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Ringrose JS, Sridar S, Araneta P, Chan L, Kassam J, Wirzba M, Greeff K, Ramsay G, Sia W, Khurana R, Bader E, Padwal R. A comparison among oscillometric waveforms in healthy nonpregnant women, pregnancy and hypertensive disorders of pregnancy. Blood Press Monit 2024:00126097-990000000-00100. [PMID: 38465772 DOI: 10.1097/mbp.0000000000000700] [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: 03/12/2024]
Abstract
OBJECTIVE Understanding of how oscillometric waveforms (OMW) vary between pregnant and nonpregnant individuals remains low. An exploratory analysis was completed to assess for quantitative and qualitative changes in OMW and oscillometric envelope features in pregnancy. DESIGN AND METHODS Eighteen pregnant individuals (over 20 weeks gestational age) and healthy, nonpregnant (HNP) women were recruited. Six HNP were matched to six healthy pregnant (HP) women, and six pregnant women with a hypertensive disorder of pregnancy (HDP) by age, arm circumference, and cuff size. Blood pressure measurements were completed per the International Organization for Standardization (ISO) protocol using a custom-built oscillometric device as the test device and two-observer mercury auscultation as the reference measurement. Auscultatory blood pressure and blood pressure derived from slope-based and fixed ratio algorithms were determined. OMW and envelope features were compared among groups. RESULTS In HNP, HP, and HDP groups respectively: mean auscultatory blood pressure (systolic mean ± SD/diastolic mean ± SD) was 103.4 ± 12.2/67.1 ± 7.9; 109.5 ± 3.1/58.1 ± 6.4; 135.6 ± 18.9/85.1 ± 14.2 mmHg. HDP had significantly higher auscultatory systolic and diastolic blood pressure than the HP group (P = 0.001). The pregnant groups had a lower average pulse width (mean ± SD: HNP = 0.8 ± 0 s, HP = 0.6 ± 0.1 s, HDP = 0.6 ± 0.1 s; HP vs. HNP mean difference [adjusted P value]: 0.2 [P = 0.004], HDP vs. HNP 0.1 [P = 0.018]) compared with the HNP group. The HDP group had a larger area under the OMW envelope than the HNP group (mean ± SD: HNP = 22.6 ± 3.4; HDP = 28.5 ± 4.2; HDP vs. HNP mean difference [adjusted P value]: 5.9 P = 0.05). CONCLUSION In this exploratory work, differences in the OMW morphology and parameters were found in pregnancy and in hypertensive disorders of pregnancy compared with healthy controls. Even small differences may have important implications in algorithm development; further work comparing OMW envelopes in pregnancy is needed to optimize the algorithms used to determine blood pressure in pregnancy.
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Affiliation(s)
- Jennifer S Ringrose
- Department of Medicine, University of Alberta
- Women and Children's Health Research Institute
| | | | | | | | | | | | - Kate Greeff
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Winnie Sia
- Department of Medicine, University of Alberta
| | - Rshmi Khurana
- Department of Medicine, University of Alberta
- Women and Children's Health Research Institute
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Erin Bader
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta
- Women and Children's Health Research Institute
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Archibald A, Spronk E, Potvin S, Kovacs Burns K, Moran M, Peng HJ, Raso J, Bahari H, Khan S, Cruz AM, Sia W. Perspectives on Communication Technology Use for Alleviating the Impact of COVID-19 on Hospitalized Patients' Well-Being and Transitions in Care. Can J Aging 2024:1-8. [PMID: 38372162 DOI: 10.1017/s0714980824000060] [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] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic created many challenges for in-patient care including patient isolation and limitations on hospital visitation. Although communication technology, such as video calling or texting, can reduce social isolation, there are challenges for implementation, particularly for older adults. OBJECTIVE/METHODS This study used a mixed methodology to understand the challenges faced by in-patients and to explore the perspectives of patients, family members, and health care providers (HCPs) regarding the use of communication technology. Surveys and focus groups were used. FINDINGS Patients who had access to communication technology perceived the COVID-19 pandemic to have more adverse impact on their well-beings but less on hospitalization outcomes, compared to those without. Most HCPs perceived that technology could improve programs offered, connectedness of patients to others, and access to transitions of care supports. Focus groups highlighted challenges with technology infrastructure in hospitals. DISCUSSION Our study findings may assist efforts in appropriately adopting communication technology to improve the quality of in-patient and transition care.
