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Toronto, Canada

Srigley J.A.,Hamilton Health Sciences | Gardam M.,A+ Network | Fernie G.,A+ Network | Lightfoot D.,Information science | And 2 more authors.
Journal of Hospital Infection | Year: 2015

Electronic and video monitoring systems (EMS/VMS) may improve hand hygiene by providing feedback, real-time reminders or via the Hawthorne effect. The aim of this systematic review was to assess the efficacy of EMS/VMS in improving hand hygiene or reducing the incidence of healthcare-associated infection (HCAI). Experimental and quasi-experimental studies were included if they measured any hand hygiene outcome and/or HCAI incidence. Of the studies included, seven used system-defined compliance (SDC) (N=6) or hand hygiene event rate (N=1) as their outcome. SDC differed for all systems. Most (N=6) were single ward studies. Two uncontrolled pretest-post-test studies evaluating EMS that provided voice prompts showed increases in SDC, but risk of bias was high. Two uncontrolled time-series analyses of VMS that provided aggregate feedback demonstrated large, sustained improvement in SDC and were at moderate risk of bias. One non-randomized controlled trial of EMS with aggregate feedback found no difference in hand hygiene frequency but was at high risk of bias. Two studies evaluated EMS providing individual feedback and real-time reminders. A pretest-post-test study at high risk of bias showed an increase in SDC. An RCT at low risk of bias showed 6.8% higher SDC in the intervention arm partially due to a fall in SDC in the control arm. In conclusion, the overall study quality was poor. The study at lowest risk of bias showed only a small increase in SDC. VMS studies at moderate risk of bias showed rapid and sustained increases in SDC. Data were insufficient to recommend EMS/VMS. Future studies should prioritize testing of VMS using stronger study designs including control arms and validated, system-independent measures of hand hygiene. © 2014 Taibah University. Source

Medcalf K.E.,University of Toronto | Park A.L.,Li Ka Shing Knowledge Institute | Park A.L.,University of Toronto | Vermeulen M.J.,University of Toronto | And 2 more authors.
Critical Care Medicine | Year: 2016

Objectives: To evaluate maternal world region of birth, as well as maternal country of origin, and the associated risk of admission of 1) a mother to a maternal ICU, 2) her infant to a neonatal ICU, or 3) both concurrently to an ICU. Design: Retrospective population-based cohort study. Setting: Entire province of Ontario, Canada, from 2003 to 2012. Patients: All singleton maternal-child pairs who delivered in any Ontario hospital. Measurements and Main Results: We explored how maternal world region of birth, and specifically, maternal country of birth for the top 25 countries, was associated with the outcome of 1) neonatal ICU, 2) maternal ICU, and 3) both mother and newborn concurrently admitted to ICU. Relative risks were adjusted for maternal age, parity, income quintile, chronic hypertension, diabetes mellitus, obesity, dyslipidemia, drug dependence or tobacco use, and renal disease. Compared with infants of Canadian-born mothers (110.7/1,000), the rate of neonatal ICU admission was higher in immigrants from South Asia (155.2/1,000), Africa (140.4/1,000), and the Caribbean (167.3/1,000; adjusted relative risk, 1.41; 95% CI, 1.36-1.46). For maternal ICU, the adjusted relative risk was 1.79 (95% CI, 1.43-2.24) for women from Africa and 2.21 (95% CI, 1.78-2.75) for women from the Caribbean. Specifically, mothers from Ghana (adjusted relative risk, 2.71; 95% CI, 1.75-4.21) and Jamaica (adjusted relative risk, 2.74; 95% CI, 2.12-3.53) were at highest risk of maternal ICU admission. The risk of both mother and newborn concurrently admitted to ICU was even more pronounced for Ghana and Jamaica. Conclusions: Women from Africa and the Caribbean and, in particular, Ghana and Jamaica, are at higher risk of admission to ICU around the time of delivery, as are their newborns. © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. Source

Faragalla H.F.,University of Toronto | Marcon N.E.,University of Toronto | Yousef G.M.,University of Toronto | Yousef G.M.,Keenan Research Center | Streutker C.J.,University of Toronto
American Journal of Surgical Pathology | Year: 2011

Background: The muscularis mucosa underlying the metaplastic mucosa of Barrett esophagus is frequently duplicated, with an intervening layer of lamina propria between the superficial or neomuscularis mucosa (NMM) and the deep/true muscularis mucosa (TMM). This duplication causes difficulties with accurate staging of superficially invasive carcinoma in biopsy specimens and endoscopic mucosal resections (EMRs), as invasion underneath the superficial muscle layers may be mistaken for submucosal invasion. Mucosal resections or other ablative nonsurgical therapies can be curative in patients with esophageal intramucosal carcinoma, whereas patients with submucosal invasion are recommended for esophagectomy. Therefore, the accurate staging of such specimens is crucial. Smoothelin is a novel smooth muscle protein expressed only by fully differentiated smooth muscle cells and not by proliferative or noncontractile smooth muscle cells and fibroblasts. It has been suggested that in the bladder, immunohistochemistry for smoothelin may help separate hyperplastic muscularis mucosa from the true muscularis propria. We hypothesized that in the esophagus, immunohistochemistry for smoothelin would differentiate the NMM from the TMM. Design: Thirty cases of EMRs for Barrett esophagus-related neoplasia were retrieved from the archives of the pathology department, St Michael's Hospital. Immunohistochemical staining for smoothelin was performed to evaluate differential staining in the TMM versus NMM. Fifteen cases were stained for smooth muscle actin and smooth muscle myosin. The staining score was evaluated on a scale from 0 to 3 according to the percentage and intensity of staining. Results: Immunohistochemical staining results for smoothelin were as follows: the NMM showed weak focal staining (+1) in 23 of 30 cases (82%), and moderate staining (+2) in 7 of 30 cases (12%), and the TMM showed very strong and diffuse staining (+3) in 30 of 30 cases. No cases showed negative (0) staining in the NMM. With smooth muscle actin and myosin, strong and diffuse staining was observed with similar intensity in both the TMM and NMM in 15 of 15 cases. Conclusions: In our study, smoothelin staining in the NMM is significantly weaker than that seen in the true/deep muscularis mucosa. This pattern is similar to that reported for the muscularis mucosae of the urinary bladder. Although smoothelin can readily distinguish the 2 layers, its value might be limited by the need to simultaneously compare the 2 layers. Although this might be of use in EMR specimens in which both layers are visible, use in biopsies may be limited as the residual staining in the NMM may inhibit definitive evaluation. This issue may be resolved by the use of appropriate standard controls, individual optimization of the antibody, and the use of an automated digital assessment. © 2010 by Lippincott Williams & Wilkins. Source

Mei-Dan E.,Sunnybrook Health science Center | Mei-Dan E.,University of Toronto | Ray J.G.,University of Toronto | Ray J.G.,Keenan Research Center | And 4 more authors.
American Journal of Obstetrics and Gynecology | Year: 2015

Objective To evaluate the risk of adverse perinatal outcomes among pregnant women previously hospitalized for bipolar disorder. Study Design We completed a population-based cohort study of women with a singleton delivery in Ontario, Canada (2003 to 2011). Women previously hospitalized for bipolar disorder (n = 1859) or major depressive disorder (n = 3724) were each compared to women without a documented mental illness (n = 432,358). Main study outcomes were preterm birth, severe small for gestational age <3rd percentile birthweight, and severe large for gestational age >97th percentile birthweight. Secondary outcomes included stillbirth, congenital malformations, neonatal morbidity and readmission to hospital <28 days. Odds ratios (ORs) were adjusted for maternal age, parity, prepregnancy obesity, substance use, and diabetes mellitus or hypertension before or during pregnancy.Results Bipolar disorder (adjusted OR [AOR], 1.95; 95% confidence interval [CI], 1.68-2.26) and major depressive disorder (AOR, 1.91; 95% CI, 1.72-2.13) were each associated with preterm birth. Bipolar disorder was associated with severe large for gestational age (AOR, 1.31; 95% CI, 1.03-1.67). Major depressive disorder was associated with severe small for gestational age (AOR, 1.22; 95% CI, 1.05-1.42). Both mood disorder groups had significantly higher risk of congenital malformations, neonatal morbidity, and neonatal hospital readmission. Although study covariates explained some of the increased risk, we could not address all potential explanatory factors. Conclusion Women previously hospitalized for bipolar disorder are at increased risk of adverse perinatal outcomes compared with the general population. Their level of risk is comparable to women previously hospitalized for major depressive disorder. These risks must be considered in the management of pregnant women with a history of major mood disorders. Attention to potentially modifiable risk factors such as obesity, diabetes, and hypertension before and during pregnancy could reduce the risk for adverse perinatal outcomes. © 2015 Elsevier Inc. All rights reserved. Source

Huang Y.-H.,Harvard University | Zhu C.,Brigham and Womens Hospital | Kondo Y.,Harvard University | Anderson A.C.,Brigham and Womens Hospital | And 22 more authors.
Nature | Year: 2015

T-cell immunoglobulin domain and mucin domain-3 (TIM-3, also known as HAVCR2) is an activation-induced inhibitory molecule involved in tolerance andshown to induceT-cell exhaustion inchronic viral infection and cancers1-5.Under someconditions, TIM-3 expression has also been shown to be stimulatory. Considering that TIM-3, like cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed death 1 (PD-1), is being targeted for cancer immunotherapy, it is important to identify the circumstancesunder whichTIM-3 can inhibit and activateT-cell responses.Herewe show thatTIM-3 is co-expressed and forms a heterodimer with carcinoembryonic antigen cell adhesionmolecule 1 (CEACAM1), anotherwell-knownmolecule expressed on activatedTcells and involved in T-cell inhibition6-10. Biochemical, biophysical andX-ray crystallography studies showthat themembranedistalimmunoglobulin-variable (IgV)-likeamino-terminal domain of each is crucial to these interactions. The presence of CEACAM1 endows TIM-3 with inhibitory function. CEACAM1 facilitates the maturation and cell surface expression of TIM-3 by forming a heterodimeric interaction in cis through the highly related membranedistal N-terminal domains of eachmolecule. CEACAM1and TIM-3 also bind in trans through their N-terminal domains. Both cis and trans interactions between CEACAM1 and TIM-3 determine the tolerance-inducing function of TIM-3. In a mouse adoptive transfer colitis model, CEACAM1-deficient T cells are hyper-inflammatory with reduced cell surface expression ofTIM-3andregulatory cytokines, and this is restored by T-cell-specificCEACAM1expression. During chronic viral infection and in a tumour environment,CEACAM1and TIM-3mark exhaustedTcells.Co-blockade ofCEACAM1 and TIM-3 leads toenhancementofanti-tumour immuneresponseswithimproved elimination of tumours in mouse colorectal cancer models. Thus, CEACAM1serves as a heterophilic ligand for TIM-3 that is required for its ability to mediate T-cell inhibition, and this interaction has a crucial role in regulating autoimmunity and anti-tumour immunity. © 2015 Macmillan Publishers Limited. All rights reserved. Source

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