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Roche-Nagle, G., K. Bachynski, A. B. Nathens, D. Angoulvant, and B. B. Rubin. "Regionalization of services improves access to emergency vascular surgical care." Vascular 21, no. 2 (March 18, 2013): 69–74. http://dx.doi.org/10.1177/1708538113478726.
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Management of vascular surgical emergencies requires rapid access to a vascular surgeon and hospital with the infrastructure necessary to manage vascular emergencies. The purpose of this study was to assess the impact of regionalization of vascular surgery services in Toronto to University Health Network (UHN) and St Michael's Hospital (SMH) on the ability of CritiCall Ontario to transfer patients with life- and limb-threatening vascular emergencies for definitive care. A retrospective review of the CritiCall Ontario database was used to assess the outcome of all calls to CritiCall regarding patients with vascular disease from April 2003 to March 2010. The number of patients with vascular emergencies referred via CritiCall and accepted in transfer by the vascular centers at UHN or SMH increased 500% between 1 April 2003-31 December 2005 and 1 January 2006-31 March 2010. Together, the vascular centers at UHN and SMH accepted 94.8% of the 1002 vascular surgery patients referred via CritiCall from other hospitals between 1 January 2006 and 31 March 2010, and 72% of these patients originated in hospitals outside of the Toronto Central Local Health Integration Network. Across Ontario, the number of physicians contacted before a patient was accepted in transfer fell from 2.9 ± 0.4 before to 1.7 ± 0.3 after the vascular centers opened. In conclusion, the vascular surgery centers at UHN and SMH have become provincial resources that enable the efficient transfer of patients with vascular surgical emergencies from across Ontario. Regionalization of services is a viable model to increase access to emergent care.
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Samokhvalov, Andriy V., Peter Selby, Susan J. Bondy, Michael Chaiton, Anca Ialomiteanu, Robert Mann, and Jürgen Rehm. "Smokers who seek help in specialized cessation clinics: How special are they compared to smokers in general population?" Journal of Smoking Cessation 9, no. 2 (August 22, 2013): 76–84. http://dx.doi.org/10.1017/jsc.2013.23.
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Introduction: Patients of specialized nicotine dependence clinics are hypothesized to form a distinct subpopulation of smokers due to the features associated with treatment seeking. The aim of the study was to describe this subpopulation of smokers and compare it to smokers in general population.Material and methods: A chart review of 796 outpatients attending a specialized nicotine dependence clinic, located in Toronto, Ontario, Canada was performed. Client smoking patterns and sociodemographic characteristics were compared to smokers in the general population using two Ontario surveys – the Ontario Tobacco Survey (n = 898) and the Centre for Addiction and Mental Health Monitor (n = 457).Results: Smokers who seek treatment tend to smoke more and be more heavily addicted. They were older, had longer history of smoking and greater number of unsuccessful quit attempts, both assisted and unassisted. They reported lower education and income, had less social support and were likely to live with other smokers.Conclusions: Smokers who seek treatment in specialized centers differ from the smokers in general population on several important characteristics. These same characteristics are associated with lower chances for successful smoking cessation and sustained abstinence and should be taken into consideration during clinical assessment and treatment planning.
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Goldsmith, Ronald E. "FutureConsumer.Com: The Webolution of Shopping to 201020014Frank Feather. FutureConsumer.Com: The Webolution of Shopping to 2010. Warwick Publishing: Toronto, Ontario, 2000. 317 pp., ISBN: 1‐894020‐67‐7 $26.95 US $30.00 Can." Journal of Consumer Marketing 18, no. 4 (July 2001): 368–76. http://dx.doi.org/10.1108/jcm.2001.18.4.368.4.
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Murray, Collette. "Educating from Difference: Perspectives on Black Cultural Art Educators’ Experiences with Culturally Responsive Teaching." Canadian Journal of History 56, no. 3 (December 1, 2021): 353–80. http://dx.doi.org/10.3138/cjh.56-3-2021-0008.
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Since the 2009 Ontario Ministry’s Equity and Inclusive Education strategy called for the implementation of culturally responsive pedagogy across the board, the voice of the Black creative and content in arts curriculum remains invisible. This primary research centers on the perspectives of African, Caribbean, and Black artists called on for the first time to discuss the successes and challenges of teaching culturally responsive arts in diverse Ontario classrooms. This qualitative study uses critical race theory to examine their experiences of working in Greater Toronto schools and surrounding areas in Ontario, Canada. Using cultural arts from across the African diaspora as a tool, their artistic work is situated within culturally relevant pedagogy, which is an alternative approach to centering on identity, cultural frames of reference, and critical student learning. Yet, as these Black Canadian artists garner successful impacts from culturally responsive teaching in classroom space, they identify simultaneous challenges of institutional unpreparedness, anti-Black racism, cultural appropriation, and legitimizing their cultural artistry to school administration. Semi-structured interviews include rich narratives from artists specializing in contemporary and traditional expressions of orality, visual arts, dance, and drumming/percussion from the African diaspora. While navigating instances of unbelonging, recommendations are proposed to improve the understanding of the artists’ role and improve Canadian educational institutions’ relationship with Black creatives in inclusive education.
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Kim, Whan B., Judy Qiang, and Jensen Yeung. "MACEs Not Associated With the Use of Biologic Therapy for Psoriasis in Real-World Clinical Practice." Journal of Cutaneous Medicine and Surgery 20, no. 4 (February 3, 2016): 352–53. http://dx.doi.org/10.1177/1203475416631329.
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Introduction: Previous reports have shown inconsistent findings with regard to the relationship between biologic therapy and risk for major adverse cardiovascular events (MACEs). Objectives: The aim of this study was to determine the overall rate of MACEs in a cohort of 398 patients. Methods: All patients treated with biologics for psoriasis at 2 academic centers in Toronto, Ontario, between September 2005 and September 2014 were considered for inclusion. Medical records were reviewed to identify MACEs. Results: A total of 398 patients were included. The median duration of disease was 19.8 years. Median time to biologic therapy withdrawal because of an adverse event was 23.5 months. In this cohort, no MACEs were identified in patients treated with biologic therapy. Conclusions: Biologic treatment for psoriasis was not associated with increased cardiovascular risk in this cohort. These results require validation in larger studies.
