Bourke V.C.,Central Coast Area Health Service |
Bourke B.M.,Central Coast Area Health Service |
Beiles C.B.,Western Hospital
European Journal of Vascular and Endovascular Surgery | Year: 2016
Objectives The aim was to analyse a prospective, consecutive series of awake carotid endarterectomy (CEA) patients undergoing, when possible, pre- and postoperative diffusion-weighted magnetic resonance imaging brain scans (DWI). Methods All CEA patients from June 23, 2006, to January 13, 2012, were prospectively entered in the study. CEA was performed under regional cervical block. Only patients demonstrating shunt dependence were shunted. Before August 7, 2008, all longitudinal endarterectomy had been performed with a vein patch. From that date all CEA were eversions without a patch, except shunted patients who were vein patched. DWI was performed 2 days before and 5 days after (3 Tesla). Scans were reported by MRI-trained radiologists. Logistic regression analysis (LRA) identified predictive variables for MRI changes using backward stepwise elimination of variables with p >.05. Results There was a total of 295 consecutive CEA. There were no deaths but four clinical strokes (1.4 %); 89 excluded from DWI leaving 206; of these 27 (13%) developed new DWI lesions including four of 57 (7%) in the asymptomatic group and 23 of 149 (15%) symptomatic patients. Nineteen of the 206 (9.2%) were shunted. LRA showed that shunt dependence was highly associated with new DWI lesions: odds ratio (OR) 6.43; 95% confidence interval (CI) 2.3-17.9; p <.001. Both the vein patched, non-shunted group (OR.25; CI 0.09-0.72; p =.010) and the eversion (all non-shunted and all non-patched) group (OR 0.05; CI 0.01-0.22; p <.001) were associated with a low risk of new lesions, with the eversion group a lower risk than the patched group. Conclusions One in every eight CEA patients developed new DWI lesions (rate doubled in symptomatic patients). Shunt dependence in conscious CEA patients is highly associated with the development of new DWI lesions compared with non-shunted patients. For non-shunted patients the new lesion risk is low, and in those patients the risk in the eversion group is lower than in the patched group. © 2015 European Society for Vascular Surgery.
News Article | December 23, 2016
TORONTO, ONTARIO--(Marketwired - Dec. 23, 2016) - Today Kevin O'Leary launched a national committee of well- known conservatives and business leaders to identify a path to victory for his potential Conservative Leadership. A key element of this plan will be to harness O'Leary's broad appeal and unleash a national movement of supporters who know Kevin is the only one who can beat Justin Trudeau. To facilitate this, the committee has established a website - www.OlearyforCanada.ca, to mobilize public support. "Canadians are increasingly looking for something different from career politicians wasting their money and mismanaging the economy," said Mike Coates, the committee Chairman. "Canada needs a Leader who understands the economy and what it takes to get it growing again, and who isn't afraid to disrupt political convention." The national exploratory committee, Chaired by Mike Coates, will consult with Conservative Party members, Caucus, and voters, and will report back to O'Leary early in 2017. "Kevin's track record of entrepreneurship is well known to millions of Canadians and the Conservative Party needs someone of his calibre if we are to offer a real alternative in the next election," said Coates. "If you want a Leader who is ready to fight for you and will tell it like it is, we call on you to join us at www.OlearyforCanada.ca and let us know." The chair of Kevin's exploratory committee is Mike Coates, a long time conservative activist, who most recently headed up Mr. Harper's debate prep and strategy team for his leadership campaign and three successive elections. Professionally Mike was CEO of H+K Canada for 19 yrs, before becoming H+K's CEO of the Americas out of New York. He now is a vice Chairman residing in Ottawa. Mike Harris became the twenty-second Premier of Ontario following a landslide election victory. Four years later, the voters of Ontario re-elected Mike Harris and his team — making him the first Ontario Premier in more than 30 years to form a second consecutive majority government. After leaving office in 2002, Mr. Harris formed his own consulting firm. As President of Steane Consulting Ltd., Mr. Harris serves as an advisor to numerous Canadian companies including Fasken Martineau DuMoulin LLP where he currently serves as Senior Business Advisor. Ken Hughes is a successful businessman and entrepreneur who has also served with accomplishment in public life: Member of Parliament - 1988-1993; Founding Chair, Alberta Health Services – 2008-2011; Member of Legislature of Alberta – 2012-2014 (Minister of Energy, Municipal Affairs). First elected as the Member of Parliament for Stormont-Dundas-South Glengarry in 2004, and subsequently in 2006, 2008, 2011 and 2015, Guy Lauzon is a well-respected member of the Conservative Caucus. Having served 7 years as the National Conservative Caucus Chair, he worked weekly with Prime Minister Stephen Harper, members of Cabinet, and Caucus colleagues to advance policy and legislation for a better Canada. Marjory LeBreton, long time Conservative activist. Retired from Senate of Canada, July, 2015. Leader of the Government in the Senate and Cabinet Minister 2006 -2013. Past National Chair and current Board Member of MADD Canada. Rick has been a member of the Party for more than 30 years and has served as the Party's National Treasurer, on three national campaign committees, as a candidate, and is currently the VP for the South Shore St. Margaret's Conservative Party of Canada EDA. Rick is a marketing executive and entrepreneur and is an 8th generation Nova Scotian. Perry is the Co-Founder and Managing Partner of Wildeboer Dellelce LLP, Canada's leading corporate finance transactional law firm. Perry is also the Past Chair and current member of the Board of Directors of the Sunnybrook Hospital Foundation and is now serving as the Chair of the Defy the Conventional Capital Campaign for the University of Ottawa. Todd A. Halpern is President of Halpern Enterprises. He is Board Champion of the Krembil Neuroscience Centre Campaign, the Brain Campaign, the Arthritis Campaign and the Peter Munk Cardiac Centre Campaign. He has served on the Board the Toronto General & Western Hospital Foundation since 2005. Mr. Halpern is the Chair of the Grand Cru Culinary Wine Festival, which benefits research at University Health Network. He is also a member of the Nominating and Governance Committee. Sara has been involved in Conservative politics for years. She served as Press Secretary to Prime Minister Stephen Harper from 2009-2012, including the successful 2011 general election. In Opposition, Sara worked as a researcher in the Leaders Office for the Canadian Alliance from 2002-2004. She also briefly worked with the BC Liberals and now lives in Toronto and works as a Corporate Communications Consultant.
News Article | December 14, 2016
(TORONTO, Canada - Dec. 14, 2016) - Scientists from the McEwen Centre for Regenerative Medicine, University Health Network, have developed the first functional pacemaker cells from human stem cells, paving the way for alternate, biological pacemaker therapy. Their findings, "Sinoatrial node cardiomyocytes derived from human pluripotent cells function as a biological pacemaker," published online in Nature Biotechnology on Dec. 12, detail how human pluripotent stem cells can be coaxed in 21 days to develop into pacemaker cells, which regulate heart beats with electrical impulses. These human pacemaker cells were tested in rat hearts and were shown to function as a biological pacemaker, by activating the electrical impulses that trigger the contraction of the heart. Pluripotent stem cells have the potential to differentiate into more than 200 different cell types that make up every tissue and organ in the body. Sinoatrial node pacemaker cells are the heart's primary pacemaker, controlling the heartbeat throughout life. Defects in the pacemaker can lead to heart rhythm disorders that are commonly treated by implantation of electronic pacemaker devices. Learning how to generate pacemaker cells could help in understanding disorders in pacemaker cells, and provide a cell source for