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Affiliation(s)
- Andrew Archibald
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elena Spronk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sacha Potvin
- Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Katharina Kovacs Burns
- Clinical Quality Metrics, University of Alberta, Edmonton, AB, Canada
- Alberta Health Services, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Martin Moran
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Hongwei J Peng
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jim Raso
- Alberta Health Services, Edmonton, AB, Canada
- Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Hosein Bahari
- Alberta Health Services, Edmonton, AB, Canada
- Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Samina Khan
- Alberta Health Services, Edmonton, AB, Canada
| | - Antonio Miguel Cruz
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- GRRIT Hub Glenrose Rehabilitation Research, Innovation & Technology, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Winnie Sia
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Lihme F, Savu A, Basit S, Sia W, Yeung R, Barrett O, Luoma L, Ngwezi DP, Davidge S, Norris CM, Ospina MB, Cooke C, Greiner R, Wohlfahrt J, Melbye M, Lykke J, Kaul P, Boyd HA. Time trends in preeclampsia and gestational diabetes in Denmark and Alberta, Canada, 2005-2018-A population-based cohort study. Acta Obstet Gynecol Scand 2024; 103:266-275. [PMID: 37948551 PMCID: PMC10823392 DOI: 10.1111/aogs.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Preeclampsia and gestational diabetes mellitus share risk factors such as obesity and increased maternal age, which have become more prevalent in recent decades. We examined changes in the prevalence of preeclampsia and gestational diabetes between 2005 and 2018 in Denmark and Alberta, Canada, and investigated whether the observed trends can be explained by changes in maternal age, parity, multiple pregnancy, comorbidity, and body mass index (BMI) over time. MATERIAL AND METHODS This study was a register-based cohort study conducted using data from the Danish National Health Registers and the provincial health registers of Alberta, Canada. We included in the study cohort all pregnancies in 2005-2018 resulting in live-born infants and used binomial regression to estimate mean annual increases in the prevalence of preeclampsia and gestational diabetes in the two populations across the study period, adjusted for maternal characteristics. RESULTS The study cohorts included 846 127 (Denmark) and 706 728 (Alberta) pregnancies. The prevalence of preeclampsia increased over the study period in Denmark (2.5% to 2.9%) and Alberta (1.7% to 2.5%), with mean annual increases of 0.03 (95% confidence interval [CI] 0.02-0.04) and 0.06 (95% CI 0.05-0.07) percentage points, respectively. The prevalence of gestational diabetes also increased in Denmark (1.9% to 4.6%) and Alberta (3.9% to 9.2%), with average annual increases of 0.20 (95% CI 0.19-0.21) and 0.44 (95% CI 0.42-0.45) percentage points. Changes in the distributions of maternal age and BMI contributed to increases in the prevalence of both conditions but could not explain them entirely. CONCLUSIONS The prevalence of both preeclampsia and gestational diabetes increased significantly from 2005 to 2018, which portends future increases in chronic disease rates among affected women. Increasing demand for long-term follow up and care will amplify the existing pressure on healthcare systems.
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Affiliation(s)
- Frederikke Lihme
- Department of Epidemiology ResearchStatens Serum InstitutCopenhagenDenmark
| | - Ana Savu
- Canadian VIGOUR CenterUniversity of AlbertaEdmontonCanada
| | - Saima Basit
- Department of Epidemiology ResearchStatens Serum InstitutCopenhagenDenmark
| | - Winnie Sia
- Department of MedicineUniversity of AlbertaEdmontonCanada
| | - Rose Yeung
- Department of MedicineUniversity of AlbertaEdmontonCanada
| | | | - Leiah Luoma
- Canadian VIGOUR CenterUniversity of AlbertaEdmontonCanada
| | | | - Sandra Davidge
- Departments of Obstetrics/Gynecology and PhysiologyUniversity of AlbertaEdmontonCanada
| | - Colleen M. Norris
- Department of MedicineUniversity of AlbertaEdmontonCanada
- Faculty of NursingUniversity of AlbertaEdmontonCanada
- Women & Children Research InstituteUniversity of AlbertaEdmontonCanada
| | - Maria B. Ospina
- Department of Public Health SciencesQueen's UniversityKingstonOntarioCanada
| | - Christy‐Lynn Cooke
- Departments of Obstetrics/Gynecology and PhysiologyUniversity of AlbertaEdmontonCanada
| | - Russ Greiner
- Department of Computer ScienceUniversity of AlbertaEdmontonCanada
| | - Jan Wohlfahrt
- Department of Epidemiology ResearchStatens Serum InstitutCopenhagenDenmark
- Danish Cancer Society Research CenterCopenhagenDenmark
| | - Mads Melbye
- Danish Cancer Society Research CenterCopenhagenDenmark
| | - Jacob Lykke
- Department of Obstetrics and GynecologyRigshospitaletCopenhagenDenmark