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Agnew, James, Pat Helland, and Adam Cole. "FHIR: Reducing Friction in the Exchange of Healthcare Data." Queue 20, no. 2 (April 30, 2022): 67–88. http://dx.doi.org/10.1145/3534861.
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With the full clout of the Centers for Medicare and Medicaid Services currently being brought to bear on healthcare providers to meet high standards for patient data interoperability and accessibility, it would be easy to assume the only reason this goal wasn't accomplished long ago is simply a lack of will. Interoperable data? How hard can that be? Much harder than you think, it turns out. To dig into why this is the case, we asked Pat Helland, a principal architect at Salesforce, to speak with James Agnew (CTO) and Adam Cole (senior solutions architect) of Smile CDR, a Toronto, Ontario-based provider of a leading platform used by healthcare organizations to achieve FHIR (Fast Healthcare Interoperability Resources) compliance. They discuss the efforts and misadventures witnessed along the way to a time where it no longer seems inconceivable for healthcare providers to exchange patient records.
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Mazzulli, Tony, Kevin Kain, and Jagdish Butany. "Severe Acute Respiratory Syndrome: Overview With an Emphasis on the Toronto Experience." Archives of Pathology & Laboratory Medicine 128, no. 12 (December 1, 2004): 1346–50. http://dx.doi.org/10.5858/2004-128-1346-sarsow.
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Abstract Objective.—To provide an overview of the severe acute respiratory syndrome (SARS) outbreak in Toronto, Ontario, which experienced the largest outbreak outside Asia, and to review what has been learned during the past year. Data Sources.—MEDLINE search of all studies related to SARS, including review of the Centers for Disease Control and Prevention, World Health Organization (WHO), and Health Canada Web sites. Data Synthesis.—During the SARS outbreak in Toronto, 438 people had been diagnosed as having suspected or probable SARS and 44 people died. Elderly people and those with comorbid illnesses were at greatest risk of complications or death. Transmission was via direct contact with respiratory secretions. The use of gloves, gowns, N95 masks, and eye protection was effective in preventing transmission. No transmission occurred before symptom onset or after recovery. Serologic tests suggest that antibodies may not appear until 28 days after illness onset. Molecular tests give their greatest yield during the second week of illness. The value of ribavirin treatment remains questionable. The combination of interferon plus corticosteroids appears to be better than corticosteroids alone. Postmortem examination revealed pulmonary edema and evidence of diffuse alveolar damage. Very few morphological changes were noted in other organs despite the presence of viral RNA as detected by polymerase chain reaction. Conclusion.—On July 5, 2003, the WHO declared that the SARS outbreak was over. Since then, new cases of SARS have been reported in Asia. With global travel, the disease can rapidly spread throughout the world. Therefore, we must remain vigilant to prevent another pandemic.
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Sukarieh, Rana. "(Un)Managing Emotions at the Forefront: Stories from Shoreham Picket Line." New Sociology: Journal of Critical Praxis 1, no. 1 (June 26, 2020): 1–16. http://dx.doi.org/10.25071/2563-3694.20.
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In this article, I reflect on my experience as an active rank and file member of CUPE 3903, the union representing contract faculty and graduate students at York University in Toronto, Ontario, during the 2018 York University Strike, where I volunteered as a front-line communicator, or “car talker”. Drawing on these experiences, I reflect on the ways in which picketers generally try to (un)manage the emotions of drivers passing through the picket line. My analysis is focused on a particular venue - the Shoreham picket line located at the southwest entrance of the university, and centers around my personal interactions with the drivers crossing the picket line during the morning hours from March 2018 to May 2018. My analysis aims to open up space to discuss the largely overlooked role that the emotions of the public play in shaping the picket line experience. In particular, I provide a multi-directional analysis of the encounters that occurred between the picketers and the general public at the Shoreham picket line during the 2018 strike, highlighting the multiplicity of variables, such as the environment, the pre-existing beliefs of the participants, and expressions of collective anger, which informed these encounters. In doing this, I illuminate the complexity of the intertwined relationship between emotional and cognitive framing, thereby providing a more comprehensive model for understanding the role that emotions play in social movement organizing.
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Scheckler, William E. "Healthcare Epidemiology is the Paradigm for Patient Safety." Infection Control & Hospital Epidemiology 23, no. 1 (January 2002): 47–51. http://dx.doi.org/10.1086/503449.
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I was honored to receive the 2001 Lectureship Award from the Society for Healthcare Epidemiology of America (SHEA). It was my intent during the talk to review our field and implications that some of the new initiatives called “patient safety” have for our expertise. This article is based on the SHEA Lectureship that was given April 1, 2001, at the SHEA Annual Meeting in Toronto, Ontario, Canada.This article consists of four sections. First, I review lessons learned from colleagues during the 33 years that I have been associated with the field of hospital epidemiology and infection control, since my first days at the Centers for Disease Control and Prevention (CDC). Second, I explore issues raised by the Institute of Medicine (IOM) report on patient safety, adverse events, and medical errors, evaluating research that went into the extrapolation of the numbers of preventable deaths that this report highlighted. Those deaths gained everyone's attention. Third, I review the field of healthcare epidemiology, highlighting the three decades of success in our field in enhancing the safety of patients, improving their outcomes, and making a difference in the quality of medical care received in the United States. Finally, I discuss the challenges that hospital epidemiology currently faces and the opportunities that come with the expertise we have developed during more than 30 years.
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Covelli, Andrea Marie, Nancy N. Baxter, Margaret Fitch, and Frances Catriona Wright. "Taking control of cancer: Why women are choosing mastectomy." Journal of Clinical Oncology 31, no. 26_suppl (September 10, 2013): 108. http://dx.doi.org/10.1200/jco.2013.31.26_suppl.108.