developing a biological pacemaker. Biological pacemakers represent a promising alternative to electronic pacemakers, overcoming such drawbacks as a lack of hormonal responsiveness and the inability to adapt to changes in heart size in pediatric patients. The researchers used a developmental-biology approach to establish a specific protocol for generating the pacemaker cells. "What we are doing is human biology in a petri dish," says Dr. Gordon Keller, Director of the McEwen Centre, the senior author, and a trailblazer in generating a wide variety of specialized cells from human stem cells. "We are replicating nature's way of making the pacemaker cell." Based on previous findings in animal models, the researchers at the McEwen Centre tested and mapped out the specific developmental pathway of how human pluripotent stem cells become pacemaker cells. This was achieved by testing different signaling molecules at different times throughout the 21 days to guide the cells towards their goal. "It's tricky," says Dr. Stephanie Protze, a post-doctoral fellow in the laboratory of Dr. Keller and the first author in the Nature paper. "You have to determine the right signaling molecules, at the right concentration, at the right time to stimulate the stem cells." Adds Dr. Keller, who is also a Professor in the Department of Medical Biophysics at the University of Toronto: "We understand the importance of precision in developmental biology in setting out the process by which organisms grow and develop. We use that same precision in the petri dish because we are replicating these same processes." Once the team established which signaling pathways are activated at different stages to generate the pacemaker cells, they demonstrated that the new pacemaker cells could initiate and regulate the heartbeat in rats. The researchers noted that human clinical trials to test such biological pacemakers are from five to 10 years away, and that the next step is to launch safety and reliability pre-clinical trials on the pacemaker cells. Meanwhile, researchers can use their new technology to make pacemaker cells from patients suffering from pacemaker dysfunction. They can then use these patient-specific cells to study the "disease in a (petri) dish" and to identify new drugs that will improve their pacemaker function. Long term, the team hopes to develop a biological pacemaker to transplant into patients who need an electronic one. More than 10,000 electric pacemakers are implanted annually in Canada, with more than 120,000 patients living with them. They can last anywhere from five to 10 years or more -- on the average about seven years. If successful, the biological pacemaker holds the promise of a lifelong cure. This research is part of an international collaboration with Dr. Lior Gepstien from Technion Insitute of Technolgy and Dr. Peter Backx, Senior Scientist at the Peter Munk Cardiac Centre and Toronto General Research Institute, UHN. The partnership of UHN, Technion, the McEwen Centre for Regenerative Medicine and the Peter Munk Cardiac Centre, under the International Centre for Cardiovascular Innovation, is the largest scientific collaboration of its kind. Philanthropic donations to the Toronto General & Western Hospital Foundation and the Canadian Institutes of Health Research (CIHR) funded this research. About the McEwen Centre for Regenerative Medicine The McEwen Centre for Regenerative Medicine was founded with generous donations from Rob and Cheryl McEwen. The centre includes 16 scientists at five Toronto hospitals, as well as the University of Toronto. Currently, these scientists are working to accelerate the development of more effective treatments for conditions such as heart disease, diabetes, liver disease, arthritis and diseases of the blood like leukemia. The McEwen Centre is supported by philanthropic contributions and research grants, and is based at University Health Network in Toronto, Canada. University Health Network consists of Toronto General and Toronto Western Hospitals, the Princess Margaret Cancer Centre, Toronto Rehabilitation Institute, and The Michener Institute of Education at UHN. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto. http://www.
