2024-03-29T15:04:12Z
http://ir.lib.uwo.ca/do/oai/
oai:ir.lib.uwo.ca:ptpub-1000
2009-05-14T23:06:21Z
publication:pt
publication:faculties
publication:epidem
publication:ptpub
publication:epidempub
Change in Patient Concerns Following Total Knee Arthroplasty Described with the International Classification of Functioning, Disability and Health: A Repeated Measures Design
Rastogi, Ravi
Chesworth, Bert M.
Davis, Aileen M.
Background: There is no published evidence of how patient concerns change during the first six weeks following total knee arthroplasty (TKA). An understanding of the recovery process from the patient's perspective will inform clinicians on how to best educate patients about their postoperative concerns. Our objectives were to (1) quantify the level of importance for each of 32 previously identified concerns pre-operatively, and across the first six weeks following primary TKA and, (2) convey this change in importance post-operatively using the components of the International Classification of Functioning, Disability and Health (ICF).
Methods: The objectives were achieved using a repeated measures design. Convenience sampling was used to recruit 54 consecutive patients undergoing primary TKA at a hospital in Ontario, Canada. Pre-operatively and at two, four and six weeks post-operatively subjects rated the level of importance for each of the 32 previously identified patient concerns
Results: The importance rating of patient concerns in all four ICF components changed from before surgery to two weeks after surgery. Patient concerns in the Participation component became increasingly important after the first two weeks following surgery. Post-operatively from week two to week four, changes in importance ratings were also found in the Body Function and Activity components, but not in the Environmental Factors component.
Conclusion: Changes in patient concerns mirror their early recovery from TKA surgery. Consistent with this, Participation restrictions become increasingly important to patients after discharge from acute care suggesting that clinicians should think of managing patient expectations for return to societal roles early in post-operative rehabilitation.
2008-12-11T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/1
http://www.hqlo.com/content/6/1/112
Physical Therapy Publications
Scholarship@Western
Patient concern
Total knee arthroplasty
Post-operative rehabilitation
International Classification of Functioning
Disability and Health
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1001
2009-05-14T23:05:05Z
publication:pt
publication:faculties
publication:epidem
publication:ptpub
publication:epidempub
A Cross-sectional Look at Patient Concerns in the First Six Weeks Following Primary Total Knee Arthroplasty
Rastogi, Ravi
Davis, Aileen M.
Chesworth, Bert M.
Background: To date, no researchers have investigated patient concerns in the first six weeks following primary total knee arthroplasty (TKA). An understanding of patient concerns at a time when physical therapists are involved in the treatment of these patients will aid clinicians in providing patient-centered care. Linking of items to the International Classification of Functioning, Disability and Health (ICF) allows for comparison and sharing of data amongst researchers, as the ICF is the accepted framework for evaluating disability in rehabilitation. The objective of this study was to identify patient concerns in the first six weeks following primary TKA and link these concerns to components of the ICF and map them to commonly used outcome measures.
Methods: Individual interviews were conducted to identify patient concerns during their recovery following primary TKA. Concerns identified by patients were analysed for content and linked to the components of the ICF using the operational definitions of the ICF components. These concerns were mapped to the WOMAC, KOOS and Oxford Knee Scale.
Results: Thirty patients (18 female) with an average age (SD) of 68.4 (11.1) years completed the study. Patients identified 32 concerns. Twenty-two percent (n = 7) of the concerns linked to Body Function and Structure, 47% (n = 15) to Activity, 13% (n = 4) to Participation, and 13% (n = 4) to the Environmental Factors component of the ICF. Six percent (n = 2) of the concerns did not link to the ICF. Of the 32 concerns identified by patients 14 mapped to the KOOS, 11 to the WOMAC and 4 to the Oxford Knee Scale.
Conclusion: Patient concerns linked to four different components of the ICF indicating that patients are involved in or are thinking of multiple aspects of life even in this early phase of recovery. The KOOS was found to be the most appropriate for use based on the patients' perspective. However, less than half of the concerns identified by patients were covered by the KOOS, WOMAC or Oxford Knee Scale indicating that other existing measures that evaluate the concepts identified as important to patients should be considered when evaluating outcomes during this acute phase of recovery following primary TKA.
2007-08-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/2
http://www.hqlo.com/content/5/1/48
Physical Therapy Publications
Scholarship@Western
Patient concern
Total knee arthroplasty
International Classification of Functioning
Disability and Health
Physical Therapy
oai:ir.lib.uwo.ca:epidempub-1000
2009-05-15T22:59:39Z
publication:faculties
publication:epidem
publication:epidempub
Community-based Randomised Controlled Trial Evaluating Falls and Osteoporosis Risk Management Strategies
Ciaschini, P. M.
Straus, S. E.
Dolovich, L. R.
Goeree, R. A.
Leung, K. M.
Woods, C. R.
Zimmerman, G. M.
Majumdar, S. R.
Spadafora, S.
Fera, L. A.
Lee, H. N.
Background: Osteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis, as well as prevention of fractures and falls, are substantially underutilized. This paper outlines the protocol for a pragmatic randomised trial of a multifaceted community-based care program aimed at optimizing the evidence-based management of falls and fractures in patients at risk.
Design: 6-month randomised controlled study.
Methods: This population-based study was completed in the Algoma District of Ontario, Canada a geographically vast area with Sault Ste Marie (population 78 000) as its main city. Eligible patients were allocated to an immediate intervention protocol (IP) group, or a delayed intervention protocol (DP) group. The DP group received usual care for 6 months and then was crossed over to receive the interventions. Components of the intervention were directed at the physicians and their patients and included patient-specific recommendations for osteoporosis therapy as outlined by the clinical practice guidelines developed by Osteoporosis Canada, and falls risk assessment and treatment. Two primary outcomes were measured including implementation of appropriate osteoporosis and falls risk management. Secondary outcomes included quality of life and the number of falls, fractures, and hospital admissions over a twelve-month period. The patient is the unit of allocation and analysis. Analyses will be performed on an intention to treat basis.
Discussion: This paper outlines the protocol for a pragmatic randomised trial of a multi-faceted, community-based intervention to optimize the implementation of evidence based management for patients at risk for falls and osteoporosis.
Trial Registration: This trial has been registered with clinicaltrials.gov (ID: NCT00465387)
2008-11-04T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/1
http://www.trialsjournal.com/content/9/1/62
Epidemiology and Biostatistics Publications
Scholarship@Western
Osteoporosis
Fracture
Community-based care program
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1001
2011-06-30T00:13:35Z
publication:faculties
publication:epidem
publication:epidempub
Is Reporting on Interventions a Weak Link in Understanding How and Why They Work? A Preliminary Exploration Using Community Heart Health Exemplars
Riley, Barbara L.
MacDonald, JoAnne
Mansi, Omaima
Kothari, Anita
Kurtz, Donna
vonTettenborn, Linda I.
Edwards, Nancy C.
Background: The persistent gap between research and practice compromises the impact of multi-level and multi-strategy community health interventions. Part of the problem is a limited understanding of how and why interventions produce change in population health outcomes. Systematic investigation of these intervention processes across studies requires sufficient reporting about interventions. Guided by a set of best processes related to the design, implementation, and evaluation of community health interventions, this article presents preliminary findings of intervention reporting in the published literature using community heart health exemplars as case examples. Methods: The process to assess intervention reporting involved three steps: selection of a sample of community health intervention studies and their publications; development of a data extraction tool; and data extraction from the publications. Publications from three well-resourced community heart health exemplars were included in the study: the North Karelia Project, the Minnesota Heart Health Program, and Heartbeat Wales. Results: Results are organized according to six themes that reflect best intervention processes: integrating theory, creating synergy, achieving adequate implementation, creating enabling structures and conditions, modifying interventions during implementation, and facilitating sustainability. In the publications for the three heart health programs, reporting on the intervention processes was variable across studies and across processes. Conclusion: Study findings suggest that limited reporting on intervention processes is a weak link in research on multiple intervention programs in community health. While it would be premature to generalize these results to other programs, important next steps will be to develop a standard tool to guide systematic reporting of multiple intervention programs, and to explore reasons for limited reporting on intervention processes. It is our contention that a shift to more inclusive reporting of intervention processes would help lead to a better understanding of successful or unsuccessful features of multi-strategy and multi-level interventions, and thereby improve the potential for effective practice and outcomes.
2008-05-20T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/2
info:doi/10.1186/1748-5908-3-27
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2413262/
Epidemiology and Biostatistics Publications
Scholarship@Western
Community health intervention
Community heart health exemplar
Reporting of intervention process
Biostatistics
Community Health and Preventive Medicine
Epidemiology
Nursing
oai:ir.lib.uwo.ca:epidempub-1002
2018-02-09T20:14:52Z
publication:pmid
publication:faculties
publication:epidem
publication:epidempub
Mapping as a Knowledge Translation Tool for Ontario Early Years Centres: Views from Data Analysts and Managers
Kothari, Anita
Driedger, S. Michelle
Bickford, Julia
Morrison, Jason
Sawada, Michael
Graham, Ian D.
Crighton, Eric
Background: Local Ontario Early Years Centres (OEYCs) collect timely and relevant local data, but knowledge translation is needed for the data to be useful. Maps represent an ideal tool to interpret local data. While geographic information system (GIS) technology is available, it is less clear what users require from this technology for evidence-informed program planning. We highlight initial challenges and opportunities encountered in implementing a mapping innovation (software and managerial decision-support) as a knowledge translation strategy. Methods: Using focus groups, individual interviews and interactive software development events, we taped and transcribed verbatim our interactions with nine OEYCs in Ontario, Canada. Research participants were composed of data analysts and their managers. Deductive analysis of the data was based on the Ottawa Model of Research Use, focusing on the innovation (the mapping tool and maps), the potential adopters, and the environment. Results: Challenges associated with the innovation included preconceived perceptions of a steep learning curve with GIS software. Challenges related to the potential adopters included conflicting ideas about tool integration into the organization and difficulty with map interpretation. Lack of funds, lack of availability of accurate data, and unrealistic reporting requirements represent environmental challenges. Conclusion: Despite the clear need for mapping software and maps, there remain several challenges to their effective implementation. Some can be modified, while other challenges might require attention at the systemic level. Future research is needed to identify barriers and facilitators related to using mapping software and maps for decision-making by other users, and to subsequently develop mapping best practices guidelines to assist community-based agencies in circumventing some challenges, and support information equity across a region.
2008-01-18T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/3
info:doi/10.1186/1748-5908-3-4
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265301/
Epidemiology and Biostatistics Publications
Scholarship@Western
Local Ontario Early Years Centre
Knowledge translation
Mapping
Biostatistics
Community Health and Preventive Medicine
Epidemiology
Human Geography
oai:ir.lib.uwo.ca:epidempub-1003
2011-06-30T00:27:44Z
publication:faculties
publication:epidem
publication:epidempub
Correction: Using Participatory Design to Develop (Public) Health Decision Support Systems through GIS
Driedger, S. Michelle
Kothari, Anita
Morrison, Jason
Sawada, Michael
Crighton, Eric J.
Graham, Ian D.
Background: Organizations that collect substantial data for decision-making purposes are often characterized as being 'data rich' but 'information poor'. Maps and mapping tools can be very useful for research transfer in converting locally collected data into information. Challenges involved in incorporating GIS applications into the decision-making process within the non-profit (public) health sector include a lack of financial resources for software acquisition and training for nonspecialists to use such tools. This on-going project has two primary phases. This paper critically reflects on Phase 1: the participatory design (PD) process of developing a collaborative web-based GIS tool. Methods: A case study design is being used whereby the case is defined as the data analyst and manager dyad (a two person team) in selected Ontario Early Year Centres (OEYCs). Multiple cases are used to support the reliability of findings. With nine producer/user pair participants, the goal in Phase 1 was to identify barriers to map production, and through the participatory design process, develop a web-based GIS tool suited for data analysts and their managers. This study has been guided by the Ottawa Model of Research Use (OMRU) conceptual framework. Results: Due to wide variations in OEYC structures, only some data analysts used mapping software and there was no consistency or standardization in the software being used. Consequently, very little sharing of maps and data occurred among data analysts. Using PD, this project developed a web-based mapping tool (EYEMAP) that was easy to use, protected proprietary data, and permit limited and controlled sharing between participants. By providing data analysts with training on its use, the project also ensured that data analysts would not break cartographic conventions (e.g. using a chloropleth map for count data). Interoperability was built into the web-based solution; that is, EYEMAP can read many different standard mapping file formats (e.g. ESRI, MapInfo, CSV). Discussion: Based on the evaluation of Phase 1, the PD process has served both as a facilitator and a barrier. In terms of successes, the PD process identified two key components that are important to users: increased data/map sharing functionality and interoperability. Some of the challenges affected developers and users; both individually and as a collective. From a development perspective, this project experienced difficulties in obtaining personnel skilled in web application development and GIS. For users, some data sharing barriers are beyond what a technological tool can address (e.g. third party data). Lastly, the PD process occurs in real time; both a strength and a limitation. Programmatic changes at the provincial level and staff turnover at the organizational level made it difficult to maintain buy-in as participants changed over time. The impacts of these successes and challenges will be evaluated more concretely at the end of Phase 2. Conclusion: PD approaches, by their very nature, encourage buy-in to the development process, better addresses user-needs, and creates a sense of user-investment and ownership.
2007-11-27T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/4
info:doi/10.1186/1476-072X-6-53
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2175500/
Epidemiology and Biostatistics Publications
Scholarship@Western
Participatory design
Ontario Early Year Centre
Health decision support system
Mapping
Biostatistics
Community Health and Preventive Medicine
Epidemiology
Human Geography
oai:ir.lib.uwo.ca:epidempub-1004
2018-02-09T20:16:24Z
publication:pmid
publication:faculties
publication:epidem
publication:epidempub
Comparison of Two Dependent within Subject Coefficients of Variation to Evaluate the Reproducibility of Measurement Devices
Shoukri, Mohamed M.
Colak, Dilek
Kaya, Namik
Donner, Allan
Background: The within-subject coefficient of variation and intra-class correlation coefficient are commonly used to assess the reliability or reproducibility of interval-scale measurements. Comparison of reproducibility or reliability of measurement devices or methods on the same set of subjects comes down to comparison of dependent reliability or reproducibility parameters. Methods: In this paper, we develop several procedures for testing the equality of two dependent within-subject coefficients of variation computed from the same sample of subjects, which is, to the best of our knowledge, has not yet been dealt with in the statistical literature. The Wald test, the likelihood ratio, and the score tests are developed. A simple regression procedure based on results due to Pitman and Morgan is constructed. Furthermore we evaluate the statistical properties of these methods via extensive Monte Carlo simulations. The methodologies are illustrated on two data sets; the first are the microarray gene expressions measured by two plat- forms; the Affymetrix and the Amersham. Because microarray experiments produce expressions for a large number of genes, one would expect that the statistical tests to be asymptotically equivalent. To explore the behaviour of the tests in small or moderate sample sizes, we illustrated the methodologies on data from computer-aided tomographic scans of 50 patients. Results: It is shown that the relatively simple Wald's test (WT) is as powerful as the likelihood ratio test (LRT) and that both have consistently greater power than the score test. The regression test holds its empirical levels, and in some occasions is as powerful as the WT and the LRT. Conclusion: A comparison between the reproducibility of two measuring instruments using the same set of subjects leads naturally to a comparison of two correlated indices. The presented methodology overcomes the difficulty noted by data analysts that dependence between datasets would confound any inferences one could make about the differences in measures of reliability and reproducibility. The statistical tests presented in this paper have good properties in terms of statistical power.
2008-04-22T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/5
http://www.biomedcentral.com/1471-2288/8/24
Epidemiology and Biostatistics Publications
Scholarship@Western
Measurement device
Wald's test
Likelihood ratio test
Analytical, Diagnostic and Therapeutic Techniques and Equipment
Biostatistics
oai:ir.lib.uwo.ca:nursingpub-1079
2009-09-26T01:55:40Z
publication:socialworkpub
publication:affiliates
publication:faculties
publication:nursing
publication:epidem
publication:nursingpub
publication:kings
publication:epidempub
De”myth”ifying Mental Health – Findings from a Community University Research Alliance (CURA)
Csiernik, Rick
Forchuk, Cheryl
Speechley, Mark
Ward-Griffin, Catherine
Many myths exist regarding mental illness and those with mental health issues. Under the auspices of a Community-University Research Alliance on Housing and Mental Health, a partnership between academics, community health and social service agencies and representatives of consumer-survivor groups, fourteen consumer-survivor and eight family member focus groups were held throughout Southwestern Ontario. Individual interviews were also conducted with 150 male and 150 female community-based mental health system consumer-survivors living in a variety of housing environments in London, Ontario. The findings dispute beliefs around four myths: that people with mental health problems are a homogenous population, which was highlighted by significant differences between men and women in frequency and length of psychiatric hospitalizations, primary diagnosis, problem severity, psychoactive drug use and sexual abuse, are unemployed because they are uneducated, are violent and dangerous and thus spend extended periods of time incarcerated and are unsupported by their families which then leads to housing problems. Challenging these and other equally erroneous myths is essential in responding to the oppression faced by mental-health consumer-survivors and in developing a national strategy for mental health.
2007-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/nursingpub/76
http://web4.uwindsor.ca/units/socialwork/critical.nsf/main/BD3948F914D437A485257372005FF228?OpenDocument
Nursing Publications
Scholarship@Western
mental health
Ontario
Community University Research Alliance
Nursing
Public Affairs, Public Policy and Public Administration
Public Health
oai:ir.lib.uwo.ca:nursingpub-1091
2009-11-05T02:46:18Z
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:nursing
publication:epidem
publication:nursingpub
publication:epidempub
Can We Afford Consumers Choice in Home Care?
McWilliam, Carol L.
Hoch, Jeffrey S.
Coyte, Peter C.
Stewart, Moira
Vingilis, Evelyn
Ward-Griffin, Catherine
Donner, Allan
Browne, Gina
Anderson, Karen
As demands for home care escalate in a system concerned with cost containments, initiatives promoting client involvement in the management oftheir chronic illnesses and attendant services have attracted increasing attention. For longer term in-home care, varied approaches to case management reflect these trends. This article reports a study exploring the cost consequences of clients' choice of three approaches to case management within a single home care context. The first involved leaving the control of services and care to the system's case manager. The second option was to share this control in partnership with their in-home service providers. The third approach featured clients directing their own case management Overall the average costs per month of services for clients in the three groups did not differ significantly over 6 or more months. However, clients who chose direct involvement in their case management actually had significantly lower cost increases than clients with little control over their case management. While further investigation is needed, offering clients choice of involvement in their in-home case management may both lower costs and optimize clients' potential for involvement in their care.
2007-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/nursingpub/101
http://www.ingentaconnect.com/content/springer/cmanj/2007/00000008/00000004/art00002
Nursing Publications
Scholarship@Western
Aged
Aged
80 and over
Attitude to Health
Case Management
Chronic Disease
Consumer Satisfaction
Female
Geriatric Assessment
Home Care Services
Humans
Male
Pilot Projects
Nursing
oai:ir.lib.uwo.ca:epidempub-1005
2009-09-10T00:13:39Z
publication:fims
publication:pmid
publication:faculties
publication:nursing
publication:epidem
publication:nursingpub
publication:fimspub
publication:epidempub
Factors Influencing Identification of and Response to Intimate Partner Violence: A Survey of Physicians and Nurses
Gutmanis, Iris
Beynon, Charlene
Tutty, Leslie
Wathen, C. Nadine
MacMillan, Harriet L.
Background: Intimate partner violence against women (IPV) has been identified as a serious public health problem. Although the health care system is an important site for identification and intervention, there have been challenges in determining how health care professionals can best address this issue in practice. We surveyed nurses and physicians in 2004 regarding their attitudes and behaviours with respect to IPV, including whether they routinely inquire about IPV, as well as potentially relevant barriers, facilitators, experiential, and practice-related factors.
Methods: A modified Dillman Tailored Design approach was used to survey 1000 nurses and 1000 physicians by mail in Ontario, Canada. Respondents were randomly selected from professional directories and represented practice areas pre-identified from the literature as those most likely to care for women at the point of initial IPV disclosure: family practice, obstetrics and gynecology, emergency care, maternal/newborn care, and public health. The survey instrument had a case-based scenario followed by 43 questions asking about behaviours and resources specific to woman abuse.
Results: In total, 931 questionnaires were returned; 597 by nurses (59.7% response rate) and 328 by physicians (32.8% response rate). Overall, 32% of nurses and 42% of physicians reported routinely initiating the topic of IPV in practice. Principal components analysis identified eight constructs related to whether routine inquiry was conducted: preparedness, self-confidence, professional supports, abuse inquiry, practitioner consequences of asking, comfort following disclosure, practitioner lack of control, and practice pressures. Each construct was analyzed according to a number of related issues, including clinician training and experience with woman abuse, area of practice, and type of health care provider. Preparedness emerged as a key construct related to whether respondents routinely initiated the topic of IPV.
Conclusion: The present study provides new insight into the factors that facilitate and impede clinicians' decisions to address the issue of IPV with their female patients. Inadequate preparation, both educational and experiential, emerged as a key barrier to routine inquiry, as did the importance of the "real world" pressures associated with the daily context of primary care practice.
2007-01-24T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/6
http://www.biomedcentral.com/1471-2458/7/12
Epidemiology and Biostatistics Publications
Scholarship@Western
Adult
Aged
Attitude of Health Personnel
Battered Women
Communication
Decision Making
Female
Health Care Surveys
Humans
Middle Aged
Nurse-Patient Relations
Ontario
Physician's Practice Patterns
Physician-Patient Relations
Questionnaires
Specialties
Medical
Specialties
Nursing
Spouse Abuse
Specialties, Medical
Specialties, Nursing
Biostatistics
Epidemiology
Public Health
oai:ir.lib.uwo.ca:epidempub-1006
2009-09-10T00:17:47Z
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:epidem
publication:epidempub
Prevention of Catheter Lumen Occlusion with rT-PA versus Heparin (Pre-CLOT): Study Protocol of a Randomized Trial [ISRCTN35253449]
Hemmelgarn, Brenda R.
Moist, Louise
Pilkey, Rachel M.
Lok, Charmaine
Dorval, Marc
Tam, Paul Y. W.
Berall, Murray J.
LeBlanc, Martine
Toffelmire, Edwin B.
Manns, Braden J.
Scott-Douglas, Nairne
Background: Many patients with end-stage renal disease use a central venous catheter for hemodialysis access. A large majority of these catheters malfunction within one year of insertion, with up to two-thirds due to thrombosis. The optimal solution for locking the catheter between hemodialysis sessions, to decrease the risk of thrombosis and catheter malfunction, is unknown. The Prevention of Catheter Lumen Occlusion with rt-PA versus Heparin (PreCLOT) study will determine if use of weekly rt-PA, compared to regular heparin, as a catheter locking solution, will decrease the risk of catheter malfunction.
Methods/Design: The study population will consist of patients requiring chronic hemodialysis thrice weekly who are dialyzed with a newly inserted permanent dual-lumen central venous catheter. Patients randomized to the treatment arm will receive rt-PA 1 mg per lumen once per week, with heparin 5,000 units per ml as a catheter locking solution for the remaining two sessions. Patients randomized to the control arm will receive heparin 5,000 units per ml as a catheter locking solution after each dialysis session. The study treatment period will be six months, with 340 patients to be recruited from 14 sites across Canada. The primary outcome will be catheter malfunction, based on mean blood flow parameters while on hemodialysis, with a secondary outcome of catheter-related bacteremia. A cost-effectiveness analysis will be undertaken to assess the cost of maintaining a catheter using rt-PA as a locking solution, compared to the use of heparin.
Discussion: Results from this study will determine if use of weekly rt-PA, compared to heparin, will decrease catheter malfunction, as well as assess the cost-effectiveness of these locking solutions.
2006-04-11T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/7
http://www.biomedcentral.com/1471-2369/7/8
Epidemiology and Biostatistics Publications
Scholarship@Western
Bacteremia
Blood Coagulation
Catheterization
Cost-Benefit Analysis
Data Collection
Disease-Free Survival
Double-Blind Method
Drug Costs
Equipment Failure
Heparin
Humans
Life Tables
Patient Selection
Recombinant Proteins
Renal Dialysis
Research Design
Sample Size
Solutions
Survival Analysis
Thrombosis
Tissue Plasminogen Activator
Treatment Outcome
Biostatistics
Epidemiology
Nephrology
oai:ir.lib.uwo.ca:epidempub-1007
2009-09-20T23:05:01Z
publication:clinicalpub
publication:pmid
publication:faculties
publication:epidem
publication:robarts
publication:institutes
publication:epidempub
Lessons and Implications from a Mass Immunization Campaign in Squatter Settlements of Karachi, Pakistan: An Experience from a Cluster-randomized Double-blinded Vaccine Trial [NCT00125047]
Khan, Mohammad Imran
Ochiai, Rion Leon
Hamza, Hasan Bin
Sahito, Shah Muhammad
Habib, Muhammad Atif
Soofi, Sajid Bashir
Bhutto, Naveed Sarwar
Rasool, Shahid
Puri, Mahesh K.
Ali, Mohammad
Wasan, Shafi Mohammad
Khan, Mohammad Jawed
Abu-Elyazeed, Remon
Ivanoff, Bernard
Galindo, Claudia M.
Pang, Tikki
Donner, Allan
von Seidlein, Lorenz
Acosta, Camilo J.
Clemens, John D.
Nizami, Shaikh Qamaruddin
Bhutta, Zulfiqar A.
Objective: To determine the safety and logistic feasibility of a mass immunization strategy outside the local immunization program in the pediatric population of urban squatter settlements in Karachi, Pakistan.
Methods: A cluster-randomized double blind preventive trial was launched in August 2003 in 60 geographic clusters covering 21,059 children ages 2 to 16 years. After consent was obtained from parents or guardians, eligible children were immunized parenterally at vaccination posts in each cluster with Vi polysaccharide or hepatitis A vaccine. Safety, logistics, and standards were monitored and documented.
Results: The vaccine coverage of the population was 74% and was higher in those under age 10 years. No life-threatening serious adverse events were reported. Adverse events occurred in less than 1% of all vaccine recipients and the main reactions reported were fever and local pain. The proportion of adverse events in Vi polysaccharide and hepatitis A recipients will not be known until the end of the trial when the code is broken. Throughout the vaccination campaign safe injection practices were maintained and the cold chain was not interrupted. Mass vaccination in slums had good acceptance. Because populations in such areas are highly mobile, settlement conditions could affect coverage. Systemic reactions were uncommon and local reactions were mild and transient. Close community involvement was pivotal for information dissemination and immunization coverage.
Conclusion: This vaccine strategy described together with other information that will soon be available in the area (cost/effectiveness, vaccine delivery costs, etc) will make typhoid fever control become a reality in the near future.
2006-05-25T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/8
http://www.trialsjournal.com/content/7/1/17
Epidemiology and Biostatistics Publications
Scholarship@Western
immunization
vaccine trial
Pakistan
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1008
2009-09-20T23:16:01Z
publication:pmid
publication:faculties
publication:epidem
publication:epidempub
Copula Based Prediction Models: An Application to an Aortic Regurgitation Study
Kumar, Pranesh
Shoukri, Mohamed M.
Background: An important issue in prediction modeling of multivariate data is the measure of dependence structure. The use of Pearson's correlation as a dependence measure has several pitfalls and hence application of regression prediction models based on this correlation may not be an appropriate methodology. As an alternative, a copula based methodology for prediction modeling and an algorithm to simulate data are proposed.
Methods: The method consists of introducing copulas as an alternative to the correlation coefficient commonly used as a measure of dependence. An algorithm based on the marginal distributions of random variables is applied to construct the Archimedean copulas. Monte Carlo simulations are carried out to replicate datasets, estimate prediction model parameters and validate them using Lin's concordance measure.
