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Adjuvant hypofractionated versus conventional whole breast radiation therapy for early-stage breast cancer: long-term hospital-related morbidity from cardiac causes.

https://arctichealth.org/en/permalink/ahliterature104800
Source
Int J Radiat Oncol Biol Phys. 2014 Mar 15;88(4):786-92
Publication Type
Article
Date
Mar-15-2014
Author
Elisa K Chan
Ryan Woods
Mary L McBride
Sean Virani
Alan Nichol
Caroline Speers
Elaine S Wai
Scott Tyldesley
Author Affiliation
Department of Oncology, Saint John Regional Hospital, Saint John, Canada.
Source
Int J Radiat Oncol Biol Phys. 2014 Mar 15;88(4):786-92
Date
Mar-15-2014
Language
English
Publication Type
Article
Keywords
Aged
Breast - pathology
Breast Neoplasms - pathology - radiotherapy - surgery
British Columbia
Dose Fractionation
Female
Follow-Up Studies
Heart - radiation effects
Hospitalization - statistics & numerical data
Humans
Mastectomy - utilization
Middle Aged
Neoplasm Staging
Organ Size
Organs at Risk - radiation effects
Radiation Injuries - complications
Radiotherapy, Adjuvant - adverse effects
Risk factors
Thoracic Wall
Abstract
The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI.
Between 1990 and 1998, 5334 women = 80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiac risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach.
The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group had a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76).
There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early-stage breast cancer treated with HF-WBI or CF-WBI at 15-year follow-up.
PubMed ID
24606848 View in PubMed
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Antibiotic guidelines for pneumonia in chronic-care facilities.

https://arctichealth.org/en/permalink/ahliterature189268
Source
Clin Invest Med. 2002 Jun;25(3):63-4; author reply 64
Publication Type
Article
Date
Jun-2002
Author
T K Marras
C K Chan
Source
Clin Invest Med. 2002 Jun;25(3):63-4; author reply 64
Date
Jun-2002
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - administration & dosage - therapeutic use
Chronic Disease
Health Facilities - standards
Health Facility Administration
Humans
Ontario
Pneumonia, Bacterial - drug therapy
Practice Guidelines as Topic
Notes
Comment On: Clin Invest Med. 2001 Dec;24(6):304-1011767234
PubMed ID
12137250 View in PubMed
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Canadian practice assessment in chronic obstructive pulmonary disease: respiratory specialist physician perception versus patient reality.

https://arctichealth.org/en/permalink/ahliterature114458
Source
Can Respir J. 2013 Mar-Apr;20(2):97-105
Publication Type
Article
Author
Paul Hernandez
Meyer S Balter
Jean Bourbeau
Charles K Chan
Darcy D Marciniuk
Shannon L Walker
Author Affiliation
Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia. paul.hernandez@cdha.nshealth.ca
Source
Can Respir J. 2013 Mar-Apr;20(2):97-105
Language
English
Publication Type
Article
Keywords
Aged
Canada
Female
Guideline Adherence - statistics & numerical data
Health Knowledge, Attitudes, Practice
Humans
Male
Patient Compliance - statistics & numerical data
Patient Participation
Physician's Practice Patterns - statistics & numerical data
Practice Guidelines as Topic
Prospective Studies
Pulmonary Disease, Chronic Obstructive - therapy
Pulmonary Medicine - standards
Questionnaires
Severity of Illness Index
Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition and the fourth leading cause of death in Canada. Optimal COPD management requires patients to participate in their care and physician knowledge of patients' perceptions of their disease.
A prospective study in which respiratory specialist physicians completed a practice assessment questionnaire and patient assessments for 15 to 20 consecutive patients with COPD. Patients also completed a questionnaire regarding their perceptions of COPD and its management.
A total of 58 respiratory specialist physicians from across Canada completed practice assessments and 931 patient assessments. A total of 640 patients with COPD (96% with moderate, severe or very severe disease) completed questionnaires. Symptom burden was high and most patients had experienced a recent exacerbation. Potential COPD care gaps were identified with respect to appropriate medication prescription, lack of an action plan, and access to COPD educators and pulmonary rehabilitation. Perceived knowledge needs and gaps differed between physicians and patients.
Despite the dissemination of Canadian and international COPD clinical practice guidelines for more than a decade, potential care gaps remain among patients seen by respiratory specialist physicians. Differing perceptions regarding many aspects of COPD among physicians and patients may contribute to these care gaps.
Notes
Cites: Arch Intern Med. 2003 Mar 10;163(5):585-9112622605
Cites: Eur Respir J. 2004 Jun;23(6):932-4615219010
Cites: J Contin Educ Health Prof. 2004 Fall;24 Suppl 1:S31-715712775
Cites: J Contin Educ Health Prof. 2006 Winter;26(1):13-2416557505
Cites: Int J Chron Obstruct Pulmon Dis. 2012;7:201-922500120
Cites: Can Respir J. 2008 Jan-Feb;15 Suppl A:1A-8A18292855
Cites: Respir Med. 2009 Jul;103(7):1004-1219269150
Cites: CMAJ. 2010 Apr 20;182(7):673-820371646
Cites: N Engl J Med. 2010 Sep 16;363(12):1128-3820843247
Cites: Can Respir J. 2008 Jan-Feb;15(1):13-918292848
PubMed ID
23616966 View in PubMed
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Clinical features and outcome of pulmonary embolism in children.

