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1 Canadian Field Hospital in Haiti: surgical experience in earthquake relief.

https://arctichealth.org/en/permalink/ahliterature122035
Source
Can J Surg. 2012 Aug;55(4):271-4
Publication Type
Article
Date
Aug-2012
Author
Max Talbot
Bethann Meunier
Vincent Trottier
Michael Christian
Tracey Hillier
Chris Berger
Vivian McAlister
Scott Taylor
Author Affiliation
1 Canadian Field Hospital, Canadian Forces, Montreal, QC. max_talbot@hotmail.com
Source
Can J Surg. 2012 Aug;55(4):271-4
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Canada
Disaster Planning - organization & administration
Earthquakes
Female
Haiti
Hospitals, Packaged - organization & administration
Humans
International Cooperation
Male
Multiple Trauma - etiology - surgery
Operating Rooms
Relief Work - organization & administration
Surgical Procedures, Operative - statistics & numerical data
Abstract
The Canadian Forces' (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities.
Notes
Cites: Disasters. 2000 Sep;24(3):262-7011026159
Cites: Prehosp Disaster Med. 2003 Oct-Dec;18(4):278-9015310039
Cites: Disaster Manag Response. 2005 Jan-Mar;3(1):11-615627125
Cites: Mil Med. 2007 May;172(5):471-717521092
Cites: Prehosp Disaster Med. 2008 Mar-Apr;23(2):144-51; discussion 152-318557294
Cites: Ann Intern Med. 2010 Jun 1;152(11):733-720197507
Cites: Prehosp Disaster Med. 2009 Jan-Feb;24(1):9-1019557952
Cites: Science. 2010 Feb 5;327(5966):638-920133550
Cites: Nature. 2010 Feb 18;463(7283):878-920164905
Cites: N Engl J Med. 2010 Mar 18;362(11):e3820200362
Cites: Prehosp Disaster Med. 2009 Jan-Feb;24(1):3-819557951
PubMed ID
22854149 View in PubMed
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Causes of death in Canadian Forces members deployed to Afghanistan and implications on tactical combat casualty care provision.

https://arctichealth.org/en/permalink/ahliterature129125
Source
J Trauma. 2011 Nov;71(5 Suppl 1):S401-7
Publication Type
Article
Date
Nov-2011
Author
Dylan Pannell
Ronald Brisebois
Max Talbot
Vincent Trottier
Julien Clement
Naisan Garraway
Vivian McAlister
Homer C Tien
Author Affiliation
2 Field Ambulance, Canadian Forces Base Petawawa, Petawawa, Ontario, Canada.
Source
J Trauma. 2011 Nov;71(5 Suppl 1):S401-7
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adult
Afghan Campaign 2001-
Canada - epidemiology
Cause of Death
Delivery of Health Care - methods
Female
Humans
Injury Severity Score
Male
Military Medicine - organization & administration
Military Personnel
Retrospective Studies
Wounds and Injuries - diagnosis - mortality - therapy
Abstract
As part of its contribution to the Global War on Terror and North Atlantic Treaty Organization's International Security Assistance Force, the Canadian Forces deployed to Kandahar, Afghanistan, in 2006. We have studied the causes of deaths sustained by the Canadian Forces during the first 28 months of this mission. The purpose of this study was to identify potential areas for improving battlefield trauma care.
We analyzed autopsy reports of Canadian soldiers killed in Afghanistan between January 2006 and April 2008. Demographic characteristics, injury data, location of death within the chain of evacuation, and cause of death were determined. We also determined whether the death was potentially preventable using both explicit review and implicit review by a panel of trauma surgeons.
During the study period, 73 Canadian Forces members died in Afghanistan. Their mean age was 29 (+/-7) years and 98% were male. The predominant mechanism of injury was explosive blast, resulting in 81% of overall deaths during the study period. Gunshot wounds and nonblast-related motor vehicle collisions were the second and third leading mechanisms of injury causing death. The mean Injury Severity Score was 57 (+/-24) for the 63 study patients analyzed. The most common cause of death was hemorrhage (38%), followed by neurologic injury (33%) and blast injuries (16%). Three deaths were deemed potentially preventable on explicit review, but implicit review only categorized two deaths as being potentially preventable.
The majority of combat-related deaths occurred in the field (92%). Very few deaths were potentially preventable with current Tactical Combat Casualty interventions. Our panel review identified several interventions that are not currently part of Tactical Combat Casualty that may prevent future battlefield deaths.
PubMed ID
22071995 View in PubMed
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Do older patients utilize excess health care resources after liver transplantation?