| | - Padma Kaul
- Canadian VIGOUR CenterUniversity of AlbertaEdmontonCanada
- Department of MedicineUniversity of AlbertaEdmontonCanada
| | - Heather A. Boyd
- Department of Epidemiology ResearchStatens Serum InstitutCopenhagenDenmark
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Earp MA, Fassbender K, King S, Douglas M, Biondo P, Brisebois A, Davison SN, Sia W, Wasylenko E, Esau L, Simon J. Association between Goals of Care Designation orders and health care resource use among seriously ill older adults in acute care: a multicentre prospective cohort study. CMAJ Open 2022; 10:E945-E955. [PMID: 36319025 PMCID: PMC9633054 DOI: 10.9778/cmajo.20210155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Goals of Care Designation (GCD) is a medical order used to communicate the focus of a patient's care in Alberta, Canada. In this study, we aimed to determine the association between GCD type (resuscitative, medical or comfort) and resource use during hospitalization. METHODS This was a prospective cohort study of newly hospitalized inpatients in Alberta conducted from January to September 2017. Participants were aged 55 years or older with chronic obstructive pulmonary disease, congestive heart failure, cirrhosis, cancer or renal failure; aged 55-79 years and their provider answered "no" to the "surprise question" (i.e., provider would not be surprised if the patient died in the next 6 months); or aged 80 years or older with any acute condition. The exposure of interest was GCD. The primary outcome was health care resource use during admission, measured by length of stay (LOS), intensive care unit hours, Resource Intensity Weights (RIWs), flagged interventions and palliative care referral. The secondary outcome was 30-day readmission. Adjusted regression analyses were performed (adjusted for age, sex, race and ethnicity, Clinical Frailty Scale score, comorbidities and city). RESULTS We included 475 study participants. The median age was 83 (interquartile range 77-87) years, and 93.7% had a GCD at enrolment. Relative to patients with the resuscitative GCD type, patients with the medical GCD type had a longer LOS (1.42 times, 95% confidence interval [CI] 1.10-1.83) and a higher RIW (adjusted ratio 1.14, 95% CI 1.02-1.28). Patients with the comfort and medical GCD types had more palliative care referral (comfort GCD adjusted relative risk (RR) 9.32, 95% CI 4.32-20.08; medical GCD adjusted RR 3.58, 95% CI 1.75-7.33) but not flagged intervention use (comfort GCD adjusted RR 1.06, 95% CI 0.49-2.28; medical GCD adjusted RR 0.98, 95% CI 0.48-2.02) or 30-day readmission (comfort GCD adjusted RR 1.00, 95% CI 0.85-1.19; medical GCD adjusted RR 1.05, 95% CI 0.97-1.20). INTERPRETATION Goals of Care Designation type early during admission was associated with LOS, RIW and palliative care referral. This suggests an alignment between health resource use and the focus of care communicated by each GCD.
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Affiliation(s)
- Madalene A Earp
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - Konrad Fassbender
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - Seema King
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - Maureen Douglas
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - Patricia Biondo
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - Amanda Brisebois
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - Sara N Davison
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - Winnie Sia
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - Eric Wasylenko
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - LeAnn Esau
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta
| | - Jessica Simon
- Division of Palliative Medicine, Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Fassbender), Grey Nuns Community Hospital, St. Marguerite Health Services Centre; Division of Palliative Care Medicine, Department of Oncology (Fassbender), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (King), Cumming School of Medicine, University of Calgary; Division of Palliative Medicine, Department of Oncology (Douglas), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Covenant Health Palliative Institute (Douglas), Grey Nuns Community Hospital, St. Marguerite Health Services Centre, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Biondo), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine and Oncology (Palliative Care) (Brisebois) and Department of Medicine (Davison, Sia), University of Alberta, Edmonton, Alta.; Division of Palliative Medicine, Department of Oncology (Wasylenko), Cumming School of Medicine, University of Calgary, Calgary, Alta.; John Dossetor Health Ethics Centre, Faculty of Medicine and Dentistry (Wasylenko), University of Alberta, Edmonton, Alta.; Alberta Health Services, South Zone Seniors Health Integrated Home Care/Palliative Care (Esau), Edmonton, Alta.; Departments of Oncology, Medicine and Community Health Sciences (Simon), University of Calgary, Calgary, Alta.