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108 Background: Rates of both unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early stage breast cancer (ESBC) have been increasing since 2003. More extensive surgery is not a benign procedure without the risk of complications. Studies suggest that the increase is due to women choosing UM and CPM; we do not know what factors are influencing the choice for more extensive surgery. Methods: We conducted a qualitative study using grounded theory to identify factors for the choice of mastectomy. Purposive sampling was used to identify women across the Toronto Area (Ontario, Canada), who were suitable candidates for breast conserving surgery (BCS) but underwent UM or CPM. Data were collected through semi-structured interviews. Constant comparative analysis identified key concepts and themes. Results: Data saturation was achieved after 29 in-person interviews. 12 interviewees were treated at academic cancer centers, 6 at an academic non-cancer center and 11 at community centers. 15 women underwent UM; 14 underwent UM+CPM. Median age was 55. ‘Taking control of cancer’ was the dominant theme. Fear of breast cancerwas expressed at diagnosisand remains throughout decision making. Fear translates into the overestimated risk of local recurrenceand contralateral cancer. Despite discussion of the equivalence of BCS and UM, patients chose UM due to fear of recurrence and misperceived survival advantage. Similarly, patients chose CPM to eliminate the risk of contralateral cancer and misperceived survival advantage. Women were actively trying to Control Outcomes, as more surgery was seen as greater control. Conclusions: Women seeking UM and CPM for treatment of their early stage breast cancer manage their fear of cancer by undergoing more extensive surgery which in turn drives mastectomy rates. It is important to understand this process so that we may improve our ability to discuss issues of importance to women and facilitate informed decision-making.
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Coleman, Brenda L., Wil Ng, Vinaya Mahesh, Maja McGuire, Kazi Hassan, Karen Green, Shelly McNeil, Allison J. McGeer, and Kevin Katz. "Active Surveillance for Influenza Reduces but Does Not Eliminate Hospital Exposure to Patients With Influenza." Infection Control & Hospital Epidemiology 38, no. 4 (January 10, 2017): 387–92. http://dx.doi.org/10.1017/ice.2016.321.
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OBJECTIVETo describe the frequency, characteristics, and exposure associated with influenza in hospitalized patients in a Toronto hospitalDESIGN/METHODProspective data collected for consenting patients with laboratory-confirmed influenza and a retrospective review of infection control charts for roommates of cases over 3 influenza seasonsRESULTSOf the 661 patients with influenza (age range: 1 week–103 years), 557 were placed on additional precautions upon admission. Of 104 with symptoms detected after admission, 57 cases were community onset and 47 were nosocomial (10 nosocomial were part of outbreaks). A total of 78 cases were detected after admission exposing 143 roommates. Among roommates tested for influenza after exposure, no roommates of community-onset cases and 2 of 16 roommates of nosocomial cases were diagnosed with influenza. Of 637 influenza-infected patients, 25% and 57% met influenza-like illness definitions from the Public Health Agency of Canada (PHAC) and Centers for Disease Control and Prevention (CDC), respectively, and 70.3% met the Provincial Infectious Diseases Advisory Committee (PIDAC) febrile respiratory illness definition. Among the 56 patients with community-onset influenza detected after admission, only 13%, 23%, and 34%, met PHAC, CDC, and PIDAC classifications, respectively.CONCLUSIONSIn a setting with extensive screening and testing for influenza, 1 in 6 patients with influenza was not diagnosed until patients and healthcare workers had been exposed for >24 hours. Only 30% of patients with community-onset influenza detected after admission met the Ontario definition intended to identify cases, hampering efforts to prevent patient and healthcare worker exposures and reinforcing the need for prevention through vaccination.Infect Control Hosp Epidemiol 2017;38:387–392
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Saravana-Bawan, Bianka, Bourne Lewis Auguste, Alireza Zahirieh, and Karen Devon. "Ambulatory Parathyroidectomy for Secondary Hyperparathyroidism at a Large Dialysis Program in Toronto: A Program Report." Canadian Journal of Kidney Health and Disease 9 (January 2022): 205435812211279. http://dx.doi.org/10.1177/20543581221127937.
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Purpose of program: Operative wait times for non-oncology-related procedures continue to rise in Canada, and this was further exacerbated by the COVID-19 pandemic. These challenges will remain prevalent beyond the pandemic given the limited number of acute care beds and resources required to care for patients. As a result, the need for innovative approaches to optimize the utilization of health care resources while maintaining equitable and timely access is needed. In this report, we describe the development of a collaborative ambulatory parathyroidectomy program between two centers in Toronto, allowing for more expedient surgical treatment of secondary hyperparathyroidism among patients from a large dialysis program. Sources of information: The need for expanded access to surgical care for secondary hyperparathyroidism was identified through interdepartmental communication between referring nephrologists and surgeons at Sunnybrook Health Sciences Centre and Women’s College Hospital, respectively. Methods: A multidisciplinary ambulatory parathyroidectomy planning team was formed that included nephrologists, endocrine surgeons, nurses, and patient care managers to conduct a needs assessment. It was identified that patients had long wait times, and to address that gap in care, a protocol was developed to identify suitable patients requiring treatment. The teams created a plan to coordinate patient care and transfers. A clinical tool and protocol for post-operative management of hypocalcemia was developed using a Delphi model, gathering input from many members of the care team. The Delphi process to finalize the protocol included a series of virtual meetings over a period of about 4 months with various stakeholders and included input from two departmental heads (medicine and surgery), three nephrologists, a nurse practitioner, a patient care manager, and two nurse educators. Meetings involved core members of the Nephrology Quality Improvement and Patient Safety at Sunnybrook Health Sciences Centre and finalized protocol was agreed upon by members of this group at a quarterly meeting. Key findings: In this article, we describe the development, initial deployment, and planned assessment of the ambulatory parathyroidectomy program at the Women’s College Hospital and Sunnybrook Health Sciences Centre. The primary aim of the program is to increase accessibility to parathyroidectomy for secondary hyperparathyroidism. A secondary aim was to allow patients to have streamlined care with a team that is well versed with maintenance dialysis needs and optimizing treatment of post operative hypocalcemia through standardized protocols. Limitations: Ambulatory parathyroidectomy relies on effective communication, flow, and availability of acute care beds. It is anticipated that occasionally, unexpected hospital demands, and health care disruptions may occur, which can limit efficiency of the program. We will also need to examine the cost-effectiveness of this program as it may improve access but increase costs related to the procedure. As the program is implemented, useful adaptations and policies to our protocol to help mitigate these limitations will be documented and published in our outcomes report. Implications: Ontario residents with chronic kidney disease with secondary hyperparathyroidism who have failed medical management will have increased and timely access to parathyroidectomy.