News Article | December 23, 2016
TORONTO, ONTARIO--(Marketwired - 23 déc. 2016) - Kevin O'Leary a lancé aujourd'hui un comité national formé de conservateurs reconnus et de leaders du monde des affaires afin de tracer la voie de la victoire pour sa course à la direction potentielle. Un élément clé de son plan consistera à mobiliser le soutien à O'Leary et à lancer un mouvement national de partisans qui savent que Kevin est le seul qui peut battre Justin Trudeau. Le comité a créé un site Web - www.OlearypourleCanada.ca, afin de mobiliser le soutien public. « Les Canadiens recherchent de plus en plus quelque chose de différent des politiciens de carrière qui gaspillent leur argent et gèrent mal notre économie, a dit Mike Coates, le président du comité. Le Canada a besoin d'un leader qui comprend l'économie et qui sait ce qu'il faut faire pour stimuler de nouveau sa croissance, et qui n'a pas peur de déranger les conventions politiques. » Le comité exploratoire national, présidé par Mike Coates, va consulter les membres du Parti conservateur, le caucus et les électeurs, et fera un rapport à O'Leary au début de 2017. « Le bilan d'entrepreneur de Kevin est bien connu de millions de Canadiens, et le Parti conservateur a besoin de quelqu'un de son calibre si nous voulons offrir une vraie alternative aux prochaines élections, a dit M. Coates. Si vous voulez un chef qui est prêt à se battre pour vous et qui dira les choses telles qu'elles sont, nous vous pressons de vous joindre à nous au www.OlearypourleCanada.ca pour nous le faire savoir. » Le président du comité exploratoire de Kevin est Mike Coates, un militant conservateur de longue date qui a dirigé l'équipe stratégique et la préparation aux débats de M. Harper pour sa course à la direction et trois élections successives. Sur le plan professionnel, Mike a été PDG de H+K Canada pendant 19 ans, avant d'être PDG de H+K pour les Amériques, à New York. Il est maintenant vice-président et réside à Ottawa. Mike Harris est devenu le vingt-deuxième premier ministre de l'Ontario après une victoire électorale éclatante. Quatre ans plus tard, les électeurs de l'Ontario ont réélu Mike Harris et son équipe — faisant de lui le premier dirigeant de l'Ontario en plus de 30 ans à former un deuxième gouvernement majoritaire de suite. Après avoir quitté ses fonctions en 2002, M. Harris a formé sa propre firme de conseils. À titre de président de Steane Consulting Ltd., M. Harris conseille de nombreuses entreprises canadiennes, dont Fasken Martineau DuMoulin LLP, où il est actuellement conseiller principal en affaires. Ken Hughes est un homme d'affaires et un entrepreneur prospère qui a aussi servi avec distinction dans la vie publique : député – 1988-1993 ; président fondateur, Services de santé de l'Alberta – 2008-2011 ; député provincial de l'Alberta – 2012-2014 (ministre de l'Énergie, des Affaires municipales). Élu une première fois comme député fédéral de Stormont-Dundas-South Glengarry en 2004, puis de nouveau en 2006, 2008, 2011 et 2015, Guy Lauzon est un membre du caucus conservateur hautement respecté. Ayant été président du caucus conservateur national pendant sept ans, il a travaillé avec le premier ministre Stephen Harper, les membres du cabinet et ses collègues du caucus, défendant des lois et des politiques pour un Canada meilleur. Marjory LeBreton est une militante conservatrice de longue date. Elle a pris sa retraite du Sénat du Canada en juillet 2015. Elle a été leader du gouvernement au Sénat et ministre du cabinet de 2006 à 2013. Elle est l'ancienne présidente de MADD Canada et siège actuellement au conseil d'administration. Rick est membre du Parti depuis plus de 30 ans. Il a été le trésorier national du Parti, a siégé à trois comités de campagne nationaux, a été candidat et est actuellement vice-président de l'ACÉ de South Shore St. Margaret du Parti conservateur du Canada. Rick est cadre et entrepreneur en marketing et est un Néo-Écossais de 8e génération. Perry est cofondateur et associé directeur de Wildeboer Dellelce LLP, le principal cabinet d'avocats en transactions des finances de l'entreprise du Canada. Perry est aussi président sortant et membre du conseil d'administration de la Sunnybrook Hospital Foundation, et est actuellement président la campagne Défier les conventions de l'Université d'Ottawa. Todd A. Halpern est président de Halpern Enterprises. Il est champion du conseil de la Krembil Neuroscience Centre Campaign, de la Brain Campaign, de l'Arthritis Campaign et de la Peter Munk Cardiac Centre Campaign. Il siège au conseil de la Toronto General & Western Hospital Foundation depuis 2005. M. Halpern est le président du Grand Cru Culinary Wine Festival, qui soutient la recherche du Réseau universitaire de santé. Il est aussi membre du Comité des nominations et de la gouvernance. Sara travaille en politique conservatrice depuis des années. Elle a été l'attachée de presse du premier ministre Stephen Harper de 2009 à 2012, notamment aux élections générales de 2011. À l'opposition, Sara a travaillé comme chercheuse au Bureau du chef de l'Alliance canadienne de 2002 à 2004. Elle a aussi brièvement travaillé avec les Libéraux de la Colombie-Britannique et vit maintenant à Toronto, où elle travaille comme consultante en communication d'entreprise.