Results: We have carried out a correlation-based regression analysis on data from 20 patients aged 17-82 years on pre-operative and post-operative ejection fractions after surgery and estimated the prediction model: Post-operative ejection fraction = - 0.0658 + 0.8403 (Pre-operative ejection fraction); p = 0.0008; 95% confidence interval of the slope coefficient (0.3998, 1.2808). From the exploratory data analysis, it is noted that both the pre-operative and post-operative ejection fractions measurements have slight departures from symmetry and are skewed to the left. It is also noted that the measurements tend to be widely spread and have shorter tails compared to normal distribution. Therefore predictions made from the correlation-based model corresponding to the pre-operative ejection fraction measurements in the lower range may not be accurate. Further it is found that the best approximated marginal distributions of pre-operative and post-operative ejection fractions (using q-q plots) are gamma distributions. The copula based prediction model is estimated as: Post -operative ejection fraction = - 0.0933 + 0.8907 x (Pre-operative ejection fraction); p = 0.00008 ; 95% confidence interval for slope coefficient (0.4810, 1.3003). For both models differences in the predicted post-operative ejection fractions in the lower range of pre-operative ejection measurements are considerably different and prediction errors due to copula model are smaller. To validate the copula methodology we have re-sampled with replacement fifty independent bootstrap samples and have estimated concordance statistics 0.7722 (p = 0.0224) for the copula model and 0.7237 (p = 0.0604) for the correlation model. The predicted and observed measurements are concordant for both models. The estimates of accuracy components are 0.9233 and 0.8654 for copula and correlation models respectively.
Conclusion: Copula-based prediction modeling is demonstrated to be an appropriate alternative to the conventional correlation-based prediction modeling since the correlation-based prediction models are not appropriate to model the dependence in populations with asymmetrical tails. Proposed copula-based prediction model has been validated using the independent bootstrap samples.
2007-06-16T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/9
http://www.biomedcentral.com/1471-2288/7/21
Epidemiology and Biostatistics Publications
Scholarship@Western
Adolescent
Adult
Aged
Aged
80 and over
Algorithms
Aortic Valve Insufficiency
Aortography
Computer Simulation
Echocardiography
Doppler
Color
Female
Humans
Male
Middle Aged
Monte Carlo Method
Multivariate Analysis
Prognosis
Stroke Volume
Aged, 80 and over
Echocardiography, Doppler, Color
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1009
2009-09-21T00:35:13Z
publication:oncpub
publication:surgerypub
publication:pmid
publication:faculties
publication:epidem
publication:surgery
publication:onc
publication:epidempub
Neoadjuvant or Adjuvant Therapy for Resectable Esophageal Cancer: A Clinical Practice Guideline
Malthaner, Richard A.
Wong, Rebecca K. S.
Rumble, R. Bryan
Zuraw, Lisa
Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care
Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. A clinical practice guideline was developed based on a systematic review investigating neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer.
Methods: A systematic review with meta-analysis was developed and clinical recommendations were drafted. External review of the practice guideline report by practitioners in Ontario, Canada was obtained through a mailed survey, and incorporated. Final approval of the practice guideline was obtained from the Practice Guidelines Coordinating Committee.
Results: The systematic review was developed and recommendations were drafted, and the report was mailed to Ontario practitioners for external review. Ninety percent of respondents agreed with both the evidence summary and the draft recommendations, while only 69% approved of the draft recommendations as a practice guideline. Based on the external review, a revised document was created. The revised practice guideline was submitted to the Practice Guidelines Coordinating Committee for review. All 11 members of the PGCC returned ballots. Eight PGCC members approved the practice guideline report as written and three members approved the guideline conditional on specific concerns being addressed. After these recommended changes were made, the final practice guideline report was approved.
Conclusion: In consideration of the systematic review, external review, and subsequent Practice Guidelines Coordinating Committee revision suggestions, and final approval, the Gastrointestinal Cancer Disease Site Group recommends the following:For adult patients with resectable thoracic esophageal cancer for whom surgery is considered appropriate, surgery alone (i.e., without neoadjuvant or adjuvant therapy) is recommended as the standard practice.
2004-09-24T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/10
http://www.biomedcentral.com/1471-2407/4/67
Epidemiology and Biostatistics Publications
Scholarship@Western
Adenocarcinoma
Adult
Carcinoma
Squamous Cell
Chemotherapy
Adjuvant
Esophageal Neoplasms
Humans
Ontario
Population Surveillance
Radiotherapy
Adjuvant
Carcinoma, Squamous Cell
Chemotherapy, Adjuvant
Radiotherapy, Adjuvant
Biostatistics
Epidemiology
Oncology
Surgery
oai:ir.lib.uwo.ca:epidempub-1010
2009-11-03T08:28:48Z
publication:oncpub
publication:surgerypub
publication:pmid
publication:faculties
publication:epidem
publication:surgery
publication:onc
publication:epidempub
Neoadjuvant or Adjuvant Therapy for Resectable Esophageal Cancer: A Systematic Review and Meta-analysis
Malthaner, Richard A.
Wong, Rebecca K. S.
Rumble, R. Bryan
Zuraw, Lisa
Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care
Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. The large and growing number of patients affected, the high mortality rates, the worldwide geographic variation in practice, and the large body of good quality research warrants a systematic review with meta-analysis.
Methods: A systematic review and meta-analysis investigating the impact of neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer to inform evidence-based practice was produced.MEDLINE, CANCERLIT, Cochrane Library, EMBASE, and abstracts from the American Society of Clinical Oncology and the American Society for Therapeutic Radiology and Oncology were searched for trial reports.Included were randomized trials or meta-analyses of neoadjuvant or adjuvant treatments compared with surgery alone or other treatments in patients with resectable thoracic esophageal cancer. Outcomes of interest were survival, adverse effects, and quality of life. Either one- or three-year mortality data were pooled and reported as relative risk ratios.
Results: Thirty-four randomized controlled trials and six meta-analyses were obtained and grouped into 13 basic treatment approaches.Single randomized controlled trials detected no differences in mortality between treatments for the following comparisons:- Preoperative radiotherapy versus postoperative radiotherapy.- Preoperative and postoperative radiotherapy versus postoperative radiotherapy. Preoperative and postoperative radiotherapy was associated with a significantly higher mortality rate.- Postoperative chemotherapy versus postoperative radiotherapy.- Postoperative radiotherapy versus postoperative radiotherapy plus protein-bound polysaccharide versus chemoradiation versus chemoradiation plus protein-bound polysaccharide.Pooling one-year mortality detected no statistically significant differences in mortality between treatments for the following comparisons:- Preoperative radiotherapy compared with surgery alone (five randomized trials).- Postoperative radiotherapy compared with surgery alone (five randomized trials).- Preoperative chemotherapy versus surgery alone (six randomized trials).- Preoperative and postoperative chemotherapy versus surgery alone (two randomized trials).- Preoperative chemoradiation therapy versus surgery alone (six randomized trials).Single randomized controlled trials detected differences in mortality between treatments for the following comparison:- Preoperative hyperthermia and chemoradiotherapy versus preoperative chemoradiotherapy in favour of hyperthermia.Pooling three-year mortality detected no statistically significant difference in mortality between treatments for the following comparison:- Postoperative chemotherapy compared with surgery alone (two randomized trials).Pooling three-year mortality detected statistically significant differences between treatments for the following comparisons:- Preoperative chemoradiation therapy versus surgery alone (six randomized trials) in favour of preoperative chemoradiation with surgery.- Preoperative chemotherapy compared with preoperative radiotherapy (one randomized trial) in favour of preoperative radiotherapy.
Conclusion: For adult patients with resectable thoracic esophageal cancer for whom surgery is considered appropriate, surgery alone (i.e., without neoadjuvant or adjuvant therapy) is recommended as the standard practice.
2004-09-24T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/19
http://www.biomedcentral.com/1741-7015/2/35
Epidemiology and Biostatistics Publications
Scholarship@Western
Chemotherapy
Adjuvant
Esophageal Neoplasms
Humans
Hyperthermia
Induced
Neoadjuvant Therapy
Radiotherapy
Adjuvant
Randomized Controlled Trials as Topic
Chemotherapy, Adjuvant
Hyperthermia, Induced
Radiotherapy, Adjuvant
Biostatistics
Epidemiology
Oncology
Surgery
oai:ir.lib.uwo.ca:vascularpub-1009
2023-03-16T14:08:08Z
publication:vascularpub
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:epidem
publication:biochempub
publication:robarts
publication:biochem
publication:institutes
publication:epidempub
Relationship of the Metabolic Syndrome to Carotid Ultrasound Traits
Pollex, Rebecca L.
Al-Shali, Khalid Z.
House, Andrew A.
Spence, J. David
Fenster, Aaron
Mamakeesick, Mary
Zinman, Bernard
Harris, Stewart B.
Hanley, Anthony J. G.
Hegele, Robert A.
Background: The metabolic syndrome is associated with increased vascular disease risk. We evaluated two carotid ultrasound measurements, namely intima media thickness and total plaque volume, in a Canadian Oji-Cree population with a high metabolic syndrome prevalence rate. Methods: As part of the Sandy Lake Complications Prevalence and Risk Factor Study, 166 Oji-Cree subjects (baseline metabolic syndrome prevalence, 44.0%, according to the National Cholesterol Education Program Adult Treatment Panel III guidelines) were examined using a high-resolution duplex ultrasound scanner. Results: Image analysis showed that mean intima media thickness was elevated in subjects with the metabolic syndrome (818 +/- 18 vs 746 +/- 20 microm), as was total plaque volume (125 +/- 26 vs 77.3 +/- 17.0 mm3). However, after adjustment for age and sex, the differences were significant only for intima media thickness (P = 0.039). Furthermore, a significant trend towards increased intima media thickness was observed with increasing numbers of metabolic syndrome components: mean intima media thickness was highest among individuals with all five metabolic syndrome components compared to those with none (866 +/- 55 vs 619 +/- 23 microm, P = 0.0014). A similar, but non-significant trend was observed for total plaque volume. Conclusion: This is the first study of the relationship between the metabolic syndrome and two distinct carotid ultrasound traits measured in the same individuals. The results suggest that standard intima media thickness measurement shows a more consistent and stronger association with the metabolic syndrome than does total plaque volume.
2006-07-07T07:00:00Z
article
https://ir.lib.uwo.ca/vascularpub/10
info:doi/10.1186/1476-7120-4-28
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1533865/
Robarts Vascular Research Publications
Scholarship@Western
Adult
Canada
Comorbidity
Coronary Artery Disease
Female
Humans
Incidence
Male
Metabolic Syndrome X
Prognosis
Risk Assessment
Risk Factors
Sensitivity and Specificity
Tunica Intima
Cardiology
Medical Microbiology
oai:ir.lib.uwo.ca:vascularpub-1010
2009-09-25T00:29:45Z
publication:vascularpub
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:epidem
publication:biochempub
publication:robarts
publication:biochem
publication:institutes
publication:epidempub
Association Between the -455T>C Promoter Polymorphism of the APOC3 Gene and the Metabolic Syndrome in a Multi-ethnic Sample
Pollex, Rebecca L.
Ban, Matthew R.
Young, T. Kue
Bjerregaard, Peter
Anand, Sonia S.
Yusuf, Salim
Zinman, Bernard
Harris, Stewart B.
Hanley, Anthony J. G.
Connelly, Philip W.
Huff, Murray W.
Hegele, Robert A.
Background: Common polymorphisms in the promoter of the APOC3 gene have been associated with hypertriglyceridemia and may impact on phenotypic expression of the metabolic syndrome (MetS). The rs7566605 marker, located near the INSIG2 gene, has been found to be associated with obesity, making it also a potential genetic determinant for MetS. The objective of this study is to examine the APOC3 -455T>C and the INSIG2 rs7566605 polymorphisms as potential genetic determinants for MetS in a multi-ethnic sample.
Methods: Subjects were genotyped for both the APOC3 -455T>C and INSIG2 rs7566605 polymorphisms, and classified for the presence or absence of MetS (NCEP ATP III and IDF definitions). The total study population included 2675 subjects (> or =18 years of age) from six different geographical ancestries.
Results: For the overall study population, the prevalence of MetS was 22.6% (NCEP ATP III definition). Carriers of > or =1 copy of APOC3 -455C were more likely to have MetS (NCEP ATP III definition) than noncarriers (carrier odds ratio 1.73, 95% CI 1.40 to 2.14, adjusting for age and study group). The basis of the association was related not only to a higher proportion of -455C carriers meeting the triglyceride and high-density lipoprotein cholesterol criteria, but also the blood pressure criteria compared with wild-type homozygotes. Plasma apo C-III concentrations were not associated with APOC3 -455T>C genotype. The INSIG2 rs7566605 polymorphism was not associated with MetS or measures of obesity.
Conclusion: Meta-analysis of the sample of multiple geographic ancestries indicated that the functional -455T>C promoter polymorphism in APOC3 was associated with an approximately 2-fold increased risk of MetS, whereas the INSIG2 rs7566605 polymorphism was not associated with MetS.
2007-11-20T08:00:00Z
article
https://ir.lib.uwo.ca/vascularpub/11
http://www.biomedcentral.com/1471-2350/8/80
Robarts Vascular Research Publications
Scholarship@Western
Adult
Apolipoprotein C-III
Canada
Ethnic Groups
Female
Genetic Predisposition to Disease
Humans
Male
Metabolic Syndrome X
Polymorphism
Genetic
Promoter Regions
Genetic
Polymorphism, Genetic
Promoter Regions, Genetic
Medical Genetics
oai:ir.lib.uwo.ca:epidempub-1011
2009-09-26T00:26:51Z
publication:obsgyn
publication:obsgynpub
publication:paed
publication:pmid
publication:faculties
publication:epidem
publication:paedpub
publication:epidempub
Is There Value in Using Physician Billing Claims along with Other Administrative Health Care Data to Document the Burden of Adolescent Injury? An Exploratory Investigation with Comparison to Self-reports in Ontario, Canada
Potter, Beth K.
Manuel, Douglas
Speechley, Kathy N.
Gutmanis, Iris A.
Campbell, M. Karen
Koval, John J.
Background: Administrative health care databases may be particularly useful for injury surveillance, given that they are population-based, readily available, and relatively complete. Surveillance based on administrative data, though, is often restricted to injuries that result in hospitalization. Adding physician billing data to administrative data-based surveillance efforts may improve comprehensiveness, but the feasibility of such an approach has rarely been examined. It is also not clear how injury surveillance information obtained using administrative health care databases compares with that obtained using self-report surveys. This study explored the value of using physician billing data along with hospitalization data for the surveillance of adolescent injuries in Ontario, Canada. We aimed i) to document the burden of adolescent injury using administrative health care data, focusing on the relative contribution of physician billing information; and ii) to explore data quality issues by directly comparing adolescent injuries identified in administrative and self-report data.
Methods: The sample included adolescents aged 12 to 19 years who participated in the 1996-1997 cross-sectional Ontario Health Survey, and whose survey responses were linked to administrative health care datasets (N = 2067). Descriptive analysis was used to document the burden of injuries as a proportion of all physician care by gender and location of care, and to examine the distribution of both administratively-defined and self-reported activity-limiting injuries according to demographic characteristics. Administratively-defined and self-reported injuries were also directly compared at the individual level.
Results: Approximately 10% of physician care for the sample was identified as injury-related. While 18.8% of adolescents had self-reported injury in the previous year, 25.0% had documented administratively-defined injury. The distribution of injuries according to demographic characteristics was similar across data sources, but congruence was low at the individual level. Possible reasons for discrepancies between the data sources included recall errors in the survey data and errors in the physician billing data algorithm.
Conclusion: If further validated, physician billing data could be used along with hospital inpatient data to make an important and unique contribution to adolescent injury surveillance. The limitations inherent in different datasets highlight the need to continue rely on multiple information sources for complete injury surveillance information.
2005-02-18T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/11
http://www.biomedcentral.com/1472-6963/5/15
Epidemiology and Biostatistics Publications
Scholarship@Western
Activities of Daily Living
Adolescent
Adult
Cost of Illness
Female
Health Services Research
Hospitalization
Humans
Insurance Claim Review
Male
Office Visits
Ontario
Patient Credit and Collection
Population Surveillance
Prevalence
Self Disclosure
Wounds and Injuries
Biostatistics
Epidemiology
Health and Medical Administration
oai:ir.lib.uwo.ca:vascularpub-1012
2023-03-16T14:09:27Z
publication:vascularpub
publication:fammedpub
publication:fammed
publication:robartspub
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:epidem
publication:biochempub
publication:robarts
publication:biochem
publication:institutes
publication:epidempub
A Comparison of Ultrasound Measurements to Assess Carotid Atherosclerosis Development in Subjects with and without Type 2 Diabetes
Pollex, Rebecca L.
Spence, J. David
House, Andrew A.
Fenster, Aaron
Hanley, Anthony J. G.
Zinman, Bernard
Harris, Stewart B.
Hegele, Robert A.
Background: Subjects with type 2 diabetes are at an increased risk of vascular complications. The use of carotid ultrasound remains an attractive, non-invasive method to monitor atherosclerotic disease progression and/or response to treatment in patients with type 2 diabetes, with intima-media thickness routinely used as the gold standard to detect pathology. However, alternative measurements, such as plaque area or volume, may represent a potentially more powerful approach. Thus, the objective of this study was to compare the traditional intima-media thickness measurement against the novel total plaque volume measurement in analyzing carotid atherosclerosis development in individuals with type 2 diabetes. Methods: The case-control study included 49 Oji-Cree adults with diabetes or impaired glucose tolerance, aged 21-69, and 49 sex- and age-matched normoglycemic subjects. At baseline, metabolic variables were measured, including body mass index, waist circumference, total cholesterol: high density lipoprotein ratio, plasma triglycerides, plasma glucose, and serum insulin. Carotid ultrasound measurements, 7 years later, assessed carotid arterial intima-media thickness and total plaque volume. Results: At baseline, the two groups were well matched for smoking habits, hypertension, body mass index, and waist circumference. Differences were noted in baseline measurements of total cholesterol:high density lipoprotein (P = 0.0006), plasma triglycerides (P < 0.0001) and fasting glucose (P < 0.0001). After seven years, carotid ultrasound scans revealed that total plaque volume measurements (P = 0.037), but not intima-media thickness measurements, were higher in subjects with diabetes/impaired glucose tolerance compared to the normoglycemic controls. Correlation between intima-media thickness and total plaque volume was moderate. Based on our study findings, to achieve power levels > 0.70 when comparing intima-media thickness measurements for diabetics versus non-diabetics, thousands of study subjects are required. For comparing total plaque volume measurements, only hundreds of study subjects are required. Conclusion: The development of atherosclerotic plaque is greater in subjects with diabetes/impaired glucose tolerance. Total plaque volume appears to capture the atherosclerotic disease burden more effectively in subjects with type 2 diabetes, and would be an appropriate outcome measure for studies aimed at changing the diabetic milieu.
2005-06-15T07:00:00Z
article
https://ir.lib.uwo.ca/vascularpub/13
info:doi/10.1186/1476-7120-3-15
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1184090/
Robarts Vascular Research Publications
Scholarship@Western
Adult
Aged
Anatomy
Cross-Sectional
Canada
Carotid Artery Diseases
Diabetes Mellitus
Type 2
Echocardiography
Female
Humans
Image Interpretation
Computer-Assisted
Imaging
Three-Dimensional
Incidence
Male
Middle Aged
Prognosis
Reproducibility of Results
Risk Assessment
Risk Factors
Sensitivity and Specificity
Single-Blind Method
Anatomy, Cross-Sectional
Diabetes Mellitus, Type 2
Image Interpretation, Computer-Assisted
Imaging, Three-Dimensional
Cardiology
Medical Microbiology
oai:ir.lib.uwo.ca:vascularpub-1011
2009-09-26T00:00:46Z
publication:vascularpub
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:epidem
publication:biochempub
publication:robarts
publication:biochem
publication:institutes
publication:epidempub
Methylenetetrahydrofolate Reductase Polymorphism 677C>T is Associated with Peripheral Arterial Disease in Type 2 Diabetes
Pollex, Rebecca L.
Mamakeesick, Mary
Zinman, Bernard
Harris, Stewart B.
Hanley, Anthony J. G.
Hegele, Robert A.
Background: Individuals with diabetes are twice as likely to develop peripheral arterial disease (PAD), the manifestation of extensive atherosclerosis throughout the lower extremities. One putative determinant of PAD is the 677C>T polymorphism in the gene encoding methylenetetrahydrofolate reductase (MTHFR), which has previously been found to associate with various diabetic complications including retinopathy, nephropathy, atherosclerosis and coronary heart disease. The objective of this study was to investigate a possible role for the MTHFR 677C>T gene polymorphism with PAD in subjects with type 2 diabetes from an isolated aboriginal Canadian population.
Methods: The 677C>T MTHFR gene polymorphism was genotyped in 138 subjects of Oji-Cree descent. Participants were selected from a community-wide survey that included PAD assessment by ankle-brachial index (ABI) measurement, and also intermittent claudication assessment by the Rose questionnaire.
Results: MTHFR 677T allele carriers had an increased risk of PAD with an odds ratio of 3.54 (95% CI 1.01, 12.4), P = 0.049, after adjustment for age, sex, duration of diabetes, hypertension, current smoking habits, and use of insulin or oral treatment for diabetes. None of these additional co-variables was significantly associated with PAD. No association was found between MTHFR genotype and intermittent claudication.
Conclusion: The genetic influence of the MTHFR 677C>T genotype on diabetic PAD is modest, yet for the Oji-Cree it is a major risk factor in comparison to other traditional risk factors.
2005-11-07T08:00:00Z
article
https://ir.lib.uwo.ca/vascularpub/12
http://www.cardiab.com/content/4/1/17
Robarts Vascular Research Publications
Scholarship@Western
Brachial Artery
Canada
Diabetes Mellitus
Type 2
Diabetic Angiopathies
Genotype
Humans
Indians
North American
Intermittent Claudication
Methylenetetrahydrofolate Reductase (NADPH2)
Odds Ratio
Polymorphism
Genetic
Risk Factors
Diabetes Mellitus, Type 2
Indians, North American
Methylenetetrahydrofolate Reductase (NADPH2)
Polymorphism, Genetic
Cardiology
Medical Microbiology
oai:ir.lib.uwo.ca:epidempub-1012
2009-09-26T00:33:18Z
publication:obsgyn
publication:obsgynpub
publication:paed
publication:pmid
publication:faculties
publication:epidem
publication:paedpub
publication:epidempub
Socioeconomic Status and Non-fatal Injuries among Canadian Adolescents: Variations across SES and Injury Measures
Potter, Beth K.
Speechley, Kathy N.
Koval, John J.
Gutmanis, Iris A.
Campbell, M. Karen
Manuel, Douglas
Background: While research to date has consistently demonstrated that socioeconomic status (SES) is inversely associated with injury mortality in both children and adults, findings have been less consistent for non-fatal injuries. The literature addressing SES and injury morbidity among adolescents has been particularly inconclusive. To explore potential explanations for these discrepant research findings, this study uniquely compared the relationship across different measures of SES and different causes of injury (recreation versus non-recreation injuries) within a sample of Canadian adolescents.
Methods: The sample included adolescent participants (aged 12 to 19 years) in the Canadian 1996-1997 cross-sectional National Population Health Survey (n = 6967). Five SES measures (household income, two neighbourhood-level proxy measures, two parental indicators) were examined in relation to three injury outcomes (total, recreation, and non-recreation injuries) using multivariable logistic regression.
Results: Among males, a clear relationship with injury was observed only for a parental SES index, which was positively associated with total and recreation injuries (odds ratios for the highest versus lowest SES category of 1.9 for total and 2.5 for recreation injuries). Among females, there was some evidence of a positive relationship between SES and injuries, particularly for a neighbourhood-level education measure with total and recreation injuries (odds ratios of 1.7 for total and 2.0 for recreation injuries).
Conclusion: The results suggest that differences related to the measures of SES chosen and the causes of injury under study may both contribute to discrepancies in past research on SES and non-fatal injuries among adolescents. To clarify the potential SES-injury relationship among youth, the findings emphasize a need for a greater understanding of the meaning and relevance of different SES measures for adolescents, and for an exploration of the pathways through which SES may be related to injury risk.
2005-12-12T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/12
http://www.biomedcentral.com/1471-2458/5/132
Epidemiology and Biostatistics Publications
Scholarship@Western
Adolescent
Adult
Canada
Cross-Sectional Studies
Family Characteristics
Female
Health Surveys
Humans
Income
Male
Observer Variation
Recreation
Residence Characteristics
Social Class
Wounds and Injuries
Biostatistics
Epidemiology
Obstetrics and Gynecology
Pediatrics
oai:ir.lib.uwo.ca:oncpub-1003
2009-09-27T21:17:27Z
publication:oncpub
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:epidem
publication:onc
publication:epidempub
Psychometric Properties of a Prostate Cancer Radiation Late Toxicity Questionnaire
Rodrigues, George
Bauman, Glenn
Lock, Michael
D'Souza, David
Mahon, Jeff
Background: To construct a short prostate cancer radiation late toxicity (PCRT) questionnaire with health-related quality-of-life (HRQoL) domains.
Methods: The PCRT was developed by item generation, questionnaire construction (n = 7 experts, n = 8 focus group patients), pilot testing (n = 37), item reduction (n = 100), reliability testing (n = 237), and validity testing (n = 274).
Results: Reliability of the three item-reduced subscales demonstrated intraclass correlation coefficients (CC) of 0.811 (GU), 0.842 (GI), and 0.740 (sexual). Discriminant validity demonstrated Pearson CC of 0.449 (GU-GI), 0.200 (sexual-GU), and 0.09 (sexual-GI). Content validity correlations between PCRT-PCQoL were 0.35-0.78, PCRT-FACT-G(c) were 0.19-0.39, and PCRT-SF-36(R) were 0.03-0.34.
Conclusion: We successfully generated a PCRT HRQoL questionnaire including subscales with very good psychometric properties.
2007-05-31T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/3
http://www.hqlo.com/content/5/1/29
Oncology Publications
Scholarship@Western
Aged
Aged
80 and over
Brachytherapy
Focus Groups
Follow-Up Studies
Humans
Male
Middle Aged
Ontario
Outcome Assessment (Health Care)
Pilot Projects
Prostatic Neoplasms
Psychometrics
Quality of Life
Questionnaires
Radiation Oncology
Radiation
Ionizing
Radiotherapy
Sickness Impact Profile
Aged, 80 and over
Outcome Assessment (Health Care)
Radiation, Ionizing
Epidemiology
Oncology
oai:ir.lib.uwo.ca:epidempub-1013
2009-10-01T00:35:34Z
publication:clinicalpub
publication:pmid
publication:faculties
publication:epidem
publication:robarts
publication:institutes
publication:epidempub
The Prevalence of Stillbirths: A Systematic Review
Say, Lale
Donner, Allan
Gülmezoglu, A. Metin
Taljaard, Monica
Piaggio, Gilda
Background: Stillbirth rate is an important indicator of access to and quality of antenatal and delivery care. Obtaining overall estimates across various regions of the world is not straightforward due to variation in definitions, data collection methods and reporting.
Methods: We conducted a systematic review of a range of pregnancy-related conditions including stillbirths and performed meta-analysis of the subset of studies reporting stillbirth rates. We examined variation across rates and used meta-regression techniques to explain observed variation.
Results: We identified 389 articles on stillbirth prevalence among the 2580 included in the systematic review. We included 70 providing 80 data sets from 50 countries in the meta-analysis. Pooled prevalence rates show variation across various subgroup categories. Rates per 100 births are higher in studies conducted in less developed country settings as compared to more developed (1.17 versus 0.50), of inadequate quality as compared to adequate (1.12 versus 0.66), using sub-national sample as compared to national (1.38 versus 0.68), reporting all stillbirths as compared to late stillbirths (0.95 versus 0.63), published in non-English as compared to English (0.91 versus 0.59) and as journal articles as compared to non-journal (1.37 versus 0.67). The results of the meta-regression show the significance of two predictor variables - development status of the setting and study quality - on stillbirth prevalence.