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Chatzistavrou, Evangelia, R. Bruce Ross, Bryan D. Tompson, and Malcom C. Johnston. "Predisposing Factors to Formation of Cleft Lip and Palate: Inherited Craniofacial Skeletal Morphology." Cleft Palate-Craniofacial Journal 41, no. 6 (November 2004): 613–21. http://dx.doi.org/10.1597/03-090.1.
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Objective To identify inherited craniofacial morphologic features in individuals at high risk for cleft of the lip, cleft palate, or both. Subjects Twins without cleft from 33 pairs of monozygotic twins discordant for cleft lip, cleft palate, or both were studied. There were 17 males and 16 females of Caucasian origin, ranging from 3 to 18 years (15 with cleft lip and palate [CLP], 10 with cleft lip [CL], and 8 with cleft palate [CP]), collected from five craniofacial centers (United States and Canada). Design The twin without cleft (noncleft) from each set was compared with an age- and sex-matched control individual from the Burlington Growth Centre, Toronto, Ontario. Posteroanterior and lateral cephalograms were traced and digitized using a computer custom analysis. Descriptive statistics, Student's t tests, and analysis of variance were used to test 40 variables in a pilot study comparing the noncleft twin groups with the controls. Preliminary analysis permitted pooling of the CLP and CL groups (n = 25). To minimize false-positive significance, only 14 variables (from the maxillofacial area) were tested. Results Using the raw probabilities, eight variables showed significant differences between the pooled noncleft CLP and CL (CL[P]) twin group and the controls. However, when the level of significance was adjusted, only four (nasal width [p < .01], cranial base length [p < .05], cranial base width/length ratio [p < .001], and maxillary width/length ratio [p < .05]) were significantly different. No significant differences were confirmed between the noncleft CP twin group and the controls. Conclusions The noncleft member of a discordant monozygotic pair has a number of facial characteristics that differ from the general population. These may predispose to the formation of a cleft lip or palate and may result from a deficiency or distortion of the mesenchyme that forms the craniofacial structures.
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Fung, Andrea S., Richard M. Lee-Ying, Daniel E. Meyers, Hao-Wen Sim, Jennifer J. Knox, Valeriya O. Zaborska, Janine Marie Davies, et al. "Treatment of hepatocellular carcinoma (HCC) after sorafenib (S) over the last 10 years." Journal of Clinical Oncology 37, no. 4_suppl (February 1, 2019): 438. http://dx.doi.org/10.1200/jco.2019.37.4_suppl.438.
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438 Background: Until recently there were no standard treatments for HCC patients after S. This study characterizes subsequent treatments (STx) received by HCC patients over the past 10 years and assesses their impact on survival. Methods: HCC patients treated with S between 01/2008 – 06/2017 in British Columbia, Alberta, and two cancer centers in Toronto, Ontario, Canada (Princess Margaret and Sunnybrook Cancer Centre) were included. Clinical, pathologic, laboratory, treatment, and outcome data were collected. The Kaplan-Meier method was used to assess overall survival (OS) based on STx, and stratified according to a better prognostic group (BPG), defined as ECOG 0-1 and CP-A, and worse prognostic group (WPG), defined as ECOG≥2 or CP-B/C. Results: A total of 730 patients were identified. 177 (24.2%) received STx (table). Patients who received STx had longer median OS (mOS) than those who had no further treatment (12.1 vs. 3.3 months; p < 0.001). For patients treated with localized, systemic, or palliative radiation treatment, mOS was 16.8, 10.5 and 8.6 months, respectively (p < 0.001). After S, there were 206 (30.7%) patients in the BPG and 464 (69.3%) in the WPG. BPG patients were more likely to receive STx compared to WPG patients (60.5% vs. 39.5%, p < 0.001). BPG patients who received STx had better mOS than those who did not (15.9 vs. 7.0 months; p < 0.001). WPG patients also had better mOS if they received STx compared to those who did not (6.0 vs. 2.6 months; p < 0.001). Conclusions: Only a small proportion of HCC patients received subsequent treatment after sorafenib. This is likely due to poor performance status, liver dysfunction, or lack of treatment options. Patients who received subsequent treatment had improved mOS, regardless of whether they were in the better or worse prognostic group. [Table: see text]
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Yudin, Mark H., Elizabeth V. Asztalos, Ann Jefferies, and Jon F. R. Barrett. "The Management and Outcome of Higher Order Multifetal Pregnancies: Obstetric, Neonatal and Follow-up Data." Twin Research 4, no. 1 (February 1, 2001): 4–11. http://dx.doi.org/10.1375/twin.4.1.4.