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5
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Tung BW, Ng ZY, Kristanto W, Saw KW, Chan SP, Sia W, Chan KH, Chan M, Kong W, Lee R, Loh JP, Low AF, Poh KK, Tay E, Tan HC, Yeo TC, Loh PH. Characteristics and outcomes of young patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: retrospective analysis in a multiethnic Asian population. Open Heart 2021; 8:openhrt-2020-001437. [PMID: 33441469 PMCID: PMC7812097 DOI: 10.1136/openhrt-2020-001437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/06/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022] Open
Abstract
Objective ST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and outcomes of young versus older patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) to help focus public health efforts in STEMI prevention. Methods Data from the Coronary Care Unit database of the National University Hospital, Singapore from July 2015 to June 2019 were reviewed. Patients were divided into young (<50 years old) or older (≥50 years old) groups. Results Of the 1818 consecutive patients with STEMI who underwent PPCI, 465 (25.6%) were <50 years old. Young compared with older patients were more likely to be male, current smokers, of Indian ethnicity, have family history of ischaemic heart disease (IHD) and had lower 1 year mortality (3.4% vs 10.4%, p<0.0001). Although diabetes, hypertension or dyslipidaemia was less common among young patients, the prevalence of having any one of these risk factors was high in the range of 28% to 38%. Age was an independent predictor of mortality in the older but not younger patients with STEMI, and diabetes showed a trend towards mortality in both groups. Conclusion Young patients with STEMI are more often smokers, of Indian ethnicity and had family history of IHD, although cardiometabolic risk factors are also prevalent. Mortality is lower, but not negligible, among the young patients with STEMI. Public health efforts are needed to reduce the prevalence of these risk factors among the constitutionally susceptible population.
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Affiliation(s)
- Benjamin Wl Tung
- Cardiology, National University Heart Centre, Singapore .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhe Yan Ng
- Cardiology, National University Heart Centre, Singapore
| | - William Kristanto
- Cardiology, National University Heart Centre, Singapore.,Cardiology, Ng Teng Fong General Hospital, Singapore
| | | | - Siew-Pang Chan
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Winnie Sia
- Cardiology, National University Heart Centre, Singapore
| | - Koo Hui Chan
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Chan
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore
| | - William Kong
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ronald Lee
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore
| | - Joshua P Loh
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adrian F Low
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian Keong Poh
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Edgar Tay
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Huay Cheem Tan
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poay Huan Loh
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Carbonneau M, Eboreime EA, Hyde A, Campbell-Scherer D, Faris P, Gramlich L, Tsuyuki RT, Congly SE, Shaheen AA, Sadler M, Zeman M, Spiers J, Abraldes JG, Sugars B, Sia W, Green L, Abdellatif D, Schaefer JP, Selvarajah V, Marr K, Ryan D, Westra Y, Bakshi N, Varghese JC, Tandon P. The cirrhosis care Alberta (CCAB) protocol: implementing an evidence-based best practice order set for the management of liver cirrhosis - a hybrid type I effectiveness-implementation trial. BMC Health Serv Res 2020; 20:558. [PMID: 32552833 PMCID: PMC7301349 DOI: 10.1186/s12913-020-05427-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Liver cirrhosis is a leading cause of morbidity, premature mortality and acute care utilization in patients with digestive disease. In the province of Alberta, hospital readmission rates for patients with cirrhosis are estimated at 44% at 90 days. For hospitalized patients, multiple care gaps exist, the most notable stemming from i) the lack of a structured approach to best practice care for cirrhosis complications, ii) the lack of a structured approach to broader health needs and iii) suboptimal preparation for transition of care into the community. Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial which aims to address these gaps. The proposed intervention is initiated at the time of hospitalization through implementation of a clinical information system embedded electronic order set for delivering evidence-based best practices under real-world conditions. The overarching objective of the CCAB trial is to demonstrate effectiveness and implementation feasibility for use of the order set in routine patient care within eight hospital sites in Alberta. METHODS A mixed methods hybrid type I effectiveness-implementation design will be used to evaluate the effectiveness of the order set intervention. The primary outcome is a reduction in 90-day cumulative length of stay. Implementation outcomes such as reach, adoption, fidelity and maintenance will also be evaluated alongside other patient and service outcomes such as readmission rates, quality of care and cost-effectiveness. This theory-based trial will be guided by Normalization Process Theory, Consolidated Framework on Implementation Research (CFIR) and the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) Framework. DISCUSSION The CCAB project is unique in its breadth, both in the comprehensiveness of the multi-component order set and also for the breadth of its roll-out. Lessons learned will ultimately inform the feasibility and effectiveness of this approach in "real-world" conditions as well as adoption and adaptation of these best practices within the rest of Alberta, other provinces in Canada, and beyond. TRIAL REGISTRATION ClinicalTrials.gov: NCT04149223, November 4, 2019.