Gabriel L.E.K.,Western Hospital |
Webb S.A.R.,Royal Perth Hospital |
Webb S.A.R.,University of Western Australia
Current Opinion in Critical Care | Year: 2013
PURPOSE OF REVIEW: Influenza pandemics occur intermittently and represent an existential global infectious diseases threat. The purpose of this review is to describe clinical and research preparedness for future pandemics. RECENT FINDINGS: Pandemic influenza typically results in large numbers of individuals with life-threatening pneumonia requiring treatment in ICUs. Clinical preparedness of ICUs relates to planning to provide increased 'surge' capacity to meet increased demand and requires consideration of staffing, equipment and consumables, bed-space availability and management systems. Research preparedness is also necessary, as timely clinical research has the potential to change the trajectory of a pandemic. The clinical research response during the 2009 H1N1 influenza pandemic was suboptimal. SUMMARY: Better planning is necessary to optimize both clinical and research responses to future pandemics. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins.
Carolan M.,Victoria University of Melbourne |
Gill G.K.,Victoria University of Melbourne |
Steele C.,Western Hospital
BMC Pregnancy and Childbirth | Year: 2012
Background: Gestational diabetes rates have increased dramatically in the past two decades and this pattern of increase appears to relate primarily to the obesity epidemic, older maternal age and migration from world areas of high GDM risk. Women from disadvantaged and migrant backgrounds are most at risk of developing and of mismanaging this condition. The aim of the study was to explore the factors that facilitated or inhibited gestational diabetes self-management among women in a socially deprived area.Methods: Fifteen pregnant women, with a diagnosis of gestational diabetes, were purposively recruited for this study. Qualitative semi structured interviews and 1 focus group were conducted when participants were approximately 28-38 weeks gestation. The study's theoretical framework was based on interpretative phenomenology and data was analysed using a thematic analysis approach.Results: Women in this study identified a number of factors that complicated their task of GDM self-management. Barriers included: (1) time pressures; (2) physical constraints; (3) social constraints; (4) limited comprehension of requirements, and (5) insulin as an easier option. Factors facilitating GDM self-management included: thinking about the baby and psychological support from partners and families.Conclusion: Women from low socio economic and migrant backgrounds often struggle to comprehend GDM self-management requirements. To improve adherence to management plans, these women require educational and supportive services that are culturally appropriate and aimed at a low level of literacy. © 2012 Carolan et al.; licensee BioMed Central Ltd.