https://arctichealth.org/en/permalink/ahliterature156632
Source
Br J Haematol. 2008 Sep;142(5):808-18
Publication Type
Article
Date
Sep-2008
Author
Tina T Biss
Leonardo R Brandão
Walter H Kahr
Anthony K Chan
Suzan Williams
Author Affiliation
Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
Source
Br J Haematol. 2008 Sep;142(5):808-18
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Canada - epidemiology
Child
Child Mortality
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Male
Pulmonary Embolism - diagnosis - epidemiology - mortality - therapy
Retrospective Studies
Risk factors
Treatment Outcome
Abstract
Pulmonary embolism (PE) is rare in childhood but evidence suggests it is under-recognised. Children diagnosed with PE at a large tertiary centre over an 8-year period were retrospectively reviewed. Fifty-six children with radiologically proven PE were identified, 31 males and 25 females, median age 12 years. Eighty-four per cent had symptoms of PE. Risk factors for thromboembolism were present in 54 patients (96.4%); most commonly immobility (58.9%), central venous line (35.7%) and recent surgery (28.6%). Investigation revealed a thrombophilic abnormality in 14/40 patients (35%). Concurrent deep vein thrombosis was confirmed in 31 patients (55.4%), predominantly lower limb. D dimer was elevated at presentation in 26/30 patients (86.7%). Eight patients underwent systemic thrombolysis. An inferior vena cava filter was placed in five patients. Therapy was complicated by major haemorrhage in 12 patients (21.4%). The majority (82.1%) had complete or partial resolution of PE following a median of 3 months anticoagulation. Seven patients had a recurrent thromboembolic event and 12 patients died (mortality 21.4%); five due to thromboembolism (8.9%) and two due to haemorrhage. Risk factors for PE in children are distinct from adults and morbidity and mortality is significant. Multicentre prospective studies are required to determine optimal treatment and long-term outcome of childhood PE.
PubMed ID
18564359 View in PubMed
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Current trends in HIV-related hospital admissions and their impact on hospital resource utilization in Ontario.

https://arctichealth.org/en/permalink/ahliterature208941
Source
Clin Invest Med. 1997 Apr;20(2):95-101
Publication Type
Article
Date
Apr-1997
Author
M J Hyland
G. Bailey
M. Rawji
L L Peck
R H Hyland
C K Chan
Author Affiliation
Department of Medicine, Wellesley Hospital, Toronto, Ont.
Source
Clin Invest Med. 1997 Apr;20(2):95-101
Date
Apr-1997
Language
English
Publication Type
Article
Keywords
Female
HIV Infections - economics - epidemiology
Health Resources - trends - utilization
Hospitals - trends - utilization
Humans
Male
Ontario
Patient Admission - economics - statistics & numerical data - trends
Abstract
To assess changes in patterns of hospital admissions, in frequency of admissions and in average length of stay (ALOS) at a tertiary HIV referral centre, and to investigate the overall impact of care for patients with HIV infection of AIDS on peer hospitals in Ontario.
Descriptive study.
Data were obtained on patients with HIV infection or AIDS treated at the Wellesley Hospital in Toronto for the fiscal years (May 1 to Apr. 31) 1990-91, 1991-92 and 1992-93, and on admissions for HIV or AIDS in 9 peer hospitals in Ontario during the same period.
For the Wellesley Hospital, review of medical records of HIV-related admissions to determine the reasons for admission and to examine concurrent illnesses. For the Wellesley Hospital Hospital and peer hospitals, analysis of changes in ALOS and Resource Intensity Weights (RIWs).
Between May 1, 1990, and Apr. 31, 1993, the number of admissions for treatment of Pneumocystis carinii pneumonia (PCP) fell, but admissions for respiratory infections other than PCP remained very common, although they decreased slightly. Overall, infection remained the main reason for admission. The frequency of gastrointestinal complications necessitating admission increased. The frequency of admissions remained high, although the ALOS decreased significantly. In the period between Apr. 1, 1991, and Mar. 31, 1994, the proportion of HIV-related discharges and total hospital discharges among the 9 peer hospitals remained stable. The HIV-related ALOS decreased substantially. Although the HIV-related average RIW decreased slightly, this measure and the mortality rate are still much higher for HIV-related admissions than for overall admissions.
This contemporary survey suggests that nonrespiratory infection complications have become the main reason for admission of patients with HIV infection or AIDS, but that the HIV tertiary hospitals are coping with the load of HIV-related admissions and the high average RIW associated with these patients by reducing the ALOS.
Notes
Erratum In: Clin Invest Med 1997 Jun;20(3):195
PubMed ID
9088665 View in PubMed
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A demographic and health profile of gay and bisexual men in a large Canadian urban setting.

