North York General Hospital
North York General Hospital
News Article | May 1, 2017
Dr. Thomas Ungar, an Associate Professor at the University of Toronto and Head of Psychiatry at North York General Hospital, created Think You can Shrink?, a reality TV-style web series that is generating positive results among viewers. "Mental health issues are widely misunderstood and stigmatized among the general public," Dr. Ungar said. "I wanted to create something that goes beyond traditional health promotion. I hope that by playing with everyday pop culture like a reality show, we can help people become more comfortable with mental illness and get the help they need." With innovation funding from the Movember Foundation, the world's leading men's health charity, and support from the North York General Hospital Foundation, Dr. Ungar created Think You Can Shrink?, a three-episode web series that focuses on intimate subjects rarely portrayed in popular culture: suicidal depression, testicular lumps, and explaining how to deal with a narcissist. "Mental health issues are particularly acute among men, who are more likely than women to try to tough it out or struggle alone," Dr. Ungar said, noting that three out of four suicides are men and that suicide is the second-leading cause of death among men aged 15 to 29. Employing a method used to train medical students, actors are coached to portray mental health problems. Contestants with everyday jobs who think they are good at giving advice (a bartender, a hairdresser and a strip club owner) test their skills – both successfully and unsuccessfully. Judges include a psychiatrist, an emergency room/family doctor and celebrity Rick Campanelli, co-host of ET Canada. "It was a fine line to walk, trying to not be exploitive of mental health issues, but entertaining so people would watch" Dr. Ungar said. The web series avoids the shaming factor of reality TV to show that strong male support and communication is possible, de-stigmatizing the act of reaching out for help. A survey of people who watched the episodes concludes that the reality TV-style was successful in de-stigmatizing mental health issues and encouraging people to seek professional care. Seventy-five per cent of viewers said they were more likely to seek help if needed, and 86% would be more comfortable supporting a friend or family member who had the same health issue as portrayed in the video, according to the study in the Journal of Technology and Behavioral Science. The Movember Foundation is the only global charity focused solely on men's health. We raise funds that deliver innovative, breakthrough research and support programs to enable men to live happier, healthier, longer lives. Awareness and fundraising activities are run year-round, with the annual Movember Campaign in November being globally recognized for its fun, disruptive approach to fundraising and getting men to take action for their health. Since Movember started in Melbourne, Australia in 2003, millions have joined the movement, raising over $759 Million and funding over 1,200 projects focused on men's mental health & suicide prevention, prostate and testicular cancer. You can help stop men dying too young at movember.com.
News Article | August 2, 2017
Pure Storage provides the resiliency, security and high performance that improves clinician productivity and increases the time devoted to patient care, while maximizing the long-term impact of the hospital's investment in IT infrastructure. "We wanted a data platform that would give our clinicians, back-office staff and other end-users exceptional response time when accessing critical applications and data. The same solution also had to provide – at no additional cost - essential features like data compression, de-duplication and snapshots," said Sumon Acharjee, Chief Information Officer, North York General Hospital. "After looking at all-flash offerings from several vendors, the comprehensive feature set, price point and cost-benefit of Pure Storage proved to deliver significant competitive advantages." As part of Canada's government-run healthcare system, NYGH refreshes its IT infrastructure only once every seven years due to highly controlled funding. That made the Evergreen™ Storage program from Pure especially attractive. The Evergreen program enables storage that is deployed once and upgraded as needed, for a decade or more. Components can be mixed and matched – all online and without performance disruption – to keep storage dense, efficient and modern. "Evergreen is a great business model. When you have a seven-year refresh cycle, it's very valuable to know your maintenance costs for the life of the product," said Acharjee. "Cerner is deployed in every in-patient area of the hospital. It is a mission-critical system that needs to have maximum performance, resiliency and uptime. Pure Storage delivers on all three of those requirements, while saving us money now and long into the future." To underscore the cost-effectiveness of its all-flash storage solution, eliminating just two years of the maintenance fees for NYGH's legacy spinning-disk storage system paid for the acquisition of the Pure system. The impact of improved storage performance is felt across multiple areas of the hospital. Most important is the effect on physicians and other clinicians, who now spend less time waiting for files, reports and other critical data, thanks to 10-20% improvements in IO performance and consistent sub-millisecond latencies. Business operations see positive outcomes, as well. "One of the biggest benefits we've seen from the Pure system is the ability to generate reports more efficiently," Acharjee noted. "Our business intelligence decision-support team does a lot of slicing and dicing