Ooi K.,Western Hospital |
Skinner I.,Western Hospital |
Croxford M.,Western Hospital |
Faragher I.,Western Hospital |
McLaughlin S.,Western Hospital
Colorectal Disease | Year: 2012
Aim To review the preliminary results of the ligation of the intersphincteric fistula tract (LIFT) technique in treating complex anal fistulas at our hospital. Method Between March and November 2010, patients with cryptoglandular anal fistulas were recruited prospectively from the colorectal clinic and treated using the LIFT procedure. A database was set up to collect information on demographics, past surgical treatments, fistula characteristics, MRI scan results, operative data and follow-up findings. The primary end-point measured was cure of the disease. The secondary end-point was the degree of postoperative continence. Preoperative and postoperative incontinence rates were recorded using Wexner's Incontinence Scale. Results Twenty-five patients (eight women and 17 men; median age, 40years) underwent the LIFT procedure. Ten patients had recurrent fistulas and previous fistula surgery. The median operating time was 39min. No intraoperative complications were documented. The median follow-up duration was 22 (3-43)weeks. Primary healing was observed in 17 (68.0%) patients and the median healing time was 6weeks; one wound remained incompletely healed. Seven patients (28.0%) had disease recurrence presenting between 7 and 20weeks postoperatively. No patients reported any incontinence postoperatively. Conclusion The LIFT procedure has favourable healing rates with little or no risk of incontinence. This operation is safe and easy to learn. The early results from this pilot study show promise and affirm some of the findings of other researchers. These results will suggest opportunities to conduct further controlled studies comparing the LIFT procedure with standard therapies. © 2011 The Association of Coloproctology of Great Britain and Ireland.
Anpalahan M.,Western Hospital |
Gibson S.,National Ageing Research Institute
European Journal of Internal Medicine | Year: 2012
Aims: To determine the prevalence and clinical significance of carotid sinus syndrome (CSS) and vasovagal syncope (VVS), the two common types of Neurally Mediated Syncope (NMS), in a cohort of older patients with unexplained falls. Methods: Patients presenting with unexplained and accidental falls were identified from 200 consecutive admissions of falls in patients aged 65 years and older admitted to the Rapid Assessment Medical Unit (RAMU) in a teaching hospital. A sample of unexplained and accidental fallers underwent carotid sinus massage (CSM) and tilt table testing (TTT) as per a standardised protocol. Baseline characteristics, clinical variables and the prevalence of NMS were compared between the two groups. Results: Falls were unexplained in 26% of patients. The prevalence of NMS was 24% (5/21) among patients with unexplained falls who underwent assessment for NMS, whereas it was nil (0/17) in patients with accidental falls (P = 0.050). The prevalence of previous falls was significantly higher in patients with unexplained falls (P = 0.0025), but all other baseline characteristics were similar between the two groups. Conclusion: Falls are unexplained in a significant number of older patients presenting to acute hospitals. The assessment of unexplained fallers for NMS is clinically important as this may be aetiologically related in nearly a quarter of these patients. © 2011 European Federation of Internal Medicine.
McDonough M.,Western Hospital
Australian Prescriber | Year: 2012
A judicious approach in considering opioid therapy and choosing an appropriate opioid is needed. After an initial opioid trial, therapy should only be continued when there is reasonable evidence that it is effective and safe. The evidence for harm associated with long-term opioid prescribing is mounting while there is little evidence to support long-term efficacy. In many cases, reducing and eventually stopping opioid therapy may be the best course of action. Commitment by both the prescriber and the patient to a treatment plan which includes regular reviews is essential if opioid therapy is prolonged.
Taylor H.E.,Western Hospital |
Bramley D.E.P.,Western Hospital
Anaesthesia and Intensive Care | Year: 2012
The provision of written information is a component of the informed consent process for research participants. We conducted a readability analysis to test the hypothesis that the language used in patient information and consent forms in anaesthesia research in Australia and New Zealand does not meet the readability standards or expectations of the Good Clinical Practice Guidelines, the National Health and Medical Research Council in Australia and the Health Research Council of New Zealand. We calculated readability scores for 40 patient information and consent forms using the Simple Measure of Gobbledygook and Flesch-Kincaid formulas. The mean grade level of patient information and consent forms when using the Simple Measure of Gobbledygook and Flesch-Kincaid readability formulas was 12.9 (standard deviation of 0.8, 95% confidence interval 12.6 to 13.1) and 11.9 (standard deviation 1.1, 95% confidence interval 11.6 to 12.3), respectively. This exceeds the average literacy and comprehension of the general population in Australia and New Zealand. Complex language decreases readability and negatively impacts on the informed consent process. Care should be exercised when providing written information to research participants to ensure language and readability is appropriate for the audience.