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Affiliation(s)
- Michelle Carbonneau
- Alberta Health Services, Edmonton & Calgary, AB, Canada
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB, T6G2X8, Canada
| | - Ejemai Amaize Eboreime
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB, T6G2X8, Canada
| | - Ashley Hyde
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB, T6G2X8, Canada
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Peter Faris
- Alberta Health Services, Edmonton & Calgary, AB, Canada
| | - Leah Gramlich
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB, T6G2X8, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, AB, Canada
- Department of Pharmacology, University of Alberta, Edmonton, AB, Canada
| | - Stephen E Congly
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Abdel Aziz Shaheen
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Matthew Sadler
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - Marilyn Zeman
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB, T6G2X8, Canada
| | - Jude Spiers
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Juan G Abraldes
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB, T6G2X8, Canada
- Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta, Edmonton, AB, T6G2X8, Canada
| | - Benjamin Sugars
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Winnie Sia
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lee Green
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dalia Abdellatif
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey P Schaefer
- Department of Medicine, Division of General Internal Medicine, University of Calgary, Calgary, AB, Canada
| | - Vijeyakumar Selvarajah
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB, T6G2X8, Canada
| | - Kaleb Marr
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - David Ryan
- Central Alberta Digestive Disease Specialists, Red Deer, AB, Canada
| | - Yolande Westra
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Neeja Bakshi
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jayant C Varghese
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Puneeta Tandon
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB, T6G2X8, Canada.
- Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta, Edmonton, AB, T6G2X8, Canada.
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7
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Tse E, Khurana R, Clarke G, Sia W. Using anti-Xa level for adjusting intravenous unfractionated heparin infusion in peripartum thromboembolic disease. Obstet Med 2019; 12:146-150. [PMID: 31523272 DOI: 10.1177/1753495x18772993] [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: 06/19/2017] [Accepted: 03/01/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intravenous unfractionated heparin infusion is often used to minimize the duration of time without anticoagulation around delivery in pregnant patients with high thrombotic risk. Activated partial thromboplastin time is commonly used to monitor and adjust heparin dose. However, using activated partial thromboplastin time is problematic in pregnancy because activated partial thromboplastin time response to unfractionated heparin is attenuated due to elevated Factor VIII levels and may lead to incorrect dosing. CASE We report a case of deep venous thrombosis occurring in a term pregnancy managed by intravenous unfractionated heparin adjusted using anti-Xa level around the time of delivery. We modified the intravenous unfractionated heparin nomogram by using anti-Xa levels instead of activated partial thromboplastin time and observed lower dosing of unfractionated heparin than otherwise required to achieve and maintain target levels. CONCLUSION This report demonstrates the feasibility and effectiveness of using anti-Xa level to monitor and adjust intravenous unfractionated heparin infusion in pregnancy.
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Affiliation(s)
- Enrica Tse
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Rshmi Khurana
- Departments of Medicine and Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Gwen Clarke
- Canadian Blood Services, Edmonton, Alberta, Canada
| | - Winnie Sia
- Departments of Medicine and Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
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8
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Gill MM, Sia W, Hoskinson M, Niven E, Khurana R. The use of PET/CT in pregnancy: A case report of malignant parathyroid carcinoma and a review of the literature. Obstet Med 2017; 11:45-49. [PMID: 29636815 DOI: 10.1177/1753495x17724950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/23/2017] [Indexed: 12/11/2022] Open
Abstract
Positron emission tomography scanning is not commonly performed in pregnancy but can be done if required. Fetal doses of radiation can be minimized, and our case exemplifies the safe application of positron emission tomography/computed tomography in pregnancy. A 38-year-old woman in her first ongoing pregnancy presented at 28 weeks' gestation with symptomatic hypercalcemia. Given a history of parathyroid carcinoma, recurrence was suspected. Ultrasound and magnetic resonance imaging failed to locate the lesion. However, positron emission tomography/computed tomography identified a culprit supraclavicular lymph node. This was excised under local anesthesia resulting in normalization of parathyroid hormone and calcium levels. A term, healthy baby was delivered. The literature provides support that the use of positron emission tomography/computed tomography is acceptable when indicated, and there are modifications to protocols that can further limit risk.