of this data, and the improved processing we now enjoy allows them to generate a lot more business insight in a short amount of time." Installing the Pure arrays also results in lower operating costs, Acharjee added, "because we can go to our co-lo facility when we renegotiate our contract and show them how little the footprint and energy costs of the Pure array will be." "As a HIMSS Stage 6 healthcare organization, North York General Hospital is a recognized leader in applying advanced technology for the improvement of patient care," said Vik Nagjee, VP and CTO of Healthcare and Life Sciences, Pure Storage. "NYGH's decision to migrate their entire Cerner environment to our all-flash storage solution marks another milestone for Pure in the healthcare industry. More importantly, we recognize that everyone benefits when clinicians see improvements in the patient-care environment and hospital administrators see long-term savings in costs." North York General Hospital, affiliated with the University of Toronto, is one of Canada's leading community academic hospitals. We offer our culturally diverse community a wide range of acute care, ambulatory and long-term care services across three sites. Through partnerships, collaboration and academic endeavours, we seek to set new standards for patient- and family-centred care. Working together with our patients and their families, we are making a world of difference. Pure Storage (NYSE: PSTG) helps companies push the boundaries of what's possible. Pure's end-to-end data platform - including FlashArray, FlashBlade and our converged offering with Cisco, FlashStack – is powered by innovative software that's cloud-connected for management from anywhere on a mobile device and supported by the Evergreen business model. The company's all-flash based technology, combined with its customer-friendly business model, drives business and IT transformation with solutions that are effortless, efficient and evergreen. With Pure's industry leading Satmetrix-certified NPS score of 83.7, Pure customers are some of the happiest in the world, and include organizations of all sizes, across an ever-expanding range of industries. Connect with Pure Storage: Read the blog Converse on Twitter Follow on LinkedIn FlashStack Solutions Pure Storage, the "P" Logo, Evergreen, FlashArray and FlashBlade are trademarks or registered trademarks of Pure Storage, Inc. All other trademarks or names referenced in this document are the property of their respective owners.
News Article | December 9, 2016
WINNIPEG, MB--(Marketwired - December 09, 2016) - 3D Signatures Inc. (TSX VENTURE: DXD) (the "Company" or "3DS") is pleased to announce two additional strategic appointments to its Board of Directors and its Clinical and Scientific Advisory Board respectively. Helen Stevenson, Founder and Chief Executive Officer of Reformulary Group Inc., has been appointed to the Company's Board of Directors. Dr. Ian Smith, will be stepping down from the Board of Directors and will be joining the Company's Clinical and Scientific Advisory Board ("CSAB"). Both appointments will help shape 3DS' clinical priorities and its path towards commercial success. Helen Stevenson is Founder and Chief Executive Officer of Reformulary Group Inc., a company dedicated to helping manage prescription drug costs for employer drug plans while promoting better patient health outcomes. Ms. Stevenson was formerly Executive Officer of Canada's largest provincial drug program, the Ontario Public Drug Program by Order-In-Council, as well as Assistant Deputy Minister at the Ontario Ministry of Health and Long-Term Care. Ms. Stevenson led two major transformations in the prescription drug system; first with Ontario's Bill 102 (2006) and, more recently, with the Province's generic pricing reforms (2010). In addition, she led many of Ontario's drug system initiatives, including the Drugs for Rare Diseases Framework, Ontario Narcotics Strategy, Ontario Citizens' Council, MedsCheck medication review program, Compassionate Access Program, Competitive Agreements Framework, and the Drug Innovation Fund. Ms. Stevenson is a member of the Board of Trustees of the Auto Sector Retiree Health Care Trust, and a former member of the Board of North York General Hospital. Widely recognized as a champion of value-based pricing and outcomes, 3DS will greatly benefit from Ms. Stevenson's unique experience in managing healthcare budgets at both the government level and for private payers -- two stakeholder groups that will be beneficiaries of 3DS' value-based personalized medicine strategies. Ms. Stevenson brings a unique biopharma perspective on advancing novel therapeutics with physicians and payers, which will be instrumental when addressing the industry's need for personalized and appropriate use of cancer therapies, a central focus for 3DS as it aims to rapidly commercialize a new class of biomarkers and companion diagnostics for a variety of cancers and dementia. Dr. Ian Smith was an inaugural and invaluable member of 3DS' Board of Directors. He shares founder Dr. Sabine Mai's vision for advancing the personalization of medicine and is now an esteemed member the Company's Clinical and Scientific Advisory Board. Dr. Smith is currently the Chairman of the Centre for Imaging Technology Commercialization. His past research and commercialization achievements include significant success in the field of magnetic resonance imaging. Dr. Smith is a former Director General of the NRC Institute for Biological Sciences in Ottawa, and founder and Director General of the Institute for Biodiagnostics, in Winnipeg. He is a passionate advocate for the advancement of diagnostics for the early detection and treatment of disease, and successfully started nine