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Sample records for canadian thoracic society

  1. Canadian Cardiovascular Society and Canadian Thoracic Society Position Statement on Pulmonary Arterial Hypertension

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    David Langleben

    2005-01-01

    Full Text Available The Canadian Cardiovascular Society and the Canadian Thoracic Society requested a position statement on pulmonary arterial hypertension from leading Canadian experts. The present document is intended to act as an update for the clinician, to provide a template for the initial evaluation of patients, to enable the understanding of current therapeutic paradigms based on approved indications for Canada, to highlight new therapies on the horizon, and to state the positions of the Canadian Cardiovascular Society and the Canadian Thoracic Society on resource management for pulmonary arterial hypertension in Canada.

  2. Home Mechanical Ventilation: A Canadian Thoracic Society Clinical Practice Guideline

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    Douglas A McKim

    2011-01-01

    Full Text Available Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of user-friendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information.

  3. Diagnosis and Management of Asthma in Preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society Position Paper

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    Francine M Ducharme

    2015-01-01

    Full Text Available Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers.

  4. Obstructive Sleep Apnea and Driving: A Canadian Thoracic Society and Canadian Sleep Society Position Paper

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    Najib Ayas

    2014-01-01

    Full Text Available Individuals with obstructive sleep apnea (OSA experience sleep fragmentation and poor sleep quality that results in daytime sleepiness, which impairs performance during driving and leads to an increased risk for collisions. Not surprisingly, observational studies have shown that patients with OSA experience a two- to 10-fold higher risk for collision compared with healthy controls. Although treatment would clearly mitigate these risks, there is no current Canadian position on driving and OSA. This article, the first Canadian position statement addressing the issue, provides an overview of provincial regulations and proposes recommendations with regard to driving in patients with OSA.

  5. Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults

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    M. Diane Lougheed; Catherine Lemiere; Ducharme, Francine M.; Chris Licskai; Dell, Sharon D; Rowe, Brian H.; Mark FitzGerald; Richard Leigh; Wade Watson; Louis-Philippe Boulet; Canadian Thoracic Society Asthma Clinical Assembly

    2012-01-01

    BACKGROUND: In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.METHODS: Four clinical questions were identified as a focus f...

  6. Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper.

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    Ducharme, Francine M; Dell, Sharon D; Radhakrishnan, Dhenduka; Grad, Roland M; Watson, Wade T A; Yang, Connie L; Zelman, Mitchell

    2015-01-01

    Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥ 8 days/month) asthma-like symptoms or recurrent (≥ 2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.

  7. Introducing the Canadian Thoracic Society Framework for Guideline Dissemination and Implementation, with Concurrent Evaluation

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    Samir Gupta

    2013-01-01

    Full Text Available The Canadian Thoracic Society (CTS is leveraging its strengths in guideline production to enable respiratory guideline implementation in Canada. The authors describe the new CTS Framework for Guideline Dissemination and Implementation, with Concurrent Evaluation, which has three spheres of action: guideline production, implementation infrastructure and knowledge translation (KT methodological support. The Canadian Institutes of Health Research ‘Knowledge-to-Action’ process was adopted as the model of choice for conceptualizing KT interventions. Within the framework, new evidence for formatting guideline recommendations to enhance the intrinsic implementability of future guidelines were applied. Clinical assemblies will consider implementability early in the guideline production cycle when selecting clinical questions, and new practice guidelines will include a section dedicated to KT. The framework describes the development of a web-based repository and communication forum to inventory existing KT resources and to facilitate collaboration and communication among implementation stakeholders through an online discussion board. A national forum for presentation and peer-review of proposed KT projects is described. The framework outlines expert methodological support for KT planning, development and evaluation including a practical guide for implementers and a novel ‘Clinical Assembly – KT Action Team’, and in-kind logistical support and assistance in securing peer-reviewed funding.

  8. Alpha-1 Antitrypsin Deficiency Targeted Testing and Augmentation Therapy: A Canadian Thoracic Society Clinical Practice Guideline

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    DD Marciniuk

    2012-01-01

    Full Text Available Alpha-1 antitrypsin (A1AT functions primarily to inhibit neutrophil elastase, and deficiency predisposes individuals to the development of chronic obstructive pulmonary disease (COPD. Severe A1AT deficiency occurs in one in 5000 to one in 5500 of the North American population. While the exact prevalence of A1AT deficiency in patients with diagnosed COPD is not known, results from small studies provide estimates of 1% to 5%. The present document updates a previous Canadian Thoracic Society position statement from 2001, and was initiated because of lack of consensus and understanding of appropriate patients suitable for targeted testing for A1AT deficiency, and for the use of A1AT augmentation therapy. Using revised guideline development methodology, the present clinical practice guideline document systematically reviews the published literature and provides an evidence-based update. The evidence supports the practice that targeted testing for A1AT deficiency be considered in individuals with COPD diagnosed before 65 years of age or with a smoking history of <20 pack years. The evidence also supports consideration of A1AT augmentation therapy in nonsmoking or exsmoking patients with COPD (forced expiratory volume in 1 s of 25% to 80% predicted attributable to emphysema and documented A1AT deficiency (level ≤11 μmol/L who are receiving optimal pharmacological and nonpharmacological therapies (including comprehensive case management and pulmonary rehabilitation because of benefits in computed tomography scan lung density and mortality.

  9. Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults: Executive Summary

    OpenAIRE

    M. Diane Lougheed; Catherine Lemiere; Ducharme, Francine M.; Chris Licskai; Dell, Sharon D; Rowe, Brian H.; Mark FitzGerald; Richard Leigh; Wade Watson; Louis-Philippe Boulet; Canadian Thoracic Society Asthma Clinical Assembly

    2012-01-01

    BACKGROUND: In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.METHODS: Four clinical questions were identified as a focus f...

  10. Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society

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    Lionel A Mandell

    2000-01-01

    Full Text Available Community-acquired pneumonia (CAP is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in our knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity against Streptococcus pneumoniae has been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Disease Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

  11. Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Disease Society and the Canadian Thoracic Society

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    Lionel A Mandell

    2000-01-01

    Full Text Available Community-acquired pneumonia (CAP is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in the knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity against Streptococcus pneumoniae has been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Diseases Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

  12. Society of Thoracic Surgeons

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    ... STS The Society of Thoracic Surgeons Facebook Twitter LinkedIn YouTube Instagram Flickr About STS Governance and Leadership ... All Events » Tweets by @STS_CTsurgery Facebook Twitter LinkedIn YouTube Instagram Flickr Footer menu Home Contact Us ...

  13. April 2013 Arizona thoracic society notes

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    Robbins RA

    2013-04-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on Wednesday, 4/24/2013 at Scottsdale Shea beginning at 6:30 PM. There were 13 in attendance representing the pulmonary, critical care, sleep, infectious disease, and radiology communities. Drs. Gotway and August, thoracic radiologists, were both unable to attend. Dr. Tilman Kolesch from Maricopa more than capably filled in as our radiologist. The meeting was preceded by a discussion on Pharma and the availability of physicians who accept money, including dinners, from pharmaceutical companies. The Arizona Thoracic Society is sponsored by pharmaceutical companies. Ken Knox asked if Arizona Thoracic Society meetings could be held in Tucson during July and December, the two months meetings have not been scheduled. The attendees enthusiastically endorsed this expansion of the Arizona Thoracic Society meetings. In addition, Dr. Knox wishes to sponsor a winter symposium in Tucson in collaboration with the Arizona Thoracic Society. The attendees also enthusiastically endorsed this meeting. Four …

  14. November 2017 Arizona thoracic society notes

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    Robbins RA

    2017-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2017 Arizona Thoracic Society meeting was held on Wednesday, November 15, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with a lecture followed by case presentations. There were 15 in attendance representing the pulmonary, critical care, sleep, allergy, infectious disease and radiology communities. At the beginning of the meeting several issues were discussed: 1. CME offered by the Southwest Journal of Pulmonary and Critical Care Medicine (SWJPCC is currently offered to only the Southwest state thoracic societies and the Mayo Clinic. After discussion it was felt that this restriction of access was no longer appropriate and CME credits should be available to all. 2. Efforts continue to obtain CME for the Arizona Thoracic Society meetings. Our Chapter Representative, Dr. Gerry Schwartzberg, is approaching this with the American Thoracic Society. Locally, HonorHealth sent out a survey on CME needs. Members were encouraged …

  15. May 2014 Arizona thoracic society notes

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    Robbins RA

    2014-06-01

    Full Text Available No abstract available. Article truncated after first 150 words. The May 2014 Arizona Thoracic Society meeting was held on Wednesday, 5/28/2014 at Scottsdale Shea Hospital beginning at 6:30 PM. There were 13 in attendance representing the pulmonary, critical care, sleep and radiology communities. A discussion was held regarding the Arizona Thoracic Society relationship with the American Lung Association. Several members volunteered to talk to the lung association regarding common ground to strengthen the relationship. The wine tasting with the California, New Mexico and Colorado Thoracic Societies at the American Thoracic Society International Meeting was a big success. There were about 55 at the meeting. The tasting will probably be held again next year. At the ATS meeting data was presented that pirfenidone was effective in reducing the progression of idiopathic pulmonary fibrosis (IPF. The data was published in the New England Journal of Medicine on 8/29/14 (1. Lewis Wesselius is one of the investigators enrolling patients in a phase ...

  16. April 2014 Arizona thoracic society notes

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    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated at 150 words. The April 2014 Arizona Thoracic Society meeting was held on Wednesday, 4/23/2014 at Scottsdale Shea Hospital beginning at 6:30 PM. There were 15 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. It was announced that there will be a wine tasting with the California, New Mexico and Colorado Thoracic Societies at the American Thoracic Society International Meeting. The tasting will be led by Peter Wagner and is scheduled for the Cobalt Room in the Hilton San Diego Bayfront on Tuesday, May 20, from 4-8 PM. Guideline development was again discussed. The consensus was to await publication of the IDSA Cocci Guidelines and respond appropriately. George Parides, Arizona Chapter Representative, gave a presentation on Hill Day. Representatives of the Arizona, New Mexico and Washington Thoracic Societies met with their Congressional delegations, including Rep. David Schweikert, to discuss the Cigar Bill, NIH funding, and the Medicare Sustainable Growth ...

  17. March 2017 Arizona thoracic society notes

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    Robbins RA

    2017-03-01

    Full Text Available No abstract available. Article truncated after 150 words. The March 2017 Arizona Thoracic Society meeting was held on Wednesday, March 22, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There 11 attendance representing the pulmonary, critical care, sleep, thoracic surgery and radiology communities. There was a discussion of supporting the Tobacco 21 bill which had been introduced into the Arizona State Legislature. The bill was assigned to the House Commerce Committee but was not scheduled for a hearing by the Chair-Representative, Jeff Wininger from Chandler. It seems likely that the bill will be reintroduced in the future and the Arizona Thoracic Society will support the bill in the future. Three cases were presented: 1. Dr. Bridgett Ronan presented a 57-year-old man with cough and shortness of breath. His physical examination and spirometry were unremarkable. A thoracic CT scan showed large calcified and noncalcified pleural plaques and mediastinal lymphadenopathy. …

  18. March 2014 Arizona thoracic society notes

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    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated after 150 words. The March 2014 Arizona Thoracic Society meeting was a special meeting. In conjunction with the Valley Fever Center for Excellence and the Arizona Respiratory Center the Eighteenth Annual Farness Lecture was held in the Sonntag Pavilion at St. Joseph's Hospital at 6 PM on Friday, April 4, 2014. The guest speaker was Antonio "Tony" Catanzaro, MD from the University of California San Diego and current president of the Cocci Study Group. There were 57 in attendance representing the pulmonary, critical care, sleep, and infectious disease communities. After opening remarks by Arizona Thoracic Society president, Lewis Wesselius (a former fellow under Dr. Catanzaro at UCSD, John Galgiani, director of the Valley Fever Center for Excellence, gave a brief history of the Farness lecture before introducing Dr. Catanzaro. The lecture is named for Orin J. Farness, a Tucson physician, who was the first to report culture positive coccidioidomycosis (cocci or Valley Fever. ...

  19. July 2013 Arizona thoracic society notes

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    Robbins RA

    2013-01-01

    No abstract available. Article truncated after 150 words. The first Arizona Thoracic Society meeting in Tucson was held on Wednesday, 7/24/2013 at Kiewit Auditorium on the University of Arizona Medical Center campus beginning at 6:30 PM. There were 36 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. Dinner was sponsored by Accredo Health Group. A brief discussion was held of plans to have the December 2013 meeting in Tucson on a weekend as p...

  20. An Official American Thoracic Society Research Statement

    DEFF Research Database (Denmark)

    Slatore, Christopher G; Horeweg, Nanda; Jett, James R

    2015-01-01

    : In this research statement from the American Thoracic Society, a multidisciplinary group of clinicians, researchers, and patient advocates reviewed available evidence for pulmonary nodule evaluation, characterized six focus areas to direct future research efforts, and identified fundamental gaps in knowledge...... for identifying cancerous nodules. Before they are used in clinical practice, however, better evidence is needed to show that they improve more distal outcomes of importance to patients. In addition, the pace of research and the quality of clinical care would be improved by the development of registries that link...

  1. November 2014 Arizona thoracic society notes

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    Robbins RA

    2014-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2014 Arizona Thoracic Society meeting was held on Wednesday, November 19, 2014 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were about 30 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. Jud Tillinghast was nominated as the Arizona Thoracic Society physician of the year. Three cases were presented: 1. George Parides presented a case of a 70-year-old woman with a 3 areas of ground glass picked up incidentally on CT scan. She had some wheezing. A needle biopsy revealed adenocarcinoma. The biopsy and radiologic pattern were consistent with adenocarcinoma in situ or minimally invasive adenocarcinoma. Discussion centered around treatment. Most felt that if the areas could be removed that surgical resection was indicated (1. 2. Lewis Wesselius presented a 60-year-old man with Marfan's syndrome and a history of an aortic valve replacement on chronic ...

  2. September 2017 Arizona thoracic society notes

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    Robbins RA

    2017-09-01

    Full Text Available No abstract available. Article truncated at 150 words. The September 2017 Arizona Thoracic Society meeting was held on Wednesday, September 27, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 16 in attendance representing the pulmonary, critical care, sleep, and radiology communities. There was a discussion of the Tobacco 21 bill which had been introduced the last session in the Arizona State Legislature. Since it seems likely that the bill will be reintroduced, the Arizona Thoracic Society will support the bill in the future. Dr. Rick Robbins announced that the SWJPCC has applied to be included in PubMed. In addition, Dr. Robbins was assigned the task of tracking down the campaign contributions to congressional members from the tobacco PAC before the next election. There were 7 case presentations: 1.\tAshley L. Garrett, MD, pulmonary fellow at Mayo, presented an elderly man with insulin-dependent diabetes who felt he …

  3. Workshops to disseminate the Canadian Thoracic Society guidelines for chronic obstructive pulmonary disease to health care professionals in Ontario: impact on knowledge, perceived health care practices and participant satisfaction.

    Science.gov (United States)

    Moosa, Dilshad; Blouin, Maria; Hill, Kylie; Goldstein, Roger

    2009-01-01

    The Canadian Thoracic Society (CTS) has developed a clinical practice guideline (CPG) regarding the management of patients with chronic obstructive pulmonary disease (COPD). Implementation of this CPG in the primary care setting requires an effective dissemination strategy. To examine the change in knowledge, participant satisfaction and perceived changes in clinical practice among health care professionals working in the primary care setting following attendance at a workshop to disseminate the CTS CPG for COPD. A 2.5 h workshop was conducted in three community health sites within Ontario. Each workshop comprised a didactic presentation and interactive case study discussions. Before, and one month following the workshop, a structured knowledge assessment questionnaire was administered. A structured satisfaction questionnaire and evaluative form that examined the impact of the workshop on the clinical management of COPD patients were administered immediately and three months following completion of the workshop, respectively. Sixty-nine participants attended the workshop. The mean score for the structured knowledge assessment questionnaire increased from 8.5+/-2.7 to 10.6+/-2.0 following the workshop (P=0.008). Eighty-nine per cent and 96% of participants indicated that they would recommend the workshop to a colleague and had greater confidence in their management of COPD patients, respectively. Following attendance of the workshop, 73%, 69% and 46% described increased patient education, patient monitoring and the use of objective testing in clinical practice, respectively. Workshop attendance was associated with high levels of satisfaction and important self-reported changes in clinical practice, which may reflect improved knowledge of the CTS CPG for COPD.

  4. October 2013 Arizona thoracic society notes

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    Robbins RA

    2013-10-01

    Full Text Available No abstract available. Article truncated after 150 words. The October Arizona Thoracic Society meeting was held on Wednesday, 10/23/2013 at Shea Hospital beginning at 6:30 PM. There were 21 in attendance representing the pulmonary, critical care, sleep, and thoracic surgery communities. A proposal was made to decrease the number of meetings from 10 to 8 per year. After a brief discussion, this was adopted. Dr. Parides will try and coordinate these changes with Tucson. Meetings were announced for December in Tucson, January in Carmel, February in Albuquerque, and April in Phoenix. A suggestion was made to have a separate area for meetings on the SWJPCC website. There were 2 cases presented-both by Nick Sparacino, a first year fellow at Good Samaritan/VA. 1. The first case was a 48 year old man admitted to podiatry for chronic diabetic foot ulcers. His preoperative chest x-ray revealed multiple pulmonary nodules. Importantly, he had a history of working in a brake pad …

  5. November 2015 Arizona thoracic society notes

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    Robbins RA

    2015-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2015 Arizona Thoracic Society meeting was held on Wednesday, November 18, 2015 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 14 in attendance representing the pulmonary, critical care, sleep, and radiology communities. There were 3 case presentations: 1. Dr. Gerald Schwartzberg presented a case of a 56-year-old man with a history of diabetes, alcoholism and tobacco abuse who has a history of Mycobacterium avium-intracellulare (MAI with a residual thin-walled cavity in his right upper lobe (RUL. After quitting drinking and smoking and years of being asymptomatic, he presented with hemoptysis. Chest x-ray showed increasing density in the RUL. CT scan showed an intracavitary density in his previous cavity presumably a fungus ball. Sputum cultures are pending. Discussion followed on management of fungus balls. Bronchoscopy was recommended to view the bronchial anatomy to exclude other diagnosis as well ...

  6. June 2014 Arizona thoracic society notes

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    Robbins RA

    2014-06-01

    Full Text Available No abstract available. Article truncated at 150 words. The June 2014 Arizona Thoracic Society meeting was held on Wednesday, 6/25/14 at the Bio5 building on the University of Arizona Medical Center campus in Tucson beginning at 5:30 PM. This was a dinner meeting with case presentations. There were about 33 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. Four cases were presented: Eric Chase presented a 68 year old incarcerated man shortness of breath, chest pain and productive cough. The patient was a poor historian. He was supposed to be receiving morphine for back pain but this had been held. He also had a 45 pound weight loss over the past year. His PMH was positive for COPD, hypertension, congestive heart failure, chronic back pain and hepatitis C. Past surgical history included a back operation and some sort of chest operation. On physical examination he was tachypneic, tachycardic and multiple scars over his neck ...

  7. December 2013 Arizona thoracic society notes

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    Richard A. Robbins

    2013-12-01

    Full Text Available No abstract available. Article truncated at 150 words. A breakfast meeting of the Arizona Thoracic Society and the Tucson winter lung series was held on Saturday, 12/14/2013 at Kiewit Auditorium on the University of Arizona Medical Center Campus beginning at 8:30 AM. There were 31 in attendance. A lecture was presented by Joe G. N. "Skip" Garcia, MD, the senior vice president for health sciences at the University of Arizona. The title of Garcia’s talk was “Personalizing Medicine in Cardiopulmonary Disorders: The Post ACA Landscape”. Garcia began with reiterating that the Affordable Care Act (ACA, Obamacare is fact and could pose a threat to academic medical centers. However, he views the ACA as an opportunity to develop personalized medicine which grew from the human genome project. Examples cited included the genetic variability among patients in determining the dose of warfarin and bronchodilator response to beta agonists in asthma (1,2. Garcia’s laboratory has studied predominately 6 diseases including the …

  8. July 2016 Arizona thoracic society notes

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    Robbins RA

    2016-07-01

    Full Text Available No abstract available. Article truncated after first 150 words. The July 2016 Arizona Thoracic Society meeting was held on Wednesday, July 27, 2016 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 14 in attendance representing the pulmonary, critical care, sleep, and radiology communities. Prior to the case presentations, a discussion was held on 4 issues. First, Dr. Rick Robbins gave a summary of ATS Hill Day. During Hill Day a presentation was given by a representative from the Campaign for Tobacco-Free Kids. Their web site lists tobacco company contributions to members of Congress on their web site. Dr. Gary Ewart from the ATS office in Washington gave a presentation on the Traditional Cigar Manufacturing and Small Business Jobs Preservation Act before Congress (aka the Cigar Bill which the ATS opposes. He noted that cosponsors for the bill included several Congressmen from Southwestern states. Dr. Robbins combined the two ...

  9. July 2013 Arizona thoracic society notes

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    Robbins RA

    2013-07-01

    Full Text Available No abstract available. Article truncated after 150 words. The first Arizona Thoracic Society meeting in Tucson was held on Wednesday, 7/24/2013 at Kiewit Auditorium on the University of Arizona Medical Center campus beginning at 6:30 PM. There were 36 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. Dinner was sponsored by Accredo Health Group. A brief discussion was held of plans to have the December 2013 meeting in Tucson on a weekend as part of the University of Arizona winter pulmonary meeting. There were 4 cases presented: 1.Mohammad Dalabih presented a case of a 48 yo woman with respiratory failure cared for by Gordon Carr, Linda Snyder, and himself. Radiology findings were discussed by Isabel Oliva. Lung biopsy showed acute fibrinous and organizing pneumonia rather than ARDS and was presented by Richard Sobonya. 2.Franz Rischard presented a case of a 61 year old with progressive dyspnea and moderate COPD with evidence of

  10. September 2013 Arizona thoracic society notes

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    Robbins RA

    2013-09-01

    Full Text Available No abstract available. Article truncated at 150 words. The September Arizona Thoracic Society meeting was held on Wednesday, 9/25/2013 at Shea Hospital beginning at 6:30 PM. There were 13 in attendance representing the pulmonary, critical care, sleep, and pathology communities. After a brief discussion, Gerry Swartzberg was selected as Arizona’s 2014 nominee for Clinician of the Year. There was 1 case presented: Dr. Thomas Colby, pulmonary pathologist from Mayo Clinic Arizona, presented the case of a 67 year old woman with multiple pulmonary nodules. The largest was 1.2 cm CT scan. She had a fine needle aspiration of one of the nodules. The pathology revealed spindle-shaped cells which were synaptophysin + (also known as the major synaptic vesicle protein p38. Synaptophysin marks neuroendocrine tissue and on this basis the patient was diagnosed with multiple carcinoid tumors. Aguayo et al. (1 described six patients with diffuse hyperplasia and dysplasia of pulmonary neuroendocrine cells, multiple carcinoid tumorlets, and peribronchiolar fibrosis …

  11. August 2014 Arizona thoracic society notes

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    Robbins RA

    2014-08-01

    Full Text Available No abstract available. Article truncated after 150 words. The August 2014 Arizona Thoracic Society meeting was held on Wednesday, 8/27/14 at Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were about 30 in attendance representing the pulmonary, critical care, sleep and radiology communities. A presentation was given by Julie Reid of the American Lung Association in Arizona on their Lung Force initiative. This is an initiative to make women more aware that lung cancer is the number 1 cause of cancer deaths in women. There will be a fund raising Lung Force Walk on November 15, 2014 in Phoenix. More information can be found at http://www.lungforce.org/walk-events or http://www.lung.org/associations/states/arizona/local-offices/phoenix/ or contact Julie Reid at JReid@Lung Arizona.org or (602 258-7505. A discussion was instigated by Dr. Parides on whether there is an increased risk of clinical Valley Fever in patients previously treated who begin therapy with biological therapy for rheumatoid arthritis. The ...

  12. August 2013 Arizona Thoracic Society notes

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    Robbins RA

    2013-08-01

    Full Text Available No abstract available. Article truncated after first 150 words. The August Arizona Thoracic Society meeting was held on Wednesday, 8/28/2013 at Shea Hospital beginning at 6:30 PM. There were 23 in attendance representing the pulmonary, critical care, sleep, and pathology communities. A brief discussion was held about the audio-visual aids available. It was generally agreed that our current projector is inadequate. Judd Tillinghast will inquire about using a hospital overhead projector. If that is not possible, it was agreed to purchase a new projector. Plans for telecasting the meeting between Phoenix and Tucson continue. A trial of a link between Shea and the University in Tucson failed. Once the link is successfully established, it is hoped that the meeting can be telecasted. There were 6 cases presented: 1. Dr. Thomas Colby, pulmonary pathologist from Mayo Clinic Arizona, presented the case of a 10 year old boy with chronic dyspnea for > 4 yrs. He had growth retardation since age …

  13. September 2012 Arizona thoracic society notes

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    Robbins RA

    2012-09-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on 9/26//2012 at Scottsdale Shea beginning at 6:30 PM. There were 18 in attendance representing the pulmonary, critical care, sleep, pathology, and radiology communities.A discussion was held on Pending Premium Cigar Legislation HR. 1639 and S.1461, the "Traditional Cigar Manufacturing and Small Business Jobs Preservation Act of 2011”. This bill would exempt "premium cigars" from FDA oversight. The definition of premium cigars is so broad that candy flavored cigars, cigarillos and blunts would be exempted from FDA regulation. Teenage cigar smoking is increasing and this legislation may result in a further increase. The Arizona Thoracic Society is opposed to this bill. Dr. Robbins is to put a link on the Southwest Journal of Pulmonary and Critical Care website linking to the ATS website. This will enable members to contact their Congressmen opposing this legislation. A discussion was also held on a proposed combined Tucson/Phoenix …

  14. An official American Thoracic Society workshop report

    DEFF Research Database (Denmark)

    Rosenfeld, Margaret; Allen, Julian; Arets, Bert H G M

    2013-01-01

    to review six lung function tests based on a comprehensive review of the literature (infant raised-volume rapid thoracic compression and plethysmography, preschool spirometry, specific airway resistance, forced oscillation, the interrupter technique, and multiple-breath washout). In these proceedings...

  15. The Society of Thoracic Surgeons National Database 2016 Annual Report.

    Science.gov (United States)

    Jacobs, Jeffrey P; Shahian, David M; Prager, Richard L; Edwards, Fred H; McDonald, Donna; Han, Jane M; D'Agostino, Richard S; Jacobs, Marshall L; Kozower, Benjamin D; Badhwar, Vinay; Thourani, Vinod H; Gaissert, Henning A; Fernandez, Felix G; Wright, Cameron D; Paone, Gaetano; Cleveland, Joseph C; Brennan, J Matthew; Dokholyan, Rachel S; Brothers, Leo; Vemulapalli, Sreekanth; Habib, Robert H; O'Brien, Sean M; Peterson, Eric D; Grover, Frederick L; Patterson, G Alexander; Bavaria, Joseph E

    2016-12-01

    The art and science of outcomes analysis, quality improvement, and patient safety continue to evolve, and cardiothoracic surgery leads many of these advances. The Society of Thoracic Surgeons (STS) National Database is one of the principal reasons for this leadership role, as it provides a platform for the generation of knowledge in all of these domains. Understanding these topics is a professional responsibility of all cardiothoracic surgeons. Therefore, beginning in January 2016, The Annals of Thoracic Surgery began publishing a monthly series of scholarly articles on outcomes analysis, quality improvement, and patient safety. This article provides a summary of the status of the STS National Database as of October 2016 and summarizes the articles about the STS National Database that appeared in The Annals of Thoracic Surgery 2016 series, "Outcomes Analysis, Quality Improvement, and Patient Safety." Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Canadian Civil Society Organizations and Human Rights and Global ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This project aims to strengthen the capacity of Canadian civil society organizations (CSOs) to inform Canadian policy on human rights and global justice. The Canadian Council for International Co-operation (CCIC) receives core funding from the Canadian International Development Agency (CIDA). This grant will provide ...

  17. August 2012 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-08-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on 8/29/2012 at Scottsdale Shea beginning at 6:30 PM. There were 23 in attendance representing the pulmonary, critical care, sleep, pathology, radiology, and thoracic surgery communities. Four cases were presented:1.Lewis Wesselius and Thomas Colby presented a 39 yo female with cough and small amounts of hemoptysis for over a year. Chest x-ray was interpreted as perhaps showing some small nodules in the lower lobes which were more easily seen with CT scan. The scattered nodules were lower lobe predominant, non-calcified and surrounded by ground glass haloes. Coccidioidomycosis serology was negative and rheumatologic serologies were negative. Bronchoscopy showed blood in the airway but other than blood, bronchoalveolar lavage was negative. A video-assisted thorascopic (VATS biopsy showed a hemangioendothelioma, a malignant neoplasm that falls between a hemangioma and angiosarcoma. These vascular tumors can originate in the heart and often metastasize to the lung and pleura…

  18. Predictors of Major Morbidity and Mortality After Pneumonectomy Utilizing The Society for Thoracic Surgeons General Thoracic Surgery Database

    National Research Council Canada - National Science Library

    Shapiro, Mark; Swanson, Scott J; Wright, Cameron D; Chin, Cynthia; Sheng, Shubin; Wisnivesky, Juan; Weiser, Todd S

    2010-01-01

    .... The purpose of this study is to identify the risk factors responsible for adverse outcomes in patients after pneumonectomy utilizing The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTDB...

  19. Planning and Evaluation by Canadian Civil Society Organizations ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Planning and Evaluation by Canadian Civil Society Organizations : Bridging Gaps between Methodologies. In the current global context, Canadian civil society organizations (CSOs) are finding it increasingly difficult to assess their efficiency and effectiveness, and report to external stakeholders, both donor agencies and ...

  20. An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation

    NARCIS (Netherlands)

    M.A. Spruit (Martijn); S.J. Singh (Sally); C. Garvey (Chris); R. Zu Wallack (Richard); L. Nici (Linda); C. Rochester (Carolyn); K. Hill (Kylie); A.E. Holland (Anne); S.C. Lareau (Suzanne); W.D.-C. Man (William); F. Pitta (Fabio); L. Sewell (Louise); J. Raskin (Jonathan); J. Bourbeau (Jean); R. Crouch (Rebecca); F.M.E. Franssen (Frits); R. Casaburi (Richard); J.H. Vercoulen (Jan); I. Vogiatzis (Ioannis); R.A.A.M. Gosselink (Rik); E.M. Clini (Enrico); T.W. Effing (Tanja); F. Maltais (François); J. van der Palen (Job); T. Troosters; D.J.A. Janssen (Daisy); E. Collins (Eileen); J. Garcia-Aymerich (Judith); D. Brooks (Dina); B.F. Fahy (Bonnie); M.A. Puhan (Milo); M. Hoogendoorn (Martine); R. Garrod (Rachel); A.M.W.J. Schols (Annemie); B. Carlin (Brian); R. Benzo (Roberto); P. Meek (Paula); M. Morgan (Mike); M.P.M.H. Rutten-van Mölken (Maureen); A.L. Ries (Andrew); B. Make (Barry); R.S. Goldstein (Roger); C.A. Dowson (Claire); J.L. Brozek (Jan); C.F. Donner (Claudio); E.F.M. Wouters (Emiel)

    2013-01-01

    textabstractBackground: Pulmonary rehabilitation is recognized as a core component of themanagement of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable

  1. Enhancing Canadian Civil Society Research and Knowledge-Based ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Enhancing Canadian Civil Society Research and Knowledge-Based Practice in a Rapidly Changing Landscape for International Development ... Women in the developing world continue to face obstacles that limit their ability to establish careers and become leaders in the fields of science, technology, engineering, and ...

  2. Successful linking of the Society of Thoracic Surgeons Database to Social Security data to examine the accuracy of Society of Thoracic Surgeons mortality data.

    Science.gov (United States)

    Jacobs, Jeffrey P; O'Brien, Sean M; Shahian, David M; Edwards, Fred H; Badhwar, Vinay; Dokholyan, Rachel S; Sanchez, Juan A; Morales, David L; Prager, Richard L; Wright, Cameron D; Puskas, John D; Gammie, James S; Haan, Constance K; George, Kristopher M; Sheng, Shubin; Peterson, Eric D; Shewan, Cynthia M; Han, Jane M; Bongiorno, Phillip A; Yohe, Courtney; Williams, William G; Mayer, John E; Grover, Frederick L

    2013-04-01

    The Society of Thoracic Surgeons Adult Cardiac Surgery Database has been linked to the Social Security Death Master File to verify "life status" and evaluate long-term surgical outcomes. The objective of this study is explore practical applications of the linkage of the Society of Thoracic Surgeons Adult Cardiac Surgery Database to Social Securtiy Death Master File, including the use of the Social Securtiy Death Master File to examine the accuracy of the Society of Thoracic Surgeons 30-day mortality data. On January 1, 2008, the Society of Thoracic Surgeons Adult Cardiac Surgery Database began collecting Social Security numbers in its new version 2.61. This study includes all Society of Thoracic Surgeons Adult Cardiac Surgery Database records for operations with nonmissing Social Security numbers between January 1, 2008, and December 31, 2010, inclusive. To match records between the Society of Thoracic Surgeons Adult Cardiac Surgery Database and the Social Security Death Master File, we used a combined probabilistic and deterministic matching rule with reported high sensitivity and nearly perfect specificity. Between January 1, 2008, and December 31, 2010, the Society of Thoracic Surgeons Adult Cardiac Surgery Database collected data for 870,406 operations. Social Security numbers were available for 541,953 operations and unavailable for 328,453 operations. According to the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the 30-day mortality rate was 17,757/541,953 = 3.3%. Linkage to the Social Security Death Master File identified 16,565 cases of suspected 30-day deaths (3.1%). Of these, 14,983 were recorded as 30-day deaths in the Society of Thoracic Surgeons database (relative sensitivity = 90.4%). Relative sensitivity was 98.8% (12,863/13,014) for suspected 30-day deaths occurring before discharge and 59.7% (2120/3551) for suspected 30-day deaths occurring after discharge. Linkage to the Social Security Death Master File confirms the accuracy of

  3. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline

    DEFF Research Database (Denmark)

    Girard, Timothy D; Alhazzani, Waleed; Kress, John P

    2017-01-01

    BACKGROUND: Interventions that lead to earlier liberation from mechanical ventilation can improve patient outcomes. This guideline, a collaborative effort between the American Thoracic Society (ATS) and the American College of Chest Physicians (CHEST), provides evidence-based recommendations to o...

  4. The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 1-Statistical Methodology

    National Research Council Canada - National Science Library

    O'Brien, Sean M; Jacobs, Jeffrey P; Pasquali, Sara K; Gaynor, J William; Karamlou, Tara; Welke, Karl F; Filardo, Giovanni; Han, Jane M; Kim, Sunghee; Shahian, David M; Jacobs, Marshall L

    2015-01-01

    ... after congenital cardiac operations. Included were patients of all ages undergoing cardiac operations, with or without cardiopulmonary bypass, at centers participating in The Society of Thoracic Surgeons Congenital Heart Surgery Data...

  5. The Canadian Atherosclerosis Society--history and present status.

    Science.gov (United States)

    Haust, M D

    1991-10-01

    Since its inception in 1983 the Canadian Atherosclerosis Society (CAS) has established itself firmly on the national and international scene as a forceful scientific voice. Its presence and activities have had their dominant expression at annual meetings held jointly with the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Canadian Society for Clinical Investigation (CSCI) and in sponsoring other scientific and educational events, the most important of which was the Canadian Consensus Conference on Cholesterol (Ottawa, March 1988). It provided a forum for interaction between the scientific community, government, funding agencies, industry and the general public, and culminated in concrete recommendations for the populace of Canada. It also 'induced' a continuum in governmental and public concern for health with respect to atherosclerosis, and beyond it, the field of cardiovascular diseases. This dialogue continues. As a member (Constituent Society) of the International Atherosclerosis Society (IAS), the CAS has a voice in the international community, its policies and activities. The membership increase from 69 in 1983 to 175 in 1991 reflects steady growth of the CAS. The Society has been active in other areas (publications, awards for young investigators, and common educational endeavours with other groups) and will be host to the 1994 International Symposium on Atherosclerosis. Over a short period of only eight years, all of the above attests to sufficient progress (or achievement) for any scientific society. And yet, there remain quite a few areas not addressed as yet and some sad experiences (eg, that with the Long Term Planning Committee) that must be quickly remedied, if the Society is to keep pace with the everchanging emphasis in research that in the final analysis aims at improving the overall well-being and health of all Canadians. Inherent in the definition of history is the premise that accounts be provided of facts only. Historians

  6. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation

    NARCIS (Netherlands)

    Spruit, M.A.; Singh, S.J.; Garvey, C.; ZuWallack, R.; Nici, L.; Rochester, C.; Hill, K.; Holland, A.E.; Lareau, S.C.; Man, W.D.; Pitta, F.; Sewell, L.; Raskin, J.; Bourbeau, J.; Crouch, R.; Franssen, F.M.; Casaburi, R.; Vercoulen, J.H.M.M.; Vogiatzis, I.; Gosselink, R.; Clini, E.M.; Effing, T.W.; Maltais, F.; Palen, J.A.M. van der; Troosters, T.; Janssen, D.J.; Collins, E.; Garcia-Aymerich, J.; Brooks, D.; Fahy, B.F.; Puhan, M.A.; Hoogendoorn, M.; Garrod, R.; Schols, A.M.W.J.; Carlin, B.; Benzo, R.; Meek, P.; Morgan, M.; Molken, M.P. Rutten-van; Ries, A.L.; Make, B.; Goldstein, R.S.; Dowson, C.A.; Brozek, J.L.; Donner, C.F.; Wouters, E.F.; Rehabilitation, A.E.T.F.o.P.

    2013-01-01

    BACKGROUND: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our

  7. An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation

    NARCIS (Netherlands)

    Spruit, Martijn A.; Singh, Sally J.; Garvey, Chris; ZuWallack, Richard; Nici, Linda; Rochester, Carolyn; Hill, Kylie; Holland, Anne E.; Lareau, Suzanne C.; Man, W.D.C.; Pitta, Fabio; Sewell, Louise; Raskin, Jonathan; Bourbeau, Jean; Crouch, Rebecca; Franssen, Frits M.E.; Casaburi, Richard; Vercoulen, Jan H.; Vogiatzit, Ioannis; Gosselink, Rik; Clini, Enrico M.; Effing, T.W.; Maltais, Francois; van der Palen, Jacobus Adrianus Maria; Troosters, Thierry; Janssen, Daisy J.A.; Collins, Eileen; Garcia-Aymerich, Judith; Brooks, Dina; Fahy, Bonnie F.; Puhan, Milo A.; Hoogendoorn, Martine; Garrod, Rachel; Schols, Annemie M.W.J.; Carlin, Brian; Benzo, Roberto; Meek, Paula; Morgan, Mike; Rutten-van Mölken, Maureen P.M.H.; Ries, Andrew L.; Make, Barry; Goldstein, Roger S.; Dowson, Claire A.; Brozek, Jan L.; Donner, Claudio F.; Wouters, Emiel F.M.

    2013-01-01

    Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our

  8. An official American Thoracic Society/European Respiratory Society statement: research questions in COPD.

    Science.gov (United States)

    Celli, Bartolome R; Decramer, Marc; Wedzicha, Jadwiga A; Wilson, Kevin C; Agustí, Alvar; Criner, Gerard J; MacNee, William; Make, Barry J; Rennard, Stephen I; Stockley, Robert A; Vogelmeier, Claus; Anzueto, Antonio; Au, David H; Barnes, Peter J; Burgel, Pierre-Regis; Calverley, Peter M; Casanova, Ciro; Clini, Enrico M; Cooper, Christopher B; Coxson, Harvey O; Dusser, Daniel J; Fabbri, Leonardo M; Fahy, Bonnie; Ferguson, Gary T; Fisher, Andrew; Fletcher, Monica J; Hayot, Maurice; Hurst, John R; Jones, Paul W; Mahler, Donald A; Maltais, François; Mannino, David M; Martinez, Fernando J; Miravitlles, Marc; Meek, Paula M; Papi, Alberto; Rabe, Klaus F; Roche, Nicolas; Sciurba, Frank C; Sethi, Sanjay; Siafakas, Nikos; Sin, Don D; Soriano, Joan B; Stoller, James K; Tashkin, Donald P; Troosters, Thierry; Verleden, Geert M; Verschakelen, Johny; Vestbo, Jorgen; Walsh, John W; Washko, George R; Wise, Robert A; Wouters, Emiel F M; ZuWallack, Richard L

    2015-04-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified. Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes. Copyright ©ATS/ERS 2015.

  9. An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

    Directory of Open Access Journals (Sweden)

    Bartolome R. Celli

    2015-06-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a leading cause of morbidity, mortality and resource use worldwide. The goal of this official American Thoracic Society (ATS/European Respiratory Society (ERS Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. Clinicians, researchers and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified. Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers and patient advocates believe will have the greatest impact on patient-centred outcomes.

  10. Canadian Council for Area Studies Learned Societies - 2007-2008 ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    CCASLS) provides a shared secretariat for four area studies associations: the Canadian Association of African Studies (CAAS); the Canadian Asian Studies Association (CASA): the Canadian Association of Latin American and Caribbean Studies ...

  11. The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis

    OpenAIRE

    Hamdan Al-Jahdali; Abdullah Alshimemeri; Abdullah Mobeireek; Albanna, Amr S.; Al Shirawi, Nehad N.; Siraj Wali; Khaled Alkattan; Alrajhi, Abdulrahman A.; Khalid Mobaireek; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.; Chang, Anne B; Stefano Aliberti

    2017-01-01

    This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to...

  12. Abstracts from the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society Quebec City, April 2012

    OpenAIRE

    Auais, M.; Morin, S.; Finch, L.; Sara, A.; Mayo, N.; Charise, A.; Islam, A.; Muir, Susan; Montero-Odasso, Manuel; Kennedy, C.C.; Papaioannou, A.; Ioannidis, G.; Giangregorio, L.M.; Adachi, J.D.; Thabane, L.

    2012-01-01

    The opinions expressed in the abstracts are those of the authors and are not to be construed as the opinion of the publisher (Canadian Geriatrics Society) or the organizers of the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society. Although the publisher (Canadian Geriatrics Society) has made every effort to accurately reproduce the abstracts, the Canadian Geriatrics Society and the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society assumes no responsibility and/...

  13. Canadian Pain Society Position Statement on Pain Relief

    Directory of Open Access Journals (Sweden)

    Judith H Watt-Watson

    1999-01-01

    Full Text Available The present report outlines key requirements that are central to helping patients manage pain effectively. Although current standards are available as guides for practice, the prevalence of pain suggests that many health professionals do not know and/or cannot relate to these standards. Therefore, a brief, pragmatic statement may be more useful initially for health professionals and patients learning about problematic pain outcomes. The principles in the brief statement produced by the Canadian Pain Society clarify and emphasize key underlying assumptions that have directed the development of many pain standards. The aim of the present paper is to increase awareness of ineffective pain practices and the importance of pain relief, and to stimulate further work in this area.

  14. Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society.

    Science.gov (United States)

    Abman, Steven H; Hansmann, Georg; Archer, Stephen L; Ivy, D Dunbar; Adatia, Ian; Chung, Wendy K; Hanna, Brian D; Rosenzweig, Erika B; Raj, J Usha; Cornfield, David; Stenmark, Kurt R; Steinhorn, Robin; Thébaud, Bernard; Fineman, Jeffrey R; Kuehne, Titus; Feinstein, Jeffrey A; Friedberg, Mark K; Earing, Michael; Barst, Robyn J; Keller, Roberta L; Kinsella, John P; Mullen, Mary; Deterding, Robin; Kulik, Thomas; Mallory, George; Humpl, Tilman; Wessel, David L

    2015-11-24

    Pulmonary hypertension is associated with diverse cardiac, pulmonary, and systemic diseases in neonates, infants, and older children and contributes to significant morbidity and mortality. However, current approaches to caring for pediatric patients with pulmonary hypertension have been limited by the lack of consensus guidelines from experts in the field. In a joint effort from the American Heart Association and American Thoracic Society, a panel of experienced clinicians and clinician-scientists was assembled to review the current literature and to make recommendations on the diagnosis, evaluation, and treatment of pediatric pulmonary hypertension. This publication presents the results of extensive literature reviews, discussions, and formal scoring of recommendations for the care of children with pulmonary hypertension. © 2015 by the American Heart Association, Inc., and the American Thoracic Society.

  15. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument.

    Science.gov (United States)

    Petcharaporn, Maty; Pawelek, Jeff; Bastrom, Tracey; Lonner, Baron; Newton, Peter O

    2007-09-15

    A retrospective chart review and radiographic analysis. To evaluate the association between thoracic hyperkyphosis and patient quality of life measures as determined by the Scoliosis Research Society (SRS) outcomes instrument. Although validated outcomes questionnaires (e.g., Pediatric Outcomes Data Collection Instrument and SRS) have been used to evaluate patients with scoliosis, there has been little written about the effects of sagittal plane alignment on these functional outcome measurements. Data from the SRS outcomes instrument were collected from patients with thoracic hyperkyphosis as well as those with normal spinal alignment. A total of 50 patients with thoracic kyphosis >or=45 degrees were compared with 50 normal patients with thoracic kyphosis hyperkyphosis were significantly more symptomatic than normal subjects in all domains. The r values for this analysis of kyphosis (0.40-0.66), in fact were substantially greater than those previously reported for scoliosis magnitude versus SRS Questionnaire scores (0.16-0.26), suggesting this instrument may be even better suited for the evaluation of hyperkyphosis patients.

  16. The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis

    Directory of Open Access Journals (Sweden)

    Hamdan Al-Jahdali

    2017-01-01

    Full Text Available This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to develop recommendations about management of bronchiectasis suitable to our local health-care system and available resources. We aim to provide clinicians with tools to standardize the diagnosis and management of bronchiectasis. This guideline targets primary care physicians, family medicine practitioners, practicing internists and respiratory physicians, and all other health-care providers involved in the care of the patients with bronchiectasis.

  17. Canadian Civil Society Organizations Influencing Policy and Practice

    International Development Research Centre (IDRC) Digital Library (Canada)

    IDRC CRDI

    those of the author(s), and do not necessarily represent those of IDRC or its Board of Governors. Canadian ...... The literature on policy-making is in many ways intertwined with what has been written on research ...... the access to education for indigenous girls, the consequences of the armed conflict on indigenous women ...

  18. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2017 Update on Outcomes and Quality.

    Science.gov (United States)

    Jacobs, Jeffrey P; Mayer, John E; Mavroudis, Constantine; O'Brien, Sean M; Austin, Erle H; Pasquali, Sara K; Hill, Kevin D; Overman, David M; St Louis, James D; Karamlou, Tara; Pizarro, Christian; Hirsch-Romano, Jennifer C; McDonald, Donna; Han, Jane M; Becker, Susan; Tchervenkov, Christo I; Lacour-Gayet, Francois; Backer, Carl L; Fraser, Charles D; Tweddell, James S; Elliott, Martin J; Walters, Hal; Jonas, Richard A; Prager, Richard L; Shahian, David M; Jacobs, Marshall L

    2017-03-01

    The Society of Thoracic Surgeons Congenital Heart Surgery Database is the largest congenital and pediatric cardiac surgical clinical data registry in the world. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and the improvement of quality in this subspecialty. This report summarizes current aggregate national outcomes in congenital and pediatric cardiac surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency. The reported data about aggregate national outcomes are exemplified by an analysis of 10 benchmark operations performed from January 2012 to December 2015. This analysis documents the overall aggregate operative mortality (interquartile range among all participating programs) for the following procedural groups: off-bypass coarctation repair, 1.3% (0.0% to 1.8%); ventricular septal defect repair, 0.6% (0.0% to 0.9%); tetralogy of Fallot repair, 1.1% (0.0% to 1.4%); complete atrioventricular canal repair, 3.0% (0.0% to 4.7%); arterial switch operation, 2.7% (0.0% to 4.1%); arterial switch operation and ventricular septal defect repair, 5.3% (0.0% to 6.7%); Glenn/hemi-Fontan, 2.5% (0.0% to 4.5%); Fontan operation, 1.2% (0.0% to 1.2%); truncus arteriosus repair, 9.4% (0.0% to 16.7%); and Norwood procedure, 15.7% (8.9% to 25.0%). Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 2-Clinical Application.

    Science.gov (United States)

    Jacobs, Jeffrey P; O'Brien, Sean M; Pasquali, Sara K; Gaynor, J William; Mayer, John E; Karamlou, Tara; Welke, Karl F; Filardo, Giovanni; Han, Jane M; Kim, Sunghee; Quintessenza, James A; Pizarro, Christian; Tchervenkov, Christo I; Lacour-Gayet, Francois; Mavroudis, Constantine; Backer, Carl L; Austin, Erle H; Fraser, Charles D; Tweddell, James S; Jonas, Richard A; Edwards, Fred H; Grover, Frederick L; Prager, Richard L; Shahian, David M; Jacobs, Marshall L

    2015-09-01

    The empirically derived 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model incorporates adjustment for procedure type and patient-specific factors. The purpose of this report is to describe this model and its application in the assessment of variation in outcomes across centers. All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010, to December 31, 2013) were eligible for inclusion. Isolated patent ductus arteriosus closures in patients weighing less than or equal to 2.5 kg were excluded, as were centers with more than 10% missing data and patients with missing data for key variables. The model includes the following covariates: primary procedure, age, any prior cardiovascular operation, any noncardiac abnormality, any chromosomal abnormality or syndrome, important preoperative factors (mechanical circulatory support, shock persisting at time of operation, mechanical ventilation, renal failure requiring dialysis or renal dysfunction (or both), and neurological deficit), any other preoperative factor, prematurity (neonates and infants), and weight (neonates and infants). Variation across centers was assessed. Centers for which the 95% confidence interval for the observed-to-expected mortality ratio does not include unity are identified as lower-performing or higher-performing programs with respect to operative mortality. Included were 52,224 operations from 86 centers. Overall discharge mortality was 3.7% (1,931 of 52,224). Discharge mortality by age category was neonates, 10.1% (1,129 of 11,144); infants, 3.0% (564 of 18,554), children, 0.9% (167 of 18,407), and adults, 1.7% (71 of 4,119). For all patients, 12 of 86 centers (14%) were lower-performing programs, 67 (78%) were not outliers, and 7 (8%) were higher-performing programs. The 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model facilitates description of outcomes

  20. British Thoracic Society Paediatric Pneumonia Audit: a review of 3 years of data.

    Science.gov (United States)

    Bowen, Sarah-Jane M; Thomson, Anne H

    2013-07-01

    The British Thoracic Society (BTS) guidelines for the management of community-acquired pneumonia in children are used as the audit standard for the annual BTS Paediatric Pneumonia Audit. This report examines 3 years of data from this national audit, highlighting trends in clinical practice and the impact of the 2011 revisions to the BTS guidelines. The findings suggest an over-reliance on investigations to diagnose pneumonia and underuse of oral antibiotics, particularly amoxicillin. There is inappropriate use of chest physiotherapy, outpatient appointments and repeat chest x-rays. Increasing adherence to the BTS guidelines would improve care and also preserve valuable secondary care resources.

  1. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines.

    Science.gov (United States)

    Ferraris, Victor A; Brown, Jeremiah R; Despotis, George J; Hammon, John W; Reece, T Brett; Saha, Sibu P; Song, Howard K; Clough, Ellen R; Shore-Lesserson, Linda J; Goodnough, Lawrence T; Mazer, C David; Shander, Aryeh; Stafford-Smith, Mark; Waters, Jonathan; Baker, Robert A; Dickinson, Timothy A; FitzGerald, Daniel J; Likosky, Donald S; Shann, Kenneth G

    2011-03-01

    Practice guidelines reflect published literature. Because of the ever changing literature base, it is necessary to update and revise guideline recommendations from time to time. The Society of Thoracic Surgeons recommends review and possible update of previously published guidelines at least every three years. This summary is an update of the blood conservation guideline published in 2007. The search methods used in the current version differ compared to the previously published guideline. Literature searches were conducted using standardized MeSH terms from the National Library of Medicine PUBMED database list of search terms. The following terms comprised the standard baseline search terms for all topics and were connected with the logical 'OR' connector--Extracorporeal circulation (MeSH number E04.292), cardiovascular surgical procedures (MeSH number E04.100), and vascular diseases (MeSH number C14.907). Use of these broad search terms allowed specific topics to be added to the search with the logical 'AND' connector. In this 2011 guideline update, areas of major revision include: 1) management of dual anti-platelet therapy before operation, 2) use of drugs that augment red blood cell volume or limit blood loss, 3) use of blood derivatives including fresh frozen plasma, Factor XIII, leukoreduced red blood cells, platelet plasmapheresis, recombinant Factor VII, antithrombin III, and Factor IX concentrates, 4) changes in management of blood salvage, 5) use of minimally invasive procedures to limit perioperative bleeding and blood transfusion, 6) recommendations for blood conservation related to extracorporeal membrane oxygenation and cardiopulmonary perfusion, 7) use of topical hemostatic agents, and 8) new insights into the value of team interventions in blood management. Much has changed since the previously published 2007 STS blood management guidelines and this document contains new and revised recommendations. Copyright © 2011 The Society of Thoracic

  2. Analysis of regional congenital cardiac surgical outcomes in Florida using the Society of Thoracic Surgeons Congenital Heart Surgery Database.

    Science.gov (United States)

    Jacobs, Jeffrey P; Quintessenza, James A; Burke, Redmond P; Bleiweis, Mark S; Byrne, Barry J; Ceithaml, Eric L; Decampli, William M; Giroud, Jorge M; Perryman, Richard A; Rosenkranz, Eliot R; Wolff, Grace; Posner, Vicki; Steverson, Sue; Blanchard, William B; Schiebler, Gerry L

    2009-08-01

    Florida is the fourth largest state in the United States of America. In 2004, 218,045 live babies were born in Florida, accounting for approximately 1744 new cases of congenital heart disease. We review the initial experience of The Society of Thoracic Surgeons Congenital Heart Surgery Database with a regional outcomes report, namely the Society of Thoracic Surgeons Florida Regional Report. Eight centres in Florida provide services for congenital cardiac surgery. The Children's Medical Services of Florida provide a framework for quality improvement collaboration between centres. All congenital cardiac surgical centres in Florida have voluntarily agreed to submit data to the Society of Thoracic Surgeons Database. The Society of Thoracic Surgeons and Duke Clinical Research Institute prepared a Florida Regional Report to allow detailed regional analysis of outcomes for congenital cardiac surgery. The report of 2007 from the Society of Thoracic Surgeons Congenital Heart Surgery Database includes details of 61,014 operations performed during the 4 year data harvest window, which extended from 2003 through 2006. Of these operations, 6,385 (10.5%) were performed in Florida. Discharge mortality in the data from Florida overall, and from each Florida site, with 95% confidence intervals, is not different from cumulative data from the entire Society of Thoracic Surgeons Database, both for all patients and for patients stratified by complexity. A regional consortium of congenital heart surgery centres in Florida under the framework of the Children's Medical Services has allowed for inter-institutional collaboration with the goal of quality improvement. This experience demonstrates, first, that the database maintained by the Society of Thoracic Surgeons can provide the framework for regional analysis of outcomes, and second, that voluntary regional collaborative efforts permit the pooling of data for such analysis.

  3. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.

    Science.gov (United States)

    Spruit, Martijn A; Singh, Sally J; Garvey, Chris; ZuWallack, Richard; Nici, Linda; Rochester, Carolyn; Hill, Kylie; Holland, Anne E; Lareau, Suzanne C; Man, William D-C; Pitta, Fabio; Sewell, Louise; Raskin, Jonathan; Bourbeau, Jean; Crouch, Rebecca; Franssen, Frits M E; Casaburi, Richard; Vercoulen, Jan H; Vogiatzis, Ioannis; Gosselink, Rik; Clini, Enrico M; Effing, Tanja W; Maltais, François; van der Palen, Job; Troosters, Thierry; Janssen, Daisy J A; Collins, Eileen; Garcia-Aymerich, Judith; Brooks, Dina; Fahy, Bonnie F; Puhan, Milo A; Hoogendoorn, Martine; Garrod, Rachel; Schols, Annemie M W J; Carlin, Brian; Benzo, Roberto; Meek, Paula; Morgan, Mike; Rutten-van Mölken, Maureen P M H; Ries, Andrew L; Make, Barry; Goldstein, Roger S; Dowson, Claire A; Brozek, Jan L; Donner, Claudio F; Wouters, Emiel F M

    2013-10-15

    Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.

  4. American Thoracic Society-European Respiratory Society Classification of the Idiopathic Interstitial Pneumonias: Advances in Knowledge since 2002.

    Science.gov (United States)

    Sverzellati, Nicola; Lynch, David A; Hansell, David M; Johkoh, Takeshi; King, Talmadge E; Travis, William D

    2015-01-01

    In the updated American Thoracic Society-European Respiratory Society classification of the idiopathic interstitial pneumonias (IIPs), the major entities have been preserved and grouped into (a) "chronic fibrosing IIPs" (idiopathic pulmonary fibrosis and idiopathic nonspecific interstitial pneumonia), (b) "smoking-related IIPs" (respiratory bronchiolitis-associated interstitial lung disease and desquamative interstitial pneumonia), (c) "acute or subacute IIPs" (cryptogenic organizing pneumonia and acute interstitial pneumonia), and (d) "rare IIPs" (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis). Furthermore, it has been acknowledged that a final diagnosis is not always achievable, and the category "unclassifiable IIP" has been proposed. The diagnostic interpretation of the IIPs is often challenging because other diseases with a known etiology (most notably, connective tissue disease and hypersensitivity pneumonitis) may show similar morphologic patterns. Indeed, more emphasis has been given to the integration of clinical, computed tomographic (CT), and pathologic findings for multidisciplinary diagnosis. Typical CT-based morphologic patterns are associated with the IIPs, and radiologists play an important role in diagnosis and characterization. Optimal CT quality and a systematic approach are both pivotal for evaluation of IIP. Interobserver variation for the various patterns encountered in the IIPs is an issue. It is important for radiologists to understand the longitudinal behavior of IIPs at serial CT examinations, especially for providing a framework for cases that are unclassifiable or in which a histologic diagnosis cannot be obtained. (©)RSNA, 2015.

  5. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation.

    Science.gov (United States)

    Rochester, Carolyn L; Vogiatzis, Ioannis; Holland, Anne E; Lareau, Suzanne C; Marciniuk, Darcy D; Puhan, Milo A; Spruit, Martijn A; Masefield, Sarah; Casaburi, Richard; Clini, Enrico M; Crouch, Rebecca; Garcia-Aymerich, Judith; Garvey, Chris; Goldstein, Roger S; Hill, Kylie; Morgan, Michael; Nici, Linda; Pitta, Fabio; Ries, Andrew L; Singh, Sally J; Troosters, Thierry; Wijkstra, Peter J; Yawn, Barbara P; ZuWallack, Richard L

    2015-12-01

    Pulmonary rehabilitation (PR) has demonstrated physiological, symptom-reducing, psychosocial, and health economic benefits for patients with chronic respiratory diseases, yet it is underutilized worldwide. Insufficient funding, resources, and reimbursement; lack of healthcare professional, payer, and patient awareness and knowledge; and additional patient-related barriers all contribute to the gap between the knowledge of the science and benefits of PR and the actual delivery of PR services to suitable patients. The objectives of this document are to enhance implementation, use, and delivery of pulmonary rehabilitation to suitable individuals worldwide. Members of the American Thoracic Society (ATS) Pulmonary Rehabilitation Assembly and the European Respiratory Society (ERS) Rehabilitation and Chronic Care Group established a Task Force and writing committee to develop a policy statement on PR. The document was modified based on feedback from expert peer reviewers. After cycles of review and revisions, the statement was reviewed and formally approved by the Board of Directors of the ATS and the Science Council and Executive Committee of the ERS. This document articulates policy recommendations for advancing healthcare professional, payer, and patient awareness and knowledge of PR, increasing patient access to PR, and ensuring quality of PR programs. It also recommends areas of future research to establish evidence to support the development of an updated funding and reimbursement policy regarding PR. The ATS and ERS commit to undertake actions that will improve access to and delivery of PR services for suitable patients. They call on their members and other health professional societies, payers, patients, and patient advocacy groups to join in this commitment.

  6. The effect of the perioperative blood transfusion and blood conservation in cardiac surgery Clinical Practice Guidelines of the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists upon clinical practices.

    Science.gov (United States)

    Likosky, Donald S; FitzGerald, Daniel C; Groom, Robert C; Jones, Dwayne K; Baker, Robert A; Shann, Kenneth G; Mazer, C David; Spiess, Bruce D; Body, Simon C

    2010-06-01

    The 2007 Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Clinical Practice Guideline for Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery was recently promulgated and has received much attention. Using a survey of cardiac anesthesiologists and perfusionists' clinical practice, we assessed the current practices of perfusion, anesthesia, and surgery, as recommended by the Guidelines and also determined the role the Guidelines had in changing these practices. Nontrainee members of the Society of Cardiovascular Anesthesiologists, the American Academy of Cardiovascular Perfusion, the Canadian Society of Clinical Perfusion, and the American Society of ExtraCorporeal Technology were surveyed using a standardized survey instrument that examined clinical practices and responses to the Guidelines. One thousand four hundred and two surveys from 1,061 institutions principally in the United States (677 institutions) and Canada (34 institutions) were returned, with a 32% response rate. There was wide distribution of the Guidelines with 78% of anesthesiologists and 67% of perfusionists reporting having read all, part, or a summary of the Guidelines. However, only 20% of respondents reported that an institutional discussion had taken place as a result of the Guidelines, and only 14% of respondents reported that an institutional monitoring group had been formed. There was wide variability in current preoperative testing, perfusion, surgical, and pharmacological practices reported by respondents. Twenty-six percent of respondents reported one or more practice changes in response to the Guidelines.The changes made were reported to be highly (9%) or somewhat effective (31%) in reducing overall transfusion rates. Only four of 38 Guideline recommendations were reported by more than 5% of respondents to have been changed in response to the Guidelines. Wide variation in clinical practices of cardiac surgery was reported. Little

  7. Effect of the perioperative blood transfusion and blood conservation in cardiac surgery clinical practice guidelines of the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists upon clinical practices.

    Science.gov (United States)

    Likosky, Donald S; FitzGerald, Daniel C; Groom, Robert C; Jones, Dwayne K; Baker, Robert A; Shann, Kenneth G; Mazer, C David; Spiess, Bruce D; Body, Simon C

    2010-08-01

    The 2007 Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Clinical Practice Guideline for Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery was recently promulgated and has received much attention. Using a survey of cardiac anesthesiologists and perfusionists' clinical practice, we aimed to assess the current practices of perfusion, anesthesia, and surgery, as recommended by the Guidelines, and to also determine the role the Guidelines had in changing these practices. Nontrainee members of the Society of Cardiovascular Anesthesiologists, the American Academy of Cardiovascular Perfusion, the Canadian Society of Clinical Perfusion, and the American Society of ExtraCorporeal Technology were surveyed using a standardized survey instrument that examined clinical practices and responses to the Guidelines. A total of 1402 surveys from 1061 institutions principally in the United States (677 institutions) and Canada (34 institutions) were returned, a 32% response rate. There was wide distribution of the Guidelines with 78% of anesthesiologists and 67% of perfusionists reporting having read all, part, or a summary of the Guidelines. However, only 20% of respondents reported that an institutional discussion had taken place as a result of the Guidelines, and only 14% of respondents reported that an institutional monitoring group had been formed. There was wide variability in current preoperative testing, perfusion, surgical, and pharmacological practices reported by respondents. Twenty-six percent of respondents reported 1 or more practice changes in response to the Guidelines. The changes made were reported to be highly (9%) or somewhat (31%) effective in reducing overall transfusion rates. Only 4 of 38 Guideline recommendations were reported by >5% of respondents to have been changed in response to the Guidelines. Wide variation in clinical practices of cardiac surgery was reported. Little change in clinical practices

  8. Korean Society of Thoracic Radiology Guideline for Lung Cancer Screening with Low-Dose CT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Ju [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Kim, Jin Hwan [Dept. of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon (Korea, Republic of); Kim, Yoon Kyung [Dept. of Radiology, Gachon University Gil Medical Center, Incheon (Korea, Republic of); Park, Chang Min [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeong, Yeon Joo [Dept. of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan (Korea, Republic of)

    2012-09-15

    The National Lung Screening Trial (NLST), a nation-wide randomized controlled trial involving more than 50,000 current and former heavy smokers ages 55 to 74, compared the effects of two screening procedures (low-dose helical CT and standard chest radiography) on lung cancer mortality and found 20 percent fewer lung cancer deaths among trial participants screened with low-dose CT. Korean Society of Thoracic Radiology (KSTR) planned to establish an effective guideline for lung cancer screening with low-dose CT to improve health of Korean people and to reduce harms from misuse of lung cancer screening with low-dose CT. KSTR guideline for lung cancer screening with low-dose CT established based on objective medical evidences obtained by NLST.

  9. Adults miscoded and misdiagnosed as having pneumonia: results from the British Thoracic Society pneumonia audit.

    Science.gov (United States)

    Daniel, Priya; Bewick, Thomas; Welham, Sally; Mckeever, Tricia M; Lim, Wei Shen

    2017-04-01

    A key objective of the British Thoracic Society national community-acquired pneumonia (CAP) audit was to determine the clinical characteristics and outcomes of hospitalised adults given a primary discharge code of pneumonia but who did not fulfil accepted diagnostic criteria for pneumonia. Adults miscoded as having pneumonia (n=1251) were older compared with adults with CAP (n=6660) (median 80 vs 78 years, p<0.001) and had more comorbid disease, significantly fewer respiratory symptoms (fever, cough, dyspnoea, pleuritic pain), more constitutional symptoms (general deterioration, falls) and significantly lower 30-day inpatient mortality (14.3% vs 17.0%, adjusted OR 0.75, p=0.003). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Official American Thoracic Society technical standards: flexible airway endoscopy in children.

    Science.gov (United States)

    Faro, Albert; Wood, Robert E; Schechter, Michael S; Leong, Albin B; Wittkugel, Eric; Abode, Kathy; Chmiel, James F; Daines, Cori; Davis, Stephanie; Eber, Ernst; Huddleston, Charles; Kilbaugh, Todd; Kurland, Geoffrey; Midulla, Fabio; Molter, David; Montgomery, Gregory S; Retsch-Bogart, George; Rutter, Michael J; Visner, Gary; Walczak, Stephen A; Ferkol, Thomas W; Michelson, Peter H

    2015-05-01

    Flexible airway endoscopy (FAE) is an accepted and frequently performed procedure in the evaluation of children with known or suspected airway and lung parenchymal disorders. However, published technical standards on how to perform FAE in children are lacking. The American Thoracic Society (ATS) approved the formation of a multidisciplinary committee to delineate technical standards for performing FAE in children. The committee completed a pragmatic synthesis of the evidence and used the evidence synthesis to answer clinically relevant questions. There is a paucity of randomized controlled trials in pediatric FAE. The committee developed recommendations based predominantly on the collective clinical experience of our committee members highlighting the importance of FAE-specific airway management techniques and anesthesia, establishing suggested competencies for the bronchoscopist in training, and defining areas deserving further investigation. These ATS-sponsored technical standards describe the equipment, personnel, competencies, and special procedures associated with FAE in children.

  11. Respiratory health equality in the United States. The American thoracic society perspective.

    Science.gov (United States)

    Celedón, Juan C; Roman, Jesse; Schraufnagel, Dean E; Thomas, Alvin; Samet, Jonathan

    2014-05-01

    Because the frequency of major risk factors for respiratory diseases (e.g., tobacco use) differs across demographic groups (defined by socioeconomic status, race/ethnicity, sexual orientation, health care access, occupation, or other characteristics), health disparities are commonly encountered in pediatric and adult pulmonary, critical care, and sleep medicine. As part of its policy on respiratory health disparities, the American Thoracic Society (ATS) Executive Committee created a Health Equality Subcommittee of the Health Policy Committee, with an initial mandate of defining respiratory health equality and, as a subsequent task, providing recommendations to the ATS leadership as to how our society may help attain such equality in the United States. After receiving input from the ATS assemblies and committees, the subcommittee developed this document on respiratory health equality. This document defines respiratory health disparities and respiratory health equality, and expands on a recent ATS and European Respiratory Society policy statement on disparities in respiratory health. Attainment of respiratory health equality requires the ending of respiratory health disparities, which can be achieved only through multidisciplinary efforts to eliminate detrimental environmental exposures while promoting a healthy lifestyle, implementing all components of high-quality health care (prevention, screening, diagnosis, and treatment), and conducting research that will lead to better prevention and management of respiratory diseases for everyone. The ATS recognizes that such efforts must include all stakeholders: members of society at large, governmental and nongovernmental organizations, and other professional societies. The ATS urges all of its members and those of sister societies to work to achieve this laudable goal.

  12. Impacts of the Canadian Evaluation Society's Evaluation Competitions for Students: Guest Editors' Introduction.

    Science.gov (United States)

    Obrecht, Michael; Porteous, Nancy L.

    2003-01-01

    Introduces the special section on the Student Paper Contest and the Case Competition sponsored by the Canadian Evaluation Society to foster the development of evaluators. The articles are written by former participants and include reflections on the value of the competition for evaluator development. (SLD)

  13. An Official American Thoracic Society/European Respiratory Society Statement: Update on Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Maltais, François; Decramer, Marc; Casaburi, Richard; Barreiro, Esther; Burelle, Yan; Debigaré, Richard; Dekhuijzen, P. N. Richard; Franssen, Frits; Gayan-Ramirez, Ghislaine; Gea, Joaquim; Gosker, Harry R.; Gosselink, Rik; Hayot, Maurice; Hussain, Sabah N. A.; Janssens, Wim; Polkey, Micheal I.; Roca, Josep; Saey, Didier; Schols, Annemie M. W. J.; Spruit, Martijn A.; Steiner, Michael; Taivassalo, Tanja; Troosters, Thierry; Vogiatzis, Ioannis; Wagner, Peter D.

    2014-01-01

    Background: Limb muscle dysfunction is prevalent in chronic obstructive pulmonary disease (COPD) and it has important clinical implications, such as reduced exercise tolerance, quality of life, and even survival. Since the previous American Thoracic Society/European Respiratory Society (ATS/ERS) statement on limb muscle dysfunction, important progress has been made on the characterization of this problem and on our understanding of its pathophysiology and clinical implications. Purpose: The purpose of this document is to update the 1999 ATS/ERS statement on limb muscle dysfunction in COPD. Methods: An interdisciplinary committee of experts from the ATS and ERS Pulmonary Rehabilitation and Clinical Problems assemblies determined that the scope of this document should be limited to limb muscles. Committee members conducted focused reviews of the literature on several topics. A librarian also performed a literature search. An ATS methodologist provided advice to the committee, ensuring that the methodological approach was consistent with ATS standards. Results: We identified important advances in our understanding of the extent and nature of the structural alterations in limb muscles in patients with COPD. Since the last update, landmark studies were published on the mechanisms of development of limb muscle dysfunction in COPD and on the treatment of this condition. We now have a better understanding of the clinical implications of limb muscle dysfunction. Although exercise training is the most potent intervention to address this condition, other therapies, such as neuromuscular electrical stimulation, are emerging. Assessment of limb muscle function can identify patients who are at increased risk of poor clinical outcomes, such as exercise intolerance and premature mortality. Conclusions: Limb muscle dysfunction is a key systemic consequence of COPD. However, there are still important gaps in our knowledge about the mechanisms of development of this problem

  14. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines-Anticoagulation During Cardiopulmonary Bypass.

    Science.gov (United States)

    Shore-Lesserson, Linda; Baker, Robert A; Ferraris, Victor A; Greilich, Philip E; Fitzgerald, David; Roman, Philip; Hammon, John W

    2018-02-01

    Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation therapy for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of Extracorporeal Technology developed an Evidence Based Workgroup. This was a group of interdisciplinary professionals gathered to summarize the evidence and create practice recommendations for various aspects of CPB. To date, anticoagulation practices in CPB have not been standardized in accordance with the evidence base. This clinical practice guideline was written with the intent to fill the evidence gap and to establish best practices in anticoagulation therapy for CPB using the available evidence. To identify relevant evidence, a systematic review was outlined and literature searches were conducted in PubMed using standardized medical subject heading (MeSH) terms from the National Library of Medicine list of search terms. Search dates were inclusive of January 2000 to December 2015. The search yielded 833 abstracts, which were reviewed by two independent reviewers. Once accepted into the full manuscript review stage, two members of the writing group evaluated each of 286 full papers for inclusion eligibility into the guideline document. Ninety-six manuscripts were included in the final review. In addition, 17 manuscripts published before 2000 were included to provide method, context, or additional supporting evidence for the recommendations as these papers were considered sentinel publications. Members of the writing group wrote and developed recommendations based on review of the articles obtained and achieved

  15. British Thoracic Society quality standards for home oxygen use in adults.

    Science.gov (United States)

    Suntharalingam, Jay; Wilkinson, Tom; Annandale, Joseph; Davey, Claire; Fielding, Rhea; Freeman, Daryl; Gibbons, Michael; Hardinge, Maxine; Hippolyte, Sabrine; Knowles, Vikki; Lee, Cassandra; MacNee, William; Pollington, Jacqueline; Vora, Vandana; Watts, Trefor; Wijesinghe, Meme

    2017-01-01

    The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for home oxygen provision in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for Home Oxygen Use in Adults. Development of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. 10 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for home oxygen use, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. BTS Quality Standards for home oxygen use in adults form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline's recommendations.

  16. Official Executive Summary of an American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline

    DEFF Research Database (Denmark)

    Schmidt, Gregory A; Girard, Timothy D; Kress, John P

    2017-01-01

    BACKGROUND: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and American College of Chest Physicians (CHEST). METHODS: A mult...

  17. An Official American Thoracic Society Research Statement : Current Challenges Facing Research and Therapeutic Advances in Airway Remodeling

    NARCIS (Netherlands)

    Prakash, Y S; Halayko, Andrew J; Gosens, Reinoud; Panettieri Jr., Reynold A; Camoretti-Mercado, Blanca; Penn, Raymond B; Burgess, Janette K

    2017-01-01

    BACKGROUND: Airway remodeling (AR) is a prominent feature of asthma and other obstructive lung diseases that is minimally affected by current treatments. The goals of this Official American Thoracic Society (ATS) Research Statement are to discuss the scientific, technological, economic, and

  18. Lung volume reduction surgery since the National Emphysema Treatment Trial: study of Society of Thoracic Surgeons Database.

    Science.gov (United States)

    Decker, Marquita R; Leverson, Glen E; Jaoude, Wassim Abi; Maloney, James D

    2014-12-01

    The National Emphysema Treatment Trial demonstrated that lung volume reduction surgery is an effective treatment for emphysema in select patients. With chronic lower respiratory disease being the third leading cause of death in the United States, this study sought to assess practice patterns and outcomes for lung volume reduction surgery on a national level since the National Emphysema Treatment Trial. Aggregate statistics on lung volume reduction surgery reported in the Society of Thoracic Surgeons Database from January 2003 to June 2011 were analyzed to assess procedure volume, preoperative and operative characteristics, and outcomes. Comparisons with published data from the National Emphysema Treatment Trial were made using chi-square and 2-sided t tests. In 8.5 years, 538 patients underwent lung volume reduction surgery, with 20 to 118 cases reported in the Society of Thoracic Surgeons Database per year. When compared with subjects in the National Emphysema Treatment Trial, subjects in the Society of Thoracic Surgeons Database were younger (P volume in 1 second was 31% versus 28% of predicted (P lung volume reduction surgery. It underscores the need for dedicated centers to increasingly address the heavy burden of chronic lower respiratory disease in the United States in a multidisciplinary fashion, particularly for preoperative evaluation and postoperative management of emphysema. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  19. An official American Thoracic Society workshop report: the Integrated Care of The COPD Patient.

    Science.gov (United States)

    Nici, Linda; ZuWallack, Richard

    2012-03-01

    The optimal care of the patient with chronic obstructive pulmonary disease (COPD) requires an individualized, patient-centered approach that recognizes and treats all aspects of the disease, addresses the systemic effects and comorbidities, and integrates medical care among healthcare professionals and across healthcare sectors. In many ways the integration of medical care for COPD is still in its infancy, and its implementation will undoubtedly represent a paradigm shift in our thinking. This article summarizes the proceedings of a workshop, The Integrated Care of the COPD Patient, which was funded by the American Thoracic Society. This workshop included participants who were chosen because of their expertise in the area as well as their firsthand experience with disease management models. Our summary describes the concepts of integrated care and chronic disease management, details specific components of disease management as they may apply to the patient with COPD, and provides several innovative examples of COPD disease management programs originating from different healthcare systems. It became clear from the discussions and review of the literature that more high-quality research in this area is vital. It is our hope that the information presented here provides a "call to arms" in this regard.

  20. American Thoracic Society and National Heart, Lung, and Blood Institute Implementation Research Workshop Report.

    Science.gov (United States)

    Bender, Bruce G; Krishnan, Jerry A; Chambers, David A; Cloutier, Michelle M; Riekert, Kristin A; Rand, Cynthia S; Schatz, Michael; Thomson, Carey C; Wilson, Sandra R; Apter, Andrea; Carson, Shannon S; George, Maureen; Gerald, Joe K; Gerald, Lynn; Goss, Christopher H; Okelo, Sande O; Mularski, Richard A; Nguyen, Huong Q; Patel, Minal R; Szefler, Stanley J; Weiss, Curtis H; Wilson, Kevin C; Freemer, Michelle

    2015-12-01

    To advance implementation research (IR) in respiratory, sleep, and critical care medicine, the American Thoracic Society and the Division of Lung Diseases from the NHLBI cosponsored an Implementation Research Workshop on May 17, 2014. The goals of IR are to understand the barriers and facilitators of integrating new evidence into healthcare practices and to develop and test strategies that systematically target these factors to accelerate the adoption of evidence-based care. Throughout the workshop, presenters provided examples of IR that focused on the rate of adoption of evidence-based practices, the feasibility and acceptability of interventions to patients and other stakeholders who make healthcare decisions, the fidelity with which practitioners use specific interventions, the effects of specific barriers on the sustainability of an intervention, and the implications of their research to inform policies to improve patients' access to high-quality care. During the discussions that ensued, investigators' experience led to recommendations underscoring the importance of identifying and involving key stakeholders throughout the research process, ensuring that those who serve as reviewers understand the tenets of IR, managing staff motivation and turnover, and tackling the challenges of scaling up interventions across multiple settings.

  1. An Official American Thoracic Society Statement: The Importance of Healthy Sleep. Recommendations and Future Priorities.

    Science.gov (United States)

    Mukherjee, Sutapa; Patel, Sanjay R; Kales, Stefanos N; Ayas, Najib T; Strohl, Kingman P; Gozal, David; Malhotra, Atul

    2015-06-15

    Despite substantial public interest, few recommendations on the promotion of good sleep health exist to educate health care providers and the general public on the importance of sleep for overall health. The aim of this American Thoracic Society (ATS) statement is to provide a review of the current scientific literature to assist health care providers, especially pulmonologists and sleep physicians, in making recommendations to patients and the general public about the importance of achieving good quality and adequate quantity of sleep. ATS members were invited, based on their expertise in sleep medicine, and their conclusions were based on both empirical evidence identified after comprehensive literature review and clinical experience. We focus on sleep health in both children and adults, including the impact of occupation on sleep, the public health implications of drowsy driving, and the common sleep disorders of obstructive sleep apnea and insomnia. This ATS statement also delineates gaps in research and knowledge that should be addressed and lead to new focused research priorities to advance knowledge in sleep and sleep health. Good quality and quantity of sleep are essential for good health and overall quality of life; therefore a strong recommendation was made for the implementation of public education programs on the importance of sleep health.

  2. Survey of International Members of the American Thoracic Society on Climate Change and Health.

    Science.gov (United States)

    Sarfaty, Mona; Kreslake, Jennifer; Ewart, Gary; Guidotti, Tee L; Thurston, George D; Balmes, John R; Maibach, Edward W

    2016-10-01

    The American Thoracic Society (ATS), in collaboration with George Mason University, surveyed international members of the society to assess perceptions, clinical experiences, and preferred policy responses related to global climate change. A recruitment email was sent by the ATS President in October 2015 to 5,013 international members. Subsequently, four reminder emails were sent to nonrespondents. Responses were received from 489 members in 68 countries; the response rate was 9.8%. Half of respondents reported working in countries in Asia (25%) or Europe (25%), with the remainder in South America (18%), North America (Canada and Mexico) (18%), Australia or New Zealand (9%), and Africa (6%). Survey estimate confidence intervals were ± 5% or smaller. A high percentage of international ATS survey respondents judged that climate change is happening (96%), that it is driven by human activity (70%), and that it is relevant to patient care ("a great deal"/"a moderate amount") (80%). A majority of respondents also indicated they are already observing health impacts of climate change among their patients; most commonly as increases in chronic disease severity from air pollution (88%), allergic symptoms from exposure to plants or mold (72%), and severe weather injuries (69%). An even larger majority anticipated seeing these climate-related health impacts in the next two decades. Respondents further indicated that physicians and physician organizations should play an active role in educating patients, the public, and policy makers on the human health effects of climate change. International ATS respondents, like their counterparts in the U.S., observed that human health is already adversely affected by climate change, and support responses to address this situation.

  3. Quality of Care for Percutaneous Coronary Intervention: Development of Canadian Cardiovascular Society Quality Indicators.

    Science.gov (United States)

    Quraishi, Ata Ur Rehman; Lambert, Laurie J; Madan, Mina; Gong, Yanyan; Forsey, Anne; Galbraith, Diane; Gill, Neala; Oakes, Garth H; Lavoie, Andrea; Carere, Ronald G; Welsh, Robert C

    2016-12-01

    Currently there are more than 40 centres in Canada that perform more than 65,000 percutaneous coronary interventions (PCIs) in a year. Considering the high volume of procedures and number of operators, the potential for variation in processes of care is high, and might lead to variation in the quality of care. As part of its quality initiative, the Canadian Cardiovascular Society convened a working group to develop a set of PCI Quality Indicators (QIs) that would be relevant, scientifically acceptable, and feasible to measure and report. The working group was comprised of clinical experts from across Canada and members of provincial and federal organizations involved in promoting the quality of health care. Using the Canadian Cardiovascular Society "Best Practices for Developing Cardiovascular Quality Indicators" methodology, a total of 23 QIs were proposed. Subsequent ranking and discussion led to the selection of 8 QIs. The selection and ranking of QIs were on the basis of clinical importance and relevance, scientific acceptability, and feasibility of their operationalization at a national level. The data definitions and technical notes of the QIs were refined after feasibility testing and Web consultation. Feasibility testing indicated that standardization and enhancements of knowledge infrastructure are essential to provide the comprehensive patient data necessary to evaluate the quality of PCI across Canada. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  4. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: introduction.

    Science.gov (United States)

    Marelli, Ariane; Beauchesne, Luc; Mital, Seema; Therrien, Judith; Silversides, Candice K

    2010-03-01

    With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. Since the 2001 Canadian Cardiovascular Society consensus conference report on the management of adults with CHD, there have been significant advances in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. The present introductory section is a summary of the epidemiology and scope of adult CHD in Canada, the structure of the Canadian health care system and adult congenital cardiac health services in Canada. The recommendations for antibiotic prophylaxis and genetic evaluation in this population are included. The complete document consists of four manuscripts, which are published online in the present issue of The Canadian Journal of Cardiology, including sections on genetics, outcomes, diagnostic workups, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy and contraception risks, and follow-up recommendations. The complete document and references can also be found at www.ccs.ca or www.cachnet.org.

  5. An Official American Thoracic Society Workshop Report: Noninvasive Identification of Inspiratory Flow Limitation in Sleep Studies.

    Science.gov (United States)

    Pamidi, Sushmita; Redline, Susan; Rapoport, David; Ayappa, Indu; Palombini, Luciana; Farre, Ramon; Kirkness, Jason; Pépin, Jean-Louis; Polo, Olli; Wellman, Andrew; Kimoff, R John

    2017-07-01

    This report summarizes the proceedings of the American Thoracic Society Workshop on the Noninvasive Identification of Inspiratory Flow Limitation in Sleep Studies held on May 16, 2015, in Denver, Colorado. The goal of the workshop was to discuss methods for standardizing the scoring of flow limitation from nasal cannula pressure tracings. The workshop began with presentations on the physiology underlying flow limitation, existing methods of scoring flow limitation, the effects of signal acquisition and filtering on flow shapes, and a review of the literature examining the adverse outcomes related to flow limitation. After these presentations, the results from online scoring exercises, which were crowdsourced to workshop participants in advance of the workshop, were reviewed and discussed. Break-out sessions were then held to discuss potential algorithms for scoring flow limitation. Based on these discussions, subsequent online scoring exercises, and webinars after the workshop, a consensus-based set of recommendations for a scoring algorithm for flow limitation was developed. Key conclusions from the workshop were: (1) a standardized and automated approach to scoring flow limitation is needed to provide a metric of nonepisodic elevated upper airway resistance, which can then be related to clinical outcomes in large cohorts and patient groups; (2) at this time, the most feasible method for standardization is by proposing a consensus-based framework, which includes scoring rules, developed by experts (3) hardware and software settings of acquisition devices, including filter settings, affect the shape of the flow curve, and should be clearly specified; and (4) a priority for future research is the generation of an open-source, expert-derived training set to encourage and support validation of automated flow limitation scoring algorithms.

  6. Official American Thoracic Society technical standards: spirometry in the occupational setting.

    Science.gov (United States)

    Redlich, Carrie A; Tarlo, Susan M; Hankinson, John L; Townsend, Mary C; Eschenbacher, William L; Von Essen, Susanna G; Sigsgaard, Torben; Weissman, David N

    2014-04-15

    This document addresses aspects of the performance and interpretation of spirometry that are particularly important in the workplace, where inhalation exposures can affect lung function and cause or exacerbate lung diseases, such as asthma, chronic obstructive pulmonary disease, or fibrosis. Issues that previous American Thoracic Society spirometry statements did not adequately address with respect to the workplace were identified for systematic review. Medline 1950-2012 and Embase 1980-2012 were searched for evidence related to the following: training for spirometry technicians; testing posture; appropriate reference values to use for Asians in North America; and interpretative strategies for analyzing longitudinal change in lung function. The evidence was reviewed and technical recommendations were developed. Spirometry performed in the work setting should be part of a comprehensive workplace respiratory health program. Effective technician training and feedback can improve the quality of spirometry testing. Posture-related changes in FEV1 and FVC, although small, may impact interpretation, so testing posture should be kept consistent and documented on repeat testing. Until North American Asian-specific equations are developed, applying a correction factor of 0.88 to white reference values is considered reasonable when testing Asian American individuals in North America. Current spirometry should be compared with previous tests. Excessive loss in FEV1 over time should be evaluated using either a percentage decline (15% plus loss expected due to aging) or one of the other approaches discussed, taking into consideration testing variability, worker exposures, symptoms, and other clinical information. Important aspects of workplace spirometry are discussed and recommendations are provided for the performance and interpretation of workplace spirometry.

  7. Clinically Useful Spirometry in Preschool-Aged Children: Evaluation of the 2007 American Thoracic Society Guidelines

    Science.gov (United States)

    Gaffin, Jonathan M.; Shotola, Nancy Lichtenberg; Martin, Thomas R.; Phipatanakul, Wanda

    2010-01-01

    Rationale In 2007 the American Thoracic Society (ATS) recommended guidelines for acceptability and repeatability for assessing spirometry in preschool children. The authors aim to determine the feasibility of spirometry among children in this age group performing spirometry for the first time in a busy clinical practice. Methods First-time spirometry for children age 4 to 5 years old was selected from the Children’s Hospital Boston Pulmonary Function Test (PFT) database. Maneuvers were deemed acceptable if (1) the flow-volume loop showed rapid rise and smooth descent; (2) the back extrapolated volume (Vbe), the volume leaked by a subject prior to the forced maneuver, was ≤80 ml and 12.5% of forced vital capacity (FVC); and (3) cessation of expiratory flow was at a point ≤10% of peak expiratory flow rate (PEFR). Repeatability was determined by another acceptable maneuver with forced expiratory volume in t seconds (FEVt) and FVC within 10% or 0.1 L of the best acceptable maneuver. Post hoc analysis compared spirometry values for those with asthma and cystic fibrosis to normative values. Results Two hundred and forty-eight preschool children performed spirometry for the first time between August 26, 2006, and August 25, 2008. At least one technically acceptable maneuver was found in 82.3% (n = 204) of the tests performed. Overall, 54% of children were able to perform acceptable and repeatable spirometry based on the ATS criteria. Children with asthma or cystic fibrosis did not have spirometry values that differed significantly from healthy controls. However, up to 29% of the overall cohort displayed at least one abnormal spirometry value. Conclusions Many preschool-aged children are able to perform technically acceptable and repeatable spirometry under normal conditions in a busy clinical setting. Spirometry may be a useful screen for abnormal lung function in this age group. PMID:20653495

  8. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines-Anticoagulation During Cardiopulmonary Bypass.

    Science.gov (United States)

    Shore-Lesserson, Linda; Baker, Robert A; Ferraris, Victor A; Greilich, Philip E; Fitzgerald, David; Roman, Philip; Hammon, John W

    2018-02-01

    Despite more than a half century of "safe" cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation therapy for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of Extracorporeal Technology developed an Evidence Based Workgroup. This was a group of interdisciplinary professionals gathered to summarize the evidence and create practice recommendations for various aspects of CPB. To date, anticoagulation practices in CPB have not been standardized in accordance with the evidence base. This clinical practice guideline was written with the intent to fill the evidence gap and to establish best practices in anticoagulation therapy for CPB using the available evidence. To identify relevant evidence, a systematic review was outlined and literature searches were conducted in PubMed using standardized medical subject heading (MeSH) terms from the National Library of Medicine list of search terms. Search dates were inclusive of January 2000 to December 2015. The search yielded 833 abstracts, which were reviewed by two independent reviewers. Once accepted into the full manuscript review stage, two members of the writing group evaluated each of 286 full papers for inclusion eligibility into the guideline document. Ninety-six manuscripts were included in the final review. In addition, 17 manuscripts published before 2000 were included to provide method, context, or additional supporting evidence for the recommendations as these papers were considered sentinel publications. Members of the writing group wrote and developed recommendations based on review of the articles obtained and achieved

  9. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons

    National Research Council Canada - National Science Library

    Thomas, Randal J; King, Marjorie; Lui, Karen; Oldridge, Neil; Piña, Ileana L; Spertus, John; Bonow, Robert O; Estes, 3rd, N A Mark; Goff, David C; Grady, Kathleen L; Hiniker, Ann R; Masoudi, Frederick A; Radford, Martha J; Rumsfeld, John S; Whitman, Gayle R

    2007-01-01

      Endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association...

  10. The Society of Thoracic Surgeons Congenital Heart Surgery Database Public Reporting Initiative.

    Science.gov (United States)

    Jacobs, Jeffrey P

    2017-01-01

    Three basic principles provide the rationale for the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) public reporting initiative: (1) Variation in congenital and pediatric cardiac surgical outcomes exist. (2) Patients and their families have the right to know the outcomes of the treatments that they will receive. (3). It is our professional responsibility to share this information with them in a format they can understand. The STS CHSD public reporting initiative facilitates the voluntary transparent public reporting of congenital and pediatric cardiac surgical outcomes using the STS CHSD Mortality Risk Model. The STS CHSD Mortality Risk Model is used to calculate risk-adjusted operative mortality and adjusts for the following variables: age, primary procedure, weight (neonates and infants), prior cardiothoracic operations, non-cardiac congenital anatomic abnormalities, chromosomal abnormalities or syndromes, prematurity (neonates and infants), and preoperative factors (including preoperative/preprocedural mechanical circulatory support [intraaortic balloon pump, ventricular assist device, extracorporeal membrane oxygenation, or cardiopulmonary support], shock [persistent at time of surgery], mechanical ventilation to treat cardiorespiratory failure, renal failure requiring dialysis and/or renal dysfunction, preoperative neurological deficit, and other preoperative factors). Operative mortality is defined in all STS databases as (1) all deaths, regardless of cause, occurring during the hospitalization in which the operation was performed, even if after 30 days (including patients transferred to other acute care facilities); and (2) all deaths, regardless of cause, occurring after discharge from the hospital, but before the end of the 30th postoperative day. The STS CHSD Mortality Risk Model has good model fit and discrimination with an overall C statistics of 0.875 and 0.858 in the development sample and the validation sample

  11. Differential gene expression profiles according to the Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society histopathological classification in lung adenocarcinoma subtypes.

    Science.gov (United States)

    Molina-Romero, Camilo; Rangel-Escareño, Claudia; Ortega-Gómez, Alette; Alanis-Funes, Gerardo J; Avilés-Salas, Alejandro; Avila-Moreno, Federico; Mercado, Gabriela E; Cardona, Andrés F; Hidalgo-Miranda, Alfredo; Arrieta, Oscar

    2017-08-01

    The current lung cancer classification from the Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society has considerably changed the pathologic diagnosis of lung invasive adenocarcinoma, identifying disease subtypes with substantial implications for medical practice, such as clinical, radiological, molecular, and prognostic differences. We analyzed the differences in the genetic expression of adenocarcinoma subtypes according to the new classification. Microarray gene expression analysis was performed on a cohort of 29 adenocarcinoma patients treated at the Instituto Nacional de Cancerología of Mexico from 2008 to 2011. All patients had an available biopsy sample and were classified into 4 different subtypes of adenocarcinoma (2015 World Health Organization classification). Lepidic-predominant adenocarcinoma was the only pattern that exhibited a marked gene expression difference compared with other predominant histologic patterns, revealing genes with significant expression (P adenocarcinoma that could be used as a gene signature. The lepidic-predominant histologic pattern has a differential gene expression profile compared with all predominant histologic patterns. Additionally, we identified a gene expression signature of 13 genes that have a unique behavior in the lepidic histologic pattern; these 13 genes are candidates for follow-up studies for their potential use as biomarkers or therapeutic targets. Results from this study highlight the importance of the new Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification and exemplify the potential clinical implications of correlating histopathology with exclusive molecular beacons. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Publication rate of abstracts presented at the 2010 Canadian Ophthalmological Society Annual Meeting.

    Science.gov (United States)

    Basilious, Alfred; Benavides Vargas, Ana Maria; Buys, Yvonne M

    2017-08-01

    To evaluate the publication rate of submitted abstracts accepted for presentation at the 2010 Canadian Ophthalmological Society (COS) Annual Meeting in peer-reviewed journals. A retrospective analysis and literature search of abstracts presented at the 2010 COS Annual Meeting. Abstracts accepted as an oral presentation or poster from the 2010 COS Annual Meeting were tabulated by type of presentation (oral vs poster), subspecialty, study design, number of authors, and principal investigator's institution. A PubMed search was conducted for each abstract by key word, first author, and last author. The year of publication, journal, and impact factor were recorded for identified publications. Publication rate was calculated by type of presentation, subspecialty, study design, number of authors, and institution. A total of 175 abstracts were presented at the 2010 COS Annual Meeting. There were 105 oral (60%) and 70 poster (40%) presentations. The overall publication rate was 45.7%; 49.5% for oral presentations and 40.0% for posters. Cornea (57.6%) and public health (54.5%) had the highest publication rates of all subspecialties. Randomized control trials (71.4%) and cohort studies (70.0%) had higher publication rates than other study designs. Overall, 28.8% of abstracts were published in the Canadian Journal of Ophthalmology. The average impact factor of all publications was 2.73. Of abstracts presented at the 2010 COS Annual Meeting, 45.7% were published within 5 years after the conference. This publication rate is within the upper end of previously reported meeting publication rates for medical societies. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  13. An Official American Thoracic Society Workshop Report 2015. Stem Cells and Cell Therapies in Lung Biology and Diseases.

    Science.gov (United States)

    Wagner, Darcy E; Cardoso, Wellington V; Gilpin, Sarah E; Majka, Susan; Ott, Harald; Randell, Scott H; Thébaud, Bernard; Waddell, Thomas; Weiss, Daniel J

    2016-08-01

    The University of Vermont College of Medicine, in collaboration with the NHLBI, Alpha-1 Foundation, American Thoracic Society, Cystic Fibrosis Foundation, European Respiratory Society, International Society for Cellular Therapy, and the Pulmonary Fibrosis Foundation, convened a workshop, "Stem Cells and Cell Therapies in Lung Biology and Lung Diseases," held July 27 to 30, 2015, at the University of Vermont. The conference objectives were to review the current understanding of the role of stem and progenitor cells in lung repair after injury and to review the current status of cell therapy and ex vivo bioengineering approaches for lung diseases. These are all rapidly expanding areas of study that both provide further insight into and challenge traditional views of mechanisms of lung repair after injury and pathogenesis of several lung diseases. The goals of the conference were to summarize the current state of the field, discuss and debate current controversies, and identify future research directions and opportunities for both basic and translational research in cell-based therapies for lung diseases. This 10th anniversary conference was a follow up to five previous biennial conferences held at the University of Vermont in 2005, 2007, 2009, 2011, and 2013. Each of those conferences, also sponsored by the National Institutes of Health, American Thoracic Society, and respiratory disease foundations, has been important in helping guide research and funding priorities. The major conference recommendations are summarized at the end of the report and highlight both the significant progress and major challenges in these rapidly progressing fields.

  14. An official American Thoracic Society workshop report: stem cells and cell therapies in lung biology and diseases.

    Science.gov (United States)

    Weiss, Daniel J; Chambers, Daniel; Giangreco, Adam; Keating, Armand; Kotton, Darrell; Lelkes, Peter I; Wagner, Darcy E; Prockop, Darwin J

    2015-04-01

    The University of Vermont College of Medicine and the Vermont Lung Center, in collaboration with the NHLBI, Alpha-1 Foundation, American Thoracic Society, European Respiratory Society, International Society for Cell Therapy, and the Pulmonary Fibrosis Foundation, convened a workshop, "Stem Cells and Cell Therapies in Lung Biology and Lung Diseases," held July 29 to August 1, 2013 at the University of Vermont. The conference objectives were to review the current understanding of the role of stem and progenitor cells in lung repair after injury and to review the current status of cell therapy and ex vivo bioengineering approaches for lung diseases. These are all rapidly expanding areas of study that both provide further insight into and challenge traditional views of mechanisms of lung repair after injury and pathogenesis of several lung diseases. The goals of the conference were to summarize the current state of the field, discuss and debate current controversies, and identify future research directions and opportunities for both basic and translational research in cell-based therapies for lung diseases. This conference was a follow-up to four previous biennial conferences held at the University of Vermont in 2005, 2007, 2009, and 2011. Each of those conferences, also sponsored by the National Institutes of Health, American Thoracic Society, and Respiratory Disease Foundations, has been important in helping guide research and funding priorities. The major conference recommendations are summarized at the end of the report and highlight both the significant progress and major challenges in these rapidly progressing fields.

  15. The European Respiratory Society and European Society of Thoracic Surgeons clinical guidelines for evaluating fitness for radical treatment (surgery and chemoradiotherapy) in patients with lung cancer.

    Science.gov (United States)

    Brunelli, Alessandro; Charloux, Anne; Bolliger, Chris T; Rocco, Gaetano; Sculier, Jean-Paul; Varela, Gonzalo; Licker, Marc; Ferguson, Mark K; Faivre-Finn, Corinne; Huber, Rudolf Maria; Clini, Enrico M; Win, Thida; De Ruysscher, Dirk; Goldman, Lee

    2009-07-01

    The European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS) established a joint task force with the purpose to develop clinical evidence-based guidelines on evaluation of fitness for radical therapy in patients with lung cancer. The following topics were discussed, and are summarized in the final report along with graded recommendations: Cardiologic evaluation before lung resection; lung function tests and exercise tests (limitations of ppoFEV1; DLCO: systematic or selective?; split function studies; exercise tests: systematic; low-tech exercise tests; cardiopulmonary (high tech) exercise tests); future trends in preoperative work-up; physiotherapy/rehabilitation and smoking cessation; scoring systems; advanced care management (ICU/HDU); quality of life in patients submitted to radical treatment; combined cancer surgery and lung volume reduction surgery; compromised parenchymal sparing resections and minimally invasive techniques: the balance between oncological radicality and functional reserve; neoadjuvant chemotherapy and complications; definitive chemo and radiotherapy: functional selection criteria and definition of risk; should surgical criteria be re-calibrated for radiotherapy?; the patient at prohibitive surgical risk: alternatives to surgery; who should treat thoracic patients and where these patients should be treated?

  16. Mortality Trends in Pediatric and Congenital Heart Surgery: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database.

    Science.gov (United States)

    Jacobs, Jeffrey P; He, Xia; Mayer, John E; Austin, Erle H; Quintessenza, James A; Karl, Tom R; Vricella, Luca; Mavroudis, Constantine; O'Brien, Sean M; Pasquali, Sara K; Hill, Kevin D; Husain, S Adil; Overman, David M; St Louis, James D; Han, Jane M; Shahian, David M; Cameron, Duke; Jacobs, Marshall L

    2016-10-01

    Previous analyses of The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database have demonstrated a reduction over time of risk-adjusted operative mortality after coronary artery bypass grafting. The STS Congenital Heart Surgery Database (STS CHSD) was queried to assess multiinstitutional trends over time in discharge mortality and postoperative length of stay (PLOS). Since 2009, operations in the STS CHSD have been classified according to STAT (The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery) Congenital Heart Surgery Mortality Categories. The five STAT Mortality Categories were chosen to be optimal with respect to minimizing variation within categories and maximizing variation between categories. For this study, all index cardiac operations from 1998 to 2014, inclusive, were grouped by STAT Mortality Category (exclusions: patent ductus arteriosus ligation in patients weighing less than or equal to 2.5 kg and operations that could not be assigned to a STAT Mortality Category). End points were discharge mortality and PLOS in survivors for the entire period and for 4-year epochs. The Cochran-Armitage trend test was used to test the null hypothesis that the mortality was the same across epochs, by STAT Mortality Category. The analysis encompassed 202,895 index operations at 118 centers. The number of centers participating in STS CHSD increased in each epoch. Overall discharge mortality was 3.4% (6,959 of 202,895) for 1998 to 2014 and 3.1% (2,308 of 75,337) for 2011 to 2014. Statistically significant improvement in discharge mortality was seen in STAT Mortality Categories 2, 3, 4, and 5 (p values for STAT Mortality Categories 1 through 5 are 0.060, <0.001, 0.015, <0.001, and <0.001, respectively). PLOS in survivors was relatively unchanged over the same time intervals. Sensitivity analyses reveal that the finding of declining risk-stratified rates of discharge mortality over time is not simply attributable to the addition

  17. The importance of patient-specific preoperative factors: an analysis of the society of thoracic surgeons congenital heart surgery database.

    Science.gov (United States)

    Jacobs, Jeffrey Phillip; O'Brien, Sean M; Pasquali, Sara K; Kim, Sunghee; Gaynor, J William; Tchervenkov, Christo Ivanov; Karamlou, Tara; Welke, Karl F; Lacour-Gayet, Francois; Mavroudis, Constantine; Mayer, John E; Jonas, Richard A; Edwards, Fred H; Grover, Frederick L; Shahian, David M; Jacobs, Marshall Lewis

    2014-11-01

    The most common forms of risk adjustment for pediatric and congenital heart surgery used today are based mainly on the estimated risk of mortality of the primary procedure of the operation. The goals of this analysis were to assess the association of patient-specific preoperative factors with mortality and to determine which of these preoperative factors to include in future pediatric and congenital cardiac surgical risk models. All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) during 2010 through 2012 were eligible for inclusion. Patients weighing less than 2.5 kg undergoing patent ductus arteriosus closure were excluded. Centers with more than 10% missing data and patients with missing data for discharge mortality or other key variables were excluded. Rates of discharge mortality for patients with or without specific preoperative factors were assessed across age groups and were compared using Fisher's exact test. In all, 25,476 operations were included (overall discharge mortality 3.7%, n=943). The prevalence of common preoperative factors and their associations with discharge mortality were determined. Associations of the following preoperative factors with discharge mortality were all highly significant (psurgery could lead to increased precision in predicting risk of operative mortality and comparison of observed to expected outcomes. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  18. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management during Cardiopulmonary Bypass

    Science.gov (United States)

    Engelman, Richard; Baker, Robert A.; Likosky, Donald S.; Grigore, Alina; Dickinson, Timothy A.; Shore-Lesserson, Linda; Hammon, John W.

    2015-01-01

    Abstract: To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation. PMID:26543248

  19. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass--Temperature Management during Cardiopulmonary Bypass.

    Science.gov (United States)

    Engelman, Richard; Baker, Robert A; Likosky, Donald S; Grigore, Alina; Dickinson, Timothy A; Shore-Lesserson, Linda; Hammon, John W

    2015-09-01

    To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation.

  20. Canadian Society of Nephrology commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD.

    Science.gov (United States)

    Moist, Louise M; Troyanov, Stéphan; White, Colin T; Wazny, Lori D; Wilson, Jo-Anne; McFarlane, Phil; Harwood, Lori; Sood, Manish M; Soroka, Steven D; Bass, Adam; Manns, Braden J

    2013-11-01

    The KDIGO (Kidney Disease: Improving Global Outcomes) 2012 clinical practice guideline for anemia management in patients with chronic kidney disease provides the structural and evidence base for the Canadian Society of Nephrology commentary on this guideline's relevancy and application to the Canadian health care system. While in general agreement, we provide commentary on 11 of the 61 KDIGO guideline statements. Specifically, we agreed that a therapeutic trial of iron is appropriate in cases in which a reduction in erythropoiesis-stimulating agent (ESA) dosage or avoidance of ESA and transfusion is desired, transferrin saturations are >30%, and ferritin concentrations are >500 μg/L. However, we concluded that there is insufficient evidence to support an upper target or threshold for ferritin and transferrin saturation levels. We agree with the initiation of ESA treatment when hemoglobin (Hb) level is 90-100 g/L; however, we specifically state that an acceptable range for Hb level is 95-115 g/L, with a target of 100-110 g/L, and add caution to individualization above this range due to concerns regarding the safety of ESAs. We agree that ESAs should be used with considerable caution in patients with active malignancy, history of stroke, or history of malignancy, and we suggest initiating ESA therapy at Hb level of 90 g/L and to aim for a Hb level in the range of 90-105 g/L. The reader is encouraged to note the level of evidence and review the entire KDIGO anemia guideline to interpret the guideline statements and commentary appropriately. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  1. The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery.

    Science.gov (United States)

    2017-03-01

    The Society of Thoracic Surgeons Task Force on Resuscitation After Cardiac Surgery provides this professional society perspective on resuscitation in patients who arrest after cardiac surgery. This document was created using a multimodal methodology for evidence generation and includes information from existing guidelines, from the International Liaison Committee on Resuscitation, from our own structured literature reviews on issues particular to cardiac surgery, and from an international survey on resuscitation hosted by CTSNet. In gathering evidence for this consensus paper, searches were conducted using the MEDLINE keywords "cardiac surgery," "resuscitation," "guideline," "thoracic surgery," "cardiac arrest," and "cardiac massage." Weight was given to clinical studies in humans, although some case studies, mannequin simulations of potential protocols, and animal models were also considered. Consensus was reached using a modified Delphi method consisting of two rounds of voting until 75% agreement on appropriate wording and strength of the opinions was reached. The Society of Thoracic Surgeons Workforce on Critical Care was enlisted in this process to provide a wider variety of experiences and backgrounds in an effort to reinforce the opinions provided. We start with the premise that external massage is ineffective for an arrest due to tamponade or hypovolemia (bleeding), and therefore these subsets of patients will receive inadequate cerebral perfusion during cardiac arrest in the absence of resternotomy. Because these two situations are common causes for an arrest after cardiac surgery, the inability to provide effective external cardiopulmonary resuscitation highlights the importance of early emergency resternotomy within 5 minutes. In addition, because internal massage is more effective than external massage, it should be used preferentially if other quickly reversible causes are not found. We present a protocol for the cardiac arrest situation that

  2. Current practices in the management of malignant pleural effusions: a survey among members of the European Society of Thoracic Surgeons.

    Science.gov (United States)

    Scarci, Marco; Caruana, Edward; Bertolaccini, Luca; Bedetti, Benedetta; Brunelli, Alessandro; Varela, Gonzalo; Papagiannopoulos, Kostas; Kuzdzal, Jaroslaw; Massard, Gilbert; Ruffini, Enrico; Falcoz, Pierre Emmanuel; Opitz, Isabelle; Batirel, Hasan; Toker, Alper; Rocco, Gaetano

    2017-03-01

    Malignant pleural effusion (MPE) commonly complicates advanced malignancy and their exact management is still undefined. We undertook a survey to determine the current practice among members of the European Society of Thoracic Surgeons (ESTS). A cross-sectional survey focused on the current practice of management of MPE was developed by the authors. The questions were outlined after a review of the literature and circulated in an Internet-based survey format. Computed tomography (125, 92%) and chest X-ray (106, 78%) are the most common imaging modalities performed in the initial evaluation. Video-assisted thoracoscopic surgery for washout and pleurodesis (93, 68%) was reported as the preferred approach to patients with uncomplicated MPE. Sixty-one (45%) of the responding colleagues routinely use large bore chest tubes for draining malignant effusions. Forty-nine (35%) surgeons would not apply suction to the drainage system, whilst 50 (37%) would use -2 kPa or less. Talc (124, 91%) is the most commonly used sclerosing agent for pleurodesis in the context of malignant pleural effusion. The practice of 76 (56%) of the respondents is not informed by any clinical guidelines, whilst 60 (44%) reported adhering to the 2010 British Thoracic Society Pleural Disease Guideline. Seventy-one (52%) declared that the guidance was in need of updating or revision. This survey demonstrates the lacking adoption of the existing clinical guidance in this field, as well as the need for more contemporary guidelines for a better-informed practice. The ESTS Working Group on the management of MPE has been established for this purpose.

  3. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma.

    Science.gov (United States)

    Travis, William D; Brambilla, Elisabeth; Noguchi, Masayuki; Nicholson, Andrew G; Geisinger, Kim R; Yatabe, Yasushi; Beer, David G; Powell, Charles A; Riely, Gregory J; Van Schil, Paul E; Garg, Kavita; Austin, John H M; Asamura, Hisao; Rusch, Valerie W; Hirsch, Fred R; Scagliotti, Giorgio; Mitsudomi, Tetsuya; Huber, Rudolf M; Ishikawa, Yuichi; Jett, James; Sanchez-Cespedes, Montserrat; Sculier, Jean-Paul; Takahashi, Takashi; Tsuboi, Masahiro; Vansteenkiste, Johan; Wistuba, Ignacio; Yang, Pan-Chyr; Aberle, Denise; Brambilla, Christian; Flieder, Douglas; Franklin, Wilbur; Gazdar, Adi; Gould, Michael; Hasleton, Philip; Henderson, Douglas; Johnson, Bruce; Johnson, David; Kerr, Keith; Kuriyama, Keiko; Lee, Jin Soo; Miller, Vincent A; Petersen, Iver; Roggli, Victor; Rosell, Rafael; Saijo, Nagahiro; Thunnissen, Erik; Tsao, Ming; Yankelewitz, David

    2011-02-01

    Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. The classification addresses both resection specimens, and small biopsies and cytology. The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with ≤ 5 mm invasion (MIA) to define patients who, if they undergo complete resection, will have 100% or near 100

  4. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma

    Science.gov (United States)

    Travis, William D.; Brambilla, Elisabeth; Noguchi, Masayuki; Nicholson, Andrew G.; Geisinger, Kim R.; Yatabe, Yasushi; Beer, David G.; Powell, Charles A.; Riely, Gregory J.; Van Schil, Paul E.; Garg, Kavita; Austin, John H. M.; Asamura, Hisao; Rusch, Valerie W.; Hirsch, Fred R.; Scagliotti, Giorgio; Mitsudomi, Tetsuya; Huber, Rudolf M.; Ishikawa, Yuichi; Jett, James; Sanchez-Cespedes, Montserrat; Sculier, Jean-Paul; Takahashi, Takashi; Tsuboi, Masahiro; Vansteenkiste, Johan; Wistuba, Ignacio; Yang, Pan-Chyr; Aberle, Denise; Brambilla, Christian; Flieder, Douglas; Franklin, Wilbur; Gazdar, Adi; Gould, Michael; Hasleton, Philip; Henderson, Douglas; Johnson, Bruce; Johnson, David; Kerr, Keith; Kuriyama, Keiko; Lee, Jin Soo; Miller, Vincent A.; Petersen, Iver; Roggli, Victor; Rosell, Rafael; Saijo, Nagahiro; Thunnissen, Erik; Tsao, Ming; Yankelewitz, David

    2015-01-01

    Introduction Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. Methods An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. Results The classification addresses both resection specimens, and small biopsies and cytology. The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with ≤5 mm invasion (MIA) to define patients who, if they undergo complete resection

  5. Differences in cardiopulmonary exercise test results by American Thoracic Society/European Respiratory Society-Global Initiative for Chronic Obstructive Lung Disease stage categories and gender.

    Science.gov (United States)

    Pinto-Plata, Victor M; Celli-Cruz, Romulo A; Vassaux, Carlos; Torre-Bouscoulet, Luis; Mendes, Asante; Rassulo, John; Celli, Bartolome R

    2007-10-01

    The American Thoracic Society (ATS)/European Respiratory Society (ERS)-Global Initiative for Chronic Obstructive Lung Disease (GOLD) has developed a new staging system based on the degree of airflow obstruction. Its validity to predict exercise capacity as an outcome has not been extensively studied. We hypothesized that exercise performance measured by cardiopulmonary exercise test (CPET) results should decline significantly with each disease stage, independent of gender. We examined 453 consecutive incremental CPET and pulmonary function tests performed in patients who had been referred to a single respiratory physiology laboratory in a tertiary care hospital. They were divided into a control group (normal lung function) and ATS/ERS-GOLD stages 1 to 4. We measured anthropometrics, peak work (in watts), peak oxygen uptake (in liters per kilogram per minute and percent predicted), breathing reserve (in percent predicted), and arterial blood gas response. We compared these results between different stages and genders. The mean (+/- SD) age for the entire group was 64 +/- 11 years, the mean FEV(1) was 66 +/- 28%, and the mean body mass index (BMI) was 27.2 +/- 5.82 kg/m(2). Patients in stage 4 were significantly younger (p difference disappeared when adjusted by COPD stages. The ATS/ERS-GOLD staging system can be used to indicate differences in exercise capacity in patients with COPD stages 2 to 4 and to normalize apparent gender disparities. The value of differentiating stage 1 patients requires further studies with different outcomes.

  6. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: rate and rhythm management.

    Science.gov (United States)

    Gillis, Anne M; Verma, Atul; Talajic, Mario; Nattel, Stanley; Dorian, Paul

    2011-01-01

    The goals of atrial fibrillation (AF) and atrial flutter (AFL) arrhythmia management are to alleviate patient symptoms, improve patient quality of life, and minimize the morbidity associated with AF and AFL. Arrhythmia management usually commences with drugs to slow the ventricular rate. The addition of class I or class III antiarrhythmic drugs for restoration or maintenance of sinus rhythm is largely determined by patient symptoms and preferences. For rate control, treatment of persistent or permanent AF and AFL should aim for a resting heart rate of myocardial infarction or left ventricular dysfunction. Digoxin is not recommended as monotherapy for rate control in active patients. Digoxin and dronedarone may be used in combination with other agents to optimize rate control. The first-choice antiarrhythmic drug for maintenance of sinus rhythm in patients with non structural heart disease can be any one of dronedarone, flecainide, propafenone, or sotalol. In patients with abnormal ventricular function but left ventricular ejection fraction >35%, dronedarone, sotalol, or amiodarone is recommended. In patients with left ventricular ejection fraction <35%, amiodarone is the only drug usually recommended. Intermittent antiarrhythmic drug therapy ("pill in the pocket") may be considered in symptomatic patients with infrequent, longer-lasting episodes of AF or AFL as an alternative to daily antiarrhythmic therapy. Referral for ablation of AF may be considered for patients who remain symptomatic after adequate trials of antiarrhythmic drug therapy and in whom a rhythm control strategy remains desired. Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  7. 2015 Annual Meeting of the Canadian Society for History and Philosophy of Mathematics

    CERN Document Server

    Landry, Elaine

    2016-01-01

    This volume contains seventeen papers that were presented at the 2015 Annual Meeting of the Canadian Society for History and Philosophy of Mathematics/La Société Canadienne d’Histoire et de Philosophie des Mathématiques, held in Washington, D.C. In addition to showcasing rigorously reviewed modern scholarship on an interesting variety of general topics in the history and philosophy of mathematics, this meeting also honored the memories of Jacqueline (Jackie) Stedall and Ivor Grattan-Guinness; celebrated the Centennial of the Mathematical Association of America; and considered the importance of mathematical communities in a special session. These themes and many others are explored in these collected papers, which cover subjects such as New evidence that the Latin translation of Euclid’s Elements was based on the Arabic version attributed to al-Ḥajjāj Work done on the arc rampant in the seventeenth century The history of numerical methods for finding roots of nonlinear equations An original play feat...

  8. 2016 Annual Meeting of the Canadian Society for History and Philosophy of Mathematics

    CERN Document Server

    Schlimm, Dirk

    2017-01-01

    This volume contains fourteen papers that were presented at the 2016 Annual Meeting of the Canadian Society for History and Philosophy of Mathematics/La Société Canadienne d’Histoire et de Philosophie des Mathématiques, held at the University of Calgary in Alberta, Canada. In addition to showcasing rigorously reviewed modern scholarship on an interesting variety of topics in the history and philosophy of mathematics, this meeting also honored the life and work of the logician and philosopher of mathematics Aldo Antonelli (1962-2015). The first four papers in this book are part of that remembrance and have a philosophical focus. Included in these are a discussion of Bolzano’s objections to Kant’s philosophy of mathematics and an examination of the influence of rhetorical and poetic aesthetics on the development of symbols in the 16th and 17thCenturies. The remaining papers deal with the history of mathematics and cover such subjects as Early schemes for polar ordinates in the work of L’Hôpital, bas...

  9. 2014 Annual Meeting of the Canadian Society for History and Philosophy of Mathematics

    CERN Document Server

    Landry, Elaine

    2015-01-01

    This volume contains thirteen papers that were presented at the 2014 Annual Meeting of the Canadian Society for History and Philosophy of Mathematics/La Société Canadienne d’Histoire et de Philosophie des Mathématiques, held on the campus of Brock University in St. Catharines, Ontario, Canada. It contains rigorously reviewed modern scholarship on general topics in the history and philosophy of mathematics, as well as on the meeting’s special topic, Early Scientific Computation. These papers cover subjects such as •Physical tools used by mathematicians in the seventeenth century •The first historical appearance of the game-theoretical concept of mixed-strategy equilibrium •George Washington’s mathematical cyphering books •The development of the Venn diagram •The role of Euler and other mathematicians in the development of algebraic analysis •Arthur Cayley and Alfred Kempe’s influence on Charles Peirce's diagrammatic logic •The influence publishers had on the development of mathematical...

  10. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    Science.gov (United States)

    Doherty, John U; Kort, Smadar; Mehran, Roxana; Schoenhagen, Paul; Soman, Prem; Dehmer, Greg J; Doherty, John U; Schoenhagen, Paul; Amin, Zahid; Bashore, Thomas M; Boyle, Andrew; Calnon, Dennis A; Carabello, Blase; Cerqueira, Manuel D; Conte, John; Desai, Milind; Edmundowicz, Daniel; Ferrari, Victor A; Ghoshhajra, Brian; Mehrotra, Praveen; Nazarian, Saman; Reece, T Brett; Tamarappoo, Balaji; Tzou, Wendy S; Wong, John B; Doherty, John U; Dehmer, Gregory J; Bailey, Steven R; Bhave, Nicole M; Brown, Alan S; Daugherty, Stacie L; Dean, Larry S; Desai, Milind Y; Duvernoy, Claire S; Gillam, Linda D; Hendel, Robert C; Kramer, Christopher M; Lindsay, Bruce D; Manning, Warren J; Mehrotra, Praveen; Patel, Manesh R; Sachdeva, Ritu; Wann, L Samuel; Winchester, David E; Wolk, Michael J; Allen, Joseph M

    2017-10-20

    This document is 1 of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. This document addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas the second, companion document addresses this topic with regard to structural heart disease. Although there is clinical overlap, the documents addressing valvular and structural heart disease are published separately, albeit with a common structure. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of valvular and structural heart disease, encompassing multiple imaging modalities. Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association guidelines. A separate, independent rating panel scored the 92 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario. The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will

  11. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    Science.gov (United States)

    Doherty, John U; Kort, Smadar; Mehran, Roxana; Schoenhagen, Paul; Soman, Prem

    2017-12-01

    This document is 1 of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. This document addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas the second, companion document addresses this topic with regard to structural heart disease. Although there is clinical overlap, the documents addressing valvular and structural heart disease are published separately, albeit with a common structure. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of valvular and structural heart disease, encompassing multiple imaging modalities.Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association guidelines.A separate, independent rating panel scored the 92 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario.The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will

  12. SHIFTING GROUND, SOLID FOUNDATIONS: IMAGINING A NEW PARADIGM FOR CANADIAN CIVIL SOCIETY ENGAGEMENT

    Directory of Open Access Journals (Sweden)

    Nandini Ramanujam

    2015-02-01

    Full Text Available Members of civil society are increasingly decrying what they identify as an insidious trend whereby the government is targeting organizations whose mandates run contrary to the federal government’s political and economic agendas and creating a chill around public policy and advocacy work. The media as well as civil society organizations [CSOs] themselves have documented government attempts to undermine and stifle the voices of dissenting organizations, ranging from rhetorical attacks to the withdrawal of funding for ambiguous reasons. The climate of resentment and suspicion between civil society actors and the government is detrimental for safeguarding the tradition of accountability and transparency in Canada’s democratic institutions. Amidst this turbulent environment, this paper examines the often-made claim by CSO leaders in Canada that public funding is a necessary requirement for a strong civil society, with the aim of challenging and mobilizing the civil society community to not only survive but to reinvigorate its engagement to further social justice in this changing social and economic landscape. We argue that discussions of the state of civil society in Canada focus disproportionately on the question of funding and relationship-building with the government and expose the unforeseen consequences of this trade-off for CSOs, their members, and constituent communities.  We close by introducing the potential of a new paradigm of “principled engagement” that would allow Canadian CSOs to thrive as sustainable, adaptable social justice advocates in coming years.   Les membres de la société civile décrient de plus en plus ce qu’ils appellent la tendance insidieuse du gouvernement à cibler les organisations dont les mandats vont à l’encontre de ses programmes politiques et économiques et à freiner le travail de représentation et de plaidoyer lié aux politiques publiques. Tant les médias que les organisations de la soci

  13. Prognostic value of the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification in stage IB lung adenocarcinoma.

    Science.gov (United States)

    Xu, C-h; Wang, W; Wei, Y; Hu, H-d; Zou, J; Yan, J; Yu, L-k; Yang, R-s; Wang, Y

    2015-10-01

    Patients with pathological stage IB lung adenocarcinoma have a variable prognosis, even if received the same treatment. This study investigated the prognostic value of the new International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) lung adenocarcinoma classification in resected stage IB lung adenocarcinoma. We identified 276 patients with pathological stage IB adenocarcinoma who had undergone surgical resection at the Nanjing Chest Hospital between 2005 and 2010. The histological subtypes of all patients were classified according to the 2011 IASLC/ATS/ERS international multidisciplinary lung adenocarcinoma classification. Kaplan-Meier and Cox regression analyses were used to analyze the correlation between the IASLC/ATS/ERS classification and patients' prognosis. Two hundred and seventy-six patients with pathological stage IB adenocarcinoma had an 86.2% 5-year overall survival (OS) and 80.4% 5-year disease-free survival (DFS). Patients with micropapillary and solid predominant tumors had a significantly worse OS and DFS as compared to those with other subtypes predominant tumors (p = 0.003 and 0.001). Multivariate analysis revealed that the new classification was an independent prognostic factor for both OS and DFS of pathological stage IB adenocarcinoma (p = 0.009 and 0.003). Our study revealed that the new IASLC/ATS/ERS classification was an independent prognostic factor of pathological stage IB adenocarcinoma. This new classification is valuable of screening out high risk patients to receive postoperative adjuvant therapy. Copyright © 2015. Published by Elsevier Ltd.

  14. American Thoracic Society/National Heart, Lung, and Blood Institute Asthma-Chronic Obstructive Pulmonary Disease Overlap Workshop Report.

    Science.gov (United States)

    Woodruff, Prescott G; van den Berge, Maarten; Boucher, Richard C; Brightling, Christopher; Burchard, Esteban G; Christenson, Stephanie A; Han, MeiLan K; Holtzman, Michael J; Kraft, Monica; Lynch, David A; Martinez, Fernando D; Reddel, Helen K; Sin, Don D; Washko, George R; Wenzel, Sally E; Punturieri, Antonello; Freemer, Michelle M; Wise, Robert A

    2017-08-01

    Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic obstructive lung diseases with an associated high burden of disease. Asthma, which is often allergic in origin, frequently begins in infancy or childhood with variable airflow obstruction and intermittent wheezing, cough, and dyspnea. Patients with COPD, in contrast, are usually current or former smokers who present after the age of 40 years with symptoms (often persistent) including dyspnea and a productive cough. On the basis of age and smoking history, it is often easy to distinguish between asthma and COPD. However, some patients have features compatible with both diseases. Because clinical studies typically exclude these patients, their underlying disease mechanisms and appropriate treatment remain largely uncertain. To explore the status of and opportunities for research in this area, the NHLBI, in partnership with the American Thoracic Society, convened a workshop of investigators in San Francisco, California on May 14, 2016. At the workshop, current understanding of asthma-COPD overlap was discussed among clinicians, pathologists, radiologists, epidemiologists, and investigators with expertise in asthma and COPD. They considered knowledge gaps in our understanding of asthma-COPD overlap and identified strategies and research priorities that will advance its understanding. This report summarizes those discussions.

  15. ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for the Treatment of Patients With Severe Aortic Stenosis: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    Science.gov (United States)

    Bonow, Robert O; Brown, Alan S; Gillam, Linda D; Kapadia, Samir R; Kavinsky, Clifford J; Lindman, Brian R; Mack, Michael J; Thourani, Vinod H; Dehmer, Gregory J; Bonow, Robert O; Lindman, Brian R; Beaver, Thomas M; Bradley, Steven M; Carabello, Blase A; Desai, Milind Y; George, Isaac; Green, Philip; Holmes, David R; Johnston, Douglas; Leipsic, Jonathon; Mick, Stephanie L; Passeri, Jonathan J; Piana, Robert N; Reichek, Nathaniel; Ruiz, Carlos E; Taub, Cynthia C; Thomas, James D; Turi, Zoltan G; Doherty, John U; Dehmer, Gregory J; Bailey, Steven R; Bhave, Nicole M; Brown, Alan S; Daugherty, Stacie L; Dean, Larry S; Desai, Milind Y; Duvernoy, Claire S; Gillam, Linda D; Hendel, Robert C; Kramer, Christopher M; Lindsay, Bruce D; Manning, Warren J; Mehrotra, Praveen; Patel, Manesh R; Sachdeva, Ritu; Wann, L Samuel; Winchester, David E; Allen, Joseph M

    2018-02-01

    The American College of Cardiology collaborated with the American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons to develop and evaluate Appropriate Use Criteria (AUC) for the treatment of patients with severe aortic stenosis (AS). This is the first AUC to address the topic of AS and its treatment options, including surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). A number of common patient scenarios experienced in daily practice were developed along with assumptions and definitions for those scenarios, which were all created using guidelines, clinical trial data, and expert opinion in the field of AS. The 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(1) and its 2017 focused update paper (2) were used as the primary guiding references in developing these indications. The writing group identified 95 clinical scenarios based on patient symptoms and clinical presentation, and up to 6 potential treatment options for those patients. A separate, independent rating panel was asked to score each indication from 1 to 9, with 1-3 categorized as "Rarely Appropriate," 4-6 as "May Be Appropriate," and 7-9 as "Appropriate." After considering factors such as symptom status, left ventricular (LV) function, surgical risk, and the presence of concomitant coronary or other valve disease, the rating panel determined that either SAVR or TAVR is Appropriate in most patients with symptomatic AS at intermediate or high surgical risk; however, situations

  16. An Official American Thoracic Society/European Respiratory Society Workshop Report: Evaluation of Respiratory Mechanics and Function in the Pediatric and Neonatal Intensive Care Units.

    Science.gov (United States)

    Peterson-Carmichael, Stacey; Seddon, Paul C; Cheifetz, Ira M; Frerichs, Inéz; Hall, Graham L; Hammer, Jürg; Hantos, Zoltán; van Kaam, Anton H; McEvoy, Cindy T; Newth, Christopher J L; Pillow, J Jane; Rafferty, Gerrard F; Rosenfeld, Margaret; Stocks, Janet; Ranganathan, Sarath C

    2016-02-01

    Ready access to physiologic measures, including respiratory mechanics, lung volumes, and ventilation/perfusion inhomogeneity, could optimize the clinical management of the critically ill pediatric or neonatal patient and minimize lung injury. There are many techniques for measuring respiratory function in infants and children but very limited information on the technical ease and applicability of these tests in the pediatric and neonatal intensive care unit (PICU, NICU) environments. This report summarizes the proceedings of a 2011 American Thoracic Society Workshop critically reviewing techniques available for ventilated and spontaneously breathing infants and children in the ICU. It outlines for each test how readily it is performed at the bedside and how it may impact patient management as well as indicating future areas of potential research collaboration. From expert panel discussions and literature reviews, we conclude that many of the techniques can aid in optimizing respiratory support in the PICU and NICU, quantifying the effect of therapeutic interventions, and guiding ventilator weaning and extubation. Most techniques now have commercially available equipment for the PICU and NICU, and many can generate continuous data points to help with ventilator weaning and other interventions. Technical and validation studies in the PICU and NICU are published for the majority of techniques; some have been used as outcome measures in clinical trials, but few have been assessed specifically for their ability to improve clinical outcomes. Although they show considerable promise, these techniques still require further study in the PICU and NICU together with increased availability of commercial equipment before wider incorporation into daily clinical practice.

  17. American Thoracic Society

    Science.gov (United States)

    ... Environmental Health Policy Ethics and Conflict of Interest Finance Health Equality and Diversity Committee Health Policy International ... for Entering a Flooded Home Our Sites ATS Foundation ATS Conferences ATS Guidelines ATS Journals ATS Newsletters ...

  18. Linking the congenital heart surgery databases of the Society of Thoracic Surgeons and the Congenital Heart Surgeons' Society: part 1--rationale and methodology.

    Science.gov (United States)

    Jacobs, Jeffrey P; Pasquali, Sara K; Austin, Erle; Gaynor, J William; Backer, Carl; Hirsch-Romano, Jennifer C; Williams, William G; Caldarone, Christopher A; McCrindle, Brian W; Graham, Karen E; Dokholyan, Rachel S; Shook, Gregory J; Poteat, Jennifer; Baxi, Maulik V; Karamlou, Tara; Blackstone, Eugene H; Mavroudis, Constantine; Mayer, John E; Jonas, Richard A; Jacobs, Marshall L

    2014-04-01

    The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) is the largest Registry in the world of patients who have undergone congenital and pediatric cardiac surgical operations. The Congenital Heart Surgeons' Society Database (CHSS-D) is an Academic Database designed for specialized detailed analyses of specific congenital cardiac malformations and related treatment strategies. The goal of this project was to create a link between the STS-CHSD and the CHSS-D in order to facilitate studies not possible using either individual database alone and to help identify patients who are potentially eligible for enrollment in CHSS studies. Centers were classified on the basis of participation in the STS-CHSD, the CHSS-D, or both. Five matrices, based on CHSS inclusionary criteria and STS-CHSD codes, were created to facilitate the automated identification of patients in the STS-CHSD who meet eligibility criteria for the five active CHSS studies. The matrices were evaluated with a manual adjudication process and were iteratively refined. The sensitivity and specificity of the original matrices and the refined matrices were assessed. In January 2012, a total of 100 centers participated in the STS-CHSD and 74 centers participated in the CHSS. A total of 70 centers participate in both and 40 of these 70 agreed to participate in this linkage project. The manual adjudication process and the refinement of the matrices resulted in an increase in the sensitivity of the matrices from 93% to 100% and an increase in the specificity of the matrices from 94% to 98%. Matrices were created to facilitate the automated identification of patients potentially eligible for the five active CHSS studies using the STS-CHSD. These matrices have a sensitivity of 100% and a specificity of 98%. In addition to facilitating identification of patients potentially eligible for enrollment in CHSS studies, these matrices will allow (1) estimation of the denominator of patients potentially

  19. Linking the congenital heart surgery databases of the Society of Thoracic Surgeons and the Congenital Heart Surgeons' Society: part 2--lessons learned and implications.

    Science.gov (United States)

    Jacobs, Jeffrey P; Pasquali, Sara K; Austin, Erle; Gaynor, J William; Backer, Carl; Hirsch-Romano, Jennifer C; Williams, William G; Caldarone, Christopher A; McCrindle, Brian W; Graham, Karen E; Dokholyan, Rachel S; Shook, Gregory J; Poteat, Jennifer; Baxi, Maulik V; Karamlou, Tara; Blackstone, Eugene H; Mavroudis, Constantine; Mayer, John E; Jonas, Richard A; Jacobs, Marshall L

    2014-04-01

    A link has been created between the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and the Congenital Heart Surgeons' Society Database (CHSS-D). Five matrices have been created that facilitate the automated identification of patients who are potentially eligible for the five active CHSS studies using the STS-CHSD. These matrices are now used to (1) estimate the denominator of patients eligible for CHSS studies and (2) compare "eligible and enrolled patients" to "potentially eligible and not enrolled patients" to assess the generalizability of CHSS studies. The matrices were applied to 40 consenting institutions that participate in both the STS-CHSD and the CHSS to (1) estimate the denominator of patients that are potentially eligible for CHSS studies, (2) estimate the completeness of enrollment of patients eligible for CHSS studies among all CHSS sites, (3) estimate the completeness of enrollment of patients eligible for CHSS studies among those CHSS institutions participating in each CHSS cohort study, and (4) compare "eligible and enrolled patients" to "potentially eligible and not enrolled patients" to assess the generalizability of CHSS studies. The matrices were applied to all participants in the STS-CHSD to identify patients who underwent frequently performed operations and compare "eligible and enrolled patients" to "potentially eligible and not enrolled patients" in following five domains: (1) age at surgery, (2) gender, (3) race, (4) discharge mortality, and (5) postoperative length of stay. Completeness of enrollment was defined as the number of actually enrolled patients divided by the number of patients identified as being potentially eligible for enrollment. For the CHSS Critical Left Ventricular Outflow Tract Study (LVOTO) study, for the Norwood procedure, completeness of enrollment at centers actively participating in the LVOTO study was 34%. For the Norwood operation, discharge mortality was 15% among 227 enrolled patients

  20. Linking the Congenital Heart Surgery Databases of the Society of Thoracic Surgeons and the Congenital Heart Surgeons’ Society: Part 1—Rationale and Methodology

    Science.gov (United States)

    Jacobs, Jeffrey P.; Pasquali, Sara K.; Austin, Erle; Gaynor, J. William; Backer, Carl; Hirsch-Romano, Jennifer C.; Williams, William G.; Caldarone, Christopher A.; McCrindle, Brian W.; Graham, Karen E.; Dokholyan, Rachel S.; Shook, Gregory J.; Poteat, Jennifer; Baxi, Maulik V.; Karamlou, Tara; Blackstone, Eugene H.; Mavroudis, Constantine; Mayer, John E.; Jonas, Richard A.; Jacobs, Marshall L.

    2014-01-01

    Purpose The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) is the largest Registry in the world of patients who have undergone congenital and pediatric cardiac surgical operations. The Congenital Heart Surgeons’ Society Database (CHSS-D) is an Academic Database designed for specialized detailed analyses of specific congenital cardiac malformations and related treatment strategies. The goal of this project was to create a link between the STS-CHSD and the CHSS-D in order to facilitate studies not possible using either individual database alone and to help identify patients who are potentially eligible for enrollment in CHSS studies. Methods Centers were classified on the basis of participation in the STS-CHSD, the CHSS-D, or both. Five matrices, based on CHSS inclusionary criteria and STS-CHSD codes, were created to facilitate the automated identification of patients in the STS-CHSD who meet eligibility criteria for the five active CHSS studies. The matrices were evaluated with a manual adjudication process and were iteratively refined. The sensitivity and specificity of the original matrices and the refined matrices were assessed. Results In January 2012, a total of 100 centers participated in the STS-CHSD and 74 centers participated in the CHSS. A total of 70 centers participate in both and 40 of these 70 agreed to participate in this linkage project. The manual adjudication process and the refinement of the matrices resulted in an increase in the sensitivity of the matrices from 93% to 100% and an increase in the specificity of the matrices from 94% to 98%. Conclusion Matrices were created to facilitate the automated identification of patients potentially eligible for the five active CHSS studies using the STS-CHSD. These matrices have a sensitivity of 100% and a specificity of 98%. In addition to facilitating identification of patients potentially eligible for enrollment in CHSS studies, these matrices will allow (1) estimation of

  1. Value of American Thoracic Society guidelines in predicting infection or colonization with multidrug-resistant organisms in critically ill patients.

    Directory of Open Access Journals (Sweden)

    Jianfeng Xie

    Full Text Available The incidence rate of infection by multidrug-resistant organisms (MDROs can affect the accuracy of etiological diagnosis when using American Thoracic Society (ATS guidelines. We determined the accuracy of the ATS guidelines in predicting infection or colonization by MDROs over 18 months at a single ICU in eastern China.This prospective observational study examined consecutive patients who were admitted to an intensive care unit (ICU in Nanjing, China. MDROs were defined as bacteria that were resistant to at least three antimicrobial classes, such as methicillin-resistant Staphylococcus aureus (MRSA, vancomycin-resistant enterococci (VRE, Pseudomonas aeruginosa, Acinetobacter baumannii. Screening for MDROs was performed at ICU admission and discharge. Risk factors for infection or colonization with MDROs were recorded, and the accuracy of the ATS guidelines in predicting infection or colonization with MDROs was documented.There were 610 patients, 225 (37% of whom were colonized or infected with MDROs at ICU admission, and this increased to 311 (51% at discharge. At admission, the sensitivity (70.0%, specificity (31.6%, positive predictive value (38.2%, and negative predictive value (63.5%, all based on ATS guidelines for infection or colonization with MDROs were low. The negative predictive value was greater in patients from departments with MDRO infection rates of 31-40% than in patients from departments with MDRO infection rates of 30% or less and from departments with MDRO infection rates more than 40%.ATS criteria were not reliable in predicting infection or colonization with MDROs in our ICU. The negative predictive value was greater in patients from departments with intermediate rates of MDRO infection than in patients from departments with low or high rates of MDRO infection.ClinicalTrials.gov NCT01667991.

  2. Management of pulmonary nodules in head and neck cancer patients - Our experience and interpretation of the British Thoracic Society Guidelines.

    Science.gov (United States)

    Green, Richard; King, Matthew; Reid, Helen; Murchison, John T; Evans, Andrew; Nixon, Iain J

    2017-08-01

    and purpose of the study: The frequency of lung nodules in the head and neck cancer population is unknown, currently the only guidance available recommends following local policy. The aim of this study was to determine the incidence of pulmonary nodules in our head and neck cancer group and interpret the recently updated British Thoracic Society (BTS) Lung Nodule Guidelines in a head and neck cancer setting. 100 patients were diagnosed with head and neck cancer between July 2013-March 2014, clinico-pathological, demographic and radiological data was extracted from the electronic records. Images with lung findings were re-reviewed by a single consultant radiologist for patients with lung pathology on the initial staging CT report. Twenty patients (20%) had discreet pulmonary findings on CT. Eleven (11%) had lung nodules, 6 (6%) had lesions suspicious for metastasis and 3 (3%) had co-incidental bronchogenic primary cancers. These patients were re-imaged between 6 and 18 months and in 1 patient the previously identified 7 mm nodule had progressed to 16 mm at 1 year. There was no set follow up imaging protocol used. The MDT in NHS Lothian has reviewed the BTS guidance and now has a local policy for the management of lung nodules in head and neck cancer patients. Lung Nodules in the head and neck cancer population are common >10%. Higher risk patients with larger nodules should be risk assessed with validated assessment tools. PET-CT has a place in the assessment of lung nodules when risk of malignancy is high. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  3. Practice pattern of transthoracic needle biopsy: 2016 survey in the members of Korean society of thoracic radiology

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    Jo, Ye Seul [Dept. of Radiology, Incheon St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Incheon (Korea, Republic of); Han, Kyong Min [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Park, Jai Soung [Dept. of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Kim, Tae Jung [Dept. of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2017-11-15

    To assess the current practice patterns of radiologists who perform transthoracic needle biopsy (TNB). An email survey of 71 questions on TNB was sent to 240 members of the Korean Society of Thoracic Radiology. The answers to multiple-choice questions (n = 56) were analyzed. Of 60 respondents, 45% had 10 or more years of experience in chest radiology, and 70% had 5 or more years of experience in TNB. For the question on the most frequently used diagnostic method for lesions with high probability of being resectable-stage lung cancer, 70% of respondents answered that TNB is initially used, with or without bronchoscopy. In patients at high-risk of TNB-related complications, the proportion of the respondents who consistently declined TNB was only 5%. The number of rebiopsies was said to be increased; molecular analysis for an established target therapy (43.6%) and clinical trial of a new drug (28.2%) were the two most common reasons for it. The most popular needle type was the coaxial cutting needle (55%), and the popular guiding modality was conventional computed tomography (CT) (56.7%). In addition, 15% of respondents have encountered air embolism. Despite high variation in how TNB is being performed in Korea, some patterns were noted. It is common for patients with resectable-stage lung cancer to undergo TNB prior to surgery. Rebiopsy is now more common than before, with personalized medicine as the most important reason for it. The most popular type of needle is the coaxial system; the most popular modality for guidance is still CT.

  4. Shared Decision Making in Intensive Care Units: An American College of Critical Care Medicine and American Thoracic Society Policy Statement

    Science.gov (United States)

    Kon, Alexander A.; Davidson, Judy E.; Morrison, Wynne; Danis, Marion; White, Douglas B.

    2015-01-01

    Objectives Shared decision-making (SDM) is endorsed by critical care organizations, however there remains confusion about what SDM is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define SDM, recommend when SDM should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. Methods The American College of Critical Care Medicine (ACCM) and American Thoracic Society (ATS) Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of ACCM and ATS were included in the statement. Main Results Six recommendations were endorsed: 1) Definition: Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a SDM process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Conclusions Patient and surrogate preferences for decision-making roles regarding value

  5. Adherence to the recommendations in respiratory rehabilitation of the British Thoracic Society in patients with cystic fibrosis. a study of colombian physiotherapists

    OpenAIRE

    Duran-Palomino, Diana; Programa de Especialización en Rehabilitación, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario. Bogotá D.C, Colombia. Fisioterapeuta especialista en rehabilitación cardiaca y pulmonar.; Chapetón, Olga; Departamento Fisioterapia, Clínica Fundación Valle del Lili. Cali, Colombia. fisioterapeuta en rehabilitación cardiopulmonar.; Martínez-Santa, Jaime; Programa de Especialización en Rehabilitación, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario. Bogotá D.C, Colombia. fisioterapeuta especialista en Epidemiologia.; Campos-Rodríguez, Adriana; Grupo GICAEDS, Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás. Bogotá, D.C, Colombia. fisioterapeuta máster en Educación.; Ramírez-Vélez, Robinson; Grupo GICAEDS, Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás. Bogotá, D.C, Colombia. Programa de Fisioterapia, Universidad Manuela Beltrán, Bogotá D.C, Colombia. fisioterapeuta PhD en Ciencias Biomédicas.

    2014-01-01

    The aim was to evaluate compliance with the recommendations in respiratory rehabilitation (ReR), raised by the British Thoracic Society (BTS) in patients with cystic fibrosis. A cross-sectional study was conducted in 224 Colombian physiotherapists to identify interventions and components of ReR programs as recommended by the BTS. Interventions with high level of evidence (Grade A) such as: Bronchial Hygiene Therapy (54.0%), and Active Cycle of Breathing Techniques (35.3%) were identified....

  6. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: Executive summary

    Science.gov (United States)

    Silversides, Candice K; Bradley, Timothy; Colman, Jack; Connelly, Michael; Harris, Louise; Khairy, Paul; Mital, Seema; Niwa, Koichiro; Oechslin, Erwin; Poirier, Nancy; Schwerzmann, Markus; Taylor, Dylan; Muhll, Isabelle Vonder; Baumgartner, Helmut; Benson, Lee; Celermajer, David; Greutmann, Matthias; Horlick, Eric; Landzberg, Mike; Meijboom, Folkert; Mulder, Barbara; Warnes, Carole; Webb, Gary; Therrien, Judith

    2010-01-01

    With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. They have distinctive forms of heart failure, and their cardiac disease can be associated with pulmonary hypertension, thromboemboli, complex arrhythmias and sudden death. Medical aspects that need to be considered relate to the long-term and multisystemic effects of single-ventricle physiology, cyanosis, systemic right ventricles, complex intracardiac baffles and failing subpulmonary right ventricles. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with CHD, there have been significant advances in the understanding of the late outcomes, genetics, medical therapy and interventional approaches in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. The present executive summary is a brief overview of the new guidelines and includes the recommendations for interventions. The complete document consists of four manuscripts that are published online in the present issue of The Canadian Journal of Cardiology, including sections on genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy and contraception risks, and follow-up requirements. The complete document and references can also be found at www.ccs.ca or www.cachnet.org. PMID:20352134

  7. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy

    OpenAIRE

    Rey, E; LeLorier, J; Burgess, E; Lange, I R; Leduc, L

    1997-01-01

    OBJECTIVE: To provide Canadian physicians with evidence-based guidelines for the pharmacologic treatment of hypertensive disorders in pregnancy. OPTIONS: No medication, or treatment with antihypertensive or anticonvulsant drugs. OUTCOMES: Prevention of maternal complications, and prevention of perinatal complications and death. EVIDENCE: Pertinent articles published from 1962 to September 1996 retrieved from the Pregnancy and Childbirth Module of the Cochrane Database of Systematic Reviews an...

  8. Reliability and validity of the French-Canadian version of the scoliosis research society 22 questionnaire in France.

    Science.gov (United States)

    Lonjon, Guillaume; Ilharreborde, Brice; Odent, Thierry; Moreau, Sébastien; Glorion, Christophe; Mazda, Keyvan

    2014-01-01

    Outcome study to determine the internal consistency, reproducibility, and concurrent validity of the French-Canadian version of the Scoliosis Research Society 22 (SRS-22 fcv) patient questionnaire in France. To determine whether the SRS-22 fcv can be used in a population from France. The SRS-22 has been translated and validated in multiple countries, notably in the French-Canadian language in Quebec, Canada. Use of SRS-22 fcv seems appropriate for evaluating adolescent idiopathic scoliosis in France. However, French-Canadian French is noticeably different from the French spoken in France, and no study has investigated the use of a French-Canadian version of a health-quality questionnaire in another French population. The methods used for validating the SRS-22 fcv in Quebec were adopted for use with a group of 200 adolescents with idiopathic scoliosis and 60 healthy adolescents in France. Reliability and reproducibility were measured by the Cronbach α and intraclass correlation coefficient (ICC), construct validity by factorial analysis, concurrent validity by the Short-Form of the survey, and discriminant validity by analysis of variance and multivariate linear regression. In France, the SRS-22 fcv showed good global internal consistency (Cronbach α = 0.87, intraclass correlation coefficient = 0.92), a coherent factorial structure, and high correlation coefficients between the SRS-22 fcv and Short-Form of the survey (P France, but further development and validation of a specific French questionnaire remain necessary to improve the assessment of functional outcomes of adolescents with scoliosis in France. N/A.

  9. An Official American Thoracic Society Research Statement: Current Challenges Facing Research and Therapeutic Advances in Airway Remodeling.

    Science.gov (United States)

    Prakash, Y S; Halayko, Andrew J; Gosens, Reinoud; Panettieri, Reynold A; Camoretti-Mercado, Blanca; Penn, Raymond B

    2017-01-15

    Airway remodeling (AR) is a prominent feature of asthma and other obstructive lung diseases that is minimally affected by current treatments. The goals of this Official American Thoracic Society (ATS) Research Statement are to discuss the scientific, technological, economic, and regulatory issues that deter progress of AR research and development of therapeutics targeting AR and to propose approaches and solutions to these specific problems. This Statement is not intended to provide clinical practice recommendations on any disease in which AR is observed and/or plays a role. An international multidisciplinary group from within academia, industry, and the National Institutes of Health, with expertise in multimodal approaches to the study of airway structure and function, pulmonary research and clinical practice in obstructive lung disease, and drug discovery platforms was invited to participate in one internet-based and one face-to-face meeting to address the above-stated goals. Although the majority of the analysis related to AR was in asthma, AR in other diseases was also discussed and considered in the recommendations. A literature search of PubMed was performed to support conclusions. The search was not a systematic review of the evidence. Multiple conceptual, logistical, economic, and regulatory deterrents were identified that limit the performance of AR research and impede accelerated, intensive development of AR-focused therapeutics. Complementary solutions that leverage expertise of academia and industry were proposed to address them. To date, numerous factors related to the intrinsic difficulty in performing AR research, and economic forces that are disincentives for the pursuit of AR treatments, have thwarted the ability to understand AR pathology and mechanisms and to address it clinically. This ATS Research Statement identifies potential solutions for each of these factors and emphasizes the importance of educating the global research community as to the

  10. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

    Science.gov (United States)

    Duceppe, Emmanuelle; Parlow, Joel; MacDonald, Paul; Lyons, Kristin; McMullen, Michael; Srinathan, Sadeesh; Graham, Michelle; Tandon, Vikas; Styles, Kim; Bessissow, Amal; Sessler, Daniel I; Bryson, Gregory; Devereaux, P J

    2017-01-01

    The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  11. Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: A Canadian Thoracic Society clinical practice guideline

    Science.gov (United States)

    Marciniuk, Darcy D; Goodridge, Donna; Hernandez, Paul; Rocker, Graeme; Balter, Meyer; Bailey, Pat; Ford, Gordon; Bourbeau, Jean; O’Donnell, Denis E; Maltais, Francois; Mularski, Richard A; Cave, Andrew J; Mayers, Irvin; Kennedy, Vicki; Oliver, Thomas K; Brown, Candice

    2011-01-01

    Dyspnea is a cardinal symptom of chronic obstructive pulmonary disease (COPD), and its severity and magnitude increases as the disease progresses, leading to significant disability and a negative effect on quality of life. Refractory dyspnea is a common and difficult symptom to treat in patients with advanced COPD. There are many questions concerning optimal management and, specifically, whether various therapies are effective in this setting. The present document was compiled to address these important clinical issues using an evidence-based systematic review process led by a representative interprofessional panel of experts. The evidence supports the benefits of oral opioids, neuromuscular electrical stimulation, chest wall vibration, walking aids and pursed-lip breathing in the management of dyspnea in the individual patient with advanced COPD. Oxygen is recommended for COPD patients with resting hypoxemia, but its use for the targeted management of dyspnea in this setting should be reserved for patients who receive symptomatic benefit. There is insufficient evidence to support the routine use of anxiolytic medications, nebulized opioids, acupuncture, acupressure, distractive auditory stimuli (music), relaxation, hand-held fans, counselling programs or psychotherapy. There is also no evidence to support the use of supplemental oxygen to reduce dyspnea in nonhypoxemic patients with advanced COPD. Recognizing the current unfamiliarity with prescribing and dosing of opioid therapy in this setting, a potential approach for their use is illustrated. The role of opioid and other effective therapies in the comprehensive management of refractory dyspnea in patients with advanced COPD is discussed. PMID:21499589

  12. Recommendations for Patients with Chronic Respiratory Disease Considering Air Travel: A Statement from the Canadian Thoracic Society

    Directory of Open Access Journals (Sweden)

    Dale Lien

    1998-01-01

    Full Text Available Patients with respiratory disease regularly seek the convenience of commercial airline travel. In addition to the stresses that all patients with chronic disease encounter, these patients are exposed to the affects of acute altitudinal hypoxemia. This in turn has the potential to produce significant symptoms and complications in-flight for patients with chronic respiratory disease. This article reviews the current literature, and seeks to help the practicing physician by providing recommendations on which patients should be assessed preflight, the type of assessment that should be carried out and recommendations for providing advice to these travelling patients.

  13. Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: a Canadian Thoracic Society clinical practice guideline.

    Science.gov (United States)

    Marciniuk, Darcy D; Goodridge, Donna; Hernandez, Paul; Rocker, Graeme; Balter, Meyer; Bailey, Pat; Ford, Gord; Bourbeau, Jean; O'Donnell, Denis E; Maltais, Francois; Mularski, Richard A; Cave, Andrew J; Mayers, Irvin; Kennedy, Vicki; Oliver, Thomas K; Brown, Candice

    2011-01-01

    Dyspnea is a cardinal symptom of chronic obstructive pulmonary disease (COPD), and its severity and magnitude increases as the disease progresses, leading to significant disability and a negative effect on quality of life. Refractory dyspnea is a common and difficult symptom to treat in patients with advanced COPD. There are many questions concerning optimal management and, specifically, whether various therapies are effective in this setting. The present document was compiled to address these important clinical issues using an evidence-based systematic review process led by a representative interprofessional panel of experts. The evidence supports the benefits of oral opioids, neuromuscular electrical stimulation, chest wall vibration, walking aids and pursed-lip breathing in the management of dyspnea in the individual patient with advanced COPD. Oxygen is recommended for COPD patients with resting hypoxemia, but its use for the targeted management of dyspnea in this setting should be reserved for patients who receive symptomatic benefit. There is insufficient evidence to support the routine use of anxiolytic medications, nebulized opioids, acupuncture, acupressure, distractive auditory stimuli (music), relaxation, handheld fans, counselling programs or psychotherapy. There is also no evidence to support the use of supplemental oxygen to reduce dyspnea in nonhypoxemic patients with advanced COPD. Recognizing the current unfamiliarity with prescribing and dosing of opioid therapy in this setting, a potential approach for their use is illustrated. The role of opioid and other effective therapies in the comprehensive management of refractory dyspnea in patients with advanced COPD is discussed.

  14. Managing Dyspnea in Patients with Advanced Chronic Obstructive Pulmonary Disease: A Canadian Thoracic Society Clinical Practice Guideline

    Directory of Open Access Journals (Sweden)

    Darcy D Marciniuk

    2011-01-01

    Full Text Available Dyspnea is a cardinal symptom of chronic obstructive pulmonary disease (COPD, and its severity and magnitude increases as the disease progresses, leading to significant disability and a negative effect on quality of life. Refractory dyspnea is a common and difficult symptom to treat in patients with advanced COPD. There are many questions concerning optimal management and, specifically, whether various therapies are effective in this setting. The present document was compiled to address these important clinical issues using an evidence-based systematic review process led by a representative interprofessional panel of experts.

  15. Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease.

    Science.gov (United States)

    Wong, Kenny K; Fournier, Anne; Fruitman, Deborah S; Graves, Lisa; Human, Derek G; Narvey, Michael; Russell, Jennifer L

    2017-02-01

    Congenital heart disease is the most common congenital malformation and approximately 3 in 1000 newborns have critical congenital heart disease (CCHD). Timely diagnosis affects morbidity, mortality, and disability, and newborn pulse oximetry screening has been studied to enhance detection of CCHD. In this position statement we present an evaluation of the literature for pulse oximetry screening. Current detection strategies including prenatal ultrasound examination and newborn physical examination are limited by low diagnostic sensitivity. Pulse oximetry screening is safe, noninvasive, easy to perform, and widely available with a high specificity (99.9%) and moderately high sensitivity (76.5%). When an abnormal saturation is obtained, the likelihood of having CCHD is 5.5 times greater than when a normal result is obtained. The use of pulse oximetry combined with current strategies has shown sensitivities of up to 92% for detecting CCHD. False positive results can be minimized by screening after 24 hours, and testing the right hand and either foot might further increase sensitivity. Newborns with abnormal screening results should undergo a comprehensive assessment and echocardiography performed if a cardiac cause cannot be excluded. Screening has been studied to be cost neutral to cost effective. We recommend that pulse oximetry screening should be routinely performed in all healthy newborns to enhance the detection of CCHD in Canada. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  16. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy.

    Science.gov (United States)

    Rey, E; LeLorier, J; Burgess, E; Lange, I R; Leduc, L

    1997-11-01

    To provide Canadian physicians with evidence-based guidelines for the pharmacologic treatment of hypertensive disorders in pregnancy. No medication, or treatment with antihypertensive or anticonvulsant drugs. Prevention of maternal complications, and prevention of perinatal complications and death. Pertinent articles published from 1962 to September 1996 retrieved from the Pregnancy and Childbirth Module of the Cochrane Database of Systematic Reviews and from MEDLINE; additional articles retrieved through a manual search of bibliographies; and expert opinion. Recommendations were graded according to levels of evidence. Maternal and fetal well-being were equally valued, with the belief that treatment side effects should be minimized. Reduction in the rate of adverse perinatal outcomes, including death. Potential side effects of antihypertensive drugs include placental hypoperfusion, intrauterine growth retardation and long-term effects on the infant. A systolic blood pressure greater than 169 mm Hg or a diastolic pressure greater than 109 mm Hg in a pregnant woman should be considered an emergency and pharmacologic treatment with hydralazine, labetalol or nifedipine started. Otherwise, the thresholds at which to start antihypertensive treatment are a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg in women with gestational hypertension without proteinuria or pre-existing hypertension before 28 weeks' gestation, those with gestational hypertension and proteinuria or symptoms at any time during the pregnancy, those with pre-existing hypertension and underlying conditions or target-organ damage, and those with pre-existing hypertension and superimposed gestational hypertension. The thresholds in other circumstances are a systolic pressure of 150 mm Hg or a diastolic pressure of 95 mm Hg. For nonsevere hypertension, methyldopa is the first-line drug; labetalol, pindolol, oxprenolol and nifedipine are second-line drugs. Fetal distress attributed to

  17. Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society

    Directory of Open Access Journals (Sweden)

    DE Moulin

    2007-01-01

    Full Text Available Neuropathic pain (NeP, generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics and anticonvulsants (gabapentin and pregabalin. Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.

  18. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass--Temperature Management During Cardiopulmonary Bypass.

    Science.gov (United States)

    Engelman, Richard; Baker, Robert A; Likosky, Donald S; Grigore, Alina; Dickinson, Timothy A; Shore-Lesserson, Linda; Hammon, John W

    2015-08-01

    In order to improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including: 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendations: CLASS I RECOMMENDATIONS: a)The oxygenator arterial outlet blood temperature is recommended to be utilized as a surrogate for cerebral temperature measurement during CPB. (Class I, Level C) b)To monitor cerebral perfusate temperature during warming, it should be assumed that the oxygenator arterial outlet blood temperature under-estimates cerebral perfusate temperature. (Class I, Level C) c)Surgical teams should limit arterial outlet blood temperature to<37°C to avoid cerebral hyperthermia. (Class 1, Level C) d)Temperature gradients between the arterial outlet and venous inflow on the oxygenator during CPB cooling should not exceed 10°C to avoid generation of gaseous emboli. (Class 1, Level C) e)Temperature gradients between the arterial outlet and venous inflow on the oxygenator during CPB rewarming should not exceed 10°C to avoid out-gassing when blood is returned to the patient. (Class 1, Level C) CLASS IIa a)Pulmonary artery or nasopharyngeal temperature recording is reasonable for weaning and immediate post-bypass temperature measurement. (Class IIa, Level C)b)Rewarming when arterial blood outlet temperature ≥30° C: i.To achieve the desired temperature for separation from bypass, it is reasonable to maintain a temperature gradient between

  19. The Canadian experience with Durata and Riata ST Optim defibrillator leads: a report from the Canadian Heart Rhythm Society Device Committee.

    Science.gov (United States)

    Bennett, Matthew T; Ha, Andrew C T; Exner, Derek V; Tung, Stanley K K; Parkash, Ratika; Connors, Sean; Coutu, Benoit; Crystal, Eugene; Champagne, Jean; Philippon, Francois; Yee, Raymond; Stephenson, Elizabeth A; Nery, Pablo B; Essebag, Vidal; Sanatani, Shubhayan; Redfearn, Damian; Krahn, Andrew D; Healey, Jeffrey S

    2013-10-01

    The St. Jude Medical Riata family of implantable cardioverter-defibrillator (ICD) leads has demonstrated a high rate of externalized conductors and electrical failure. Given similar design elements of Durata to Riata, the purpose of this study was to assess the rates of failure of the Riata ST Optim and Durata lead families in Canada. All Canadian ICD-implanting centers were invited to submit follow-up information on all Optim-coated ICD leads implanted. Electrical failure was defined as a rapid change in impedance or pacing capture threshold leading to lead revision, or oversensing due to noise. Externalized conductors were defined as appearance of conductor wires outside the lead body. Systematic fluoroscopic screening for externalized conductors was not performed. As of December 1, 2012, 15 of 25 centers provided data on 3981 leads (44% of those sold in Canada during the same timeframe): 3477 Durata and 504 Riata ST Optim leads. The most common model numbers were 7122 (1516 leads [38%]), 7121 (707 leads [18%]), and 7120 (622 leads [16%]). Mean follow-up duration from implant to December 1, 2012, was 4.47 ± 0.48 years for Riata ST Optim leads and 2.00 ± 1.10 years for Durata leads. The annual rate of lead failure was 0.27% per year for Riata ST Optim leads and 0.24% per year for Durata leads. No instances of externalized conductors were identified in the failed leads. No deaths were attributed to lead failure; however, 2 patients experienced inappropriate shocks due to lead failure. The overall electrical failure rates of the Riata ST Optim and Durata leads appear to be low, and no instances of externalized conductors were observed. © 2013 Heart Rhythm Society. All rights reserved.

  20. Statistical Indicators of Ethno-Cultural Community Integration in Canadian Society = Indicateurs statistiques de l'integration des communautes ethnoculturelles dans la societe canadienne.

    Science.gov (United States)

    de Vries, John

    This paper addresses the issue of measuring the integration of various ethnocultural communities into Canadian society by means of statistical or social indicators. The overall philosophy of the study is based on the following principles: (1) indicators should have a clear meaning with respect to the underlying concept of integration; (2)…

  1. Safety and effectiveness of the herpes zoster vaccine to prevent postherpetic neuralgia: 2014 Update and consensus statement from the Canadian Pain Society

    Directory of Open Access Journals (Sweden)

    Canadian Pain Society Study Day participants

    2015-01-01

    Full Text Available The Canadian Pain Society (CPS hosted its first Study Day in Toronto in July 2014, attended by experts in various fields of pain management and research (listed below. The aim was to review the National Advisory Committee on Immunization guidelines and to prepare a CPS position statement concerning the use of the zoster vaccine in Canada.

  2. Lesbian mommy blogging in Canada: documenting subtle homophobia in Canadian society and building community online.

    Science.gov (United States)

    Hunter, Andrea

    2015-01-01

    This article analyzes how lesbian mommy bloggers in Canada are using their blogs as forums for self-expression and a means to form community, as they record their unique experiences as queer parents. Further, it argues that lesbian mommy blogging is documenting a subtle form of homophobia that exists in Canada in terms of social acceptance. Although there is legal acceptance of queer families, society has not necessarily caught up with the law. These blogs show that lesbian parents in Canada still struggle with issues of equality, including difficulties being "out," invisibility, and having to advocate for the non-birth parent.

  3. Recommendations from the European Society of Thoracic Surgeons (ESTS) regarding computed tomography screening for lung cancer in Europe

    DEFF Research Database (Denmark)

    Pedersen, Jesper Holst; Rzyman, Witold; Veronesi, Giulia

    2017-01-01

    In order to provide recommendations regarding implementation of computed tomography (CT) screening in Europe the ESTS established a working group with eight experts in the field. On a background of the current situation regarding CT screening in Europe and the available evidence, ten recommendati......In order to provide recommendations regarding implementation of computed tomography (CT) screening in Europe the ESTS established a working group with eight experts in the field. On a background of the current situation regarding CT screening in Europe and the available evidence, ten...... reports). Thoracic Surgeons will play a key role in this process and therefore the ESTS is committed to providing guidance and facilitating this process for the benefit of patients and surgeons....

  4. Educators of the Information Society: Information Literacy Instruction in Canadian Informational Cities

    Directory of Open Access Journals (Sweden)

    Maria Henkel

    2015-06-01

    Full Text Available As information literacy is a key competence of the information society, information literacy instruction in public as well as academic libraries is crucial. Today, librarians do not only act as providers of information but also as educators of the information society's citizens. The rapid development of information and communications technologies is constantly changing the way we interact with information, making it difficult to keep up to date with instructional trends. This study aims to assess the perceived quality of information literacy instruction in libraries of Canada's informational cities: Montreal, Toronto and Vancouver. Therefore, librarians were interviewed by means of a questionnaire inspired by the SERVQUAL diagnostic tool. The questionnaire comprises of two parts: The first part consists of questions regarding information literacy instruction, in the second part the focus is on the seven competence areas of information literacy. Based on the difference between the librarians' "Expectation" and "Experience", gap scores for all questionnaire items were calculated and are now being presented and discussed.

  5. Control and prevention of tuberculosis in the United Kingdom: code of practice 2000. Joint Tuberculosis Committee of the British Thoracic Society.

    Science.gov (United States)

    2000-11-01

    The guidelines on control and prevention of tuberculosis in the United Kingdom have been reviewed and updated. A subcommittee was appointed by the Joint Tuberculosis Committee (JTC) of the British Thoracic Society to revise the guidelines published in 1994 by the JTC, including representatives of the Royal College of Nursing, Public Health Medicine Environmental Group, and Medical Society for Study of Venereal Diseases. In preparing the revised guidelines the authors took account of new published evidence and graded the strength of evidence for their recommendations. The guidelines have been approved by the JTC and the Standards of Care Committee of the British Thoracic Society. Tuberculosis services in each district should have staffing and resources to fulfil both the control and prevention recommendations in this document and to ensure adequate treatment monitoring. Notification of tuberculosis is required for surveillance and to initiate contact tracing (where appropriate). The following areas are discussed and recommendations made where appropriate: (1) public health law in relation to tuberculosis; (2) the organisational requirements for tuberculosis services; (3) measures for control of tuberculosis in hospitals, including segregation of patients; (4) the requirements for health care worker protection, including HIV infected health care workers; (5) measures for control of tuberculosis in prisons; (6) protection for other groups with potential exposure to tuberculosis; (7) awareness of the high rates of tuberculosis in the homeless together with local plans for detection and action; (8) detailed advice on contact tracing; (9) contact tracing required for close contacts of bovine tuberculosis; (10) management of tuberculosis in schools; (11) screening of new immigrants and how this should be performed; (12) outbreak contingency investigation; and (13) BCG vaccination and the management of positive reactors found in the schools programme.

  6. Standards for quality care in respiratory rehabilitation in patients with chronic pulmonary disease. Quality Healthcare Committee. Spanish Society of Pneumology and Thoracic Surgery (SEPAR).

    Science.gov (United States)

    Güell, Maria Rosa; Cejudo, Pilar; Rodríguez-Trigo, Gema; Gàldiz, Juan Bautista; Casolive, Vinyet; Regueiro, Mônica; Soler-Cataluña, Juan Jose

    2012-11-01

    Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection. Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.

  7. An official American Thoracic Society workshop report: optimal lung function tests for monitoring cystic fibrosis, bronchopulmonary dysplasia, and recurrent wheezing in children less than 6 years of age.

    Science.gov (United States)

    Rosenfeld, Margaret; Allen, Julian; Arets, Bert H G M; Aurora, Paul; Beydon, Nicole; Calogero, Claudia; Castile, Robert G; Davis, Stephanie D; Fuchs, Susanne; Gappa, Monika; Gustaffson, Per M; Hall, Graham L; Jones, Marcus H; Kirkby, Jane C; Kraemer, Richard; Lombardi, Enrico; Lum, Sooky; Mayer, Oscar H; Merkus, Peter; Nielsen, Kim G; Oliver, Cara; Oostveen, Ellie; Ranganathan, Sarath; Ren, Clement L; Robinson, Paul D; Seddon, Paul C; Sly, Peter D; Sockrider, Marianna M; Sonnappa, Samatha; Stocks, Janet; Subbarao, Padmaja; Tepper, Robert S; Vilozni, Daphna

    2013-04-01

    Although pulmonary function testing plays a key role in the diagnosis and management of chronic pulmonary conditions in children under 6 years of age, objective physiologic assessment is limited in the clinical care of infants and children less than 6 years old, due to the challenges of measuring lung function in this age range. Ongoing research in lung function testing in infants, toddlers, and preschoolers has resulted in techniques that show promise as safe, feasible, and potentially clinically useful tests. Official American Thoracic Society workshops were convened in 2009 and 2010 to review six lung function tests based on a comprehensive review of the literature (infant raised-volume rapid thoracic compression and plethysmography, preschool spirometry, specific airway resistance, forced oscillation, the interrupter technique, and multiple-breath washout). In these proceedings, the current state of the art for each of these tests is reviewed as it applies to the clinical management of infants and children under 6 years of age with cystic fibrosis, bronchopulmonary dysplasia, and recurrent wheeze, using a standardized format that allows easy comparison between the measures. Although insufficient evidence exists to recommend incorporation of these tests into the routine diagnostic evaluation and clinical monitoring of infants and young children with cystic fibrosis, bronchopulmonary dysplasia, or recurrent wheeze, they may be valuable tools with which to address specific concerns, such as ongoing symptoms or monitoring response to treatment, and as outcome measures in clinical research studies.

  8. Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society….

    Science.gov (United States)

    Parma, Radosław; Zembala, Michał O; Dąbrowski, Maciej; Jagielak, Dariusz; Witkowski, Adam; Suwalski, Piotr; Dudek, Dariusz; Olszówka, Piotr; Wojakowski, Wojciech; Przybylski, Roman; Gil, Robert; Kuśmierczyk, Mariusz; Lesiak, Maciej; Sadowski, Jerzy; Dobrzycki, Sławomir; Ochała, Andrzej; Hoffman, Piotr; Kapelak, Bogusław; Kaźmierczak, Jarosław; Jasiński, Marek; Stępińska, Janina; Szymański, Piotr; Hryniewiecki, Tomasz; Kochman, Janusz; Grygier, Marek; Zembala, Marian; Legutko, Jacek; Różański, Jacek

    2017-01-01

    Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, devel-oped this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multi-disciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establish-ment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.

  9. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons.

    Science.gov (United States)

    Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

    2017-10-01

    The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes and stable ischemic heart disease (SIHD) were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD.Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing group felt were affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization.A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range of 4 to 6 indicate that

  10. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons.

    Science.gov (United States)

    Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

    2017-04-01

    The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes (ACS) and stable ischemic heart disease were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and in an effort to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing ACS and stable ischemic heart disease individually. This document presents the AUC for ACS. Clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, presence of clinical instability or ongoing ischemic symptoms, prior reperfusion therapy, risk level as assessed by noninvasive testing, fractional flow reserve testing, and coronary anatomy. This update provides a reassessment of clinical scenarios that the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization. A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range (4 to 6

  11. Perioperative mechanical circulatory support in children: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

    Science.gov (United States)

    Mascio, Christopher E; Austin, Erle H; Jacobs, Jeffrey P; Jacobs, Marshall L; Wallace, Amelia S; He, Xia; Pasquali, Sara K

    2014-02-01

    Analyses of mechanical circulatory support (MCS) in pediatric heart surgery have primarily focused on single-center outcomes or narrow applications. We describe the patterns of use, patient characteristics, and MCS-associated outcomes across a large multicenter cohort. Patients (aged institutions. Of 96,596 operations (80 centers), MCS was used in 2.4%. The MCS patients were younger (13 vs 195 days, P vs 32.7%, P vs 2.9% of non-MCS patients; P institutions, with both high- and low-volume hospitals having substantial variation in MCS rates. Perioperative MCS use varied widely across centers. The MCS rates were greatest overall for the Norwood procedure and complex biventricular repairs. Although MCS can be a life-saving therapy, more than one half of MCS patients will not survive to hospital discharge, with mortality >70% for some operations. Future studies aimed at better understanding the appropriate indications, optimal timing, and management of MCS could help to reduce the variation in MCS use across hospitals and improve outcomes. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  12. A risk score to predict the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy: An analysis from the European Society of Thoracic Surgeons database.

    Science.gov (United States)

    Pompili, Cecilia; Falcoz, Pierre Emmanuel; Salati, Michele; Szanto, Zalan; Brunelli, Alessandro

    2017-04-01

    The study objective was to develop an aggregate risk score for predicting the occurrence of prolonged air leak after video-assisted thoracoscopic lobectomy from patients registered in the European Society of Thoracic Surgeons database. A total of 5069 patients who underwent video-assisted thoracoscopic lobectomy (July 2007 to August 2015) were analyzed. Exclusion criteria included sublobar resections or pneumonectomies, lung resection associated with chest wall or diaphragm resections, sleeve resections, and need for postoperative assisted mechanical ventilation. Prolonged air leak was defined as an air leak more than 5 days. Several baseline and surgical variables were tested for a possible association with prolonged air leak using univariable and logistic regression analyses, determined by bootstrap resampling. Predictors were proportionally weighed according to their regression estimates (assigning 1 point to the smallest coefficient). Prolonged air leak was observed in 504 patients (9.9%). Three variables were found associated with prolonged air leak after logistic regression: male gender (P classes with an incremental risk of prolonged air leak (P class A (score 0 points, 1493 patients) 6.3% with prolonged air leak, class B (score 1 point, 2240 patients) 10% with prolonged air leak, class C (score 2 points, 1219 patients) 13% with prolonged air leak, and class D (score >2 points, 117 patients) 25% with prolonged air leak. An aggregate risk score was created to stratify the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy. The score can be used for patient counseling and to identify those patients who can benefit from additional intraoperative preventative measures. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  13. The Perioperative Use of Dexmedetomidine in Pediatric Patients with Congenital Heart Disease: An Analysis from the Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons Congenital Heart Disease Database.

    Science.gov (United States)

    Schwartz, Lawrence I; Twite, Mark; Gulack, Brian; Hill, Kevin; Kim, Sunghee; Vener, David F

    2016-09-01

    Dexmedetomidine is a selective α-2 receptor agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic for pediatric patients with congenital heart disease (CHD). Although several smaller, single-center studies suggest that dexmedetomidine use is gaining traction in the perioperative setting in children with CHD, there are limited multicenter data, with little understanding of the variation in use across age ranges, procedural complexity, and centers. The aim of this study was to use the Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons (CCAS-STS) registry to describe patient- and center-level variability in the use of dexmedetomidine in the perioperative setting in children with heart disease. To describe the use of dexmedetomidine in patients for CHD surgery, we analyzed all index cardiopulmonary bypass operations entered in the CCAS-STS database from 2010 to 2013. Patient and operative characteristics were compared between those who received intraoperative dexmedetomidine and those who did not. Selective outcomes associated with dexmedetomidine use were also described. Of the 12,142 operations studied, 3600 (29.6%) received perioperative dexmedetomidine (DEX) and 8542 did not receive the drug (NoDEX). Patient characteristics were different between the 2 groups with the DEX group generally exhibiting both lower patient and procedural risk factors. Patients who received dexmedetomidine were more likely to have a lower level of Society of Thoracic Surgeons mortality complexity than patient who did not receive it. Consistent with their overall lower risk profile, children in the DEX group also demonstrated improved outcomes compared with patients who did not receive dexmedetomidine. We described the growing use of dexmedetomidine in children anesthetized for surgical repair of CHD. Dexmedetomidine appears to be preferentially given to older and larger children who are undergoing less complex CHD surgery. We believe

  14. Correlation of EGFR mutation status with predominant histologic subtype of adenocarcinoma according to the new lung adenocarcinoma classification of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society.

    Science.gov (United States)

    Villa, Celina; Cagle, Philip T; Johnson, Melissa; Patel, Jyoti D; Yeldandi, Anjana V; Raj, Rishi; DeCamp, Malcolm M; Raparia, Kirtee

    2014-10-01

    Epidermal growth factor receptor (EGFR) mutations have been identified as predictors of response to EGFR tyrosine kinase inhibitors in non-small cell lung cancer. To investigate the relationship of EGFR mutation status to the histologic subtype of adenocarcinoma according to the new International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification. We screened EGFR mutation in 200 consecutive lung adenocarcinoma resection specimens diagnosed between 2008 and 2011. Among 200 lung adenocarcinomas, EGFR mutations were identified in 41 tumors (20.5%). The mean age in the EGFR-mutant group was 64.8 years and this group consisted of 78% females and 22% males. Most patients with EGFR-positive lung cancers were never-smokers (51%) as compared to 8% with EGFR-negative cancers (P adenocarcinoma was lepidic (44%) in EGFR-mutant lung cancers as compared to 69% with acinar pattern in EGFR wild-type lung cancers (P adenocarcinomas, 8 (36%) had EGFR mutations, accounting for 20% of adenocarcinomas with EGFR mutations (P adenocarcinoma was lepidic (44%) in EGFR-mutant lung cancers (P lung adenocarcinomas of other subtypes.

  15. Does patient gender affect outcomes after concomitant coronary artery bypass graft and aortic valve replacement? An Australian Society of Cardiac and Thoracic Surgeons Database study.

    Science.gov (United States)

    Saxena, Akshat; Poh, Chin-Leng; Dinh, Diem T; Reid, Christopher M; Smith, Julian A; Shardey, Gilbert C; Newcomb, Andrew E

    2011-01-01

    Women undergoing isolated coronary artery bypass graft (CABG) surgery have been previously shown to be at an independently increased risk for post-operative morbidity and mortality. However, there are considerably less data on whether this trend remains true in patients undergoing concomitant aortic valve replacement (AVR) and CABG surgery. The aim of our study was to investigate this pertinent issue. Data obtained between June 2001 and December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program were retrospectively analysed. Demographic, operative data and post-operative complications were compared between male and female patients using χ(2) and t tests. Long-term survival analysis was performed using Kaplan-Meier survival curves and the log-rank test. Independent risk factors for short- and long-term mortality were identified using binary logistic and Cox regression, respectively. Concomitant AVR and CABG surgery was undertaken in 2,563 patients; 31.8% were female. Female patients were older (mean age 76 vs. 73 years; p gender was independently associated with post-operative myocardial infarction (p = 0.022) and red blood cell transfusion (p difference in long-term survival between men and women on multivariate analysis (p = 0.413). Female gender is not associated with poorer short- or long-term outcomes after concomitant CABG and AVR surgery. Copyright © 2011 S. Karger AG, Basel.

  16. The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes.

    Science.gov (United States)

    Jimenez Ruiz, Carlos A; Solano Reina, Segismundo; de Granda Orive, Jose Ignacio; Signes-Costa Minaya, Jaime; de Higes Martinez, Eva; Riesco Miranda, Juan Antonio; Altet Gómez, Neus; Lorza Blasco, Jose Javier; Barrueco Ferrero, Miguel; de Lucas Ramos, Pilar

    2014-08-01

    The electronic cigarette (EC) is a device formed by three basic elements: battery, atomizer and cartridge. When assembled, it looks like a cigarette. The cartridge contains different substances: propylene glycol, glycerine and, sometimes, nicotine. When the user "vapes", the battery is activated, the atomizer is heated and the liquid is drawn in and vaporized. The smoker inhales the mist produced. Various substances have been detected in this mist: formaldehyde, acetaldehyde and acrolein and some heavy metals. Although these are found in lower concentrations than in cigarettes, they may still be harmful for the human body. Several surveys show that 3-10% of smokers regularly use e-cigarettes. A randomized study has shown that the efficacy of e-cigarettes for helping smokers to quit is similar to nicotine patches. Nevertheless, the study has relevant methodological limitations and reliable conclusions cannot be deduced. This report sets down the Position Statement of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) on the efficacy and safety of e-cigarettes. This statement declares that e-cigarettes should be regulated as medicinal products. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  17. An official American Thoracic Society statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults.

    Science.gov (United States)

    Schwab, Richard J; Badr, Safwan M; Epstein, Lawrence J; Gay, Peter C; Gozal, David; Kohler, Malcolm; Lévy, Patrick; Malhotra, Atul; Phillips, Barbara A; Rosen, Ilene M; Strohl, Kingman P; Strollo, Patrick J; Weaver, Edward M; Weaver, Terri E

    2013-09-01

    Continuous positive airway pressure (CPAP) is considered the treatment of choice for obstructive sleep apnea (OSA), and studies have shown that there is a correlation between patient adherence and treatment outcomes. Newer CPAP machines can track adherence, hours of use, mask leak, and residual apnea-hypopnea index (AHI). Such data provide a strong platform to examine OSA outcomes in a chronic disease management model. However, there are no standards for capturing CPAP adherence data, scoring flow signals, or measuring mask leak, or for how clinicians should use these data. American Thoracic Society (ATS) committee members were invited, based on their expertise in OSA and CPAP monitoring. Their conclusions were based on both empirical evidence identified by a comprehensive literature review and clinical experience. CPAP usage can be reliably determined from CPAP tracking systems, but the residual events (apnea/hypopnea) and leak data are not as easy to interpret as CPAP usage and the definitions of these parameters differ among CPAP manufacturers. Nonetheless, ends of the spectrum (very high or low values for residual events or mask leak) appear to be clinically meaningful. Providers need to understand how to interpret CPAP adherence tracking data. CPAP tracking systems are able to reliably track CPAP adherence. Nomenclature on the CPAP adherence tracking reports needs to be standardized between manufacturers and AHIFlow should be used to describe residual events. Studies should be performed examining the usefulness of the CPAP tracking systems and how these systems affect OSA outcomes.

  18. Cumplimiento de las recomendaciones en rehabilitación respiratoria de la British Thoracic Society en pacientes con fibrosis quística: estudio en fisioterapeutas colombianos

    Directory of Open Access Journals (Sweden)

    Diana Duran-Palomino

    2013-06-01

    Full Text Available Con el objetivo de evaluar el cumplimiento de las recomendaciones en rehabilitación respiratoria (ReR, planteadas por la British Thoracic Society (BTS en pacientes con fibrosis quística (FQ se realizó un estudio transversal entre 224 fisioterapeutas colombianos para identificar el tipo de intervenciones y las características de los programas de ReR como componentes del cumplimiento de las guías clínicas basadas en la evidencia de la BTS. Un elevado porcentaje de profesionales respondieron “realizar siempre” intervenciones con alto nivel de evidencia (grado A como: técnicas de higiene bronquial (54,0% y ciclo activo de la respiración (35,3%. Se observaron también intervenciones con menor grado de recomendación (grado D como: uso de solución salina hipertónica y broncodilatador para evitar el broncoespasmo (33,9%, y técnicas de terapia manual o ejercicios de movilidad torácica y resistida (38,4% para corregir problemas posturales y respiratorios. En conclusión, se encontraron importantes discrepancias con las intervenciones y componentes sugeridos por BTS en pacientes con FQ.

  19. Are lung imaging reporting and data system categories clear to radiologists? A survey of the Korean Society of Thoracic Radiology members on ten difficult -to classify scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Han, Dae Hee; Ahn, Myeong Im [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Goo, Jin Mo [Dept. of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of); Chong, Se Min [Dept. of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    To evaluate possible variability in chest radiologists' interpretations of the Lung Imaging Reporting and Data System (Lung-RADS) on difficult-to-classify scenarios. Ten scenarios of difficult-to-classify imaginary lung nodules were prepared as an online survey that targeted Korean Society of Thoracic Radiology members. In each question, a description was provided of the size, consistency, and interval change (new or growing) of a lung nodule observed using annual repeat computed tomography, and the respondent was instructed to choose one answer from five choices: category 2, 3, 4A, or 4B, or 'un-categorizable.' Consensus answers were established by members of the Korean Imaging Study Group for Lung Cancer. Of the 420 answers from 42 respondents (excluding multiple submissions), 310 (73.8%) agreed with the consensus answers; eleven (26.2%) respondents agreed with the consensus answers to six or fewer questions. Assigning the imaginary nodules to categories higher than the consensus answer was more frequent (16.0%) than assigning them to lower categories (5.5%), and the agreement rate was below 50% for two scenarios. When given difficult-to-classify scenarios, chest radiologists showed large variability in their interpretations of the Lung-RADS categories, with high frequencies of disagreement in some specific scenarios.

  20. A benchmarking project on the quality of previous guidelines about the management of malignant pleural effusion from the European Society of Thoracic Surgeons (ESTS) Pleural Diseases Working Group.

    Science.gov (United States)

    Bertolaccini, Luca; Bedetti, Benedetta; Brunelli, Alessandro; Marinova, Katerina; Raveglia, Federico; Rocco, Gaetano; Shargall, Yaron; Solli, Piergiorgio; Varela, Gonzalo; Papagiannopoulos, Kostas; Kuzdzal, Jaroslaw; Massard, Gilbert; Ruffini, Enrico; Falcoz, Pierre-Emmanuel; Martinez-Barenys, Carlos; Opitz, Isabelle; Batirel, Hasan F; Toker, Alper; Scarci, Marco

    2017-08-01

    In the European Society of Thoracic Surgeons (ESTS) survey about management of malignant pleural effusions (MPE), 56% of respondents are not informed of any relevant clinical guidelines and 52%, who are aware of the existence of guidelines, declared that they are in need of updating or revision. The ESTS Pleural Diseases Working Group developed a benchmarking project on quality of previous guidelines on the management of MPE. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used to assess each guideline. Each item was scored on a 7-point scale. Scores for each domain were calculated. Economic data for the nations which have issued the guidelines were collected from the Organisation for Economic Cooperation and Development health statistics database. Six guidelines fitted the inclusion criteria and were assessed. Five out of 6 guidelines were produced by a multinational collaboration. Observers would recommend only 2 guidelines with minimal modification. Two areas that received the best score were clarity of presentation and scope and purpose (objectives and health questions target population). The applicability of guideline domain had the lowest score. Multivariate analysis demonstrated that clarity of presentation, international guidelines and publication through medical journal were related to improved scores. A strong correlation was observed between the measures of economic status. The quality of guidelines assessed by the AGREE II criteria was found to be extremely variable. Guidelines achieving higher AGREE II scores were more likely to come from the European Union with the direct involvement of scientific societies in their development. It was also recognized that some fundamental unanswered questions remain about the management of MPE.

  1. Lifestyle modifications to prevent and control hypertension. 3. Recommendations on alcohol consumption. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

    Science.gov (United States)

    Campbell, N R; Ashley, M J; Carruthers, S G; Lacourcière, Y; McKay, D W

    1999-05-04

    low-risk drinking guidelines (i.e., healthy adults who choose to drink should limit alcohol consumption to 2 or fewer standard drinks per day, with consumption not exceeding 14 standard drinks per week for men and 9 standard drinks per week for women). (3) Hypertensive patients should also be advised to limit alcohol consumption to the levels set out in the Canadian low-risk drinking guidelines. These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension and the previous recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control and the Canadian Hypertension Society. They have not been clinically tested. The low-risk drinking guidelines are those of the Addiction Research Foundation of Ontario and the Canadian Centre on Substance Abuse. The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. The low-risk drinking guidelines have been endorsed by the College of Family Physicians of Canada and several provincial organizations.

  2. 55th Annual Canadian Society for Molecular Biosciences Conference on Epigenetics and Genomic Stability. Whistler, British Columbia, Canada, 14–18 March 2012.

    Science.gov (United States)

    Nelson, Christopher J; Ausió, Juan

    2012-06-01

    The 55th Annual Canadian Society for Molecular Biosciences Conference on Epigenetics and Genomic Stability in Whistler, Canada, 14-18 March 2012, brought together 31 speakers from different nationalities. The organizing committee, led by Jim Davie (Chair) at the University of Manitoba (Manitoba, Canada), consisted of several established researchers in the fields of chromatin and epigenetics from across Canada. The meeting was centered on the contribution of epigenetics to gene expression, DNA damage and repair, and the role of environmental factors. A few interesting talks on replication added some insightful information on the controversial issue of histone post-translational modifications as genuine epigenetic marks that are inherited through cell division.

  3. An Official American Thoracic Society Clinical Practice Guideline: Sleep Apnea, Sleepiness, and Driving Risk in Noncommercial Drivers. An Update of a 1994 Statement

    Science.gov (United States)

    Strohl, Kingman P.; Brown, Daniel B.; Collop, Nancy; George, Charles; Grunstein, Ronald; Han, Fang; Kline, Lawrence; Malhotra, Atul; Pack, Alan; Phillips, Barbara; Rodenstein, Daniel; Schwab, Richard; Weaver, Terri; Wilson, Kevin

    2013-01-01

    Background: Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for drowsy driving two to three times. The purpose of these guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, sleep apnea, and driving risk. Methods: A multidisciplinary panel was convened to develop evidence-based clinical practice guidelines for the management of sleepy driving due to OSA. Pragmatic systematic reviews were performed, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to formulate and grade the recommendations. Critical outcomes included crash-related mortality and real crashes, whereas important outcomes included near-miss crashes and driving performance. Results: A strong recommendation was made for treatment of confirmed OSA with continuous positive airway pressure to reduce driving risk, rather than no treatment, which was supported by moderate-quality evidence. Weak recommendations were made for expeditious diagnostic evaluation and initiation of treatment and against the use of stimulant medications or empiric continuous positive airway pressure to reduce driving risk. The weak recommendations were supported by very low–quality evidence. Additional suggestions included routinely determining the driving risk, inquiring about additional causes of sleepiness, educating patients about the risks of excessive sleepiness, and encouraging clinicians to become familiar with relevant laws. Discussion: The recommendations presented in this guideline are based on the current evidence, and will require an update as new evidence and/or technologies becomes available. PMID:23725615

  4. Contemporary impact of state certificate-of-need regulations for cardiac surgery: an analysis using the Society of Thoracic Surgeons' National Cardiac Surgery Database.

    Science.gov (United States)

    DiSesa, Verdi J; O'Brien, Sean M; Welke, Karl F; Beland, Sarah M; Haan, Constance K; Vaughan-Sarrazin, Mary S; Peterson, Eric D

    2006-11-14

    Prior research using administrative data associated certificate-of-need (CON) regulation for open heart surgery with higher hospital coronary artery bypass grafting (CABG) volume and lower CABG operative mortality rates in elderly patients. It is unclear whether these findings apply in a general population and after controlling for detailed clinical characteristics and region. Using the Society of Thoracic Surgeons' (STS) National Cardiac Surgery Database, we examined isolated CABG surgery volume, operative mortality, and the composite end point of operative mortality or major morbidity for the years 2000 to 2003. The presence of CON regulations for open heart surgery was ascertained from the National Directory of the American Health Policy Association and by contacting CON administrators. Results were analyzed nationally, by state, and by region (West, Northeast, Midwest, South) and were adjusted for clinical factors and both population density and region with mixed-effects hierarchical logistic regression models. During 2000 to 2003, there were 314,710 isolated CABG surgeries performed at 294 STS hospitals in CON states (n=27, including Washington, DC) and 280 512 procedures at 343 STS hospitals in non-CON states (n=24). Patient clinical characteristics were similar among CON and non-CON hospitals. States with CON regulations tended to have higher population densities and had significantly higher median hospital annual CABG volumes in each of the years 2000 to 2003 (Pnational Medicare database. CON states have significantly higher hospital CABG surgery volumes but similar mortality compared with non-CON states. CON regulation alone is not a sufficient mechanism to ensure quality of care for CABG surgery.

  5. An official American Thoracic Society Clinical Practice Guideline: sleep apnea, sleepiness, and driving risk in noncommercial drivers. An update of a 1994 Statement.

    Science.gov (United States)

    Strohl, Kingman P; Brown, Daniel B; Collop, Nancy; George, Charles; Grunstein, Ronald; Han, Fang; Kline, Lawrence; Malhotra, Atul; Pack, Alan; Phillips, Barbara; Rodenstein, Daniel; Schwab, Richard; Weaver, Terri; Wilson, Kevin

    2013-06-01

    Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for drowsy driving two to three times. The purpose of these guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, sleep apnea, and driving risk. A multidisciplinary panel was convened to develop evidence-based clinical practice guidelines for the management of sleepy driving due to OSA. Pragmatic systematic reviews were performed, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to formulate and grade the recommendations. Critical outcomes included crash-related mortality and real crashes, whereas important outcomes included near-miss crashes and driving performance. A strong recommendation was made for treatment of confirmed OSA with continuous positive airway pressure to reduce driving risk, rather than no treatment, which was supported by moderate-quality evidence. Weak recommendations were made for expeditious diagnostic evaluation and initiation of treatment and against the use of stimulant medications or empiric continuous positive airway pressure to reduce driving risk. The weak recommendations were supported by very low-quality evidence. Additional suggestions included routinely determining the driving risk, inquiring about additional causes of sleepiness, educating patients about the risks of excessive sleepiness, and encouraging clinicians to become familiar with relevant laws. The recommendations presented in this guideline are based on the current evidence, and will require an update as new evidence and/or technologies becomes available.

  6. Variation in ventilation time after coronary artery bypass grafting: an analysis from the society of thoracic surgeons adult cardiac surgery database.

    Science.gov (United States)

    Jacobs, Jeffrey P; He, Xia; O'Brien, Sean M; Welke, Karl F; Filardo, Giovanni; Han, Jane M; Ferraris, Victor A; Prager, Richard L; Shahian, David M

    2013-09-01

    Short postoperative ventilation times are accepted as a marker of quality. This analysis assesses center level variation in postoperative ventilation time in a subset of patients undergoing isolated coronary artery bypass grafting (CABG). In 2009 and 2010, 325,129 patients in the STS Adult Cardiac Surgery Database underwent isolated CABG. Patients were excluded if they were intubated before entering the operating room, required ventilation for greater than 24 hours, or had missing data on key covariates. The final study cohort was 274,231 isolated CABG patients from 1,008 centers. Bayesian hierarchical models were used to assess between-center variation in ventilation time and to explore the effect of center-level covariates. Analyses were performed with and without adjusting for case mix. After adjusting for case mix, the ratio of median ventilator time at the 90th percentile of the center-level distribution compared with the tenth percentile was 9.0:5.0=1.8 (95% credible interval: 1.79 to 1.85). This ratio illustrates the scale of between-center differences: centers above the 90th percentile have a ventilation time of at least 1.8 times that of centers below the tenth percentile. Smaller hospital volume, presence of a residency program, and some census regions were associated with longer ventilation times. After adjustment for severity of illness, substantial inter-center variation exists in postoperative ventilation time in this subset of patients undergoing isolated CABG. This finding represents an opportunity for multi-institutional quality improvement initiatives designed to limit variations in ventilator management and achieve the shortest possible ventilation times for all patients, thus benefiting both clinical outcomes and resource utilization. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Obesity-associated severe asthma represents a distinct clinical phenotype: analysis of the British Thoracic Society Difficult Asthma Registry Patient cohort according to BMI.

    Science.gov (United States)

    Gibeon, David; Batuwita, Kannangara; Osmond, Michelle; Heaney, Liam G; Brightling, Chris E; Niven, Rob; Mansur, Adel; Chaudhuri, Rekha; Bucknall, Christine E; Rowe, Anthony; Guo, Yike; Bhavsar, Pankaj K; Chung, Kian Fan; Menzies-Gow, Andrew

    2013-02-01

    Obesity has emerged as a risk factor for the development of asthma and it may also influence asthma control and airway inflammation. However, the role of obesity in severe asthma remains unclear. Thus, our objective was to explore the association between obesity (defied by BMI) and severe asthma. Data from the British Thoracic Society Difficult Asthma Registry were used to compare patient demographics, disease characteristics, and health-care utilization among three BMI categories (normal weight: 18.5-24.99; overweight: 25-29.99; obese: 30) in a well-characterized group of adults with severe asthma. The study population consisted of 666 patients with severe asthma; the group had a median BMI of 29.8 (interquartile range, 22.5-34.0). The obese group exhibited greater asthma medication requirements in terms of maintenance corticosteroid therapy (48.9% vs 40.4% and 34.5% in the overweight and normal-weight groups, respectively), steroid burst therapy, and short-acting b 2 -agonist use per day. Significant differences were seen with gastroesophageal reflux disease (53.9% vs 48.1% and 39.7% in the overweight and normal weight groups, respectively) and proton pump inhibitor use. Bone density scores were higher in the obese group, while pulmonary function testing revealed a reduced FVC and elevated carbon monoxide transfer coefficient. Serum IgE levels decreased with increasing BMI and the obese group was more likely to report eczema, but less likely to have a history of nasal polyps. Patients with severe asthma display particular characteristics according to BMI that support the view that obesity-associated severe asthma may represent a distinct clinical phenotype.

  8. Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification.

    Science.gov (United States)

    Travis, William D; Brambilla, Elisabeth; Noguchi, Masayuki; Nicholson, Andrew G; Geisinger, Kim; Yatabe, Yasushi; Ishikawa, Yuichi; Wistuba, Ignacio; Flieder, Douglas B; Franklin, Wilbur; Gazdar, Adi; Hasleton, Philip S; Henderson, Douglas W; Kerr, Keith M; Petersen, Iver; Roggli, Victor; Thunnissen, Erik; Tsao, Ming

    2013-05-01

    The new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification provides, for the first time, standardized terminology for lung cancer diagnosis in small biopsies and cytology; this was not primarily addressed by previous World Health Organization classifications. Until recently there have been no therapeutic implications to further classification of NSCLC, so little attention has been given to the distinction of adenocarcinoma and squamous cell carcinoma in small tissue samples. This situation has changed dramatically in recent years with the discovery of several therapeutic options that are available only to patients with adenocarcinoma or NSCLC, not otherwise specified, rather than squamous cell carcinoma. This includes recommendation for use of special stains as an aid to diagnosis, particularly in the setting of poorly differentiated tumors that do not show clear differentiation by routine light microscopy. A limited diagnostic workup is recommended to preserve as much tissue for molecular testing as possible. Most tumors can be classified using a single adenocarcinoma marker (eg, thyroid transcription factor 1 or mucin) and a single squamous marker (eg, p40 or p63). Carcinomas lacking clear differentiation by morphology and special stains are classified as NSCLC, not otherwise specified. Not otherwise specified carcinomas that stain with adenocarcinoma markers are classified as NSCLC, favor adenocarcinoma, and tumors that stain only with squamous markers are classified as NSCLC, favor squamous cell carcinoma. The need for every institution to develop a multidisciplinary tissue management strategy to obtain these small specimens and process them, not only for diagnosis but also for molecular testing and evaluation of markers of resistance to therapy, is emphasized.

  9. Mitosis trumps T stage and proposed international association for the study of lung cancer/american thoracic society/european respiratory society classification for prognostic value in resected stage 1 lung adenocarcinoma.

    Science.gov (United States)

    Duhig, Edwina Elizabeth; Dettrick, Andrew; Godbolt, David Burleigh; Pauli, John; van Zwieten, Anthony; Hansen, Aaron Richard; Yang, Ian Anthony; Fong, Kwun Meng; Clarke, Belinda Edith; Bowman, Rayleen Veronica

    2015-04-01

    We investigated whether a group of pathologists could reproducibly apply the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification for lung adenocarcinoma to a cohort of stage 1 tumors and whether this architectural classification and/or other parameters could demonstrate survival advantage. A total of 145 cases of 7 edition of tumor, node, metastasis stage 1 adenocarcinoma were retrospectively reviewed for predominant architectural pattern, including cribriform pattern, nuclear grade, mitotic index, and necrosis. The parameters were assessed for reproducibility and survival and using multivariate analysis, compared with stage, age, and sex. The majority of tumors had a mixed architecture with the acinar pattern being the most common predominant architecture. Micropapillary and cribriform architecture were the least frequent patterns. This study demonstrated that a group of five pathologists could reproducibly apply the IASLC/ATS/ERS classification. Although there were insufficient cribriform-predominant adenocarcinomas for assessment, when the percentage of all cribriform was combined with other architectures, it was associated with a worse prognosis. The majority of the parameters assessed demonstrated significance with univariate analysis but only mitotic index, as assessed by the highest count/10 high-power fields remained significant with multivariate analysis. In this study of resected stage 1 primary lung adenocarcinoma, we found mitotic index to be the only independent prognostic marker. It was more closely associated with outcome than either pathologic T stage or IASLC/ATS/ERS architecture-based classification. Further validation of concordance and reproducibility in reporting mitotic index, as well as validation of prognostic significance, needs to be undertaken in independent data sets.

  10. An official American thoracic society statement: position statement on ATS activities for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States.

    Science.gov (United States)

    Brown, Lee K; Angus, Derek C; Marin, Matthew G; Balmes, John R; Barker, Alan F; Ewart, Gary; Halbower, Ann C; Lutz, Peter O; Mularski, Richard A; Nathanson, Ian T; Sanders, Mark H; Stewart, George L; Upson, Dona J

    2009-11-15

    The 1997 American Thoracic Society (ATS) statement "A Framework for Health Care Policy in the United States" outlined core principles for the Society's activities in the public health arena. In the succeeding 10 years, profound changes have taken place in the United States health care environment. In addition, the 2005 publication of the Society's Vision highlighted some differences between the original Statement and our current priorities. Therefore, the Health Policy Committee embarked on a re-analysis and re-statement of the Society's attitudes and strategies with respect to health and public policy. This Statement reflects the findings of the Committee. To outline the key aspects of an internal ATS strategy for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States. Committee discussion and consensus-building occurred both before and after individual members performed literature searches and drafted sections of the document. Comments were solicited on the draft document from ATS committee and assembly chairs and the Executive Committee, resulting in substantive revisions of the final document. Specific strategies are suggested for the ATS in the arenas of research, training and education, patient care, and advocacy so as to enhance the delivery of health care in the fields of respiratory medicine, sleep medicine, and critical care. The American Thoracic Society's Mission, Core Principles, and Vision provide clear guidance for the formulation of specific strategies that will serve to promote improved respiratory health and care of the critically ill in the United States.

  11. [Thoracic splenosis].

    Science.gov (United States)

    Ferraz, R; Miranda, J; Vieira, M M; Carlos Mota, J

    2010-01-01

    Thoracic splenosis is a rare clinical condition consisting in the heterotopic autotransplantation of pieces of splenic tissue into the chest, following a previous trauma, with spleen and diaphragm laceration. In this paper, the authors report the clinical case of a thoracic splenosis in a 26 years old male, who had suffered a severe thoraco-abdominal trauma in childhood, leading to an emergency splenectomy. The patient, with the previous diagnosis of malignancy, namely pleural fibrotic tumors, underwent surgical management for removal of some nodular tumors of the pleura. Pathological studies confirmed the diagnosis of thoracic splenosis. The clinical diagnosis of thoracic splenosis should be suspicious facing asymptomatic patients, with a history of previous thoraco-abdominal trauma and nodular peripheral tumors in the chest x-rays.

  12. Thoracic Splenosis

    Directory of Open Access Journals (Sweden)

    Dr. Vandana Jeebun

    2006-01-01

    Full Text Available A 22-year old man presented with the history of productive cough and also complained of some weight loss. Examination was essentially unremarkable. On detailed investigations like chest X-ray, CT thorax, Fine Needle Aspiration Cytology, Tc-99m scan, a diagnosis of thoracic splenosis was then made. To conclude, thoracic splenosis is a rare entity that needs patient’s reassurance and radiological surveillance. It should also be considered as differential diagnoses of the pleural based masses.

  13. Diagnosis of stable ischemic heart disease: summary of a clinical practice guideline from the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons.

    Science.gov (United States)

    Qaseem, Amir; Fihn, Stephan D; Williams, Sankey; Dallas, Paul; Owens, Douglas K; Shekelle, Paul

    2012-11-20

    The American College of Physicians (ACP) developed this guideline in collaboration with the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, and Society of Thoracic Surgeons to help clinicians diagnose known or suspected stable ischemic heart disease. Literature on this topic published before November 2011 was identified by using MEDLINE, Embase, Cochrane CENTRAL, PsychINFO, AMED, and SCOPUS. Searches were limited to human studies published in English. This guideline grades the evidence and recommendations according to a translation of the ACCF/AHA grading system into ACP's clinical practice guidelines grading system. This guideline includes 28 recommendations that address the following issues: the initial diagnosis of the patient who might have stable ischemic heart disease, cardiac stress testing to assess the risk for death or myocardial infarction in patients diagnosed with stable ischemic heart disease, and coronary angiography for risk assessment.

  14. A Decade’s Experience With Quality Improvement in Cardiac Surgery Using the Veterans Affairs and Society of Thoracic Surgeons National Databases

    Science.gov (United States)

    Grover, Frederick L.; Shroyer, A. Laurie W.; Hammermeister, Karl; Edwards, Fred H.; Ferguson, T. Bruce; Dziuban, Stanley W.; Cleveland, Joseph C.; Clark, Richard E.; McDonald, Gerald

    2001-01-01

    Objective To review the Department of Veteran Affairs (VA) and the Society of Thoracic Surgeons (STS) national databases over the past 10 years to evaluate their relative similarities and differences, to appraise their use as quality improvement tools, and to assess their potential to facilitate improvements in quality of cardiac surgical care. Summary Background Data The VA developed a mandatory risk-adjusted database in 1987 to monitor outcomes of cardiac surgery at all VA medical centers. In 1989 the STS developed a voluntary risk-adjusted database to help members assess quality and outcomes in their individual programs and to facilitate improvements in quality of care. Methods A short data form on every veteran operated on at each VA medical center is completed and transmitted electronically for analysis of unadjusted and risk-adjusted death and complications, as well as length of stay. Masked, confidential semiannual reports are then distributed to each program’s clinical team and the associated administrator. These reports are also reviewed by a national quality oversight committee. Thus, VA data are used both locally for quality improvement and at the national level with quality surveillance. The STS dataset (217 core fields and 255 extended fields) is transmitted for each patient semiannually to the Duke Clinical Research Institute (DCRI) for warehousing, analysis, and distribution. Site-specific reports are produced with regional and national aggregate comparisons for unadjusted and adjusted surgical deaths and complications, as well as length of stay for coronary artery bypass grafting (CABG), valvular procedures, and valvular/CABG procedures. Both databases use the logistic regression modeling approach. Data for key processes of care are also captured in both databases. Research projects are frequently carried out using each database. Results More than 74,000 and 1.6 million cardiac surgical patients have been entered into the VA and STS databases

  15. Thoracic splenosis.

    Science.gov (United States)

    Madjar, S.; Weissberg, D.

    1994-01-01

    BACKGROUND--Thoracic splenosis is an uncommon side effect of thoracoabdominal trauma involving injury to the diaphragm and spleen. Only 20 patients with a similar problem have been reported previously. METHODS--Two patients with thoracic splenosis were studied. RESULTS--One of the patients had undergone thoracotomy for resection of a "pulmonary nodule". The other remains under observation. CONCLUSION--Presence of a pulmonary nodule in a patient with history of injury to the diaphragm and spleen should arouse suspicion of splenosis. Appropriate investigation may prevent an unnecessary and potentially harmful operation. Images PMID:7974296

  16. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: outflow tract obstruction, coarctation of the aorta, tetralogy of Fallot, Ebstein anomaly and Marfan's syndrome

    NARCIS (Netherlands)

    Silversides, Candice K.; Kiess, Marla; Beauchesne, Luc; Bradley, Timothy; Connelly, Michael; Niwa, Koichiro; Mulder, Barbara; Webb, Gary; Colman, Jack; Therrien, Judith

    2010-01-01

    With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. Since the 2001 Canadian Cardiovascular Society

  17. An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death.

    Science.gov (United States)

    Gries, Cynthia J; White, Douglas B; Truog, Robert D; Dubois, James; Cosio, Carmen C; Dhanani, Sonny; Chan, Kevin M; Corris, Paul; Dark, John; Fulda, Gerald; Glazier, Alexandra K; Higgins, Robert; Love, Robert; Mason, David P; Nakagawa, Thomas A; Shapiro, Ron; Shemie, Sam; Tracy, Mary Fran; Travaline, John M; Valapour, Maryam; West, Lori; Zaas, David; Halpern, Scott D

    2013-07-01

    Donation after circulatory determination of death (DCDD) has the potential to increase the number of organs available for transplantation. Because consent and management of potential donors must occur before death, DCDD raises unique ethical and policy issues. To develop an ethics and health policy statement on adult and pediatric DCDD relevant to critical care and transplantation stakeholders. A multidisciplinary panel of stakeholders was convened to develop an ethics and health policy statement. The panel consisted of representatives from the American Thoracic Society, Society of Critical Care Medicine, International Society for Heart and Lung Transplantation, Association of Organ Procurement Organizations, and the United Network of Organ Sharing. The panel reviewed the literature, discussed important ethics and health policy considerations, and developed a guiding framework for decision making by stakeholders. A framework to guide ethics and health policy statement was established, which addressed the consent process, pre- and post mortem interventions, the determination of death, provisions of end-of-life care, and pediatric DCDD. The information presented in this Statement is based on the current evidence, experience, and clinical rationale. New clinical research and the development and dissemination of new technologies will eventually necessitate an update of this Statement.

  18. [The Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis: a paradigm shift and the return of the clinical nephrologist].

    Science.gov (United States)

    Piccoli, Giorgina

    2014-01-01

    The recent guideline of the Canadian Society of Nephrology for timing the initiation of chronic dialysis may be seen as a "paradigm shift", meaning, according to the Kuhns theory, the development of a different viewpoint. The guideline is based on a careful review of the literature, with primary emphasis on patient survival and quality of life. Hence, the Authors choose qualitative keywords (intention -to-defer, in place of the intention-to-start-early), but also a qualitative process for deciding the start of dialysis, by providing an intentionally concise list of signs and symptoms not reducible to numbers, such as the presence of uremic symptoms. The recent guideline of the Canadian Society of Nephrology, regarding the timing of the initiation of chronic dialysis, may be seen as a "paradigm shift", that means, according to Kuhns theory, the development of a different viewpoint. The guideline is based on a careful review of the literature, with primary emphasis on patient survival and quality of life. Hence, the Authors choose not only qualitative keywords (intention -to-defer, in place of intention-to-start-early), but also a qualitative process for deciding the start of dialysis, by providing an intentionally concise list of signs and symptoms not reducible to numbers, such as the presence of uremic symptoms. The clinical Nephrologist emerges victorious; the decision to initiate dialysis is in his-her hands; it is not a team-work, or a numeric algorhythm: its a clinical choice. The clinical judgment is the only guide above 6 mL/min of eGFR. Below this limit, dialysis has to be started; however, the Authors state that the optimal management of patients with an eGFR of 6 mL/min per 1.73 m2 or less, it is based on limited data. Hence, numbers are back to haunt us; nevertheless, we should take the best of this paradigm shift: the decision is again in our hands, the clinic is our weapon, the responsibility is not reducible to pretty formulae. If we cannot hide

  19. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    Science.gov (United States)

    Patel, Manesh R; Bailey, Steven R; Bonow, Robert O; Chambers, Charles E; Chan, Paul S; Dehmer, Gregory J; Kirtane, Ajay J; Wann, L Samuel; Ward, R Parker

    2012-05-29

    The American College of Cardiology Foundation, in collaboration with the Society for Cardiovascular Angiography and Interventions and key specialty and subspecialty societies, conducted a review of common clinical scenarios where diagnostic catheterization is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of noninvasive imaging appropriate use criteria. The 166 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). Diagnostic catheterization may include several different procedure components. The indications developed focused primarily on 2 aspects of diagnostic catheterization. Many indications focused on the performance of coronary angiography for the detection of coronary artery disease with other procedure components (e.g., hemodynamic measurements, ventriculography) at the discretion of the operator. The majority of the remaining indications focused on hemodynamic measurements to evaluate valvular heart disease, pulmonary hypertension, cardiomyopathy, and other conditions, with the use of coronary angiography at the discretion of the operator. Seventy-five indications were rated as appropriate, 49 were rated as uncertain, and 42 were rated as inappropriate. The appropriate use criteria for diagnostic catheterization have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.

  20. Management of stable ischemic heart disease: summary of a clinical practice guideline from the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons.

    Science.gov (United States)

    Qaseem, Amir; Fihn, Stephan D; Dallas, Paul; Williams, Sankey; Owens, Douglas K; Shekelle, Paul

    2012-11-20

    The American College of Physicians (ACP) developed this guideline with the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, and Society of Thoracic Surgeons to present the available evidence on the management of stable known or suspected ischemic heart disease. Literature on this topic published before November 2011 was identified by using MEDLINE, Embase, Cochrane CENTRAL, PsychINFO, AMED, and SCOPUS. Searches were limited to human studies published in English. This guideline grades the evidence and recommendations according to a translation of the ACCF/AHA grading system into ACP's clinical practice guidelines grading system. The guideline includes 48 specific recommendations that address the following issues: patient education, management of proven risk factors (dyslipidemia, hypertension, diabetes, physical activity body weight, and smoking), risk factor reduction strategies of unproven benefit, medical therapy to prevent myocardial infarction and death and to relieve symptoms, alternative therapy, revascularization to improve survival and symptoms, and patient follow-up.

  1. Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

    Science.gov (United States)

    Cléroux, J; Feldman, R D; Petrella, R J

    1999-05-04

    of moderate rhythmic exercise of the lower limbs, such as brisk walking or cycling, 3 or 4 times per week to reduce blood pressure, (2) Exercise should be prescribed as an adjunctive therapy for people who require pharmacologic therapy for hypertension, especially those who are not receiving beta-blockers. (3) People who do not have hypertension should participate in regular exercise as it will decrease blood pressure and reduce the risk of coronary artery disease, although there is no direct evidence that it will prevent hypertension. These recommendations agree with those of the World Hypertension League, the American College of Sports Medicine, the report of the US Surgeon General on physical activity and health, and the US National Institutes of Health Consensus Development Panel on Physical Activity and Cardiovascular Health. These guidelines have not been clinically tested. The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada.

  2. Thoracic spine CT scan

    Science.gov (United States)

    CAT scan - thoracic spine; Computed axial tomography scan - thoracic spine; Computed tomography scan - thoracic spine; CT scan - ... Philadelphia, PA: Elsevier Mosby; 2013:chap 44. US Food and Drug Administration. Computed tomography (CT). Updated August ...

  3. Lessons learned in applying the International Society for Pharmacoeconomics and Outcomes Research methodology to translating Canadian Emergency Department Information System Presenting Complaints List into German.

    Science.gov (United States)

    Brammen, Dominik; Greiner, Felix; Dormann, Harald; Mach, Carsten; Wrede, Christian; Ballaschk, Anne; Stewart, Declan; Walker, Steven; Oesterling, Christine; Kulla, Martin

    2017-03-02

    The patient's presenting complaint guides diagnosis and treatment in the emergency department, but there is no classification system available in German. The Canadian Emergency Department Information System (CEDIS) Presenting Complaint List (PCL) is available only in English and French. As translation risks the altering of meaning, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) has set guidelines to ensure translational accuracy. The aim of this paper is to describe our experiences of using the ISPOR guidelines to translate the CEDIS PCL into German. The CEDIS PCL (version 3.0) was forward-translated and back-translated in accordance with the ISPOR guidelines using bilingual clinicians/translators and an occupationally mixed evaluation group that completed a self-developed questionnaire. The CEDIS PCL was forward-translated (four emergency physicians) and back-translated (three mixed translators). Back-translation uncovered eight PCL items requiring amendment. In total, 156 comments were received from 32 evaluators, six of which resulted in amendments. The ISPOR guidelines facilitated adaptation of a PCL into German, but the process required time, language skills and clinical knowledge. The current methodology may be applicable to translating the CEDIS PCL into other languages, with the aim of developing a harmonized, multilingual PCL.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.

  4. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    Science.gov (United States)

    Ronan, Grace; Wolk, Michael J; Bailey, Steven R; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Rosenbaum, Lisa; Shaw, Leslee J; Stainback, Raymond F; Allen, Joseph M; Brindis, Ralph G; Kramer, Christopher M; Shaw, Leslee J; Cerqueira, Manuel D; Chen, Jersey; Dean, Larry S; Fazel, Reza; Hundley, W Gregory; Itchhaporia, Dipti; Kligfield, Paul; Lockwood, Richard; Marine, Joseph Edward; McCully, Robert Benjamin; Messer, Joseph V; O'Gara, Patrick T; Shemin, Richard J; Wann, L Samuel; Wong, John B; Patel, Manesh R; Kramer, Christopher M; Bailey, Steven R; Brown, Alan S; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Lindsay, Bruce D; Min, James K; Shaw, Leslee J; Stainback, Raymond F; Wann, L Samuel; Wolk, Michael J; Allen, Joseph M

    2014-02-01

    The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting. The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1-9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology. The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram (ECG

  5. 2003 Canadian Asthma Consensus Guidelines Executive Summary

    Directory of Open Access Journals (Sweden)

    Becker Allan

    2006-03-01

    Full Text Available Abstract Background Guidelines for the diagnosis and management of asthma have been published over the last 15 years; however, there has been little focus on issues relating to asthma in childhood. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies, particularly in children, have highlighted the need to incorporate new information into the asthma guidelines. The objectives of this article are to review the literature on asthma published between January 2000 and June 2003 and to evaluate the influence of new evidence on the recommendations made in the 1999 Canadian Asthma Consensus Report and its 2001 update, with a major focus on pediatric issues. Methods The diagnosis of asthma in young children and prevention strategies, pharmacotherapy, inhalation devices, immunotherapy, and asthma education were selected for review by small expert resource groups. The reviews were discussed in June 2003 at a meeting under the auspices of the Canadian Network For Asthma Care and the Canadian Thoracic Society. Data published through December 2004 were subsequently reviewed by the individual expert resource groups. Results This report evaluates early-life prevention strategies and focuses on treatment of asthma in children, emphasizing the importance of early diagnosis and preventive therapy, the benefits of additional therapy, and the essential role of asthma education. Conclusion We generally support previous recommendations and focus on new issues, particularly those relevant to children and their families. This document is a guide for asthma management based on the best available published data and the opinion of health care professionals, including asthma experts and educators.

  6. Superusers in social networks for smoking cessation: analysis of demographic characteristics and posting behavior from the Canadian Cancer Society's smokers' helpline online and StopSmokingCenter.net.

    Science.gov (United States)

    van Mierlo, Trevor; Voci, Sabrina; Lee, Sharon; Fournier, Rachel; Selby, Peter

    2012-06-26

    Online social networks are popular components of behavior-change websites. Research has identified the participation of certain network members who assume leadership roles by providing support, advice, and direction to other members. In the literature, these individuals have been variously defined as key players, posters, active users, or caretakers. Despite their identification, very little research has been conducted on the contributions or demographic characteristics of this population. For this study, we collectively categorized key players, posters, active users, and caretakers as superusers. To analyze data from two large but distinct Web-assisted tobacco interventions (WATI) to help gain insight into superuser demographic characteristics and how they use social networks. We extracted cross-sectional data sets containing posting behaviors and demographic characteristics from a free, publicly funded program (the Canadian Cancer Society's Smokers' Helpline Online: SHO), and a free, privately run program (StopSmokingCenter.net: SSC). Within the reporting period (SHO: June 26, 2008 to October 12, 2010; SSC: May 17, 2007 to October 12, 2010), 21,128 individuals registered for the SHO and 11,418 registered for the SSC. Within the same period, 1670 (7.90%) registrants made at least one post in the SHO social network, and 1627 (14.25%) registrants made at least one post in the SSC social network. SHO and SSC superusers accounted for 0.4% (n = 95) and 1.1% (n = 124) of all registrants, and 5.7% (95/1670) and 7.62% (124/1627) of all social network participants, and contributed to 34.78% (29,422/84,599) and 46.22% (61,820/133,753) of social network content, respectively. Despite vast differences in promotion and group management rules, and contrary to the beliefs of group moderators, there were no statistically significant differences in demographic characteristics between the two superuser groups. To our knowledge, this is the first study that compared demographic

  7. European risk models for morbidity (EuroLung1) and mortality (EuroLung2) to predict outcome following anatomic lung resections: an analysis from the European Society of Thoracic Surgeons database.

    Science.gov (United States)

    Brunelli, Alessandro; Salati, Michele; Rocco, Gaetano; Varela, Gonzalo; Van Raemdonck, Dirk; Decaluwe, Herbert; Falcoz, Pierre Emmanuel

    2017-03-01

    To develop models of 30-day mortality and cardiopulmonary morbidity from data on anatomic lung resections deposited in the European Society of Thoracic Surgeons (ESTS) database. Retrospective analysis of 47 960 anatomic lung resections from the ESTS database (July 2007-August 2015) (36 376 lobectomies, 2296 bilobectomies, 5040 pneumonectomies and 4248 segmentectomies). Logistic regression analyses were used to test the association between baseline and surgical variables and morbidity or mortality. Bootstrap resampling was used for internal validation and to check predictors of stability. Variables that occurred in more than 50% of the bootstrap samples were deemed reliable. User-friendly aggregate scores were then created by assigning points to each variable in the model by proportionally weighting the regression coefficients. Patients were grouped in classes of incremental risk according to their scores. Cardiopulmonary morbidity and 30-day mortality rates were 18.4% (8805 patients) and 2.7% (1295 patients). The following variables were reliably associated with morbidity after logistic regression analysis (C-index 0.68): male sex ( P  morbidity risk ( P  morbidity and mortality models can be used to define risk-adjust outcome indicators for auditing quality of care and to counsel patients about their surgical risk.

  8. [Video-assisted thoracic surgery, lung transplantation and mediastinitis: major issues in thoracic surgery in 2010].

    Science.gov (United States)

    Borro, José M; Moreno, Ramón; Gómez, Ana; Duque, José Luis

    2011-01-01

    We reviewed the major issues in thoracic surgery relating to the advances made in our specialty in 2010. To do this, the 43(rd) Congress of the Spanish Society of Pneumology and Thoracic Surgery held in La Coruña and the articles published in the Society's journal, Archivos de Bronconeumología, were reviewed. The main areas of interest were related to the development of video-assisted thoracic surgery, lung transplantation and descending mediastinitis. The new tumor-node-metastasis (TNM) classification (7(th) edition), presented last year, was still a topical issue this year. The First Forum of Thoracic Surgeons and the Update in Thoracic Surgery together with the Nurses' Area have constituted an excellent teaching program. Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

  9. The Society for Translational Medicine

    DEFF Research Database (Denmark)

    Gao, Shugeng; Zhang, Zhongheng; Aragón, Javier

    2017-01-01

    The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendati......The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy...

  10. Lifestyle modifications to prevent and control hypertension. 1. Methods and an overview of the Canadian recommendations. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

    Science.gov (United States)

    Campbell, N R; Burgess, E; Choi, B C; Taylor, G; Wilson, E; Cléroux, J; Fodor, J G; Leiter, L A; Spence, D

    1999-05-04

    the studies reviewed. Supplementing the diet with potassium, calcium and magnesium has not been associated with a clinically important reduction in blood pressure in people consuming a healthy diet. (1) It is recommended that health care professionals determine the body mass index (weight in kilograms/[height in metres]2) and alcohol consumption of all adult patients and assess sodium consumption and stress levels in all hypertensive patients. (2) To reduce blood pressure in the population at large, it is recommended that Canadians attain and maintain a healthy body mass index. For those who choose to drink alcohol intake should be limited to 2 or fewer standard drinks per day (maximum of 14/week for men and 9/week for women). Adults should exercise regularly. (3) To reduce blood pressure in hypertensive patients, individualized therapy is recommended. This therapy should emphasize weight loss for overweight patients, abstinence from or moderation in alcohol intake, regular exercise, restriction of sodium intake and, in appropriate circumstances, individualized cognitive behaviour modification to reduce the negative effects of stress. The recommendations were reviewed by all of the sponsoring organizations and by participants in a satellite symposium of the fourth international Conference on Preventive Cardiology. They are similar to those of the World Hypertension League and the Joint National committee, with the exception of the recommendations on stress management, which are based on new information. They have not been clinically tested. The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at health Canada, and the Heart and Stroke Foundation of Canada.

  11. February 2013 Arizona Thoracic Society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-02-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on Wednesday, 2/27/2013 at Scottsdale Shea beginning at 6:30 PM. There were 27 in attendance representing the pulmonary, critical care, sleep, infectious disease, nursing, pathology and radiology communities.Dr. George Parides congratulated on Allen Thomas on being named ATS 2013 Clinician of the Year. Lewis Wesselius announced the ALA 2013 Fight for Air Walk. This will be at the Scottsdale Civic Center on April 27, 2013. To participate or sponsor a walker contact Lonie Padilla at lpadilla@lungarizona.org or 602-429-0007. Rick Robbins, editor of the Southwest Journal of Pulmonary and Critical Care, announced Tim Kuberski has been named an associate editor. A discussion was held regarding other states in the Southwest to partner with the Southwest Journal of Pulmonary and Critical Care. Seven cases were presented: 1. Elijah Poulos, pulmonary fellow from the VA, presented a follow-up to a patient presented with optic neuritis, a positive …

  12. November 2012 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-11-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on Wednesday, 11/28/2012 at Scottsdale Shea beginning at 6:30 PM. There were 20 in attendance representing the pulmonary, critical care, sleep, infectious disease, pathology, and radiology communities. Dr. George Parides stated he was unable to find further information on treating patients begun on biologicals for RA who developed a + QuantiFERON. Four cases were presented: 1. Dr. Suresh Uppalapu, a pulmonary fellow at Good Samaritan/VA, presented a case of a 29 yo woman with a rash and a myriad of nonspecific complaints. She had recently been a contestant in a reality TV show. Just prior to admission she developed a neurologic complaints including incontinence. Her CXR was negative but CT of the chest showed scattered areas of ground glass opacities peripherally. A MRI of the brain revealed nonspecific abnormalities. CBC showed an elevated eosinophil count of 8%. Coccidioidomycosis antigen was negative. An LP was performed …

  13. Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults: An Analysis of Data From the Society of Thoracic Surgeons Database.

    Science.gov (United States)

    O'Byrne, Michael L; Kim, Sunghee; Hornik, Christoph P; Yerokun, Babatunde A; Matsouaka, Roland A; Jacobs, Jeffrey P; Jacobs, Marshall L; Jonas, Richard A

    2017-08-22

    Extreme body mass index (BMI; either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of BMI on perioperative outcomes in congenital heart disease patients has not been evaluated. A multicenter retrospective cohort study was performed studying patients 10 to 35 years of age undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between January 1, 2010, and December 31, 2015. The primary outcomes were operative mortality and a composite outcome (1 or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age- and sex-adjusted BMI percentiles and these outcomes were assessed, with adjustment for patient-level risk factors, with multivariate logistic regression. Of 18 337 patients (118 centers), 16% were obese, 15% were overweight, 53% were normal weight, 7% were underweight, and 9% were severely underweight. Observed risks of operative mortality (P=0.04) and composite outcome (Pobese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (odds ratio, 1.28; P=0.008), severely underweight (odds ratio, 1.29; PObesity and underweight BMI were associated with increased risk of composite adverse outcome independently of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome. © 2017 American Heart Association, Inc.

  14. Professional Legitimation for Education in Canadian Universities: "The Canadian Journal of Education", 1976-1997

    Science.gov (United States)

    Fisher, Donald

    2017-01-01

    In this commentary, Donald Fisher reports on the history of the "The Canadian Journal of Education" as part of this 40th anniversary issue. Fisher states that the history of the Canadian Society for the Study of Education (CSSE) has been profoundly influenced by changes in the role of the Canadian State. The 1960s and 1970s were a time…

  15. The Canadian Association for the Study of International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The Canadian Association for the Study of International Development (CASID) was founded in 1989 to provide a forum for Canadian scholars, policymakers, and civil society to meet and exchange views. It is the only Canadian learned society devoted to the study of international development. The Association's journal, the ...

  16. Transcatheter valve implantation for patients with aortic stenosis: A position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

    NARCIS (Netherlands)

    A. Vahanian (Alec); O. Alfieri (Ottavio); N. Al-Attar (Nawwar); M. Antunes (Manuel); J.J. Bax (Jeroen); B. Cormier (Bertrand); A. Cribier (Alain); P.P.T. de Jaegere (Peter); G. Fournial (Gerard); A.P. Kappetein (Arie Pieter); J. Kovac (Jan); S. Ludgate (Susanne); F. Maisano (Francesco); N. Moat (Neil); F.W. Mohr (Friedrich); P. Nataf (Patrick); L. Pié rard (Luc); J.L. Pomar (Jose); J. Schofer (Joachim); P. Tornos (Pilar); M. Tuzcu (Murat); B.A. van Hout (Ben); L.K. von Segesser (Ludwig); T. Walther (Thomas)

    2008-01-01

    textabstractAims: To critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development. Methods and results: A committee of experts including European Association of Cardio-Thoracic Surgery and

  17. Thoracic spine pain

    Directory of Open Access Journals (Sweden)

    Aleksey Ivanovich Isaikin

    2013-01-01

    Full Text Available Thoracic spine pain, or thoracalgia, is one of the common reasons for seeking for medical advice. The epidemiology and semiotics of pain in the thoracic spine unlike in those in the cervical and lumbar spine have not been inadequately studied. The causes of thoracic spine pain are varied: diseases of the cardiovascular, gastrointestinal, pulmonary, and renal systems, injuries to the musculoskeletal structures of the cervical and thoracic portions, which require a thorough differential diagnosis. Facet, costotransverse, and costovertebral joint injuries and myofascial syndrome are the most common causes of musculoskeletal (nonspecific pain in the thoracic spine. True radicular pain is rarely encountered. Traditionally, treatment for thoracalgia includes a combination of non-drug and drug therapies. The cyclooxygenase 2 inhibitor meloxicam (movalis may be the drug of choice in the treatment of musculoskeletal pain.

  18. Imaging of thoracic textiloma.

    Science.gov (United States)

    Ridene, Imene; Hantous-Zannad, Saoussen; Zidi, Asma; Smati, Belhassen; Baccouche, Ines; Kilani, Tarek; Ben Miled-M'rad, Khaoula

    2011-03-01

    Intrathoracic textiloma or gossypiboma, a retained surgical sponge in the thoracic cavity, is an exceptional but serious complication following thoracic or abdominal surgery. The purpose of this work is to highlight the topographic features of thoracic textiloma and to describe imaging aspects, and, particularly, computed tomography (CT) features. Eight patients have been operated in our thoracic surgery department for thoracic gossypiboma. In the past, three patients had undergone hepatic surgery and the five others had a history of thoracic surgery. All the patients had a chest radiograph, five of them had a thoracic ultrasonography, all had a chest CT, and one patient had a chest magnetic resonance imaging (MRI). In patients with a history of abdominal surgery, the foreign body was located in the parenchyma of the right lower lobe. In the other patients, the foreign body was either intrapleural or mediastinal. Ultrasonography suggested the diagnosis of textiloma in three of the five patients by demonstrating a non-calcified hyperechoic mass with acoustic shadow. At CT, the gossypiboma was a low-attenuating mass containing trapped gas lucencies in six patients and it was a high-attenuating mass in two patients. MRI showed a diaphragmatic defect in one patient with an intrapulmonary gossypiboma that migrated from the abdomen. The CT aspect of thoracic gossypiboma may be different according to pleural or parenchymal location. The spongiform appearance, characteristic in abdominal gossypiboma, is not the only CT presentation of thoracic gossypiboma. The confrontation of the surgical history with the CT signs helps to have a preoperative diagnosis. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  19. Hereditary angioedema: beyond international consensus - circa December 2010 - The Canadian Society of Allergy and Clinical Immunology Dr. David McCourtie Lecture

    Directory of Open Access Journals (Sweden)

    Bowen Tom

    2011-02-01

    Full Text Available Abstract Background The 2010 International Consensus Algorithm for the Diagnosis, Therapy and Management of Hereditary Angioedema was published earlier this year in this Journal (Bowen et al. Allergy, Asthma & Clinical Immunology 2010, 6:24 - http://www.aacijournal.com/content/6/1/24. Since that publication, there have been multiple phase III clinical trials published on either prophylaxis or therapy of hereditary angioedema and some of these products have changed approval status in various countries. This manuscript was prepared to review and update the management of hereditary angioedema. Objective To review approaches for the diagnosis and management of hereditary angioedema (HAE circa December 2010 and present thoughts on moving from HAE management from international evidence-based consensus to facilitate more local health unit considerations balancing costs, efficacies of treatments, and risk benefits. Thoughts will reflect Canadian and international experiences. Methods PubMed searches including hereditary angioedema and diagnosis, therapy, management and consensus were reviewed as well as press releases from various pharmaceutical companies to early December 2010. Results The 2010 International Consensus Algorithms for the Diagnosis, Therapy and Management of Hereditary Angioedema is reviewed in light of the newly published phase III Clinical trials for prevention and therapy of HAE. Management approaches and models are discussed. Conclusions Consensus approach and double-blind placebo controlled trials are only interim guides to a complex disorder such as HAE and should be replaced as soon as possible with large phase IV clinical trials, meta analyses, data base registry validation of approaches including quality of life and cost benefit analyses, safety, and head-to-head clinical trials investigating superiority or non-inferiority comparisons of available approaches. Since not all therapeutic products are available in all jurisdictions

  20. Canadian petroleum history bibliography

    Energy Technology Data Exchange (ETDEWEB)

    Cass, D.

    2003-09-27

    The Petroleum History Bibliography includes a list of more than 2,000 publications that record the history of the Canadian petroleum industry. The list includes books, theses, films, audio tapes, published articles, company histories, biographies, autobiographies, fiction, poetry, humour, and an author index. It was created over a period of several years to help with projects at the Petroleum History Society. It is an ongoing piece of work, and as such, invites comments and additions.

  1. Thoracic outlet anatomy (image)

    Science.gov (United States)

    ... spinal vertebra to the rib. There may be pain in the neck and shoulders, and numbess in the last 3 fingers and inner forearm. Thoracic outlet syndrome is usually treated with physical therapy which helps ...

  2. National Quality Forum Metrics for Thoracic Surgery.

    Science.gov (United States)

    Cipriano, Anthony; Burfeind, William R

    2017-08-01

    The National Quality Forum (NQF) is a multistakeholder, nonprofit, membership-based organization improving health care through preferential use of valid performance measures. NQF-endorsed measures are considered the gold standard for health care measurement in the United States. The Society of Thoracic Surgeons is the steward of the only six NQF-endorsed general thoracic surgery measures. These measures include one structure measure (participation in a national general thoracic surgery database), two process measures (recording of clinical stage and recording performance status before lung and esophageal resections), and three outcome measures (risk-adjusted morbidity and mortality after lung and esophageal resections and risk-adjusted length of stay greater than 14 days after lobectomy). Copyright © 2017 Elsevier Inc. All rights reserved.

  3. American Society for Radiation Oncology (ASTRO) survey of radiation biology educators in U.S. and Canadian radiation oncology residency programs.

    Science.gov (United States)

    Rosenstein, Barry S; Held, Kathryn D; Rockwell, Sara; Williams, Jacqueline P; Zeman, Elaine M

    2009-11-01

    To obtain, in a survey-based study, detailed information on the faculty currently responsible for teaching radiation biology courses to radiation oncology residents in the United States and Canada. In March-December 2007 a survey questionnaire was sent to faculty having primary responsibility for teaching radiation biology to residents in 93 radiation oncology residency programs in the United States and Canada. The responses to this survey document the aging of the faculty who have primary responsibility for teaching radiation biology to radiation oncology residents. The survey found a dramatic decline with time in the percentage of educators whose graduate training was in radiation biology. A significant number of the educators responsible for teaching radiation biology were not fully acquainted with the radiation sciences, either through training or practical application. In addition, many were unfamiliar with some of the organizations setting policies and requirements for resident education. Freely available tools, such as the American Society for Radiation Oncology (ASTRO) Radiation and Cancer Biology Practice Examination and Study Guides, were widely used by residents and educators. Consolidation of resident courses or use of a national radiation biology review course was viewed as unlikely by most programs. A high priority should be given to the development of comprehensive teaching tools to assist those individuals who have responsibility for teaching radiation biology courses but who do not have an extensive background in critical areas of radiobiology related to radiation oncology. These findings also suggest a need for new graduate programs in radiobiology.

  4. Thoracic surgical resident education: a costly endeavor.

    Science.gov (United States)

    Calhoon, John H; Baisden, Clint; Holler, Ben; Hicks, George L; Bove, Ed L; Wright, Cameron D; Merrill, Walter H; Fullerton, Dave A

    2014-12-01

    We sought to define an accurate measure of thoracic surgical education costs. Program directors from six distinct and differently sized and geographically located thoracic surgical training programs used a common template to provide estimates of resident educational costs. These data were reviewed, clarifying questions or discrepancies when noted and using best estimates when exact data were unavailable. Subsequently, a composite of previously published cost-estimation products was used to capture accurate cost data. Data were then compiled and averaged to provide an accurate picture of all costs associated with thoracic surgical education. Before formal accounting was performed, the estimated average for all programs was approximately $250,000 per year per resident. However, when formal evaluations by the six programs were performed, the annual cost of resident education ranged from $330,000 to $667,000 per year per resident. The average cost of $483,000 per year was almost double the initial estimates. Variability was noted by region and size of program. Faculty teaching costs varied from $208,000 to $346,000 per year. Simulation costs ranged from $0 to $80,000 per year. Resident savings to program ranged from $0 to $135,000 per year and averaged $37,000 per year per resident. Thoracic surgical education costs are considerably higher than initial estimates from program directors and probably represent an unappreciated source of financial burden for cardiothoracic surgical educational programs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. [Thoracic Trauma - Prehospital Treatment].

    Science.gov (United States)

    Hansen, Michael; Hachenberg, Thomas

    2017-06-01

    Penetrating thoracic injuries are rare in Germany and common in urban regions. 10 percent of the patients in Emergency Departments suffer from blunt thoracic trauma. Mechanism of trauma can predict the severity of the injuries. Very fast life-threatening injuries with hemodynamic problems like tension pneumothorax or cardiac tamponade have to be diagnosed. Prehospital emergency physicians need skills in ultrasound for diagnosis and in invasive therapy like chest tube or pericardium drainage tube. The application of an algorithm in exploration of a thoracic trauma seems to be useful. The selection of trauma center depends on the severity of the trauma, if necessary with the availability of extracorporeal circulation. Georg Thieme Verlag KG Stuttgart · New York.

  6. Engendering migrant health: Canadian perspectives

    National Research Council Canada - National Science Library

    Spitzer, Denise L

    2011-01-01

    .... Focusing on the context of Canadian policy and society, the contributors illuminate migrants' testimonies of struggle, resistance, and solidarity as they negotiate a place for themselves in a new country. Topics range from the difficulties of Francophone refugees and the changing roles of fathers, to the experiences of queer newcomers and the importance of social unity to communal and individual health."--pub. desc.

  7. Thoracic empyema caused by Campylobacter rectus.

    Science.gov (United States)

    Ogata, Tomoyuki; Urata, Teruo; Nemoto, Daisuke; Hitomi, Shigemi

    2017-03-01

    We report a case of thoracic empyema caused by Campylobacter rectus, an organism considered as a periodontal pathogen but rarely recovered from extraoral specimens. The patient fully recovered through drainage of purulent pleural fluid and administration of antibiotics. The present case illustrates that C. rectus can be a cause of not only periodontal disease but also pulmonary infection. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  8. Thoracic and abdominopelvic actinomycosis

    African Journals Online (AJOL)

    This infection was patho- logically proven to be actinomycosis and the patient duly responded to IV penicillin treatment. REVIEW ARTICLE. 5. SA JOURNAL OF RADIOLOGY • December 2005. Figs 2a and b. Axial post-contrast CT scan of the chest demonstrating a left para-aor- tic mass extending to the anterior thoracic.

  9. I Am Canadian

    DEFF Research Database (Denmark)

    Goddard, Joe

    2011-01-01

    "I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness......."I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness....

  10. Thoracic textilomas: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Machado, Dianne Melo; Zanetti, Glaucia; Araujo Neto, Cesar Augusto; Nobre, Luiz Felipe; Meirelles, Gustavo de Souza Portes; Silva, Jorge Luiz Pereira e; Guimaraes, Marcos Duarte; Escuissato, Dante Luiz; Souza Junior, Arthur Soares; Hochhegger, Bruno; Marchiori, Edson, E-mail: edmarchiori@gmail.com [Hospital Universitario Antonio Pedro (HUAP/UFF), Niteroi, RJ (Brazil)

    2014-09-15

    Objective: the aim of this study was to analyze chest CT scans of patients with thoracic textiloma. Methods: this was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. Results: the majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). Conclusions: it is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication. (author)

  11. [Thoracic actinomycosis: three cases].

    Science.gov (United States)

    Herrak, L; Msougar, Y; Ouadnouni, Y; Bouchikh, M; Benosmane, A

    2007-09-01

    Actinomycosis is a rare condition which, in the thoracic localisation, can mimic cancer or tuberculosis. We report a series of three case of thoracic actinomycosis treated in the Ibn Sina University Thoracic Surgery Unit in Rabat, Morocco. CASE N degrees 1: This 45-year-old patient presented a tumefaction on the left anterior aspect of the chest. Physical examination identified a parietal mass with fistulisation to the skin. Radiography demonstrated a left pulmonary mass. Transparietal puncture led to the pathological diagnosis of actinomycosis. The patient was given medical treatment and improved clinically and radiographically. CASE N degrees 2: This 68-year-old patient presented repeated episodes of hemoptysis. The chest x-ray revealed atelectasia of the middle lobe and bronchial fibroscopy demonstrated the presence of a bud in the middle lobar bronchus. Biopsies were negative. The patient underwent surgery and the histology examination of the operative specimen revealed pulmonary actinomycosis. The patient recovered well clinically and radiographically with antibiotic therapy. CASE N degrees 3: This 56-year-old patient presented cough and hemoptysis. Physical examination revealed a left condensation and destruction of the left lung was noted on the chest x-ray. Left pleuropulmonectomy was performed. Histological analysis of the surgical specimen identified associated Aspergillus and Actinomyces. The outcome was favorable with medical treatment. The purpose of this work was to recall the radiological, clinical, histological, therapeutic, outcome aspects of this condition and to relate the problems of differential diagnosis when can suggest other diseases.

  12. [Surgery for thoracic tuberculosis].

    Science.gov (United States)

    Kilani, T; Boudaya, M S; Zribi, H; Ouerghi, S; Marghli, A; Mestiri, T; Mezni, F

    2015-01-01

    Tuberculosis is mainly a medical disease. Surgery has been the unique therapeutic tool for a long time before the advent of specific antituberculous drugs, and the role of surgery was then confined to the treatment of the sequelae of tuberculosis and their complications. The resurgence of tuberculosis and the emergence of multidrug-resistant TB combined to immunosuppressed patients represent a new challenge for tuberculosis surgery. Surgery may be indicated for a diagnostic purpose in patients with pulmonary, pleural, mediastinal or thoracic wall involvement, or with a therapeutic purpose (drainage, resection, residual cavity obliteration). Modern imaging techniques and the advent of video-assisted thoracic surgery allowed a new approach of this pathology; the majority of diagnostic interventions and selected cases requiring lung resection can be performed through a mini-invasive approach. Patients proposed for aggressive surgery may be treated with the best results thanks to a good evaluation of the thoracic lesions, of the patients' nutritional, infectious and general status combined with a good coordination between the specialized medical team for an optimal preparation to surgery. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiología Intervencionista; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention).

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-06-01

    This article provides a brief summary of the relevant recommendations and references related to percutaneous mechanical circulatory support. The goal was to provide the clinician with concise, evidence-based contemporary recommendations, and the supporting documentation to encourage their application. The full text includes disclosure of all relevant relationships with industry for each writing committee member. A fundamental aspect of all expert consensus statements is that these carefully developed, evidence-based documents can neither encompass all clinical circumstances, nor replace the judgment of individual physicians in management of each patient. The science of medicine is rooted in evidence, and the art of medicine is based on the application of this evidence to the individual patient. This expert consensus statement has adhered to these principles for optimal management of patients requiring percutaneous mechanical circulatory support. © 2015 by The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, the Heart Failure Society of America, and The Society for Thoracic Surgery.

  14. Determination of Effective Thoracic Mass

    Directory of Open Access Journals (Sweden)

    Jeffrey H. Marcus

    1996-01-01

    Full Text Available Effective thoracic mass is an important parameter in specifying mathematical and mechanical models (such as crash dummies of humans exposed to impact conditions. A method is developed using a numerical optimizer to determine effective thoracic mass (and mass distribution given a number of acceleration signals and a force signal response. Utilizing previously reported lateral and frontal impact tests with human cadaveric test specimens in a number of different conditions, the effective thoracic mass is computed. The effective thoracic masses are then computed for a variety of crash dummies exposed to identical test conditions.

  15. Ectopic pancreatic tissue in the thoracic cavity: report of two cases.

    Science.gov (United States)

    Fayoumi, Said; Al-Husseini, Luai; Jalil, Riad; Abbasi, Salah

    2010-08-01

    Ectopic pancreas in the thoracic cavity is uncommon. We report 2 patients who had large cystic or cystic-solid masses containing pancreatic tissue in the thorax. Their clinical presentation, imaging, and pathologic findings are described. Both patients underwent total surgical resection of the masses, with no recurrence. Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Thoracic damage control surgery.

    Science.gov (United States)

    Gonçalves, Roberto; Saad, Roberto

    2016-01-01

    The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis patients. This article aims to revise the various damage control techniques in thoracic organs that must be known to the surgeon engaged in emergency care. RESUMO A cirurgia de controle de danos surgiu com a filosofia de se aplicar manobras essenciais para controle de sangramento e contaminação abdominal, em doentes traumatizados, nos limites de suas reservas fisiológicas. Este conceito se estendeu para as lesões torácicas, onde manobras relativamente simples, podem abreviar o tempo operatório de doentes in extremis. Este artigo tem como objetivo, revisar as diversas técnicas de controle de dano em órgãos torácicos, que devem ser de conhecimento do cirurgião que atua na emergência.

  17. The European educational platform on thoracic surgery.

    Science.gov (United States)

    Massard, Gilbert; Rocco, Gaetano; Venuta, Federico

    2014-05-01

    As the largest scientific organisation world-wide exclusively dedicated to general thoracic surgery (GTS), the European Society of Thoracic Surgeons (ESTS) recognized that one of its priorities is education. The educational platform designed ESTS addresses not only trainees, but also confirmed thoracic surgeons. The two main aims are (I) to prepare trainees to graduation and to the certification by the European Board of Thoracic Surgery and (II) to offer opportunities for continuous medical education in the perspective of life-long learning and continuous professional development to certified thoracic surgeons. It is likely that recertification will become an obligation during the coming decade. At its inception, the platform differentiated two different events. A 6-day course emphasizing on theoretic knowledge was created in Antalya in 2007. The same year, a 2-day school oriented to practical issues with hands-on in the animal lab was launched in Antalya. These two teaching tracks need further development. In the knowledge track, we intend to organize highly specialized 2-day courses to deepen insight into theoretical questions. The skill track will be implemented by specialized courses for high technology such as tracheal surgery, ECMO, robotics or chest wall reconstruction. In order to promote tomorrows' leadership, we created an academic competence track giving an insight into medical communication, methodology and management. We also had to respond to an increasing demand from the Russian speaking countries, where colleagues may face problems to attend western meetings, and where the language bareer may be a major impediment. We initiated a Russian school with three events yearly in 2012. Contemporary teaching must be completed with an e-learning platform, which is currently under development. The school activities are organized by the educational committee, which is headed by the ESTS Director of Education, assisted by coordinators of the teaching tracks and

  18. Universal values of Canadian astronauts

    Science.gov (United States)

    Brcic, Jelena; Della-Rossa, Irina

    2012-11-01

    Values are desirable, trans-situational goals, varying in importance, that guide behavior. Research has demonstrated that universal values may alter in importance as a result of major life events. The present study examines the effect of spaceflight and the demands of astronauts' job position as life circumstances that affect value priorities. We employed thematic content analysis for references to Schwartz's well-established value markers in narratives (media interviews, journals, and pre-flight interviews) of seven Canadian astronauts and compared the results to the values of National Aeronautics and Space Administration (NASA) and Russian Space Agency (RKA) astronauts. Space flight did alter the level of importance of Canadian astronauts' values. We found a U-shaped pattern for the values of Achievement and Tradition before, during, and after flight, and a linear decrease in the value of Stimulation. The most frequently mentioned values were Achievement, Universalism, Security, and Self-Direction. Achievement and Self Direction are also within the top 4 values of all other astronauts; however, Universalism was significantly higher among the Canadian astronauts. Within the value hierarchy of Canadian astronauts, Security was the third most frequently mentioned value, while it is in seventh place for all other astronauts. Interestingly, the most often mentioned value marker (sub-category) in this category was Patriotism. The findings have important implications in understanding multi-national crew relations during training, flight, and reintegration into society.

  19. Thoracic epidural abscess.

    Science.gov (United States)

    Liem, L K; Rigamonti, D; Wolf, A L; Robinson, W L; Edwards, C C; DiPatri, A

    1994-10-01

    Twenty-one cases of thoracic spinal epidural abscess occurring over a 10-year period were retrospectively reviewed. Diagnosis was made by MRI or myelography and confirmed in the operative cases. A bacterial agent was isolated in 18 of the cases (86%). When measured, the erythrocyte sedimentation rate was elevated in all cases. Four patients who presented without neurologic deficits remained intact. All patients who presented with neurological deficits underwent surgical intervention in addition to intravenous antibiotics. Of the 15 patients who presented with a paraparesis of less than antigravity strength, five eventually were independent ambulators and continent. A good outcome resulted in 80% of those who underwent decompression within 24 h, as opposed to only 10% of the patients decompressed after 24 h. Good results can be obtained despite severe neurologic compromise when treated by rapid diagnosis and decompression of the spinal canal.

  20. [Thoracic manifestation of tuberculosis].

    Science.gov (United States)

    Kienzl-Palma, D; Prosch, H

    2016-10-01

    Tuberculosis (TB) is a granulomatous disease caused by Mycobacterium tuberculosis and transmission is via an airborne route by droplet infection. In the majority of cases patients have thoracic TB, which most frequently presents with hilar lymphadenopathy and pulmonary manifestation. Due to the rise in incidence of TB in central Europe to be expected over the coming years, it is essential to be acquainted with the radiological manifestations of pulmonary TB, particularly to be able to discriminate active from inactive TB. Due to the use of molecular techniques entailing DNA fingerprinting, the traditional classification of TB in primary and postprimary TB is being challenged. These genetic studies have revealed that variations in the clinical and radiographic appearance of TB are mainly affected by the immune status of the patients. Due to the low prevalence of TB in central Europe and the wide variation of radiological presentations, the diagnosis and therapy of TB is often delayed. In this article, the radiographic manifestations of thoracic TB are summarized and discussed. Together with the medical history and bacteriological tests, chest X‑ray imaging and computed tomography (CT) play a major role not only in the detection of TB but also in the follow-up during and after therapy. Chest X‑radiographs should be the primary diagnostic method in patients with suspected TB in screening as well as for diagnosis and therapy monitoring. The use of CT is more sensitive than chest radiographs and is frequently performed after chest radiographs to obtain detailed information about subtle parenchymal changes or lymph node manifestation. When active TB is suspected CT should be performed. Tree in bud, lobular consolidations, centrilobular nodules, cavities and ground-glass opacification are typical changes in active TB.

  1. Role of Computed Tomography and Mediastinoscopy in the Staging of Lung Cancer: A Canadian Opinion Poll

    Directory of Open Access Journals (Sweden)

    Graham L Jones

    1997-01-01

    Full Text Available OBJECTIVES: To address the Canadian Lung Oncology group’s recently published results and recommendations suggesting that mediastinoscopy is unnecessary in the staging nonsmall cell lung cancer when computed tomography shows no enlarged mediastinal lymph nodes (larger than 1 cm in short axis; to evaluate the practice of thoracic surgeons across Canada in staging presumably operable lung cancer; and to assess the effect of the Canadian Lung Oncology Group’s recommendations on current thoracic surgical practice in Canada.

  2. General thoracic surgery workforce: training, migration and practice profile in Brazil.

    Science.gov (United States)

    Tedde, Miguel Lia; Petrere, Oleno; Pinto Filho, Darcy Ribeiro; Pereira, Sergio Tadeu L Fortunato; Monteiro, Rosangela; Sassaki, Ana Maria; Togoro, Silvia Yukari; Trindade, Evelinda; Saad, Roberto; Jatene, Fabio Biscegli

    2015-01-01

    This study is aimed at drawing the profile of the Brazilian general thoracic surgeon. This experience has been fruitful in other areas, helping attract manpower and to better serve the interests of other Societies. This is the first survey of this kind in Brazil and in Latin America. An electronic invitation was sent to the members of the Brazilian Society of Thoracic Surgery to answer a web-based questionnaire and physicians potentially practising thoracic surgery, with 82 questions including demographic data, medical education, training in general and thoracic surgery, continued professional education, practice profile, research activities and certifications, participation in medical societies, income/compensation and career satisfaction. Quantitative and qualitative analyses are presented. The estimated level of participation was 82% (468). The mean age of the active general thoracic surgeon is 43.2 (range 45.3±11.4) years. Women comprised 8% (37) of respondents, and 60% (277) of the participants had graduated from public medical schools. Four states nationwide trained 88% (391) of the thoracic surgeons. Only 32% (149) of the surgeons work exclusively with thoracic surgery. The public health system is the main provider of income for thoracic surgeons. Only 11 of 27 states have an adequate, although poorly distributed, number of thoracic surgeons. Although Brazil has a reasonable number of general thoracic surgeons, inequalities in their distribution through the country arise as one of the most concerning problems of the speciality. The results of this study show that leadership actions and consistent government policies are required to improve work conditions and provide efficient workforce planning. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  3. Dictionaries of Canadian English

    African Journals Online (AJOL)

    Information Technology

    ... Globe and Mail said, an enterprising publication. Despite the existence of the Winston dictionary, some Canadians were still, at the end of the 1950s, prepared to dismiss Canadian lexicography as pointless. When the idea of a Canadian dictionary was introduced to the Dean of Arts and Science at Dalhousie University in ...

  4. "In Canada Even History Divides": Unique Features of Canadian Citizenship.

    Science.gov (United States)

    Sears, Alan

    1997-01-01

    Explores the unique features of Canadian history and society that influence the conception of Canadian citizenship. These include the historical development of Canada as a frontier crown territory, the search for an elusive national identity, the decentralized political structure, and the proximity to the United States. (MJP)

  5. Imaging of thoracic cavity tumors.

    Science.gov (United States)

    Hayes, Sara A; Plodkowski, Andrew J; Ginsberg, Michelle S

    2014-10-01

    Computed tomography (CT) is the primary imaging modality for the diagnosis, staging, and follow-up of most thoracic cavity tumors. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT has established itself as a supplementary tool to CT in lung cancer staging and in the assessment for distant metastases of many thoracic tumors. Magnetic resonance imaging is an important adjunctive imaging modality in thoracic oncologic imaging and is used as a problem-solving tool to assess for chest wall invasion, intraspinal extension, and cardiac/vascular invasion. Imaging can facilitate minimally invasive biopsy of most thoracic tumors and is vital in the pretreatment planning of radiation therapy. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Canadian guidelines for acute bacterial rhinosinusitis

    Science.gov (United States)

    Kaplan, Alan

    2014-01-01

    Objective To provide a clinical summary of the Canadian clinical practice guidelines for acute bacterial rhinosinusitis (ABRS) that includes relevant considerations for family physicians. Quality of evidence Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology—Head and Neck Surgery, Canadian Association of Emergency Physicians, and the Family Physicians Airways Group of Canada). Main message Diagnosis of ABRS is based on the presence of specific symptoms and their duration; imaging or culture are not needed in uncomplicated cases. Treatment is dependent on symptom severity, with intranasal corticosteroids (INCSs) recommended as monotherapy for mild and moderate cases, although the benefit might be modest. Use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours, and for initial treatment of patients with severe symptoms. Antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunct therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist. The guidelines address situations unique to the Canadian health care environment, including actions to take during prolonged wait periods for specialist referral or imaging. Conclusion The Canadian guidelines provide up-to-date recommendations for diagnosis and treatment of ABRS that reflect an evolving understanding of the disease. In addition, the guidelines offer useful tools to help

  7. Canadian women opting for less effective birth control

    National Research Council Canada - National Science Library

    Lauren Vogel

    2017-01-01

    More Canadian women are relying on less effective methods of birth control and are using them less consistently than they did a decade ago, according to the Society of Obstetricians and Gynaecologists of Canada (SOGC...

  8. Consensus statement: the development of a national Canadian Migraine Strategy.

    Science.gov (United States)

    Becker, W J; Christie, S N; Mackie, G; Cooper, P

    2010-07-01

    Migraine is a significant cause of suffering and disability in the Canadian population, and imposes a major cost on Canadian Society. Based on current medical science, much more could be done to provide better comprehensive medical care to the millions of individuals with migraine in Canada. To propose and design a national Canadian Migraine Strategy which could be implemented to reduce migraine related disability in Canada. A multidisciplinary task force of the Canadian Headache Society met for a Canadian Migraine Summit Meeting in Halifax, Nova Scotia in June, 2009. Pertinent literature was reviewed and a consensus document was produced based upon the round table discussion at the meeting. The outline of a national Canadian Migraine Strategy was created. This strategy is based on the chronic disease management model, and would include: an outline of what constitutes appropriate migraine care for Canadians, educational programs (for health care professionals, individuals with migraine, and the general public), research programs, and the development of the necessary organizations and partnerships to develop further and implement the Canadian Migraine Strategy. Based upon the medical literature and expert discussion at the meeting, a national Canadian Migraine Strategy with a patient self-management focus has the potential to improve patient care and reduce headache related disability in Canada.

  9. Spirometry. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR).

    Science.gov (United States)

    García-Río, Francisco; Calle, Myriam; Burgos, Felip; Casan, Pere; Del Campo, Félix; Galdiz, Juan B; Giner, Jordi; González-Mangado, Nicolás; Ortega, Francisco; Puente Maestu, Luis

    2013-09-01

    Spirometry is the main pulmonary function test and is essential for the evaluation and monitoring of respiratory diseases. Its utility transcends the field of Respiratory Medicine, is becoming increasingly important in primary care and applications have even been described outside the field of respiratory diseases. This document is therefore intended to serve as support for all health professionals who use spirometry, providing recommendations based on the best scientific evidence available. An update of the indications and contraindications of the test is proposed. The document sets out recommendations on the requirements necessary for conventional spirometers and portable office equipment, as well as on spirometer hygiene and quality control measures. Spirometric parameters that must be considered, performance of manoeuvres, criteria for acceptability and repeatability of measurements and their quality control are defined. A proposal is also established for presentation of the results and an evaluation and interpretation is proposed according to information generated in recent years. Finally, lines of adaptation and integration of spirometry in the field of new technologies are considered. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  10. Paediatric spirometry guideline of the South African Thoracic Society ...

    African Journals Online (AJOL)

    We reviewed the recommendations on the technical aspects of performing spirometry in children, from the available guidelines and clinical trials. The focus was on the indications, methods and the interpretation of lung function tests in children <12 years of age. Reliable lung function testing can be performed in children, but ...

  11. Paediatric spirometry guideline of the South African Thoracic Society ...

    African Journals Online (AJOL)

    Spirometry forms an important component in the diagnosis and management of pulmonary diseases in children. In the paediatric setting, there are ... an altered mental state[10] or learning difficulties[2,3]. • chest .... When maximal expiration is met, fill up the lungs again by taking another quick, deep breath. ×. ✓. Repeat for a ...

  12. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention.

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-05-19

    Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. Copyright © 2015 The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, The Heart Failure Society of America, and The Society for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  13. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie D'intervention).

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-06-01

    Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella®; left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines. © 2015 by The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, The Heart Failure Society of America, and The Society for Thoracic Surgery.

  14. Research Awards: Canadian Partnerships Program Deadline: 12 ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Jean-Claude Dumais

    2012-09-12

    Sep 12, 2012 ... This award provides young and upcoming professionals with a unique opportunity to strengthen their research skills and gain a fresh perspective on the Canadian community – both in universities and civil society organizations (CSOs) – that is actively engaged in creating, sharing, and using knowledge to ...

  15. [A Germany-wide survey on anaesthesia in thoracic surgery].

    Science.gov (United States)

    Defosse, J; Schieren, M; Böhmer, A; von Dossow, V; Loop, T; Wappler, F; Gerbershagen, M U

    2016-06-01

    This study's objective was to evaluate current thoracic anaesthesia practice in Germany and to quantify potential differences depending on the hospital's level of care. A four-part online survey containing 28 questions was mailed to all anaesthesiology department chairs (n = 777) registered with the German Society of Anaesthesiology and Intensive Care Medicine. The general response rate was 31.5 % (n = 245). High monthly volumes (>50 operations/month) of intrathoracic procedures, performed by specialized thoracic surgeons are mostly limited to hospitals of maximum care, university hospitals, and specialized thoracic clinics. In hospitals with a lower level of care, intrathoracic operations occur less frequently (1-5/month) and are commonly performed by general (69.3 %) rather than thoracic surgeons (15.4 %). Video-assisted thoracic surgeries are the most invasive intrathoracic procedures for most hospitals with a low level of care (61.5 %). Extended resections and pneumonectomies occur mainly in hospitals of maximum care and university hospitals. Thoracic anaesthesia is primarily performed by consultants or senior physicians (59.9 %). The double lumen tube (91.4 %) is the preferred method to enable one-lung ventilation (bronchial blockers: 2.7 %; missing answer: 5.9 %). A bronchoscopic confirmation of the correct placement of a double lumen tube is considered mandatory by 87.7 % of the respondents. Bronchial blockers are available in 64.7 % of all thoracic anaesthesia departments. While CPAP-valves for the deflated lung are commonly used (74.9 %), jet-ventilators are rarely accessible, especially in hospitals with a lower level of care (15.4 %). Although general algorithms for a difficult airway are widely available (87.7 %), specific recommendations for a difficult airway in thoracic anaesthesia are uncommon (4.8 %). Laryngeal mask airways (90.9 %) and videolaryngoscopy (88.8 %) are the primary adjuncts in store for a difficult

  16. Statistics in action a Canadian outlook

    CERN Document Server

    Lawless, Jerald F

    2014-01-01

    Commissioned by the Statistical Society of Canada (SSC), Statistics in Action: A Canadian Outlook helps both general readers and users of statistics better appreciate the scope and importance of statistics. It presents the ways in which statistics is used while highlighting key contributions that Canadian statisticians are making to science, technology, business, government, and other areas. The book emphasizes the role and impact of computing in statistical modeling and analysis, including the issues involved with the huge amounts of data being generated by automated processes.The first two c

  17. Canadian Petroleum Products Institute: Annual report 1991

    Energy Technology Data Exchange (ETDEWEB)

    1992-01-01

    Annual report of the Institute, which represents the refining and marketing sectors of the petroleum industry on environmental, health, safety, and business issues affecting the industry and Canadian society. The report describes the Institute; gives highlights for the year; describes the recipient of the first CPPI Chairman's Award, Dr. Linton Kulak; provides a general policy and guiding principles for environment, health, and safety; describes the environmental achievements and challenges of the Canadian petroleum industry; and describes industry economics and operations. A list of 1991 publications is also included.

  18. Rare Giant Prevertebral Thoracic Myelomeningocele.

    Science.gov (United States)

    Choi, Bryan D; Fehnel, Katie P; Butler, William E

    2018-01-01

    Here we report a 72-year-old man who presented with complaint of sudden-onset weakness and impaired sensation in the left lower extremity. Radiographic evaluation revealed a congenital malformation with multiple formation defects including a giant thoracic prevertebral myelomeningocele. Following microsurgical detethering of the spinal cord, the patient recovered ambulation with assist. While thoracic myelomeningoceles are themselves rare, in this case the patient presented at a late age and responded well to conservative management. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Framing Canadian federalism

    National Research Council Canada - National Science Library

    Saywell, John; Anastakis, Dimitry; Bryden, Penny E

    2009-01-01

    ... the pervasive effects that federalism has on Canadian politics, economics, culture, and history, and provide a detailed framework in which to understand contemporary federalism. Written in honour of John T. Saywell's half-century of accomplished and influential scholarly work and teaching, Framing Canadian Federalism is a timely and fitting t...

  20. Thoracic Endometriosis Syndrome Other Than Pneumothorax: Clinical and Pathological Findings.

    Science.gov (United States)

    Bobbio, Antonio; Canny, Emeline; Mansuet Lupo, Audrey; Lococo, Filippo; Legras, Antoine; Magdeleinat, Pierre; Regnard, Jean-François; Gompel, Anne; Damotte, Diane; Alifano, Marco

    2017-12-01

    Thoracic endometriosis syndrome refers to a broad spectrum of clinical manifestations related to the presence of ectopic intrathoracic endometrial tissue. Few studies have reported on manifestations other than pneumothorax. Clinical, surgical, and pathology records of all consecutive women of reproductive age referred to our institution from September 2001 to August 2016 for clinically suspected thoracic endometriosis syndrome were retrospectively reviewed. After excluding women with pneumothorax, we enrolled 31 patients, divided into three subgroups: catamenial chest pain (n = 20), endometriosis-related diaphragmatic hernia (n = 6), and endometriosis-related pleural effusion (n = 5). Surgery was performed in 11 patients with catamenial thoracic pain (median age, 30 years; range, 23 to 42). Median pain intensity assessed on the 0 to 10 Visual Analogue Scale was 8 (range, 8 to 9) before surgery. At surgery, 8 patients had diaphragmatic endometriosis implants, which were resected with direct suture of diaphragm. At follow-up, median pain score was 3 (range, 0 to 8). In the group presenting with diaphragmatic hernia (median age, 36 years; range, 29 to 50), diaphragm was repaired by direct suture or placement of prosthesis in 4 and 2 cases, respectively. At follow-up, no sign of recurrent hernia was observed. Finally, among women with endometriosis-related pleural effusion (median age, 30 years; range, 25 to 42), surgical treatment was represented by evacuation of the pleural effusion and biopsy (n = 4) or removal (n = 1) of visible endometrial foci. Thoracic endometriosis syndrome is a poorly recognized entity responsible for various manifestations other than pneumothorax. In case of catamenial thoracic pain, diaphragmatic hernia and catamenial pleural effusion surgery should be advised in a multidisciplinary setting. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. REVIEW ARTICLE Thoracic endometriosis syndrome: current ...

    African Journals Online (AJOL)

    KESIEME

    Thoracic endometriosis syndrome: current concept in pathophysiology and management. Emeka B KESIEME1 ... Objective: To review the current concepts in the pathophysiology and management of thoracic endometriosis syndrome. ... in reproductive age group; the incidence of extrapelvic endometriosis in these women.

  2. Core curriculum case illustration: blunt traumatic thoracic aortic pseudo aneurysm.

    Science.gov (United States)

    Ramzan, Muhammad Mubashir; Fadl, Shaimaa Abdelhassib; Robinson, Jeffrey D

    2017-06-19

    Core Curriculum Illustration: [blunt thoracic aortic pseudo aneurysm]. This is the [40th] installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.aseronline.org/curriculum/toc.html.

  3. Late neurological recovery of paraplegia after endovascular repair of an infected thoracic aortic aneurysm.

    Science.gov (United States)

    Mees, Barend M E; Bastos Gonçalves, Frederico; Koudstaal, Peter J; Verhagen, Hence J M

    2013-02-01

    Spinal cord ischemia is a potentially devastating complication after thoracic endovascular aorta repair (TEVAR). Patients with spinal cord ischemia after TEVAR often develop paraplegia, which is considered irreversible, and have significant increased postoperative morbidity and mortality. We report the case of a patient with unusual late complete neurologic recovery of acute-onset paraplegia after TEVAR for an infected thoracic aortic aneurysm. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  4. Thoracic and lumbar intraforaminal ligaments.

    Science.gov (United States)

    Akdemir, Gökhan

    2010-09-01

    The author conducted a study to investigate the anatomy of the intraforaminal ligaments of the thoracic and lumbar nerve roots and describe their anatomical relationships and functional properties. This anatomical study performed on the intervertebral foramina, intraforaminal ligaments, transforaminal ligaments, and nerve roots of the thoracic and lumbar spine was performed in human cadavers. The foraminal anatomy was studied in 11 whole cadavers (5 females, 6 males) previously prepared with formaldehyde, whose ages at the time of death ranged from 16 to 71 years. The thoracic and lumbar spinal columns were separated from the cervical and sacral segments en bloc using an electric band saw. The paraspinal muscles and their attachments were removed by sharp and meticulous dissection, and the thoracic and lumbar intervertebral foramina were examined under a surgical microscope. The intervertebral foraminal ligaments and nerve roots were exposed. The foraminal contents were identified and studied in detail. The intraforaminal ligaments were stained using H & E to determine ligamentous fiber. Intraforaminal ligaments connect the periosteum and transforaminal ligaments to the nerve root sleeves and vessels within the fatty areolar tissue. Histologically, the ligamentous attachment of the nerve roots within the foramina consists of adipose and connective tissue. The nerve roots are surrounded by intraforaminal ligaments, which may act in conjunction with the dura and periosteum to protect the nerve roots mechanically.

  5. Nanotechnology applications in thoracic surgery.

    Science.gov (United States)

    Hofferberth, Sophie C; Grinstaff, Mark W; Colson, Yolonda L

    2016-07-01

    Nanotechnology is an emerging, rapidly evolving field with the potential to significantly impact care across the full spectrum of cancer therapy. Of note, several recent nanotechnological advances show particular promise to improve outcomes for thoracic surgical patients. A variety of nanotechnologies are described that offer possible solutions to existing challenges encountered in the detection, diagnosis and treatment of lung cancer. Nanotechnology-based imaging platforms have the ability to improve the surgical care of patients with thoracic malignancies through technological advances in intraoperative tumour localization, lymph node mapping and accuracy of tumour resection. Moreover, nanotechnology is poised to revolutionize adjuvant lung cancer therapy. Common chemotherapeutic drugs, such as paclitaxel, docetaxel and doxorubicin, are being formulated using various nanotechnologies to improve drug delivery, whereas nanoparticle (NP)-based imaging technologies can monitor the tumour microenvironment and facilitate molecularly targeted lung cancer therapy. Although early nanotechnology-based delivery systems show promise, the next frontier in lung cancer therapy is the development of 'theranostic' multifunctional NPs capable of integrating diagnosis, drug monitoring, tumour targeting and controlled drug release into various unifying platforms. This article provides an overview of key existing and emerging nanotechnology platforms that may find clinical application in thoracic surgery in the near future. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. Thoracic tumors : prognostic and thearapeutic improvements

    NARCIS (Netherlands)

    Jong, Wouter Karst de

    2008-01-01

    Thoracic tumors are a major burden of disease in many countries. Non-small cell lung cancer and small-cell lung cancer are the most common thoracic malignancies, both tumors are one of the most well-known of the less common thoracic tumors. In this thesis, new ways in estimating the prognosis of

  7. Thoracic aortic catastrophes : towards the endovascular solution

    NARCIS (Netherlands)

    Jonker, F.H.W.

    2010-01-01

    Descending thoracic aortic catastrophes include a variety of acute pathologies of the descending thoracic aorta, which are all associated with high morbidity and mortality rates, requiring immediate intervention. For this thesis, we explored the management and outcomes of several thoracic aortic

  8. Norman Bethune, Canadian surgeon: his Chinese connection.

    Science.gov (United States)

    Summers, G V

    1983-07-01

    Norman Bethune, a Canadian thoracic surgeon who dabbled in painting, poetry, criticism, teaching and invention, was a member of the Communist Party of Canada. He became involved in two civil wars on opposite sides of the world and amassed both criticism and respect from colleagues and national leaders. The author describes Bethune's time in China, during which he developed front line field hospitals for Mao Tse-tung and his guerrillas in their struggle against the Japanese during 1938 and 1939. His efforts in China on behalf of the wounded brought him into contact with the primitive military medicine of the country and the poverty of its people; it earned for him a local reputation as saviour and benefactor and gave him an honoured place in Chinese military history.

  9. Autism Society

    Science.gov (United States)

    ... Español Improving the lives of all affected by autism. The Autism Society is the nation's leading grassroots ... more Improving the lives of all affected by autism. The Autism Society is the nation's leading grassroots ...

  10. Canadians' eating habits

    National Research Council Canada - National Science Library

    Garriguet, Didier

    2007-01-01

    This report is an overview of Canadians' eating habits: total calories consumed and the number of servings from the various food groups, as well as the percentage of total calories from fat, protein and carbohydrates...

  11. Mass Society

    DEFF Research Database (Denmark)

    Borch, Christian

    2017-01-01

    the negative features usually ascribed by late nineteenth-century crowd psychology to spontaneous crowds, and attributes these to the entire social fabric. However, in contrast to crowd psychology, theorists of mass society often place greater emphasis on how capitalism, technological advances, or demographic......Mass society is a societal diagnosis that emphasizes – usually in a pejorative, modernity critical manner – a series of traits allegedly associated with modern society, such as the leveling of individuality, moral decay, alienation, and isolation. As such, the notion of mass society generalizes...... developments condition such negative features, and some theorists argue that mass society produces a propensity to totalitarianism. Discussions of mass society culminated in the early and mid-twentieth century....

  12. Thoracic causes of acute abdominal pain

    Energy Technology Data Exchange (ETDEWEB)

    Breda Vriesman, Adriaan C. van; Smithuis, Robin H.M. [Rijnland Hospital, Department of Radiology, Leiderdorp (Netherlands); Puylaert, Julien B.C.M. [MCH Westeinde Hospital, Department of Radiology, The Hague (Netherlands)

    2010-06-15

    The origin of abdominal pain may be extra-abdominal, caused by a thoracic illness. This article illustrates the various thoracic disorders that may present with acute abdominal pain. An erroneous focus on the abdomen alone can easily lead to misdiagnosis and incorrect treatment. In cases of unexplained acute abdominal pain, radiologists should be aware of also viewing beyond the borders of the abdomen. The key to most of these thoracic diagnoses is detection of pulmonary consolidation, pleural fluid or pericardial fluid. (orig.)

  13. Committing Canadian sociology: developing a Canadian sociology and a sociology of Canada.

    Science.gov (United States)

    Matthews, Ralph

    2014-05-01

    This paper is a slightly revised version of the author's "Outstanding Career Award Lecture" presented at the Annual Meeting of the Canadian Sociological Association in Victoria, British Columbia on June 6, 2013. The paper distinguishes between Canadian Sociology and the Sociology of Canada. The former involves the explanatory stance that one takes to understanding Canada. The latter addresses the significant social dimensions that underlie Canadian social organization, culture, and behavior. I make a case for a Canadian Sociology that focuses on the unique features of Canadian society rather than adopting a comparative perspective. I also argue that there is a continuing need within the Sociology of Canada to address the issues of staples development. However, I argue that "new" staples analysis must have a directional change from that of the past, in that social processes now largely determine the pattern of staples development. Moreover, new staples analysis must include issues that were never part of earlier staples analysis, such as issues of environmental impacts and of staples depletion under conditions, such as climate change. The paper concludes by analyzing four factors that provide the dominant social contexts for analyzing modern staples development: (1) the rise of neoliberal government, (2) the implementation of globalization and its social consequences, (3) the assumption of aboriginal rights and entitlement, and (4) the rise of environmentalism. These factors were generally not considered in earlier staples approaches. They are critical to understanding the role of staples development and its impact on Canada in the present time.

  14. Thoracal spinal extradural arachnoid cyst

    Directory of Open Access Journals (Sweden)

    Olcay Eser

    2011-12-01

    Full Text Available Arachnoid cyst are fluid-filled that are located between the arachnoid and piamater or duplicationof arachnoid membrane. Extradural arachnoid cysts in the spine are rare and primary are congenital or acquired. These are occurring idiopathic, posttraumatic and post arachnoiditis. A 32 year-old male patient is became a clinic with urinary retention and gait disorders. Thoracic Magnetic Resonance Imaging showed a spinal extradurally cystic mass isointense with that cerebro-spinal fluid at T7-8 level. Patient underwent an operation. The diagnosis of arachnoid cyst was made based on histopathology exam. The case was reported due to very rare occurrence of this entity.

  15. Percutaneous thoracic intervertebral disc nucleoplasty: technical notes from 3 patients with painful thoracic disc herniations

    NARCIS (Netherlands)

    Chua Hai Liang, N.; Gultuna, I.; Riezebos, P.; Beems, T.; Vissers, K.C.P.

    2011-01-01

    Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic

  16. FOUNDING SOCIETIES

    National Research Council Canada - National Science Library

    Henry Petroski

    2008-01-01

      [...] with the development of the railroads, the telegraph, and other marvels of the Industrial Revolution, a civil engineering society did not provide a sufficiently broad umbrella under which mining...

  17. Prenatal diagnosis of asphyxiating thoracic dysplasia.

    Science.gov (United States)

    Lipson, M; Waskey, J; Rice, J; Adomian, G; Lachman, R; Filly, R; Rimoin, D

    1984-06-01

    A fetus at risk for asphyxiating thoracic dysplasia was studied with ultrasound examination at 16, 18, and 23 weeks of pregnancy. Definite shortness of fetal femora was observed. Radiographic and histologic examinations after pregnancy termination confirmed the diagnosis. Asphyxiating thoracic dysplasia appears to be one of an increasing number of skeletal dysplasias that can be diagnosed prenatally with ultrasound.

  18. [Thoracic computer tomography in malignant Hodgkin lymphoma].

    Science.gov (United States)

    Vock, P; Haertel, M; Fuchs, W A

    1981-06-01

    A retrospective study of 65 histologically proven lymphoma patients evaluated the staging capabilities of CT in Hodgkin's disease. Nodal and extranodal tumor manifestations were detected in the mediastinum (89%), thoracic bones (23%), pleura (26%), periphery of the lung, and in 14% as an infiltrating thoracic well lesion. Advantages and disadvantages of the method are discussed.

  19. Thoracic radiographic anatomy in sheep | Makungu | Tanzania ...

    African Journals Online (AJOL)

    The right pulmonary cupula pleura was more radiolucent, wide and extended further cranially than the left pulmonary cupula pleura. Knowledge of the normal thoracic radiographic anatomy of individual species is important for accurate interpretation of thoracic radiographs. Keywords: sheep, thorax, radiography, anatomy ...

  20. Bilateral locked facets in the thoracic spine

    NARCIS (Netherlands)

    M.H.A. Willems; Braakman, R. (Reinder); B. van Linge (Bert)

    1984-01-01

    textabstractTwo cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine.

  1. Thoracic Ectopia Cordis in an Ethiopian Neonate

    African Journals Online (AJOL)

    GB

    2017-03-01

    Mar 1, 2017 ... BACKGROUND: Ectopia Cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect with failure of fusion of the sternum with extra thoracic location of the heart. The estimated prevalence of this case is 5.5 to 7.9 per million live births.

  2. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; Zwan, J.M.V.D.; Izarzugaza, I.; Jaal, J.; Treasure, T.; Foschi, R.; Ricardi, U.; Groen, H.; Tavilla, A.; Ardanaz, E.

    2012-01-01

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  3. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; van der Zwan, Jan Maarten; Izarzugaza, Isabel; Jaal, Jana; Treasure, Tom; Foschi, Roberto; Ricardi, Umberto; Groen, Harry; Tavilla, Andrea; Ardanaz, Eva

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  4. Thoracic duct lymphography by subcutaneous contrast agent ...

    African Journals Online (AJOL)

    A 4-year-old male Japanese Shiba Inu presented with recurrent chylothorax. The thoracic duct was successfully imaged using computed tomography after the injection of an iodine contrast agent into the subcutaneous tissue surrounding the anus. The thoracic duct was successfully ligated and pericardectomy performed via ...

  5. Twitter and Canadian Educators

    Science.gov (United States)

    Cooke, Max

    2012-01-01

    An emerging group of leaders in Canadian education has attracted thousands of followers. They've made Twitter an extension of their lives, delivering twenty or more tweets a day that can include, for example, links to media articles, research, new ideas from education bloggers, or to their own, or simply a personal thought. At their best,…

  6. Partial distal deployment for precise placement of the GORE Thoracic Endoprosthesis.

    Science.gov (United States)

    Stanley, Gregory A

    2017-08-01

    The GORE TAG Thoracic Endoprosthesis (TAG) device (W. L. Gore & Associates, Flagstaff, Ariz) and the GORE Conformable TAG Thoracic Endoprosthesis (CTAG) are commonly implanted and effective stent grafts for use during thoracic endovascular aortic repair. Precise placement of the endograft is paramount during thoracic endovascular aortic repair, but like all thoracic stent grafts, maldeployment with inaccurate landing has been reported. The partial distal deployment technique describes an alteration of the TAG and CTAG deployment mechanism to allow isolated deployment of the distal half of the graft, which provides stability during deployment. The graft can be safely repositioned after partial distal deployment, thus allowing precise positioning in the proximal landing zone. Similarly, this technique can be used for precision in the distal landing zone, making the TAG and CTAG devices the only thoracic endografts currently available in the United States with a distal-first deployment option. A discussion of the usefulness of this technique and potential pitfalls is included. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  7. Pan-Canadian REspiratory STandards INitiative for Electronic Health Records (PRESTINE): 2011 national forum proceedings.

    Science.gov (United States)

    Lougheed, M Diane; Minard, Janice; Dworkin, Shari; Juurlink, Mary-Ann; Temple, Walley J; To, Teresa; Koehn, Marc; Van Dam, Anne; Boulet, Louis-Philippe

    2012-01-01

    In a novel knowledge translation initiative, the Government of Ontario's Asthma Plan of Action funded the development of an Asthma Care Map to enable adherence with the Canadian Asthma Consensus Guidelines developed under the auspices of the Canadian Thoracic Society (CTS). Following its successful evaluation within the Primary Care Asthma Pilot Project, respiratory clinicians from the Asthma Research Unit, Queen's University (Kingston, Ontario) are leading an initiative to incorporate standardized Asthma Care Map data elements into electronic health records in primary care in Ontario. Acknowledging that the issue of data standards affects all respiratory conditions, and all provinces and territories, the Government of Ontario approached the CTS Respiratory Guidelines Committee. At its meeting in September 2010, the CTS Respiratory Guidelines Committee agreed that developing and standardizing respiratory data elements for electronic health records are strategically important. In follow-up to that commitment, representatives from the CTS, the Lung Association, the Government of Ontario, the National Lung Health Framework and Canada Health Infoway came together to form a planning committee. The planning committee proposed a phased approach to inform stakeholders about the issue, and engage them in the development, implementation and evaluation of a standardized dataset. An environmental scan was completed in July 2011, which identified data definitions and standards currently available for clinical variables that are likely to be included in electronic medical records in primary care for diagnosis, management and patient education related to asthma and COPD. The scan, sponsored by the Government of Ontario, includes compliance with clinical nomenclatures such as SNOMED-CT® and LOINC®. To help launch and create momentum for this initiative, a national forum was convened on October 2 and 3, 2011, in Toronto, Ontario. The forum was designed to bring together key

  8. Pan-Canadian Respiratory Standards Initiative for Electronic Health Records (PRESTINE: 2011 National Forum Proceedings

    Directory of Open Access Journals (Sweden)

    M Diane Lougheed

    2012-01-01

    Full Text Available In a novel knowledge translation initiative, the Government of Ontario’s Asthma Plan of Action funded the development of an Asthma Care Map to enable adherence with the Canadian Asthma Consensus Guidelines developed under the auspices of the Canadian Thoracic Society (CTS. Following its successful evaluation within the Primary Care Asthma Pilot Project, respiratory clinicians from the Asthma Research Unit, Queen’s University (Kingston, Ontario are leading an initiative to incorporate standardized Asthma Care Map data elements into electronic health records in primary care in Ontario. Acknowledging that the issue of data standards affects all respiratory conditions, and all provinces and territories, the Government of Ontario approached the CTS Respiratory Guidelines Committee. At its meeting in September 2010, the CTS Respiratory Guidelines Committee agreed that developing and standardizing respiratory data elements for electronic health records are strategically important. In follow-up to that commitment, representatives from the CTS, the Lung Association, the Government of Ontario, the National Lung Health Framework and Canada Health Infoway came together to form a planning committee. The planning committee proposed a phased approach to inform stakeholders about the issue, and engage them in the development, implementation and evaluation of a standardized dataset. An environmental scan was completed in July 2011, which identified data definitions and standards currently available for clinical variables that are likely to be included in electronic medical records in primary care for diagnosis, management and patient education related to asthma and COPD. The scan, sponsored by the Government of Ontario, includes compliance with clinical nomenclatures such as SNOMED-CT® and LOINC®. To help launch and create momentum for this initiative, a national forum was convened on October 2 and 3, 2011, in Toronto, Ontario. The forum was designed to

  9. Radiologic findings of thoracic trauma

    Directory of Open Access Journals (Sweden)

    Akgul Ozmen C

    2017-08-01

    Full Text Available Cihan Akgul Ozmen,1 Serdar Onat,2 Delal Aycicek3 1Department of Radiology, 2Department of Chest Surgery, Dicle University School of Medicine, Diyarbakir, 3Radiology Unit, Siirt State Hospital, Siirt, Turkey Introduction: Chest trauma may be blunt or penetrating and the chest is the third most common trauma region. It is a significant cause of mortality. Multidetector computed tomography (MDCT has been an increasingly used method to evaluate chest trauma because of its high success in detecting tissue and organ injuries. Herein, we aimed to present MDCT findings in patients with blunt and penetrating chest trauma admitted to our department. Methods: A total of 240 patients admitted to the emergency department of our hospital between April 2012 and July 2013 with a diagnosis of chest trauma who underwent MDCT evaluations were included. Most of the patients were male (83.3% and victims of a blunt chest trauma. The images were analyzed with respect to the presence of fractures of bony structures, hemothorax, pneumothorax, mediastinal organ injury, and pulmonary and vascular injuries. Results: MDCT images of the 240 patients yielded a prevalence of 41.7% rib fractures, 11.2% scapular fractures, and 7.5% clavicle fractures. The prevalence of thoracic vertebral fracture was 13.8% and that of sternal fracture was 3.8%. The prevalence of hemothorax, pneumothorax, pneumomediastinum, and subcutaneous emphysema was 34.6%, 62.1%, 9.6%, and 35.4%, respectively. The prevalence of rib, clavicle, and thoracic vertebral fractures and pulmonary contusion was higher in the blunt trauma group, whereas the prevalence of hemothorax, subcutaneous emphysema, diaphragmatic injury, and other vascular lacerations was significantly higher in the penetrating trauma group than in the blunt trauma group (p<0.05. Conclusion: MDCT images may yield a high prevalence of fracture of bony structures, soft tissue lacerations, and vascular lesions, which should be well understood by

  10. Pulmonary function tests correlated with thoracic volumes in adolescent idiopathic scoliosis.

    Science.gov (United States)

    Ledonio, Charles Gerald T; Rosenstein, Benjamin E; Johnston, Charles E; Regelmann, Warren E; Nuckley, David J; Polly, David W

    2017-01-01

    Scoliosis deformity has been linked with deleterious changes in the thoracic cavity that affect pulmonary function. The causal relationship between spinal deformity and pulmonary function has yet to be fully defined. It has been hypothesized that deformity correction improves pulmonary function by restoring both respiratory muscle efficiency and increasing the space available to the lungs. This research aims to correlate pulmonary function and thoracic volume before and after scoliosis correction. Retrospective correlational analysis between thoracic volume modeling from plain x-rays and pulmonary function tests was conducted. Adolescent idiopathic scoliosis patients enrolled in a multicenter database were sorted by pre-operative Total Lung Capacities (TLC) % predicted values from their Pulmonary Function Tests (PFT). Ten patients with the best and ten patients with the worst TLC values were included. Modeled thoracic volume and TLC values were compared before and 2 years after surgery. Scoliosis correction resulted in an increase in the thoracic volume for patients with the worst initial TLCs (11.7%) and those with the best initial TLCs (12.5%). The adolescents with the most severe pulmonary restriction prior to surgery strongly correlated with post-operative change in total lung capacity and thoracic volume (r2  = 0.839; p Scoliosis correction in adolescents was found to increase thoracic volume and is strongly correlated with improved TLC in cases with severe restrictive pulmonary function, but no correlation was found in cases with normal pulmonary function. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:175-182, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  11. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle

    2017-01-01

    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...... shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45...

  12. Macrolides: A Canadian Infectious Disease Society Position Paper

    Directory of Open Access Journals (Sweden)

    S McKenna

    2001-01-01

    Full Text Available Since the introduction of erythromycin in 1965, no new compounds from the macrolide antimicrobial class were licensed in Canada until the 1990s. Clarithromycin and azithromycin, since their introduction, have become important agents for treating a number of common and uncommon infectious diseases. They have become prime agents in the treatment of respiratory tract infections, and have revolutionized the management of both genital chlamydial infections, by the use of single-dose therapy with azithromycin, and nontuberculous mycobacterial infections, by the use of clarithromycin. The improvement of clarithromycin and azithromycin over the gastrointestinal intolerability of erythromycin has led to supplanting the use of the latter for many primary care physicians. Unfortunately, the use of these agents has also increased the likelihood for misuse and has raised concerns about a resultant increase in the rates of macrolide resistance in many important pathogens, such as Streptococcus pneumoniae. This paper reviews the pharmacology and evidence for the current indications for use of these newer agents, and provides recommendations for appropriate use.

  13. Enhancing Canadian Civil Society Research and Knowledge-Based ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The increasingly complex interplay between peace and security, environmental sustainability, and social and economic development is changing the world of ... Engaging in the development agenda CCIC works globally to achieve sustainable human development, end global poverty, and promote social justice and human ...

  14. OFF COURSE: Restoring Balance between Canadian Society and ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This crucial concept of "sustainability" brings us directly to the thesis and overriding thrust of the Brundtland Report, Our Common Future, by the world Commission on ...... The triad of deficits, debts, and inflation continues to bedevil the global economy, which functions solely in terms of the expansionist world view. This triad ...

  15. Off Course: Restoring Balance between Canadian Society and the ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    1994-01-01

    Jan 1, 1994 ... The concept of sustainable development was set out in the Brundtland Report in 1987 and since has become part of the environmental and political vocabulary of the South and the North. Author Duncan M. Taylor argues, however, that the term sustainable development is often misused. He uses the crisis ...

  16. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp; Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp; Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp; Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp; Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp; Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp [Kansai Medical University, Department of Radiology (Japan)

    2017-01-15

    PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

  17. Network Society

    DEFF Research Database (Denmark)

    Clausen, Lars; Tække, Jesper

    2018-01-01

    the five strands of theory on the network society. Each theoretical position has its specific implications for acting toward strategic goals. In its entirety, the five perspectives give a thorough understanding of the conditions for successful strategic communication in the 21st century....

  18. Network Society

    DEFF Research Database (Denmark)

    Clausen, Lars; Tække, Jesper

    2017-01-01

    the five strands of theory on the network society. Each theoretical position has its specific implications for acting toward strategic goals. In its entirety, the five perspectives give a thorough understanding of the conditions for successful strategic communication in the 21st century....

  19. Canadian Mathematical Congress

    CERN Document Server

    1977-01-01

    For two weeks in August, 1975 more than 140 mathematicians and other scientists gathered at the Universite de Sherbrooke. The occasion was the 15th Biennial Seminar of the Canadian Mathematical Congress, entitled Mathematics and the Life Sciences. Participants in this inter­ disciplinary gathering included researchers and graduate students in mathematics, seven different areas of biological science, physics, chemistry and medical science. Geographically, those present came from the United States and the United Kingdom as well as from academic departments and government agencies scattered across Canada. In choosing this particular interdisciplinary topic the programme committee had two chief objectives. These were to promote Canadian research in mathematical problems of the life sciences, and to encourage co-operation and exchanges between mathematical scientists" biologists and medical re­ searchers. To accomplish these objective the committee assembled a stim­ ulating programme of lectures and talks. Six ...

  20. Emergency Anaesthetic Management of Extensive Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    H C Chandola

    2007-01-01

    Full Text Available High speed vehicles, drug abuse, alcohol and easy availability of handguns are the main reasons of increasing number of trauma especially thoracic trauma. Anaesthesiologist plays an important role in the management of extensive thoracic trauma. Thoracic trauma, penetrating or blunt, may cause damage to organs suspended in thorax viz. pleura, lungs, heart, great vessels, trachea and oesophagus. It may lead to pneumothorax, cardiac tamponade or life threatening haemorrhage. With aggressive care and management of these factors, majority of patients can survive and return to normal life.

  1. Tuberculosis in Aboriginal Canadians

    Directory of Open Access Journals (Sweden)

    Vernon H Hoeppner

    2000-01-01

    Full Text Available Endemic tuberculosis (TB was almost certainly present in Canadian aboriginal people (aboriginal Canadians denotes status Indians, Inuit, nonstatus Indians and metis as reported by Statistics Canada before the Old World traders arrived. However, the social changes that resulted from contact with these traders created the conditions that converted endemic TB into epidemic TB. The incidence of TB varied inversely with the time interval from this cultural collision, which began on the east coast in the 16th century and ended in the Northern Territories in the 20th century. This relatively recent epidemic explains why the disease is more frequent in aboriginal children than in Canadian-born nonaboriginal people. Treatment plans must account for the socioeconomic conditions and cultural characteristics of the aboriginal people, especially healing models and language. Prevention includes bacillus Calmette-Guerin vaccination and chemoprophylaxis, and must account for community conditions, such as rates of suicide, which have exceeded the rate of TB. The control of TB requires a centralized program with specifically directed funding. It must include a program that works in partnership with aboriginal communities.

  2. Canadian identity: Implications for international social work by Canadians

    DEFF Research Database (Denmark)

    Hiranandani, Vanmala Sunder

    2011-01-01

    This paper is in response to recent calls to conceptualize and articulate Canadian perspectives and experiences in international social work, given that the Canadian standpoint has been lacking in international social work literature. This paper contends that it is imperative, first of all......, to critically examine and unpack our ‘Canadian’ identity in order to practice international work that is socially just and anti-imperialist. Drawing on the work of post-colonial authors, critical race theorists, and those who study national myth-making, this essay revisits Canadian identity because...... it is this identity that Canadian social workers often carry into their international work....

  3. Smoke & Mirrors: The Canadian Tobacco War | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... before parliamentary committees, given hundreds of media interviews in Canada and the United States, published numerous tobacco-related articles, and initiated private prosecutions for violations of tobacco control laws. Cunningham now works in Ottawa as a senior policy analyst for the Canadian Cancer Society.

  4. Self-Perceived Eating Habits and Food Skills of Canadians.

    Science.gov (United States)

    Slater, Joyce J; Mudryj, Adriana N

    2016-01-01

    This study identified and described Canadians' self-perceived eating habits and food skills through the use of population-based data. Data from the Canadian Community Health Survey 2013 Rapid Response on Food Skills was used to examine the eating quality and patterns of Canadians. Data were collected from all provinces in January and February 2013. Respondent variables (sex, age, Aboriginal/immigrant status) were examined to assess differentiations between socio-demographic groupings (family structure, marital status, education, and income). Logistic regression was used to determine whether demographic variables increased the likelihood of certain responses. Forty-six percent of Canadians believe they have excellent/very good eating habits, with 51% categorizing their habits as good or fair. Similarly, the majority report having good food skills. Sex and age were significantly associated with food skills, with women rating their cooking skill proficiency higher than men (72% vs 55%), and older Canadians reporting higher food skill knowledge than their younger counterparts. Results indicate that while portions of the Canadian population have adequate food skills, others are lacking, which may negatively impact their diet. Findings from this study have implications for education and health promotion programs focusing on foods skills, particularly among vulnerable target groups. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  5. Catamenial pneumothorax caused by thoracic endometriosis

    Directory of Open Access Journals (Sweden)

    Paolo Maniglio, MD

    2018-02-01

    Conclusion: The diagnosis of thoracic endometriosis is challenging. The first line of treatment is medical, whereas the surgical treatment is performed secondly. Moreover, surgical treatment can lead to a significant rate of recurrence, often reduced by a coadjutant medical treatment.

  6. Thoracic duct injury from blunt trauma.

    Science.gov (United States)

    Pai, G P; Bhatti, N A; Ellison, R G; Rubin, J W; Moore, H V

    1984-05-01

    We have reported a case of traumatic chylothorax occurring as a rare complication of fracture dislocation of the dorsal spine. When conservative management by drainage, low-fat diet, and parenteral alimentation proved unsuccessful, thoracic duct ligation effected a cure.

  7. THORACIC KYPHOSIS TREATED WITH GLOBAL POSTURAL REEDUCATION

    OpenAIRE

    Pita, Marisa de Castro

    2008-01-01

    This article describes the case of a patient subjected to physical therapy who had thoracic kyphosis of 55 degrees, chronic lumbar pain, and other postural deviations. The physical therapeutic treatment used was the technique of Global Posture Reeducation (RPG), aiming at morphological corrections and pain relief. The results obtained demonstrated improvement concerning the postural aspect, decrease of 16 degrees in the thoracic kyphosis and remission of the pain.

  8. A History of Thoracic Aortic Surgery.

    Science.gov (United States)

    McFadden, Paul Michael; Wiggins, Luke M; Boys, Joshua A

    2017-08-01

    Ancient historical texts describe the presence of aortic pathology conditions, although the surgical treatment of thoracic aortic disease remained insurmountable until the 19th century. Surgical treatment of thoracic aortic disease then progressed along with advances in surgical technique, conduit production, cardiopulmonary bypass, and endovascular technology. Despite radical advances in aortic surgery, principles established by surgical pioneers of the 19th century hold firm to this day. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Thoracic splenosis mimicking a pleuropneumonia

    Science.gov (United States)

    Baldolli, Aurélie; Coeuret, Solène; Le Pennec, Vincent; Agostini, Denis; Verdon, Renaud

    2017-01-01

    Abstract Rationale: Splenosis is the development of one or more heterotopic splenic tissue autoimplants following rupture of the spleen and remains mostly asymptomatic. Patient concerns: We report a case of a 50-year old post-traumatic splenectomized man admitted for a left side community acquired pneumonia resistant to antibiotics. Diagnoses: The diagnosis of intrathoracic ectopic spleen was suspected because of the history of spleen trauma with diaphragm rupture and the absence of Howell-Jolly bodies. Interventions: Technetium (Tc)-99m colloid scintigraphy SPECT, fused with CT scan showed an intense radionuclide uptake on hyper vascularized masses without any additional pathologic uptake and confirmed the diagnosis of thoracic splenosis. Outcomes: Despite any lifelong penicillin prophylaxis, he had no history of infections eight years after the diagnosis. Lessons: Physician must be aware of this differential diagnosis and of its consequences. Depending on its size and location, it may lead to incorrect diagnosis (tumor, empyema, abscess ...), treatment and invasive procedures while the diagnosis of splenosis only relies upon imaging studies associated with functionnal study of the uptake of particles or cells. PMID:28723778

  10. Thoracic trauma: analysis of 100 consecutive cases

    Directory of Open Access Journals (Sweden)

    Maíra Benito Scapolan

    2010-09-01

    Full Text Available Objective: To analyze thoracic trauma assisted by the EmergencyService of Hospital da Irmandade da Santa Casa de Misericórdia deSão Paulo. Methods: One hundred patients with thoracic trauma wereassisted throughout six months in 2006. Data from their records werecollected and a protocol of thoracic trauma was fulfilled. The RevisedTrauma Score was used to evaluate gravity of injury and to calculatethe survival index. Results: Prevalence of trauma injury in male from20 to 29 years old was observed. Out of all patients, 44 had blunttrauma and 56 penetrating trauma (78.6% presented stab woundsand 21.4% gun shots. Up to the settings of injuries, 23% were in thethoracoabdominal transition, 7% in the precordium and 70% in theremainder thoracic area. In those with the thoracoabdominal transitioninjury, 22.7% were hemodynamically unstable and 77.3% stable.Thoracoabdominal injury patients presented 40.9% of diaphragmwound and all were stable. Of those with precordium wound, 37.5%presented cardiac injury. In cardiac onset, 66.7% presented stableand 33.3% unstable. Thoracic drainage was the most accomplishedsurgical procedure (71%. Conclusions: The thoracic trauma patientis most prevalently young male with stab wound penetrating injury,without associated injuries, hemodynamically stable, presentinghemothorax, with high probability of survival.

  11. MRI of thoracic outlet syndrome in children

    Energy Technology Data Exchange (ETDEWEB)

    Chavhan, Govind B.; Batmanabane, Vaishnavi [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); Muthusami, Prakash [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); The Hospital for Sick Children, Division of Image Guided Therapy, Department of Diagnostic Imaging, Toronto, ON (Canada); Towbin, Alexander J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology and Medical Imaging, Cincinnati, OH (United States); Borschel, Gregory H. [The Hospital for Sick Children and University of Toronto, Division of Plastic Surgery, Department of Pediatric Surgery, Toronto, ON (Canada)

    2017-09-15

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation. (orig.)

  12. Cryptozoology Society

    Science.gov (United States)

    Richman, Barbara T.

    Reports of Loch Ness monsters, Bigfoot, and the Yeti spring u p from time to time, sparking scientific controversy about the veracity of these observations. Now an organization has been established to help cull, analyze, and disseminate information on the alleged creatures. The International Society of Cryptozoology, formed at a January meeting at the U.S. National Museum of Natural History of the Smithsonian Institution, will serve as the focal point for the investigation, analysis, publication, and discussion of animals of unexpected form or size or of unexpected occurrences in time or space.

  13. Photogrammetry: an accurate and reliable tool to detect thoracic musculoskeletal abnormalities in preterm infants.

    Science.gov (United States)

    Davidson, Josy; dos Santos, Amelia Miyashiro N; Garcia, Kessey Maria B; Yi, Liu C; João, Priscila C; Miyoshi, Milton H; Goulart, Ana Lucia

    2012-09-01

    To analyse the accuracy and reproducibility of photogrammetry in detecting thoracic abnormalities in infants born prematurely. Cross-sectional study. The Premature Clinic at the Federal University of São Paolo. Fifty-eight infants born prematurely in their first year of life. Measurement of the manubrium/acromion/trapezius angle (degrees) and the deepest thoracic retraction (cm). Digitised photographs were analysed by two blinded physiotherapists using a computer program (SAPO; http://SAPO.incubadora.fapesp.br) to detect shoulder elevation and thoracic retraction. Physical examinations performed independently by two physiotherapists were used to assess the accuracy of the new tool. Thoracic alterations were detected in 39 (67%) and in 40 (69%) infants by Physiotherapists 1 and 2, respectively (kappa coefficient=0.80). Using a receiver operating characteristic curve, measurement of the manubrium/acromion/trapezius angle and the deepest thoracic retraction indicated accuracy of 0.79 and 0.91, respectively. For measurement of the manubrium/acromion/trapezius angle, the Bland and Altman limits of agreement were -6.22 to 7.22° [mean difference (d)=0.5] for repeated measures by one physiotherapist, and -5.29 to 5.79° (d=0.75) between two physiotherapists. For thoracic retraction, the intra-rater limits of agreement were -0.14 to 0.18cm (d=0.02) and the inter-rater limits of agreement were -0.20 to -0.17cm (d=0.02). SAPO provided an accurate and reliable tool for the detection of thoracic abnormalities in preterm infants. Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  14. The increasing role of radiologists in thoracic diagnosis: more thoracic biopsies are performed percutaneously.

    Science.gov (United States)

    Sharpe, Richard E; Levin, David C; Parker, Laurence; Rao, Vijay M

    2013-10-01

    The rate of thoracic biopsies overall and by type of biopsy from 1998 to 2010 is not known. The aim of this study was to examine the utilization rate of various types of thoracic biopsies within the Medicare population. Source data was obtained from the CMS Physician/Supplier Procedure Summary Master Files from 1998 to 2010. Allowed primary claims submitted for percutaneous thoracic biopsy, bronchoscopic thoracic biopsy, and surgical thoracic biopsy were extracted. Annual volume and utilization rates were calculated and analyzed by biopsy type and provider type. Total thoracic biopsy volume in 1998 was 176,125 and in 2010 was 167,911 (-4.7%). The utilization rate for all thoracic biopsies decreased from 5.47 per 1,000 in 1998 to 4.76 per 1,000 (-13.0%) in 2010. The percutaneous biopsy utilization rate increased 3.6% from 1998 to 2010, while the rate for surgical biopsy decreased by 20.9% and the rate of bronchoscopic biopsy decreased by 19.6% during the same time period. In 2010, radiologists performed 96.4% (58,679) of all percutaneous biopsies. Radiologists' thoracic biopsy market share increased from 26.2% (46,084 of 176,125) in 1998 to 35.0% (58,700 of 167,911) in 2010 (+33.6%). The overall rate of thoracic biopsy decreased from 1998 to 2010, with fewer biopsies being performed surgically and bronchoscopically and more biopsies being performed percutaneously. Radiologists are responsible for an increasing role in thoracic diagnosis, as they have increased market share of thoracic biopsies. These findings may be the result of changing trends toward less invasive procedures, changing patterns of reimbursement, and increased availability of percutaneous biopsy. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  15. Iron sufficiency of Canadians.

    Science.gov (United States)

    Cooper, Marcia; Greene-Finestone, Linda; Lowell, Hélène; Levesque, Johanne; Robinson, Stacey

    2012-12-01

    Iron deficiency is the most common nutritional deficiency in the world, but little is known about the iron status of people in Canada, where the last estimates are from 1970-1972. The data are from cycle 2 (2009 to 2011) of the Canadian Health Measures Survey, which collected blood samples from a nationally representative sample of Canadians aged 3 to 79. Descriptive statistics (percentages, arithmetic means, geometric means) were used to estimate hemoglobin and serum ferritin concentrations, and other markers of iron status. Analyses were performed by age/sex group, household income, self-perceived health, diet, and use of iron supplements. World Health Organization reference values (2001) were used to estimate the prevalence of iron sufficiency and anemia. The overall prevalence of anemia was low in the 2009-to-2011 period--97% of Canadians had sufficient hemoglobin levels. Generally, hemoglobin concentration increased compared with 1970-1972; however, at ages 65 to 79, rates of anemia were higher than in 1970-1972. Depleted iron stores were found in 13% of females aged 12 to 19 and 9% of females aged 20 to 49. Lower household income was associated with a lower prevalence of hemoglobin sufficiency, but was not related to lower serum ferritin sufficiency. Self-perceived health and diet were not significantly associated with hemoglobin and serum ferritin levels. The lack of a relationship between iron status and diet may be attributable to the use of questions about food consumption frequency that were not specifically designed to estimate dietary iron intake. Factors other than iron intake might have contributed to the increase in the prevalence of anemia among seniors.

  16. Canadian space robotic activities

    Science.gov (United States)

    Sallaberger, Christian; Space Plan Task Force, Canadian Space Agency

    The Canadian Space Agency has chosen space robotics as one of its key niche areas, and is currently preparing to deliver the first flight elements for the main robotic system of the international space station. The Mobile Servicing System (MSS) is the Canadian contribution to the international space station. It consists of three main elements. The Space Station Remote Manipulator System (SSRMS) is a 7-metre, 7-dof, robotic arm. The Special Purpose Dextrous Manipulator (SPDM), a smaller 2-metre, 7-dof, robotic arm can be used independently, or attached to the end of the SSRMS. The Mobile Base System (MBS) will be used as a support platform and will also provide power and data links for both the SSRMS and the SPDM. A Space Vision System (SVS) has been tested on Shuttle flights, and is being further developed to enhance the autonomous capabilities of the MSS. The CSA also has a Strategic Technologies in Automation and Robotics Program which is developing new technologies to fulfill future robotic space mission needs. This program is currently developing in industry technological capabilities in the areas of automation of operations, autonomous robotics, vision systems, trajectory planning and object avoidance, tactile and proximity sensors, and ground control of space robots. Within the CSA, a robotic testbed and several research programs are also advancing technologies such as haptic devices, control via head-mounted displays, predictive and preview displays, and the dynamic characterization of robotic arms. Canada is also now developing its next Long Term Space Plan. In this context, a planetary exploration program is being considered, which would utilize Canadian space robotic technologies in this new arena.

  17. Endovascular treatment of thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2013-01-01

    Full Text Available Bacground/Aim. Endovascular treatment of thoracic aortic diseases is an adequate alternative to open surgery. This method was firstly performed in Serbia in 2004, while routine usage started in 2007. Aim of this study was to analyse initial experience in endovacular treatment of thoracic aortic diseses of three main vascular hospitals in Belgrade - Clinic for Vascular and Endovascular Surgery of the Clinical Center of Serbia, Clinic for Vascular Surgery of the Military Medical Academy, and Clinic for Vascular Surgery of the Institute for Cardiovascular Diseases “Dedinje”. Methods. Between March 2004. and November 2010. 41 patients were treated in these three hospitals due to different diseases of the thoracic aorta. A total of 21 patients had degenerative atherosclerotic aneurysm, 6 patients had penetrating aortic ulcer, 6 had posttraumatic aneurysm, 4 patients had ruptured thoracic aortic aneurysm, 1 had false anastomotic aneurysm after open repair, and 3 patients had dissected thoracic aneurysm of the thoracoabdominal aorta. In 15 cases the endovascular procedure was performed as a part of the hybrid procedure, after carotidsubclavian bypass in 4 patients and subclavian artery transposition in 1 patient due to the short aneurysmatic neck; in 2 patients iliac conduit was used due to hypoplastic or stenotic iliac artery; in 5 patients previous reconstruction of abdominal aorta was performed; in 1 patient complete debranching of the aortic arch, and in 2 patients visceral abdominal debranching were performed. Results. The intrahospital mortality rate (30 days was 7.26% (3 patients with ruptured thoracic aneurysms died. Endoleak type II in the first control exam was revealed in 3 patients (7. 26%. The patients were followed up in a period of 1-72 months, on average 29 months. The most devastating complication during a followup period was aortoesofageal fistula in 1 patient a year after the treatment of posttraumatic aneurysm. Conversion was

  18. Assessing Canadian Bank Branch Operating Efficiency Using Data Envelopment Analysis

    Science.gov (United States)

    Yang, Zijiang

    2009-10-01

    In today's economy and society, performance analyses in the services industries attract more and more attention. This paper presents an evaluation of 240 branches of one big Canadian bank in Greater Toronto Area using Data Envelopment Analysis (DEA). Special emphasis was placed on how to present the DEA results to management so as to provide more guidance to them on what to manage and how to accomplish the changes. Finally the potential management uses of the DEA results were presented. All the findings are discussed in the context of the Canadian banking market.

  19. Unique Factors Affecting Canadian Education.

    Science.gov (United States)

    Farquhar, Robin H.

    In a background statement identifying what is unique about Canada and the issues it currently faces, this paper begins by discussing the concurrent movements toward Canadian nationalism and Quebec nationalism as an illustration of the problems caused by large size and great diversity. It then focuses on unique aspects of Canadian education,…

  20. Thoracic fraction of inhaled fiber aerosol.

    Science.gov (United States)

    Cheng, Yung Sung; Su, Wei-Chung

    2013-01-01

    Size-selective sampling is a health-related method to collect airborne particles based on penetration of inhaled particles into different regions of the human respiratory tract; thus, it is the most relevant sampling method to correlate health risks with occupational exposure. The current practice of sampling asbestos and other fibers is not a size-selective method. The thoracic size fraction, defined as the portion of inhaled particles that can penetrate through the larynx, has been suggested as the most relevant size-selective sampling method for fiber aerosol. The thoracic fraction is based on 1-deposition of inhaled spherical particles in the human extrathoracic airways for mouth breathing and corrected for the particle inhalability. There is no comparable information for fiber aerosols; therefore, there is no technical basis to ascertain whether the current thoracic fraction definition is suitable for fiber aerosols. No human data are available from controlled experiments of inhaled fiber aerosols for the obvious reason that most fiber materials are potentially hazardous when inhaled. Our approach was to measure penetration of fiber aerosol in realistic human oropharyngeal airway replicas and to compare that with data from spherical particles. We showed that realistic human oral airway replicas (including the oral cavity, pharynx, and larynx regions) provided useful spherical and fiber particle deposition in the human head airway. These data could be used to test the thoracic fraction curves. The spherical penetration is in agreement with human in vivo data used to establish the thoracic fraction curve. Fiber penetrations through the larynx of two human oral airway replicas were higher than those for spherical particles for the same aerodynamic diameter using the same replicas. The thoracic curve as defined for spherical particles, therefore, may not include some fibers that could penetrate to the thoracic region.

  1. Thoracic wall reconstruction after tumor resection

    Directory of Open Access Journals (Sweden)

    Kamran eHarati

    2015-10-01

    Full Text Available Introduction: Surgical treatment of malignant thoracic wall tumors represents a formidable challenge. In particular, locally advanced tumors that have already infiltrated critical anatomic structures are associated with a high surgical morbidity and can result in full thickness defects of the thoracic wall. Plastic surgery can reduce this surgical morbidity by reconstructing the thoracic wall through various tissue transfer techniques. Sufficient soft tissue reconstruction of the thoracic wall improves life quality and mitigates functional impairment after extensive resection. The aim of this article is to illustrate the various plastic surgery treatment options in the multimodal therapy of patients with malignant thoracic wall tumors.Material und methods: This article is based on a review of the current literature and the evaluation of a patient database.Results: Several plastic surgical treatment options can be implemented in the curative and palliative therapy of patients with malignant solid tumors of the chest wall. Large soft tissue defects after tumor resection can be covered by local, pedicled or free flaps. In cases of large full-thickness defects, flaps can be combined with polypropylene mesh to improve chest wall stability and to maintain pulmonary function. The success of modern medicine has resulted in an increasing number of patients with prolonged survival suffering from locally advanced tumors that can be painful, malodorous or prone to bleeding. Resection of these tumors followed by thoracic wall reconstruction with viable tissue can substantially enhance the life quality of these patients. Discussion: In curative treatment regimens, chest wall reconstruction enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. In palliative disease treatment, stadium plastic surgical techniques of thoracic wall reconstruction provide palliation of tumor-associated morbidity and can therefore improve

  2. Thoracic CT in the ED: a study of thoracic computed tomography utilisation.

    LENUS (Irish Health Repository)

    Williams, E

    2010-02-01

    The aim of this retrospective study was to investigate the use of thoracic Computed Tomography (CT) in the Emergency Department of a Dublin Academic Teaching Hospital over a six month period. Data was retrieved using the hospital\\'s computerised information system. There were 202 referrals in total for thoracic CT from the Emergency Department during this time period. The most common indication for thoracic CT referral was for the investigation of pulmonary embolism with 127 (63%) referrals. There were 40 (25%) referrals for suspected malignancy and lung disease, whilst 8 (4%) of the referrals were for investigation of thoracic aortic dissection, 8 (4%) for infection, and 6 (3%) were for investigation of thoracic injury. Only 8 (4%) of all referrals were for investigation of injury as a result of chest trauma.

  3. Reversing thoracic hyperkyphosis: a case report featuring mirror image® thoracic extension rehabilitation

    Science.gov (United States)

    Miller, Jason E.; Oakley, Paul A.; Levin, Scott B.; Harrison, Deed E.

    2017-01-01

    [Purpose] To present a case of non-surgical reduction of thoracic hyperkyphosis utilizing a multimodal rehabilitation program emphasizing the mirror image® concept. [Subject and Methods] A 15-year-old female presented to a rehabilitation office suffering from back and neck pains and headaches. The patient was treated sporadically over a period of 13-months. Treatment consisted of anterior thoracic translation and thoracic extension exercises, spinal traction and spinal manipulation. [Results] After 13-months of treatment the patient displayed a significant reduction in hyperkyphosis and a dramatic correction of her overall posture and spine alignment corresponding to the reduction in back/neck pains, headaches and the simultaneous improvement of various other health issues. [Conclusion] Thoracic hyperkyphosis can be reduced through a multimodal rehabilitation program emphasizing mirror image thoracic extension procedures. PMID:28744061

  4. Reversing thoracic hyperkyphosis: a case report featuring mirror image(®) thoracic extension rehabilitation.

    Science.gov (United States)

    Miller, Jason E; Oakley, Paul A; Levin, Scott B; Harrison, Deed E

    2017-07-01

    [Purpose] To present a case of non-surgical reduction of thoracic hyperkyphosis utilizing a multimodal rehabilitation program emphasizing the mirror image(®) concept. [Subject and Methods] A 15-year-old female presented to a rehabilitation office suffering from back and neck pains and headaches. The patient was treated sporadically over a period of 13-months. Treatment consisted of anterior thoracic translation and thoracic extension exercises, spinal traction and spinal manipulation. [Results] After 13-months of treatment the patient displayed a significant reduction in hyperkyphosis and a dramatic correction of her overall posture and spine alignment corresponding to the reduction in back/neck pains, headaches and the simultaneous improvement of various other health issues. [Conclusion] Thoracic hyperkyphosis can be reduced through a multimodal rehabilitation program emphasizing mirror image thoracic extension procedures.

  5. [Possibilities of videothoracoscopy for penetrating thoracic injuries].

    Science.gov (United States)

    Voskresenskij, O V; Radchenko, Yu A; Abakumov, M M

    2015-01-01

    It was analyzed the medical reports of 596 victims with thoracic injuries including 360 cases with following conventional therapeutic approach and 236 patients who underwent videothoracoscopy. We estimated condition severity in case of injuries of thoracic wall, lungs, pericardium and heart. Hemodynamic disorders were estimated according to Allgower-Burri shock index. Intrapleural bleeding was calculated using volume of hemothorax and time before injury and operation. Severity of physiological damages was determined using RTS criterion, anatomic--using ISS criterion. We estimated possibility for videothoracoscopy in patients with conventional therapeutic approach comparing severity of injuries, severity of condition in both groups and volume of surgery. Retrospective analysis revealed possibility of videothoracoscopy in 86.7% of victims with pulmonary injury, in 83.3% with bleeding at the muscular vessels of thoracic wall, in 40.3% with intercostal vessels injury, in 31.2% with heart injury, in 27.3% with damage of pericardium and in 18.8% with internal thoracic vessels injury. Our investigation revealed that videothoracoscopy may be used more widely in case of thoracic injury.

  6. [Knot in a thoracic epidural catheter].

    Science.gov (United States)

    Fischer, F; Helms, O; Hentz, J-G; Steib, A

    2011-02-01

    We report a case of impossible injection into a thoracic epidural catheter associated with a difficult withdrawal of this catheter after its introduction on the T3-T4 level. Thanks to a gentle and continuous traction, the catheter was finally successfully removed without being broken, but presented a simple knot at 13mm from its end. No neurological complication was observed later on. This complication happened during the introduction of the catheter at the thoracic level where anatomic conditions are less favorable for this kind of complication to happen than at the lumbar level. We have been probably confronted with a catheter taking an abnormal direction due to an anatomic structure. This case shows us that knots in an epidural catheter are also possible on the high thoracic level and that its ascent within the epidural space must happen without any resistance. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  7. Palpation of the upper thoracic spine

    DEFF Research Database (Denmark)

    Christensen, Henrik Wulff; Vach, Werner; Vach, Kirstin

    2002-01-01

    OBJECTIVE: To assess the intraobserver reliability (in terms of hour-to-hour and day-to-day reliability) and the interobserver reliability with 3 palpation procedures for the detection of spinal biomechanic dysfunction in the upper 8 segments of the thoracic spine. DESIGN: A repeated-measures des......OBJECTIVE: To assess the intraobserver reliability (in terms of hour-to-hour and day-to-day reliability) and the interobserver reliability with 3 palpation procedures for the detection of spinal biomechanic dysfunction in the upper 8 segments of the thoracic spine. DESIGN: A repeated...... procedure. RESULTS: Using an "expanded" definition of agreement that accepts small inaccuracies (+/-1 segment) in the numbering of spinal segments, we found--based on the pooled data from the thoracic spine--kappa values of 0.59 to 0.77 for the hour-to-hour and the day-to-day intraobserver reliability...

  8. Thoracic ultrasonography for the pulmonary specialist.

    Science.gov (United States)

    Koenig, Seth J; Narasimhan, Mangala; Mayo, Paul H

    2011-11-01

    Thoracic ultrasonography is a noninvasive and readily available imaging modality that has important applications in pulmonary medicine outside of the ICU. It allows the clinician to diagnose a variety of thoracic disorders at the point of care. Ultrasonography is useful in imaging lung consolidation, pleural-based masses and effusions, pneumothorax, and diaphragmatic dysfunction. It can identify complex or loculated effusions and be useful in planning treatment. Identifying intrathoracic mass lesions can guide sampling by aspiration and biopsy. This article summarizes thoracic ultrasonography applications for the pulmonary specialist, related procedural codes, and reimbursement. The major concepts are illustrated with cases. These case summaries are enhanced with online supplemental videos and chest radiograph, chest CT scan, and ultrasound correlation.

  9. Thoracal paravertebral block for breast surgery

    Directory of Open Access Journals (Sweden)

    Serbülent Gökhan Beyaz

    2012-12-01

    Full Text Available Thoracic paravertebral block (TPVB is an alternativemethod to general anesthesia because of provides a safeanesthesia with balanced hemodynamic response, allowspostoperative pain control by means of catheter and haslow side effect profile. TPVB performed safely for the patientsundergoing breast cancer surgery with the samereason, has used in too few center instead of general anesthesia.This technique provides an adequate anesthesiafor the patients undergoing breast surgery and in additionprovides stable hemodynamic status with unilateralsomatic and sympathetic blockade, near-perfect controlof postoperative pain, minimal nausea and vomiting rate,early discharge and low cost. For this reason, thoracicparavertebral block which is a standard method in breastsurgeries for some centers should be known by all anesthesiologists.We believe that, thoracic paravertebralblock is a method can be applied instead of general anesthesia.Key words: Paravertebral block, thoracic, breast surgery,regional anesthesia

  10. Blunt thoracic aortic injuries: an autopsy study.

    Science.gov (United States)

    Teixeira, Pedro G R; Inaba, Kenji; Barmparas, Galinos; Georgiou, Chrysanthos; Toms, Carla; Noguchi, Thomas T; Rogers, Christopher; Sathyavagiswaran, Lakshmanan; Demetriades, Demetrios

    2011-01-01

    The objective of this study was to identify the incidence and patterns of thoracic aortic injuries in a series of blunt traumatic deaths and describe their associated injuries. All autopsies performed by the Los Angeles County Department of Coroner for blunt traumatic deaths in 2005 were retrospectively reviewed. Patients who had a traumatic thoracic aortic (TTA) injury were compared with the victims who did not have this injury for differences in baseline characteristics and patterns of associated injuries. During the study period, 304 (35%) of 881 fatal victims of blunt trauma received by the Los Angeles County Department of Coroner underwent a full autopsy and were included in the analysis. The patients were on average aged 43 years±21 years, 71% were men, and 39% had a positive blood alcohol screen. Motor vehicle collision was the most common mechanism of injury (50%), followed by pedestrian struck by auto (37%). A TTA injury was identified in 102 (34%) of the victims. The most common site of TTA injury was the isthmus and descending thoracic aorta, occurring in 67 fatalities (66% of the patients with TTA injuries). Patients with TTA injuries were significantly more likely to have other associated injuries: cardiac injury (44% vs. 25%, p=0.001), hemothorax (86% vs. 56%, pinjury (74% vs. 49%, pinjury. Patients with a TTA injury were significantly more likely to die at the scene (80% vs. 63%, p=0.002). Thoracic aortic injuries occurred in fully one third of blunt traumatic fatalities, with the majority of deaths occurring at the scene. The risk for associated thoracic and intra-abdominal injuries is significantly increased in patients with thoracic aortic injuries.

  11. Failures and complications of thoracic drainage

    Directory of Open Access Journals (Sweden)

    Đorđević Ivana

    2006-01-01

    Full Text Available Background/Aim. Thoracic drainage is a surgical procedure for introducing a drain into the pleural space to drain its contents. Using this method, the pleura is discharged and set to the physiological state which enables the reexpansion of the lungs. The aim of the study was to prove that the use of modern principles and protocols of thoracic drainage significantly reduces the occurrence of failures and complications, rendering the treatment more efficient. Methods. The study included 967 patients treated by thoracic drainage within the period from January 1, 1989 to June 1, 2000. The studied patients were divided into 2 groups: group A of 463 patients treated in the period from January 1, 1989 to December 31, 1994 in whom 386 pleural drainage (83.36% were performed, and group B of 602 patients treated form January 1, 1995 to June 1, 2000 in whom 581 pleural drainage (96.51% were performed. The patients of the group A were drained using the classical standards of thoracic drainage by the general surgeons. The patients of the group B, however, were drained using the modern standards of thoracic drainage by the thoracic surgeons, and the general surgeons trained for this kind of the surgery. Results. The study showed that better results were achieved in the treatment of the patients from the group B. The total incidence of the failures and complications of thoracic drainage decreased from 36.52% (group A to 12.73% (group B. The mean length of hospitalization of the patients without complications in the group A was 19.5 days versus 10 days in the group B. The mean length of the treatment of the patients with failures and complications of the drainage in the group A was 33.5 days versus 17.5 days in the group B. Conclusion. The shorter length of hospitalization and the lower morbidity of the studied patients were considered to be the result of the correct treatment using modern principles of thoracic drainage, a suitable surgical technique, and a

  12. The effect of mid-thoracic VEPTR opening wedge thoracostomy on cervical tilt associated with congenital thoracic scoliosis in patients with thoracic insufficiency syndrome.

    Science.gov (United States)

    Campbell, Robert M; Adcox, Brent M; Smith, Melvin D; Simmons, James W; Cofer, Barry R; Inscore, Stephen C; Grohman, C

    2007-09-15

    Prospective clinical trial of vertical expandable prosthetic titanium rib (VEPTR) surgery in patients with congenital thoracic scoliosis with thoracic insufficiency syndrome and cervical tilt. Report efficacy and safety of VEPTR mid-thoracic opening wedge thoracostomy in treatment of cervical tilt and head/truncal decompensation in children with thoracic insufficiency syndrome associated with thoracic congenital scoliosis. Cervical tilt in children is a rare problem, usually associated with congenital cervical or cervical-thoracic scoliosis, and in progressive deformity, surgical fusion or hemi-vertebrectomy risks neurologic injury, loss of motion of the cervical spine, and unknown effect on pulmonary function. VEPTR patients with congenital scoliosis can have severe neck tilt with poor cosmesis, with the risk of neck pain in adulthood. VEPTR mid-thoracic opening wedge thoracostomy treats thoracic insufficiency syndrome, and paradoxically also appears to improve the neck alignment cosmesis. Patients with fused ribs and congenital scoliosis, thoracic insufficiency syndrome, and cervical tilt were treated with VEPTR mid-thoracic thoracostomy. Complication rates, respiratory outcome, pulmonary function tests in older children, Cobb angles, head/truncal decompensation, T1 oblique take-off, space available for lung, height of the thoracic spine, and cervical tilt angle were measured. Fourteen patients with cervical tilt, fused ribs, progressive congenital scoliosis, and TIS were treated. The primary thoracic scoliosis and space available for lung improved, cervical tilt stabilized, and head and truncal decompensation improved. One child was weaned off a ventilator. Complications included device migration, infection, and transient brachial palsy. Mid-thoracic VEPTR opening wedge thoracostomy can stabilize cervical tilt associated with thoracic congenital scoliosis and fused ribs and may be an alternative to cervicothoracic spine fusion or hemi-vertebrectomy in some young

  13. The Outcome of Extracorporeal Life Support After General Thoracic Surgery: Timing of Application.

    Science.gov (United States)

    Lee, Heemoon; Cho, Yang Hyun; Chang, Hyoung Woo; Yang, Ji-Hyuk; Cho, Jong Ho; Sung, Kiick; Lee, Young Tak

    2017-08-01

    Extracorporeal life support (ECLS) is widely used in refractory cardiac or pulmonary failure. Because complications of general thoracic surgery frequently involve the heart or lungs, ECLS can be a useful option. Therefore, we retrospectively reviewed our experience with ECLS after general thoracic surgery. There were 17,185 adult general thoracic surgery procedures between 2005 and 2013 at our institution, including resection of the lung (n = 10,434; 60.7%), esophagus (n = 1,847; 0.7%), and other procedures (n = 4,904; 28.5%). Twenty-nine patients (0.2%) were supported by ECLS postoperatively. The median age was 64 years (range, 24 to 81). Primary operations were lobectomy (n = 13; 44.8%), pneumonectomy (n = 11; 37.9%), and bilobectomy (n = 5; 17.2%). The initial mode of ECLS was venovenous in 20 patients (69.0%) and venoarterial in 9 patients (31.0%). There were 10 patients (34.5%) who survived to decannulation and 7 patients (24.1%) who survived to discharge. Over the same period, the survival to decannulation rate and survival to discharge rate were 49.5% and 35.0%, respectively, among all ECLS patients (n = 759) at our institution. The hospital mortality of patients with surgery to ECLS time of longer than 2 days was 90.9%. Multivariate analysis revealed that a longer surgery to ECLS time was a risk factor for hospital mortality (odds ratio 1.720, 95% confidence interval: 1.039 to 2.849, p = 0.035). ECLS after general thoracic surgery can be a viable rescue therapy option. Late presentation of complications or ECLS for late complications of general thoracic surgery may be predictors of death. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. The Requirement of Sutures to Close Intercostal Drains Site Wounds in Thoracic Surgery.

    Science.gov (United States)

    Smelt, Jeremy L C; Simon, Natalie; Veres, Lukacs; Harrison-Phipps, Karen; Bille, Andrea

    2018-02-01

    Chest drains are used routinely in thoracic surgery. Often a pursestring or mattress suture is used to facilitate closure of the defect on removal of the drain. This stitch can cause an unsightly scar, increase drain removal pain, and necessitate that the patient attend a community health care center to have this removed. The objective of this study was to assess whether this stitch is necessary in modern thoracic surgical practice. Data from a single surgeon's practice were collected over an 18-month period. During this time, all patients who underwent both emergency and elective thoracic surgery who had at least one postoperative chest drain of 28F or above inserted were included in the study. The surgeon did not routinely use a suture to close the drain site. In all, 312 patients underwent thoracic surgery during the 18-month period. Each patient had a range of 1 to 3 drains inserted of a size between 28F and 32F. No patients had drain sutures for closure of the drain site. Four patients had pneumothoraces after drain removal requiring further chest drain insertion. Five patients had superficial drain site infections. A single patient had to have a suture inserted at a local hospital owing to leakage from the drain site. The use of pursestring sutures in thoracic surgery is an outdated practice that causes not only unsightly scars but is also associated with increased pain. Furthermore, these unnecessary pursestring sutures place a burden on the patient and health care system to have them removed. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. A look at the thoracic surgery workforce in Canada: how demographics and scope of practice may impact future workforce needs

    Science.gov (United States)

    Grondin, Sean C.; Schieman, Colin; Kelly, Elizabeth; Darling, Gail; Maziak, Donna; Mackay, Moné Palacios; Gelfand, Gary

    2013-01-01

    Background The purpose of this study is to describe the demographics, training and practice characteristics of physicians performing thoracic surgery across Canada to better assess workforce needs. Methods We developed a questionnaire using a modified Delphi process to generate questionnaire items. The questionnaire was administered to all Canadian thoracic surgeons via email (n = 102) or mail (n = 35). Results In all, 97 surgeons completed the survey (71% response rate). The mean age of respondents was 47.7 (standard deviation 9.1) years; 10.3% were older than 60. Ninety respondents (88.7%) were men, 95 (81.1%) practised in English and 93 (76%) were born in Canada. Most (90.4%) had a medical school affiliation, with an equal proportion practising in community or university teaching hospitals. Only 18% of respondents reported working fewer than 60 hours per week, and 34% were on call more than 1 in 3. Three-quarters of work hours were devoted to clinical care, with the remaining time split among research, administration and teaching. Malignant lung disease accounted for 61.2% of practice time, with the remaining time equally split between benign and malignant thoracic diseases. Preoperative testing (49.4%) and insufficient operating time (49.5%) were the most common factors delaying delivery of care. More than 80% of respondents reported being satisfied with their careers, with 62.1% planning on retiring after age 60. Conclusion This survey characterizes Canadian thoracic surgeons by providing specific demographic, satisfaction and scope of practice information. Despite challenges in obtaining adequate resources for providing timely care, job satisfaction remains high, with a balanced workforce supply and demand anticipated for the foreseeable future. PMID:23883508

  16. Canadian National Vegetation Classification (CNVC)

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The mandate of the CNVC is to comprehensively classify and describe natural and semi-natural Canadian vegetation in an ecologically meaningful manner. The...

  17. Engendering migrant health: Canadian perspectives

    National Research Council Canada - National Science Library

    Spitzer, Denise L

    2011-01-01

    .... What contributes to this deterioration, and how can its effects be mitigated? Engendering Migrant Health brings together researchers from across Canada to address the intersections of gender, immigration, and health in the lives of new Canadians...

  18. Natural history of Canadian mammals

    National Research Council Canada - National Science Library

    Naughton, Donna; Banfield, A. W. F

    2012-01-01

    .... A complete revision of A.W.F. Banfield's classic text Mammals of Canada, it features brand-new, full-colour images of each species, as well as stunning photographs from Canadian Geographic magazine's national photography...

  19. Engendering migrant health: Canadian perspectives

    National Research Council Canada - National Science Library

    Spitzer, Denise L

    2011-01-01

    "Voluntary migrants to Canada are generally healthier than the average Canadian, but after ten years in the country they report poorer health and higher rates of chronic disease than those born here...

  20. Unveiled Sentiments: Gendered Islamophobia and Experiences of Veiling among Muslim Girls in a Canadian Islamic School

    Science.gov (United States)

    Zine, Jasmin

    2006-01-01

    The practice of veiling has made Muslim women subject to dual oppressions--racism and Islamophobia--in society at large and patriarchal oppression and sexism from within their communities. Based on a narrative analysis of the politics of veiling in schools and society, the voices of young Muslim women attending a Canadian Islamic school speak to…

  1. Thoracic endometriosis syndrome: Current concept in ...

    African Journals Online (AJOL)

    Objective: To review the current concepts in the pathophysiology and management of thoracic endometriosis syndrome. Methodology: The main source of information included manual library search and journal publications on PubMed/Medline, Google Scholar, and EMBASE. Results: Many theories have been proposed to ...

  2. An unusual cause of thoracic mass.

    Science.gov (United States)

    Wilson, D C; Redmond, A O

    1990-01-01

    A previously well 10 year old boy presented with scoliosis, a mass in the chest wall, and a pleural effusion. Chest radiography showed the triad of chronic consolidation, pleural effusion, and rib periostitis. Investigations confirmed thoracic actinomycosis. Tissue spread was evaluated by computed tomography. It was successfully treated with benzylpenicillin, which was later replaced by clindamycin. Images p991-a PMID:2221975

  3. Thoracic epidural anaesthesia for major abdominal surgeries ...

    African Journals Online (AJOL)

    Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endotracheal intubation. Aims: To evaluate the ... Information obtained included: age, gender, ASA status, diagnosis and type of surgery performed. Data analysis was ...

  4. Evolution of Thoracic Surgery in Canada

    Directory of Open Access Journals (Sweden)

    Jean Deslauriers

    2015-01-01

    Full Text Available BACKGROUND: Canada’s contributions toward the 21st century’s practice of thoracic surgery have been both unique and multilayered. Scattered throughout are tales of pioneers where none had gone before, where opportunities were greeted by creativity and where iconic figures followed one another.

  5. Thoracic myelocystomeningocele in a neurologically intact infant ...

    African Journals Online (AJOL)

    This case is an example of a high congenital spinal lesion with very minimal or negligible neurological deficits, with no other congenital malformations. Key Words: Thoracic spine, Myelocystomeningocele, Intact nervous system. Résumé Rapporter un cas peu commun et un cas rare d'une anomalie congenitale vertébrale ...

  6. Operativ behandling af thoracic outlet syndrome

    DEFF Research Database (Denmark)

    Birkeland, Peter; Stiasny, Jerzy

    2012-01-01

    We present three cases with longstanding true neurogenic thoracic outlet syndrome. All patients had aching pain in the shoulder, arm and ulnar border of the hand. On examination, we found atrophy of the hand muscles. Electromyography revealed signs of compromised function of the inferior trunk...

  7. Thoracic epidural anaesthesia for major abdominal surgeries ...

    African Journals Online (AJOL)

    Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endotracheal intubation. Aims: To evaluate the feasibility of TEA for major abdominal surgeries in the private hospital setting. Patients and methods: This was a retrospective ...

  8. Endovascular management of traumatic thoracic aortic transection.

    Science.gov (United States)

    Asmat, Atasha; Tan, Lenny; Caleb, Michael George; Lee, Chuen-Neng; Robless, Peter Ashley

    2009-10-01

    The conventional treatment of traumatic thoracic aortic transection is open surgical repair but it is associated with high rates of morbidity and mortality, particularly in patients with multiple injuries. We reviewed our experience of endovascular repair of traumatic thoracic aortic transection. Between March 2002 and December 2007, 7 patients (male 6, female 1; mean age 40 years) with multiple injuries secondary to blunt trauma underwent endovascular stenting. One patient required adjunctive surgery to facilitate endovascular stenting. Mean intensive care unit stay was 8.6 days (range, 3-16 days). Arterial access in all patients was obtained by femoral cut-down. The mean operating time was 122 min. Technical success was achieved in all cases. There was no mortality. One patient suffered a right parietal stroke, but none developed procedure-related paralysis. The mean follow-up period was 18.6 months (range, 6-48 months). There was no evidence of endoleak, stent migration, or late pseudoaneurysm formation on follow-up computed tomography. Endovascular stents can be used to treat traumatic thoracic aortic transection, with low rates of morbidity and mortality. Although early and midterm results are promising, the long-term durability of endovascular stenting for traumatic thoracic aortic transection remains unknown.

  9. Evaluation of registration methods on thoracic CT

    DEFF Research Database (Denmark)

    Murphy, K.; van Ginneken, B.; Reinhardt, J.

    2011-01-01

    EMPIRE10 (Evaluation of Methods for Pulmonary Image REgistration 2010) is a public platform for fair and meaningful comparison of registration algorithms which are applied to a database of intra-patient thoracic CT image pairs. Evaluation of non-rigid registration techniques is a non trivial task...

  10. Left thoracic kidney: A rare finding at intravenous urography ...

    African Journals Online (AJOL)

    Thoracic kidney is a rare type of renal ectopia. Patients with thoracic kidneys are usually asymptomatic and the condition is usually discovered incidentally during radiological evaluation for other conditions or during thoracic surgery. An intravenous urography done for a thirty-eight year old man referred on account of a ...

  11. Right thoracic curvature in the normal spine

    Directory of Open Access Journals (Sweden)

    Masuda Keigo

    2011-01-01

    Full Text Available Abstract Background Trunk asymmetry and vertebral rotation, at times observed in the normal spine, resemble the characteristics of adolescent idiopathic scoliosis (AIS. Right thoracic curvature has also been reported in the normal spine. If it is determined that the features of right thoracic side curvature in the normal spine are the same as those observed in AIS, these findings might provide a basis for elucidating the etiology of this condition. For this reason, we investigated right thoracic curvature in the normal spine. Methods For normal spinal measurements, 1,200 patients who underwent a posteroanterior chest radiographs were evaluated. These consisted of 400 children (ages 4-9, 400 adolescents (ages 10-19 and 400 adults (ages 20-29, with each group comprised of both genders. The exclusion criteria were obvious chest and spinal diseases. As side curvature is minimal in normal spines and the range at which curvature is measured is difficult to ascertain, first the typical curvature range in scoliosis patients was determined and then the Cobb angle in normal spines was measured using the same range as the scoliosis curve, from T5 to T12. Right thoracic curvature was given a positive value. The curve pattern was organized in each collective three groups: neutral (from -1 degree to 1 degree, right (> +1 degree, and left ( Results In child group, Cobb angle in left was 120, in neutral was 125 and in right was 155. In adolescent group, Cobb angle in left was 70, in neutral was 114 and in right was 216. In adult group, Cobb angle in left was 46, in neutral was 102 and in right was 252. The curvature pattern shifts to the right side in the adolescent group (p Conclusions Based on standing chest radiographic measurements, a right thoracic curvature was observed in normal spines after adolescence.

  12. Canadian leadership in energy

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-09-15

    Canada's energy is complex and an important resource as it fuels and funds the economy. The unique character of Canada's energy production and consumption provides strength to the country. The purpose of this booklet was to highlight Canada's energy production and consumption and to demonstrate Canada's rank globally with other major global energy players. The document also presented information on the value of Canada's energy exports, Canada's relationship with the United States, and Canada's energy-related carbon dioxide emissions. Specifically, the document discussed Canada's energy in a global context; the value of Canada's energy exports; domestic value of energy; Canada's unique energy mix; Canada's electricity mix; Canada's carbon dioxide emissions; energy strategies; and the importance of energy to Canadians. It was concluded that there are 14 federal, provincial and territorial jurisdictions managing their respective energy resources. All of these regions, with the exception of Saskatchewan have produced an energy strategy document or a climate change action plan focusing on 8 areas of action, notably awareness; benefit; efficiency; development; diversification; electricity; and emissions. refs., tabs., figs.

  13. Thoracic Idiopathic Scoliosis Severity Is Highly Correlated with 3D Measures of Thoracic Kyphosis.

    Science.gov (United States)

    Sullivan, T Barrett; Reighard, Fredrick G; Osborn, Emily J; Parvaresh, Kevin C; Newton, Peter O

    2017-06-07

    Loss of thoracic kyphosis has been associated with thoracic idiopathic scoliosis. Modern 3-dimensional (3D) imaging systems allow more accurate characterization of the scoliotic deformity than traditional radiographs. In this study, we utilized 3D calculations to characterize the association between increasing scoliosis severity and changes in the sagittal and axial planes. Patients evaluated in a scoliosis clinic and determined to have either a normal spine or idiopathic scoliosis were included in the analysis. All underwent upright, biplanar radiography with 3D reconstructions. Two-dimensional (2D) measurements of the magnitude of the thoracic major curve and the thoracic kyphosis were recorded. Image processing and MATLAB analysis were utilized to produce a 3D calculation of thoracic kyphosis and apical vertebral axial rotation. Regression analysis was performed to determine the correlation of 2D kyphosis, 3D kyphosis, and apical axial rotation with the magnitude of the thoracic major curve. The 442 patients for whom 2D and 3D data were collected had a main thoracic curve magnitude ranging from 1° to 118°. Linear regression analysis of the 2D and 3D T5-T12 kyphosis versus main thoracic curve magnitude yielded significant models (p scoliosis magnitude increased, at a rate of more than half the increase in the main thoracic curve magnitude. Analysis confirmed a surprisingly strong correlation between scoliosis severity and loss of 3D kyphosis that was absent in the 2D analysis. A similarly strong correlation between curve magnitude and apical axial rotation was evident. These findings lend further credence to the concept that scoliosis progresses in the coronal, sagittal, and axial planes simultaneously. The findings of this study suggest that 3D assessment is critical for adequate characterization of the multiplanar deformity of idiopathic scoliosis and deformity in the sagittal plane is linked to deformity in the coronal plane. Increasing severity of coronal

  14. Non-analgetic effects of thoracic epidural anaesthesia.

    Science.gov (United States)

    Kozian, Alf; Schilling, Thomas; Hachenberg, Thomas

    2005-02-01

    This review presents a brief overview of the non-analgetic effects of thoracic epidural anaesthesia. It covers the cardiac, pulmonary and gastrointestinal effects of thoracic epidural anaesthesia. The results of newer studies are of particular importance regarding mortality and major morbidity after thoracic epidural anaesthesia. The clinical effects of thoracic epidural anaesthesia are mainly attributed to a transient thoracic sympathetic block affecting different organs. Furthermore, local anaesthetic itself reabsorbed from the epidural space may contribute to the non-analgetic effects of thoracic epidural anaesthesia. Experimental studies have suggested that thoracic epidural anaesthesia may attenuate the perioperative stress response after major surgery. The possible beneficial mechanisms of action include an improvement of left ventricular function by direct anti-ischaemic effects, a reduction in cardiovascular complications, an advance on gastrointestinal function, and a reduction in pulmonary complications, as well as a positive impact on the coagulation system and the postoperative inflammatory response. However, it is questionable whether these effects of thoracic epidural anaesthesia may lead to an improved perioperative outcome after major surgery. Recent studies have suggested that, despite the superior quality of pain relief and better quality of life, thoracic epidural anaesthesia does not reduce mortality and major morbidity, especially after major abdominal and cardiac surgery. Despite this controversy, the numerous positive effects and advantages of thoracic epidural anaesthesia are the reasons for its increasing popularity. However, the advantages of thoracic epidural anaesthesia must be incorporated into a multimodal treatment management aimed at improving outcomes after surgery.

  15. Dry needling for the management of thoracic spine pain

    Science.gov (United States)

    Fernández-de-las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-01-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars. PMID:26309385

  16. Dry needling for the management of thoracic spine pain.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-07-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars.

  17. Canadian synthetic resins industry

    Energy Technology Data Exchange (ETDEWEB)

    Margeson, J. [Industry Canada, Ottawa, ON (Canada)

    2000-06-01

    The growth of the synthetic resin industry in Canada is described. In 1999 the industry had shipments totalling $6.3 billion and employed about 9,000 people in 105 establishments. The industry is concentrated in Alberta, Ontario and Quebec. Plants in Alberta produce commodity-grade thermoplastic resins from raw materials derived mainly from natural gas, whereas plants in Ontario and Quebec produce both thermoplastic and thermoset resins using raw materials derived from both crude oil and natural gas. Sixty-four per cent of the synthetic reins produced in Canada, worth about $4.1 billion, are exported. This is offset by imports of 68 per cent of domestic consumption, (valued at $5.0 billion) reflecting rationalization and specialization of the resin industry on a continental basis. Process and product technologies used in Canada are up-to-date and licensed from parent or other foreign chemical companies. Capital investment in the Canadian resin industry is lagging behind investment in the United States, however, this is expected to change once the impact of recent investments in the industry in Alberta is reflected in the statistics. A five to seven per cent real average annual growth in world-wide consumption is predicted over the next five years. Growth in North America is projected to be in the three to four per cent range. The Alberta-based component of the industry, being relatively new, is expected to improve its ability to compete globally in commodity thermoplastics. In contrast, the plants in Ontario and Quebec suffer from the fact that they were built prior to the Free Trade Agreement and were designed to satisfy domestic requirements. They are attempting to compensate for their lack of economics of scale by developing strategies to supply niche products. 8 figs.

  18. Incidental Cardiac Findings on Thoracic Imaging.

    LENUS (Irish Health Repository)

    Kok, Hong Kuan

    2013-02-07

    The cardiac structures are well seen on nongated thoracic computed tomography studies in the investigation and follow-up of cardiopulmonary disease. A wide variety of findings can be incidentally picked up on careful evaluation of the pericardium, cardiac chambers, valves, and great vessels. Some of these findings may represent benign variants, whereas others may have more profound clinical importance. Furthermore, the expansion of interventional and surgical practice has led to the development and placement of new cardiac stents, implantable pacemaker devices, and prosthetic valves with which the practicing radiologist should be familiar. We present a collection of common incidental cardiac findings that can be readily identified on thoracic computed tomography studies and briefly discuss their clinical relevance.

  19. RESPIRATORY REEDUCATION IN THORACIC CONTUSION RECOVERY

    Directory of Open Access Journals (Sweden)

    Aurelia PREDA

    2015-04-01

    Full Text Available Respiratory reeducation is a way to recover the thoracic contusion. Correcting dyspnea induced by pain, decreases the required postcontuzional recovery time and, therefore, the required social reintegration time. This is achieved an increasing of the pacient life quality, and significant savings of human and material resources: reducing medical and somato-functional recovery costs, reducing the sick leave payment and the work days off to. The „TES” device has been designed in order to improve respiratory reeducation and to recover the thoracic contusion. A study showed that the postcontuzional recovery was significantly increased by using the physical exercises of respiratory reeducation. The „TES” device demonstrated his role in this.

  20. Thoracic gas volume in early childhood.

    Science.gov (United States)

    Hatch, D J; Taylor, B W

    1976-01-01

    A total body plethysmograph is descirbed which was used to study thoracic gas volume (TGV) in infants and young children from birth to 2 1/2 years, and was suitable for use even in very sick babies. Normal TGV values were obtained in 42 studies of 35 healthy infants and young children, and 16 children with abnormal lung volume are described. TGV correlated well with length, weight, chest circumference, and age in the healthy infants. A low TGV was found in children with respiratory difficulties after cardiac and thoracic surgery, in respiratory distress syndrome of the newborn, and in association with pulmonary infection and chest cage abnormalities. Abnormally high TGV was most frequently seen in infants with small airways disease. PMID:1008592

  1. Comminuted fracture of the thoracic spine.

    LENUS (Irish Health Repository)

    Cashman, J P

    2012-02-03

    BACKGROUND: Road deaths fell initially after the introduction of the penalty points but despite this, the rate of spinal injuries remained unchanged. AIMS: We report a patient with a dramatic spinal injury, though without neurological deficit. We discuss the classification, management and economic impact of these injuries. METHODS: We describe the management of a patient with a comminuted thoracic spinal fracture without neurological injury. We conducted a literature review with regard to the availability of literature of the management of these injuries. RESULTS: This 17-year-old female was managed surgically and had a good functional outcome. There is no clear consensus in the published literature on the management of these injuries. CONCLUSIONS: Comminuted thoracic spinal factures are potentially devastating. Such a patient presents challenges in determining the appropriate treatment.

  2. [Digital thoracic radiology: devices, image processing, limits].

    Science.gov (United States)

    Frija, J; de Géry, S; Lallouet, F; Guermazi, A; Zagdanski, A M; De Kerviler, E

    2001-09-01

    In a first part, the different techniques of digital thoracic radiography are described. Since computed radiography with phosphore plates are the most commercialized it is more emphasized. But the other detectors are also described, as the drum coated with selenium and the direct digital radiography with selenium detectors. The other detectors are also studied in particular indirect flat panels detectors and the system with four high resolution CCD cameras. In a second step the most important image processing are discussed: the gradation curves, the unsharp mask processing, the system MUSICA, the dynamic range compression or reduction, the soustraction with dual energy. In the last part the advantages and the drawbacks of computed thoracic radiography are emphasized. The most important are the almost constant good quality of the pictures and the possibilities of image processing.

  3. Predicting Thoracic Injury in Children With Multitrauma.

    Science.gov (United States)

    Weerdenburg, Kirstin D; Wales, Paul W; Stephens, Derek; Beno, Suzanne; Gantz, Jessica; Alsop, Jessie; Schuh, Suzanne

    2017-05-08

    Previous pediatric trauma studies focused on predictors of abnormal chest radiographs or included patients with low injury severity. This study identified predictors of thoracic injury (TI) diagnoses in a high-risk population and determined TI rate without predictors. This study was a retrospective trauma registry analysis of previously healthy children aged 0 to 17 years with multisystem blunt trauma requiring trauma team activation and chest radiography who were divided into those with and without TI. Plausible TI predictors included Glasgow Coma Scale score of 13 or less, abnormal thoracic symptoms/signs, abnormal chest auscultation, respiratory distress/ rate higher than the 95th percentile, oxygen saturation less than 95%, abnormal abdominal signs/symptoms, tachycardia higher than the 95th percentile, blood pressure lower than the 5th percentile, and femur fracture. One hundred forty-one (29%) of 493 eligible patients had TI. Independent TI predictors include thoracic symptoms/signs (odds ratio [OR], 6.0; 95% confidence interval [CI], 3.6-10.1), abnormal chest auscultation (OR, 3.5; 95% CI, 2.0-6.2), saturation less than 95% (OR, 3.1; 95% CI, 1.8-5.5), blood pressure lower than the 5th percentile (OR, 3.7; 95% CI, 1.1-12.2), and femur fracture (OR, 2.5; 95% CI, 1.2-5.4). Six (5%) of 119 children (95% CI, 0.01-0.09) without predictors had TI. Predictors of TI include thoracic symptoms/signs, abnormal chest auscultation, saturation less than 95%, blood pressure lower than the 5th percentile, and femur fracture. Because an important portion of children without predictors had TI, chest radiography should remain part of pediatric trauma resuscitation.

  4. [Thoracic aortic aneurysm complicating pseudo-coarctation].

    Science.gov (United States)

    Frikha, I; Masmoudi, S; Hadjkacem, A; Ghemissou, N; Kolsi, K; Khannous, M; Karoui, A; Sahnoun, Y

    2000-02-01

    The aneurysm of the descending aorta complicating a pseudocoarctation, itself due to a congenital elongation with kinking of the aorta is a rare entity. We report a case of aortic aneurysm discovered in a 72 years old woman without notable antecedents, which was referred for recurrent bronchitis. The X-ray showed a calcified opacity of the upper mediastinum, 5 cm of large. A thoracic CT-scan evoked the presence of a circulating sacciform aneurysm with calcified walls, developing on the final part of the aortic arch, which was with abnormally ascending way going up to the cervico-thoracic orifice and carrying out an aspect of aortic kinking. The assessment was complemented by a RMI as well as an aortic opacification. A thoracic scintigraphy showed an hypoperfusion of the left lung. The remainder of the cardiac assessment was normal. The patient was operated under femoro-femoral extracorporeal circulation through a left posterolateral thoracotomy of the 4th intercostal space. The examination showed a 7 cm diameter calcified aneurysm of the descending thoracic aorta complicating a tight stenosis in connection with an elongation and a kinking. The upper section of the aorta was shifted towards the pleural dome. The aortic section above aneurism was of normal size whereas the lower section was dilated. The aneurism was excised and a prosthetic graft was carried out. The surgery follow-up was marked by an hemodynamic stability, without neurological deficit. A ventilatory assistance was necessary during 5 days. Currently with 8 months follow-up, the patient goes well. A prosthetic replacement in front of this type of aneurism is legitimate given the risk of the occurrence of complications secondary to the pseudocoarctation (arterial hypertension, aortic insufficiency) or to the aneurism itself, dissection or compression of vicinity (pulmonary artery).

  5. One-stage sequential bilateral thoracic expansion for asphyxiating thoracic dystrophy (Jeune syndrome).

    Science.gov (United States)

    Muthialu, Nagarajan; Mussa, Shafi; Owens, Catherine M; Bulstrode, Neil; Elliott, Martin J

    2014-10-01

    Jeune syndrome (asphyxiating thoracic dystrophy) is a rare disorder characterized by skeletal dysplasia, reduced diameter of the thoracic cage and extrathoracic organ involvement. Fatal, early respiratory insufficiency may occur. Two-stage lateral thoracic expansion has been reported, addressing each side sequentially over 3-12 months. While staged repair theoretically provides less invasive surgery in a small child with respiratory distress, we utilized a single stage, bilateral procedure aiming to rapidly maximize lung development. Combined bilateral surgery also offered the chance of rapid recovery, and reduced hospital stay. We present our early experience of this modification of existing surgical treatment for an extremely rare condition, thought to be generally fatal in early childhood. Nine children (6 males, 3 females; median age 30 months [3.5-75]) underwent thoracic expansion for Jeune syndrome in our centre. All patients required preoperative respiratory support (5 with tracheostomy, 8 requiring positive pressure ventilation regularly within each day/night cycle). Two children underwent sequential unilateral (2-month interval between stages) and 7 children bilateral thoracic expansion by means of staggered osteotomies of third to eighth ribs and plate fixation of fourth to fifth rib and sixth to seventh rib, leaving the remaining ribs floating. There was no operative mortality. There were 2 deaths within 3 months of surgery, due to pulmonary hypertension (1 following two-stage and 1 following single-stage thoracic expansion). At the median follow-up of 11 months (1-15), 3 children have been discharged home from their referring unit and 2 have significantly reduced respiratory support. One child remains on non-invasive ventilation and another is still ventilated with a high oxygen requirement. Jeune syndrome is a difficult condition to manage, but bilateral thoracic expansion offers an effective reduction in ventilator requirements in these children

  6. Responsible Canadian energy progress report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-07-01

    The Canadian Association of Petroleum Producers (CAPP) represents oil and gas companies throughout Canada; its members produce over 90% of Canada's natural gas and crude oil output. The aim of the Association is to improve the economics of the Canadian upstream petroleum sector in an environmentally and socially responsible way. The aim of this Responsible Canadian Energy report is to present the performance data of CAPP's members for the year 2009. Data, trends, and performance analyses are provided throughout the document. This analysis makes it possible to determine where progress has been made and where performance improvement is necessary. It also presents success stories and best practices so that other companies can learn from them how to improve their own performance. This paper provides useful information on the performance of the upstream petroleum industry in Canada and highlights where the focus should be for further improvement in its performance.

  7. Surgical outcome of video-assisted thoracic surgery for acute thoracic empyema using pulsed lavage irrigation.

    Science.gov (United States)

    Nakamura, Hiroshige; Taniguchi, Yuji; Miwa, Ken; Adachi, Yoshin; Fujioka, Shinji; Haruki, Tomohiro

    2010-03-01

    The essential points of video-assisted thoracic surgery (VATS) for acute thoracic empyema are the decortication of thickened pleura, resection of necrotic tissues and fibrin blocks, and drainage. Pulsed lavage irrigation, which is commonly used in orthopedic surgery as a method of sufficiently performing the technique, was used under a thoracoscope to study the efficacy of the treatment for acute thoracic empyema. The subjects comprised 31 patients who had undergone VATS for acute thoracic empyema. There were 26 men and 5 women with an average age of 60.5 years. For the surgical technique, the thickened pus-producing pleura were decorticated under a thoracoscope. The pulsed lavage irrigation system was used after the intrathoracic space had become a single cavity. Using the tip for an intraspinal space, lavage and suctioning were repeated with 5-10 l of a pressurized warm saline solution. Fibrin blocks and necrotic tissues were easily removed by spray washing with pressurized fluid. The operating time was 150.8 min; the amount of bleeding, including suctioned pleural effusion, was 478.5 g; and the postoperative duration of drainage was 10.7 days. During the postoperative course, the addition of open window thoracotomy due to the relapse of empyema due to methicillin-resistant Staphylococcus aureus was observed in only one patient (3.2%). All of the other patients improved despite their concomitant diseases. The use of pulsed lavage irrigation under a thoracoscope for acute thoracic empyema provides simple, efficient débridement or drainage.

  8. Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

    Directory of Open Access Journals (Sweden)

    Hong-Fei Nie

    2013-01-01

    Full Text Available Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS, MacNab classification, and Oswestry disability index (ODI. At the final follow up (mean: 17 months; range: 6–41 months, patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery.

  9. [Anesthetic Management in Thoracic Trauma Patients].

    Science.gov (United States)

    Kozian, Alf; Bergmann, Astrid; Hachenberg, Thomas; Schilling, Thomas

    2017-06-01

    In daily practice, management of patients with blunt thoracic trauma is challenging for the anesthetist. Injuries of airways, lungs, diaphragm, heart and large vessels are the main difficulties.Respiratory and circulatory physiology in general is affected by general anesthesia, which may result in an increased number of perioperative complications. Therefore, anesthetic management of patients with thoracic trauma needs to address different clinical topics: management of difficult airways, intrinsic effects of anesthetics and mechanical ventilation on respiratory and cardiac function, the adequate replacement of blood loss as well as type and extent of the surgical intervention. Postoperatively, sufficient pain therapy avoids pulmonary complications and can improve outcome.Therefore, a high degree of (patho-)physiological understanding and manual skills are required in this scenario. Interdisciplinary cooperation during diagnostic, treatment and in the perioperative course is a prerequisite for a successful management.The present work describes the main characteristics of thoracic trauma and discusses important precautions and typical problems the anesthetist has to face in the clinical setting. Georg Thieme Verlag KG Stuttgart · New York.

  10. CT findings in severe thoracic sarcoidosis

    Energy Technology Data Exchange (ETDEWEB)

    Hennebicque, Anne-Sophie; Brillet, Pierre-Yves; Moulahi, Hassen; Brauner, Michel W. [UFR Bobigny, Department of Radiology, Federation MARTHA and EA 2363, Bobigny Cedex (France); Nunes, Hilario; Valeyre, Dominique [UFR Bobigny, Department of Pneumology, Federation MARTHA and EA 2363, Bobigny Cedex (France)

    2005-01-01

    Severe thoracic sarcoidosis includes manifestations with significant clinical and functional impairment and a risk of mortality. Severe thoracic sarcoidosis can take on various clinical presentations and is associated with increased morbidity. The purpose of this article was to describe the CT findings in severe thoracic sarcoidosis and to explain some of their mechanisms. Subacute respiratory insufficiency is a rare and early complication due to a high profusion of pulmonary lesions. Chronic respiratory insufficiency due to pulmonary fibrosis is a frequent and late complication. Three main CT patterns are identified: bronchial distortion, honeycombing and linear opacities. CT can be helpful in diagnosing some mechanisms of central airway obstruction such as bronchial distortion due to pulmonary fibrosis or an extrinsic bronchial compression by enlarged lymph nodes. An intrinsic narrowing of the bronchial wall by endobronchial granulomatous lesions may be suggested by CT when it shows evidence of bronchial mural thickening. Pulmonary hypertension usually occurs in patients with end-stage pulmonary disease and is related to fibrotic destruction of the distal capillary bed and to the resultant chronic hypoxemia. Several other mechanisms may contribute to the development of pulmonary hypertension including extrinsic compression of major pulmonary arteries by enlarged lymph nodes and secondary pulmonary veno-occlusive disease. Aspergilloma colonization of a cavity is the main cause of hemoptysis in sarcoidosis. Other rare causes are bronchiesctasis, necrotizing bronchial aspergillosis, semi-invasive pulmonary aspergillosis, erosion of a pulmonary artery due to a necrotic sarcoidosis lesion, necrosis of parenchymal sarcoidosis lesions and specific endobronchial macroscopic lesions. (orig.)

  11. Epidemiology and pathogenesis of thoracic outlet syndrome

    Directory of Open Access Journals (Sweden)

    Wojcik Gustaw

    2015-03-01

    Full Text Available The superior thoracic aperture is a place particularly vulnerable to the occurrence of tissue conflict and the development of a number of neurovascular changes carrying a risk of upper limb dysfunction. The triggering factor in this case is the pressure on the nerve vascular elements brought about by too large muscles of the chest and neck, clavicle fracture and dislocation of the upper ribs, anomalies in the form of ribs, in the neck, or by apex of the lung tumors. Each anatomical anomaly may be a cause of a number of lesions and lead to the development of the disease. Due to the nature of the oppressed structures, there are two basic groups: neurogenic and vascular. The most common variant giving clinical symptoms is neurogenic thoracic outlet syndrome. In this, the compression ratio, the brachial plexus, and for this reason, the vascular surface of the upper limb dysfunction is often overlooked. However, the vascular variant, and especially arterial sub-variant, is very dangerous because it can give complications even in the form of aneurysms, and even upper limb ischemia. The aim of the study is to present the most common changes in the thoracic outlet causing functional disorders of the upper limb.

  12. Inspiratory muscle training improves exercise capacity with thoracic load carriage.

    Science.gov (United States)

    Shei, Ren-Jay; Chapman, Robert F; Gruber, Allison H; Mickleborough, Timothy D

    2018-02-01

    Thoracic load carriage (LC) exercise impairs exercise performance compared to unloaded exercise, partially due to impaired respiratory mechanics. We investigated the effects of LC on exercise and diaphragmatic fatigue in a constant-load exercise task; and whether inspiratory muscle training (IMT) improved exercise capacity and diaphragmatic fatigue with LC. Twelve recreationally active males completed three separate running trials to exhaustion (T lim ) at a fixed speed eliciting 70% of their V˙O 2max . The first two trials were completed either unloaded (UL) or while carrying a 10 kg backpack (LC). Subjects then completed 6 weeks of either true IMT or placebo-IMT. Posttraining, subjects completed an additional LC trial identical to the pretraining LC trial. Exercise metabolic and ventilatory measures were recorded. Diaphragm fatigue was assessed as the difference between preexercise and postexercise twitch diaphragmatic pressure (P di, tw ), assessed by bilateral stimulation of the phrenic nerve with esophageal balloon-tipped catheters measuring intrathoracic pressures. T lim was significantly shorter (P  0.05). Minute ventilation and breathing mechanics were unchanged post-IMT (P > 0.05). Six weeks of flow-resistive IMT improved exercise capacity, but did not mitigate diaphragmatic fatigue following submaximal, constant-load running to volitional exhaustion with LC. © 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

  13. Transnational archives: the Canadian case

    Directory of Open Access Journals (Sweden)

    Julia Creet

    2011-05-01

    Full Text Available This paper is a brief overview of the concept of the transnational archive as a counterpoint to the idea that a national archive is necessarily a locus of a static idea of nation. The Canadian national archives is used as a case study of an archives that was transnational in its inception, and one that has continued to change in its mandate and materials as a response to patterns in migration and changing notions of multiculturalism as a Canadian federal policy. It introduces the most recent formation of the transnational archive and its denizens: the genealogical archive inhabited by family historians.

  14. Canadian Children's Literature: An Alberta Survey

    Science.gov (United States)

    Bainbridge, Joyce; Carbonaro, Mike; Green, Nicole

    2005-01-01

    This article presents the findings of an online survey administered to Alberta elementary school teachers in 2000-2001. The survey explored the teachers' knowledge and use of Canadian children's literature and their thoughts about the role of Canadian literature in elementary school classrooms. Canadian children's trade books espouse particular…

  15. [The preoperative thoracic X-ray for tactical decisions for the thoracic injuries treatment].

    Science.gov (United States)

    Voskresenskiĭ, O V; Beresneva, É A; Sharifullin, F A; Popova, I E; Abakumov, M M

    2011-01-01

    Data of 379 patients with penetrating thoracic wounds were analyzed. The pathologic changes on X-ray of the thoracic cavity were registered 239 (63,1%) patients: the hemothorax was diagnosed in 44,3%, pneumothorax - in 26,8% and hemopneumothorax - in 28,9%. 154 patients had videothoracoscopic surgery and 225 patients were operated on using traditional open methods. Operative findings were compared with X-ray data. The sensitivity of plain chest radiography in diagnostics of hemothorax was 52,1%, the specificity - 92,1%. Mistakes of interpreting X-ray data in diagnosing of low-volume hemo- or pneumothorax were defined. The computed tomography of the thorax proved to be the most precise means of intrapleural injuries diagnostics. The optimal algorithm of preoperative thoracic X-ray was suggested.

  16. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

    Energy Technology Data Exchange (ETDEWEB)

    Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)

    2015-06-15

    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

  17. Migration of thoracic aorta after the anterior correction of thoracic idiopathic scoliosis without parietal pleura closure.

    Science.gov (United States)

    Zhu, Feng; Chen, Wen-jun; Wang, Wei-jun; Wang, Bing; Zhu, Ze-zhang; Zhu, Bin; Qiu, Yong

    2011-08-01

    To compare the preoperative and postoperative relative position of the thoracic aorta to the vertebrae in patients with idiopathic scoliosis (IS) after anterior corrective surgery without parietal pleura closure. To investigate the impact of unrepaired parietal pleura on thoracic aorta migration after anterior correction of right thoracic IS. Vascular injuries caused by vertebral screws have been reported in several studies. Recent studies showed an anteromedial shift of thoracic aorta after anterior curve correction with closure of the parietal pleura in thoracic IS. Migration of the aorta in patients with nonclosed parietal pleura has not been studied before, although it has been speculated in benefiting the transposition of the aorta and thus reduces the risk of vascular injury. Fifteen IS patients with predominant right thoracic scoliosis who underwent anterior instrumentation without parietal pleura closure were recruited for the study. There were 10 female and 5 male patients with an average age of 15.9 years. The following parameters were measured on preoperative and postoperative computed tomographic scans: angle α: aorta-vertebral angle; distance a: distance between the aorta and the left rib head; distance b: distance from aorta to vertebral body cortex. From computed tomographic measurements, the angle α from T5 to T12 ranged from 28.9 to 68.3 degrees before surgery and 18.8 to 63.2 degrees after surgery. The distance a ranged from 5.6 mm to 28.1 mm before surgery and 2.3 mm to 24.3 mm after surgery. The distance b ranged from 1.7 mm to 4.3 mm before surgery and 2.3 mm to 8.0 mm after surgery. These changes in all the parameters reached statistically significant difference at all the levels except in upper and lower end vertebrae (Ppleura closure.

  18. Impact of a six-year integrated thoracic surgery training program at the Medical College of Wisconsin.

    Science.gov (United States)

    Gasparri, Mario G; Tisol, William B; Masroor, Saqib

    2012-02-01

    Thoracic residency program enrollment continues to decline. While job market and decreasing reimbursements are often cited as the main reasons, length of and format of training may also be significant. The Medical College of Wisconsin established an Accreditation Council for Graduate Medical Education-approved 6-year integrated thoracic training program. The number and characteristics of applicants to the 6-year program were then compared with previous applicants applying to the traditional 2-year program. Applicants to the 6-year integrated program scored higher on the United States Medical Licensing Examination part 1 and part 2 than previous applicants to the traditional 2-year program. The 6-year applicants also were more published and a greater percentage of them held other advanced degrees. Institution of a 6-year integrated thoracic surgery training program at the Medical College of Wisconsin led to a significant increase in number of applications. Additionally, the 6-year applicants appeared to be more academically accomplished than previous applicants to the traditional 2-year program. While early in the experience, it appears that interest in thoracic surgery is high among medical students and institution of a 6-year program has the potential to once again attract the "best and the brightest" to this specialty. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Timing of Changes in Three-Dimensional Spinal Parameters After Selective Thoracic Fusion in Lenke 1 Adolescent Idiopathic Scoliosis: Two-Year Follow-up.

    Science.gov (United States)

    Pasha, Saba; Flynn, John M; Sponseller, Paul D; Orlando, Giuseppe; Newton, Peter O; Cahill, Patrick J

    2017-11-01

    Retrospective analysis of the prospectively collected data. To investigate the relationship between the axial rotation of the unfused lumbar spine and the parameters of the instrumented thoracic spine at varying time points after selective thoracic fusion (STF) in Lenke 1B and 1C adolescent idiopathic scoliosis (AIS). The impact of STF on the spontaneous lumbar curve correction in AIS has been studied mainly in the frontal planes. The relationship between the spontaneous transverse plane correction of the lumbar spine and the parameters of the fused thoracic spine is not well documented. Twenty-one Lenke 1B and 1C patients who had received STF with minimum two years' follow-up were selected. Thoracic and lumbar Cobb angles, kyphosis, lordosis, and thoracic and lumbar apical vertebrae rotations were measured at preoperative, first-erect, six-month, one-year, and two-year follow-ups. The association between the lumbar apical vertebral rotation and other thoracic and lumbar variables at different time points were determined using regression analysis. The variables significantly predicting the lumbar axial rotation correction at two years were determined from the preceding follow-up visits. Kyphosis, thoracic Cobb, thoracic apical vertebral rotation, and lumbar Cobb were significantly different between the preoperative and all the postoperative follow-ups (p < .05). At the two-year follow-up, a decrease in thoracic rotation and lumbar Cobb and a higher residual thoracic Cobb were associated with an improved spontaneous lumbar rotation (R(2) = 0.41, p < .05). Lumbar rotation at two years was predicted from thoracic derotation and lumbar Cobb at first erect (R(2) = 0.30, p < .05). Spontaneous lumbar curve rotation correction correlated to the fused and unfused spinal parameters in the three anatomic planes. The relationship between thoracic and lumbar rotation persist up to two years after STF. Thoracic derotation is an important factor determining the lumbar rotation

  20. Canadian Public Libraries Are Aware of Their Role as Information Literacy Training Providers, but Face Several Challenges. A Review of: Lai, H.-J. (2011. Information literacy training in public libraries: A case from Canada. Educational Technology & Society, 14(2, 81-88.

    Directory of Open Access Journals (Sweden)

    Laura Newton Miller

    2012-03-01

    Full Text Available Objective– To explore the current state of information literacy (IL training in Canadian public libraries, and to identify strategies used for improving IL training skills for staff and patrons.Design – Mixed-methods approach, including document analysis, observations, and focus group interviews.Setting – Two libraries of a large public library system in Canada: the central library and one branch library.Subjects – Six staff members (manager, administrator, training coordinator, instructor, and computer technician who have been involved in designing and teaching information literacy courses for library patrons and staff.Methods – The researcher analyzed internal and external library documents related to information literacy, including, but not limited to, reports, posters, lesson plans, newsletters, and training scripts. He also observed interactions and behaviours of patrons during IL training sessions. Finally, he conducted a focus group with people involved in IL training, asking questions about facilities and resources, programs, patron reaction, librarian knowledge of IL theory, and impediments and benefits of IL training programs in public libraries.Main Results – Staff were aware of the importance of IL training in the library. Attracting more library patrons (including building partnerships with other organizations, improving staff IL and training skills, employing effective strategies for running training programs, and dealing with financial issues were all concerns about running IL training that were highlighted.Conclusion – Canadian public libraries are well aware of their role as IL training providers, but they still face several challenges in order to improve their effectiveness.

  1. Phonological Variability in Canadian English.

    Science.gov (United States)

    de Wolf, Gaelan Dodds

    A study compared salient variables of Canadian English from two concurrent sociodialectal surveys, one for Ottawa, Ontario and one for Vancouver, British Columbia. Using the Labovian model of phonological variation in association with sociological parameters and other linguistic variables within each specific area, the analysis investigated four…

  2. The CBC and the Public: Management Decision Making in the English Television Service of the Canadian Broadcasting Corporation, 1970-1974.

    Science.gov (United States)

    McKay, Bruce

    A discussion of mass media studies, public broadcasting, and the relationship between public broadcasting and society provides the background for this study. Models for communication research study are examined to establish the methodology for the study of the Canadian Broadcasting Corporation (CBC). General background on Canadian public…

  3. [Spirometry interpretation feasibility among pre-school children according to the European Respiratory Society and American Thoracic Society Guidelines].

    Science.gov (United States)

    Donaire, Roberto M; González, Scarlett A; Moya, Ana I; Fierro, Laura T; Brockmann, Pablo V; Caussade, Solange L

    2015-01-01

    Spirometry is the most used test to evaluate pulmonary function. Guidelines that defined acceptability and repeatability criteria for its implementation and interpretation among preschoolers were published in 2007. Our objective was to quantify the actual compliance with these criteria among pre-school patients. A review was performed on the baseline spirometry measured in patients aged 2 to 5 years in the Pediatric Respiratory Laboratory of the Pontificia Universidad Católica de Chile, who were admitted due to recurrent or persistent coughing or wheezing. Only those results obtained in patients who took the test for the first time were considered. They were analyzed by international standards. A total of 93 spirometry results (mean age 57.4 ± 8.6 months, 48 males) were obtained, of which 44 (47%) met all acceptable criteria, 87 (93%) obtained expiratory time of ≥ 0.5seconds, and 67 (72%) of the patients had an end-expiratory flow of ≤10% from peak flow. The variation in the measurement of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) was very low (intraclass correlation coefficient > 0.9). It was possible to meet the acceptability and repeatability criteria for spirometry among pre-school children in our Center, which was similar to previous reports. As in older children, this test is fully recommended for pre-school children who require lung function studies. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  4. Thoracic fistulas of the pancreas and their complications in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Fritsch, R.; Schirg, E.; Buerger, D.

    1981-08-01

    The article reports on two thoracic fistulas of the pancreas in infants. Anamnesis revealed that recurring abdominal pain had occured in those children for years; at the time of their admission to hospital there was considerable dyspnoea with thoracic pain depending on the respiration. Fistulas of the pancreas with thoracic connection were identified as the cause. The article goes into the details of genesis, differential diagnosis and course of the disease.

  5. Long-term survival after use of internal thoracic artery in octogenarians is gender related.

    Science.gov (United States)

    Singh, Arun K; Maslow, Andrew D; Machan, Jason T; Fingleton, James G; Feng, William C; Schwartz, Carl; Rotenberg, Fred A; Bert, Arthur A

    2015-10-01

    The goal of this study is to assess the benefits of a left internal thoracic artery as a bypass conduit in octogenarians undergoing elective coronary artery bypass grafting. We hypothesize that there is no survival advantage and that outcome may be gender related. In a retrospective analysis of 1141 octogenarians (aged >80 years) undergoing isolated coronary artery bypass grafting from 1996 to 2012, patients were divided into 2 groups: Group I (coronary artery bypass grafting-left internal thoracic artery) included 870 patients (339 female/531 male), and group II (coronary artery bypass grafting-saphenous vein graft) included 271 patients (131 female/140 male). The overall 30-day mortality was 5.7%: 4.3% in group I and 7.0% in group II (P = .1). Group II had a lower trend of any postoperative complication (P = .05) and pneumonia (P = .05). When analyzed by gender, there were no discernable differences in long-term survival for male patients in group I (65% at 5 years and 29% at 10 years) versus male patients in group II (65% at 5 years and 31% at 10 years) (P = .2). However, survival was significantly greater for female patients in group I (70% at 5 years and 35% at 10 years) versus female patients in group II (63% at 5 years and 21% at 19 years) (P = .01). Multiple logistic and Cox regression analysis showed that left internal thoracic artery use is associated with improved survival in female patients (hazard ratio [HR], 0.72; confidence interval [CI], 0.56-0.93) but not in male patients (HR, 1.14; CI, 0.9-1.4). Advanced age was associated with an increased risk of mortality (HR, 1.08 per year; CI, 1.05-1.1). Both patient age (P = .01) and Society of Thoracic Surgeons-predicted 30-day mortality (P = .03) remain in the final model for 30-day mortality. The benefit of the left internal thoracic artery after coronary artery bypass grafting in octogenarians may be gender related. This study shows that the benefit of the left internal thoracic artery in the

  6. Citizenship in civil society?

    NARCIS (Netherlands)

    Ossewaarde, Marinus R.R.

    2007-01-01

    This article seeks to provide a conceptual framework to complement and guide the empirical analysis of civil society. The core argument is that civil society must be understood, not as a category of (post)industrialized society, but as one of individualized society. Civil society is characterized by

  7. The influence of power in the Canadian healthcare system.

    Science.gov (United States)

    Seenandan-Sookdeo, Kendra-Ann I

    2012-01-01

    This article presents a review of the literature as it relates to the influence of the word power in the context of the Canadian healthcare system. The concept of power is used to explore issues of gender and the evolution of advanced nurse practice in the development of the Canadian healthcare system. Furthermore, issues related to the call for interprofessional collaboration are addressed. Healthcare workers, in particular nurses, are trusted in a society that seeks, promotes, and aspires for power and control. In addition, societal norms continue to shape our healthcare reform. As a consequence, the discussion centers on a call for true collaboration among our healthcare providers and concludes with implications for nursing.

  8. Thoracic sympathetic block reduces respiratory system compliance

    Directory of Open Access Journals (Sweden)

    Fábio Ely Martins Benseñor

    Full Text Available CONTEXT AND OBJECTIVE: Thoracic epidural anesthesia (TEA following thoracic surgery presents known analgesic and respiratory benefits. However, intraoperative thoracic sympathetic block may trigger airway hyperreactivity. This study weighed up these beneficial and undesirable effects on intraoperative respiratory mechanics. DESIGN AND SETTING: Randomized, double-blind clinical study at a tertiary public hospital. METHODS: Nineteen patients scheduled for partial lung resection were distributed using a random number table into groups receiving active TEA (15 ml 0.5% bupivacaine, n = 9 or placebo (15 ml 0.9% saline, n = 10 solutions that also contained 1:200,000 epinephrine and 2 mg morphine. Under general anesthesia, flows and airway and esophageal pressures were recorded. Pressure-volume curves, lower inflection points (LIP, resistance and compliance at 10 ml/kg tidal volume were established for respiratory system, chest wall and lungs. Student’s t test was performed, including confidence intervals (CI. RESULTS: Bupivacaine rose 5 ± 1 dermatomes upwards and 6 ± 1 downwards. LIP was higher in the bupivacaine group (6.2 ± 2.3 versus 3.6 ± 0.6 cmH2O, p = 0.016, CI = -3.4 to -1.8. Respiratory system and lung compliance were higher in the placebo group (respectively 73.3 ± 10.6 versus 51.9 ± 15.5, p = 0.003, CI = 19.1 to 23.7; 127.2 ± 31.7 versus 70.2 ± 23.1 ml/cmH2O, p < 0.001, CI = 61 to 53. Resistance and chest wall compliance showed no difference. CONCLUSION: TEA decreased respiratory system compliance by reducing its lung component. Resistance was unaffected. Under TEA, positive end-expiratory pressure and recruitment maneuvers are advisable.

  9. A reappraisal of pediatric thoracic surface anatomy.

    Science.gov (United States)

    Fischer, Nicholas J; Morreau, Jonty; Sugunesegran, Ramanen; Taghavi, Kiarash; Mirjalili, S Ali

    2017-09-01

    Accurate knowledge of surface anatomy is fundamental to safe clinical practice. A paucity of evidence in the literature regarding thoracic surface anatomy in children was identified. The associations between surface landmarks and internal structures were meticulously analyzed by reviewing high quality computed tomography (CT) images of 77 children aged from four days to 12 years. The results confirmed that the sternal angle is an accurate surface landmark for the azygos-superior vena cava junction in a plane through to the level of upper T4 from birth to age four, and to lower T4 in older children. The concavity of the aortic arch was slightly below this plane and the tracheal and pulmonary artery bifurcations were even lower. The cardiac apex was typically at the 5 th intercostal space (ICS) from birth to age four, at the 4 th ICS and 5 th rib in 4-12 year olds, and close to the midclavicular line at all ages. The lower border of the diaphragm was at the level of the 6 th or 7 th rib at the midclavicular line, the 7 th ICS and 8 th rib at the midaxillary line, and the 11 th thoracic vertebra posteriorly. The domes of the diaphragm were generally flatter and lower in children, typically only one rib level higher than its anterior level at the midclavicular line. Diaphragm apertures were most commonly around the level of T9, T10, and T11 for the IVC, esophagus and aorta, respectively. This is the first study to provide an evidence-base for thoracic surface anatomy in children. Clin. Anat. 30:788-794, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  10. The reported thoracic injuries in Homer's Iliad

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    Apostolaki Mary

    2010-11-01

    Full Text Available Abstract Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%, the stones (7.4%, the arrow (5.5% and the sword (5.5%. We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim, medium (those which cause the victim to abandon the battlefield, and severe (those which cause death of the victim. According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95% and the remaining 8 an Achaean (21.05%. The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield.

  11. The reported thoracic injuries in Homer's Iliad.

    Science.gov (United States)

    Apostolakis, Efstratios; Apostolaki, Georgia; Apostolaki, Mary; Chorti, Maria

    2010-11-19

    Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%), the stones (7.4%), the arrow (5.5%) and the sword (5.5%). We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim), medium (those which cause the victim to abandon the battlefield), and severe (those which cause death of the victim). According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95%) and the remaining 8 an Achaean (21.05%). The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield.

  12. Thoracic hyperkyphosis: a survey of Australian physiotherapists.

    Science.gov (United States)

    Perriman, Diana M; Scarvell, Jennifer M; Hughes, Andrew R; Lueck, Christian J; Dear, Keith B G; Smith, Paul N

    2012-09-01

    Age-related thoracic hyperkyphosis can lead to poor health outcomes including pain and dysfunction. Physiotherapists are fundamentally involved in the assessment and treatment of this problem but there is no published data that details assessment and treatment strategies or the attitudes of practitioners with respect to hyperkyphosis. The purpose of the study is to ascertain current physiotherapy practice for, and attitudes to, the assessment and treatment of thoracic hyperkyphosis in Australia. A stratified random sample (N = 468) of Australian physiotherapists in all states and territories working in hospitals, outpatient clinics and community clinics were sent an anonymous cross-sectional postal survey. The survey had six sections identifying clinical profile, prevalence, measurement strategy, treatment frequency, treatment strategy and evidence source. A response rate of 47% with anonymity preserved was achieved. The majority of respondents had a musculoskeletal practice profile (75%). Seventy-eight per cent encountered hyperkyphosis at least weekly, and three treatment sessions were most commonly given (35%). Visual inspection was almost universally used to assess the degree of hyperkyphosis (98%), and for 64% it was their only measurement tool. Postural re-education was the most common treatment strategy (90%) but the range of treatments reported was diverse. The primary source of evidence used by the majority of respondents was their undergraduate education, and there was concern expressed that physiotherapists lack good evidence upon which to make therapeutic decisions about hyperkyphosis. Thoracic hyperkyphosis is commonly encountered by physiotherapists. Measurement of treatment efficacy is highly subjective, and the treatment modalities employed are diverse. Many physiotherapists based their management of hyperkyphosis on their undergraduate education alone. Copyright © 2011 John Wiley & Sons, Ltd.

  13. [Treatment of thoracic disc herniation. Case report].

    Science.gov (United States)

    Picado-Baca, Mauricio Leonardo; Mireles-Cano, José Nicolás; León-Meza, Víctor Manuel; García-González, Oscar Guillermo; Ramos-Trujillo, Alejandro

    2016-01-01

    Herniated thoracic intervertebral disc is a rare cause of spinal cord compression. Its frequency varies from 0.15% to 1.7% of all disc herniations, and produces symptoms in 0.5% to 0.8%. Case 1. A 50-year-old woman, with pain and burning sensation in left hemithorax of four months of onset. It was treated as a herpetic syndrome, with no improvement. She was seen after thirteen days of exacerbation of clinical symptoms. The physical examination showed asymmetric paraparesis, lower left pelvic limb 1/5, and right pelvic limb 3/5¸ sensory level T8, with left Babinski positive. A thoracic disc herniation in space T8-T9 was diagnosed. A 55-year-old patient with a history of presenting pain in lumbar area of 5 years onset. She also had radicular pain that radiated to the right pelvic limb, with intensity 10/10 on a Visual Analogue Scale. Her physical examination showed muscle strength 5/5, with normal sensitivity in all dermatomes and tendon reflexes, and a positive right Babinski. Thoracic disc herniation T7-T8 level was diagnosed. Due to anatomical conditions that define this type of hernia, the extracavitary posterolateral approach should be the recommended surgical procedure when the simultaneously performed anterior decompression and fixation with posterior instrumentation are the treatments proposed. Despite the different anatomical structures of this special area, it was possible to obtain satisfactory results for both clinical cases. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  14. Integrated diagnostic imaging of primary thoracic rhabdomyosarcoma.

    Science.gov (United States)

    Almberger, M; Iannicelli, E; Matrunola, M; Schiavetti, A; Capocaccia, P

    2001-01-01

    We report a rare case of primary thoracic rhabdomyosarcoma in a girl who was referred with acute chest pain, hacking cough, and wheezing. A chest X-ray revealed a complete opacity of the right hemithorax. Ultrasound revealed a right-sided pleural effusion and a solid mass above the liver dome, suggesting a neoplastic disease, which quickly led to further specific examination. Use of CT and MRI together with bone scintigraphy completed the investigation. The biopsy specimen showed a pattern of alveolar rhabdomyosarcoma. This case was reported to emphasize the role of US in the evaluation of a child with hemithorax opacity.

  15. Conservative management of thoracic outlet syndrome.

    Science.gov (United States)

    Novak, C B

    1996-04-01

    Conservative management of thoracic outlet syndrome requires accurate evaluation of the peripheral nervous system, posture, and the cervico-scapular muscles. Patients should be instructed in postural correction in sitting, standing and sleeping, stretching exercises (ie, upper trapezius, levator scapulae, suboccipitals, scalenes, sternocleidomastoid and pectoral muscles), and strengthening exercises of the lower scapular stabilizers beginning in gravity-assisted positions to regain normal movement patterns in the cervico-scapular region. Patient education, compliance to an exercise program, and behavioral modification at home and work are critical to successful conservative management.

  16. Idiopathic thoracic aortic aneurysm at pediatric age.

    Science.gov (United States)

    Marín-Manzano, E; González-de-Olano, D; Haurie-Girelli, J; Herráiz-Sarachaga, J I; Bermúdez-Cañete, R; Tamariz-Martel, A; Cuesta-Gimeno, C; Pérez-de-León, J

    2009-03-01

    A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

  17. Integrated diagnostic imaging of primary thoracic rhabdomyosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Almberger, M.; Iannicelli, E. [Dept. of Radiology, University ' ' La Sapienza' ' , Rome (Italy); Matrunola, M.; Schiavetti, A.; Capocaccia, P. [Dept. of Pediatric Radiology, University ' ' La Sapienza' ' , Rome (Italy)

    2001-03-01

    We report a rare case of primary thoracic rhabdomyosarcoma in a girl who was referred with acute chest pain, hacking cough, and wheezing. A chest X-ray revealed a complete opacity of the right hemithorax. Ultrasound revealed a right-sided pleural effusion and a solid mass above the liver dome, suggesting a neoplastic disease, which quickly led to further specific examination. Use of CT and MRI together with bone scintigraphy completed the investigation. The biopsy specimen showed a pattern of alveolar rhabdomyosarcoma. This case was reported to emphasize the role of US in the evaluation of a child with hemithorax opacity. (orig.)

  18. Thoracic Ganglioneuromas Resulting in Nonimmune Hydrops Fetalis

    Directory of Open Access Journals (Sweden)

    Paul Singh

    2014-05-01

    Full Text Available Introduction - Most often, ganglioneuromas affect older pediatric and adult patients. They are typically slow growing tumors that remain clinically silent until they become large enough to cause symptoms by compression of adjacent structures. Case - We report a case of a 22-year-old Hispanic gravida 2 para 1 female patient who was found to have massive hydrops fetalis at 20 completed gestational weeks. Fetal echocardiography revealed a narrowed distal ductal arch and proximal descending aorta. Cesarean delivery was undertaken at 29 completed gestational weeks for refractory labor and nonreassuring fetal status. The neonate expired at 47 minutes of life despite aggressive resuscitation. At autopsy, multiple thoracic masses were found adjacent to a compressed proximal descending aorta. Histological and immunohistochemical analysis confirmed the diagnosis of a ganglioneuroma, a rare type of neural crest tumor. Discussion - A variety of intrathoracic masses have previously been reported to cause hydrops fetalis including teratomas, fibrosarcomas, and lymphangiomas. To our knowledge, this case is the first description of hydrops fetalis caused by ganglioneuromas. We propose that multiple thoracic ganglioneuromas led to biventricular distal outflow tract obstruction and hydrops fetalis.

  19. Comparative Analysis of the Radiology of Osteoporotic Vertebral Fractures in Women and Men: Cross-Sectional and Longitudinal Observations from the Canadian Multicentre Osteoporosis Study (CaMos).

    Science.gov (United States)

    Lentle, Brian C; Berger, Claudie; Probyn, Linda; Brown, Jacques P; Langsetmo, Lisa; Fine, Ben; Lian, Kevin; Shergill, Arvind K; Trollip, Jacques; Jackson, Stuart; Leslie, William D; Prior, Jerilynn C; Kaiser, Stephanie M; Hanley, David A; Adachi, Jonathan D; Towheed, Tanveer; Davison, K Shawn; Cheung, Angela M; Goltzman, David

    2017-07-19

    We compared two methods for osteoporotic vertebral fracture (VF) assessment on lateral spine radiographs, the Genant semiquantitative (GSQ) technique and a modified algorithm-based qualitative (mABQ) approach. We evaluated 4465 women and 1771 men aged ≥50 years from the Canadian Multicentre Osteoporosis Study with available X-ray images at baseline. Observer agreement was lowest for grade 1 VFs determined by GSQ. Among physician readers, agreement was greater for VFs diagnosed by mABQ (ranging from 0.62 [95% confidence interval (CI) 0.00-1.00] to 0.88 [0.76-1.00]) than by GSQ (ranging from 0.38 [0.17-0.60] to 0.69 [0.54-0.85]). GSQ VF prevalence (16.4% [95% CI 15.4-17.4]) and incidence (10.2/1000 person-years [9.2; 11.2]) were higher than with the mABQ method (prevalence 6.7% [6.1-7.4] and incidence 6.3/1000 person-years [5.5-7.1]). Women had more prevalent and incident VFs relative to men as defined by mABQ but not as defined by GSQ. Prevalent GSQ VFs were predominantly found in the mid-thoracic spine, whereas prevalent mABQ and incident VFs by both methods co-localized to the junction of the thoracic and lumbar spine. Prevalent mABQ VFs compared with GSQ VFs were more highly associated with reduced adjusted L 1 to L 4 bone mineral density (BMD) (-0.065 g/cm 2 [-0.087 to -0.042]), femoral neck BMD (-0.051 g/cm 2 [-0.065 to -0.036]), and total hip BMD (-0.059 g/cm 2 [-0.076 to -0.041]). Prevalent mABQ VFs compared with prevalent GSQ were also more highly associated with incident VF by GSQ (odds ratio [OR] = 3.3 [2.2-5.0]), incident VF by mABQ (9.0 [5.3-15.3]), and incident non-vertebral major osteoporotic fractures (1.9 [1.2-3.0]). Grade 1 mABQ VFs, but not grade 1 GSQ VFs, were associated with incident non-vertebral major osteoporotic fractures (OR = 3.0 [1.4-6.5]). We conclude that defining VF by mABQ is preferred to the use of GSQ for clinical assessments. © 2017 American Society for Bone and Mineral Research. © 2017 American Society for Bone

  20. The Canadian safeguards support program

    Energy Technology Data Exchange (ETDEWEB)

    Keeffe, R. [Atomic Energy Control Board, Canadian Safeguards Support Program, Ottawa, Ontario (Canada)

    1998-07-01

    Canada supports international safeguards as a means by which the proliferation of nuclear weapons can be discouraged. Canada recognizes that,to meet that the IAEA must have effective safeguards techniques and the active cooperation of Member States. Therefore the Canadian Government decided in 1976 to initiate a program in support of IAEA safeguards, known as the Canadian Safeguards Support Program (CSSP). The CSSP is funded and administered by the Atomic Energy Control Board (AECB). The CSSP is a co-ordinated program for the development and the application of safeguards instruments and techniques for nuclear facilities and materials on behalf of the IAEA and also in support of Canada's own national nuclear material safeguards system, implemented by the AECB. (author)

  1. Canadian safeguards - an historical perspective

    Energy Technology Data Exchange (ETDEWEB)

    Ironside, A.M. (Ontario Hydro, Toronto, Ontario (Canada)); Smith, R.M.

    1992-01-01

    The paper summarizes safeguards activities and programs undertaken in Canada. In 1970, Canada, in collaboration with the IAEA, began a study of procedures and equipment required for the application of safeguards to on-line-fueled reactors. In 1977, this assistance was substantially increased and formalized into the Canadian Safeguards Support Program (CSSP). To date, Canada has spent in excess of $35 million Canadian on this program. The CSSP provides support to the IAEA safeguards effort for areas in which Canada has expertise and has been primarily engaged in developing safeguards procedures and equipment for the CANDU power reactors in Canada and throughout the world. Work, projects, and equipment development undertaken by CANDU CSSP are highlighted.

  2. Canadian prostate brachytherapy in 2012

    Science.gov (United States)

    Keyes, Mira; Crook, Juanita; Morris, W. James; Morton, Gerard; Pickles, Tom; Usmani, Nawaid; Vigneault, Eric

    2013-01-01

    Prostate brachytherapy can be used as a monotherapy for low- and intermediate-risk patients or in combination with external beam radiation therapy (EBRT) as a form of dose escalation for selected intermediate- and high-risk patients. Prostate brachytherapy with either permanent implants (low dose rate [LDR]) or temporary implants (high dose rate [HDR]) is emerging as the most effective radiation treatment for prostate cancer. Several large Canadian brachytherapy programs were established in the mid- to late-1990s. Prostate brachytherapy is offered in British Columbia, Alberta, Manitoba, Ontario, Quebec and New Brunswick. We anticipate the need for brachytherapy services in Canada will significantly increase in the near future. In this review, we summarize brachytherapy programs across Canada, contemporary eligibility criteria for the procedure, toxicity and prostate-specific antigen recurrence free survival (PRFS), as published from Canadian institutions for both LDR and HDR brachytherapy. PMID:23671495

  3. Reframing the Canadian Oil Sands

    OpenAIRE

    Patchett, Merle M; Lozowy, A

    2012-01-01

    Reframing the Canadian Oil Sands” is a collaborative exchange between photographer Andriko Lozowy and cultural geographer Merle Patchett that engages photography and photographic theory to evoke a more critical and politically meaningful visual engagement with the world’s largest capital oil project. Since the appearance of Edward Burtynsky’s aerial and abstracted photographic-mappings of the region, capturing the scale of the Oil Sands from ‘on high’ has become the dominant visual imaginary....

  4. Outcomes after endovascular or open repair for degenerative descending thoracic aortic aneurysm using linked hospital data.

    Science.gov (United States)

    von Allmen, R S; Anjum, A; Powell, J T

    2014-09-01

    The population-based effectiveness of thoracic endovascular aortic repair (TEVAR) versus open surgery for descending thoracic aortic aneurysm remains in doubt. Patients aged over 50 years, without a history of aortic dissection, undergoing repair of a thoracic aortic aneurysm between 2006 and 2011 were assessed using mortality-linked individual patient data from Hospital Episode Statistics (England). The principal outcomes were 30-day operative mortality, long-term survival (5 years) and aortic-related reinterventions. TEVAR and open repair were compared using crude and multivariable models that adjusted for age and sex. Overall, 759 patients underwent thoracic aortic aneurysm repair, mainly for intact aneurysms (618, 81·4 per cent). Median ages of TEVAR and open cohorts were 73 and 71 years respectively (P open repair (6·5 versus 7·6 per cent; odds ratio 0·79, 95 per cent confidence interval (c.i.) 0·41 to 1·49), but the 5-year survival rate was significantly worse after TEVAR (54·2 versus 65·6 per cent; adjusted hazard ratio 1·45, 95 per cent c.i. 1·08 to 1·94). After 5 years, aortic-related mortality was similar in the two groups, but cardiopulmonary mortality was higher after TEVAR. TEVAR was associated with more aortic-related reinterventions (23·1 versus 14·3 per cent; adjusted HR 1·70, 95 per cent c.i. 1·11 to 2·60). There were 141 procedures for ruptured thoracic aneurysm (97 TEVAR, 44 open), with TEVAR showing no significant advantage in terms of operative mortality. In England, operative mortality for degenerative descending thoracic aneurysm was similar after either TEVAR or open repair. Patients who had TEVAR appeared to have a higher reintervention rate and worse long-term survival, possibly owing to cardiopulmonary morbidity and other selection bias. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  5. Thoracic ectopia cordis in an Ethiopian neonate | Tadele | Ethiopian ...

    African Journals Online (AJOL)

    Background: Ectopia Cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect with failure of fusion of the sternum with extra thoracic location of the heart. The estimated prevalence of this case is 5.5 to 7.9 per million live births. Case Presentation: We had a ...

  6. Thoracic cage injury imaging in rugby players | de Villiers | SA ...

    African Journals Online (AJOL)

    Rugby players often sustain high-impact collisions and are therefore at risk of significant traumatic thoracic injuries. Injury to the thoracic cage may be associated with potentially life-threatening sequelae. Player management is often based on the accuracy of the imaging report. The author suggests a combination of ...

  7. Lung cancer screening and video-assisted thoracic surgery

    DEFF Research Database (Denmark)

    Petersen, René Horsleben; Hansen, Henrik Jessen; Dirksen, Asger

    2012-01-01

    The objective of this study is to report the impact of computed tomography (CT) screening on the use of Video-Assisted Thoracic Surgery (VATS) in a randomized screening trial.......The objective of this study is to report the impact of computed tomography (CT) screening on the use of Video-Assisted Thoracic Surgery (VATS) in a randomized screening trial....

  8. Video-Assisted Thoracic Surgery in Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Calvin SH Ng

    2002-01-01

    Full Text Available The proven safety and efficacy of minimal access video-assisted thoracic surgery has changed the way that spontaneous pneumothorax is managed. This review presents some of the experiences of the decade, discusses the controversies and reviews the current video-assisted thoracic surgical management of spontaneous pneumothorax.

  9. ORIGINAL ARTICLES Fifty years of thoracic surgical research in ...

    African Journals Online (AJOL)

    2009-08-01

    Aug 1, 2009 ... staging in non-small-cell lung cancer.7 A non-randomised prospective study reported on the effect of normovolaemic haemodilution in 10 patients before thoracic surgery.14. Of the 252 publications, 189 (75%) had a thoracic surgeon as first author, of which 141 reported clinical data in case. Cardiac.

  10. Reconstruction of a Rollover Crash for Thoracic Injury Etiology Investigation

    Directory of Open Access Journals (Sweden)

    Tana Tan

    2017-11-01

    Full Text Available The cause of serious and fatal thoracic injuries in passenger vehicle rollover crashes is currently not well understood. Previous research on thoracic injuries resulting from rollover crashes have focused primarily on statistical analysis of crash data. This study seeks to develop a better understanding of where in the rollover sequence thoracic injuries may occur. To do this, a real-world passenger vehicle rollover crash where the driver sustained serious bilateral thoracic injuries was reconstructed. Multi-body analysis was used to determine the vehicle’s pre-trip trajectory and to obtain the vehicle’s position and kinematics at the point of trip. This information was then used to prescribe the motion of the vehicle in a finite element analysis. A finite element model of the EuroSID-2re anthropomorphic test device was placed in the driver’s seat. Four simulations, each with the anthropomorphic test device positioned in different postures, were performed. Rib deflection, spinal acceleration, and thoracic impact velocity were obtained from the anthropomorphic test device and compared to existing thoracic injury assessment reference values. From the analysis, lateral thoracic impact velocity indicates that a serious thoracic injury is likely to have occurred when the driver impacted the centre console during the vehicle’s fourth quarter-turn.

  11. Menstruation in an unusual place: A case of thoracic endometriosis ...

    African Journals Online (AJOL)

    While pelvic endometriosis is relatively common, thoracic menstruation is rare. A report of what is believed to be the first case of thoracic endometriosis in Uganda is given. A 34 year old female was complaining of on and off chest pain mainly on the right side. Clinically she had signs of pleural effusion and 500 mls of altered ...

  12. The major thoracic vascular invasion of lung cancer

    Directory of Open Access Journals (Sweden)

    Soichi Oka

    2017-08-01

    Conclusion: The positive predictive value of the preoperative CT findings for tumor invasion of the thoracic vessels was low. Therefore, surgical opportunities that offer the chance of a cure shouldn't be missed in advanced lung cancer patients because the tumor is located near the major thoracic vessels on preoperative CT.

  13. Biomechanical study of the funnel technique applied in thoracic ...

    African Journals Online (AJOL)

    Abstract. Background: Funnel technique is a method used for the insertion of screw into thoracic pedicle. Aim: To evaluate the biomechanical characteristics of thoracic pedicle screw placement using the Funnel technique, trying to provide biomechanical basis for clinical application of this technology. Methods: 14 functional ...

  14. Biomechanical study of the funnel technique applied in thoracic ...

    African Journals Online (AJOL)

    Background: Funnel technique is a method used for the insertion of screw into thoracic pedicle. Aim: To evaluate the biomechanical characteristics of thoracic pedicle screw placement using the Funnel technique, trying to provide biomechanical basis for clinical application of this technology. Methods: 14 functional spinal ...

  15. State of the art thoracic ultrasound: intervention and therapeutics

    NARCIS (Netherlands)

    Corcoran, John P.; Tazi-Mezalek, Rachid; Maldonado, Fabien; Yarmus, Lonny B.; Annema, Jouke T.; Koegelenberg, Coenraad F. N.; St Noble, Victoria; Rahman, Najib M.

    2017-01-01

    The use of thoracic ultrasound outside the radiology department and in everyday clinical practice is becoming increasingly common, having been incorporated into standards of care for many specialties. For the majority of practitioners, their experience of, and exposure to, thoracic ultrasound will

  16. Pathology of the thoracic wall: congenital and acquired

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Pena, Pilar; Barber, Ignasi [Hospital Materno-Infantil, Pediatric Radiology, Barcelona (Spain)

    2010-06-15

    This review aims to cover the main congenital and acquired lesions that arise in the thoracic wall of infants and children. Imaging often plays an essential role in the evaluation of symptomatic and asymptomatic thoracic wall abnormalities. The use of appropriate imaging modalities for each condition will be addressed, as well as the range of benign and malignant conditions that can occur. (orig.)

  17. Intramedullary spinal epidermoid presenting after thoracic meningocele repair: case report.

    Science.gov (United States)

    Grobelny, Bartosz T; Weiner, Howard L; Harter, David H

    2015-06-01

    A 4-year-old girl with a history of thoracic meningocele repair at the age of 3 months presented with progressive myelopathy. An intramedullary thoracic epidermoid was identified on MRI. The patient underwent excision of the epidermoid and subsequently returned to neurological baseline. This case illustrates the potential for delayed development of intraspinal epidermoid after initial repair of a simple meningocele.

  18. variations in dimensions and shape of thoracic cage with aging

    African Journals Online (AJOL)

    ABSTRACT. The thoracic cage variations in dimensions and proportions are influenced by age, sex and race. The objective of the present review was to describe the age related changes occurring in thoracic wall and its influence on the pattern of respiration in infants, adult and elderly. We had systematically reviewed, ...

  19. Thoracic electrical bioimpedance versus suprasternal Doppler in emergency care.

    Science.gov (United States)

    Elwan, Mohammed H; Hue, Jeremy; Green, Samira J; Eltahan, Salah M; Sims, Mark R; Coats, Timothy J

    2017-08-01

    There are a number of cardiac output (CO) monitors that could potentially be used in the ED. Two of the most promising methods, thoracic electrical bioimpedance and suprasternal Doppler, have not been directly compared. The aim of this study was to investigate the feasibility of CO monitoring using suprasternal Doppler and bioimpedance in emergency care and compare haemodynamic data obtained from both monitors. Haemodynamic measurements were made on the same group of patients using bioimpedance (Niccomo, Medis, Germany) and suprasternal Doppler (USCOM, Sydney, Australia). Usable CO data were obtained in 97% of patients by suprasternal Doppler and 87% by bioimpedance. The median CO obtained by Doppler was 3.4 L/min lower than bioimpedance. The stroke volume median was lower by 51 mL in Doppler. These two methods of non-invasive cardiac monitoring are not interchangeable. The results suggest that the choice of non-invasive cardiac monitor is important, but the grounds on which to make this choice are not currently clear. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  20. Ergonomics in thoracoscopic surgery: results of a survey among thoracic surgeons†

    Science.gov (United States)

    Welcker, Katrin; Kesieme, Emeka B.; Internullo, Eveline; Kranenburg van Koppen, Laura J.C.

    2012-01-01

    OBJECTIVES The frequent and prolonged use of thoracoscopic equipment raises ergonomic risks which may cause physical distress. We aimed to determine the relationship between ergonomic problems encountered in thoracoscopic surgery and physical distress among thoracic surgeons. METHODS An online questionnaire which investigated personal factors, product factors, interaction factors and physical discomfort was sent to all members of the European Society of Thoracic Surgeons (ESTS). RESULTS Of the respondents, 2.4% indicated that a one arm's length should be the optimal distance between the surgeon and the monitor. Only 2.4% indicated that the monitor should be positioned below the eye level of the surgeon. Most of the respondents agreed, partially to fully, that they experienced neck discomfort because of inappropriate monitor height, bad monitor position and bad table height. Most respondents experienced numb fingers and shoulder discomfort due to instrument manipulation. Most of the respondents (77.1%) experienced muscle fatigue to some extent due to a static posture during thoracoscopic surgery. The majority of respondents (81.9, 76.3 and 83.2% respectively) indicated that they had varying degrees of discomfort mainly in the neck, shoulder and back. Some 94.4% of respondents were unaware of any guidelines concerning table height, monitor and instrument placement for endoscopic surgery. CONCLUSIONS Most thoracic surgeons in Europe are unaware of ergonomic guidelines and do not practise them, hence they suffer varying degrees of physical discomfort arising from ergonomic issues. PMID:22586071

  1. Nutritional risk among older Canadians.

    Science.gov (United States)

    Ramage-Morin, Pamela L; Garriguet, Didier

    2013-03-01

    Nutritional risk screening is typically done in clinical settings to identify individuals at risk of malnourishment. This article presents the first population-level assessment of nutritional risk based on a large national sample representative of Canadian householders aged 65 or older. Data from the 2008/2009 Canadian Community Health Survey-Healthy Aging were used to estimate the prevalence of nutritional risk by selected characteristics. Factors associated with nutritional risk were examined with restricted and full logistic models. The distribution of responses on the SCREEN II-AB nutritional risk instrument is reported. Based on the results of the 2008/2009 survey, 34% of Canadians aged 65 or older were at nutritional risk. Women were more likely than men to be at risk. Among people with depression, 62% were at nutritional risk, compared with 33% of people without depression. Level of disability, poor oral health, and medication use were associated with nutritional risk, as were living alone, low social support, infrequent social participation, and not driving on a regular basis. Lower income and education were also associated with nutritional risk. Nutritional risk is common among seniors living in private households in Canada. The characteristics of people most likely to be at nutritional risk provide evidence for targeted screening and assessment.

  2. Quality in Family Child Care: A Focus Group Study with Canadian Providers

    Science.gov (United States)

    Doherty, Gillian

    2015-01-01

    A substantial proportion of American, Canadian and English preschoolers regularly participate in family child care making its quality of vital importance for the children concerned, their parents, the school system and the society in which they live. This article discusses the seven key caregiver behaviors and physical space characteristics…

  3. Using a Wider Lens to Shift the Discourse on Food in Canadian Curriculum Policies

    Science.gov (United States)

    Robertson, Lorayne; Scheidler-Benns, Joli

    2016-01-01

    Healthy eating is important to overall health, but Canadian health agencies disagree on the degree to which lifestyle or society determines healthy eating. The authors review the literature and design a policy analysis framework that captures discursive elements of both arguments. They apply this framework to education policy, analysing the…

  4. 50 Shades of Green: An Examination of Sustainability Policy on Canadian Campuses

    Science.gov (United States)

    Vaughter, Philip; Wright, Tarah; Herbert, Yuill

    2015-01-01

    Koichiro Matsuura, Director-General of UNESCO, asserts that education is one of the most effective instruments that society can employ in the effort to adopt sustainable development. This paper is a first effort to explore the degree to which Canadian institutions of higher education, including colleges and universities, have embraced this…

  5. Accessory liver lobe in the left thoracic cavity.

    Science.gov (United States)

    Han, Serdar; Soylu, Lutfi

    2009-06-01

    Accessory liver of the thoracic cavity is usually asymptomatic, and its incidental detection is extremely rare. In this study, an unusual case of an accessory liver lobe of the thoracic cavity in a 26-year-old woman is described. A chest roentgenogram and thoracic computed tomographic scan revealed a mass in the left thoracic cavity. Left posterolateral thoracotomy was performed by removing a 10 x 8 x 5 cm(3) mass separated from lung. The arterial and venous supply of the mass originated from the abdomen. The diaphragm was found to be intact. The pathologist reported a normal hepatic tissue. This report presented a very rare occurrence of accessory liver in the thoracic cavity.

  6. Representing Canadian Muslims: Media, Muslim Advocacy Organizations, and Gender in the Ontario Shari’ah Debate

    Directory of Open Access Journals (Sweden)

    Meena Sharify-Funk

    2009-01-01

    Full Text Available This paper analyzes a highly public conflict between two Muslim non-profit organizations, the Canadian Islamic Congress (CIC and the Muslim Canadian Congress (MCC, as it played out on the pages of Canadian newspapers and Internet websites. Sparked by profoundly divergent convictions about gender norms and fuelled by contradictory blueprints for “being Muslim in Canada”, this incendiary conflict was fanned by Canadian media coverage. Focusing especially, but not exclusively, on the 2003-2005 debate over Shari’ah-based alternative dispute resolution in Ontario, I will argue that the media have played a role in constructing internal Muslim debates and identity negotiations concerning what it means to be genuinely Canadian and authentically Muslim through controversy-driven journalism that has highlighted opposing ends of a liberal/progressive versus conservative/traditional axis in a search for “point/counter-point” views. Through short stories and commentaries on controversial topicsthat juxtapose two increasingly antagonistic organizational voices, the media have not merely reflected Muslim realities, but also helped to shape them and, more often than not, reinforce polarization between a “majority Muslim” culture seeking to secure space for itself within Canadian society and a “dissident Muslim” culture that seeks to consolidate external support for internal change.

  7. Heritability of Thoracic Spine Curvature and Genetic Correlations With Other Spine Traits: The Framingham Study.

    Science.gov (United States)

    Yau, Michelle S; Demissie, Serkalem; Zhou, Yanhua; Anderson, Dennis E; Lorbergs, Amanda L; Kiel, Douglas P; Allaire, Brett T; Yang, Laiji; Cupples, L Adrienne; Travison, Thomas G; Bouxsein, Mary L; Karasik, David; Samelson, Elizabeth J

    2016-12-01

    Hyperkyphosis is a common spinal disorder in older adults, characterized by excessive forward curvature of the thoracic spine and adverse health outcomes. The etiology of hyperkyphosis has not been firmly established, but may be related to changes that occur with aging in the vertebrae, discs, joints, and muscles, which function as a unit to support the spine. Determining the contribution of genetics to thoracic spine curvature and the degree of genetic sharing among co-occurring measures of spine health may provide insight into the etiology of hyperkyphosis. The purpose of our study was to estimate heritability of thoracic spine curvature using T4 -T12 kyphosis (Cobb) angle and genetic correlations between thoracic spine curvature and vertebral fracture, intervertebral disc height narrowing, facet joint osteoarthritis (OA), lumbar spine volumetric bone mineral density (vBMD), and paraspinal muscle area and density, which were all assessed from computed tomography (CT) images. Participants included 2063 women and men in the second and third generation offspring of the original cohort of the Framingham Study. Heritability of kyphosis angle, adjusted for age, sex, and weight, was 54% (95% confidence interval [CI], 43% to 64%). We found moderate genetic correlations between kyphosis angle and paraspinal muscle area (ρˆG , -0.46; 95% CI, -0.67 to -0.26), vertebral fracture (ρˆG , 0.39; 95% CI, 0.18 to 0.61), vBMD (ρˆG , -0.23; 95% CI, -0.41 to -0.04), and paraspinal muscle density (ρˆG , -0.22; 95% CI, -0.48 to 0.03). Genetic correlations between kyphosis angle and disc height narrowing (ρˆG , 0.17; 95% CI, -0.05 to 0.38) and facet joint OA (ρˆG , 0.05; 95% CI, -0.15 to 0.24) were low. Thoracic spine curvature may be heritable and share genetic factors with other age-related spine traits including trunk muscle size, vertebral fracture, and bone mineral density. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and

  8. Recent Canadian ophthalmology graduates: experiences in finding jobs and assessment of their training.

    Science.gov (United States)

    Bellan, Lorne

    2012-06-01

    To examine the ability of recent Canadian ophthalmology graduates to commence clinical practice and obtain surgical privileges. A secondary objective was to assess their perception of the adequacy of their residency training. An Internet questionnaire survey. Canadian graduates of Canadian ophthalmology residency programs between 2005 and 2009, inclusive. Email addresses for the participants were obtained from the Canadian Ophthalmological Society and invitations to participate were sent, followed by 2 reminder emails. A 44% response rate was obtained (65 out of 154 emails sent). Of the respondents, 91% were working full time, and 89% had operating-room time. Training was adequate for all CanMEDs competencies except working as a manager. Assessment that one's practice did not live up to expectations correlated with male gender, dissatisfaction with location, inability to get operating-room time, inability to get other hospital resources, feelings about fairness of distribution of resources, and net income below expectations. For the most part, recent graduates are successful in establishing practices that meet their expectations. Training in management skills should be improved in residency programs. Copyright © 2012 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  9. Reconstructive or cosmetic plastic surgery? Factors influencing the type of practice established by Canadian plastic surgeons.

    Science.gov (United States)

    McInnes, Colin W; Courtemanche, Douglas J; Verchere, Cynthia G; Bush, Kevin L; Arneja, Jugpal S

    2012-01-01

    Some argue that the specialty of plastic surgery is facing a changing identity. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have increasingly adopted cosmetic-focused practices. The present study investigated the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors that influence practice type to determine whether a similar pattern exists in Canada. An anonymous online survey regarding practice profiles was distributed to all 352 Canadian plastic surgeons with e-mail accounts registered with the Canadian Society of Plastic Surgeons and/or the Canadian Society for Aesthetic Plastic Surgery. The survey response rate was 34% (120 responses), of which 75% of respondents currently had a reconstructive practice and 25% had a cosmetic practice. Reconstructive surgeons had more educational debt following their training, spent more time on emergency call, academics and teaching and, when deciding which type of practice to establish, were more influenced by academic opportunities and less influenced by financial and nonfinancial metrics. Similarities between the groups included hours worked per week and academic achievements. The field of reconstructive plastic surgery appears to be thriving in Canada. While a transition from reconstructive to cosmetic practice is common, compared with their American colleagues, a greater proportion of Canadian plastic surgeons maintain reconstructive practices. Differences between reconstructive and cosmetic plastic surgeons are discussed.

  10. Supplementary Educational Models in Canadian Neurosurgery Residency Programs.

    Science.gov (United States)

    Ryu, Won Hyung A; Chan, Sonny; Sutherland, Garnette R

    2017-03-01

    The proposed implementation of work hour restrictions has presented a significant challenge of maintaining the quality of resident education and ensuring adequate hands-on experience that is essential for novice surgeons. To maintain the level of resident surgical competency, revision of the apprentice model of surgical education to include supplementary educational methods, such as laboratory and virtual reality (VR) simulations, have become frequent topics of discussion. We aimed to better understand the role of supplementary educational methods in Canadian neurosurgery residency training. An online survey was sent to program directors of all 14 Canadian neurosurgical residency programs and active resident members of the Canadian Neurosurgical Society (N=85). We asked 16 questions focusing on topics of surgeon perception, current implementation and barriers to supplementary educational models. Of the 99 surveys sent, 8 out of 14 (57%) program directors and 37 out of 85 (44%) residents completed the survey. Of the 14 neurosurgery residency programs across Canada, 7 reported utilizing laboratory-based teaching within their educational plan, while only 3 programs reported using VR simulation as a supplementary teaching method. The biggest barriers to implementing supplementary educational methods were resident availability, lack of resources, and cost. Work-hour restrictions threaten to compromise the traditional apprentice model of surgical training. The potential value of supplementary educational methods for surgical education is evident, as reported by both program directors and residents across Canada. However, availability and utilization of laboratory and VR simulations are limited by numerous factors such as time constrains and lack of resources.

  11. Social Support and Exclusive Breast feeding among Canadian Women.

    Science.gov (United States)

    Laugen, Chris M; Islam, Nazrul; Janssen, Patricia A

    2016-09-01

    The World Health Organization recommendation for exclusive breast feeding for 6 months has been endorsed by Health Canada, the Canadian Pediatric Society, Dietitians of Canada, and the Breastfeeding Committee for Canada as of 2012. This study examines whether social support is associated with exclusive breast feeding up to 6 months among Canadian mothers. We utilised data from the Canadian Community Health Survey and limited our sample to mothers who gave birth in the 5 years prior to the 2009-2010 survey (n = 2133). Multivariable logistic regression was used to examine the relationship between exclusive breast feeding and four dimensions of social support: (i) tangible, (ii) affectionate, (iii) positive social interaction, and (iv) emotional and informational, based on the Medical Outcomes Study Social Support Scale. Absolute and relative differences in the probability of breast feeding exclusively and their 95% confidence intervals were calculated. In adjusted models, differences in the probability of exclusive breast feeding for 6 months were not different among women with high vs. low social support. The association between social support and breastfeeding exclusively was modified by education level, with significantly higher probability of breast feeding exclusively among women with lower education and high vs. low levels of tangible and affectionate support. Among women with education below a high school level, high tangible and affectionate support significantly increased probability of exclusive breast feeding for 6 months in this study. Efforts to encourage exclusive breast feeding need to address social support for mothers, especially those with lower education. © 2016 John Wiley & Sons Ltd.

  12. Video assisted thoracic surgery in children

    Directory of Open Access Journals (Sweden)

    Shah Rasik

    2007-01-01

    Full Text Available Thoracoscopic surgery, i.e., video assisted thoracic surgery (VATS has been in use in children for last 98 years. Its use initially was restricted to the diagnostic purposes. However, with the improvement in the optics, better understanding of the physiology with CO2 insufflation, better capabilities in achieving the single lung ventilation and newer vessel sealing devices have rapidly expanded the spectrum of the indication of VATS. At present many complex lung resections, excision of mediastinal tumors are performed by VATS in the experienced centre. The VATS has become the standard of care in empyema, lung biopsy, Mediastinal Lymphnode biopsy, repair of diaphragmatic hernia, etc. The article discusses the indications of VATS, techniques to achieve the selective ventilation and surgical steps in the different surgical conditions in children.

  13. Impedance plethysmographic observations in thoracic outlet syndrome.

    Directory of Open Access Journals (Sweden)

    Nerurkar S

    1990-07-01

    Full Text Available Forty patients with symptoms of neuro-vascular compression in the upper extremities were subjected to impedance plethysmographic study using Parulkar′s method. Two patients recorded decreased blood flow (BFI in supine position and were diagnosed as having partial occlusion at subclavian level. Sixteen of the patients recorded decreased BFI on 90 degrees abduction and hyper-abduction. Twelve of these patients had radiological evidence of anomalous cervicle ribs. In remaining four patients extrinsic impression on the subclavian artery due to fibrous deposits was confirmed by arteriography. Remaining 22 patients recorded normal impedance plethysmograms. Impedance plethysmography thus provided a non-invasive modality for confirmation of vascular compression in thoracic outlet syndrome.

  14. Motion correction in thoracic positron emission tomography

    CERN Document Server

    Gigengack, Fabian; Dawood, Mohammad; Schäfers, Klaus P

    2015-01-01

    Respiratory and cardiac motion leads to image degradation in Positron Emission Tomography (PET), which impairs quantification. In this book, the authors present approaches to motion estimation and motion correction in thoracic PET. The approaches for motion estimation are based on dual gating and mass-preserving image registration (VAMPIRE) and mass-preserving optical flow (MPOF). With mass-preservation, image intensity modulations caused by highly non-rigid cardiac motion are accounted for. Within the image registration framework different data terms, different variants of regularization and parametric and non-parametric motion models are examined. Within the optical flow framework, different data terms and further non-quadratic penalization are also discussed. The approaches for motion correction particularly focus on pipelines in dual gated PET. A quantitative evaluation of the proposed approaches is performed on software phantom data with accompanied ground-truth motion information. Further, clinical appl...

  15. Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma

    Directory of Open Access Journals (Sweden)

    Abdurrahman Aycan

    2016-01-01

    Full Text Available A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS. The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI showed an image of a mass compressing the medulla.

  16. Thoracic spine compression fracture after TASER activation.

    Science.gov (United States)

    Sloane, Christian M; Chan, Theodore C; Vilke, Gary M

    2008-04-01

    The TASER is a less lethal weapon seeing increased use by police jurisdictions across the country. As a result, subjects of TASER use are being seen with increasing frequency in emergency departments across the country. The potential injury patterns of the device are important for emergency physicians to understand. This report describes the case of an officer who complained of back pain after a single 5-s TASER discharge during a routine training exercise. Subsequent evaluation led to the diagnosis of an acute thoracic vertebral compression fracture. We discuss the potential mechanisms of injury in this case. Because we were unable to find any cases like this in our review of TASER-related injuries, we liken it to compression fractures that have been documented after seizures. We recommend that physicians consider obtaining back radiographs to rule out a vertebral compression fracture in any individual who has sustained a TASER discharge and has ongoing or persistent back pain.

  17. Benchmarking in Thoracic Surgery. Third Edition.

    Science.gov (United States)

    Freixinet Gilart, Jorge; Varela Simó, Gonzalo; Rodríguez Suárez, Pedro; Embún Flor, Raúl; Rivas de Andrés, Juan José; de la Torre Bravos, Mercedes; Molins López-Rodó, Laureano; Pac Ferrer, Joaquín; Izquierdo Elena, José Miguel; Baschwitz, Benno; López de Castro, Pedro E; Fibla Alfara, Juan José; Hernando Trancho, Florentino; Carvajal Carrasco, Ángel; Canalís Arrayás, Emili; Salvatierra Velázquez, Ángel; Canela Cardona, Mercedes; Torres Lanzas, Juan; Moreno Mata, Nicolás

    2016-04-01

    Benchmarking entails continuous comparison of efficacy and quality among products and activities, with the primary objective of achieving excellence. To analyze the results of benchmarking performed in 2013 on clinical practices undertaken in 2012 in 17 Spanish thoracic surgery units. Study data were obtained from the basic minimum data set for hospitalization, registered in 2012. Data from hospital discharge reports were submitted by the participating groups, but staff from the corresponding departments did not intervene in data collection. Study cases all involved hospital discharges recorded in the participating sites. Episodes included were respiratory surgery (Major Diagnostic Category 04, Surgery), and those of the thoracic surgery unit. Cases were labelled using codes from the International Classification of Diseases, 9th revision, Clinical Modification. The refined diagnosis-related groups classification was used to evaluate differences in severity and complexity of cases. General parameters (number of cases, mean stay, complications, readmissions, mortality, and activity) varied widely among the participating groups. Specific interventions (lobectomy, pneumonectomy, atypical resections, and treatment of pneumothorax) also varied widely. As in previous editions, practices among participating groups varied considerably. Some areas for improvement emerge: admission processes need to be standardized to avoid urgent admissions and to improve pre-operative care; hospital discharges should be streamlined and discharge reports improved by including all procedures and complications. Some units have parameters which deviate excessively from the norm, and these sites need to review their processes in depth. Coding of diagnoses and comorbidities is another area where improvement is needed. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

  18. Does the frontal airbag avoid thoracic injury?

    Science.gov (United States)

    Matthes, G; Schmucker, U; Lignitz, E; Huth, M; Ekkernkamp, A; Seifert, J

    2006-10-01

    The airbag is an established car safety device. However, recent studies pointed out that even the airbag might cause injuries. Nevertheless, most physicians do consider a lower risk in accident victims sustaining severe injury of the chest, when a deployed frontal airbag has been reported. We set out to verify the frequency and pattern of thoracic injury in car drivers protected by a frontal airbag during traffic accidents. This investigation was conducted as part of a prospective surveillance analyzing traffic accidents. Enrolled were car drivers included in a databank between January 2001 and December 2004 consecutively. The chance for sustaining chest injury with or without a frontal airbag was described using the relative risk. A total of 188 car drivers were included in the analysis. In 54 (28.7%) cases a deployed airbag and in 134 (71.3%) the absence of an airbag has been documented. Out of those cases 16 (29.6%) drivers with airbag and 30 (22.4%) without airbag sustained a chest injury. The mean abbreviated injury scale (AIS) of chest injuries in drivers with deployed airbag was 2.3 (1-5; SD +/- 1.45; mean injury severity scale [ISS] 21.1 [SD +/- 17.18]), in drivers without airbag 1.6 (1-4; SD +/- 1.12; mean ISS 15.8 [SD +/- 20.6]). For belted drivers with an airbag the relative risk to sustain chest injury was 1.96 compared to those without an airbag. The airbag does not avoid chest injury definitively. Much more, it has been demonstrated that the relative risk to sustain relevant thoracic injury seems to be almost higher in restrained drivers with a frontal airbag.

  19. Sleep duration estimates of Canadian children and adolescents.

    Science.gov (United States)

    Chaput, Jean-Philippe; Janssen, Ian

    2016-10-01

    The objective of this study was to provide contemporary sleep duration estimates of Canadian school-aged children and adolescents and to determine the proportion adhering to the sleep duration recommendations. This study included 24 896 participants aged 10-17 years from the 2013/2014 Canadian Health Behaviour in School-aged Children study (HBSC), a nationally representative cross-sectional study. Bedtime and wake-up times were reported by participants and their sleep duration was calculated. Participants were then classified as having a sleep duration that met the recommended range (9-11 h per night for 10-13-year-olds or 8-10 h per night for 14-17-year-olds), a sleep duration that was shorter than the recommended range or a sleep duration that was longer than the recommended range. An estimated 68% of children aged 10-13 years and 72% of adolescents aged 14-17 years sleep for the recommended amount per night when averaged across all days of the week. Short sleepers represent 31% of school-aged children and 26% of adolescents. Long sleepers are rare (adolescents sleep ~1 h more at weekends compared to weekdays. Approximately 5% of the participants typically went to bed after midnight on weekdays and 31% did so at weekends; these proportions reached 11 and 45%, respectively, within 16-17-year-olds. In general, differences in sleep times between boys and girls are small and not clinically significant. In conclusion, almost one-third of Canadian children and adolescents sleep less than the recommended amount. Public health efforts should continue to monitor the sleep of Canadian children and adolescents and identify subgroups of the population more likely to be affected by insufficient sleep. © 2016 European Sleep Research Society.

  20. Canadian cardiac surgeons' perspectives on biomedical innovation.

    Science.gov (United States)

    Snyman, Gretchen; Tucker, Joseph E L; Cimini, Massimo; Narine, Kishan; Fedak, Paul W M

    2012-01-01

    Barriers to successful innovation can be identified and potentially addressed by exploring the perspectives of key stakeholders in the innovation process. Cardiac surgeons in Canada were surveyed for personal perspectives on biomedical innovation. Quantitative data was obtained by questionnaire and qualitative data via interviews with selected survey participants. Surgeons were asked to self-identify into 1 of 3 categories: "innovator," "early adopter," or "late adopter," and data were compared between groups. Most surgeons viewed innovation favourably and this effect was consistent irrespective of perceived level of innovativeness. Key barriers to the innovation pathway were identified: (1) support from colleagues and institutions; (2) Canada's health system; (3) sufficient investment capital; and (4) the culture of innovation within the local environment. Knowledge of the innovation process was perceived differently based on self-reported innovativeness. The majority of surgeons did not perceive themselves as having the necessary knowledge and skills to effectively translate innovative ideas to clinical practice. In general, responses indicate support for implementation of leadership and training programs focusing on the innovation process in an effort to prepare surgeons and enhance their ability to successfully innovate and translate new therapies. The perspectives of cardiac surgeons provide an intriguing portal into the challenges and opportunities for healthcare innovation in Canada. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  1. Emergency endovascular repair of acute descending thoracic aortic dissection

    Directory of Open Access Journals (Sweden)

    Muhammad Anees Sharif

    2007-11-01

    Full Text Available Muhammad Anees Sharif, Mark Edward O’Donnell, Paul Henry Blair, Peter KennedyDepartment of Vascular and Endovascular Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, United KingdomBackground: Acute descending thoracic aortic dissection is a life-threatening emergency. It is not often considered as the initial diagnosis in patients presenting with epigastric pain and could easily be missed in a busy casualty department.Aim: This case report is aimed to highlight the feasibility of the technique and the need for long-term surveillance following endovascular repair of acute thoracic aortic dissection.Results: The patient presented with epigastric pain radiating to the interscapular region with a stable hemodynamic status. A computerized tomography (CT scan demonstrated type B thoracic aortic dissection of the proximal descending thoracic aorta. A successful endovascular repair was carried out with uneventful recovery and follow-up CT scan six years after stent-grafting shows satisfactory position of the stent-graft, patent false lumen in the abdominal aorta perfusing the right kidney, and progressively enlarging diameter of the abdominal aorta.Conclusion: Thoracic aortic dissection should be considered as a differential diagnosis in patients presenting with epigastric and interscapular chest pain. Emergency endovascular repair of acute thoracic aortic dissection is feasible and relatively safe. Regular follow-up with CT scan is required to evaluate the long-term effi cacy and identify the need for re-intervention.Keywords: aortic, dissection, endovascular, thoracic

  2. Robotic thoracic surgery: The state of the art

    Science.gov (United States)

    Kumar, Arvind; Asaf, Belal Bin

    2015-01-01

    Minimally invasive thoracic surgery has come a long way. It has rapidly progressed to complex procedures such as lobectomy, pneumonectomy, esophagectomy, and resection of mediastinal tumors. Video-assisted thoracic surgery (VATS) offered perceptible benefits over thoracotomy in terms of less postoperative pain and narcotic utilization, shorter ICU and hospital stay, decreased incidence of postoperative complications combined with quicker return to work, and better cosmesis. However, despite its obvious advantages, the General Thoracic Surgical Community has been relatively slow in adapting VATS more widely. The introduction of da Vinci surgical system has helped overcome certain inherent limitations of VATS such as two-dimensional (2D) vision and counter intuitive movement using long rigid instruments allowing thoracic surgeons to perform a plethora of minimally invasive thoracic procedures more efficiently. Although the cumulative experience worldwide is still limited and evolving, Robotic Thoracic Surgery is an evolution over VATS. There is however a lot of concern among established high-volume VATS centers regarding the superiority of the robotic technique. We have over 7 years experience and believe that any new technology designed to make minimal invasive surgery easier and more comfortable for the surgeon is most likely to have better and safer outcomes in the long run. Our only concern is its cost effectiveness and we believe that if the cost factor is removed more and more surgeons will use the technology and it will increase the spectrum and the reach of minimally invasive thoracic surgery. This article reviews worldwide experience with robotic thoracic surgery and addresses the potential benefits and limitations of using the robotic platform for the performance of thoracic surgical procedures. PMID:25598601

  3. Scoliosis Research Society

    Science.gov (United States)

    Scoliosis Research Society Close Menu Member Login Become a Member Home Find a Specialist | Calendar Contact | Donate ... a Member Find a Specialist Calendar Contact Donate Scoliosis Research Society Dedicated to the optimal care of ...

  4. The Canadian mobile satellite system

    Science.gov (United States)

    Bertenyi, Elemer

    1992-07-01

    Plans to upgrade Canadian mobile data services by introducing a full, two way mobile voice and data service, using a large geostationary satellite which is scheduled to be launched in 1994, are reported. This Mobile Satellite (MSAT) will offer customers the ability to communicate, using mobile or transportable terminals, from the most remote parts of the continent, to any other point within North America, and indeed the whole world. Currently planned MSAT services are reviewed, the main features of the overall system are outlined, and the configuration and key performance parameters of the MSAT satellite are presented. The communications subsystem is detailed, and a summary of the spacecraft service module is given.

  5. Financial unhealthiness predicts worse health outcomes: evidence from a sample of working Canadians.

    Science.gov (United States)

    Dilmaghani, Maryam

    2017-03-01

    This paper investigates how financial health associates with self-rated health, for a sample of working Canadians. Financial health is defined as an indicator of the proportionality of household consumption to its income. The study draws on the Canadian General Social Survey of 2011, a cross-sectional data set. Multivariate regression analysis is employed. The results show that financial unhealthiness is a statistically significant and strong predictor of worse physical and mental health outcomes, controlling for a wide array of characteristics, including income and job security implied by occupational category. Policy implications are explored. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  6. Reclaiming Society Publishing

    Directory of Open Access Journals (Sweden)

    Philip E. Steinberg

    2015-07-01

    Full Text Available Learned societies have become aligned with commercial publishers, who have increasingly taken over the latter’s function as independent providers of scholarly information. Using the example of geographical societies, the advantages and disadvantages of this trend are examined. It is argued that in an era of digital publication, learned societies can offer leadership with a new model of open access that can guarantee high quality scholarly material whose publication costs are supported by society membership dues.

  7. Thoracic splenosis: noninvasive diagnosis using Technetium-99 sulfur colloid.

    Science.gov (United States)

    Bhalani, Viraj V; Hecht, Harvey; Sachs, Paul; King, Michael

    2012-01-01

    Splenosis is the autotransplantation of splenic tissue to abnormal sites, either the abdomen or thorax, following traumatic injury of the spleen. For splenic tissue to reach the thorax, there must be concomitant diaphragmatic injury. Thoracic splenosis is usually discovered incidentally on routine thoracic imaging as single or multiple, indeterminate pleural-based masses limited to the left hemithorax. Traditionally, diagnosis required invasive procedures and/or surgery to acquire tissue samples in order to rule out other causes of lung masses, ie, cancer. We report a case in which nuclear imaging was used to make the diagnosis of thoracic splenosis, thus preventing the need for invasive procedures and avoiding unnecessary patient apprehension.

  8. Breakthrough in the Transplantation of Thoracic Organs in Hungary.

    Science.gov (United States)

    Rényi-Vámos, F; Hartyánszky, I; Szabolcs, Z; Lang, G

    2017-09-01

    In 2016 the focus was, by all means, on the transplantation on thoracic organs. More than 50 heart transplantations were performed in this year. With this achievement, the Hungarian Heart Transplantation Program became one of the leading programs in the world. In the Thoracic Surgery Unit of the National Institute of Oncology and the Thoracic Surgery Department of Semmelweis University the first successful lung transplantation was carried out on December 12, 2015 when the Hungarian Lung Transplantation Program was launched. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. CASID and Canadian Journal of Development Studies ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    CASID and Canadian Journal of Development Studies : Organizational Strengthening 2007-2010. The Canadian Association for the Study of International Development (CASID) is a national, bilingual, multidisciplinary and pluralistic association devoted to the study of international development in all parts of the world.

  10. Guide to Canadian Aerospace Related Industries,

    Science.gov (United States)

    1984-03-01

    fabrication, PWC assembly & test, automatic backplane wiring, computerized wire History : AEI, an established Canadian company for over 55...production of Automatic Number Identification (ANI) systems and 911 Emergency History : Aeo Machining Ltd is a small machining company Reporting Systems for...Aircraft, DeHavilland, Grumman Aircraft, and Canadian Digital Radar Data Processing - Contract with Fundacao Vickers Ltd. Educacional de Bauru, Brazil

  11. 47 CFR 90.121 - Canadian registration.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Canadian registration. 90.121 Section 90.121 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES PRIVATE LAND MOBILE RADIO SERVICES Applications and Authorizations § 90.121 Canadian registration. Form 410 shall be...

  12. Rural Canadian Youth Exposed to Physical Violence

    Science.gov (United States)

    Laye, Adele M.; Mykota, David B.

    2014-01-01

    Exposure to physical violence is an unfortunate reality for many Canadian youth as it is associated with numerous negative psychosocial effects. The study aims to assist in understanding resilience in rural Canadian youth exposed to physical violence. This is accomplished by identifying the importance of protective factors, as measured by the…

  13. [Treatment of the thoracic outlet vascular syndrome].

    Science.gov (United States)

    Davidović, L B; Lotina, S I; Vojnović, B R; Kostić, D M; Colić, M M; Stanić, M I; Djorić, P D

    1998-01-01

    The title "Thoracic Outlet Syndrome" (TOS) was introduced by Peet in 1956 [1]. In 1958 Charles Rob defined TOS as a "set of symptoms that may exist due to compression on the brachial plexus and on subclavian vessels in the region of the thoracic outlet" [2]. Compression due to cervical rib was first described by Galenus and Veaslius in the 2nd century A.D. The first unsuccessful resection of the cervical rib in patients with TOS was performed by Coote in 1861 [4]. In 1905 Murphy first made a successful resection of the cervical rib in patients with TOS and subclavian artery aneurysm [5]. He also removed the normal first rib in patients with TOS using the supraclavicular approach for the first time [6]. In 1920 Law described ligaments and other structures originating in soft tissue associated with TOS [8], while Adson and Coffey in 1927 emphasized the role of the scalene anticus muscle in TOS [3]. Ochsner, Gage and DeBakey in 1935 named it the "scalenus anticus syndrome", and made the first successful resection of the anterior scalene muscle [9]. In 1966 David Ross introduced the transaxillary resection of the first rib to relieve TOS [11]. The aim of the paper is to describe the treatment of patients with vascular TOS. Over a six-year-period (1990-1997) 12 patients with vascular TOS were evaluated at our Centre. Seven (58%) were female and 5 (42%) male patients, average age 33.1 years. Eleven of them had congenital TOS, and one acquired TOS after trauma at neck-shoulder region. Seven patients had arterial and 5 venous TOS. Two patients with arterial TOS had ischaemia of the upper extremity due to embolism of the brachial artery. In one of them axillary artery was completely thrombosed, and in the other postenotic dilatation of the subclavian artery was present. The other 5 patients with arterial TOS demonstrated only hand pain and radial puls during hyperabduction of the arm. One of our patients with venous TOS had also symptoms and signs of hand oedema during

  14. The Information Society

    Directory of Open Access Journals (Sweden)

    Hiranya Nath

    2017-03-01

    Full Text Available This article briefly discusses various definitions and concepts of the so-called information society. The term information society has been proposed to refer to the post-industrial society in which information plays a pivotal role. The definitions that have been proposed over the years highlight five underlying characterisations of an information society: technological, economic, sociological, spatial, and cultural. This article discusses those characteristics. While the emergence of an information society may be just a figment of one’s imagination, the concept could be a good organising principle to describe and analyse the changes of the past 50 years and of the future in the 21st century.

  15. Simultaneous thoracic and abdominal transplantation: can we justify two organs for one recipient?

    Science.gov (United States)

    Wolf, J H; Sulewski, M E; Cassuto, J R; Levine, M H; Naji, A; Olthoff, K M; Shaked, A; Abt, P L

    2013-07-01

    Simultaneous thoracic and abdominal (STA) transplantation is controversial because two organs are allocated to a single individual. We studied wait-list urgency, and whether transplantation led to successful outcomes. Candidates and recipients for heart-kidney (SHK), heart-liver (SHLi), lung-liver (SLuLi) and lung-kidney (SLuK) were identified through the United Network for Organ Sharing (UNOS) and outcomes were compared to single-organ transplantation. Since 1987, there were 1801 STA candidates and 836 recipients. Wait-list survival at 1- and 3 years for SHK (67.4%, 40.8%; N = 1420), SHLi (65.7%, 43.6%; N = 218) and SLuLi (65.7%, 41.0%; N = 122), was lower than controls (p organ candidates. STA outcomes were similar to thoracic transplantation; however, outcomes were similar to abdominal transplantation for SHLi only. Although select patients benefit from STA, risk-exposure variables for decreased survival should be identified, aiming to eliminate futile transplantation. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

  16. Multilingualism in Canadian schools: Myths, realities and possibilities

    Directory of Open Access Journals (Sweden)

    Patricia A. Duff

    2007-08-01

    Full Text Available Abstract Bilingualism and multiculturalism have for four decades been official ideologies and policies in Canada but, as is often the case, the implementation and outcomes of such government policies nationally are less impressive than the rhetoric would suggest. This article reviews the political, theoretical and demographic contexts justifying support for the learning and use of additional languages in contemporary Canadian society and schools, and summarizes research demonstrating that bilingualism and multilingualism are indeed cognitively, socially, and linguistically advantageous for children (and adults, as well as for society. The five studies in this special issue are then previewed with respect to the following themes that run across them: (1 the potential for bilingual synergies and transformations in language awareness activities and crosslinguistic knowledge construction; (2 the role of multiliteracies and multimodality in mediated learning; and (3 the interplay of positioning, identity, and agency in language learning by immigrant youth. The article concludes that more Canadian schools and educators must, like the researchers in this volume, find ways to embrace and build upon students’ prior knowledge, their creativity, their collaborative problem-solving skills, their potential for mastering and manipulating multiple, multilingual semiotic tools, and their desire for inclusion and integration in productive, engaging learning communities.

  17. Ectopic intrapleural thymoma: a rare location in the thoracic cavity

    OpenAIRE

    Lopez-Marco, Ana; Al-Zuhir, Naail; Kornaszewska, Malgorzata

    2016-01-01

    We present a patient with a large thymoma on the right thoracic cavity developing from the visceral pleura. This is a rare location for this tumour, and only a few had been reported to date in the literature.

  18. Thoracic splenosis as a differential diagnosis of juxtapleural nodules

    Directory of Open Access Journals (Sweden)

    B. Lopes

    2014-01-01

    Full Text Available Thoracic splenosis is rare and consists of ectopic implantation of splenic tissue into the chest after concomitant thoracic and abdominal trauma with diaphragm injury. It occurs in about 18% of cases of splenic ruptures. In almost all cases, diagnosis is given incidentally once patients are usually asymptomatic. Thoracic splenosis should be considered as a differential diagnosis in all patients with history of trauma presenting with juxtapleural nodules in chest computed tomography. However, malignant conditions should be ruled out firstly. Biopsy is not essential for the diagnosis once nuclear medicine can confirm splenosis in patients with pertinent history of trauma and suggestive tomographic image. We present a typical case of thoracic splenosis whose diagnosis was made by nuclear medicine and no invasive procedures were required.

  19. Gamification in thoracic surgical education: Using competition to fuel performance

    National Research Council Canada - National Science Library

    Mokadam, Nahush A; Lee, Richard; Vaporciyan, Ara A; Walker, Jennifer D; Cerfolio, Robert J; Hermsen, Joshua L; Baker, Craig J; Mark, Rebecca; Aloia, Lauren; Enter, Dan H; Carpenter, Andrea J; Moon, Marc R; Verrier, Edward D; Fann, James I

    2015-01-01

    In an effort to stimulate residents and trainers to increase their use of simulation training and the Thoracic Surgery Curriculum, a gamification strategy was developed in a friendly but competitive environment. "Top Gun...

  20. Anesthesia for thoracic surgery: A survey of middle eastern practice

    Science.gov (United States)

    Eldawlatly, Abdelazeem; Turkistani, Ahmed; Shelley, Ben; El-Tahan, Mohamed; Macfie, Alistair; Kinsella, John

    2012-01-01

    Purpose: The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern (ME) region. Methods: A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic-anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation (OLV), anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Results: Volume-controlled ventilation was favored over pressure-controlled ventilation (62% vs 38% of respondents, Panesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques (P<0.05). Conclusions: Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice. PMID:23162388

  1. Robotic thoracic surgery: The state of the art

    Directory of Open Access Journals (Sweden)

    Arvind Kumar

    2015-01-01

    Although the cumulative experience worldwide is still limited and evolving, Robotic Thoracic Surgery is an evolution over VATS. There is however a lot of concern among established high-volume VATS centers regarding the superiority of the robotic technique. We have over 7 years experience and believe that any new technology designed to make minimal invasive surgery easier and more comfortable for the surgeon is most likely to have better and safer outcomes in the long run. Our only concern is its cost effectiveness and we believe that if the cost factor is removed more and more surgeons will use the technology and it will increase the spectrum and the reach of minimally invasive thoracic surgery. This article reviews worldwide experience with robotic thoracic surgery and addresses the potential benefits and limitations of using the robotic platform for the performance of thoracic surgical procedures.

  2. The immediate effects of spinal thoracic manipulation on respiratory functions

    National Research Council Canada - National Science Library

    Shin, Doo Chul; Lee, Yong Woo

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effects of thoracic spinal manipulation therapy on respiratory function including forced vital capacity and forced expiratory volume in one second...

  3. Selective diaphragm muscle weakness after contractile inactivity during thoracic surgery.

    NARCIS (Netherlands)

    Welvaart, W.N.; Paul, M.A.; Stienen, G.J.; Hees, H.W.H. van; Loer, S.A.; Bouwman, R.; Niessen, H.; Man, F.S. de; Witt, C.C.; Granzier, H.; Vonk-Noordegraaf, A.; Ottenheijm, C.A.C.

    2011-01-01

    RATIONALE: Postoperative pulmonary complications are significant contributors to morbidity in patients who have undergone upper abdominal, thoracic, or cardiac surgery. The pathophysiology of these complications might involve postoperative inspiratory muscle weakness. The nature of postoperative

  4. Cardiovascular complications following thoracic radiotherapy in patients with cancer

    DEFF Research Database (Denmark)

    Nielsen, Kirsten Melgaard; Borchsenius, Julie I Helene; Offersen, Birgitte Vrou

    2016-01-01

    Cardiovascular complications following thoracic radiotherapy in patients with cancer are well described. Advancements in surgery, radiotherapy and systemic treatments have led to an increasing number of cancer survivors and thus an increasing number of patients with long-term side effects...... of their cancer treatments. This article describes the short- and long-term cardiovascular morbidity and mortality following thoracic radiotherapy and further, optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients....

  5. Transthoracic Ultrasound Evaluation of Arch and Descending Thoracic Aortic Pathology.

    Science.gov (United States)

    D'Abate, Fabrizio; Oladokun, Dare; La Leggia, Angelo; Hinchliffe, Robert; Thompson, Matthew; Holt, Peter; de Bruin, Jorg; Loftus, Ian; Patterson, Benjamin

    2018-02-02

    Duplex ultrasonography (DUS) currently has limited applicability in the diagnosis and surveillance of thoracic aortic pathologies because of associated limitations. This study investigates the feasibility of using an optimised DUS protocol to detect descending thoracic aortic pathology. Forty patients were scanned (20 cases and 20 controls). All patients but one had a technically adequate assessment of the thoracic aorta (at least one view of the descending thoracic aorta). Using a size threshold of 40 mm, 16 out of 19 cases and two out of 20 control patients would have been recommended for definitive imaging. Using a cutoff of 35 mm, this became 18 out of 19 cases and six of 20 controls. Sensitivity and specificity were 100% and 70% for a threshold of 35 mm, and 84% and 90% for a threshold of 40 mm. This was a prospective, case control cohort study. Patients with computed tomography (CT) confirmed thoracic aortic pathology underwent DUS of the thoracic aorta. A control group known to have no thoracic pathology also underwent DUS. The sonographer performing DUS was blinded to the CT findings, and recorded the presence of pathology or any dilated aortic segment where visualised. Diameter cutoff points of 35 mm and 40 mm were compared. DUS has the potential to be used as a diagnostic modality for thoracic aortic pathology, and may have a role in surveillance for some patients for whom CT scanning is contraindicated. Further validation and refinements to this technique are required. However, this study provides proof of concept. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  6. Total Spinal Block after Thoracic Paravertebral Block.

    Science.gov (United States)

    Beyaz, Serbülent Gökhan; Özocak, Hande; Ergönenç, Tolga; