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MacDonald R.L.,Dalhousie University | Robar J.L.,Dalhousie University | Robar J.L.,Nova Scotia Health Authority | Thomas C.G.,Dalhousie University | Thomas C.G.,Nova Scotia Health Authority
Medical physics | Year: 2017

PURPOSE: To investigate potential dosimetric improvements through the optimization of fixed-couch rotational position in cranial cancer stereotactic treatments.METHODS: Using previously delivered cranial stereotactic radiotherapy plans treated at the Nova Scotia Health Authority (NSHA), we have redesigned the treatment arrangement to find the optimal couch rotation positions based on the reduction of overlap between organs-at-risk of exposure (OARs) and target volume (PTV). Maintaining the gantry arrangements from the delivered treatment, the couch positions were determined based on a cost function analysis of accumulation of overlap score from an equation developed by Yang et al. and refined by MacDonald et al. The algorithm incorporates factors for radiation dose sensitivities of each OAR, depth of both OARs and target (PTV) volumes, and orthogonality of the 3D vector between OAR and PTV in the case of proximal OAR position.RESULTS: The plan evaluation was conducted on 16 acoustic neuroma patients treated with stereotactic radiotherapy plans at the NSHA. Maximum and mean doses to the OARs were reduced by approximately 14.30% ± 2.86% and 19.25% ± 2.10%, respectively, with application of this optimization technique as compared to the delivered treatment plans. In addition, PTV conformity and homogeneity were improved with application of this optimization technique.CONCLUSION: This variation of the existing delivery techniques with guidance from a PTV-OAR overlap cost function analysis technique can yield significant dosimetric improvements with no increase to delivery or planning time. © 2016 American Association of Physicists in Medicine.


Obaid N.M.,Dalhousie University | Bedard K.,Dalhousie University | Huang W.-Y.,Dalhousie University | Huang W.-Y.,Nova Scotia Health Authority
International Journal of Molecular Sciences | Year: 2017

The development of resistance to previously effective treatments has been a challenge for health care providers and a fear for patients undergoing cancer therapy. This is an unfortunately frequent occurrence for patients undergoing targeted therapy for tumours harboring the activating V600E mutation of the BRAF gene. Since the initial identification of the BRAF mutation in 2002, a series of small molecular inhibitors that target the BRAFV600E have been developed, but intrinsic and acquired resistance to these drugs has presented an ongoing challenge. More recently, improvements in therapy have been achieved by combining the use of BRAF inhibitors with other drugs, such as inhibitors of the downstream effector mitogen activated protein kinase (MAPK)/extracellular-signal regulated kinase (ERK) kinase (MEK). Despite improved success in response rates and in delaying resistance using combination therapy, ultimately, the acquisition of resistance remains a concern. Recent research articles have shed light on some of the underlying mechanisms of this resistance and have proposed numerous strategies that might be employed to overcome or avoid resistance to targeted therapies. This review will explore some of the resistance mechanisms, compare what is known in melanoma cancer to colorectal cancer, and discuss strategies under development to manage the development of resistance. © 2017 by the authors. Licensee MDPI, Basel, Switzerland.


Marshall E.G.,Dalhousie University | Gibson R.J.,Nova Scotia Health Authority | Lawson B.,Dalhousie University | Burge F.,Dalhousie University
BMJ Open | Year: 2017

Introduction: There is little evidence on how primary care providers (PCPs) model their practices in Nova Scotia (NS), Canada, what services they offer or what accessibility is like for the average patient. This study will create a database of all family physicians and primary healthcare nurse practitioners in NS, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. Methods and analysis: 3 census surveys of all family physicians, primary care nurse practitioners (ie, PCPs) and their practices in NS will be conducted. The first will be a telephone survey conducted during typical daytime business hours. At each practice, the person answering the telephone will be asked questions about the practice's accessibility and model of care. The second will be a telephone survey conducted after typical daytime business hours to determine what out-of-office services PCP practices offer their patients. The final will be a tailored fax survey that will collect information that could not be obtained in the first 2 surveys plus new information on scope of practice, practice model and willingness to participate in research. Survey data will be linked with billing data from administrative health databases. Multivariate regression analysis will be employed to assess whether access and availability outcome variables are associated with PCP and model of practice characteristics. Negative binomial regression analysis will be employed to assess the association between independent variables from the survey data and health system use outcomes from administrative data. Ethics and dissemination: This study has received ethical approval from the Nova Scotia Health Authority and the Health Data Nova Scotia Data Access Committee. Dissemination approached will include stakeholder engagement at local and national levels, conference presentations, peer-reviewed publications and a public website.