companies (such as Novadaq and IMRIS), with a present value of $2.5 billion with more than 300 employees in Canada and worldwide. From 2001 to 2016, he served as a Member of the Manitoba Premier's Economic Advisory Council. He was appointed Officer of the Order of Canada in 2008 for his leadership in the advancement, development and commercialization of Canada's diagnostic technologies, notably magnetic resonance imaging, in the field of health care. In addition, Dr. Smith received the 2008 Outstanding Achievement Award of the Public Service of Canada, presented to individuals who have displayed long-term excellence throughout their careers in Canada's public service. He was awarded the Queen's Gold (2002) and Diamond (2012) Jubilee Medals for his contributions. Dr. Smith is widely recognized as a successful pioneer and creator of value for med tech companies with a disciplined scientific and business acumen that was critical to 3DS as is formed the Board, management team and early strategic priorities. As a member of the CSAB, he will make important contributions including leveraging his imaging expertise and professional network, so that 3DS can complete the development of its proprietary TeloView™ software. Upon completion, TeloView™ will comprise a fully automated, scalable and end-to-end solution for 3DS' clinical lab partners to submit 3D images and generate and deliver personalized medical reports. "We are honored to welcome Dr. Smith to our Clinical and Scientific Advisory Board and Ms. Stevenson to our Board of Directors. Dr. Smith is a renowned scientist who will continue to be invaluable in guiding the development of this entirely new class of minimally invasive biomarkers," said John Swift, Chairman of 3D Signatures Inc. "Ms. Stevenson is a significant new addition to our team who brings strategic experience both at the government level and within private industry, in addition to her global networks and deep biopharma insights which will be of great benefit to the Company as we rapidly move towards commercialization," he remarked. Helen Stevenson's appointment to the Board of Directors is pending approval from the TSX Venture Exchange. The Company has granted 210,000 incentive stock options (the "Options") to directors, officers and employees of 3DS, at an exercise price of $0.76 per share. The Options are exercisable for a ten-year period from the date of grant, December 9, 2016, and vest as follows: 135,000 options at the date of grant and 75,000 twelve months later. A total of 4,647,956 options are now issued and outstanding and 24,827 remain for future issuance. The Options are granted pursuant to the Company's stock option plan, which was most recently approved by the shareholders of the Company at the annual general meeting of shareholders held on February 29, 2016. 3DS (TSX VENTURE: DXD) is a personalized medicine company with a proprietary software platform based on the three-dimensional analysis of chromosomal signatures. The technology is well developed and supported by 16 clinical studies on over 1,500 patients on 13 different cancers and Alzheimer's disease. Depending on the desired application, the technology can measure the stage of disease, rate of progression of disease, drug efficacy, and drug toxicity. The technology is designed to predict the course of disease and to personalize treatment for the individual patient. For more information, visit the Company's new website at http://www.3dsignatures.com. This news release includes forward-looking statements that are subject to risks and uncertainties. Forward-looking statements involve known and unknown risks, uncertainties, and other factors that could cause the actual results of the Company to be materially different from the historical results or from any future results expressed or implied by such forward-looking statements. All statements within, other than statements of historical fact, are to be considered forward looking. In particular, the Company's statements that it expects to benefit greatly from its association with the individuals named in this news release is forward-looking information. Although 3DS believes the expectations expressed in such forward-looking statements are based on reasonable assumptions, such statements are not guarantees of future performance and actual results or developments may differ materially from those in forward-looking statements. Risk factors that could cause actual results or outcomes to differ materially from the results expressed or implied by forward-looking information include, among other things: market demand; technological changes that could impact the Company's existing products or the Company's ability to develop and commercialize future products; competition; existing governmental legislation and regulations and changes in, or the failure to comply with, governmental legislation and regulations; the ability to manage operating expenses, which may adversely affect the Company's financial condition; the Company's ability to successfully maintain and enforce its intellectual property rights and defend third-party claims of infringement of their intellectual property rights; adverse results or unexpected delays in clinical trials; changes in laws, general economic and business conditions; and changes in the regulatory regime. There can be no assurances that such statements will prove accurate and, therefore, readers are advised to rely on their own evaluation of such uncertainties. We do not assume any obligation to update any forward-looking statements. Neither the TSX Venture Exchange nor its Regulation Service Provider (as that term is defined in the policies of the TSX Venture Exchange) accepts responsibility for the adequacy or accuracy of this release.