https://arctichealth.org/en/permalink/ahliterature131376
Source
Ann Hepatol. 2011 Oct-Dec;10(4):477-81
Publication Type
Article
Author
Neil Shankar
Mamoun AlBasheer
Paul Marotta
William Wall
Vivian McAlister
Natasha Chandok
Author Affiliation
Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada.
Source
Ann Hepatol. 2011 Oct-Dec;10(4):477-81
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Chi-Square Distribution
Delivery of Health Care - economics - utilization
Female
Health Resources - economics - utilization
Humans
Intensive Care - utilization
Length of Stay
Liver Transplantation - adverse effects - economics
Male
Middle Aged
Odds Ratio
Ontario
Patient Readmission
Referral and Consultation - utilization
Regression Analysis
Reoperation
Risk assessment
Risk factors
Time Factors
Treatment Outcome
Abstract
Liver transplantation is a highly effective treatment for end-stage liver disease. However, there is debate over the practice of liver transplantation in older recipients (age = 60 years) given the relative shortage of donor grafts, worse post-transplantation survival, and concern that that older patients may utilize excess resources postoperatively, thus threatening the economic feasibility of the procedure.
To determine if patients = 60 years of age utilize more health resources following liver transplantation compared with younger patients.
Consecutive adult patients who underwent primary liver transplantation (n = 208) at a single center were studied over a 2.5-year period. Data were collected on clinico-demographic characteristics and resource utilization. Descriptive statistics, including means, standard deviations, or frequencies were obtained for baseline variables. Patients were stratified into 2 groups: age = 60 years (n = 51) and
PubMed ID
21911888 View in PubMed
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Early steroid withdrawal after liver transplantation: the Canadian tacrolimus versus microemulsion cyclosporin A trial: 1-year follow-up.

https://arctichealth.org/en/permalink/ahliterature185117
Source
Liver Transpl. 2003 Jun;9(6):587-95
Publication Type
Article
Date
Jun-2003
Author
Paul Greig
Leslie Lilly
Charles Scudamore
Siegfried Erb
Eric Yoshida
Norman Kneteman
Vince Bain
Cameron Ghent
Paul Marotta
David Grant
William Wall
Jean Tchervenkov
Jeffrey Barkun
Andre Roy
Denis Marleau
Vivian McAlister
Kevork Peltekian
Author Affiliation
University of Toronto, Canada. paul.greig@uhn.on.ca
Source
Liver Transpl. 2003 Jun;9(6):587-95
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adrenal Cortex Hormones - administration & dosage - adverse effects
Adult
Aged
Aged, 80 and over
Canada
Child
Chronic Disease
Cyclosporine - administration & dosage
Emulsions
Female
Follow-Up Studies
Graft Rejection - drug therapy - mortality
Graft Survival - drug effects
Humans
Immunosuppressive Agents - administration & dosage
Liver Transplantation
Male
Middle Aged
Prospective Studies
Tacrolimus - administration & dosage
Abstract
Corticosteroid therapy contributes significant toxicity to liver transplantation. The safety and efficacy of early steroid withdrawal were determined in patients treated with either tacrolimus or microemulsion cyclosporin A (micro-CsA). The primary outcome was the proportion of patients who were steroid-free 1 year posttransplantation. From the seven Canadian adult liver transplant centers, 143 patients were randomly allocated oral treatment with either tacrolimus (n = 71) or micro-CsA (n = 72), together with corticosteroids and azathioprine. Eligibility criteria for steroid withdrawal included freedom from acute rejection for a minimum of 3 months, and prednisone
PubMed ID
12783400 View in PubMed
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Evaluation of the updated definition of early allograft dysfunction in donation after brain death and donation after cardiac death liver allografts.