News Article | May 19, 2017
Site: www.marketwired.com

Beds sit empty at Digby hospital, while neighboring hospitals unable to meet needs of all patients DIGBY, NOVA SCOTIA--(Marketwired - May 19, 2017) - "The Nova Scotia Health Authority (NSHA) is not doing enough to ensure the Digby General Hospital is being used to full capacity," says Carl Crouse, CUPE national representative. "Right now, there are approximately half of the 33 beds sitting empty, while hospitals nearby are reportedly in need of more beds on a regular basis." "Digby has had empty in-patient beds and empty restorative care beds for months now," adds Crouse. "In a provincial health care system where there is overcrowding and bed shortages, it's a real failure of the health authority to have any facility operating below capacity." "Our members are joining the call by the community, including the Digby Health Coalition, to improve public health care in the area," says the Nan McFadgen, president of CUPE Nova Scotia. "We agree with the coalition. The health authority and elected officials are not listening to the workers who provide health care services or the residents who depend on them," says McFadgen. "We want to see a comprehensive plan that will deliver better quality, full-service health care and allow the Digby community to be a part of the decision-making process." CUPE 8920 represents 4,700 members working in acute care facilities across the province, including the Digby General Hospital.


PubMed | Provincial Laboratory for Public Health, Institute National Of Sante Publique Du Quebec, Public Health Agency of Canada, Public Health Ontario and 7 more.
Type: | Journal: The Journal of antimicrobial chemotherapy | Year: 2017

Previously we studied the antibiotic susceptibility of invasive Haemophilus influenzae collected in Canada from 1990 to 2006 and characterized isolates by serotype, MLST and ftsI gene sequencing for significant PBP3 mutations.To provide an update based on isolates collected from 2007 to 2014.A total of 882 case isolates were characterized by serotype using slide agglutination and PCR. MLST was carried out to determine ST. Isolates were tested for -lactamase production, presence of significant PBP3 mutations and antibiotic susceptibility by disc diffusion against 14 antibiotics. MIC values of three antibiotics were determined for 316 isolates using microbroth dilution.Non-typeable H. influenzae accounted for 54.6% of the isolates and 45.4% were serotypeable, predominantly type a (23.1%), type b (8.3%) and type f (10.8%). The overall rate of ampicillin resistance due to -lactamase production was 16.4% and increased from 13.5% in 2007-10 to 19% in 2011-14. Significant PBP3 mutations were identified in 129 isolates (14.6%) with 23 (2.6%) also producing -lactamase. MLST identified related STs (ST-136, ST-14 and ST-367) associated exclusively with genetically -lactamase-negative, ampicillin-resistant isolates and confirmed previously reported associations between significant PBP3 mutations and ST.A significant increase in -lactamase-producing isolates was observed from 2007 to 2014; the rate of significant PBP3 mutations has increased since previously reported and 52.5% of non-typeable H. influenzae now show resistance markers. Resistance to trimethoprim/sulfamethoxazole was common and no resistance to fluoroquinolones or third-generation cephalosporins was found.


Stevenson C.,Nova Scotia Health Authority | Burstall D.,Nova Scotia Health Authority
Healthcare Management Forum | Year: 2016

The District Health Authority Consolidation (Transition and Design) project in Nova Scotia was initiated to consolidate the existing nine district health authorities into one provincial health authority. This article provides an overview of the internal change management approach and activities that were developed to support the various phases of the design and transition process. Three phases of work are outlined, and specific change management activities are described as are lessons learned from the overall approach. © 2016 The Canadian College of Health Leaders. All rights reserved.


Stanzel R.D.P.,Nova Scotia Health Authority | Henderson M.,Nova Scotia Health Authority
Perfusion (United Kingdom) | Year: 2016

Advances in cardiopulmonary bypass equipment have played a critical role in improving outcomes for cardiac surgery patients. Recent advancements include reduced priming volumes, biocompatible coatings and gaseous microemboli handling, as well as the incorporation of an arterial filter into the oxygenator. The purpose of this study was to conduct a comprehensive clinical evaluation of adult oxygenators on the market. Oxygenators assessed included the Sorin Synthesis® (n = 30), the Sorin Inspire 6F® (n = 10) and Inspire 8F® (n = 30), the Terumo FX15® (n = 13) and FX25® (n = 30), the Maquet Quadrox-i® (n = 30) and the Medtronic Fusion® (n = 30). Parameters assessed included functional prime volumes, gas exchange, pressure gradients and the effects on patient hematology. The Synthesis had the largest functional prime volume (1426 ml), the FX15 the lowest (956 ml). The Inspire 6F, 8F and Fusion had the greatest O2 transfer. The Sorin oxygenators required the lowest sweep gas flows to obtain a PaCO2 of 40 mmHg. The Sorin oxygenators had the largest pressure gradients. While no differences were observed for hemoglobin and platelet levels post cross-clamp removal, the Sorin Synthesis and Inspire 8F had the largest increases in white blood cell (WBC) counts (122% and 141% of baseline, respectively) and neutrophils (162% and 185% of baseline, respectively). The data demonstrate that no single product is superior in all aspects. The choice of ideal oxygenator depends on the aspect(s) of oxygenator performance the perfusion team believes most clinically acceptable based on available data. © SAGE Publications.