News Article | December 16, 2016
The International Association of HealthCare Professionals is pleased to welcome Stephen Andrew Chung, MD, Anesthesiologist, to their prestigious organization with his upcoming publication in The Leading Physicians of the World. Dr. Chung is a highly trained and qualified anesthesiologist with a vast expertise in all facets of his work. Dr. Chung has been in practice for more than 27 years and is currently serving patients at Valley Anesthesiology and Pain Consultants in Phoenix, Arizona. The center is one of the nation’s premier providers of anesthesia and pain management services, ensuring that their patients receive exceptional perioperative anesthesia care. Furthermore, Dr. Chung is affiliated with Scottsdale Healthcare and Banner Healthcare Network. Dr. Chung’s career in medicine began in 1987 when he graduated with his Medical Degree from the University of Calgary Faculty of Medicine. Following his graduation, Dr. Chung subsequently completed his internship at North York General Hospital, followed by his Cardiothoracic Surgery fellowship at the University of Toronto. Dr. Chung holds board certification in Anesthesiology, and keeps up to date with the latest advances and developments in his field through his professional membership with the American Society of Anesthesiologists, the Arizona Society of Anesthesiologists, and the Canadian Medical Association. He attributes his success to his good training, being flexible, and staying on top of the changes in medicine. When he is not assisting patients, Dr. Chung enjoys skiing, running, cooking, and watching college football. Learn more about Dr. Chung by reading his upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics. Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review. FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise. A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life. For more information about FindaTopDoc, visit:http://www.findatopdoc.com
Loudon K.,University of Aberdeen |
Treweek S.,University of Aberdeen |
Sullivan F.,North York General Hospital |
Donnan P.,University of Dundee |
And 3 more authors.
BMJ (Online) | Year: 2015
PRECIS (2009) was a tool with 10 domains to design clinical trials on a continuum of explanatory attitude (ideal situation) to more pragmatic attitude (usual care) Cited over 300 times by end of 2014, but weaknesses have been highlighted: no rating scale, problems with some domains, needing better guidance, and not validated This paper presents PRECIS-2 - a validated, improved version of the tool - together with guidance for how to use it PRECIS-2 has nine domains including three new ones (recruitment, setting, and organisation), each scored on a 5-point Likert continuum (from 1=very explanatory "ideal conditions" to 5=very pragmatic "usual care conditions") so that trialists, clinicians, and policymakers can more easily consider whether design decisions match their intended purpose. © BMJ Publishing Group Ltd 2015.