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Affiliation(s)
| | - Winnie Sia
- 1Department of Medicine, University of Alberta, Edmonton, Canada.,2Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Michael Hoskinson
- 3Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Erin Niven
- 4Diagnostic Imaging, Alberta Health Services, Edmonton, Canada
| | - Rshmi Khurana
- 1Department of Medicine, University of Alberta, Edmonton, Canada.,2Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
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Abstract
Obstetric medicine is a growing area of interest within internal medicine in Canada. Canadians continue to travel broadly to obtain relevant training, particularly in the United Kingdom. However, there is now a sufficient body of expertise in Canada that a cadre of 'home-grown' obstetric internists is emerging and staying within Canada to improve maternity care. As this critical mass of practitioners grows, it is apparent that models of obstetric medicine delivery have developed according to local needs and patterns of practice. This article aims to describe the state of obstetric medicine in Canada, including general internal medicine services as the rock on which Canadian obstetric medicine has been built, the Canadian training curriculum and opportunities, organisation of obstetric medicine service delivery and the future.
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Affiliation(s)
- Laura A Magee
- Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK; Department of Obstetrics and Gynaecology, St. George's Hospital and NHS Foundation Trust, London, UK
| | - Anne-Marie Cote
- Department of Medicine, Université de Sherbrooke, Québec, Canada
| | - Geena Joseph
- Department of Medicine, McMaster University, Ontario, Canada
| | - Tabassum Firoz
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Winnie Sia
- Department of Medicine, University of Alberta, Alberta, Canada
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Affiliation(s)
- Mathew P Estey
- DynaLIFEDx, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta;
| | - Gwen Clarke
- Royal Alexandra Hospital, University of Alberta
| | - Winnie Sia
- Departments of Medicine and Obstetrics and Gynecology, University of Alberta, Alberta, Canada
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11
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Janmohamed R, Montgomery-Fajic E, Sia W, Germaine D, Wilkie J, Khurana R, Nerenberg KA. Cardiovascular Risk Reduction and Weight Management at a Hospital-Based Postpartum Preeclampsia Clinic. Journal of Obstetrics and Gynaecology Canada 2015; 37:330-337. [DOI: 10.1016/s1701-2163(15)30283-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Geenes V, Chambers J, Khurana R, Shemer EW, Sia W, Mandair D, Elias E, Marschall HU, Hague W, Williamson C. Rifampicin in the treatment of severe intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol 2015; 189:59-63. [PMID: 25864112 DOI: 10.1016/j.ejogrb.2015.03.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/23/2015] [Accepted: 03/19/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To describe the use of combined ursodeoxycholic acid (UDCA) and rifampicin treatment in intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN A questionnaire survey of 27 women with 28 affected pregnancies identified via the UK and International Obstetric Medicine forum. The clinical case notes of women with ICP treated with combined UDCA and rifampicin therapy were reviewed, and data regarding maternal and perinatal outcomes extracted. RESULTS Serum bile acids remained high whilst taking UDCA as monotherapy. In 14 pregnancies (54%) serum bile acids decreased following the introduction of rifampicin. In 10 pregnancies (38%), there was a 50% reduction in serum bile acids. There were no adverse effects reported with either drug. CONCLUSIONS This is the first report of the use of rifampicin in ICP. The data suggest that combined treatment with UDCA and rifampicin is an effective way of treating women with severe ICP who do not respond to treatment with UDCA alone.