Conclusion: Stillbirth prevalence at the community level is typically less than 1% in more developed parts of the world and could exceed 3% in less developed regions. Regular reviews of stillbirth rates in appropriately designed and reported studies are useful in monitoring the adequacy of care. Systematic reviews of prevalence studies are helpful in explaining sources of variation across rates. Exploring these methodological issues will lead to improved standards for assessing the burden of reproductive ill-health.
2006-01-10T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/13
http://www.reproductive-health-journal.com/content/3/1/1
Epidemiology and Biostatistics Publications
Scholarship@Western
reproductive health
stillbirth
Biostatistics
Epidemiology
Obstetrics and Gynecology
oai:ir.lib.uwo.ca:epidempub-1014
2009-10-02T00:46:25Z
publication:pmid
publication:faculties
publication:epidem
publication:epidempub
Interval Estimation and Optimal Design for the Within-subject Coefficient of Variation for Continuous and Binary Variables
Shoukri, Mohamed M.
Elkum, Nasser
Walter, Stephen D.
Background: In this paper we propose the use of the within-subject coefficient of variation as an index of a measurement's reliability. For continuous variables and based on its maximum likelihood estimation we derive a variance-stabilizing transformation and discuss confidence interval construction within the framework of a one-way random effects model. We investigate sample size requirements for the within-subject coefficient of variation for continuous and binary variables.
Methods: We investigate the validity of the approximate normal confidence interval by Monte Carlo simulations. In designing a reliability study, a crucial issue is the balance between the number of subjects to be recruited and the number of repeated measurements per subject. We discuss efficiency of estimation and cost considerations for the optimal allocation of the sample resources. The approach is illustrated by an example on Magnetic Resonance Imaging (MRI). We also discuss the issue of sample size estimation for dichotomous responses with two examples.
Results: For the continuous variable we found that the variance stabilizing transformation improves the asymptotic coverage probabilities on the within-subject coefficient of variation for the continuous variable. The maximum like estimation and sample size estimation based on pre-specified width of confidence interval are novel contribution to the literature for the binary variable.
Conclusion: Using the sample size formulas, we hope to help clinical epidemiologists and practicing statisticians to efficiently design reliability studies using the within-subject coefficient of variation, whether the variable of interest is continuous or binary.
2006-05-10T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/14
http://www.biomedcentral.com/1471-2288/6/24
Epidemiology and Biostatistics Publications
Scholarship@Western
Algorithms
Confidence Intervals
Efficiency
Humans
Magnetic Resonance Imaging
Models
Statistical
Monte Carlo Method
Observer Variation
Patient Selection
Reproducibility of Results
Sample Size
Selection Bias
Models, Statistical
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1015
2009-10-03T01:34:21Z
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:epidem
publication:epidempub
Where to Deliver? Analysis of Choice of Delivery Location from a National Survey in India
Thind, Amardeep
Mohani, Amir
Banerjee, Kaberi
Hagigi, Fred
Background: In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state.
Methods: Cross sectional analyses of the National Family Health Survey - 2 dataset.
Setting: Maharashtra state. The dataset had a sample size of 5391 ever-married females between the ages of 15 to 49 years. Data were abstracted for the most recent birth (n = 1510) and these were used in the analyses. Conceptual framework was the Andersen Behavioral Model. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery.
Results: A majority delivered at home (n = 559, 37%); with private and public facility deliveries accounting for 32% (n = 493) and 31% (n = 454) respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery.
Conclusion: As India's economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net.
2008-01-24T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/15
http://www.biomedcentral.com/1471-2458/8/29
Epidemiology and Biostatistics Publications
Scholarship@Western
Adolescent
Adult
Choice Behavior
Delivery
Obstetric
Female
Health Care Surveys
Home Childbirth
Hospitals
Private
Hospitals
Public
Humans
India
Maternal Health Services
Middle Aged
Patient Acceptance of Health Care
Pregnancy
Delivery, Obstetric
Hospitals, Private
Hospitals, Public
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1017
2009-10-12T04:23:12Z
publication:pmid
publication:faculties
publication:epidem
publication:epidempub
A Mass Vaccination Campaign Targeting Adults and Children to Prevent Typhoid Fever in Hechi; Expanding the Use of Vi Polysaccharide Vaccine in Southeast China: A Cluster-randomized Trial
Yang, Jin
Acosta, Camilo J.
Si, Guo-ai
Zeng, Jun
Li, Cui-yun
Liang, Da-bin
Ochiai, R. Leon
Page, Anne-Laure
Danovaro-Holliday, M. Carolina
Zhang, Jie
Zhou, Bao-de
Liao, He-zhuang
Wang, Ming-liu
Tan, Dong-mei
Tang, Zhen-zhu
Gong, Jian
Park, Jin-kyung
Ali, Mohammad
Ivanoff, Bernard
Liang, Gui-chen
Yang, Hong-hui
Pang, Tikki
Xu, Zhi-yi
Donner, Allan
Galindo, Claudia M.
Dong, Bai-qing
Clemens, John D.
Background: One of the goals of this study was to learn the coverage, safety and logistics of a mass vaccination campaign against typhoid fever in children and adults using locally produced typhoid Vi polysaccharide (PS) and group A meningococcal PS vaccines in southern China.
Methods: The vaccination campaign targeted 118,588 persons in Hechi, Guangxi Province, aged between 5 to 60 years, in 2003. The study area was divided into 107 geographic clusters, which were randomly allocated to receive one of the single-dose parenteral vaccines. All aspects regarding vaccination logistics, feasibility and safety were documented and systematically recorded. Results of the logistics, feasibility and safety are reported.
Results: The campaign lasted 5 weeks and the overall vaccination coverage was 78%. On average, the 30 vaccine teams gave immunizations on 23 days. Vaccine rates were higher in those aged < or = 15 years (90%) than in adolescents and young adults (70%). Planned mop-up activities increased the coverage by 17%. The overall vaccine wastage was 11%. The cold chain was maintained and documented. 66 individuals reported of adverse events out of all vaccinees, where fever (21%), malaise (19%) and local redness (19%) were the major symptoms; no life-threatening event occurred. Three needle-sharp events were reported.
Conclusion: The mass immunization proved feasible and safe, and vaccine coverage was high. Emphasis should be placed on: injection safety measures, community involvement and incorporation of mop-up strategies into any vaccination campaign. School-based and all-age Vi mass immunizations programs are potentially important public health strategies for prevention of typhoid fever in high-risk populations in southern China.
2005-05-18T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/17
http://www.biomedcentral.com/1471-2458/5/49
Epidemiology and Biostatistics Publications
Scholarship@Western
Adolescent
Adult
Antigens
Bacterial
Child
China
Cluster Analysis
Feasibility Studies
Geography
Humans
Injections
Intramuscular
Injections
Subcutaneous
Mass Immunization
Meningitis
Meningococcal
Meningococcal Vaccines
Middle Aged
Polysaccharides
Bacterial
Public Health Administration
Safety
Social Marketing
Typhoid Fever
Typhoid-Paratyphoid Vaccines
Antigens, Bacterial
Injections, Intramuscular
Injections, Subcutaneous
Meningitis, Meningococcal
Polysaccharides, Bacterial
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1016
2010-09-19T02:07:58Z
publication:pmid
publication:faculties
publication:epidem
publication:epidempub
A Blended Knowledge Translation Initiative to Improve Colorectal Cancer Staging [ISRCTN56824239]
Wright, Frances C.
Law, Calvin H. L.
Last, Linda D.
Klar, Neil
Ryan, David P.
Smith, Andrew J.
Background: A significant gap has been documented between best practice and the actual practice of surgery. Our group identified that colorectal cancer staging in Ontario was suboptimal and subsequently developed a knowledge translation strategy using the principles of social marketing and the influence of expert and local opinion leaders for colorectal cancer.
Methods/Design: Opinion leaders were identified using the Hiss methodology. Hospitals in Ontario were cluster-randomized to one of two intervention arms. Both groups were exposed to a formal continuing medical education session given by the expert opinion leader for colorectal cancer. In the treatment group the local Opinion Leader for colorectal cancer was detailed by the expert opinion leader for colorectal cancer and received a toolkit. Forty-two centres agreed to have the expert opinion leader for colorectal cancer come and give a formal continuing medical education session that lasted between 50 minutes and 4 hours. No centres refused the intervention. These sessions were generally well attended by most surgeons, pathologists and other health care professionals at each centre. In addition all but one of the local opinion leaders for colorectal cancer met with the expert opinion leader for colorectal cancer for the academic detailing session that lasted between 15 and 30 minutes.
Discussion: We have enacted a unique study that has attempted to induce practice change among surgeons and pathologists using an adapted social marketing model that utilized the influence of both expert and local opinion leaders for colorectal cancer in a large geographic area with diverse practice settings.
2006-01-16T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/16
info:doi/10.1186/1472-6963-6-4
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395360/
Epidemiology and Biostatistics Publications
Scholarship@Western
Attitude of Health Personnel
Benchmarking
Clinical Competence
Colorectal Neoplasms
Education
Medical
Continuing
General Surgery
Humans
Leadership
Neoplasm Staging
Oncology Service
Hospital
Ontario
Pathology
Clinical
Physician's Practice Patterns
Program Evaluation
Quality Assurance
Health Care
Social Marketing
Education, Medical, Continuing
Oncology Service, Hospital
Pathology, Clinical
Quality Assurance, Health Care
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:oncpub-1009
2009-10-12T04:41:35Z
publication:oncpub
publication:pmid
publication:faculties
publication:epidem
publication:onc
publication:epidempub
Comparing Two Strategies of Dynamic Intensity Modulated Radiation Therapy (dIMRT) with 3-Dimensional Conformal Radiation Therapy (3DCRT) in the Hypofractionated Treatment of High-risk Prostate Cancer
Yuen, Jasper
Rodrigues, George
Trenka, Kristina
Coad, Terry
Yartsev, Slav
D'Souza, David
Lock, Michael
Bauman, Glenn
Background: To compare two strategies of dynamic intensity modulated radiation therapy (dIMRT) with 3-dimensional conformal radiation therapy (3DCRT) in the setting of hypofractionated high-risk prostate cancer treatment.
Methods: 3DCRT and dIMRT/Helical Tomotherapy(HT) planning with 10 CT datasets was undertaken to deliver 68 Gy in 25 fractions (prostate) and simultaneously delivering 45 Gy in 25 fractions (pelvic lymph node targets) in a single phase. The paradigms of pelvic vessel targeting (iliac vessels with margin are used to target pelvic nodes) and conformal normal tissue avoidance (treated soft tissues of the pelvis while limiting dose to identified pelvic critical structures) were assessed compared to 3DCRT controls. Both dIMRT/HT and 3DCRT solutions were compared to each other using repeated measures ANOVA and post-hoc paired t-tests.
Results: When compared to conformal pelvic vessel targeting, conformal normal tissue avoidance delivered more homogenous PTV delivery (2/2 t-test comparisons; p < 0.001), similar nodal coverage (8/8 t-test comparisons; p = ns), higher and more homogenous pelvic tissue dose (6/6 t-test comparisons; p < 0.03), at the cost of slightly higher critical structure dose (Ddose, 1-3 Gy over 5/10 dose points; p < 0.03). The dIMRT/HT approaches were superior to 3DCRT in sparing organs at risk (22/24 t-test comparisons; p < 0.05).
Conclusion: dIMRT/HT nodal and pelvic targeting is superior to 3DCRT in dose delivery and critical structure sparing in the setting of hypofractionation for high-risk prostate cancer. The pelvic targeting paradigm is a potential solution to deliver highly conformal pelvic radiation treatment in the setting of nodal location uncertainty in prostate cancer and other pelvic malignancies.
2008-01-07T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/9
http://www.ro-journal.com/content/3/1/1
Oncology Publications
Scholarship@Western
Dose-Response Relationship
Radiation
Humans
Male
Prostatic Neoplasms
Radiotherapy Dosage
Radiotherapy Planning
Computer-Assisted
Radiotherapy
Intensity-Modulated
Tomography
X-Ray Computed
Dose-Response Relationship, Radiation
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Intensity-Modulated
Tomography, X-Ray Computed
Epidemiology
Oncology
oai:ir.lib.uwo.ca:psychiatrypub-1005
2010-04-07T00:34:52Z
publication:psychiatrypub
publication:pmid
publication:faculties
publication:psychiatry
publication:epidem
publication:epidempub
The Abilities of Improved Schizophrenia Patients to Work and Live Independently in the Community: A 10-year Long-term Outcome Study from Mumbai, India
Srivastava, Amresh Kumar
Stitt, Larry
Thakar, Meghana
Shah, Nilesh
Chinnasamy, Gurusamy
Background: The outcome of schizophrenia has several determinants. Socioecological factors, particularly living conditions, migration, community and culture, not only affect the level of risk but also the outcome. Mega cities around the world show a unique socioecological condition that has several challenges for mental health. The present study reports on the long-term status of patients with schizophrenia in such a mega city: Mumbai, India. Aim This study aims to reveal the long-term outcome of patients suffering from schizophrenia with special reference to clinical symptoms and social functioning.
Methods: The cohort for this study was drawn from a 10-year follow-up of first episode schizophrenia. Patients having completed 10 years of consistent treatment after first hospitalisation were assessed on psychopathological and recovery criteria. Clinical as well as social parameters of recovery were evaluated. Descriptive statistics with 95% confidence intervals are provided.
Results: Of 200 patients recruited at the beginning of this study, 122 patients (61%) were present in the city of Mumbai at the end of 10-year follow-up study period. Among 122 available patients, 101 patients (50.5%) were included in the assessment at the end of 10-year follow-up study period, 6 patients (3.0%) were excluded from the study due to changed diagnosis, and 15 patients (7.5%) were excluded due to admission into long-term care facilities. This indicates that 107 out of 122 available patients (87.7%) were living in the community with their families. Out of 101 (50.5%) patients assessed at the end of 10 years, 61 patients (30.5%) showed improved recovery on the Clinical Global Impression Scale, 40 patients (20%) revealed no improvement in the recovery, 43 patients (72.9%) were able to live independently, and 24 patients (40%) were able to find employment.
Conclusions: With 10 years of treatment, the recovery rate among schizophrenia patients in Mumbai was 30.5%. Among the patients, 87.7% of patients lived in the community, 72.9% of patients lived independently, and 40% of patients obtained employment. However, 60% of patients were unable to return to work, which highlights the need for continued monitoring and support to prevent the deterioration of health in these patients. It is likely that socioecological factors have played a role in this outcome.
2009-10-13T07:00:00Z
article
https://ir.lib.uwo.ca/psychiatrypub/6
info:doi/10.1186/1744-859X-8-24
http://www.annals-general-psychiatry.com/content/8/1/24
Psychiatry Publications
Scholarship@Western
schizophrenia
Mumbai
recovery
independence
Psychiatry and Psychology
oai:ir.lib.uwo.ca:oncpub-1010
2009-10-24T03:18:49Z
publication:biophysicspub
publication:oncpub
publication:surgerypub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:surgery
publication:onc
publication:epidempub
Post-Operative Extended Volume External Beam Radiation Therapy in High Risk Esophageal Cancer Patients: A Prospective Experience
Yu, E.
Tai, P.
Younus, J.
Malthaner, R.
Truong, P.
Stitt, L.
Rodrigues, G.
Ash, R.
Dar, R.
Yaremko, B.
Tomiak, A.
Dingle, B.
Sanatani, M.
Vincent, M.
Kocha, W.
Fortin, D.
Inculet, R.
Background and purpose: Extended volume external beam radiation therapy (RT) following esophagectomy is controversial. This prospective study evaluates the feasibility of extended volume RT treatment in high-risk esophagectomy patients with cervical anastomosis receiving post–operative combined chemo-radiation therapy. Patients and methods: From 2001-2006, 15 patients with resected esophageal cancer were prospectively accrued to this pilot study, to evaluate the adverse effects of extended volume RT. Eligibility criteria were pathologically proven esophageal malignancy, T3-4, N0-1, disease amenable to surgical resection and esophagectomy with or without resection margin involvement. Patients with distant metastases (M1) and patients treated with previous RT were excluded. All 15 patients received four cycles of 5-fluorouracil-based chemotherapy. External beam RT utilized conformal computerized tomography (CT) planning, with multi-field arrangement tailored to the pathological findings with clinical target volume encompassing the primary tumour bed and anastomotic site in the neck. The radiation therapy dose was 50.40Gy at 1.8Gy per fraction, delivered concurrently with the third cycle of chemotherapy. Outcomes were disease-free survival (DFS) and overall survival (OS), calculated by Kaplan–Meier method. Treatment-related toxicities were assessed using NCI-CTC Grading System. Results: There were 10 male and 5 female patients. The median age was 64 years (ranging 48 to 80 years). The TNM stages included one T3N0, two T2N1, eleven T3N1 and one T4N1. The histopathology included 5 adenocarcinomas and 10 squamous cell carcinomas. Resection margins were clear in 10 patients. The median follow up time was 19 months (range: 3.5-53.4 months). Delay in chemotherapy occurred in 20% of patients and dose reduction was required in 13.3% of patients prior to radiation therapy. During the concurrent chemo-radiation therapy phase, 20% and 6.6% had chemotherapy delay and dose reduction, respectively. No patient experienced treatment related acute and chronic esophagitis of > Grade 2. Disease recurrence occurred in 40% (6/15) and the median time to relapse was 24 months. There was no tumour recurrence at the anastomotic site. The median DFS and OS rate were 23 months and 21 months, respectively. Conclusion: Extended volume external beam radiation therapy encompassing the tumour bed and the anastomotic site is feasible and safe after esophagectomy. These findings support proceeding with a larger trial to assess its efficacy in patients with high-risk esophageal cancer.
2009-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/10
http://www.current-oncology.com/index.php/oncology/article/view/355
Oncology Publications
Scholarship@Western
Pilot study
cancer
esophagus
extended volume
irradiation
Medical Biophysics
Oncology
Surgery
oai:ir.lib.uwo.ca:oncpub-1011
2009-10-24T03:37:20Z
publication:biophysicspub
publication:oncpub
publication:surgerypub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:surgery
publication:onc
publication:epidempub
Is Extended Volume External Beam Radiation Therapy Covering the Anastomotic Site Beneficial in Post-esophagectomy High Risk Patients?
Yu, Edward
Dar, Rashid
Rodrigues, George B.
Stitt, Larry
Videtic, Gregory M. M.
Truong, Pauline
Tomiak, Anna
Ash, Robert
Brecevic, Ed
Inculet, Richard
Malthaner, Richard
Vincent, Mark
Craig, Ian
Kocha, Walter
Lefcoe, Michael
Background and purpose: To assess the impact of extended volume radiation therapy (RT) with anastomotic coverage on local control in high risk post-operative esophageal cancer patients.
Patients and methods: This is a retrospective study of high risk (T(3), T(4), nodes positive, with or without margin involvement) post-operative esophageal cancer patients treated at London Regional Cancer Centre from 1989 to 1999. After esophagectomy, all patients received adjuvant combined modality therapy consisting of four cycles of fluorouracil-based chemotherapy, and loco-regional RT with or without coverage of the anastomotic site. RT dose ranged from 45 to 60 Gy at 1.8-2.0 Gy/fraction with treatment fields tailored to the pathologic findings and location of the anastomosis. CT planning was used in all patients to design spinal cord sparing beam arrangements. First relapse rate (first incidence of an event), disease specific survival and overall survival were calculated by Chi-Square, Log-Rank, and Kaplan-Meier (K-M) methods.
Results: During the study period, 72 patients had underwent esophagectomy and were considered for adjuvant chemoradiation therapy. Three patients were excluded due to disease progression prior to therapy. The 69 remaining patients formed the study cohort for the present analysis. The median age of the study group was 60 years (range 35-82 years). Pathologic stage distribution (AJCC 1997 staging) was T(2,3) N(1) in 94% patients, 65% of the cases were adenocarcinoma and had undergone transhiatal esophagectomy (86%) with positive/close margins in 34 (49%) patients. Median follow-up was 30.5 months (range 3.4-116.3 months). Two- and 5-year actuarial overall survivals rates were 50 and 31%, respectively. First relapse rate after adjuvant therapy was 63.7% (n = 44) and median time to relapse was 27.2 months. Anastomosis recurrence rates were 29% with small volume and 0% with extended volume RT (P = 0.041). Local and regional relapse occurred in 74.2% of patients treated with small volume RT compared to 15.4% in patients treated with extended volume RT (P < 0.001). After adjusting for resection margin status, the local control benefit of extended volume RT remained significant (P = 0.003). Treatment interruptions and late gastrointestinal toxicity were not significantly increased with the use of extended volume RT.
Conclusions: A significant decrease in local and regional relapse without added late toxicity was achieved with the use of extended volume RT encompassing the anastomotic site post-operatively in high risk esophageal cancer patients.
2004-11-01T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/11
http://dx.doi.org/10.1016/j.radonc.2004.08.024
Oncology Publications
Scholarship@Western
Adult
Aged
Aged
80 and over
Anastomosis
Surgical
Brachytherapy
Combined Modality Therapy
Esophageal Neoplasms
Esophagectomy
Female
Humans
Male
Middle Aged
Neoplasm Recurrence
Local
Neoplasm Staging
Probability
Prognosis
Radiotherapy Dosage
Radiotherapy
Adjuvant
Registries
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Survival Analysis
Time Factors
Treatment Outcome
Aged, 80 and over
Anastomosis, Surgical
Neoplasm Recurrence, Local
Radiotherapy, Adjuvant
Oncology
Surgery
oai:ir.lib.uwo.ca:oncpub-1014
2009-10-26T00:38:55Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Eleven-year Follow-up Results in the Delay of Breast Irradiation after Conservative Breast Surgery in Node-negative Breast Cancer Patients
Vujovic, Olga
Yu, Edward
Cherian, Anil
Dar, A. Rashid
Stitt, Larry
Perera, Francisco
Purpose: This retrospective review was conducted to determine if delay in the start of radiotherapy after conservative breast surgery had any detrimental effect on local recurrence or disease-free survival in node-negative breast cancer patients.
Methods and materials: A total of 568 patients with T1 and T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, without adjuvant systemic therapy, between January 1, 1985 and December 31, 1992 at the London Regional Cancer Centre. The time intervals from definitive breast surgery to breast irradiation used for analysis were 0 to 8 weeks (201 patients), greater than 8 to 12 weeks (235 patients), greater than 12 to 16 weeks (91 patients), and greater than 16 weeks (41 patients). Kaplan-Meier estimates of time to local-recurrence and disease-free survival rates were calculated.
Results: Median follow-up was 11.2 years. Patients in all 4 time intervals were similar in terms of age and pathologic features. No statistically significant difference was seen between the 4 groups in local recurrence or disease-free survival with surgery radiotherapy interval (p = 0.521 and p = 0.222, respectively). The overall local-recurrence rate at 5 and 10 years was 4.6% and 11.3%, respectively. The overall disease-free survival at 5 and 10 years was 79.6% and 67.0%, respectively.
Conclusion: This retrospective study suggests that delay in the start of breast irradiation of up to 16 weeks from definitive surgery does not increase the risk of recurrence in node-negative breast cancer patients. The certainty of these results is limited by the retrospective nature of this analysis.
2006-03-01T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/14
http://dx.doi.org/10.1016/j.ijrobp.2005.08.004
Oncology Publications
Scholarship@Western
Adult
Aged
Aged
80 and over
Breast Neoplasms
Carcinoma
Ductal
Breast
Carcinoma
Lobular
Combined Modality Therapy
Disease-Free Survival
Female
Follow-Up Studies
Humans
Mastectomy
Segmental
Middle Aged
Neoplasm Recurrence
Local
Regression Analysis
Retrospective Studies
Time Factors
Aged, 80 and over
Carcinoma, Ductal, Breast
Carcinoma, Lobular
Mastectomy, Segmental
Neoplasm Recurrence, Local
Oncology
oai:ir.lib.uwo.ca:oncpub-1012
2009-10-26T00:13:46Z
publication:biophysicspub
publication:oncpub
publication:surgerypub
publication:faculties
publication:biophysics
publication:epidem
publication:surgery
publication:onc
publication:epidempub
Definitive Radiation Therapy Management for Medically Non-resectable Clinically Localised Non-small Cell Lung Cancer: Results & Prognostic Factors
Yu, Edward
Tai, Patricia
Ash, Robert
Lee, Michael
Stitt, Larry
Rodrigues, George
Dar, Rashid
Vincent, Mark
Inculet, Richard
Malthaner, Richard
The aim of this paper is to review the experience of radical radiation therapy and the prognostic factors of patient outcome for clinically localised, medically inoperable non-small cell lung cancer (NSCLC) patients. Clinically staged node-negative NSCLC patients who were not a surgical candidates due to co-morbid diseases but who were eligible for curative treatment, were reviewed in the London Regional Cancer Program (LRCP). This study population was treated between 1st Jan 1985 to 31st Jan 2004. Patients were excluded if they were previously treated with chest radiotherapy. Patients with localised disease, but who refused surgery, were also included in the study. Eligible patients received radiation therapy which was given via localised portals and underwent simulation prior to therapy. The dose prescription range was from 50 Gy in 2.5 Gy per fraction to 60 Gy in 2 Gy per fraction. Hazard ratios and P-values were determined for time to recurrence and patient survival. A total of 74 patients met the study eligibility criteria. The median age of the cohort was 70 years (range 38-92 years). The cohort consisted of 52 males and 22 females. 39/74 (53%) had a pathological diagnosis of squamous cell carcinoma. Clinical stages were 21 (28%) T1 , 40 (54%) T2 , and 13 (18%) T3 , respectively. 59/74 (78%) completed their planned radical radiotherapy but 15/74 declined radiotherapy. The median follow-up time was 17.6 months (range 0.4-123.6 months). For patients who completed radiotherapy, the two-year and five-year disease-free survival (DFS) rates were 38.1% and 11.4%. Overall survival (OS) two-year and five-year rates were 33.2% and 6.9%, respectively. The median DFS and OS for T1 , T2 , and T3 were 18.7, 14, 15 months; and 23.1, 18.5, 14.5 months, respectively. Patients who received radiotherapy compared to those who did not, had median lung cancer-specific survival (CSS) times of 21 months and 4.9 months (P<0.001); OS times of 20 months and 5 months (P<0.001), respectively. Tumour size had impact on patient survival in univariate (P=0.004) and multivariate (P=0.002) analyses. In conclusion, radical radiotherapy significantly improves survival for patients with medically inoperable clinically staged localised NSCLC, and tumour size is a predictor of patient outcome. The OS, CSS, and DFS rates for patients with tumour size greater than 6 cm are significantly worse than those with smaller size tumours.
2007-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/12
http://www.nowotwory.edu.pl/files/pdf/s_263e_Yu_-_Definitive_radiation.pdf
Oncology Publications
Scholarship@Western
radiation therapy
lung cancer
Epidemiology
Oncology
Surgery
oai:ir.lib.uwo.ca:oncpub-1016
2009-10-26T01:16:21Z
publication:biophysicspub
publication:oncpub
publication:surgerypub
publication:faculties
publication:biophysics
publication:epidem
publication:surgery
publication:onc
publication:epidempub
The 4th annual Ontario Thoracic Cancer Conference at Niagara-on-the-lake
Ung, Y. C.
Yu, E.
Malthaner, R.
Burkes, R.
Ellis, P.
Goss, G.
Solow, H.
Irvine, S.
Laffan, S.
The 4th annual Ontario Thoracic Cancer Conference at Niagara-on-the-lake focused on the themes of innova- tions in the management of lung cancer, controversies in the management of esophageal cancer, and molecu- lar targeted therapies in lung cancer. This conference summary highlights the presentations and provides clinicians with a referenced update on these topics.
2009-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/16
http://www.current-oncology.com/index.php/oncology/article/view/516
Oncology Publications
Scholarship@Western
lung cancer
esophageal cancer
molecular targeted therapies
Oncology
oai:ir.lib.uwo.ca:oncpub-1017
2009-11-15T11:01:35Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Chemotherapy in Neuroendocrine/Merkel Cell Carcinoma of the Skin: Case Series and Review of 204 Cases
Tai, Patricia T. H.