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AbstractThe objective of this study was to describe current obstetric, neonatal, and long-term neurodevelopmental outcomes of higher order multifetal gestations (≥ 3 fetuses) in the 1990s. We also intended to identify a target gestational age at which neonatal and neurodevelopmental morbidities are low. Records from all multifetal pregnancies (≥ 3 viable fetuses ≥ 20 weeks gestation) delivered at the two perinatal centers in Toronto, Ontario, Canada during the study period (January 1, 1990–December 31, 1996) were reviewed. Data were collected on obstetric, neonatal, and long-term neurodevelopmental outcomes. Follow up data were gathered regarding the presence of a severe deficit in four categories (vision, hearing, cognition, and motor skills). Statistical analysis was performed to determine a gestational age at which a significant decrease in deficit occurred. During the study period 165 multifetal pregnancies were delivered. This resulted in 511 fetuses, of which 496 were live births. Of these 496 infants, 453 survived to discharge. Follow up data were obtained on 332 (73.3 per cent) infants. Infant survival increased with gestational age, and was approximately 90 per cent or greater at 26 weeks or more. Of all infants followed, the proportion of those without deficit increased with increasing gestational age, such that the per cent without deficit was 96.9 at 31 weeks or greater. Of all infants followed, 301 (90.7 per cent) had no deficit. Statistical analysis revealed a significant difference in long-term neurodevelopmental outcome between infants born before and after 28 weeks gestation. The incidence of a major deficit was 44.1 per cent for those born earlier than and 5.4 per cent for those born later than this gestational age (p = 0.001). In our cohort, survival figures were high. Even in lower gestational groupings, survival was high, but not without serious concerns about severe morbidity. This information is useful when counseling parents of higher order multifetal pregnancies.
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Hershenfeld, Samantha A., Kimberly Maki, Lana Rothfels, Cindy Susan Murray, Aaron D. Schimmer, and Mary Doherty. "Sharing Post-AML Consolidation Supportive Therapy with Local Centers Reduces Patient Travel Burden without Compromising Safety and Efficacy of Care." Blood 126, no. 23 (December 3, 2015): 534. http://dx.doi.org/10.1182/blood.v126.23.534.534.
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Abstract AML (acute myeloid leukemia) is frequently treated with intensive induction and consolidation chemotherapy that often requires prolonged admissions to hospital. Our group and others demonstrated that consolidation chemotherapy for AML can be safely and effectively administered to selected patients on an ambulatory basis. However, this ambulatory care is centralized in quaternary centers, requiring some patients to travel long distances to these specialized centres. Recently, we developed a shared care model where patients receive their consolidation chemotherapy for AML at the specialized quaternary care center, but receive post-consolidation supportive care including blood checks, transfusions, and treatment for febrile neutropenia at their local hospitals. Here, we reviewed the impact of our new model of care with a focus on savings in travel time and distance. Between 2009-2013, 73 patients with AML (n=61,) or APL (n=12) received post-consolidation care after CR1 at 14 local centers in the province of Ontario. These centers were regional cancer centers staffed by oncologists and/or hematologists experienced in the management of cytopenias and febrile neutropenia. However, these centers did not provide induction or consolidation chemotherapy for AML. Patients were seen at least weekly as out-patients at these hospitals while recovering from their consolidation chemotherapy. These centers were located a median of 70 km (range: 36-190) from the quaternary centre (The Princess Margaret Cancer Centre in Toronto, Canada). The 73 patients received 137 cycles of intensive consolidation where the post-consolidation care was provided by their local centre. The local centers treated a median of 2 patients (range of 1-19 patients) during the time frame evaluated. Patients receiving shared care had a median age of 57 years (range: 21.7-78.6) and 40 (54.8%) were male. 7 (9.6%) had favourable, 42 (57.5%) had intermediate, 6 (8.2%) had poor and 18 (24.7%) had indeterminate cytogenetic profiles. Google Maps (www.google.ca/maps) was used to calculate the distance travelled and estimated travel time between the patient's home and the quaternary centre or their local centre. Use of toll roads was permitted to achieve the fastest and shortest distance. Patients in the shared care model travelled a mean distance of 99.5 km ± 57.8 (median: 87.8 range: 28.4-266 km) each way to the quaternary care centre versus 26.3 km ± 33.6 (median: 14.5 range: 0.55-211 km) each way to their local treatment centre (p <0.001 for difference in means by t-test). The estimated mean time to travel from their home to the quaternary center was 71.6 ± 38 minutes (median: 62 range: 29-170) and the estimated time to travel to their local center was 23.3 ± 21.9 minutes (median: 18 range: 2-137) (p <0.001 for difference in means by t-test). Thus, by receiving post-consolidation care locally, patients saved a mean round trip travel distance of 146.5 km ± 99.6 and 96.7 min ± 63.4 of round trip travel time per visit compared to travelling to the quaternary care centre. To assess the safety and efficacy of the shared care model, we compared the survival of the patients who received shared care to that of the other 344 patients with AML (n=297) or APL (n=47) who received consolidation chemotherapy in CR1 during the same time frame and remained at the quaternary care centre for all of their post-consolidation care. Gender, age and cytogenetic risk did not significantly differ between the shared care group and the group of patients receiving all of their care at the quaternary center (p>0.05). There was no significant difference in overall survival between the 2 groups (p value of log-rank test >0.05). 30, 60, and 90 day survival from start of consolidation chemotherapy was 98.6%, 97.2%, and 95.9% for the patients receiving shared care and 98.8%, 97.1%, and 95.3% for patients receiving all of their care at the quaternary center. Multivariate Cox proportional hazards model revealed no significant increase in hazard of death for the Shared Care patients compared to control when controlling for age, gender, AML vs. APL and cytogenetic prognosis (p value >0.05). Thus, a collaborative care delivery model utilizing partnerships with regional centres for post-consolidation care in AML reduces patient travel burden while maintaining safety and efficacy. Disclosures No relevant conflicts of interest to declare.
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Nazarali, Samina, Cal H. Robinson, Farah Khan, Tayler Pocsai, Dipika Desai, Russell J. De Souza, Girish Bhatt, et al. "Deriving Normative Data on 24-Hour Ambulatory Blood Pressure Monitoring for South Asian Children (ASHA): A Clinical Research Protocol." Canadian Journal of Kidney Health and Disease 9 (January 2022): 205435812110723. http://dx.doi.org/10.1177/20543581211072329.