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Affiliation(s)
- Victoria Geenes
- Women's Health Academic Centre, King's College London, London, United Kingdom
| | - Jenny Chambers
- Women's Health Research Centre, Imperial College London, London, United Kingdom
| | - Rshmi Khurana
- Royal Alexandra Hospital, University of Alberta, Edmonton, Canada
| | - Elisabeth Wikstrom Shemer
- Department of Women's and Children's Health, Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - Winnie Sia
- Royal Alexandra Hospital, University of Alberta, Edmonton, Canada
| | - Dalvinder Mandair
- Liver Unit, University of Birmingham Trust Hospital, Birmingham, United Kingdom
| | - Elwyn Elias
- Liver Unit, University of Birmingham Trust Hospital, Birmingham, United Kingdom
| | | | - William Hague
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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13
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Lin W, Lee GK, Loh JP, Tay EL, Sia W, Lau TC, Hooi SC, Poh KK. Effectiveness of early cardiology undergraduate learning using simulation on retention, application of learning and level of confidence during clinical clerkships. Singapore Med J 2015; 56:98-102. [PMID: 25715855 PMCID: PMC4350465 DOI: 10.11622/smedj.2015023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
INTRODUCTION This study aimed to assess the effectiveness of the use of a cardiopulmonary patient simulator in the teaching of second-year medical students. Effectiveness was measured in terms of the extent of knowledge retention and students' ability to apply the skills learned in subsequent real-life patient contact. METHODS In this study, ten third-year medical students who had previously undergone simulator training as part of their second-year curriculum underwent an objective structured clinical examination (OSCE) and a multiple-choice question (MCQ) test to assess their ability to apply the knowledge gained during the simulator training when dealing with real patients. The performance of this group of students was compared with that of a group of ten fourth-year medical students who did not undergo simulation training. RESULTS Although the third-year medical students performed well in the OSCE, they were outperformed by the group of fourth-year medical students, who had an extra year of clinical exposure. The MCQ scores of the two groups of students were similar. Post-simulation training survey revealed that students were generally in favour of incorporating cardiopulmonary simulator training in the preclinical curriculum. CONCLUSION Cardiopulmonary simulator training is a useful tool for the education of preclinical medical students. It aids the translation of preclinical knowledge into real-life clinical skills.
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Affiliation(s)
| | | | | | | | | | | | | | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228.
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14
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Affiliation(s)
| | | | | | | | | | | | - Winnie Sia
- University of Alberta, 332 Community Services Centre, 10240 Kingsway Avenue, Edmonton, Alberta T5H 3V9, Canada
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15
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Abstract
BACKGROUND Women with venous thromboembolism (VTE), thrombophilias or mechanical heart valves may require anticoagulation during pregnancy and postpartum. The incidence of postpartum hemorrhage (PPH) in the literature is 2.9-6%, but the rate while on anticoagulation is not well documented. AIMS To determine the incidence of haemorrhagic complications associated with the use of peripartum anticoagulation, and the types and risk factors for haemorrhagic complications. METHODS A retrospective chart review was conducted on women who delivered at an academic teaching hospital and received peripartum anticoagulation between January 2000 and August 2009. Women with known bleeding disorders were excluded. RESULTS In total, 195 cases were identified with mean age 31.3 years and gestational age of 37.7 weeks. Of these, 49% had a history of VTE, 21% had active VTE in the index pregnancy, and 63% had vaginal delivery. Types of anticoagulation used antepartum were unfractionated heparin (UFH) (43%) and low molecular weight heparin (LMWH) (36%), with 26% receiving therapeutic doses. The rate of haemorrhagic complications was 12.8%, with majority being PPH (80%). Sixty percent of the PPH occurred before reintroduction of anticoagulation postpartum. Use of therapeutic UFH antepartum was associated with increased risk of haemorrhagic complications compared to LMWH (OR 3.08, 95% CI 0.663 - 15.03, p = 0.183). CONCLUSION The rate of haemorrhagic complications is higher in women on peripartum anticoagulation compared with published incidence in unselected obstetric populations; however, this rate is similar to our institution's reported rates. Our findings inform clinicians about competing risks of thrombotic and haemorrhagic complications in this population.
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Affiliation(s)
| | - Catherine A Marnoch
- Department of Medicine and Department of Obstetrics and Gynaecology, Waitemata District Health Board, Auckland, New Zealand
| | - Rshmi Khurana
- Department of Medicine and Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Winnie Sia
- Department of Medicine and Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Nesé Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
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Poh KK, Xu X, Chan MY, Lee CH, Tay EL, Low AF, Chan KH, Sia W, Tang LQ, Tan HC, Lui CY, Nguyen V, Fujise K, Huang MH. Safety of combination therapy with milrinone and esmolol for heart protection during percutaneous coronary intervention in acute myocardial infarction. Eur J Clin Pharmacol 2014; 70:527-30. [PMID: 24463539 DOI: 10.1007/s00228-014-1650-9] [Citation(s) in RCA: 4] [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] [Received: 12/10/2013] [Accepted: 01/11/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Ischemia/reperfusion injury remains an untreated clinical problem in patients with acute myocardial infarction (AMI) despite significant advances in emergent revascularization through percutaneous coronary intervention (PCI). Pharmacological intervention for infarct size reduction is unavailable. We have identified that the medications milrinone and esmolol, when administered together at the beginning of the reperfusion, significantly decrease infarct size via reducing reperfusion injury in an experimental model. The present study tested the safety of combination therapy of milrinone and esmolol (M + E) in patients with AMI. METHODS Sixteen subjects with AMI requiring PCI were consecutively recruited. M + E was intravenously infused simultaneously for 10 min started at 5 min before anticipated angioplasty balloon inflation. Another 16 consecutively recruited AMI patients requiring PCI served as a placebo arm treated per routine clinical protocol. Blood pressure (BP) and heart rate (HR) were monitored continuously during PCI. RESULTS M + E combination therapy resulted in a trend of non-significant reduction in BP compared with a control group. There was a modest but significant increase in HR at the later phase of M + E infusion compared with a control group. No significant cardiac arrhythmia was induced during M + E infusion. CONCLUSIONS The combination therapy with M + E produces a minimal change in hemodynamics and appears safe as an adjunctive therapy to PCI in AMI patients. Further studies are warranted.