Yu, Edward
Winquist, Eric
Hammond, Alex
Stitt, Larry
Tonita, Jon
Gilchrist, Jim
Purpose: To study the use of chemotherapy for Merkel cell carcinoma (MCC) of the skin.
Patients and methods: Twenty-five cases of MCC were treated at the London Regional Cancer Center between 1987 and 1997. Thirteen cases treated with chemotherapy were reviewed with 191 cases from the literature.
Results: At presentation, 24 patients had localized skin lesions (stage I) and one had locoregional involvement (stage II). Among the nine cases with recurrent nodal disease, six had chemotherapy as a component of salvage treatment. They were all free of disease at a median of 19 months (range, 12 to 37 months). In contrast, two patients who had salvage radiotherapy alone died of disease. Overall survival (OS) and disease-free survival (DFS) were 59% and 43%, respectively, at two years. Median OS and DFS were 29 months (range, 1 to 133 months) and 9 months (range, 1 to 133 months), respectively. Nodal disease developed in 12 (50%) of 24 patients with stage I disease, and distant metastases developed in six (25%) of 24. Including those from the literature, there were 204 cases treated with chemotherapy. Cyclophosphamide/doxorubicin (or epirubicin)/vincristine combination +/- prednisone was the most commonly used chemotherapy regimen (47 cases), with an overall response rate of 75.7% (35.1% complete, 35. 1% partial, and 5.4% minor responses). Etoposide/cisplatin (or carboplatin) was the next most commonly used regimen (27 cases), with an overall response rate of 60% (36% complete and 24% partial responses). The difference in response rate was not statistically significant (P =.19). Among the 204 cases, there were seven (3.4%) toxic deaths.
Conclusion:: Chemoradiation for locally recurrent or advanced disease may be an option for patients with a good performance status.
2000-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/17
http://jco.ascopubs.org/cgi/content/abstract/18/12/2493
Oncology Publications
Scholarship@Western
Aged
Aged
80 and over
Antineoplastic Combined Chemotherapy Protocols
Carcinoma
Merkel Cell
Combined Modality Therapy
Disease-Free Survival
Female
Humans
Karnofsky Performance Status
Male
Middle Aged
Neoplasm Staging
Prognosis
Skin Neoplasms
Treatment Outcome
Aged, 80 and over
Carcinoma, Merkel Cell
Epidemiology
Oncology
oai:ir.lib.uwo.ca:oncpub-1028
2009-11-02T00:38:49Z
publication:biophysicspub
publication:oncpub
publication:surgerypub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:surgery
publication:onc
publication:epidempub
Management and Prognosis in Synchronous Solitary Resected Brain Metastasis from Non–Small-Cell Lung Cancer
Louie, Alexander V.
Rodrigues, George
Yaremko, Brian
Yu, Edward
Dar, A. Rashid
Dingle, Brian
Vincent, Mark
Sanatani, Michael
Malthaner, Richard
Inculet, Richard
Background: Reports in the medical literature have described cases of extended survival of patients with non-small-cell lung cancer (NSCLC) with solitary metastatic disease who have received aggressive treatment both to the brain metastasis and to the local/regional disease. The objective of this research is to analyze prognostic factors that predict for outcome in this unique patient population.
Patients and methods: A single-institution, retrospective chart review was performed on 35 patients with NSCLC and a synchronous solitary brain metastasis (SSBM) treated with craniotomy and whole-brain radiation therapy. Eight patients (22.9%) had chest surgery, 24 (68.6%) had chemotherapy, and 14 (40%) had thoracic radiation as part of their local management. Fourteen had stage I/II disease (42.9%), and 20 had stage III disease (57.1%). Mean age at diagnosis was 58.5 years. Eighteen patients (56.25%) had a brain metastasis < 3 cm, and 14 patients (43.75%) had a metastasis > 3 cm.
Results: Median survival was 7.8 months, and at last follow-up, 3 patients (8.6%) were alive and well, 6 patients (17.1%) were alive and with disease, 24 patients (68.6%) had died of disease, and 2 patients (5.7%) had died of other causes. Univariate analysis demonstrated that lung surgery (P = .0033), primary lung treatment > 8 weeks after brain surgery (P = .0128), and stage I/II disease (P = .0467) were predictive of overall survival.
Conclusion: Survival remains poor for patients with NSCLC with an SSBM. However, patients with thoracic disease amenable to local resection should be considered for such therapy because a survival advantage could exist compared with patients with more locally advanced disease.
2009-05-01T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/28
http://cigjournals.metapress.com/content/506526020m5610k1/?p=5f802118b7d04304af4114dab0debb4cπ=5
Oncology Publications
Scholarship@Western
Adult
Aged
Brain Neoplasms
Carcinoma
Non-Small-Cell Lung
Cranial Irradiation
Humans
Infant
Lung Neoplasms
Male
Middle Aged
Neoplasm Staging
Prognosis
Retrospective Studies
Carcinoma, Non-Small-Cell Lung
Epidemiology
Oncology
Surgery
oai:ir.lib.uwo.ca:oncpub-1026
2009-11-02T00:14:35Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Effect of Interval to Definitive Breast Surgery on Clinical Presentation and Survival in Early-Stage Invasive Breast Cancer
Vujovic, Olga
Yu, Edward
Cherian, Anil
Perera, Francisco
Dar, A. Rashid
Stitt, Larry
Hammond, A.
Purpose: To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer.
Methods and materials: The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined for the three groups. Cox regression analysis was used to evaluate the effect of clinical presentation and interval to definitive surgery on survival.
Results: The median follow-up was 11.2 years. No statistically significant difference was found in local recurrence as a function of the interval to definitive surgery (p = .424). A significant difference was noted in disease-free survival (p = .040) and cause-specific survival (p = .006) with an interval of >12 weeks to definitive breast surgery. However, the interval to definitive surgery was dependent on the presentation for cause-specific survival, with a substantial effect for patients with a mammographic presentation and a negligible effect for patients with a lump presentation (interaction p = .041).
Conclusion: The results of this study suggest that an interval of >12 weeks to breast surgery might be associated with decreased survival for patients with a mammographic presentation, but it appeared to have no effect on survival for patients presenting with a palpable breast lump.
2009-11-01T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/26
http://www.redjournal.org/article/S0360-3016%2808%2903837-6/abstract
Oncology Publications
Scholarship@Western
Adult
Aged
Aged
80 and over
Axilla
Breast Neoplasms
Disease-Free Survival
Female
Follow-Up Studies
Humans
Lymph Node Excision
Mammography
Middle Aged
Neoplasm Recurrence
Local
Neoplasm Staging
Palpation
Radiotherapy Dosage
Regression Analysis
Retrospective Studies
Time Factors
Aged, 80 and over
Neoplasm Recurrence, Local
Epidemiology
Oncology
oai:ir.lib.uwo.ca:oncpub-1031
2010-07-27T19:59:37Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
The Number of Axillary Nodes Removed as a Predictor of Regional Recurrence in Node Negative Breast Cancer
Vujovic, Olga
Yu, Edward
Cherian, Anil
Dar, A. Rashid
Stitt, Larry
Perera, Francisco
Purpose: To determine if the number of axillary nodes removed is a predictor of recurrence in node negative breast cancer.
Materials and methods: Five hundred thirty-six patients with T1-T2, N0 invasive breast cancer, treated with lumpectomy and axillary node dissection (AND), were reviewed from January 1, 1986 to December 31, 1992. Patients received radiation to whole breast only, without regional nodal radiation. There was no adjuvant chemotherapy or Tamoxifen given. Patients were grouped according to the number of axillary nodes dissected as follows: 1-5 nodes (91 patients), 6-10 nodes (225 patients) and > 10 nodes (220 patients). Hazard ratios and p-values were determined for time to local recurrence, regional recurrence and for disease specific survival.
Results: Median follow-up was 11.2 years. The overall local recurrence and regional recurrence rates for the three groups were: 1-5 nodes, 9.9% and 8.8%, respectively, 6-10 nodes, 10.2% and 2.2%, respectively, and > 10 nodes, 11.8% and 2.7%, respectively. The effect of number of axillary nodes removed was statistically significant only for regional recurrence (p = 0.017). There was no adverse effect on disease specific survival (p = 0.363).
Conclusion: The number of axillary nodes removed predicts only for regional recurrence in node negative breast cancer patients, with less than 6 nodes removed associated with higher regional recurrence. This may have clinical implications with the current practice of sentinel node biopsy (SNB) replacing axillary node dissection in early stage breast cancer.
2009-04-01T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/31
info:doi/10.1016/j.radonc.2008.05.003
http://dx.doi.org/10.1016/j.radonc.2008.05.003
Oncology Publications
Scholarship@Western
Adult
Axilla
Breast Neoplasms
Female
Follow-Up Studies
Humans
Lymph Node Excision
Lymphatic Metastasis
Neoplasm Recurrence
Local
Neoplasm Staging
Predictive Value of Tests
Proportional Hazards Models
Survival Rate
Neoplasm Recurrence, Local
Epidemiology
Oncology
oai:ir.lib.uwo.ca:epidempub-1018
2012-03-29T00:14:24Z
publication:biophysicspub
publication:oncpub
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Dosimetric Evaluation of Helical Tomotherapy Treatment Planning for Non-small Cell Lung Cancer
Chu, Karen
Rodrigues, George
Yartsev, Slav
Dar, A. Rashid
Yu, Edward
Ash, Robert
Yaremko, Brian
MacKenzie, Marc
Quon, Harvey
Bauman, Glenn
Roa, Wilson
Helical tomotherapy (HT) is a novel technique to deliver intensity modulated radiation therapy guided by 3D megavoltage CT imaging. The purpose of our study is to assess the dosimetric parameters related to HT and 3DCRT in advanced non-small cell lung cancer (NSCLC). Eleven patients from the London Regional Cancer Centre and the Cross Cancer Institute with NSCLC underwent individualized treatment planning on both HT and 3DCRT. Corresponding HT and 3DCRT plans for each patient were analyzed using dose-volume histograms for GTV, PTV (median dose 60Gy/30 fractions), and critical structures (lung V5-30, esophageal V50-60, and spinal cord D1). Observed differences in tumor and normal tissue dosimetry were assessed for statistical significance using paired t-tests. A statistically significant improvement on GTV homogeneity but not PTV homogeneity was found in relation with HT. 3DCRT was associated with improved V5 (14%, p = 0.02), V10 (9%, p = 0.04) and V15 (6%, p = 0.04). However, there was no difference in V20 (2%, p = NS); while HT demonstrated superior V30 (5%, p = 0.002). HT achieved excellent tumor coverage relative to 3DCRT in the setting of routinely clinically planned radiation therapy with improvements in the V30 lung parameter. This was at the expense of a modest increase in V5-V15 total lung dose.
2008-09-01T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/18
http://www.cancer-therapy.org/CT/v6/B/PDF/60._Chu_et_al,_571-576.pdf
Epidemiology and Biostatistics Publications
Scholarship@Western
Helical tomotherapy
non-small cell lung cancer
Three-dimensional Conformal Radiotherapy
Dosimetric Comparison
Lung Cancer
Biostatistics
Epidemiology
Oncology
oai:ir.lib.uwo.ca:oncpub-1035
2009-11-08T08:35:56Z
publication:physics
publication:robartspub
publication:biophysicspub
publication:oncpub
publication:surgerypub
publication:pmid
publication:faculties
publication:physicspub
publication:biophysics
publication:epidem
publication:robarts
publication:surgery
publication:institutes
publication:onc
publication:epidempub
3D Thoracoscopic Ultrasound Volume Measurement Validation in an Ex Vivo and In Vivo Porcine Model of Lung Tumours
Hornblower, V. D. M.
Yu, E.
Fenster, A.
Battista, J. J.
Malthaner, R. A.
The purpose of this study was to validate the accuracy and reliability of volume measurements obtained using three-dimensional (3D) thoracoscopic ultrasound (US) imaging. Artificial "tumours" were created by injecting a liquid agar mixture into spherical moulds of known volume. Once solidified, the "tumours" were implanted into the lung tissue in both a porcine lung sample ex vivo and a surgical porcine model in vivo. 3D US images were created by mechanically rotating the thoracoscopic ultrasound probe about its long axis while the transducer was maintained in close contact with the tissue. Volume measurements were made by one observer using the ultrasound images and a manual-radial segmentation technique and these were compared with the known volumes of the agar. In vitro measurements had average accuracy and precision of 4.76% and 1.77%, respectively; in vivo measurements had average accuracy and precision of 8.18% and 1.75%, respectively. The 3D thoracoscopic ultrasound can be used to accurately and reproducibly measure "tumour" volumes both in vivo and ex vivo.
2007-01-07T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/35
http://www.iop.org/EJ/abstract/0031-9155/52/1/007
Oncology Publications
Scholarship@Western
Agar
Algorithms
Animals
Automation
Humans
Image Processing
Computer-Assisted
Imaging
Three-Dimensional
Lung
Lung Neoplasms
Neoplasm Transplantation
Phantoms
Imaging
Reproducibility of Results
Swine
Ultrasonography
Image Processing, Computer-Assisted
Imaging, Three-Dimensional
Phantoms, Imaging
Bioimaging and Biomedical Optics
Oncology
Surgery
oai:ir.lib.uwo.ca:oncpub-1036
2009-11-08T08:54:56Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
The Effect of Timing of Radiotherapy after Breast-conserving Surgery in Patients with Positive or Close Resection Margins, Young Age, and Node-negative Disease, with Long Term Follow-up
Vujovic, Olga
Cherian, Anil
Yu, Edward
Dar, A. Rashid
Stitt, Larry
Perera, Francisco
Purpose: The aim of this study was to determine the effect of timing of radiotherapy after conservative breast surgery on local recurrence in women with positive resection margins and young age, treated without systemic therapy.
Methods and Materials: A total of 568 patients with T1 and T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, between January 1, 1985, and December 31, 1992, at the London Regional Cancer Centre. 63 patients (11.1%) had positive/close resection margins (< 2 mm) and 48 patients (8.4%) were age < or = 40 years. For patients with positive resection margins, the time intervals from breast surgery to breast irradiation used for analysis were, 0 to 8 weeks, > 8 to 12 weeks and > 12 weeks. For patients < or = 40 years, the intervals used for analysis were 0 to 8 weeks and > 8 weeks.
Results: Median follow up was 11.2 years. For patients < or = 40 years, local recurrence rate at 5 and 10 years was 17.2% and 19.8% respectively. Four patients (17.4%) treated in the 0-week to 8-week interval and 7 patients (28.0%) treated in the > 8 week interval had local recurrences. For patients < or = 40 years with positive resection margins, the local recurrence rate was 25.0%. For patients with positive resection margins, 5-year and 10-year local recurrence rates were as follows: 0 to 8 weeks, 0% and 10.5% respectively; > 8 to 12 weeks, 10.3% and 10.3% respectively; and > 12 weeks, 13.3% and 20.0% respectively.
Conclusion: Patients < or = 40 years have an increased local recurrence rate which occurs early. Patients with positive resection margins have higher local recurrence rates that become apparent when breast irradiation is delayed.
2006-11-01T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/36
http://www.redjournal.org/article/S0360-3016%2806%2900978-3/abstract
Oncology Publications
Scholarship@Western
Adult
Age Factors
Aged
Aged
80 and over
Breast Neoplasms
Carcinoma
Ductal
Breast
Carcinoma
Lobular
Disease-Free Survival
Female
Follow-Up Studies
Humans
Mastectomy
Segmental
Middle Aged
Neoplasm Recurrence
Local
Neoplasm
Residual
Time Factors
Aged, 80 and over
Carcinoma, Ductal, Breast
Carcinoma, Lobular
Mastectomy, Segmental
Neoplasm Recurrence, Local
Neoplasm, Residual
Epidemiology
Medical Biophysics
Oncology
oai:ir.lib.uwo.ca:oncpub-1039
2009-11-09T00:32:16Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Does Sex Influence the Impact that Smoking, Treatment Interruption and Impaired Pulmonary Function Have on Outcomes in Limited Stage Small Cell Lung Cancer Treatment?
Videtic, Gregory M. M.
Truong, Pauline T.
Ash, Robert B.
Yu, Edward W.
Kocha, Walter I.
Vincent, Mark D.
Tomiak, Anna T.
Dar, A Rashid
Whiston, Frances
Stitt, Larry W.
PURPOSE: To look for survival differences between men and women with limited stage small cell lung cancer (LS-SCLC) by examining stratified variables that impair treatment efficacy.
METHODS: A retrospective review of 215 LS-SCLC patients treated from 1989 to 1999 with concurrent chemotherapy-radiotherapy modelled on the 'early-start' thoracic radiotherapy arm of a National Cancer Institute of Canada randomized trial.
RESULTS: Of 215 LS-SCLC patients, 126 (58.6%) were men and 89 (41.4%) were women. Smoking status during treatment for 186 patients (86.5%) was: 107 (58%) nonsmoking (NS) (76 [71%] male [M]; 31 [29%] female [F]) and 79 (42%) smoking (S) (36 M [46%]; 43 F [54%]) (continuing-to-smoke F versus M, P=0.001). Fifty-six patients (26%) had radiotherapy interruptions (RTI) during chemotherapy-radiotherapy because of toxicity. Radiotherapy breaks were not associated with sex (P=0.95). Survival by sex and smoking status at two years was: F + NS = 38.7%; F + S = 21.6%; M + NS = 22.9%; and M + S = 9.1% (P=0.0046). Survival by sex and RTI status at two years was: F + no RTI = 32.4%; F + RTI = 23.6%; M + no RTI = 23.0%; and M + RTI = 3.8% (P=0.0025). Diffusion capacity for carbon monoxide (DLCO) was recorded for 86 patients (40%) and median survival by sex and DLCO was F = 16.7 months and M = 12.1 months for a DLCO less than 60%; and for a DLCO 60% or more, F = 15.1 months and M = 15.3 months. First relapses were recorded in 132 cases (61%), with chest failure in men (45%) greater than for women (35%) and cranial failure rates similar between sexes (48%). Upon multivariable analysis, continued smoking was the strongest negative factor affecting survival.
CONCLUSIONS: In LS-SCLC, women overall do better than men, with or without a negative variable. The largest quantifiable improvement in survival for women came from smoking cessation, and for men from avoidance of breaks during treatment.
2005-07-01T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/39
http://www.pulsus.com/journals/abstract.jsp?sCurrPg=abstract&jnlKy=4&atlKy=1191&isuKy=357&isArt=t&fromfold=
Oncology Publications
Scholarship@Western
Adult
Aged
Aged
80 and over
Carcinoma
Small Cell
Female
Humans
Lung Neoplasms
Male
Middle Aged
Multivariate Analysis
Radiotherapy Dosage
Retrospective Studies
Sex Factors
Smoking
Survival Analysis
Aged, 80 and over
Carcinoma, Small Cell
Epidemiology
Medical Biophysics
Oncology
oai:ir.lib.uwo.ca:epidempub-1019
2009-11-21T00:16:16Z
publication:pmid
publication:faculties
publication:epidem
publication:epidempub
Penetrance of Colorectal Cancer among MLH1/MSH2 Carriers Participating in the Colorectal Cancer Familial Registry in Ontario
Choi, Yun-Hee
Cotterchio, Michelle
McKeown-Eyssen, Gail
Neerav, Monga
Bapat, Bharati
Boyd, Kevin
Gallinger, Steven
McLaughlin, John
Aronson, Melyssa
Briollais, Laurent
Background: Several DNA mismatch repair (MMR) genes, responsible for the majority of Lynch Syndrome cancers, have been identified, predominantly MLH1 and MSH2, but the risk associated with these mutations is still not well established. The aim of this study is to provide population-based estimates of the risks of colorectal cancer (CRC) by gender and mutation type from the Ontario population.
Methods: We analyzed 32 families segregating MMR mutations selected from the Ontario Familial Colorectal Cancer Registry and including 199 first-degree and 421 second-degree relatives. The cumulative risks were estimated using a modified segregation-based approach, which allows correction for the ascertainment of the Lynch Syndrome families and permits account to be taken for missing genotype information.
Results: The risks of developing CRC by age 70 were 60% and 47% among men and women carriers of any MMR mutation, respectively. Among MLH1 mutation carriers, males had significantly higher risks than females at all ages (67% vs. 35% by age 70, p-value = 0.02), while the risks were similar in MSH2 carriers (about 54%). The relative risk associated with MLH1 was almost constant with age (hazard ratio (HR) varied between 5.5-5.1 over age 30-70), while the HR for MSH2 decreased with age (from 13.1 at age 30 to 5.4 at age 70).
Conclusion: This study provides a unique population-based study of CRC risks among MSH2/MLH1 mutation carriers in a Canadian population and can help to better define and understand the patterns of risks among members of Lynch Syndrome families.
2009-08-23T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/24
info:doi/10.1186/1897-4287-7-14
http://www.hccpjournal.com/content/7/1/14
Epidemiology and Biostatistics Publications
Scholarship@Western
colorectal cancer
MLH1
MSH2
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:medpub-1021
2009-11-14T09:04:30Z
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:epidem
publication:epidempub
Can Cognitive Enhancers Reduce the Risk of Falls in Older People with Mild Cognitive Impairment? A Protocol for a Randomised Controlled Double Blind Trial
Montero-Odasso, Manuel
Wells, Jennie L.
Borrie, Michael J.
Speechley, Mark
Background: Older adults with cognitive problems have a higher risk of falls, at least twice that of cognitively normal older adults. The consequences of falls in this population are very serious: fallers with cognitive problems suffer more injuries due to falls and are approximately five times more likely to be admitted to institutional care. Although the mechanisms of increased fall risk in cognitively impaired people are not completely understood, it is known that impaired cognitive abilities can reduce attentional resource allocation while walking. Since cognitive enhancers, such as cholinesterase inhibitors, improve attention and executive function, we hypothesise that cognitive enhancers may reduce fall risk in elderly people in the early stages of cognitive decline by improving their gait and balance performance due to an enhancement in attention and executive function.
Method/Design: Double blinded randomized controlled trial with 6 months follow-up in 140 older individuals with Mild Cognitive Impairment (MCI). Participants will be randomized to the intervention group, receiving donepezil, and to the control group, receiving placebo. A block randomization by four and stratification based on fall history will be performed. Primary outcomes are improvements in gait velocity and reduction in gait variability. Secondary outcomes are changes in the balance confidence, balance sway, attention, executive function, and number of falls.
Discussion: By characterizing and understanding the effects of cognitive enhancers on fall risk in older adults with cognitive impairments, we will be able to pave the way for a new approach to fall prevention in this population. This RCT study will provide, for the first time, information regarding the effect of a medication designed to augment cognitive functioning have on the risk of falls in older adults with Mild Cognitive Impairment. We expect a significant reduction in the risk of falls in this vulnerable population as a function of the reduced gait variability achieved by treatment with cognitive enhancers. This study may contribute to a new approach to prevent and treat fall risk in seniors in early stages of dementia.
Trial Registration: The protocol for this study is registered with the Clinical Trials Registry, identifier number: NCT00934531 http://www.clinicaltrials.gov.
2009-08-12T07:00:00Z
article
https://ir.lib.uwo.ca/medpub/15
info:doi/10.1186/1471-2377-9-42
http://www.biomedcentral.com/1471-2377/9/42
Department of Medicine Publications
Scholarship@Western
Accidental Falls
Aged
Aged
80 and over
Cholinesterase Inhibitors
Clinical Protocols
Cognition Disorders
Community-Based Participatory Research
Double-Blind Method
Female
Gait
Humans
Indans
Male
Patient Selection
Piperidines
Treatment Outcome
Aged, 80 and over
Cognition and Perception
Neurology
oai:ir.lib.uwo.ca:epidempub-1020
2009-11-11T08:11:40Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Prediction of Radiation Pneumonitis by Dose-volume Histogram Parameters in Lung Cancer--A Systematic Review
Rodrigues, George
Lock, Michael
D'Souza, David
Yu, Edward
Van Dyk, Jake
BACKGROUND AND PURPOSE: To perform a systematic review of the predictive ability of various dose-volume histogram (DVH) parameters (V(dose), mean lung dose (MLD), and normal tissue complication probability (NTCP)) in the incidence of radiation pneumonitis (RP) caused by external-beam radiation therapy.
METHODS AND MATERIALS: Studies assessing the relationship between CT-based DVH reduction parameters and RP rate in radically treated lung cancer were eligible for the review. Synonyms for RP, lung cancer, DVH and its associated parameters (NTCP, V(20), V(30), MLD) were combined in a search strategy involving electronic databases, secondary reference searching, and consultation with experts. Individual or group data were abstracted from the various reports to calculate operating characteristics and odds ratios for the different DVH metrics.
RESULTS: A total of 12 published studies and two abstracts were identified. Eleven studies assessed V(dose), seven assessed MLD, and eight assessed NTCP. Nine studies exclusively analyzed the association between various DVH metrics and RP risk. Five studies also analyzed other patient, tumor, and treatment variables in conjunction with standard DVH metrics. A direct comparison between studies and the generation of summary statistics (i.e. meta-analysis) could not be achieved due to significant predictive and outcome variable heterogeneity. Most studies did show an association between DVH parameters and RP risk. However, overall accuracy, sensitivity, specificity, and positive predictive value were generally poor to fair for all three classes of DVH metrics.
CONCLUSIONS: An association between DVH parameters and RP risk has been demonstrated in the literature. However, the ideal DVH metric with excellent operating characteristics, either alone or in a model with other predictive variables, for RP risk prediction has not yet been identified. Several recommendations for reporting and conduct of future research into the association between DVH metrics and RP risk are provided.
2004-05-01T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/20
info:doi/10.1016/j.radonc.2004.02.015
http://dx.doi.org/10.1016/j.radonc.2004.02.015
Epidemiology and Biostatistics Publications
Scholarship@Western
Carcinoma
Non-Small-Cell Lung
Carcinoma
Small Cell
Dose-Response Relationship
Radiation
Female
Humans
Lung
Lung Neoplasms
Male
Predictive Value of Tests
Prognosis
Radiation Pneumonitis
Radiation Tolerance
Radiotherapy Dosage
Radiotherapy Planning
Computer-Assisted
Radiotherapy
Conformal
Randomized Controlled Trials as Topic
Risk Assessment
Severity of Illness Index
Carcinoma, Non-Small-Cell Lung
Carcinoma, Small Cell
Dose-Response Relationship, Radiation
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Conformal
Biostatistics
Epidemiology
Oncology
oai:ir.lib.uwo.ca:oncpub-1043
2009-11-12T03:25:15Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Shifting from Hypofractionated to "Conventionally" Fractionated Thoracic Radiotherapy: A Single Institution's 10-year Experience in the Management of Limited-stage Small-cell Lung Cancer Using Concurrent Chemoradiation
Videtic, Gregory M. M.
Truong, Pauline T.
Dar, A. Rashid
Yu, Edward W.
Stitt, Larry W.
PURPOSE: To perform a retrospective review of a single institution's 10-year experience in treating limited-stage small-cell lung cancer (LS-SCLC) with a concurrent chemoradiation regimen modeled after the experimental arm of a randomized National Cancer Institute of Canada trial in which hypofractionated radiotherapy started with cycle 2 of chemotherapy. We then looked at the impact on patient outcomes of changing the RT during the course of the decade to a "conventionally" (2 Gy) fractionated regimen, with a focus on toxicity and survival rates.
METHODS AND MATERIALS: Between 1989 and 1999, 215 LS-SCLC patients received six cycles of chemotherapy consisting of cyclophosphamide, doxorubicin, and vincristine alternating with etoposide and cisplatin every 3 weeks. Thoracic RT was administered concurrently with etoposide and cisplatin (at cycle 2 or 3) only and consisted of either 40 Gy in 15 fractions for 3 weeks or 50 Gy in 25 fractions for 5 weeks. RT fields encompassed gross and suspected microscopic disease with 2-cm margins. Prophylactic cranial irradiation (PCI) was offered to complete responders according to clinician preference. RT interruption during concurrent chemoradiation was used as the "marker" for treatment toxicity. The analysis compared the RT schedules for differences in toxicity, survival, and recurrence patterns.