https://arctichealth.org/en/permalink/ahliterature191906
Source
AIDS Care. 2002 Feb;14(1):111-5
Publication Type
Article
Date
Feb-2002
Author
S. Low-Beer
K. Bartholomew
A E Weber
K. Chan
M. Landolt
D. Oram
A. Schilder
R. Hogg
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital.
Source
AIDS Care. 2002 Feb;14(1):111-5
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Bisexuality - statistics & numerical data
British Columbia - epidemiology
HIV Infections - epidemiology
Health Surveys
Homosexuality - statistics & numerical data
Humans
Male
Middle Aged
Socioeconomic Factors
Urban health
Abstract
The purpose of this study was to provide both a population estimate and a socio-economic and health profile of gay and bisexual men living with HIV/AIDS in a large Canadian urban centre. A random telephone survey was used to determine the number of men in the study area over the age of 20 identifying as gay or bisexual and to characterize their health and socio-economic status. Out of a total of 1,176 completed interviews, 300 males described themselves as gay or bisexual. Projecting this figure on recent census data we estimated the number of men identifying as gay or bisexual in this region of downtown Vancouver, BC, at 5,100. Among these men we found an HIV prevalence rate of 16%, with those who reported a positive serostatus being less likely to be employed full time and more likely to earn less than $20,000 per year. In terms of clinical characteristics, HIV-positive men had a median CD4 cell count of 397 cells/mm(3) and a median viral load of less than 500 copies/ml. Eighty-three per cent of the HIV-positive respondents were on antiretroviral therapy and the median number of drugs taken by these men was three. In summary, random surveys of populations affected by this epidemic are important for policy makers, clinicians and persons caring for those with HIV/AIDS as they paint a clearer picture of who is being affected and help to identify areas where increased services are needed.
PubMed ID
11798410 View in PubMed
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The end of the line: has rapid transit contributed to the spatial diffusion of HIV in one of Canada's largest metropolitan areas?

https://arctichealth.org/en/permalink/ahliterature197343
Source
Soc Sci Med. 2000 Sep;51(5):741-8
Publication Type
Article
Date
Sep-2000
Author
E. Wood
K. Chan
J S Montaner
M T Schechter
M. Tyndall
M V O'Shaughnessy
R S Hogg
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.
Source
Soc Sci Med. 2000 Sep;51(5):741-8
Date
Sep-2000
Language
English
Publication Type
Article
Keywords
Adult
Anti-HIV Agents - therapeutic use
Canada - epidemiology
Catchment Area (Health) - statistics & numerical data
Censuses
Data Collection
Demography
Female
HIV Infections - drug therapy - epidemiology
Humans
Male
Middle Aged
Multivariate Analysis
Social Class
Transportation
Urban health
Abstract
The objective of this study is to describe the relationship between socio-demographic characteristics and the geographic distribution of persons with HIV in the metropolitan area surrounding Vancouver, British Columbia. Specifically, we sought to determine the location of persons with HIV and the population based characteristics related to the rate of anti-HIV medication use. In addition, we investigated the relationship between the distribution of persons on anti-HIV medications and the city's monorail "SkyTrain" route. The residences of persons on anti-HIV therapy were linked to Census Tracts. Data from the most recent census were used to create a socio-demographic profile of each geographic area. The spatial relationship between the distribution of persons on anti-HIV therapy and the path of the monorail was assessed by digitizing the SkyTrain route over a digital Census Tract map. Statistical analyses were used to determine the characteristics of Census Tracts associated with the rate of anti-HIV medication use. The overall rate of anti-HIV medication use in the Census Tracts that are within 1 km of SkyTrain was 66 per 100,000 population, whereas the rate was only 22 in the non-proximal Census Tracts. Multivariate analyses indicated that persons on anti-HIV therapy were significantly less likely to reside where there is a higher proportion of the population female, and were more likely to reside in areas with a higher proportion of the population of First Nations or Aboriginal descent, a higher population density, and in areas within 1 km of the SkyTrain route. Our analyses suggest that neither migration, nor a heightened access to therapy explain these findings. The environment surrounding the SkyTrain may have been conducive to the spatial diffusion of HIV, and could be the focus of targeted public health interventions. The mechanisms responsible for the clustering of persons on anti-HIV medications around the SkyTrain require further investigation.
PubMed ID
10975233 View in PubMed
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Exposure of health-care workers to aerosolized pentamidine.