Popovich K.,North York General Hospital
Healthcare quarterly (Toronto, Ont.) | Year: 2010
North York General Hospital (NYGH), in collaboration with Nursing Practice Solutions, Smith & Nephew and the Central Community Care Access Centre, implemented a program in skin and wound care that has made best-practice, evidenced-based wound care management possible, affordable and sustainable. Focused action using advanced wound care products and proven clinical approaches has dramatically improved the identification, protection and support of skin integrity. Wound prevention and management are among the most direct and cost-effective measures a healthcare organization can take to improve patient safety and quality of life, and they allow for the reduction of expenditures and re-allocation of funds into other important areas. The Skin and Wound Care Program was designed to create and maintain resources within NYGH to ensure the delivery of consistent, best-practice wound prevention and management. The program has successfully sustained a significant reduction in the prevalence of pressure ulcers. Benefits of the program include improved patient safety, health and quality of life. The Skin and Wound Care Program has seen the transfer of knowledge and evidence-based best practices to both the bedside and the community. Extending the collaborative effort beyond the walls of NYGH has helped the hospital gain further insight into and experience with our community partners to spread skin and wound best practices across the healthcare continuum. Lessons learned have been shared with other healthcare organizations in forums such as the Congress of the World Union of Wound Healing Societies, thus contributing to the advancement of continuous improvement in healthcare.
Richards R.N.,North York General Hospital
Journal of Cutaneous Medicine and Surgery | Year: 2010
Background: Intralesional steroid (ILS; usually triamcinolone acetonide) is commonly used, and the literature contains much information about its use in keloids, hemangiomas, and alopecia areata. Little has been written about its use in inflammatory dermatoses such as psoriasis and localized dermatitis since the 1960s, the conditions for which it was originally most studied and used. Objective: To clarify the use of ILS and to encourage its use in psoriasis and localized dermatitis. Methods: Medline peer-reviewed literature in English (1956-2008) was searched for the use of ILS in all skin diseases. Six standard textbooks of dermatology were reviewed. Information as to how they used ILS was obtained from a questionnaire completed by 33 dermatologists and from personal discussions with 15 other dermatologists. Additional information was obtained from 40 years of personal ILS use and from observation of 42 dermatologists working intermittently in our office over the past 25 years. ILS product package inserts and company drug monographs were reviewed. Results: ILS is used by most dermatologists, but there are considerable divergences in technique and dosing. Current textbooks contain little on its use in psoriasis and localized dermatitis. There have been no clinical studies since the 1960s, and their end points and descriptions were somewhat vague by today's standards. Product package inserts are dated and not helpful. Nevertheless, the use of ILS is safe and economical, and the original authors and our office have found it consistently to be virtually 100% effective at 2.5 mg/mL in small plaques of psoriasis on the trunk and limbs and highly effective in localized dermatitis (such as lichen simplex chronicus, prurigo nodularis, and nonspecific eczema). Clinical studies indicate that we can safely increase our ILS from the usual 3 cc (7.5 mg) to 6 cc (15 mg) or even to 8 cc (20 mg) for patients over 50 kg every 3 to 4 weeks. Serum cortisol can be performed if there are concerns about adrenal suppression, with use in periorbital hemangiomas and with intranasal ILS. Blindness (from central artery occlusion) was reported with injections of ILS around the eyes wih older products during the early development stages; and more recently with the use of ILS for periorbital hemangiomas and with ILS used intranasally. It has never been reported with low pressure injections of ILS using triamcinalone acetonide at 2.5 mg around the eyes. Limitations: No formal clinical studies since the 1960s. Poor statistical end points. Conclusions: ILS at 2.5 mg/cc is safe, economical, and effective and its greater use should be encouraged in inflammatory dermatoses such as psoriasis and localized dermatitis. Further well-designed research would be helpful. © 2010 Canadian Dermatology Association.
Abdalian R.,North York General Hospital |
Saqui O.,University of Toronto |
Fernandes G.,University of Toronto |
Allard J.P.,University of Toronto
Journal of Parenteral and Enteral Nutrition | Year: 2013
Background: Long-term parenteral nutrition (PN) can be associated with micronutrient deficiency or toxicity depending on supplementation. Recently, hypermanganesemia and potential neurological toxicity were reported. The aim of this study was to assess the effect of manganese supplementation in a sample of patients on long-term PN receiving manganese (Mn) as part of a multi-trace element (TE) supplement. Methods: A convenience sample of 16 patients underwent clinical and blood biochemical measurements as well as magnetic resonance imaging (MRI) of the brain. Descriptive statistics were performed. Results: The mean daily Mn supplementation was 7.28 ± 0.97 μmol/d (400 ± 53 μg/d), which was within the American Medical Association Nutrition Advisory Group guidelines of 2.73-14.56 μmol/d (150-800 μg/d) but exceeded the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) 2002 recommendations of 1.09-1.82 μmol/d (60-100 μg/d). The mean whole blood Mn level was 1.38 ± 0.29 times the upper limit of normal (ULN), and 8 of 14 patients with blood measurements had Mn levels above ULN. On MRI, 81% of patients had high signals on T1-weighted images assumed to be Mn deposits in their basal ganglia. Two patients with positive MRI (15%) had a clinical diagnosis of Parkinson disease. Multiple neuropsychiatric complaints were reported, including depression (66%), lack of concentration (42%), memory disturbances (17%), and gait instability (8%). Conclusion: These results suggest that Mn status is elevated in these patients. Manganese supplementation should be used with caution in patients receiving long-term PN, and attention should be paid to the Mn content of multi-TE supplements. © 2012 American Society for Parenteral and Enteral Nutrition.