https://arctichealth.org/en/permalink/ahliterature121605
Source
Hepatobiliary Pancreat Dis Int. 2012 Aug 15;11(4):372-6
Publication Type
Article
Date
Aug-15-2012
Author
Kris P Croome
William Wall
Douglas Quan
Sai Vangala
Vivian McAlister
Paul Marotta
Roberto Hernandez-Alejandro
Author Affiliation
Multi-Organ Transplant Program, London Health Sciences Centre, The University of Western Ontario, London, Canada. kris.croome@hotmail.com
Source
Hepatobiliary Pancreat Dis Int. 2012 Aug 15;11(4):372-6
Date
Aug-15-2012
Language
English
Publication Type
Article
Keywords
Adult
Biliary Tract Diseases - etiology
Brain Death
Cholestasis - etiology
Female
Graft Survival
Humans
Incidence
International Normalized Ratio
Liver Transplantation - adverse effects - mortality
Logistic Models
Male
Middle Aged
Ontario
Predictive value of tests
Primary Graft Dysfunction - classification - diagnosis - etiology - mortality
Risk assessment
Risk factors
Terminology as Topic
Time Factors
Tissue Donors
Treatment Outcome
Abstract
An updated definition of early allograft dysfunction (EAD) was recently validated in a multicenter study of 300 deceased donor liver transplant recipients. This analysis did not differentiate between donation after brain death (DBD) and donation after cardiac death (DCD) allograft recipients.
We reviewed our prospectively entered database for all DBD (n=377) and DCD (n=38) liver transplantations between January 1, 2006 and October 30, 2011. The incidence of EAD as well as its ability to predict graft failure and survival was compared between DBD and DCD groups.
EAD was a valid predictor of both graft and patient survival at six months in DBD allograft recipients, but in DCD allograft recipients there was no significant difference in the rate of graft failure in those with EAD (11.5%) compared with those without EAD (16.7%) (P=0.664) or in the rate of death in recipients with EAD (3.8%) compared with those without EAD (8.3%) (P=0.565). The graft failure rate in the first 6 months in those with international normalized ratio =1.6 on day 7 who received a DCD allograft was 37.5% compared with 6.7% for those with international normalized ratio
PubMed ID
22893463 View in PubMed
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Kidney and liver transplants from donors after cardiac death: initial experience at the London Health Sciences Centre.

https://arctichealth.org/en/permalink/ahliterature144680
Source
Can J Surg. 2010 Apr;53(2):93-102
Publication Type
Article
Date
Apr-2010
Author
Roberto Hernandez-Alejandro
Yves Caumartin
Cameron Chent
Mark A Levstik
Douglas Quan
Norman Muirhead
Andrew A House
Vivian McAlister
Anthony M Jevnikar
Patrick P W Luke
William Wall
Author Affiliation
The Multi-Organ Transplant Program, London Health Sciences Centre, the Division of General Surgery, Department of Surgery, University of Western Ontario, London, ON.
Source
Can J Surg. 2010 Apr;53(2):93-102
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Death
Female
Follow-Up Studies
Heart Arrest
Humans
Kidney Transplantation
Length of Stay - statistics & numerical data
Life Support Care
Liver Transplantation
Male
Middle Aged
Ontario
Postoperative Complications
Retrospective Studies
Time Factors
Tissue Donors
Tissue and Organ Procurement
Treatment Outcome
Withholding Treatment
Young Adult
Abstract
The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs.
We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors.
The mean age of the donors was 38 (range 18-59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3-9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107-220) micromol/L and a mean estimated creatinine clearance of 64 (range 41-96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5-8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3-20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%.
Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for transplant, and its widespread implementation in Canada should be encouraged.
Notes
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Cites: Am J Transplant. 2007 Jan;7(1):122-917061982
PubMed ID
20334741 View in PubMed
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Long-term outcomes of emergency liver transplantation for acute liver failure.