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Affiliation(s)
- Kian-Keong Poh
- Cardiac Department, National University Heart Center, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore, 19228, Singapore,
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17
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Li Y, Tai BC, Sia W, Phua QH, Richards MA, Low A, Chan KH, Teo SG, Sim TB, Lee CH, Roe MT, Yeo TC, Tan HC, Chan MY. Angiographic and platelet reactivity outcomes with prasugrel 60 mg pretreatment and clopidogrel 600 mg pretreatment in primary percutaneous coronary intervention. J Thromb Thrombolysis 2012; 34:499-505. [DOI: 10.1007/s11239-012-0782-y] [Citation(s) in RCA: 6] [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] [Indexed: 11/28/2022]
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18
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Nevis IF, Reitsma A, Dominic A, McDonald S, Thabane L, Akl EA, Hladunewich M, Akbari A, Joseph G, Sia W, Iansavichus AV, Garg AX. Pregnancy outcomes in women with chronic kidney disease: a systematic review. Clin J Am Soc Nephrol 2011; 6:2587-98. [PMID: 21940842 DOI: 10.2215/cjn.10841210] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Pregnant women with chronic kidney disease (CKD) are at risk of adverse maternal and fetal outcomes. We conducted a systematic review of observational studies that described this risk. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We searched several databases from their date of inception through June 2010 for eligible articles published in any language. We included any study that reported maternal or fetal outcomes in at least five pregnant women in each group with or without CKD. We excluded pregnant women with a history of transplantation or maintenance dialysis. RESULTS We identified 13 studies. Adverse maternal events including gestational hypertension, pre-eclampsia, eclampsia, and maternal mortality were reported in 12 studies. There were 312 adverse maternal events among 2682 pregnancies in women with CKD (weighted average of 11.5%) compared with 500 events in 26,149 pregnancies in normal healthy women (weighted average of 2%). One or more adverse fetal outcomes such as premature births, intrauterine growth restriction, small for gestational age, neonatal mortality, stillbirths, and low birth weight were reported in nine of the included studies. Overall, the risk of developing an adverse fetal outcome was at least two times higher among women with CKD compared with those without. CONCLUSIONS This review summarizes current available evidence to guide physicians in their decision-making, advice, and care for pregnant women with CKD. Additional studies are needed to better characterize the risks.
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Affiliation(s)
- Immaculate F Nevis
- Department of Medicine, University of Western Ontario, London, Ontario, Canada.
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Griffiths J, Sia W, Shapiro AMJ, Tataryn I, Turner AR. Laparoscopic splenectomy for the treatment of refractory immune thrombocytopenia in pregnancy. J Obstet Gynaecol Can 2006; 27:771-4. [PMID: 16287009 DOI: 10.1016/s1701-2163(16)30729-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Immune thrombocytopenic purpura (ITP) is a condition with potential hazard during pregnancy for both mother and fetus if platelet concentrations fall below a critical level. This report describes the use of laparoscopic splenectomy following unsuccessful medical management. CASE A 35-year-old primigravid woman with systemic lupus erythematosis (SLE) developed ITP several years before becoming pregnant. She was treated early in pregnancy with high-dose oral prednisone and weekly intravenous immunoglobulin (IVIG) alternating with anti-D immune globulin, but laparoscopic splenectomy was indicated at 20 weeks' gestation because of thrombocytopenia. Following surgery, she continued prednisone and intermittent IVIG therapy until spontaneous delivery at 34 weeks' gestation. A small accessory spleen was identified postpartum by nuclear medicine scan. Satisfactory platelet concentrations were maintained postpartum using danazol and prednisone. CONCLUSION Laparoscopic splenectomy is a therapeutic option for women with ITP during pregnancy that fails to respond to medical management.
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Affiliation(s)
- Jill Griffiths
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB
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