Legge A.,Nova Scotia Health Authority | Doucette S.,Dalhousie University | Hanly J.G.,Nova Scotia Health Authority
Journal of Rheumatology | Year: 2016

Objective. To describe organ damage accrual, predictors of damage progression, and effect on health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). Methods.A longitudinal database of patients who met the American College of Rheumatology (ACR) classification criteria for SLE was used. Annual assessments included the Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) and the Medical Outcomes Study Short Form-36 (SF-36). The prognostic significance of demographic, disease-related, and treatment-related factors on damage progression was examined using multivariable Cox regression. The effect of changes in SDI scores on HRQOL, measured using the SF-36 summary and subscale scores, was assessed using linear mixed-effects modeling. Results. There were 273 patients with SLE studied over a mean (SD) duration of followup of 7.3 (4.3) years. During followup, 126 (46.2%) had an increase in SDI scores. Patients with preexisting damage at baseline were more likely to have earlier damage progression (HR 2.09, 95% CI 1.44-3.01). Older age, ≥ 8 ACR classification criteria, immunosuppressive drugs, cigarette smoking, and higher mean serum C-reactive protein levels were associated with an earlier increase in SDI scores in multivariable analysis. In general, changes in SDI scores were associated with initial declines in SF-36 scores at the time that damage occurred, with subsequent change comparable to that seen in patients without damage progression. Conclusion. This study identified multiple risk factors, some modifiable, associated with damage progression in patients with SLE. The negative effect on HRQOL emphasizes the need for treatment strategies to reduce the risk of organ damage over time. Copyright © 2016. All rights reserved.


Pavlova B.,Nova Scotia Health Authority | Pavlova B.,Dalhousie University | Perlis R.H.,Massachusetts General Hospital | Alda M.,Nova Scotia Health Authority | And 3 more authors.
The Lancet Psychiatry | Year: 2015

Background: Anxiety disorders are increasingly recognised as an important determinant of outcomes in patients with bipolar disorder. However, a reliable estimate of their prevalence is still missing, because the published prevalence of anxiety disorders in individuals with bipolar disorder varies widely. In this study, we aimed to quantify the lifetime prevalence of anxiety disorders in individuals with bipolar disorder and compare it with rates in people without the disorder. Methods: We searched the Web of Knowledge and Medline (through the PubMed interface) for articles published in any language from the database inception dates up until June 1, 2014, using a combination of the word "bipolar" and search terms for anxiety disorders. We included studies that reported original data about the lifetime prevalence of DSM-III and DSM-IV anxiety disorders in adults with bipolar disorder that recruited participants irrespective of comorbidities and that used a validated diagnostic interview to establish the diagnoses of bipolar disorder and at least one anxiety disorder. We excluded studies that reported only the current prevalence or if we were unable to establish whether they described current or lifetime prevalence, and those with discrepancies in the data that could not be resolved by contacting the authors. We did a random-effects meta-analysis of lifetime prevalence of DSM-III and DSM-IV anxiety disorders in adults with bipolar disorder, in which we quantified the lifetime prevalence of any anxiety disorder in people with bipolar disorder. We compared this prevalence in people with bipolar I disorder versus those with bipolar II disorder, and in people with bipolar disorder versus population controls. Findings: Data from 40 studies, including 14 914 individuals from North America, Europe, Australia, South America, and Asia, indicate that the lifetime prevalence of anxiety disorders in individuals with bipolar disorder is 45% (95% CI 40-51). Direct comparison in five samples with a total of 1378 individuals with bipolar disorder and 56 812 population controls without bipolar disorder indicates a three-fold increase (risk ratio [RR] 3·22 [95% CI 2·41-4·29]; p<0·0001) in the prevalence of anxiety disorders in those with bipolar disorder. 13 studies that included both individuals with bipolar I disorder (n=4270) and those with bipolar II disorder (n=1939) showed no difference in the lifetime prevalence of anxiety disorders between these subtypes (RR 1·07 [95% CI 0·96-1·20]; p=0·223). We noted significant heterogeneity among included studies that was not accounted for by reported differences in study characteristics. Interpretation: People with bipolar disorder are at increased risk of anxiety disorders compared with those without bipolar disorder; nearly one in two has an anxiety disorder in their lifetime. Anxiety disorders should therefore be assessed alongside the mood symptoms in patients with bipolar disorder. Funding: Capital Health Research Fund. © 2015 Elsevier Ltd.


PubMed | Nova Scotia Health Authority, Dalhousie University and Cape Breton University
Type: | Journal: Journal of clinical nursing | Year: 2017

Participant narratives from a feminist and queer phenomenological study aim to broaden current understandings of trauma. Examining structural marginalization within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships.Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have an increased risk of trauma due to structurally marginalizing processes that create and maintain socially constructed differences.Analysis of the qualitative data was guided by feminist and queer phenomenology. This was well suited to understanding queer womens storied narratives of trauma, including disempowering processes of structural marginalization.Semi-structured and conversational interviews were conducted with a purposeful sample of thirteen queer identified women who had experiences of birthing in rural Nova Scotia, Canada.Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that reconstructs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality.Normative practices were found to further the effects of structural marginalization suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces. This article is protected by copyright. All rights reserved.

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