RESULTS: The overall survival rate for 215 patients at 2 and 5 years was 22.7% and 7.2%, respectively, with a median survival of 14.7 months. Thoracic RT consisted of 40 Gy in 3 weeks for 122 patients (57%) and 50 Gy in 5 weeks for 92 patients (43%). PCI was administered to 21 (44%) and 47 (56%) patients receiving 40 Gy and 50 Gy, respectively. The patient- and treatment-related variables were comparable between the two cohorts treated with the different RT prescriptions. RT interruptions during concurrent chemoradiation were recorded in 56 cases (26%), with a median duration of 5 days (range 1-18). No differences in treatment-related toxicity rates were demonstrated between the two dose cohorts (p = 0.35). The overall and disease-free survival rates (patients stratified by PCI use) at 5 years for the 40- and 50-Gy schedules were 14.3% and 12.0% (p = 0.71) and 20.7% and 22.2% (p = 0.76), respectively. Sites of first failure were recorded in 132 patients (61%). Comparing the 40-Gy and 50-Gy cohorts, the rate of any first relapse was 40% vs. 42% and the chest as the first relapse site was 34% vs. 45% (patients stratified by PCI use), respectively. The brain failure rate reflected PCI use and was not related to the thoracic RT schedule.
CONCLUSION: Changing from a hypofractionated to a conventionally fractionated RT thoracic prescription did not alter outcomes because the survival, thoracic control, and toxicity rates were statistically similar. This suggests that the hypofractionated schedule remains practicable and should be considered in the setting of randomized clinical trials. In view of the benefits that accelerated schedules provide for both patients and cost containment, clinicians may opt to use this tolerable regimen in managing LS-SCLC. Regarding the future development of novel chemoradiation programs, the most critical factor in ensuring improved outcomes for LS-SCLC may be limiting the duration of RT and overall treatment time.
2003-11-01T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/43
info:doi/10.1016/S0360-3016(03)00635-7
http://www.redjournal.org/article/S0360-3016%2803%2900635-7/abstract
Oncology Publications
Scholarship@Western
Adult
Aged
Aged
80 and over
Antineoplastic Combined Chemotherapy Protocols
Carcinoma
Small Cell
Cisplatin
Cyclophosphamide
Dose Fractionation
Doxorubicin
Etoposide
Female
Humans
Lung Neoplasms
Male
Middle Aged
Multivariate Analysis
Neoplasm Staging
Retrospective Studies
Survival Rate
Vincristine
Aged, 80 and over
Carcinoma, Small Cell
Epidemiology
Oncology
oai:ir.lib.uwo.ca:epidempub-1021
2009-11-12T03:14:21Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Impaired Diffusion Capacity Predicts for Decreased Treatment Tolerance and Survival in Limited Stage Small Cell Lung Cancer Patients Treated with Concurrent Chemoradiation
Videtic, Gregory M. M.
Stitt, Larry W.
Ash, Robert B.
Truong, Pauline T.
Dar, A. Rashid
Yu, Edward W.
Whiston, Frances
PURPOSE: To determine if stratification of limited stage small cell lung cancer (LSCLC) patients by pre-treatment pulmonary function test (PFT) prognostic indicators predicts for treatment-related toxicity risks and survival following concurrent chemoradiation.
MATERIALS AND METHODS: From 1989 to 1999, 215 LSCLC patients received six cycles of alternating cyclophosphamide/doxorubicin/vincristine and etoposide/cisplatin (EP). Thoracic radiation (RT) was initiated only with EP and at cycle 2 or 3. RT dose was: 40 Gy/15 fractions/3 weeks or 50 Gy/25 fractions/5 weeks. RT fields encompassed gross and suspected microscopic disease with a 2 cm margin. Pre-treatment PFT values analyzed included forced expiratory volume in 1s (FEV1) (in liter and as % predicted) and diffusion capacity for carbon monoxide (DLCO) (as % predicted). The "marker" for toxicity during concurrent chemoradiation was the duration of any RT breaks initiated for severe hematologic or locoregional symptomatology. Patient outcomes were analyzed for associations between recognized PFT cut-offs (FEV1 <2l, > or =2l; FEV1 <60%, > or =60% predicted; DLCO <60%, > or =60% predicted), toxicity rates, and survival.
RESULTS: For the whole study cohort, median, 2- and 5-year overall survivals were: 14.7 months, 22.7 and 7.2%, respectively. Fifty-six patients (26%) required treatment breaks due to toxicity. FEV1 and DLCO results were available for 96 (45%) and 86 (40%) patients, respectively. Two thirds of FEV1s measured were <2l. On statistical analysis, the incidence of toxicity-related interruptions was significant for DLCO<60% (P=0.043), suggestive for FEV1<2l (P=0.1) and non-significant for FEV1<60%. Patients with simultaneous DLCO<60% and FEV1<2l showed a trend toward increase toxicity risk (P=0.1). For selected PFT measures, median overall survivals were: 12.7 months versus 14.8 months for DLCO<60% versus > or =60%; 13.4 months versus 17.7 months for FEV1<2l versus> or =2l; 15.4 months versus 19.9 months for DLCO<60% + FEV1<2l versus DLCO> or =60% + FEV1> or =2l. Although absolute differences favored all patients with PFT values above the prognostic cut-offs, differences were not statistically significant on this analysis. Patients with both a treatment break and a DLCO<60% had the poorest median survival of all patient subsets, at 11.4 months (P=0.09).
CONCLUSIONS: Impaired DLCO (i.e. <60%) is a novel predictor of increased treatment-related toxicity leading to interruptions. The present study suggests a probable role for DLCO and FEV1 (in l) as prognostic factors for predicting survival but larger patient samples are required for confirmation. Patients with impaired DLCOs experiencing treatment interruptions have the poorest survival. Assessment of pre-treatment PFTs contributes to determining optimal management strategies for LSCLC patients receiving definitive chemoradiation.
2004-02-01T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/21
info:doi/10.1016/j.lungcan.2003.08.026
http://dx.doi.org/10.1016/j.lungcan.2003.08.026
Epidemiology and Biostatistics Publications
Scholarship@Western
Adult
Aged
Aged
80 and over
Algorithms
Antineoplastic Combined Chemotherapy Protocols
Cisplatin
Combined Modality Therapy
Cyclophosphamide
Doxorubicin
Etoposide
Female
Humans
Lung Neoplasms
Male
Middle Aged
Predictive Value of Tests
Prognosis
Radiation Injuries
Retrospective Studies
Risk Factors
Spirometry
Survival Analysis
Treatment Outcome
Vincristine
Aged, 80 and over
Epidemiology
Oncology
oai:ir.lib.uwo.ca:epidempub-1022
2009-11-23T06:48:15Z
publication:pmid
publication:faculties
publication:epidem
publication:epidempub
Penetrance of HNPCC-related Cancers in a Retrolective Cohort of 12 Large Newfoundland Families Carrying a MSH2 Founder Mutation: An Evaluation Using Modified Segregation Models
Kopciuk, Karen A.
Choi, Yun-Hee
Parkhomenko, Elena
Parfrey, Patrick
McLaughlin, John
Green, Jane
Briollais, Laurent
Background: Accurate risk (penetrance) estimates for associated phenotypes in carriers of a major disease gene are important for genetic counselling of at-risk individuals. Population-specific estimates of penetrance are often needed as well. Families ascertained from high-risk disease clinics provide substantial data to estimate penetrance of a disease gene, but these estimates must be adjusted for possible specific sources of bias.
Methods: A cohort of 12 independently ascertained HNPCC families harbouring a founder MSH2 mutation was identified from a cancer genetics clinic in St. John's, Newfoundland, Canada. Carrier status was known for 247 family members but phenotype information on up to 85 additional relatives with unknown carrier status was available; using modified segregation models these additional individuals could be included in the analyses. Three HNPCC-related phenotypes were evaluated as age at diagnosis of: any HNPCC cancer (first cancer), colorectal cancer (CRC), and endometrial cancer (EC) for females.
Results: Lifetime (age 70) risk estimates for male and female carriers were similar for developing any HNPCC cancer (Males = 98.2%, 95% Confidence Interval (CI) = (93.8%, 99.9%); Females = 92.8%, 95% CI = (82.4%, 99.1%)) but female carriers experienced substantially reduced lifetime risk for developing CRC compared to male carriers (Females = 38.9%, 95% CI = (24.2%, 62.1%); Males = 84.5%, 95% CI = (67.3%, 91.3%)). Female non-carriers had very low lifetime risk for these two outcomes while male non-carriers had lifetime risks intermediate to the female carriers and non-carriers. Female carriers had a lifetime risk of developing EC of 82.4%. Relative risks for developing any HNPCC cancer (carriers relative to non-carriers) were substantially greater for females compared to their male counterparts (Females = 54.8, 95%CI = (4.4, 379.8); Males = 9.7, 95% CI = (0.3, 23.8)). Relative risks for developing CRC at age 70 were substantially greater for females compared to their male counterparts (Females = 23.7, 95%CI = (5.6, 137.9); Males = 6.8%, 95% CI = (2.3, 66.2)). However, the risk of developing CRC decreased with age among both genders.
Conclusion: The proposed modified segregation-based models used to estimate age-specific risks for HNPCC phenotypes can reduce bias due to ascertainment and missing genotype information as well as provide estimates of absolute and relative risks.
2009-10-28T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/25
info:doi/10.1186/1897-4287-7-16
http://www.hccpjournal.com/content/7/1/16
Epidemiology and Biostatistics Publications
Scholarship@Western
HNPCC
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:oncpub-1047
2009-11-15T10:02:12Z
publication:biophysicspub
publication:oncpub
publication:surgerypub
publication:pmid
publication:medimaging
publication:faculties
publication:biophysics
publication:epidem
publication:medimagingpub
publication:surgery
publication:onc
publication:epidempub
Subsets More Likely to Benefit From Surgery or Prophylactic Cranial Irradiation After Chemoradiation for Localized Non-Small-Cell Lung Cancer
Keith, Bruce
Vincent, Mark
Stitt, Larry
Tomiak, Anna
Malthaner, Richard
Yu, Edward
Truong, Pauline
Inculet, Richard
Lefcoe, Michael
Dar, A. Rashid
Kocha, Walter
Craig, Ian
After chemoradiation for localized non-small-cell lung cancer, surgery and prophylactic cranial irradiation (PCI) have been used as additional therapies. Less than a third of patients develop brain recurrences, or have local recurrence as their sole initial site of recurrence; these are groups that would benefit from PCI or surgery, respectively. Pretreatment identification of patients more likely to benefit from surgery or PCI would be useful. A retrospective analysis of 80 patients was performed to determine prognostic factors for such patterns of failure. Twenty-nine patients were subsequently selected for surgery in a nonrandomized manner. Seventeen patients had isolated local initial recurrence and 15 had brain recurrences. In multivariable analysis, female gender and elevated LDH were found to be risk factors for brain recurrence. In the subset with stage III disease (n = 76), squamous cell histology was a risk factor for isolated initial local recurrence in both univariable and multivariable analysis. It is possible to identify subsets that may show increased benefit from PCI or surgery.
2002-12-01T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/47
http://journals.lww.com/amjclinicaloncology/Abstract/2002/12000/Subsets_More_Likely_to_Benefit_From_Surgery_or.11.aspx
Oncology Publications
Scholarship@Western
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
Brain Neoplasms
Carcinoma
Non-Small-Cell Lung
Combined Modality Therapy
Cranial Irradiation
Female
Humans
L-Lactate Dehydrogenase
Lung Neoplasms
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence
Local
Pneumonectomy
Prognosis
Radiotherapy Dosage
Radiotherapy
Adjuvant
Retrospective Studies
Risk Factors
Carcinoma, Non-Small-Cell Lung
Neoplasm Recurrence, Local
Radiotherapy, Adjuvant
Epidemiology
Oncology
Surgery
oai:ir.lib.uwo.ca:oncpub-1049
2009-11-15T10:34:32Z
publication:physics
publication:biophysicspub
publication:oncpub
publication:pmid
publication:medimaging
publication:faculties
publication:physicspub
publication:biophysics
publication:epidem
publication:medimagingpub
publication:onc
publication:epidempub
Improving the Consistency in Cervical Esophageal Target Volume Definition by Special Training
Tai, Patricia
Van Dyk, Jake
Battista, Jerry
Yu, Edward
Stitt, Larry
Tonita, Jon
Agboola, Olusegun
Brierley, James
Dar, Rashid
Leighton, Christopher
Malone, Shawn
Strang, Barbara
Truong, Pauline
Videtic, Gregory
Wong, C. Shun
Wong, Rebecca
Youssef, Youssef
PURPOSE: Three-dimensional conformal radiation therapy requires the precise definition of the target volume. Its potential benefits could be offset by the inconsistency in target definition by radiation oncologists. In a previous survey of radiation oncologists, a large degree of variation in target volume definition of cervical esophageal cancer was noted for the boost phase of radiotherapy. The present study evaluated whether special training could improve the consistency in target volume definitions.
METHODS AND MATERIALS: A pre-training survey was performed to establish baseline values. This was followed by a special one-on-one training session on treatment planning based on the RTOG 94-05 protocol to 12 radiation oncologists. Target volumes were redrawn immediately and at 1-2 months later. Post-training vs. pre-training target volumes were compared.
RESULTS: There was less variability in the longitudinal positions of the target volumes post-training compared to pre-training (p < 0.05 in 5 of 6 comparisons). One case had more variability due to the lack of a visible gross tumor on CT scans. Transverse contours of target volumes did not show any significant difference pre- or post-training.
CONCLUSION: For cervical esophageal cancer, this study suggests that special training on protocol guidelines may improve consistency in target volume definition. Explicit protocol directions are required for situations where the gross tumor is not easily visible on CT scans. This may be particularly important for multicenter clinical trials, to reduce the occurrences of protocol violations.
2002-07-01T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/49
info:doi/10.1016/S0360-3016(02)02752-9
http://dx.doi.org/10.1016/S0360-3016(02)02752-9
Oncology Publications
Scholarship@Western
Education
Medical
Continuing
Esophageal Neoplasms
Humans
Imaging
Three-Dimensional
Physical Phenomena
Physics
Radiation Oncology
Radiotherapy
Conformal
Tomography
X-Ray Computed
Education, Medical, Continuing
Imaging, Three-Dimensional
Radiotherapy, Conformal
Tomography, X-Ray Computed
Epidemiology
Medical Biophysics
Oncology
oai:ir.lib.uwo.ca:epidempub-1023
2009-11-15T09:44:50Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Continued Cigarette Smoking by Patients Receiving Concurrent Chemoradiotherapy for Limited-Stage Small-Cell Lung Cancer Is Associated With Decreased Survival
Videtic, Gregory M. M.
Stitt, Larry W.
Dar, A. Rashid
Kocha, Walter I.
Tomiak, Anna T.
Truong, Pauline T.
Vincent, Mark D.
Yu, Edward W.
PURPOSE: To determine the impact of continued smoking by patients receiving chemotherapy (CHT) and radiotherapy (RT) for limited-stage small-cell lung cancer (LSCLC) on toxicity and survival.
PATIENTS AND METHODS: A retrospective review was carried out on 215 patients with LSCLC treated between 1989 and 1999. Treatment consisted of six cycles of alternating cyclophosphamide, doxorubicin, vincristine and etoposide, cisplatin (EP). Thoracic RT was concurrent with EP (cycle 2 or 3) only. Patients were known smokers, with their smoking status recorded at the start of chemoradiotherapy (CHT/RT). RT interruption during concurrent CHT/RT was used as the marker for treatment toxicity.
RESULTS: Of 215 patients, smoking status was recorded for 186 patients (86.5%), with 79 (42%) continuing to smoke and 107 (58%) abstaining during CHT/RT. RT interruptions were recorded in 38 patients (20.5%), with a median duration of 5 days (range, 1 to 18 days). Median survival for former smokers was greater than for continuing smokers (18 v 13.6 months), with 5-year actuarial overall survival of 8.9% versus 4%, respectively (log-rank P =.0017). Proportion of noncancer deaths was comparable between the two cohorts. Continuing smokers did not have a greater incidence of toxicity-related treatment breaks (P =.49), but those who continued to smoke and also experienced a treatment break had the poorest overall survival (median, 13.4 months; log-rank P =.0014).
CONCLUSION: LSCLC patients who continue to smoke during CHT/RT have poorer survival rates than those who do not. Smoking did not have an impact on the rate of treatment interruptions attributed to toxicity.
2003-04-15T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/22
http://jco.ascopubs.org/cgi/content/abstract/21/8/1544
Epidemiology and Biostatistics Publications
Scholarship@Western
Actuarial Analysis
Antineoplastic Combined Chemotherapy Protocols
Carcinoma
Small Cell
Chemotherapy
Adjuvant
Female
Humans
Lung Neoplasms
Male
Middle Aged
Neoplasm Staging
Radiotherapy
Adjuvant
Retrospective Studies
Smoking
Survival Analysis
Treatment Outcome
Carcinoma, Small Cell
Chemotherapy, Adjuvant
Radiotherapy, Adjuvant
Epidemiology
Oncology
oai:ir.lib.uwo.ca:healthstudiespub-1003
2011-06-29T23:31:03Z
publication:pmid
publication:faculties
publication:healthstudies
publication:epidem
publication:healthstudiespub
publication:epidempub
Is Research Working for You? Validating a Tool to Examine the Capacity of Health Organizations to Use Research
Kothari, Anita
Edwards, Nancy
Hamel, Nadia
Judd, Maria
Background: 'Is research working for you? A self-assessment tool and discussion guide for health services management and policy organizations', developed by the Canadian Health Services Research Foundation, is a tool that can help organizations understand their capacity to acquire, assess, adapt, and apply research. Objectives were to: determine whether the tool demonstrated response variability; describe how the tool differentiated between organizations that were known to be lower-end or higher-end research users; and describe the potential usability of the tool. Methods: Thirty-two focus groups were conducted among four sectors of Canadian health organizations. In the first hour of the focus group, participants individually completed the tool and then derived a group consensus ranking on items. In the second hour, the facilitator asked about overall impressions of the tool, to identify insights that emerged during the review of items on the tool and to elicit comments on research utilization. Discussion data were analyzed qualitatively, and individual and consensus item scores were analyzed using descriptive and non-parametric statistics. Results: The tool demonstrated good usability and strong response variability. Differences between higher-end and lower-end research use organizations on scores suggested that this tool has adequate discriminant validity. The group discussion based on the tool was the more useful aspect of the exercise, rather than the actual score assigned. Conclusion: The tool can serve as a catalyst for an important discussion about research use at the organizational level; such a discussion, in and of itself, demonstrates potential as an intervention to encourage processes and supports for research translation.
2009-07-23T07:00:00Z
article
https://ir.lib.uwo.ca/healthstudiespub/3
info:doi/10.1186/1748-5908-4-46
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727486/
Health Studies Publications
Scholarship@Western
Health research
Research translation
Medicine and Health Sciences
oai:ir.lib.uwo.ca:medpub-1024
2010-06-21T23:59:10Z
publication:fammedpub
publication:clinicalpub
publication:fammed
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:robarts
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Ethical and Policy Issues in Cluster Randomized Trials: Rationale and Design of a Mixed Methods Research Study
Taljaard, Monica
Weijer, Charles
Grimshaw, Jeremy M.
Brown, Judith Belle
Binik, Ariella
Boruch, Robert
Brehaut, Jamie C.
Chaudhry, Shazia H.
Eccles, Martin P.
McRae, Andrew
Saginur, Raphael
Zwarenstein, Merrick
Donner, Allan
Background: Cluster randomized trials are an increasingly important methodological tool in health research. In cluster randomized trials, intact social units or groups of individuals, such as medical practices, schools, or entire communities--rather than individual themselves--are randomly allocated to intervention or control conditions, while outcomes are then observed on individual cluster members. The substantial methodological differences between cluster randomized trials and conventional randomized trials pose serious challenges to the current conceptual framework for research ethics. The ethical implications of randomizing groups rather than individuals are not addressed in current research ethics guidelines, nor have they even been thoroughly explored. The main objectives of this research are to: (1) identify ethical issues arising in cluster trials and learn how they are currently being addressed; (2) understand how ethics reviews of cluster trials are carried out in different countries (Canada, the USA and the UK); (3) elicit the views and experiences of trial participants and cluster representatives; (4) develop well-grounded guidelines for the ethical conduct and review of cluster trials by conducting an extensive ethical analysis and organizing a consensus process; (5) disseminate the guidelines to researchers, research ethics boards (REBs), journal editors, and research funders.
Methods: We will use a mixed-methods (qualitative and quantitative) approach incorporating both empirical and conceptual work. Empirical work will include a systematic review of a random sample of published trials, a survey and in-depth interviews with trialists, a survey of REBs, and in-depth interviews and focus group discussions with trial participants and gatekeepers. The empirical work will inform the concurrent ethical analysis which will lead to a guidance document laying out principles, policy options, and rationale for proposed guidelines. An Expert Panel of researchers, ethicists, health lawyers, consumer advocates, REB members, and representatives from low-middle income countries will be appointed. A consensus conference will be convened and draft guidelines will be generated by the Panel; an e-consultation phase will then be launched to invite comments from the broader community of researchers, policy-makers, and the public before a final set of guidelines is generated by the Panel and widely disseminated by the research team.
2009-07-28T07:00:00Z
article
https://ir.lib.uwo.ca/medpub/18
info:doi/10.1186/1745-6215-10-61
http://dx.doi.org/10.1186/1745-6215-10-61
Department of Medicine Publications
Scholarship@Western
Clinical Trials Data Monitoring Committees
Focus Groups
Guidelines as Topic
Health Policy
Humans
Randomized Controlled Trials as Topic
Research Design
Ethics and Political Philosophy
Medicine and Health Sciences
Philosophy of Science
oai:ir.lib.uwo.ca:epidempub-1024
2009-11-18T08:17:20Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Using Treatment Interruptions to Palliate the Toxicity from Concurrent Chemoradiation for Limited Small Cell Lung Cancer Decreases Survival and Disease Control
Videtic, Gregory M. M.
Fung, Karen
Tomiak, Anna T.
Stitt, Larry W.
Dar, A. Rashid
Truong, Pauline T.
Yu, Edward W.
Vincent, Mark D.
Kocha, Walter I.
BACKGROUND AND PURPOSE: We analyzed the impact on survival outcomes of treatment interruptions due to toxicity arising during the concurrent phase of chemotherapy/radiotherapy (ChT/RT) for our limited-stage small-cell cancer (LSCLC) population over the past 10 years.
MATERIALS AND METHODS: From 1989 to 1999, 215 patients received treatment for LSCLC, consisting of six cycles of alternating cyclophosphamide/doxorubicin or epirubicin/vincristine (CAV; CEV) and etoposide/cisplatin (EP). Thoracic RT was started with EP at either the second or third cycle (85% of patients). RT dose was either 40 Gy in 15 fractions over 3 weeks or 50 Gy in 25 fractions over 5 weeks, delivered to a target volume encompassing gross disease and suspected microscopic disease with a 2 cm margin. Treatment breaks arising during concurrent ChT+RT were used to manage severe symptomatic or hematologic toxicities. We used the interruptions in thoracic RT as the 'marker' for any concurrent break and measured 'break duration' by the total length of time (in days) RT was interrupted, since that also signaled that ChT could be re-initiated. Patient results were analyzed for the impact of interruptions/treatment prolongation on overall and disease-free survival.
RESULTS: For all patients, 2-year and 5-year overall and disease-specific survivals were 22.7 and 7.2, 27.6 and 9.3%, respectively; overall and disease-specific median survivals were 14.7 months each. A total of 56 patients (26%) had treatment breaks due to toxicity. Hematologic depression caused the majority of breaks (88%). The median duration of breaks was 5 days (range 1-18). Patients with and without interruptions were compared for a range of prognostic factors and were not found to have any significant differences. Comparing interrupted/uninterrupted courses, median survivals were 13.8 versus 15.6 months, respectively, and 5-year overall survivals were 4.2 versus 8.3%, respectively. There was a statistical difference between overall survival curves which favored the uninterrupted group (P=0.01). When comparing a series of prognostic variables, multivariable analysis found that the most significant factor influencing survival in the present study was the presence of treatment breaks (P=0.006). There was a trend for development of any recurrence in the patients with breaks (P=0.08). When controlling for the use of prophylactic cranial irradiation (PCI) in the two groups, the rate of failure in the chest was higher in the patients with RT breaks (58 vs. 33%). The rate of failure in the brain was dependent on the use of PCI only.
CONCLUSIONS: Interruptions in treatment to palliate the toxicity from concurrent chemoradiation result in poorer local control and decreased survival.
2001-08-01T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/23
info:doi/10.1016/S0169-5002(00)00240-3
http://dx.doi.org/10.1016/S0169-5002(00)00240-3
Epidemiology and Biostatistics Publications
Scholarship@Western
Adult
Aged
Aged
80 and over
Antineoplastic Combined Chemotherapy Protocols
Carcinoma
Small Cell
Cyclophosphamide
Doxorubicin
Epirubicin
Female
Humans
Lung Neoplasms
Male
Middle Aged
Neoplasm Recurrence
Local
Remission Induction
Survival Rate
Treatment Failure
Vincristine
Aged, 80 and over
Carcinoma, Small Cell
Neoplasm Recurrence, Local
Epidemiology
Medical Biophysics
Oncology
oai:ir.lib.uwo.ca:oncpub-1054
2009-11-23T00:37:47Z
publication:physics
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:physicspub
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Radiation Treatment for Cervical Esophagus: Patterns of Practice Study in Canada, 1996
Tai, Patricia
Van Dyk, Jake
Yu, Edward
Battista, Jerry
Schmid, Matthew
Stitt, Larry
Tonita, Jon
Coad, Terry
PURPOSE: To assess the patterns of practice among Canadian radiation oncologists who treat esophageal cancers, using a trans-Canada survey, completed at the end of 1996.
METHODS AND MATERIALS: One of 3 case presentations of different stages of cervical esophageal cancer was randomly assigned and sent to participating radiation oncologists by mail. Respondents were asked to fill in questionnaires regarding treatment techniques and to outline target volumes for the boost phase of radiotherapy. Radiation oncologists from 26 of 27 (96%) of all Canadian centers participated.
RESULTS: High-energy X-rays (>/= 10 MV) were employed by 68% of the respondents in part of the treatment course. The majority (83%) of the radiation oncologists used at least two phases of treatment. Very few, 10 of 59 (17%), responses started with multifield treatment. The most frequently used prescription dose was 60 Gy/30 fractions/6 weeks, given with concurrent chemotherapy. Dose prescriptions were to the isocenter in 39 of 48 (81%) or to a particular isodose line in 9 of 48 (19%) of respondents.
CONCLUSION: There was a variety of radiation treatment techniques in this trans-Canada survey. The majority of the patients had combined cisplatin-based chemoradiation. The isocenter was not used consistently as a dose prescription point.
2000-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/54
info:doi/10.1016/S0360-3016(00)00484-3
http://dx.doi.org/10.1016/S0360-3016(00)00484-3
Oncology Publications
Scholarship@Western
Aged
Antineoplastic Combined Chemotherapy Protocols
Canada
Cancer Care Facilities
Combined Modality Therapy
Esophageal Neoplasms
Health Care Surveys
Humans
Male
Physician's Practice Patterns
Radiation Oncology
Radiotherapy Dosage
Epidemiology
Medical Biophysics
Oncology
oai:ir.lib.uwo.ca:oncpub-1056
2009-11-23T01:02:06Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Does Delay in Breast Irradiation Following Conservative Breast Surgery in Node-Negative Breast Cancer Patients Have an Impact on Risk of Recurrence?
Vujovic, Olga
Perera, Francisco
Dar, A. Rashid
Stitt, Larry
Yu, Edward
Voruganti, Sachi M.
Truong, Pauline T.
PURPOSE: This retrospective review was conducted to determine if delay in the start of radiotherapy after definitive breast surgery had any detrimental effect on local recurrence or disease-free survival in node-negative breast cancer patients.