Speevak M.D.,Credit Valley Hospital |
Mcgowan-Jordan J.,Childrens Hospital of Eastern Ontario |
Chun K.,North York General Hospital
Prenatal Diagnosis | Year: 2011
Objective: To determine the detection rate of clinically significant chromosome abnormalities using quantitative fluorescent polymerase chain reaction (QF-PCR) of fetal DNA in comparison with G-banded analysis of cultured amniotic fluid cells and determine the residual risk if QF-PCR were performed alone for low-risk cases. Methods: Amniotic fluid samples were prospectively categorized based on the likelihood of the fetus having a chromosome anomaly. QF-PCR results were compared with the G-banded findings. The distribution of patients and the rates of clinically significant anomalies in each risk category were determined. Results: A total of 4176 amniotic fluid samples were studied. Among these, 331 cases with abnormalities were detected by both methods and an additional 19 abnormal cases were detected by G-banding only. Five of those undetected by QF-PCR were considered clinically significant, four of which were referred due to an elevated a priori risk (>4%). If QF-PCR is performed in all cases and G-banding performed only in higher risk cases, the residual risk for a clinically significant chromosome abnormality will be as low as 0.083%. Conclusions: This study suggests that QF-PCR alone is appropriate for patients with uncomplicated pregnancies, who are referred solely for an increased risk of a common trisomy. © 2011 John Wiley & Sons, Ltd.
Patel V.,North York General Hospital
The Cochrane database of systematic reviews | Year: 2014
Safe and effective long-term treatments that reduce the need for corticosteroids are needed for Crohn's disease. Although purine patients (RR 1.36, 95% CI 0.92 to 2.00). A GRADE analysis indicated that to high risk of bias in one study (no blinding) and very sparse data (33 events). One small (13 patients) poor quality study found no difference in continued remission between methotrexate and 5-aminosalicylic acid (RR 2.62, 95% CI 0.23 to 29.79). A pooled analysis of two studies (n = 145) including one high quality trial (n = 126) found no statistically significant difference in maintenance of remission at 36 to 48 weeks between combination therapy (methotrexate and infliximab) and infliximab monotherapy. Fifty-four percent of patients in the combination therapy group maintained remission compared to 53% of monotherapy patients (RR 1.02, 95% CI 0.76 to 1.38, P = 0.95). A GRADE analysis indicated that the overall quality of evidence supporting this outcome was low due to high risk of bias in one study (no blinding) and sparse data (78 events). Adverse events were generally mild in nature and resolved upon discontinuation or with folic acid supplementation. Common adverse events included nausea and vomiting, symptoms of a cold, abdominal pain, headache, joint pain or arthralgia, and fatigue. Moderate quality evidence indicates that intramuscular methotrexate at a dose of 15 mg/week is superior to placebo for maintenance of remission in Crohn's disease. Intramuscular methotrexate appears to be safe. Low dose oral methotrexate (12.5 to 15 mg/week) does not appear to be effective for maintenance of remission in Crohn's disease. Combination therapy (methotrexate and infliximab) does not appear to be any more effective for maintenance of remission than infliximab monotherapy. The results for efficacy outcomes between methotrexate and 6-mercaptopurine and methotrexate and 5-aminosalicylic acid were uncertain. Large-scale studies of methotrexate given orally at higher doses for maintenance of remission in Crohn's disease may provide stronger evidence for the use of methotrexate in this manner.