https://arctichealth.org/en/permalink/ahliterature147166
Source
Liver Transpl. 2009 Dec;15(12):1696-702
Publication Type
Article
Date
Dec-2009
Author
Gabriel Chan
Ali Taqi
Paul Marotta
Mark Levstik
Vivian McAlister
William Wall
Douglas Quan
Author Affiliation
Multi-Organ Transplant Programme, London Health Sciences Centre, London, Ontario, Canada. gabrielk.chan@lhsc.on.ca
Source
Liver Transpl. 2009 Dec;15(12):1696-702
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Brain Edema - complications
Emergency Treatment
Female
Humans
Kaplan-Meier Estimate
Liver Failure, Acute - etiology - mortality - surgery
Liver Transplantation - adverse effects - contraindications - mortality
Male
Middle Aged
Nervous System Diseases - etiology
Ontario - epidemiology
Patient Selection
Proportional Hazards Models
Retrospective Studies
Risk assessment
Risk factors
Survivors - statistics & numerical data
Time Factors
Tissue Donors - supply & distribution
Treatment Outcome
Waiting Lists
Young Adult
Abstract
Acute liver failure continues to be associated with a high mortality rate, and emergency liver transplantation is often the only life-saving treatment. The short-term outcomes are decidedly worse in comparison with those for nonurgent cases, whereas the long-term results have not been reported as extensively. We report our center's experience with urgent liver transplantation, long-term survival, and major complications. From 1994 to 2007, 60 patients had emergency liver transplantation for acute liver failure. The waiting list mortality rate was 6%. The mean waiting time was 2.7 days. Post-transplantation, the perioperative mortality rate was 15%, and complications included neurological problems (13%), biliary problems (10%), and hepatic artery thrombosis (5%). The 5- and 10-year patient survival rates were 76% and 69%, respectively, and the graft survival rates were 65% and 59%. Recipients of blood group-incompatible grafts had an 83% retransplantation rate. Univariate analysis by Cox regression analysis found that cerebral edema and extended criteria donor grafts were associated with worse long-term survival. Severe cerebral edema on a computed tomography scan pre-transplant was associated with either early mortality or permanent neurological deficits. The keys to long-term success and continued progress in urgent liver transplantation are the use of good-quality whole grafts and a short waiting list time, both of which depend on access to a sufficient pool of organ donors. Severe preoperative cerebral edema should be a relative contraindication to transplantation.
PubMed ID
19938124 View in PubMed
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Maimonides's cooling period and organ retrieval.

https://arctichealth.org/en/permalink/ahliterature181297
Source
Can J Surg. 2004 Feb;47(1):8-9
Publication Type
Article
Date
Feb-2004
Author
Vivian McAlister
Author Affiliation
Department of Surgery, University of Western Ontario, London, Ont. vmcalist@uwo.ca
Source
Can J Surg. 2004 Feb;47(1):8-9
Date
Feb-2004
Language
English
Publication Type
Article
Keywords
Attitude to Death
Brain Death - diagnosis
Canada
Female
History, 20th Century
History, 21st Century
Humans
Informed Consent - history
Male
Organ Transplantation - ethics - history - legislation & jurisprudence
Terminal Care - history
Tissue and Organ Procurement - history - legislation & jurisprudence
Notes
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Erratum In: Can J Surg. 2004 Jun;47(3):218
PubMed ID
14997917 View in PubMed
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8 records – page 1 of 1.