METHODS AND MATERIALS: A total of 568 patients with T1-T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, without adjuvant systemic therapy between January 1, 1985 and December 31, 1992, at the London Regional Cancer Centre. Adjuvant breast irradiation consisted either of 50 Gy in 25 fractions or 40 Gy in 15 or 16 fractions, followed by a boost of 10 Gy or 12.5 Gy to the lumpectomy site. The time intervals from definitive breast surgery to breast irradiation used for analysis were 0-8 weeks (201 patients), > 8-12 weeks (235 patients), > 1216 weeks (91 patients), and > 16 weeks (41 patients). The time intervals of 0-12 weeks (436 patients) and > 12 weeks (132 patients) were also analyzed. Kaplan-Meier estimates of time to local recurrence and disease-free survival rates were calculated. The association between surgery-radiotherapy interval, age (< or = 40, > 40 years), tumor size (< or = 2, > 2cm), Scharf-Bloom-Richardson (SBR) grade, resection margins, lymphatic vessel invasion, extensive intraductal component, and local recurrence and disease-free survival were investigated using Cox regression techniques.
RESULTS: Median follow-up was 63.5 months. Patients in all 4 time intervals were similar in terms of age and pathologic features. There was no statistically significant difference between the 4 groups in local recurrence or disease-free survival with surgery-radiotherapy interval (p = 0.189 and p = 0.413, respectively). The 5-year freedom from local relapse was 95.4%. The crude local recurrence rate was 6.9% (7.8% for 436 patients treated within 12 weeks (median follow-up 67 months) and 3.8% for 132 patients treated > 12 weeks from surgery (median follow-up 52 months). In a stepwise multivariable Cox regression model for disease-free survival, allowing for entry of known risk factors, tumour size (p < 0.001), grade (p < 0.001), and age (p = 0.048) entered the model, but the surgery-radiotherapy interval did not enter the model.
CONCLUSION: This retrospective study suggests that delay in start of breast irradiation beyond 12 and up to 16 weeks does not increase the risk of recurrence in node-negative breast cancer patients. The certainty of these results are limited by the retrospective nature of this analysis and the lack of information concerning the late local failure rate.
1998-03-01T08:00:00Z
article
https://ir.lib.uwo.ca/oncpub/56
info:doi/10.1016/S0360-3016(97)00922-X
http://dx.doi.org/10.1016/S0360-3016(97)00922-X
Oncology Publications
Scholarship@Western
Adult
Analysis of Variance
Breast Neoplasms
Carcinoma
Ductal
Breast
Carcinoma
Lobular
Combined Modality Therapy
Disease-Free Survival
Female
Humans
Middle Aged
Neoplasm Recurrence
Local
Radiotherapy Dosage
Retrospective Studies
Time Factors
Carcinoma, Ductal, Breast
Carcinoma, Lobular
Neoplasm Recurrence, Local
Epidemiology
Oncology
oai:ir.lib.uwo.ca:oncpub-1055
2009-11-23T00:47:11Z
publication:physics
publication:biophysicspub
publication:oncpub
publication:pmid
publication:medimaging
publication:faculties
publication:physicspub
publication:biophysics
publication:epidem
publication:medimagingpub
publication:onc
publication:epidempub
Variability of Target Volume Delineation in Cervical Esophageal Cancer
Tai, Patricia
Van Dyk, Jake
Yu, Edward
Battista, Jerry
Stitt, Larry
Coad, Terry
PURPOSE: Three-dimensional (3D) conformal radiation therapy (CRT) assumes and requires the precise delineation of the target volume. To assess the consistency of target volume delineation by radiation oncologists, who treat esophageal cancers, we have performed a transCanada survey.
MATERIALS AND METHODS: One of three case presentations, including CT scan images, of different stages of cervical esophageal cancer was randomly chosen and sent by mail. Respondents were asked to fill in questionnaires regarding treatment techniques and to outline boost target volumes for the primary tumor on CT scans, using ICRU-50 definitions.
RESULTS: Of 58 radiation oncologists who agreed to participate, 48 (83%) responded. The external beam techniques used were mostly anterior-posterior fields, followed by a multifield boost technique. Brachytherapy was employed by 21% of the oncologists, and concurrent chemotherapy by 88%. For a given case, and the three volumes defined by ICRU-50 (i.e., gross tumor volume [GTV], clinical target volume [CTV], and planning target volume [PTV]) we determined: 1. The total length in the cranio-caudal dimension; 2. the mean diameter in the transverse slice that was located in a CT slice that was common to all participants; 3. the total volume for each ICRU volume; and 4. the (5, 95) percentiles for each parameter. The PTV showed a mean length of 14.4 (9.6, 18.0) cm for Case A, 9.4 (5.0, 15.0) cm for Case B, 11.8 (6.0, 16.0) cm for Case C, a mean diameter of 6.4 (5.0, 9.4) cm for Case A, 4.4 (0.0, 7.3) cm for Case B, 5.2 (3.9, 7.3) cm for Case C, and a mean volume of 320 (167, 840) cm3 for Case A and 176 (60, 362) cm3 for Case C. The results indicate variability factors (95 percentile divided by 5 percentile values) in target diameters of 1.5 to 2.6, and in target lengths of 1.9 to 5.0.
CONCLUSION: There was a substantial inconsistency in defining the planning target volume, both transversely and longitudinally, among radiation oncologists. The potential benefits of 3D treatment planning with high-precision dose delivery could be offset by this inconsistency in target-volume delineation by radiation oncologists. This may be particularly important for multicenter clinical trials, for which quality assurance of this step will be essential to the interpretation of results.
1998-09-01T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/55
info:doi/10.1016/S0360-3016(98)00216-8
http://dx.doi.org/10.1016/S0360-3016(98)00216-8
Oncology Publications
Scholarship@Western
Aged
Analysis of Variance
Canada
Esophageal Neoplasms
Health Care Surveys
Humans
Male
Medical Oncology
Observer Variation
Radiotherapy Dosage
Radiotherapy Planning
Computer-Assisted
Radiotherapy
Conformal
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Conformal
Epidemiology
Medical Biophysics
Oncology
oai:ir.lib.uwo.ca:oncpub-1057
2009-11-23T01:17:23Z
publication:biophysicspub
publication:oncpub
publication:pmid
publication:faculties
publication:biophysics
publication:epidem
publication:onc
publication:epidempub
Superior Vena Cava Obstruction in Small-cell Lung Cancer
Chan, Roscoe H.
Dar, A. Rashid
Yu, Edward
Stitt, Larry W.
Whiston, Francis
Truong, Pauline
Vincent, Mark D.
Kocha, Walter I.
PURPOSE: To identify prognostic or treatment factors influencing the response of superior vena cava obstruction (SVCO), time to SVCO recurrence, and overall survival of SCLC patients with SVCO at presentation; and to assess the role of retreatment in patients with SVCO at recurrent or persistent disease.
METHODS AND MATERIALS: Between January 1983 and November 1993, 76 consecutive patients who had small-cell lung cancer (SCLC) with SVCO were treated in our institution. Analysis was done according to the disease status at diagnosis of SVCO. The first analysis concerned a group of 50 patients who had SVCO at initial presentation. The second analysis concerned a group who had SVCO as a manifestation of persistent or recurrent disease.
RESULTS: In the first analysis, 93% had significant improvement in symptoms of SVCO after chemotherapy and 94% after mediastinal radiation. Response is almost universal despite a wide range of radiation fractionation and total dose used. Seventy percent remained SVCO-free before death. Thirty percent developed recurrence of SVCO symptoms 1-16 months (median 8) after the start of initial treatment. Those who received combined chemotherapy and radiation had a longer time to SVCO recurrence (p = 0.018) compared to those who received chemotherapy alone. This effect is mainly seen in limited-stage patients. The presence of SVCO recurrence tends to have an adverse effect on the overall survival (p = 0.077) irrespective of the time when the recurrences occurred (p = 0.296). The median survival of this whole group of 50 patients in the first analysis was 9.5 months, and the 2-year survival was 10%. Stage was strongly predictive of survival (p < 0.001). Sixteen percent (3 of 19) of the patients with limited-stage diseases were long-term survivors (two patients survived 35 months and one survived 70 months). The early mortality from SVCO was 2%. In the second analysis, 85% had previously been treated with chemotherapy alone. The response rate of SVCO in the analysable patients (n = 39) was 77%. There was no significant difference in the response rate of SVCO to treatment comparing patients treated by chemotherapy first or mediastinal radiation first (p = 0.653), but most patients [82% (32 of 39)] received radiation as the initially treatment of SVCO. Ninety-three percent (38 of 41) received mediastinal radiation as a part of their ultimate retreatment regimen, and 68% (28 of 41) received mediastinal radiation as their sole retreatment regimen. Thirty-two percent (13 of 41) received chemotherapy as a part of their ultimate retreatment regimen, and only 7% received chemotherapy alone as their sole retreatment regimen. Eighty-three percent (25 of 30) of those whose SVCO responded remained free of SVCO before death, with a median survival of 3 months after recurrent or persistent disease documented.
CONCLUSION: Chemotherapy or mediastinal radiation is very effective as an initial treatment in SCLC patients with SVCO at presentation and at recurrent or persistent disease. There is no obvious need to use big radiation fraction sizes for the first few radiation treatment as was previously believed. In patients with recurrent or persistent SCLC with SVCO, especially in those who previously received chemotherapy only, we have more experience in incorporating mediastinal radiation as a major component of the palliative regimen with highly effective and durable palliation achieved.
1997-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/oncpub/57
info:doi/10.1016/S0360-3016(97)00094-1
http://dx.doi.org/10.1016/S0360-3016(97)00094-1
Oncology Publications
Scholarship@Western
Adult
Aged
Aged
80 and over
Carcinoma
Small Cell
Female
Humans
Lung Neoplasms
Male
Middle Aged
Radiotherapy Dosage
Recurrence
Retrospective Studies
Superior Vena Cava Syndrome
Aged, 80 and over
Carcinoma, Small Cell
Epidemiology
Oncology
oai:ir.lib.uwo.ca:epidempub-1028
2011-06-17T00:36:42Z
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Drug Use, Unsafe Sexual Behavior, and Internalized Homonegativity in Men Who Have Sex With Men
Ross, Michael W.
Rosser, B. R. Simon
Bauer, Greta R.
Bockting, Walter O.
Robinson, Beatrice "Bean" E.
Rugg, Deborah L.
Coleman, Eli
Previous research has identified alcohol and drug use as predictive of unsafe sexual behavior among men who have sex with men (MSM). The purpose of this study was to assess whether substances associated with the greatest alteration in consciousness are associated with increased risk behavior, and to explore any relationship between internalized homonegativity and alcohol and other drug use. Participants in the study were 422 Midwestern MSM who volunteered to evaluate a seminar on sexuality and intimacy between men. Alcohol, chemical use, and dependency during the last 2 weeks were assessed using standardized questions and CAGE screening questions. Internalized homonegativity was assessed using the 26-item Reactions to Homosexuality scale. Components of unsafe sexual behavior during the preceding 3 months was assessed using dichotomous variables and collapsed into an overall measure of contextualized risk. Consistent and strong associations (ORs between 2.32 and 4.57) were found between unsafe sexual behavior and alcohol and other drug use. The greater the alcohol problem and the harder the drugs and the more they may impact consciousness or disinhibition, the greater the apparent association with unsafe sex. Degree of alteration of consciousness and disinhibition appear to be the common underlying dimensions of risk, although dose-level data were not available. The data did not support any consistent association between internalized homonegativity and use of drugs and alcohol.
2001-03-01T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/28
info:doi/10.1023/A:1009567707294
http://dx.doi.org/10.1023/A:1009567707294
Epidemiology and Biostatistics Publications
Scholarship@Western
Drug use
Unsafe sex
Internalized homonegativity
Gay men
Men Who Have Sex With Men
MSM
Biostatistics
Epidemiology
Gender and Sexuality
oai:ir.lib.uwo.ca:epidempub-1027
2009-11-26T02:39:07Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Time Trends for HIV-1 Antiretroviral Resistance Among Antiretroviral-Experienced and Naive Pregnant Women in New York City During 1991 to Early 2001
Welles, Seth L.
Bauer, Greta R.
LaRussa, Philip S.
Colgrove, Robert C.
Pitt, Jane
Time trends in the prevalence of drug resistance to antiretroviral therapy (ART) in pregnant women have not been studied. Treatment and prophylactic efficacy could be compromised by drug-resistant HIV strains. We conducted a repeated cross-sectional study of antiretroviral resistance mutations to nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) and of major mutations to protease inhibitors (PIs) in virus isolates from 300 HIV-infected pregnant women in New York City from 1991 to early 2001. The overall prevalence of mutations for NRTIs from 1991 to early 2001 was higher for ART-experienced (25.6% [95% confidence interval (CI): 19.1% to 32.1%]) than ART-naive (8.6% [95% CI: 3.7% to 13.4%]) mothers (P < 0.002). For NNRTIs, the overall prevalence of mutations was somewhat higher among ART-experienced (5.8% [95% CI: 2.3% to 9.3%]) versus ART-naive (1.6% [95% CI: 0% to 3.7%]) women (P = 0.06), and increased over time for ART-naive women (0%-7.4%; P = 0.03) and ART-experienced women (0%-19.4%; P = 0.0002). The prevalence of PI-associated mutations was also higher overall among ART-experienced mothers (5.8% [95% CI: 2.3% to 9.3%] vs. 1.6% [95% CI: 0% to 3.7%]; P = 0.06), with increases over time seen for ART-naive women (0%-7.4%; P = 0.03) and ART-experienced women (0%-16.1%; P = 0.0008). The increasing prevalence of drug resistance in pregnant women, including those who are drug-naive, underscores the necessity for resistance testing to guide treatment to achieve suppression of the mother's virus.
2007-03-01T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/29
info:doi/10.1097/QAI.0b013e31802f1296
http://journals.lww.com/jaids/Fulltext/2007/03010/Time_Trends_for_HIV_1_Antiretroviral_Resistance.13.aspx
Epidemiology and Biostatistics Publications
Scholarship@Western
Adult
Anti-HIV Agents
Drug Resistance
Viral
Female
HIV Infections
HIV Protease Inhibitors
HIV-1
Humans
Mutation
New York City
Pregnancy
Pregnancy Complications
Infectious
RNA
Viral
Reverse Transcriptase Inhibitors
Drug Resistance, Viral
Pregnancy Complications, Infectious
RNA, Viral
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1025
2009-11-26T02:17:11Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
“I Don't Think This Is Theoretical; This Is Our Lives”: How Erasure Impacts Health Care for Transgender People
Bauer, Greta R.
Hammond, Rebecca
Travers, Robb
Kaay, Matthias
Hohenadel, Karin M.
Boyce, Michelle
For people who are transgender, transsexual, or transitioned (trans), access to primary, emergency, and transition-related health care is often problematic. Results from Phase I of the Trans PULSE Project, a community-based research project in Ontario, Canada, are presented. Based on qualitative data from focus groups with 85 trans community members, a theoretical framework describing how erasure functions to impact experiences interacting with the health care system was developed. Two key sites of erasure were identified: informational erasure and institutional erasure. How these processes work in a mutually reinforcing manner to erase trans individuals and communities and produce a system in which a trans patient or client is seen as an anomaly is shown. Thus, the impetus often falls on trans individuals to attempt to remedy systematic deficiencies. The concept of cisnormativity is introduced to aid in explaining the pervasiveness of trans erasure. Strategies for change are identified.
2009-09-01T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/26
info:doi/10.1016/j.jana.2009.07.004
http://dx.doi.org/10.1016/j.jana.2009.07.004
Epidemiology and Biostatistics Publications
Scholarship@Western
Female
Health Services Accessibility
Humans
Male
Ontario
Transsexualism
Biostatistics
Epidemiology
Gender and Sexuality
oai:ir.lib.uwo.ca:epidempub-1026
2009-11-26T02:24:16Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Are Lesbians Really Women Who Have Sex with Women (WSW)? Methodological Concerns in Measuring Sexual Orientation in Health Research
Bauer, Greta R.
Jairam, Jennifer A.
Varying measures of sexual orientation are used in women's health research. As they incorporate different dimensions, definitions, and categorical groupings, the comparability of results obtained across studies using different measures remains unknown. We examined the comparability of results using data from the U.S. 2002 National Survey of Family Growth (n = 6,356). Women were classified according to sexual orientation identity, sex of sex partners in the past year, and sex of sex partners over the lifetime. Associations with six health outcomes were compared across sexual orientation schemes. Associations differed in magnitude and statistical significance, even producing conflicting results. Our analyses resulted in a series of methodological recommendations for research on sexual minority women. Data on both behavioral and identity measures should be gathered in health research; identity groups should not be combined for analysis; and researchers should carefully consider which classification scheme(s) to use based on the theoretical basis for the study and the implications for informing interventions.
2008-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/27
info:doi/10.1080/03630240802575120
http://www.informaworld.com/smpp/content~db=all~content=a911067958
Epidemiology and Biostatistics Publications
Scholarship@Western
Adult
Attitude to Health
Bisexuality
Female
Health Services Research
Homosexuality
Female
Humans
Middle Aged
Research Design
Sexual Behavior
Sexual Partners
Stereotyping
United States
Women's Health
Homosexuality, Female
Biostatistics
Epidemiology
Gender and Sexuality
oai:ir.lib.uwo.ca:oncpub-1061
2009-12-21T00:38:45Z
publication:physics
publication:biophysicspub
publication:oncpub
publication:pmid
publication:medimaging
publication:faculties
publication:physicspub
publication:biophysics
publication:epidem
publication:medimagingpub
publication:onc
publication:epidempub
Variability of Target Volume Delineation in Cervical Esophageal Cancer
Tai, Patricia
Van Dyk, Jake
Yu, Edward
Battista, Jerry
Stitt, Larry
Coad, Terry
1999-01-01T08:00:00Z
book_contribution
https://ir.lib.uwo.ca/oncpub/61
Oncology Publications
Scholarship@Western
Aged
Analysis of Variance
Canada
Esophageal Neoplasms
Health Care Surveys
Humans
Male
Medical Oncology
Observer Variation
Radiotherapy Dosage
Radiotherapy Planning
Computer-Assisted
Radiotherapy
Conformal
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Conformal
Oncology
oai:ir.lib.uwo.ca:oncpub-1063
2009-11-28T06:53:58Z
publication:robartspub
publication:biophysicspub
publication:oncpub
publication:surgerypub
publication:faculties
publication:electricalpub
publication:biophysics
publication:epidem
publication:electrical
publication:robarts
publication:surgery
publication:institutes
publication:onc
publication:epidempub
MIRA V: An Integrated System for Minimally Invasive Robot-assisted Lung Brachytherapy
Trejos, A. L.
Lin, A. W.
Mohan, S.
Bassan, H.
Edirisinghe, C.
Patel, R. V.
Lewis, C.
Yu, E.
Fenster, A.
Malthaner, R. A.
An integrated system for minimally invasive robot-assisted image-guided lung brachytherapy has been developed. The system incorporates an experimental setup for accurate radioactive seed placement with commercially available dosimetry planning software. The end result is a complete system that allows planning and executing a brachytherapy procedure with increased accuracy. The results of the in vitro seed placement evaluation show that seed misplacement has a significant effect on the volume receiving more than 200% of the dose (V200), and the minimum dosage received by 90% of the volume (D90).
2008-05-01T07:00:00Z
conference
https://ir.lib.uwo.ca/oncpub/63
info:doi/10.1109/ROBOT.2008.4543663
http://ieeexplore.ieee.org/xpl/freeabs_all.jsp?isnumber=4543169&arnumber=4543663&count=669&index=492
Oncology Publications
Scholarship@Western
lung brachytherapy
lung cancer
robotics
Electrical and Computer Engineering
Oncology
Surgery
oai:ir.lib.uwo.ca:epidempub-1029
2009-11-28T08:04:29Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Overweight and Obesity in Sexual-Minority Women: Evidence From Population-Based Data
Boehmer, Ulrike
Bowen, Deborah J.
Bauer, Greta R.
OBJECTIVE: We sought to determine whether lesbians have higher rates of overweight and obesity than women of other sexual orientations.
METHODS: We compared population estimates of overweight and obesity across sexual orientation groups, using data from the 2002 National Survey of Family Growth.
RESULTS: Adjusted multinomial logistic regression analyses showed lesbians have more than twice the odds of overweight (odds ratio [OR]=2.69; 95% confidence interval [CI]=1.40, 5.18) and obesity (OR=2.47; 95% CI=1.19, 5.09) as heterosexual women. Bisexuals and women who reported their sexual orientation as "something else" (besides heterosexual, lesbian, or bisexual) showed no such increase in the odds of overweight and obesity.
CONCLUSIONS: Lesbian women have a higher prevalence of overweight and obesity than all other female sexual orientation groups. This finding suggests that lesbians are at greater risk for morbidity and mortality linked to overweight and obesity. This finding also highlights the need for interventions within this population.
2007-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/32
http://ajph.aphapublications.org/cgi/content/abstract/97/6/1134
Epidemiology and Biostatistics Publications
Scholarship@Western
Adult
Chi-Square Distribution
Female
Health Surveys
Homosexuality
Female
Humans
Logistic Models
Obesity
Overweight
Prevalence
Risk Factors
United States
Homosexuality, Female
Biostatistics
Epidemiology
Gender and Sexuality
oai:ir.lib.uwo.ca:epidempub-1031
2009-11-28T08:19:16Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Gag-p6 Tsg101 Binding Site Duplications in Maternal–Infant HIV Infection
Colgrove, Robert C.
Millet, Amy
Bauer, Greta R.
Pitt, Jane
Welles, Seth L.
Prevalence and patterns of HIV p6 duplications in HIV-1 mother-to-baby transmission are examined. Resistance genotyping was performed in a multisite U.S. study of antiretroviral resistance in vertical transmission. Sequence data were used in secondary analyses of HIV genetic variation. Two hundred sixty HIV viral RNA samples from HIV-infected pregnant women and their infants were analyzed with a commercial resistance genotyping kit. Chromatograms were examined for variability in the 3' region of gag. From 103 mother-baby sets, 190 samples gave readable p6 sequence. Of 103 mother-baby sets, 20 (19%) showed duplication of between 3 and 12 codons ending at the PTAPP motif of p6. When maternal p6 duplication was present and the p6 sequence was available from both maternal and infant isolates, all (seven of seven) infants had p6 duplications, but two cases showed discordancies between maternal and infant sequences. The prevalence of p6 duplication varied among geographical sites, ranging from 4 of 43 families (9%, Puerto Rico and New York sites) to 16 of 60 families (27%, Massachusetts, Texas, and Illinois). The presence of p6 duplication was not associated with differences in transmission, viral load, or disease progression in the infants, but showed a trend toward association with lower maternal CD4 count. Substantial p6 variation data are generated by resistance genotyping. PTAP duplication is prevalent in this group of HIV-infected women and infants. The duplication is efficiently transmitted from mother to infant, is present at variable prevalence at different geographic sites, and shows no clear association with vertical transmission risks.
2005-03-01T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/30
info:doi/10.1089/aid.2005.21.191
http://www.liebertonline.com/doi/abs/10.1089/aid.2005.21.191
Epidemiology and Biostatistics Publications
Scholarship@Western
Base Sequence
Binding Sites
DNA-Binding Proteins
Female
Gene Products
gag
HIV Infections
Humans
Infant
Newborn
Infectious Disease Transmission
Vertical
Molecular Sequence Data
Pregnancy
Repetitive Sequences
Amino Acid
Transcription Factors
gag Gene Products
Human Immunodeficiency Virus
Gene Products, gag
Infant, Newborn
Infectious Disease Transmission, Vertical
Repetitive Sequences, Amino Acid
gag Gene Products, Human Immunodeficiency Virus
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1030
2009-11-28T08:13:23Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Antiretroviral Resistance in Viral Isolates from HIV-1-transmitting Mothers and Their Infants
Bauer, Greta R.
Colgrove, Robert C.
Larussa, Philip S.
Pitt, Jane
Welles, Seth L.
OBJECTIVE: To characterize concordance of resistance mutations to antiretroviral drugs (ART) in mother-infant pairs. DESIGN: Case series of HIV-transmitting mothers and infants in the Women and Infants Transmission Study, where delivery occurred between April 1994 and December 1999.
METHODS: Reverse transcriptase and protease genes were sequenced in stored viral isolates from 32 mother-infant pairs. Mutations were coded as "pure mutants" where only mutant virus was detected or as "mixtures" where a mixed mutant/wild-type population was identified. ART resistance mutations were compared for concordance between mothers and their infants.
RESULTS: Maternal mutations associated with resistance to nucleoside reverse transcriptase inhibitor (NRTI) and minor protease inhibitor (PI) drugs were typically concordant with that of infant, while those associated with non-nucleoside reverse transcriptase inhibitors (NNRTI) and major PI drugs were not. Of five NRTI-associated maternal mutations observed, three pure mutants corresponded with mutant in the infant, while two wild-type-predominant mixtures corresponded with infant wild type. The only NNRTI-associated mutation observed, K103N, was not transmitted, nor were the two major PI-associated mutations, L90M and V82I/V. Transmission of minor PI-associated mutations was consistent with the sole observed or dominant variant for 20 of 21 mutations.
CONCLUSIONS: For NRTI- and minor PI-associated mutations, transmission was consistent with relative quantity of variants in maternal virus. However, where NNRTI- and major PI-associated mutations were present in three cases, they were not transmitted, even where only mutant virus was detectable in maternal isolates. This is consistent with evidence of loss of transmission with resistance to NNRTI and PI drugs.
2006-08-22T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/31
info:doi/10.1097/01.aids.0000242816.80462.81
http://journals.lww.com/aidsonline/Fulltext/2006/08220/Antiretroviral_resistance_in_viral_isolates_from.3.aspx
Epidemiology and Biostatistics Publications
Scholarship@Western
Anti-HIV Agents
Cohort Studies
Drug Resistance
Multiple
Viral
Female
HIV Infections
HIV-1
Humans
Infant
Infant
Newborn
Infectious Disease Transmission
Vertical
Mutation
Polymerase Chain Reaction
Pregnancy
Pregnancy Complications
Infectious
RNA
Messenger
Drug Resistance, Multiple, Viral
Infant, Newborn
Infectious Disease Transmission, Vertical
Pregnancy Complications, Infectious
RNA, Messenger
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1036
2009-12-05T02:47:29Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Beyond Assumptions of Negligible Risk: Sexually Transmitted Diseases and Women Who Have Sex with Women
Bauer, Greta R.
Welles, Seth L.
OBJECTIVES: This study evaluated the association of female-female sexual behavior with sexually transmitted diseases (STDs).
METHODS: Female participants (n = 286) were recruited from the Twin Cities Gay/Lesbian/Bisexual/Transgender Pride Festival. Logistic regression was used to examine the association between female-female sexual behavior and STDs.
RESULTS: Women in all partner history groups, including 13% of women with only female partners, reported a history of STD. Increased sexual exposures with women predicted an increase in the likelihood of STDs after known risk factors had been controlled. Neither number of female partners nor number of exposures was associated with obtaining regular STD testing.
CONCLUSIONS: The risk of STDs through female-female sexual exposure is not negligible. Nevertheless, patterns of STD testing do not reflect this risk.
2001-08-01T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/33
http://ajph.aphapublications.org/cgi/content/abstract/91/8/1282
Epidemiology and Biostatistics Publications
Scholarship@Western
Adolescent
Adult
Aged
Aged
80 and over
Female
Homosexuality
Female
Humans
Logistic Models
Middle Aged
Minnesota
Prevalence
Probability
Questionnaires
Risk Assessment
Sexual Behavior
Sexual Partners
Sexually Transmitted Diseases
Aged, 80 and over
Homosexuality, Female
Biostatistics
Epidemiology
Gender and Sexuality
oai:ir.lib.uwo.ca:epidempub-1032
2009-12-05T02:41:55Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Cultural Sensitivity and Research Involving Sexual Minorities
Bauer, Greta R.
Wayne, Linda D.