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Background: The global prevalence of hypertension in children and adolescents has increased over the past 2 decades and is the strongest predictor of adult hypertension. South Asians have an increased prevalence of metabolic syndrome associated risk factors including abdominal obesity, diabetes, and hypertension. All these factors contribute to their increased cardiovascular disease burden. Accurate and early identification of hypertension in South Asian children is a necessary aspect of cardiovascular disease prevention. Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard for pediatric blood pressure (BP) measurement. However, its utilization is limited due to the lack of validated normative reference data in diverse, multiethnic pediatric populations. Objective: The primary objective is to establish normative height-sex and age-sex-specific reference values for 24-h ABPM measurements among South Asian children and adolescents (aged 5-17 years) in Ontario and British Columbia, Canada. Secondary objectives are to evaluate differences in ABPM measurements by body mass index classification, to compare our normative data against pre-existing data from German and Hong Kong cohorts, and to evaluate relationships between habitual movement behaviors, diet quality, and ABPM measurements. Design: Cross-sectional study, quasi-representative sample. Setting: Participants will be recruited from schools, community centers, and places of worship in Southern Ontario (Greater Toronto and Hamilton area, including the Peel Region) and Greater Vancouver, British Columbia. Participants: We aim to recruit 2113 nonoverweight children (aged 5-17 years) for the primary objective. We aim to recruit an additional 633 overweight or obese children to address the secondary objectives. Measurements: Ambulatory BP monitoring measurements will be obtained using Spacelabs 90217 ABPM devices, which are validated for pediatric use. The ActiGraph GT3X-BT accelerometer, which has also been validated for pediatric use, will be used to obtain movement behavior data. Methods: Following recruitment, eligible children will be fitted with 24-h ABPM and physical activity monitors. Body anthropometrics and questionnaire data regarding medical and family history, medications, diet, physical activity, and substance use will be collected. Ambulatory BP monitoring data will be used to develop height-sex- and age-sex-specific normative reference values for South Asian children. Secondary objectives include evaluating differences in ABPM measures between normal weight, overweight and obese children; and comparing our South Asian ABPM data to existing German and Hong Kong data. We will also use compositional data analysis to evaluate associations between a child’s habitual movement behaviors and ABPM measures. Limitations: Bloodwork will not be performed to facilitate recruitment. A non-South Asian comparator cohort will not be included due to feasibility concerns. Using a convenience sampling approach introduces the potential for selection bias. Conclusions: Ambulatory BP monitoring is a valuable tool for the identification and follow-up of pediatric hypertension and overcomes many of the limitations of office-based BP measurement. The development of normative ABPM data specific to South Asian children will increase the accuracy of BP measurement and hypertension identification in this at-risk population, providing an additional strategy for primary prevention of cardiovascular disease.
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Hicks, Alex, and Anne Hicks. "105 Actually, it is easy being green: Ten years of the Canadian PAediatric Society Annual General Meeting viewed through a sustainability lens." Paediatrics & Child Health 25, Supplement_2 (August 2020): e43-e44. http://dx.doi.org/10.1093/pch/pxaa068.104.
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Abstract Introduction/Background The Canadian Paediatric Society (CPS) recently released the “Global climate change and health of Canadian Children” statement. As climate rapidly evolves from “change” to “crisis” there is an increasing pressure toward sustainable conferencing. Knowing the value of attending meetings, the growing body of literature evaluating travel-related carbon cost and convention sustainability can inform environmental harm minimization. Conferences can pressure venues to increase sustainability by choosing sites and venues wisely and communicating their requirements to rejected venues. They can also offer carbon offset purchase through credible companies (e.g. Gold Standard). Over the last 10 years the CPS has conducted its Annual General Meeting (AGM) at host cities that reflect Canada’s large geographic footprint. Venues included both hotel and standalone conference centers. There is no published evaluation of sustainable practices for CPS meetings. Objectives Evaluate the past 10 CPS Annual General Meetings (AGMs) for: Design/Methods Travel-related carbon cost was estimated with a round-trip calculator for economy seating the most direct available flights (https://co2.myclimate.org/en/offset_further_emissions). Cities of origin for attendee were the 11 CaRMS-matched pediatric residency training programs (https://www.carms.ca/match/psm/program-descriptions/). Venues were evaluated based on current publicly available self-reported information using conference sustainability criteria suggested through a literature review and public rating tools (Green Key, Quality Standards of the International Association of Convention Centres). Ground transportation from the airport was scored /3 by: public transport from airport (1), formal shared transport (1), fee deterrence for parking (1). Venue type was split by hotel-associated (H) and standalone convention centre (CC) meeting facilities. Sustainability of meeting facilities was divided into supports /2 (rentable supports, links to local vendors, catering and personnel) for exhibitors (1) and event planners (1), policies /3 by: sustainability, promotion of a green community (1), and waste management (1), and walkability from accommodation /1. Results The last 10 CPS AGMs were held in western (3; Vancouver 2010, Edmonton 2013, Vancouver 2017), eastern (1; Charlottetown 2016) and central (6; Quebec City 2011, London 2012, Montreal 2014, Toronto 2015, Quebec City 2018, Toronto 2019) provinces; in 2020 it is in Vancouver. Central Canada sites had the lowest air travel carbon cost per attendee. Average air travel-related carbon cost per attendee for different host cities ranged from 0.479 (London) to 0.919 (Vancouver) tonnes, with Ontario and Quebec sites averaging 0.518, Charlottetown 0.654 and Edmonton 0.756 tonnes. Ground transportation scores differed by city from Montreal (3/3 with public transit, formal transportation share and parking fees to dissuade driving) to London (0/3), with more favorable public transit options in larger cities. Venues differed when divided by hotel with meeting facilities (H) vs standalone conference center (CC), with CC outranking H for clearly posted sustainability plans (1.6 vs 1.2/2; 2=venue-specific, 1=company chain policy, 0=no plan), green and sustainable community building plans (1.6 vs 1.2/2; 2=greening local communities, 1=company chain policy, 0=no plan) and green waste management policies (1.2 vs 0/2; 2=venue-specific, 1=company chain policy, 0=no plan). Walkable accommodation was equal and present for all venues, with attached accommodation for all but one CC (Montreal), which had immediately adjacent hotels available. Conclusion As expected, the carbon cost of air transportation per attendee was lower in central provinces. Ground transportation from the airport was better in larger host cities. Standalone conference centres had more sustainable event support and locally focused policies regarding sustainability, environmentally friendly community building initiatives and waste management solutions, three major components of “greening” conferences. Based on the available resources across Canada, we recommend that the CPS considers these sustainability criteria in planning future events.
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Islam, Qazi Shafayetul, and Nasima Akter. "A Qualitative Study about the Psychosocial Issues of COVID-19 Perceived by the South Asian Bangladeshi Senior Immigrants Living in Toronto, Ontario." Asian Journal of Medicine and Health, November 20, 2021, 133–45. http://dx.doi.org/10.9734/ajmah/2021/v19i1030389.
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Background: People stayed home and got isolated during the pandemic time (COVID-19). The pandemic passed more than a year, and it is still ongoing. There is not enough information about the psychological and social issues of the COVID-19 on the South Asian senior immigrants living in Toronto.
Aim: The study aimed to explore the description of COVID-19 from the experience of the South Asian seniors and to understand the perceived psychosocial issues of COVID-19 on them. It helps policymakers develop adequate policies and initiatives for the South Asian Bangladeshi senior immigrants during and after the pandemic.
Methods: The study applied open-ended questions for the phone interview with 52 seniors (>55 years). It used thematic analysis for the interpretation of qualitative data. Each interview took 45-60 minutes to complete.
Results: The seniors described COVID-19 in medical, mental, and social aspects. They described COVID-19 as ‘viral and pandemic infections,’ ‘health problems,’ ‘lack of treatment,’ and ‘death.’ They also described COVID-19 as ‘worrying,’ ‘dangerous,’ ‘isolated society,’ ‘lack of recreation,’ ‘staying home like a prison,’ and ‘shut down everywhere.’ Many seniors felt lonely as the pandemic disconnected them from the family members and the outdoor activities. They were also scared to get infected, were worried about seeing deaths and the shortage of vaccines worldwide and were sad as they could not meet people in person. Many seniors stayed home for months. They could not go outside for worship, doctors, shopping malls, and they felt that they had an unusual lifestyle.
Conclusion: Based on findings, adequate information, mental health supports, and virtual programs are needed to address the psychological and social issues of COVID-19.
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Buajitti, Emmalin, Tristan Watson, Todd Norwood, and Laura Rosella. "Spatial epidemiology of premature mortality in Ontario, Canada." International Journal of Population Data Science 3, no. 4 (September 3, 2018). http://dx.doi.org/10.23889/ijpds.v3i4.820.
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IntroductionGeographic disparities in health indicators, such as premature mortality, may reveal area-level weaknesses in health system performance. Monitoring geographic trends can therefore have powerful implications for system evaluation and planning. However, attempts to understand patterns of population health can be complicated by underlying regional differences in demographics and behaviours.
Objectives and ApproachThis study aimed to identify regional disparities in premature mortality (defined as death before age 75), and to investigate how fully these disparities can be explained by population-level characteristics. Ontario’s 76 administrative Local Health Integration Network (LHIN) sub-regions, which vary in geographic and population size, were analyzed using linked population-level data from the Institute for Clinical Evaluative Sciences and Cancer Care Ontario.
Spatially structured, sex-stratified Bayesian hierarchical models were used to estimate standardized mortality ratios (SMRs) for each LHIN sub-region in the 2011-2015 period. Models were adjusted for key population-level demographic and behavioural risk factors.
ResultsLarge disparities in premature mortality presented at the sub-region level in males and females. Low premature mortality clustered around large, urban population centers in Ottawa and Toronto. Premature mortality was comparatively higher throughout the rest of the province, particularly in northern and southeast Ontario.
Higher prevalence of material deprivation, overweight and obesity, sedentary behaviour, and smoking were all significantly (α=0.05) associated with elevated premature mortality risk, while increased alcohol consumption and immigrant population were associated with decreased risk.
Adjusting for model covariates reduced variance of sub-region SMR estimates by 87% in males and 89% in females. Population-level characteristics thus explain a large proportion of geographic inequality in premature mortality. However, residual spatial variation suggests that systematic regional differences in premature mortality extend beyond population-level traits.
Conclusion/Implications
This study represents a novel application of small-area analytic techniques to Ontario mortality data, made possible by comprehensive linkage of vital statistics. The findings highlight the importance of population composition to geographic disparities in health. Future work should investigate the influence of system-level factors in areas with elevated premature mortality.
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de Leiva-Hidalgo, Alberto, and Alejandra de Leiva-Pérez. "On the occasion of the centennial of insulin therapy (1922–2022), II-Organotherapy of diabetes mellitus (1906–1923): Acomatol. Pancreina. Insulin." Acta Diabetologica, December 31, 2022. http://dx.doi.org/10.1007/s00592-022-02014-7.
