a national, multi-disciplinary trauma crisis resource management curriculum: results from the pilot courseThe management of blunt hepatic trauma in the age of angioembolization: a single centre experienceEarly predictors of in-hospital mortality in adult trauma patientsThe impact of open tibial fracture on health service utilization in the year preceding and following injuryA systematic review and meta-analysis of the efficacy of red blood cell transfusion in the trauma populationSources of support for paramedics managing work-related stress in a Canadian EMS service responding to multisystem trauma patientsAnalysis of prehospital treatment of pain in the multisystem trauma patient at a community level 2 trauma centreIncreased mortality associated with placement of central lines during trauma resuscitationChronic pain after serious injury — identifying high risk patientsEpidemiology of in-hospital trauma deaths in a Brazilian university teaching hospitalIncreased suicidality following major trauma: a population-based studyDevelopment of a population-wide record linkage system to support trauma researchInduction of hmgb1 by increased gut permeability mediates acute lung injury in a hemorrhagic shock and resuscitation mouse modelPatients who sustain gunshot pelvic fractures are at increased risk for deep abscess formation: aggravated by rectal injuryAre we transfusing more with conservative management of isolated blunt splenic injury? A retrospective studyMotorcycle clothesline injury prevention: Experimental test of a protective deviceA prospective analysis of compliance with a massive transfusion protocol - activation alone is not enoughAn evaluation of diagnostic modalities in penetrating injuries to the cardiac box: Is there a role for routine echocardiography in the setting of negative pericardial FAST?Achievement of pediatric national quality indicators — an institutional report cardProcess mapping trauma care in 2 regional health authorities in British Columbia: a tool to assist trauma sys tem design and evaluationPatient safety checklist for emergency intubation: a systematic reviewA standardized flow sheet improves pediatric trauma documentationMassive transfusion in pediatric trauma: a 5-year retrospective reviewIs more better: Does a more intensive physiotherapy program result in accelerated recovery for trauma patients?Trauma care: not just for surgeons. Initial impact of implementing a dedicated multidisciplinary trauma team on severely injured patientsThe role of postmortem autopsy in modern trauma care: Do we still need them?Prototype cervical spine traction device for reduction stabilization and transport of nondistraction type cervical spine injuriesGoing beyond organ preservation: a 12-year review of the beneficial effects of a nonoperative management algorithm for splenic traumaAssessing the construct validity of a global disability measure in adult trauma registry patientsThe mactrauma TTL assessment tool: developing a novel tool for assessing performance of trauma traineesA quality improvement approach to developing a standardized reporting format of ct findings in blunt splenic injuriesOutcomes in geriatric trauma: what really mattersFresh whole blood is not better than component therapy (FFP:RBC) in hemorrhagic shock: a thromboelastometric study in a small animal modelFactors affecting mortality of chest trauma patients: a prospective studyLong-term pain prevalence and health related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomized controlled trialDescribing pain following trauma: predictors of persistent pain and pain prevalenceManagement strategies for hemorrhage due to pelvic trauma: a survey of Canadian general surgeonsMajor trauma follow-up clinic: Patient perception of recovery following severe traumaLost opportunities to enhance trauma practice: culture of interprofessional education and sharing among emergency staffPrehospital airway management in major trauma and traumatic brain injury by critical care paramedicsImproving patient selection for angiography and identifying risk of rebleeding after angioembolization in the nonoperative management of high grade splenic injuriesFactors predicting the need for angioembolization in solid organ injuryProthrombin complex concentrates use in traumatic brain injury patients on oral anticoagulants is effective despite underutilizationThe right treatment at the right time in the right place: early results and associations from the introduction of an all-inclusive provincial trauma care systemA multicentre study of patient experiences with acute and postacute injury carePopulation burden of major trauma: Has introduction of an organized trauma system made a difference?Long-term functional and return to work outcomes following blunt major trauma in Victoria, AustraliaSurgical dilemma in major burns victim: heterotopic ossification of the tempromandibular jointWhich radiological modality to choose in a unique penetrating neck injury: a differing opinionThe Advanced Trauma Life Support (ATLS) program in CanadaThe Rural Trauma Team