2005-03-01T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/37
info:doi/10.1111/j.1931-2393.2005.tb00041.x
http://www3.interscience.wiley.com/journal/118716508/abstract
Epidemiology and Biostatistics Publications
Scholarship@Western
Cultural Characteristics
Health Education
Humans
Minority Groups
Needs Assessment
Patient Acceptance of Health Care
Physician's Practice Patterns
Research Design
Sex Education
Sexual Behavior
United States
Biostatistics
Epidemiology
Gender and Sexuality
oai:ir.lib.uwo.ca:epidempub-1034
2009-12-05T02:29:37Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Zidovudine Resistance Phenotype and Risk of Perinatal HIV-1 Transmission in Zidovudine Monotherapy-Treated Mothers With Moderately Advanced Disease
Bauer, Greta R.
Welles, Seth L.
Colgrove, Robert R.
Pitt, Jane
Women and Infants Transmission Study Team
The association of phenotypic zidovudine resistance with perinatal transmission was evaluated in 74 zidovudine-treated mothers enrolled in the Women and Infants Transmission Study through September 1994. Women in the sample had moderately advanced disease, with a median CD4+ cell count of 271/microL and a median plasma HIV-1 RNA level of 39,811 copies/mL. Factors independently associated with zidovudine resistance at delivery (50% inhibitory concentration [IC50], >/=0.1 microM) in multiple logistic regression included prepregnancy zidovudine use, high log plasma HIV-1 RNA level, and low CD4+ cell count. Of 74 mothers, 16 (22%) transmitted HIV-1 to their infants. After adjustment for duration of membrane rupture and CD8+ cell count, zidovudine resistance (IC50 range, 0.01-2.2 microM) was associated with an increased odds of transmission (ORadj, 1.25 per 0.1 microM; 95% confidence interval, 1.01-1.54), suggesting a decreased effect of prenatal zidovudine on preventing transmission in mothers infected with zidovudine-resistant virus. However, when the analysis was limited only to those mothers infected with virus containing zidovudine resistance mutations, no association between phenotypic resistance and transmission remained, indicating that phenotype may not provide significant additional information in predicting transmission where resistance genotype is known.
2003-11-01T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/35
http://journals.lww.com/jaids/Fulltext/2003/11010/Zidovudine_Resistance_Phenotype_and_Risk_of.10.aspx
Epidemiology and Biostatistics Publications
Scholarship@Western
Adult
CD4 Lymphocyte Count
Drug Resistance
Viral
Female
HIV Infections
HIV-1
Humans
Infant
Newborn
Infectious Disease Transmission
Vertical
Inhibitory Concentration 50
Phenotype
Point Mutation
Pregnancy
Pregnancy Complications
Infectious
RNA
Viral
Retrospective Studies
Reverse Transcriptase Inhibitors
Zidovudine
Drug Resistance, Viral
Infant, Newborn
Infectious Disease Transmission, Vertical
Pregnancy Complications, Infectious
RNA, Viral
Biostatistics
Epidemiology
oai:ir.lib.uwo.ca:epidempub-1033
2009-12-05T02:42:30Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
Measuring Sexual Orientation in Adolescent Health Surveys: Evaluation of Eight School-based Surveys
Saewyc, Elizabeth M.
Bauer, Greta R.
Skay, Carol L.
Bearinger, Linda H.
Resnick, Michael D.
Reis, Elizabeth
Murphy, Aileen
PURPOSE: To examine the performance of various items measuring sexual orientation within 8 school-based adolescent health surveys in the United States and Canada from 1986 through 1999.
METHODS: Analyses examined nonresponse and unsure responses to sexual orientation items compared with other survey items, demographic differences in responses, tests for response set bias, and congruence of responses to multiple orientation items; analytical methods included frequencies, contingency tables with Chi-square, and ANOVA with least significant differences (LSD)post hoc tests; all analyses were conducted separately by gender.
RESULTS: In all surveys, nonresponse rates for orientation questions were similar to other sexual questions, but not higher; younger students, immigrants, and students with learning disabilities were more likely to skip items or select "unsure." Sexual behavior items had the lowest nonresponse, but fewer than half of all students reported sexual behavior, limiting its usefulness for indicating orientation. Item placement in the survey, wording, and response set bias all appeared to influence nonresponse and unsure rates.
CONCLUSIONS: Specific recommendations include standardizing wording across future surveys, and pilot testing items with diverse ages and ethnic groups of teens before use. All three dimensions of orientation should be assessed where possible; when limited to single items, sexual attraction may be the best choice. Specific wording suggestions are offered for future surveys.
2004-10-01T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/36
info:doi/10.1016/j.jadohealth.2004.06.002
http://dx.doi.org/10.1016/j.jadohealth.2004.06.002
Epidemiology and Biostatistics Publications
Scholarship@Western
Adolescent
Adolescent Psychology
Analysis of Variance
Canada
Chi-Square Distribution
Data Collection
Data Interpretation
Statistical
Female
Humans
Male
Psychometrics
Sexual Behavior
Students
Uncertainty
United States
Data Interpretation, Statistical
Biostatistics
Epidemiology
Gender and Sexuality
oai:ir.lib.uwo.ca:epidempub-1035
2009-12-05T02:41:02Z
publication:pmid
publication:queercaucus
publication:faculties
publication:epidem
publication:queerpub
publication:institutes
publication:epidempub
A Randomized Controlled Intervention Trial of a Sexual Health Approach to Long-Term HIV Risk Reduction for Men Who Have Sex with Men: Effects of the Intervention on Unsafe Sexual Behavior
Rosser, B. R. Simon
Bockting, Walter O.
Rugg, Deborah L.
Robinson, Beatrice Bean E.
Ross, Michael W.
Bauer, Greta R.
Coleman, Eli
This controlled prospective study assessed the effectiveness of a sexual health approach to HIV prevention for men who have sex with men (MSM). Participants (N = 422 Midwestern MSM) were randomly assigned to the intervention group, who participated in a 2-day comprehensive human sexuality seminar designed to contextually address long-term risk factors and cofactors, or to the control group, who watched 3 hours of HIV prevention videos. Risk behavior during the preceding 3 months was measured at baseline, 3-month follow-up, and 12-month follow-up. Any unprotected anal intercourse outside a long-term seroconcordant relationship was the dependent variable. Of the total, 14%-24% of the participants were considered at risk of acquiring or transmitting HIV. At the 12-month follow-up, the control reported a 29% decrease in the use of condoms during anal intercourse; the intervention group reported an 8% increase (t = 2.546; p = .015). The sexual health seminars appear a promising new intervention at significantly reducing unprotected anal intercourse between men.
2002-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/epidempub/34
info:doi/10.1521/aeap.14.4.59.23885
http://www.atypon-link.com/GPI/doi/abs/10.1521/aeap.14.4.59.23885
Epidemiology and Biostatistics Publications
Scholarship@Western
Adolescent
Adult
HIV Infections
Health Services Research
Homosexuality
Male
Humans
Male
Middle Aged
Midwestern United States
Preventive Health Services
Program Evaluation
Risk-Taking
Safe Sex
Homosexuality, Male
Biostatistics
Epidemiology
Gender and Sexuality
Public Health
oai:ir.lib.uwo.ca:fammedpub-1002
2009-12-07T03:31:25Z
publication:vascularpub
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:epidem
publication:biochempub
publication:robarts
publication:biochem
publication:institutes
publication:epidempub
Association of the Novel Cardiovascular Risk Factors Paraoxonase 1 and Cystatin C in Type 2 Diabetes
Connelly, Philip W.
Zinman, Bernard
Maguire, Graham F.
Mamakeesick, Mary
Harris, Stewart B.
Hegele, Robert A.
Retnakaran, Ravi
Hanley, Anthony J. G.
Paraoxonase 1 (PON1) has been reported to be associated with proteinuria in subjects with type 2 diabetes mellitus (T2DM). Plasma cystatin C is more accurate than creatinine for identifying stage 3 kidney disease in T2DM. We tested the hypothesis that PON1 and cystatin C would be associated in T2DM subjects from an Aboriginal Canadian community, who are at high risk for the development of nephropathy. PON1 A(-162)G and PON2 Ala148Gly genotypes, cystatin C, HbA1c, high density lipoprotein cholesterol (HDLC), waist circumference (waist), and duration of diabetes were included in the regression analysis with log(e) (ln) of PON1 mass as the dependent variable. A regression model including PON2 Ala148Gly genotype, HDLC, and ln cystatin C explained 25.8% of the variance in PON1 mass. Conversely, waist, age, ln HbA1c, ln duration of diabetes, and ln PON1 mass, but not PON2 genotype, explained 38% of the variance in cystatin C. Subjects with cystatin C estimated glomerular filtration rate (eGFR) <60 ml>/min per 1.73 m(2) (stage 3 kidney disease) had significantly lower PON1 mass compared with subjects with cystatin C-eGFR >60 ml/min per 1.73 m(2). The lower mass of PON1, an anti-inflammatory HDL-associated enzyme, in T2DM with cystatin C-eGFR <60 ml>/min per 1.73 m(2) may contribute to their increased risk for cardiovascular disease.
2009-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/fammedpub/3
info:doi/10.1194/jlr.P800070-JLR200
http://www.jlr.org/cgi/content/abstract/50/6/1216
Family Medicine Publications
Scholarship@Western
Adult
Aryldialkylphosphatase
Canada
Cardiovascular Diseases
Cystatin C
Diabetes Complications
Diabetes Mellitus
Type 2
Female
Genetic Predisposition to Disease
Genotype
Glomerular Filtration Rate
Humans
Indians
North American
Male
Middle Aged
Models
Biological
Polymorphism
Genetic
Regression Analysis
Risk Factors
Diabetes Mellitus, Type 2
Indians, North American
Models, Biological
Polymorphism, Genetic
Medicine and Health Sciences
oai:ir.lib.uwo.ca:fammedpub-1003
2009-12-19T06:54:29Z
publication:vascularpub
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:epidem
publication:biochempub
publication:robarts
publication:biochem
publication:institutes
publication:epidempub
Metabolic Syndrome and Its Components as Predictors of Incident Type 2 Diabetes Mellitus in an Aboriginal Community
Ley, Sylvia H.
Harris, Stewart B.
Mamakeesick, Mary
Noon, Tina
Fiddler, Edith
Gittelsohn, Joel
Wolever, Thomas M. S.
Connelly, Philip W.
Hegele, Robert A.
Zinman, Bernard
Hanley, Anthony J. G.
BACKGROUND: Risk factors for type 2 diabetes remain poorly characterized among Aboriginal Canadians. We aimed to determine the incidence of type 2 diabetes in an Aboriginal community and to evaluate prospective associations with metabolic syndrome and its components.
METHODS: Of 606 participants in the Sandy Lake Health and Diabetes Project from 1993 to 1995 who were free of diabetes at baseline, 540 (89.1%) participated in 10-year follow-up assessments. Baseline anthropometry, blood pressure, fasting insulin and serum lipid levels were measured. Fasting and 2-hour postload glucose levels were obtained at follow-up to determine incident cases of type 2 diabetes.
RESULTS: The 10-year cumulative incidence of diabetes was 17.5%. High adiposity, dyslipidemia, hyperglycemia, hyperinsulinemia and hypertension at baseline were associated with an increased risk of diabetes after adjustment for age and sex (all p < or = 0.03). Metabolic syndrome had high specificity (75%-88%) and high negative predictive value (85%-87%) to correctly detect diabetes-free individuals at follow-up. It had low sensitivity (26%-48%) and low positive predictive value (29%-32%) to detect future diabetes. Metabolic syndrome at baseline was associated with incident diabetes after adjustment for age and sex, regardless of whether the syndrome was defined using the National Cholesterol Education Program criteria (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.10-3.75) or the International Diabetes Federation criteria (OR 2.14, 95% CI 1.29-3.55). The association was to the same degree as that for impaired glucose tolerance assessed using the oral glucose tolerance test (OR 2.87, 95% CI 1.52-5.40; p > 0.05 for comparison of C statistics).
INTERPRETATION: Metabolic syndrome and its components can be identified with readily available clinical measures. As such, the syndrome may be useful for identifying individuals at risk of type 2 diabetes in remote Aboriginal communities.
2009-03-17T07:00:00Z
article
https://ir.lib.uwo.ca/fammedpub/4
info:doi/10.1503/cmaj.080972
http://www.cmaj.ca/cgi/content/abstract/180/6/617
Family Medicine Publications
Scholarship@Western
Adolescent
Adult
Age Distribution
Blood Glucose
Body Fat Distribution
Body Height
Body Mass Index
Canada
Child
Diabetes Mellitus
Type 2
Dyslipidemias
Fasting
Female
Follow-Up Studies
Humans
Hyperglycemia
Hypertension
Incidence
Logistic Models
Male
Metabolic Syndrome X
Middle Aged
Predictive Value of Tests
Prospective Studies
Risk Factors
Sensitivity and Specificity
Sex Factors
Waist Circumference
Young Adult
Diabetes Mellitus, Type 2
Endocrinology, Diabetes, and Metabolism
oai:ir.lib.uwo.ca:fammedpub-1005
2009-12-25T01:14:54Z
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:nursing
publication:epidem
publication:nursingpub
publication:epidempub
Predictors of Motor Vehicle Collision Injuries Among a Nationally Representative Sample of Canadians
Vingilis, Evelyn
Wilk, Piotr
OBJECTIVE: The purpose of this study was to examine predictors of subsequent motor vehicle collision injuries, with a particular focus on health-related variables, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994-2002.
METHODS: Multiple logistic regression analysis was used to determine the relations between motor vehicle collision injury and four risk factors: binge drinking, health status, distress, and medication use. Age and sex were included as control variables. The total sample size was 14,529.
RESULTS: A higher percentage of females and younger persons reported a motor vehicle collision injury. Binge drinkers, respondents with poor health, respondents with distress, and respondents reported using two or more medications reported a higher percentage of subsequent injuries. Logistic regression analysis found that persons with poorer health status and persons who used more medications had higher odds of motor vehicle injuries. Only one statistically significant interaction effect was found: alcohol bingeing and medication use.
CONCLUSIONS: Among a nationally representative sample of Canadians, various demographic and risk factors predict subsequent injuries. Given that this number represents a considerable economic burden, this study underscores the need for continued research and countermeasures on alcohol, drugs, and driving.
2007-12-01T08:00:00Z
article
https://ir.lib.uwo.ca/fammedpub/6
info:doi/10.1080/15389580701626202
http://www.informaworld.com/smpp/content~db=all~content=a784415147
Family Medicine Publications
Scholarship@Western
Accidents
Traffic
Adolescent
Adult
Aged
Alcoholism
Automobile Driving
Canada
Female
Health Status
Health Surveys
Humans
Longitudinal Studies
Male
Middle Aged
Odds Ratio
Retrospective Studies
Risk Factors
Sex Factors
Substance-Related Disorders
Wounds and Injuries
Accidents, Traffic
Medicine and Health Sciences
oai:ir.lib.uwo.ca:medpub-1031
2010-01-13T01:51:35Z
publication:vascularpub
publication:fammedpub
publication:fammed
publication:physpharmpub
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:physpharm
publication:epidem
publication:biochempub
publication:robarts
publication:biochem
publication:institutes
publication:epidempub
The 2009 Canadian Hypertension Education Program Recommendations for the Management of Hypertension: Part 2--Therapy
Khan, Nadia A.
Hemmelgarn, Brenda
Herman, Robert J.
Bell, Chaim M.
Mahon, Jeff L.
Leiter, Lawrence A.
Rabkin, Simon W.
Hill, Michael D.
Padwal, Raj
Touyz, Rhian M.
Larochelle, Pierre
Feldman, Ross D.
Schiffrin, Ernesto L.
Campbell, Norman R. C.
Moe, Gordon
Prasad, Ramesh
Arnold, Malcolm O.
Campbell, Tavis S.
Milot, Alain
Stone, James A.
Jones, Charlotte
Ogilvie, Richard I.
Hamet, Pavel
Fodor, George
Carruthers, George
Burns, Kevin D.
Ruzicka, Marcel
deChamplain, Jacques
Pylypchuk, George
Petrella, Robert
Boulanger, Jean-Martin
Trudeau, Luc
Hegele, Robert A.
Woo, Vincent
McFarlane, Phil
Vallée, Michel
Howlett, Jonathan
Bacon, Simon L.
Lindsay, Patrice
Gilbert, Richard E.
Lewanczuk, Richard Z.
Tobe, Sheldon
Canadian Hypertension Education Program
OBJECTIVE: To update the evidence-based recommendations for the prevention and management of hypertension in adults for 2009.
OPTIONS AND OUTCOMES: For lifestyle and pharmacological interventions, evidence from randomized controlled trials and systematic reviews of trials was preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field. Progression of kidney dysfunction was also accepted as a clinically relevant primary outcome among patients with chronic kidney disease.
EVIDENCE: A Cochrane collaboration librarian conducted an independent MEDLINE search from 2007 to August 2008 to update the 2008 recommendations. To identify additional published studies, reference lists were reviewed and experts were contacted. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence.
RECOMMENDATIONS: For lifestyle modifications to prevent and treat hypertension, restrict dietary sodium to less than 2300 mg (100 mmol)/day (and 1500 mg to 2300 mg [65 mmol to 100 mmol]/day in hypertensive patients); perform 30 min to 60 min of aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index 18.5 kg/m(2) to 24.9 kg/m(2)) and waist circumference (smaller than 102 cm for men and smaller than 88 cm for women); limit alcohol consumption to no more than 14 units per week in men or nine units per week in women; follow a diet that is reduced in saturated fat and cholesterol, and that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and consider stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should be predicated on by the patient's global atherosclerotic risk, target organ damage and comorbid conditions. Blood pressure should be decreased to lower than 140/90 mmHg in all patients, and to lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease. Most patients will require more than one agent to achieve these target blood pressures. Antihypertensive therapy should be considered in all adult patients regardless of age (caution should be exercised in elderly patients who are frail). For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic and/or systolic hypertension include angiotensin- converting enzyme (ACE) inhibitors (in patients who are not black), long-acting calcium channel blockers (CCBs), angiotensin receptor antagonists (ARBs) or beta-blockers (in those younger than 60 years of age). A combination of two first-line agents may also be considered as the initial treatment of hypertension if the systolic blood pressure is 20 mmHg above the target or if the diastolic blood pressure is 10 mmHg above the target. The combination of ACE inhibitors and ARBs should not be used. Other agents appropriate for first-line therapy for isolated systolic hypertension include long- acting dihydropyridine CCBs or ARBs. In patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor/diuretic combination is preferred; in patients with proteinuric nondiabetic chronic kidney disease, ACE inhibitors or ARBs (if intolerant to ACE inhibitors) are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with hypertension who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy. Once blood pressure is controlled, acetylsalicylic acid therapy should be considered.
VALIDATION: All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
2009-05-01T07:00:00Z
article
https://ir.lib.uwo.ca/medpub/25
http://www.pulsus.com/journals/abstract.jsp?sCurrPg=abstract&jnlKy=1&atlKy=8801&isuKy=854&isArt=t&fromfold=
Department of Medicine Publications
Scholarship@Western
Adult
Aged
Antihypertensive Agents
Blood Pressure Determination
Canada
Case Management
Combined Modality Therapy
Diet
Sodium-Restricted
Female
Health Promotion
Humans
Hypertension
Life Style
Male
Middle Aged
Patient Education as Topic
Prognosis
Program Evaluation
Randomized Controlled Trials as Topic
Treatment Outcome
Diet, Sodium-Restricted
Cardiology
oai:ir.lib.uwo.ca:foodpub-1001
2010-02-24T07:26:55Z
publication:fammedpub
publication:fammed
publication:brescia
publication:pmid
publication:affiliates
publication:faculties
publication:bresciafoodnutritionalsciences
publication:epidem
publication:foodpub
publication:epidempub
Screen-related Sedentary Behaviors: Children's and Parents' Attitudes, Motivations, and Practices
He, Meizi
Piché, Leonard
Beynon, Charlene
Harris, Stewart
OBJECTIVE: To investigate school-aged children's and parents' attitudes, social influences, and intentions toward excessive screen-related sedentary behavior (S-RSB).
DESIGN: A cross-sectional study using a survey methodology.
SETTING: Elementary schools in London, Ontario, Canada.
PARTICIPANTS: All grades 5 and 6 students, their parents, and their teachers in the participating schools were invited to voluntarily participate; 508 student-parent pairs completed the surveys.
MAIN OUTCOME MEASURE: Children's screen-related behaviors.
ANALYSIS: Data were analyzed using the Independent Student t test to compare differences of continuous variables and the chi-square test to test for differences of categorical variables.
RESULTS: Children spent 3.3 +/- 0.15 (standard error) hours per day engaged in screen-related activities. Entertainment, spending time with family, and boredom were cited as the top 3 reasons for television viewing and video game playing. Compared to "low-screen users" (ie, < 2 hours/day), "high-screen users" (ie, >or= 2 hours/day) had a less negative attitude toward excessive S-RSB and perceived loosened parental rules on screen use. Parents of high-screen users had a less negative attitude toward children's S-RSB, had fewer rules about their children's screen use, and were more likely to be sedentary themselves.
CONCLUSIONS AND IMPLICATIONS: Intervention strategies aimed at reducing S-RSB should involve both parents and children and should focus on fostering behavioral changes and promoting parental role modeling.
2010-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/foodpub/2
info:doi/10.1016/j.jneb.2008.11.011
http://www.jneb.org/article/S1499-4046%2808%2900875-0/abstract
Brescia Food and Nutritional Sciences Publications
Scholarship@Western
sedentary behavior
school-aged children
attitudes
social influence
intentions
Food Science
Nutrition
Public Health
oai:ir.lib.uwo.ca:vascularpub-1041
2023-03-16T13:59:17Z
publication:vascularpub
publication:mnipub
publication:pmid
publication:immunologypub
publication:cns
publication:faculties
publication:medpub
publication:cnspub
publication:med
publication:epidem
publication:mni
publication:robarts
publication:institutes
publication:epidempub
Effects of Intensive Medical Therapy on Microemboli and Cardiovascular Risk in Asymptomatic Carotid Stenosis
Spence, J. David
Coates, Victoria
Li, Hector
Tamayo, Arturo
Muñoz, Claudio
Hackam, Daniel G.
DiCicco, Maria
DesRoches, Janine
Bogiatzi, Chrysi
Klein, Jonathan
Madrenas, Joaquim
Hegele, Robert A.
OBJECTIVE: To assess the effect of more intensive medical therapy on the rate of transcranial Doppler (TCD) microemboli and cardiovascular events in patients with asymptomatic carotid stenosis (ACS). DESIGN: A prospective study. SETTING: A teaching hospital. PATIENTS: Four hundred sixty-eight patients with ACS greater than 60% by Doppler peak velocity. MAIN OUTCOME MEASURES: We compared (1) the proportion of ACS patients who had microemboli on TCD, (2) cardiovascular events, (3) rate of carotid plaque progression, and (4) baseline medical therapy, before and since 2003. RESULTS: Among 468 ACS patients, 199 were enrolled between January 1, 2000, and December 31, 2002; and 269 were enrolled between January 1, 2003, and July 30, 2007. Microemboli were present in 12.6% before 2003 and 3.7% since 2003 (P < .001). The decline in microemboli coincided with better control of plasma lipids and slower progression of carotid total plaque area. Since 2003, there have been significantly fewer cardiovascular events among patients with ACS: 17.6% had stroke, death, myocardial infarction, or carotid endarterectomy for symptoms before 2003, vs 5.6% since 2003 (P < .001). The rate of carotid plaque progression in the first year of follow-up has declined from 69 mm(2) (SD, 96 mm(2)) to 23 mm(2) (SD, 86 mm(2)) (P < .001). CONCLUSIONS: Cardiovascular events and microemboli on TCD have markedly declined with more intensive medical therapy. Less than 5% of patients with ACS now stand to benefit from revascularization; patients with ACS should receive intensive medical therapy and should only be considered for revascularization if they have microemboli on TCD.
2010-02-01T08:00:00Z
article
https://ir.lib.uwo.ca/vascularpub/42
info:doi/10.1001/archneurol.2009.289
http://dx.doi.org/10.1001/archneurol.2009.289
Robarts Vascular Research Publications
Scholarship@Western
Microemboli
Asymptomatic Carotid Stenosis
Allergy and Immunology
Cardiology
Neurology
oai:ir.lib.uwo.ca:epidempub-1037
2010-07-20T20:28:10Z
publication:clinicalpub
publication:pmid
publication:faculties
publication:epidem
publication:robarts
publication:institutes
publication:epidempub
Electronic Search Strategies to Identify Reports of Cluster Randomized Trials in MEDLINE: Low Precision Will Improve with Adherence to Reporting Standards
Taljaard, Monica
McGowan, Jessie
Grimshaw, Jeremy M.
Brehaut, Jamie C.
McRae, Andrew
Eccles, Martin P.
Donner, Allan
BACKGROUND: Cluster randomized trials (CRTs) present unique methodological and ethical challenges. Researchers conducting systematic reviews of CRTs (e.g., addressing methodological or ethical issues) require efficient electronic search strategies (filters or hedges) to identify trials in electronic databases such as MEDLINE. According to the CONSORT statement extension to CRTs, the clustered design should be clearly identified in titles or abstracts; however, variability in terminology may make electronic identification challenging. Our objectives were to (a) evaluate sensitivity ("recall") and precision of a well-known electronic search strategy ("randomized controlled trial" as publication type) with respect to identifying CRTs, (b) evaluate the feasibility of new search strategies targeted specifically at CRTs, and (c) determine whether CRTs are appropriately identified in titles or abstracts of reports and whether there has been improvement over time.
METHODS: We manually examined a wide range of health journals to identify a gold standard set of CRTs. Search strategies were evaluated against the gold standard set, as well as an independent set of CRTs included in previous systematic reviews.
RESULTS: The existing strategy (randomized controlled trial.pt) is sensitive (93.8%) for identifying CRTs, but has relatively low precision (9%, number needed to read 11); the number needed to read can be halved to 5 (precision 18.4%) by combining with cluster design-related terms using the Boolean operator AND; combining with the Boolean operator OR maximizes sensitivity (99.4%) but would require 28.6 citations read to identify one CRT. Only about 50% of CRTs are clearly identified as cluster randomized in titles or abstracts; approximately 25% can be identified based on the reported units of randomization but are not amenable to electronic searching; the remaining 25% cannot be identified except through manual inspection of the full-text article. The proportion of trials clearly identified has increased from 28% between the years 2000-2003, to 60% between 2004-2007 (absolute increase 32%, 95% CI 17 to 47%).
CONCLUSIONS: CRTs should include the phrase "cluster randomized trial" in titles or abstracts; this will facilitate more accurate indexing of the publication type by reviewers at the National Library of Medicine, and efficient textword retrieval of the subset employing cluster randomization.
2010-02-16T08:00:00Z
article
https://ir.lib.uwo.ca/epidempub/38
info:doi/10.1186/1471-2288-10-15
http://dx.doi.org/10.1186/1471-2288-10-15
Epidemiology and Biostatistics Publications
Scholarship@Western
Search strategy
MEDLINE
Cluster randomized trial
Biostatistics
Epidemiology
Library and Information Science
oai:ir.lib.uwo.ca:vascularpub-1043
2010-03-14T22:35:31Z
publication:vascularpub
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:epidem
publication:biochempub
publication:robarts
publication:biochem
publication:institutes
publication:epidempub
APOC1 T45S Polymorphism Is Associated with Reduced Obesity Indices and Lower Plasma Concentrations of Leptin and Apolipoprotein C-I in Aboriginal Canadians
Lahiry, Piya
Cao, Henian
Ban, Matthew R.
Pollex, Rebecca L.
Mamakeesick, Mary
Zinman, Bernard
Harris, Stewart B.
Hanley, Anthony J. G.
Huff, Murray W.
Connelly, Philip W.
Hegele, Robert A.