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Abstract Aims The general objective has been the historiographical investigation of the organotherapy of diabetes mellitus between 1906 and 1923 in its scientific, social and political dimensions, with special emphasis on the most relevant contributions of researchers and institutions and on the controversies generated on the priority of the "discovery" of antidiabetic hormone. Methods We have analyzed the experimental procedures and determination of biological parameters used by researchers during the investigated period (1906–1923): pancreatic ablation techniques, induction of acinar atrophy with preservation of pancreatic islets, preparation of pancreatic extracts (PE) with antidiabetic activity, clinical chemistry procedures (glycemia, glycosuria, ketonemia, ketonuria, etc.). The field investigation has included on-site and online visits to cities, towns, buildings, laboratories, universities, museums and research centers where the reported events took place, obtaining documents, photographic images, audiovisual recordings, as well as personal interviews complementary to the documentation consulted (primary sources, critical bibliography, reference works). The documentary archival sources have been classified according to theme, including those consulted in situ with those extracted online and digitized copies received mainly by email. Among the many archives contacted, those listed below have been most useful and have been consulted on site and on repeated visits: National Library of Medicine-Historical Archives (Bethesda, MD, USA); Archives, University of Toronto and Thomas Fisher Rare Books Library (Toronto, Ontario, Canada); Francis A. County Library of Medicine, Harvard University (Boston, Mass, USA); Zentralbibliothek der Humboldt-Universität (Berlin, DE), Geheimarchiv des Preuβischen Staates (Berlin, DE); Landesamt für Bürger—und Ordnungsangelegenheiten (LABO) (Berlin, DE); Arhivele Academiei Române şi Universitǎții Carol Davila (Bucharest, RO). Main results and conclusions A) The European researchers Zülzer (Z Exp Path Ther 23:307–318, 1908) and Paulescu (CR Seances Soc Biol Fil 85:558, 1921) meet the requirements of the priority rule in the discovery of the antidiabetic hormone. B) Factors of socioeconomic and political nature related with the First World War and the inter-war period delayed the process of purification of the antidiabetic hormone in Europe. C) The Canadian scientist J. Collip, University of Alberta, temporarily assimilated to the University of Toronto, and the American chemist and researcher G. Walden, with the expert collaboration of Eli Lilly & Co., were the main authors of the purification process of the antidiabetic hormone. D) The scientific evidence, reflected in the heuristics of this research, allows to assert that the basic investigation carried out by the Department of Physiology of the University of Toronto, directed by the Scottish J. Macleod, in conjunction with the clinical research undertaken by the Department of Medicine of the University of Toronto (W. Campbell, A. Fletcher, D. Graham) made it possible in record time the successful treatment of patients with what was until then a deadly disease.
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Dason, E. S., L. Drost, E. M. Greenblatt, A. S. Scheer, J. Han, M. Sobel, L. Allen, et al. "Providers’ perspectives on the reproductive decision-making of BRCA-positive women." BMC Women's Health 22, no. 1 (December 8, 2022). http://dx.doi.org/10.1186/s12905-022-02093-2.
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Abstract Background Reproductive decision-making is difficult for BRCA-positive women. Our objective was to assess the complexities of decision-making and identify decisional supports for patients and providers when discussing reproductive options prior to risk-reducing salpingo-oophorectomy (RRSO). Methods This study was of qualitive design, using data collection via semi-structured interviews conducted from November 2018 to October 2020. Individuals were included if they were identified to provide care to BRCA-positive women. In total, 19 providers were approached and 15 consented to participate. Providers were recruited from three clinics in Toronto, Ontario located at academic centers: [1] A familial ovarian cancer clinic, [2] A familial breast cancer clinic and [3] A fertility clinic, all of which treat carriers of the BRCA1/BRCA2 genetic mutation. The interview guide was developed according to the Ottawa Decision Support Framework and included questions regarding reproductive options available to patients, factors that impact the decision-making process and the role of decisional support. Interviews were transcribed and transcripts were analyzed thematically using NVIVO 12. Results Providers identified three major decisions that reproductive-aged women face when a BRCA mutation is discovered: [1] “Do I want children?”; [2] “Do I want to take the chance of passing on this the mutation?”; and [3] “Do I want to carry a child?” Inherent decision challenges that are faced by both providers and patients included difficult decision type, competing options, scientifically uncertain outcomes, and challenging decision timing. Modifiable decisional needs included: inadequate knowledge, unrealistic expectations, unclear values and inadequate support or resources. Identified clinical gaps included counselling time constraints, lack of reliable sources of background information for patients or providers and need for time-sensitive, geographically accessible, and centralized care. Conclusion Our study identified a need for a patient information resource that can be immediately provided to patients who carry a BRCA genetic mutation. Other suggestions for clinical practice include more time during consultation appointments, adequate follow-up, value-centric counseling, access to psychosocial support, and a specialized decisional coach.
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Thompson, Connor A., Jay R. Malcolm, and Brent R. Patterson. "Individual and Temporal Variation in Use of Residential Areas by Urban Coyotes." Frontiers in Ecology and Evolution 9 (June 1, 2021). http://dx.doi.org/10.3389/fevo.2021.687504.
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Coyotes (Canis latrans) have established populations in most major urban centers across North America. While the risk of attacks on humans or their pets is low, the presence of carnivores in areas with high human use has resulted in increased public concern. Having a clearer understanding of which animals are more likely to interact with humans and when interactions are more likely to occur will help mitigate human-carnivore conflicts. Despite clear broad-scale patterns of human avoidance, human-coyote interactions occur most frequently in residential areas. Our purpose was to determine if use of residential areas varied consistently across individuals or time. We used locations from GPS collars deployed on 14 coyotes in the Greater Toronto Area, Ontario, Canada from 2012 to 2017 to fit a step selection function. Average (±SE) home range size estimates were 17.3 ± 4.6 km2 for resident coyotes and 102.8 ± 32.9 km2 for non-residents. We found that coyotes used natural areas more (β = 0.07, SE = 0.02, p < 0.0001), and roads (β = −0.50, SE = 0.13, p < 0.0001) and residential areas (β = −0.79, SE = 0.21, p = 0.0001) less during the day than at night. We also found that coyotes were more likely to use residential areas in the breeding season from January to April (β = 0.69, SE = 0.20, p = 0.0007) and the pup rearing season from May to August (β = 0.54, SE = 0.13, p < 0.0001) than in the dispersal season from September to December. Lastly, we found that resident coyotes were less likely to use residential areas than non-resident coyotes (β = −1.13, SE = 0.26, p < 0.0001). As far as we are aware, our study is the first to identify the seasons when coyotes are more likely to use residential areas. The seasonal patterns in habitat use that we observed reflect patterns that have been previously reported for human-coyote conflicts. Our results demonstrate that reducing the availability of anthropogenic food sources in residential areas, particularly in the winter and spring, should be a priority for managers aiming to reduce human-coyote conflict in urban areas.