https://arctichealth.org/en/permalink/ahliterature221564
Source
Chest. 1993 Mar;103(3):982-3
Publication Type
Article
Date
Mar-1993
Author
R A McIvor
L R Lee Pack
C K Chan
Source
Chest. 1993 Mar;103(3):982-3
Date
Mar-1993
Language
English
Publication Type
Article
Keywords
Aerosols
Health Personnel
Humans
Occupational Exposure - adverse effects
Ontario
Pentamidine - administration & dosage - adverse effects - urine
Notes
Comment On: Chest. 1992 Jun;101(6):1494-91600763
PubMed ID
8449122 View in PubMed
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Factors associated with virological suppression among HIV-positive individuals on highly active antiretroviral therapy in a multi-site Canadian cohort.

https://arctichealth.org/en/permalink/ahliterature139475
Source
HIV Med. 2011 Jul;12(6):352-60
Publication Type
Article
Date
Jul-2011
Author
A M Cescon
C. Cooper
K. Chan
A K Palmer
M B Klein
N. Machouf
M R Loutfy
J. Raboud
A. Rachlis
E. Ding
V D Lima
J S G Montaner
S B Rourke
M. Smieja
C. Tsoukas
R S Hogg
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
Source
HIV Med. 2011 Jul;12(6):352-60
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active - methods
CD4 Lymphocyte Count
Canada - epidemiology
Cohort Studies
Female
HIV Infections - drug therapy - epidemiology - immunology
HIV-1 - immunology
Humans
Male
Middle Aged
RNA, Viral - drug effects - immunology
Treatment Outcome
Viral Load
Abstract
The aim of the study was to evaluate time to virological suppression in a cohort of individuals who started highly active antiretroviral therapy (HAART), and to explore the factors associated with suppression.
Eligible participants were HIV-positive individuals from a multi-site Canadian cohort of antiretroviral-naïve patients initiating HAART on or after 1 January 2000. Viral load and CD4 measurements within 6 months prior to HAART initiation were assessed. Univariate and multivariate analyses were conducted using piecewise survival exponential models where time scale was divided into intervals (
PubMed ID
21059167 View in PubMed
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Health related quality of life among persons with HIV after the use of protease inhibitors.

https://arctichealth.org/en/permalink/ahliterature195144
Source
Qual Life Res. 2000;9(8):941-9
Publication Type
Article
Date
2000
Author
S. Low-Beer
K. Chan
E. Wood
B. Yip
J S Montaner
M V O'Shaughnessy
R S Hogg
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Source
Qual Life Res. 2000;9(8):941-9
Date
2000
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Female
HIV Infections - drug therapy
HIV Protease Inhibitors - therapeutic use
Health status
Humans
Linear Models
Male
Middle Aged
Multivariate Analysis
Quality of Life
Statistics, nonparametric
Abstract
This study was conducted to determine the effect of the use of HIV protease inhibitors on the quality of life among persons infected with HIV.
Subjects were participants in the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program who had completed two annual participant surveys, one prior to initiating therapy with a protease inhibitor and one after. Quality of life was measured using the Medical Outcomes Study Short Form Health Survey (MOS-SF). Statistical analyses were conducted using parametric and multivariate methods.
Our analysis was based on 179 HIV-positive individuals. Compared to quality of life at baseline, we found no statistically significant changes in the health perception, pain, physical, role and social functioning MOS-SF subscale scores at follow-up. The measure of mental health was the only component to decline significantly over time. Subanalyses found significant increases in the measures of health perception (p = 0.004), physical (p = 0.037), role (p
PubMed ID
11284213 View in PubMed
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43 records – page 1 of 5.