Apolipoprotein (apo) C-I is a constituent of chylomicrons, very low density lipoprotein, and high density lipoprotein. The role of apo C-I in human metabolism is incompletely defined. We took advantage of a naturally occurring amino acid polymorphism that is present in aboriginal North Americans, namely apo C-I T45S. We assessed the hypothesis that metabolic traits, including obesity-related and lipoprotein-related traits, would differ between carriers and noncarriers of apo C-I T45S. A genotyping assay was developed for APOC1 T45S and genotypes were determined in a sample of 410 Canadian Oji-Cree subjects. The allele frequency of the apo C-I S45 allele was approximately 8% in this sample. We observed the apo C-I S45 allele was significantly associated with 1) lower percent body fat (P < 0.05), 2) lower waist circumference (P = 0.058), 3) lower serum leptin levels (P < 0.05), and 4) lower plasma apo C-I levels (P < 0.0001), using a newly developed ELISA-based method. Taken together, these results suggest that at the whole human phenotype level, apo C-I is associated with the complex metabolic trait of obesity as well as with serum leptin levels.
2010-04-01T07:00:00Z
article
https://ir.lib.uwo.ca/vascularpub/44
info:doi/10.1194/jlr.P002014
http://www.jlr.org/cgi/content/abstract/51/4/843
Robarts Vascular Research Publications
Scholarship@Western
nonsynonymous variant
leptin
Canadian First Nation population
genetics
serum levels
hypertriglyceridemic waist
Cardiology
Medical Biochemistry
Medical Microbiology
oai:ir.lib.uwo.ca:surgerypub-1027
2010-03-26T21:19:32Z
publication:rwkex_researcharticles
publication:oncpub
publication:surgerypub
publication:pmid
publication:faculties
publication:stats
publication:rwkex
publication:epidem
publication:surgery
publication:statspub
publication:onc
publication:epidempub
Cyclosporin versus Tacrolimus for Liver Transplanted Patients
Haddad, Elizabeth
McAlister, Vivian
Renouf, Elizabeth
Malthaner, Richard
Kjaer, Mette S.
Gluud, Lise Lotte
A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring>tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73-0.99; graft loss: RR 0.73, 95% CI 0.61-0.86). Tacrolimus reduced the number of recipients with acute rejection (RR 0.81, 95% CI 0.75-0.88) and steroid-resistant rejection (RR 0.54, 95% CI 0.47-0.74) in the first year. Lymphoproliferative disorder or dialysis rates were not different but more de novo diabetes (RR 1.38, 95% CI 1.01-1.86) occurred with tacrolimus. More patients stopped cyclosporin than tacrolimus (RR 0.57, 95% CI 0.49-0.66). Treating 100 recipients with tacrolimus instead of cyclosporin would avoid rejection and steroid-resistant rejection in nine and seven patients respectively, graft loss and death in five and two patients respectively, but four additional patients would develop diabetes after liver transplantation.
2006-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/surgerypub/29
info:doi/10.1002/14651858.CD005161.pub2
https://ir.lib.uwo.ca/context/surgerypub/article/1027/viewcontent/FK_CsA_meta.pdf
Surgery Publications
Scholarship@Western
Acute Disease
Cyclosporine
Follow-Up Studies
Graft Rejection
Humans
Immunosuppressive Agents
Liver Transplantation
Risk Factors
Tacrolimus
Epidemiology
Oncology
Statistics and Probability
Surgery
oai:ir.lib.uwo.ca:nursingpub-1166
2010-04-02T00:21:21Z
publication:psychiatrypub
publication:faculties
publication:psychiatry
publication:nursing
publication:epidem
publication:nursingpub
publication:epidempub
Deriving a Mental Health Outcome Measure Using the Pooled Index: An Application to Psychiatric Consumer–survivors in Different Housing Types
Speechley, Mark
Forchuk, Cheryl
Hoch, Jeffrey
Jensen, Elsabeth
Wagg, Jennifer
Objective: We demonstrate the combination of several source measures into a comprehensive pooled index (PI) that measures functioning at a single point in time as well as improvement or worsening in functioning over time, and illustrate how this measure can be used to compare functioning in psychiatric clients living in three different housing types.
Methods: One hundred and forty-eight clients (55% women, mean age 45 yr.) were administered comprehensive interviews at two times one year apart. Four variables measured at both times were combined into a PI: three subscale scores from the Colorado Client Assessment Record, and the Quality of Life score from the Lehman interview. The PI was calculated for the initial interview, and between the two interviews to measure change in functioning over time (ΔPI).
Results: The greatest improvements in ΔPI scores occurred in those living independently, very slight worsening was seen among those in subsidized housing, and considerable worsening occurred among those in shelters. Regression results showed that living in a shelter, being older, PI at Year 1, being non-compliant with medications, duration of symptoms, and having more than 1 undesirable move in the past 2 years were independently associated with worsening in overall functioning over one year.
Conclusion: A pooled index change score, calculated from existing scale scores, provides a single dependent variable that quantifies the improvement or worsening of the overall functioning of psychiatric clients living in different housing types over time. A pooled index is one method of reducing multiple outcomes for analysis.
2009-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/nursingpub/147
info:doi/10.1007/s10742-009-0044-4
http://dx.doi.org/10.1007/s10742-009-0044-4
Nursing Publications
Scholarship@Western
outcome mesaure
pooled index
psychiatric survivors
mental health
housing
Nursing
oai:ir.lib.uwo.ca:fammedpub-1006
2010-04-05T06:16:22Z
publication:vascularpub
publication:fammedpub
publication:fammed
publication:pmid
publication:faculties
publication:medpub
publication:med
publication:epidem
publication:biochempub
publication:robarts
publication:biochem
publication:institutes
publication:epidempub
Association of Apolipoprotein B with Incident Type 2 Diabetes in an Aboriginal Canadian Population
Ley, Sylvia H.
Harris, Stewart B.
Connelly, Philip W.
Mamakeesick, Mary
Gittelsohn, Joel
Wolever, Thomas M.
Hegele, Robert A.
Zinman, Bernard
Hanley, Anthony J.
BACKGROUND: Expanding evidence indicates that apolipoprotein B (apo B) is superior to LDL cholesterol as a marker of vascular disease. Although traditional lipid measures are known to predict type 2 diabetes, limited data are available regarding apo B. We assessed the association of apo B with incident type 2 diabetes and compared it with traditional lipid variables as a risk predictor in aboriginal Canadians.
METHODS: Of an initial cohort of 606 individuals without diabetes in 1993-1995, 540 were contacted for the 10-year follow-up evaluation in 2003-2005. Fasting and 2-h postload glucose concentrations were obtained at baseline and follow-up to determine incident type 2 diabetes. Baseline fasting serum lipids were measured with standard laboratory procedures.
RESULTS: The cumulative 10-year incidence of type 2 diabetes was 17.5%. High concentrations of apo B, triglycerides, and LDL cholesterol, and low concentrations of HDL cholesterol were individually associated with incident type 2 diabetes in univariate analyses. Comparing C statistics of univariate models showed apo B to be a superior determinant of incident diabetes compared with LDL (P = 0.026) or HDL (P = 0.004) cholesterol. With multivariate adjustment including waist circumference, apo B (odds ratio, 1.50; 95% CI, 1.11-2.02) and triglycerides (odds ratio, 1.49; 95% CI, 1.12-1.98) remained associated with incident diabetes, whereas LDL and HDL cholesterol became nonsignificant.
CONCLUSIONS: The association of plasma apo B with incident type 2 diabetes and its better prediction of risk compared with LDL or HDL cholesterol suggest the potential for the use of apo B in type 2 diabetes risk communication and prevention.
2010-04-01T07:00:00Z
article
https://ir.lib.uwo.ca/fammedpub/7
info:doi/10.1373/clinchem.2009.136994
http://www.clinchem.org/cgi/content/abstract/56/4/666
Family Medicine Publications
Scholarship@Western
Apolipoprotein B
Type 2 Diabetes
Aboriginal
Canada
Endocrinology, Diabetes, and Metabolism
oai:ir.lib.uwo.ca:philosophypub-1139
2012-01-06T01:32:20Z
publication:philosophy
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Duty and Healing: Foundations of a Jewish Bioethic
Freedman, Benjamin
Weijer, Charles
1999-01-01T08:00:00Z
book
https://ir.lib.uwo.ca/philosophypub/142
Philosophy Publications
Scholarship@Western
Jewish bioethics
Judaism
Bioethics
Medical ethics
Benjamin Freedman
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1140
2010-05-26T01:32:09Z
publication:rwkex_books
publication:philosophy
publication:faculties
publication:philosophypub
publication:medpub
publication:rwkex
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
The Limits of Consent: A Socio-ethical Approach to Human Subject Research in Medicine
Corrigan, Oonagh
McMillan, John
Liddell, Kathleen
Richards, Martin
Weijer, Charles
Since its inception as an international requirement to protect patients and healthy volunteers taking part in medical research, informed consent has become the primary consideration in research ethics. Despite the ubiquity of consent, however, scholars have begun to question its adequacy for contemporary biomedical research. This book explores this issue, reviewing the application of consent to genetic research, clinical trials, and research involving vulnerable populations. For example, in genetic research, information obtained from an autonomous research participant may have significant bearing on the interests of family members who have not consented to the study. This casts doubt on the adequacy of consent for such studies. This book also questions the assumptions that informed consent is essential and that it satisfactorily protects the principle of individual autonomy. It reviews recent empirical studies that challenge the possibility of truly informed consent and highlights the extent to which consent is governed by social norms and expectations. It also investigates how consent might be of secondary importance in some circumstances, for example when a research project appears to protect a public or community interest.
2009-01-01T08:00:00Z
book
https://ir.lib.uwo.ca/philosophypub/141
info:doi/10.1093/acprof:oso/9780199231461.001.0001
http://dx.doi.org/10.1093/acprof:oso/9780199231461.001.0001
Philosophy Publications
Scholarship@Western
medical research
consent
biomedical research
genetic research
clinical trials
vulnerable populations
informed consent
individual autonomy
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1141
2010-07-07T00:01:50Z
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Providing Research Results to Participants: Attitudes and Needs of Adolescents and Parents of Children with Cancer
Fernandez, Conrad Vincent
Gao, Jun
Strahlendorf, Caron
Moghrabi, Albert
Pentz, Rebecca Davis
Barfield, Raymond Carlton
Baker, Justin Nathaniel
Santor, Darcy
Weijer, Charles
Kodish, Eric
PURPOSE: There is an increasing demand for researchers to provide research results to participants. Our aim was to define an appropriate process for this, based on needs and attitudes of participants.
METHODS: A multicenter survey in five sites in the United States and Canada was offered to parents of children with cancer and adolescents with cancer. Respondents indicated their preferred mode of communication of research results with respect to implications; timing, provider, and content of the results; reasons for and against providing results; and barriers to providing results.
RESULTS: Four hundred nine parents (including 19 of deceased children) and 86 adolescents responded. Most parents (n = 385; 94.2%) felt that they had a strong right to research results. For positive results, most wanted a letter or e-mail summary (n = 238; 58.2%) or a phone call followed by a letter (n = 100; 24.4%). If the results were negative, phone call (n = 136; 33.3%) or personal visits (n = 150; 36.7%) were preferred. Parents wanted the summary to include long-term sequelae and suggestions for participants (n = 341; 83.4%), effect on future treatments (n = 341; 83.4%), and subsequent research steps (n = 284; 69.5%). Understanding the researcher was a main concern about receiving results (n = 145; 35.5%). Parents felt that results provide information to support quality of life (n = 315; 77%) and raise public awareness of research (n = 282; 68.9%). Adolescents identified similar preferences.
CONCLUSION: Parents of children with cancer and adolescents with cancer feel strongly that they have a right to be offered research results and have specific preferences of how and what information should be communicated.
2009-02-20T08:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/140
info:doi/10.1200/JCO.2008.18.5223
http://dx.doi.org/10.1200/JCO.2008.18.5223
Philosophy Publications
Scholarship@Western
Attitude to Health
Clinical Ethics
Neoplasms
Patients Rights
Physician-Patient Relations
Adolescent
Adult
Aged
Attitude of Health Personnel
Canada
Disclosure
Ethics, Clinical
Ethics, Research
Female
Health Services Needs and Demand
Humans
Male
Middle Aged
Parents
Patient Rights
Patients
Questionnaires
United States
Young Adult
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1142
2010-04-20T01:06:49Z
publication:philosophy
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Research Governance Lessons from the National Placebo Initiative
Sampson, Heather
Weijer, Charles
Pullman, Daryl
2009-04-01T07:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/145
http://find.galegroup.com/gtx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T002∏Id=AONE&docId=A202134285&source=gale&srcprod=AONE&userGroupName=lond95336&version=1.0
Philosophy Publications
Scholarship@Western
Research governance
health law
Bioethics and Medical Ethics
Law
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1143
2010-04-20T01:10:30Z
publication:philosophy
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Minimal Risk and Large-scale Biobank and Cohort Research
Caulfield, Timothy
Weijer, Charles
2009-04-01T07:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/144
http://find.galegroup.com/gtx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T002∏Id=AONE&docId=A202134289&source=gale&srcprod=AONE&userGroupName=lond95336&version=1.0
Philosophy Publications
Scholarship@Western
biobank
cohort study
Bioethics and Medical Ethics
Law
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1144
2010-04-20T01:16:50Z
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Helsinki Discords: FDA, Ethics, and International Drug Trials
Kimmelman, Jonathan
Weijer, Charles
Meslin, Eric M.
2009-01-03T08:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/143
info:doi/10.1016/S0140-6736(08)61936-4
http://dx.doi.org/10.1016/S0140-6736(08)61936-4
Philosophy Publications
Scholarship@Western
Ethics
Ethics, Research
Helsinki Declaration
Humans
International Cooperation
United States
United States Food and Drug Administration
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1145
2010-06-20T22:56:57Z
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
A Comparison of Journal Instructions Regarding Institutional Review Board Approval and Conflict-of-interest Disclosure between 1995 and 2005
Rowan-Legg, Anne
Weijer, Charles
Gao, J.
Fernandez, C.
OBJECTIVES: To compare 2005 and 1995 ethics guidelines from journal editors to authors regarding requirements for institutional review board (IRB) approval and conflict-of-interest (COI) disclosure.
DESIGN: A descriptive study of the ethics guidelines published in 103 English-language biomedical journals listed in the Abridged Index Medicus in 1995 and 2005. Each journal was reviewed by the principal author and one of four independent reviewers.
RESULTS: During the period, the proportion of journals requiring IRB approval increased from 42% (95% CI 32.2% to 51.2%, p<0.001) to 76% (95% CI 66.4% to 83.1%, p<0.001). In 2005, an additional 9% referred to the Declaration of Helsinki or the International Committee of Medical Journal Editors' Uniform requirements for ethical guidelines; 15% (95% CI 8.5% to 22.5%, p<0.01) provided ambiguous or no requirements. The proportion of journals requiring COI disclosure increased from 75% (95% CI 66.6% to 83.3%, p<0.05) to 94% (95% CI 89.4% to 98.6%, p<0.05); 41% had comprehensive requirements, while some addressed only funding source (6%), were vague (10%) or both (14%). Criteria for authorship rose from 40% (95% CI 30.5% to 49.5%, p<0.05) to 72% (95% CI 63.3% to 80.7%, p<0.05). Journals with higher impact factors were more likely to require IRB approval (p<0.01). Journals in anaesthesia and radiology all required IRB approval; requirements in other disciplines varied.
CONCLUSIONS: Instructions to authors regarding ethical standards have improved. Some remain incomplete, especially regarding the scope of disclosure of COI. The ethical guidelines presented to authors need further clarification and standardisation.
2009-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/146
info:doi/10.1136/jme.2008.024299
http://dx.doi.org/10.1136/jme.2008.024299
Philosophy Publications
Scholarship@Western
Conflict of Interest
Disclosure
Ethical Review
Biomedical Research
Editorial Policies
Humans
Practice Guidelines as Topic
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1146
2010-04-20T01:46:45Z
publication:obsgyn
publication:philosophy
publication:obsgynpub
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Ethical Issues Associated With the Introduction of New Surgical Devices, or Just Because We Can, Doesn’t Mean We Should
Ross, Sue
Robert, Magali
Harvey, Marie-Andrée
Farrell, Scott
Schulz, Jane
Wilkie, David
Lovatsis, Danny
Epp, Annette
Easton, Bill
McMillan, Barry
Schachter, Joyce
Gupta, Chander
Weijer, Charles
Surgical devices are often marketed before there is good evidence of their safety and effectiveness. Our paper discusses the ethical issues associated with the early marketing and use of new surgical devices from the perspectives of the six groups most concerned. Health Canada, which is responsible for licensing new surgical devices, should amend their requirements to include rigorous clinical trials that provide data on effectiveness and safety for each new product before it is marketed. Industry should comply with all Health Canada requirements to obtain licenses for new products. Until Health Canada requires effectiveness and safety data, industry should cooperate with physicians in appropriate studies before releasing new products and should make balanced presentations of all the available evidence. Surgeons should, before using a new surgical device, assess the evidence on its effectiveness and safety and ensure they are properly trained and competent in using the device. Surgeons should provide their patients with an evaluation of the available evidence and inform them about possible complications and the surgeon's level of experience with the new device. Patients, who should be given an honest evaluation of the available evidence, possible complications, and the surgeon's experience, should be encouraged to evaluate the evidence and information to their own satisfaction to ensure that fully informed consent is given. Health institutions, responsible for regulating practice within their walls, should review new devices for safety, effectiveness, and economic impacts, before allowing their use. They should also limit the use of new surgical devices to surgeons trained and competent in the new technology. Professional societies should provide guidance on the early adoption of new surgical devices and technologies. We urge all those involved in the development, licensing, and use of new surgical devices to aim for higher ethical standards to protect the health and safety of patients requiring surgery. The lowest acceptable ethical standard would require device manufacturers to provide surgeons with accurate and timely information on the efficacy and safety of their products, allowing surgeons and patients to evaluate the evidence (and the significance of information not yet available) before surgery.
2008-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/147
http://www.sogc.org/jogc/abstracts/full/200806_Commentary_1.pdf
Philosophy Publications
Scholarship@Western
Clinical ethics
Risk Assessment
Safety
Ethics, Clinical
Female
Gynecologic Surgical Procedures
Humans
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1147
2010-06-24T06:45:22Z
publication:philosophy
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
U.S. Federal Regulations for Emergency Research: A Practical Guide and Commentary
McRae, Andrew
Weijer, Charles
Emergency medicine research requires the enrollment of subjects with varying decision-making capacities, including capable adults, adults incapacitated by illness or injury, and children. These different categories of subjects are protected by multiple federal regulations. These include the federal Common Rule, the Department of Health and Human Services (DHHS) regulations for pediatric research, and the Food and Drug Administration's (FDA) Final Rule for the Exception from the Requirements of Informed Consent in Emergency Situations. Investigators should be familiar with the relevant federal research regulations to optimally protect vulnerable research subjects, and to facilitate the institutional review board (IRB) review process. IRB members face particular challenges in reviewing emergency research. No regulations exist for research enrolling incapacitated subjects using proxy consent. The wording of the Final Rule may not optimally protect vulnerable subjects. It is also difficult to apply conflicting regulations to a single study that enrolls subjects with differing decision-making capacities. This article is intended as a guide for emergency researchers and IRB members who review emergency research. It reviews the elements of Federal Regulations that apply to consent, subject selection, privacy protection, and the analysis of risks and benefits in all emergency research. It explores the challenges for IRB review listed above, and offers potential solutions to these problems.
2008-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/148
info:doi/10.1111/j.1553-2712.2007.00001.x
http://dx.doi.org/10.1111/j.1553-2712.2007.00001.x
Philosophy Publications
Scholarship@Western
emergency research
research ethics
federal regulations
bioethics
community consultation
Bioethics and Medical Ethics
Epidemiology
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1149
2010-04-22T07:12:56Z
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Ethics of Surgical Training in Developing Countries
Ramsey, Kevin M.
Weijer, Charles
The practice of surgical trainees operating in developing countries is gaining interest in the medical community. Although there has been little analysis about the ethical impact of these electives, there has been some concerns raised over the possible exploitation of trainees and their patients. An ethical review of this practice shows that care needs to be taken to prevent harm. Inexperienced surgeons learning surgical skills in developing countries engender greater risk of violating basic ethical principles. Advanced surgical trainees who have already achieved surgical competence are best qualified to satisfy these ethical issues. All training programs need to develop a structured ethical review for international electives to protect their trainees and their patients from harm.
2007-11-01T07:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/150
info:doi/10.1007/s00268-007-9243-8
http://dx.doi.org/10.1007/s00268-007-9243-8
Philosophy Publications
Scholarship@Western
Clinical Competence
Developing Countries
Medical Ethics
Surgery
Ethics, Medical
General Surgery
Humans
Internship and Residency
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1151
2010-04-22T07:30:14Z
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Refuting the Net Risks Test: A Response to Wendler and Miller's "Assessing Research Risks Systematically"
Weijer, Charles
Miller, Paul B.
Earlier in the pages of this journal (p 481), Wendler and Miller offered the "net risks test" as an alternative approach to the ethical analysis of benefits and harms in research. They have been vocal critics of the dominant view of benefit-harm analysis in research ethics, which encompasses core concepts of duty of care, clinical equipoise and component analysis. They had been challenged to come up with a viable alternative to component analysis which meets five criteria. The alternative must (1) protect research subjects; (2) allow clinical research to proceed; (3) explain how physicians may offer trial enrolment to their patients; (4) address the challenges posed by research containing a mixture of interventions and (5) define ethical standards according to which the risks and potential benefits of research may be consistently evaluated. This response argues that the net risks test meets none of these criteria and concludes that it is not a viable alternative to component analysis.
2007-08-01T07:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/152
info:doi/10.1136/jme.2006.016444
http://jme.bmj.com/content/33/8/487.abstract
Philosophy Publications
Scholarship@Western
Clinical Trials
Research Subjects
Risk Assessment
Biomedical Research
Clinical Trials as Topic
Ethics Committees, Research
Humans
Nontherapeutic Human Experimentation
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1148
2010-06-24T06:53:49Z
publication:philosophy
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Revisiting Equipoise: A Response to Gifford
Miller, Paul B.
Weijer, Charles
The authors respond to objections Fred Gifford has raised against their paper "Rehabilitating Equipoise." They situate this exchange in the wider context of recent debate over equipoise, highlighting substantial points of agreement between themselves and Gifford. The authors offer a brief restatement of "Rehabilitating Equipoise" in which they amplify some of its core arguments. They then assess Gifford's objections. Finding each to be unfounded, they argue that there is no justification for "pulling the plug" on clinical equipoise.
2007-09-01T07:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/149
http://muse.jhu.edu/journals/kennedy_institute_of_ethics_journal/v017/17.3miller.pdf
Philosophy Publications
Scholarship@Western
Medical research
Moral and ethics
Clinical trials
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1150
2010-06-24T06:50:53Z
publication:philosophy
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Evaluating Benefits and Harms in Intensive Care Research
Weijer, Charles
Miller, Paul B.
2007-10-01T07:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/151
info:doi/10.1007/s00134-007-0818-5
http://dx.doi.org/10.1007/s00134-007-0818-5
Philosophy Publications
Scholarship@Western
Human Experimentation
Intensive Care
Risk Assessment
Health Services Research
Humans
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1152
2010-07-06T06:18:11Z
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Equipoise and the Duty of Care in Clinical Research: A Philosophical Response to Our Critics
Miller, Paul B.
Weijer, Charles
Franklin G. Miller and colleagues have stimulated renewed interest in research ethics through their work criticizing clinical equipoise. Over three years and some twenty articles, they have also worked to articulate a positive alternative view on norms governing the conduct of clinical research. Shared presuppositions underlie the positive and critical dimensions of Miller and colleagues' work. However, recognizing that constructive contributions to the field ought to enjoy priority, we presently scrutinize the constructive dimension of their work. We argue that it is wanting in several respects.
2007-03-01T08:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/155
info:doi/10.1080/03605310701255735
http://dx.doi.org/10.1080/03605310701255735
Philosophy Publications
Scholarship@Western
Clinical Trials
Research Ethics
Research Design
Clinical Trials as Topic
Ethics, Research
Humans
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1154
2010-07-06T06:22:52Z
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
Obligations in Offering to Disclose Genetic Research Results
Fernandez, Conrad V.
Weijer, Charles
2006-12-01T08:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/153
info:doi/10.1080/15265160600938575
http://dx.doi.org/10.1080/15265160600938575
Philosophy Publications
Scholarship@Western
Decision Making
Research Ethics
Moral Obligations
Research Subjects
Researcher-Subject Relations
Truth Disclosure
Duty to Recontact
Ethics, Research
Genetic Research
Humans
Reproducibility of Results
Research Personnel
Bioethics and Medical Ethics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1153
2010-07-06T06:11:42Z
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
The Return of Research Results to Participants: Pilot Questionnaire of Adolescents and Parents of Children with Cancer
Fernandez, Conrad V.
Santor, Darcy
Weijer, Charles
Strahlendorf, Caron
Moghrabi, Albert
Pentz, Rebecca
Gao, Jun
Kodish, Eric
PURPOSE: The offer to return research results to participants is increasingly recognized as an ethical obligation, although few researchers routinely return results. We examined the needs and attitudes of parents of children with cancer and of adolescents with cancer to the return of research results.
METHODS: Seven experts in research ethics scored content validity on parent and adolescent questionnaires previously developed through focus group and phone interviews. The questionnaires were revised and provided to 30 parents and 10 adolescents in a tertiary care oncology setting.
RESULTS: The content validity index for individual questions and the overall questionnaires scored as 0.86 for both questionnaires. All 30 parents and 10 adolescents who agreed to participate returned questionnaires. The majority (>95%) indicated that they had a strong or very strong right to receive results. Letter or e-mail was a satisfactory means to return results described as good or neutral (66% parents, 100% adolescents) but more participants wished face-to-face disclosure of results with negative implications (50% parents, 60% adolescents). Very few wanted results disseminated through a Web site. The majority acknowledged the need for peer-review before disclosure (60% of adolescents and parents) but did not want "to be the last to know."
CONCLUSIONS: Our data suggest that pediatric oncology patients and parents of children with cancer strongly feel that they have a right to research results, and that they wish to receive these in a timely manner.
2007-04-01T07:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/154
info:doi/10.1002/pbc.20766
http://dx.doi.org/10.1002/pbc.20766
Philosophy Publications
Scholarship@Western
Clinical Trials
Neoplasms
Patient Rights
Patient Satisfaction
Peer Review
Research Subjects
Truth Disclosure
Adolescent
Adult
Affect
Child
Clinical Trials as Topic
Humans
Internet
Parents
Patient Access to Records
Patients
Pilot Projects
Questionnaires
Sampling Studies
Stress, Psychological
Time Factors
Treatment Outcome
Bioethics and Medical Ethics
Oncology
Pediatrics
Philosophy
oai:ir.lib.uwo.ca:philosophypub-1155
2010-07-06T06:37:01Z
publication:philosophy
publication:pmid
publication:faculties
publication:philosophypub
publication:medpub
publication:med
publication:epidem
publication:rotman
publication:rotmanpub
publication:institutes
publication:epidempub
The Balm of Gilead: Is the Provision of Treatment to those Who Seroconvert in HIV Prevention Trials a Matter of Moral Obligation or Moral Negotiation?
Weijer, Charles
Leblanc, Guy J.
Must treatment be provided to subjects who acquire HIV during the course of a prevention study? An analysis of ethical foundation, regulation, and recent argumentation provides no basis for the obligation. We outline an alternative approach to the problem based on moral negotiation.
2006-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/philosophypub/163
info:doi/10.1111/j.1748-720X.2006.00099.x
http://dx.doi.org/10.1111/j.1748-720X.2006.00099.x
Philosophy Publications
Scholarship@Western
Clinical Trials
Compensation and Redress
Developing Countries
International Cooperation
Moral Obligations
Anti-HIV Agents
Clinical Trials as Topic
Female
HIV Infections
HIV Seropositivity
Humans
Male
Negotiating
Bioethics and Medical Ethics
Philosophy
847955/oai_dc/100//