Development Course (RTTDC) in Pakistan: Is there a role?Novel deployment of BC mobile medical unit for coverage of BMX world cup sporting eventIncidence and prevalence of intra-abdominal hypertension and abdominal compartment syndrome in critically ill adults: a systematic review and meta-analysisRisk factors for intra-abdominal hypertension and abdominal compartment syndrome in critically ill or injured adults: a systematic review and meta-analysisA comparison of quality improvement practices at adult and pediatric trauma centresInternational trauma centre survey to evaluate content validity, usability and feasibility of quality indicatorsLong-term functional recovery following decompressive craniectomy for severe traumatic brain injuryMorbidity and mortality associated with free falls from a height among teenage patients: a 5-year review from a level 1 trauma centreA comparison of adverse events between trauma patients and general surgery patients in a level 1 trauma centreProcoagulation, anticoagulation and fibrinolysis in severely bleeding trauma patients: a laboratorial characterization of the early trauma coagulopathyThe use of mobile technology to facilitate surveillance and improve injury outcome in sport and physical activityIntegrated knowledge translation for injury quality improvement: a partnership between researchers and knowledge usersThe impact of a prevention project in trauma with young and their learningIntraosseus vascular access in adult trauma patients: a systematic reviewThematic analysis of patient reported experiences with acute and post-acute injury careAn evaluation of a world health organization trauma care checklist quality improvement pilot programProspective validation of the modified pediatric trauma triage toolThe 16-year evolution of a Canadian level 1 trauma centre: growing up, growing out, and the impact of a booming economyA 20-year review of trauma related literature: What have we done and where are we going?Management of traumatic flail chest: a systematic review of the literatureOperative versus nonoperative management of flail chestEmergency department performance of a clinically indicated and technically successful emergency department thoracotomy and pericardiotomy with minimal equipment in a New Zealand institution without specialized surgical backupBritish Columbia’s mobile medical unit — an emergency health care support resourceRoutine versus ad hoc screening for acute stress: Who would benefit and what are the opportunities for trauma care?A geographical analysis of the Early Development Instrument (EDI) and childhood injuryDevelopment of a pediatric spinal cord injury nursing course“Kids die in driveways” — an injury prevention campaignEpidemiology of traumatic spine injuries in childrenA collaborative approach to reducing injuries in New Brunswick: acute care and injury preventionImpact of changes to a provincial field trauma triage tool in New BrunswickEnsuring quality of field trauma triage in New BrunswickBenefits of a provincial trauma transfer referral system: beyond the numbersThe field trauma triage landscape in New BrunswickImpact of the Rural Trauma Team Development Course (RTTDC) on trauma transfer intervals in a provincial, inclusive trauma systemTrauma and stress: a critical dynamics study of burnout in trauma centre healthcare professionalsUltrasound-guided pediatric forearm fracture reduction with sedation in the emergency departmentBlock first, opiates later? The use of the fascia iliaca block for patients with hip fractures in the emergency department: a systematic reviewRural trauma systems — demographic and survival analysis of remote traumas transferred from northern QuebecSimulation in trauma ultrasound trainingIncidence of clinically significant intra-abdominal injuries in stable blunt trauma patientsWake up: head injury management around the clockDamage control laparotomy for combat casualties in forward surgical facilitiesDetection of soft tissue foreign bodies by nurse practitioner performed ultrasoundAntihypertensive medications and walking devices are associated with falls from standingThe transfer process: perspectives of transferring physiciansDevelopment of a rodent model for the study of abdominal compartment syndromeClinical efficacy of routine repeat head computed tomography in pediatric traumatic brain injuryEarly warning scores (EWS) in trauma: assessing the “effectiveness” of interventions by a rural ground transport service in the interior of British ColumbiaAccuracy of trauma patient transfer documentation in BCPostoperative echocardiogram after penetrating cardiac injuries: a retrospective studyLoss to follow-up in trauma studies comparing operative methods: a systematic reviewWhat matters where and to whom: a survey of experts on the Canadian pediatric trauma systemA quality initiative to enhance pain management for trauma patients: baseline attitudes of practitionersComparison of rotational thromboelastometry (ROTEM) values in massive and nonmassive transfusion patientsMild traumatic brain injury defined by GCS: Is it really mild?The CMAC videolaryngosocpe is superior to the glidescope for the intubation of trauma patients: a prospective analysisInjury patterns and outcome of urban versus suburban major traumaA cost-effective, readily accessible technique for progressive abdominal closureEvolution and impact of the use of pan-CT scan in a tertiary urban trauma centre: a 4-year auditAdditional and repeated CT scan in interfacilities trauma transfers: room for standardizationPediatric trauma in situ simulation facilitates identification and resolution of system issuesHospital code orange plan: there’s an app for thatDiaphragmatic rupture from blunt trauma: an NTDB studyEarly closure of open abdomen using component separation techniqueSurgical fixation versus nonoperative management of flail chest: a meta-analysisIntegration of intraoperative angiography as part of damage control surgery in major traumaMass casualty preparedness of regional trauma systems: recommendations for an evaluative frameworkDiagnostic peritoneal aspirate: An obsolete diagnostic modality?Blunt hollow viscus injury: the frequency and consequences of delayed diagnosis in the era of selective nonoperative managementEnding “double jeopardy:” the diagnostic impact of cardiac ultrasound and chest radiography on operative sequencing in penetrating thoracoabdominal traumaAre trauma patients with hyperfibrinolysis diagnosed by rotem salvageable?The risk of cardiac injury after penetrating thoracic trauma: Which is the better predictor, hemodynamic status or pericardial window?The online Concussion Awareness Training Toolkit for health practitioners (CATT): a new resource for recognizing, treating, and managing concussionThe prevention of concussion and brain injury in child and youth team sportsRandomized controlled trial of an early rehabilitation intervention to improve return to work Rates following road traumaPhone call follow-upPericardiocentesis in trauma: a systematic review. Can J Surg 2013. [DOI: 10.1503/cjs.005813] [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: 11/01/2022] Open
|
50
|
Kobetz E, Menard J, Hazan G, Koru-Sengul T, Joseph T, Nissan J, Barton B, Blanco J, Kornfeld J. Perceptions of HPV and cervical cancer among Haitian immigrant women: implications for vaccine acceptability. Educ Health (Abingdon) 2011; 24:479. [PMID: 22267344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Women in Haiti and throughout the Haitian Diaspora shoulder a disproportionate burden of cervical cancer morbidity and mortality. The widespread Human Papillomavirus (HPV) vaccination holds promise for helping to attenuate this disparity. However, previous research has not fully examined Haitian women's perceptions of, and barriers to, HPV vaccination, which is essential for informing future intervention. The current paper aims to fill this gap. METHODS As part of ongoing Community-Based Participatory Research (CBPR) efforts, we conducted a series of focus groups with Haitian immigrant women in Little Haiti, the predominantly Haitian neighborhood in Miami, Florida, U.S. Focus group questions assessed women's knowledge and beliefs about cervical cancer and HPV, their opinions of vaccines in general, their knowledge and perceptions of the HPV vaccine specifically and health communications preferences for cervical cancer prevention. RESULTS Among the participants who had heard of HPV, many held misconceptions about virus transmission and did not understand the role of HPV in the development of cervical cancer. Virtually all participants expressed support for vaccines in general as beneficial for health. Some women had heard of the HPV vaccine, primarily as the result of a contemporary popular media campaign promoting the Gardasil® vaccine. Physician recommendation was commonly mentioned as a reason for vaccination, in addition to having more than one sex partner. Women felt the HPV vaccine was less appropriate for adolescent girls who are presumed as not sexually active. Women indicated a strong preference to obtain health information through trusted sources, such as Haitian physicians, Haitian Community Health Workers, and especially Kreyol-language audiovisual media. DISCUSSION Study findings indicate a need for culturally and linguistically appropriate educational initiatives to promote awareness of HPV and its role in cervical cancer, the importance of vaccination against the virus, explicitly differentiating HPV from HIV and providing specific information about vaccine safety. CONCLUSION In the U.S., there is a substantial lack of educational information available in Haitian about HPV and cervical cancer. This gap results in missed opportunities to promote disease prevention through vaccination and regular screening. Addressing such gaps is essential for achieving health equity among Haitian immigrant women and other, similarly underserved women, who are disproportionately burdened by cervical cancer.
Collapse
Affiliation(s)
- E Kobetz
- University of Miami Miller School of Medicine, Miami, Florida, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|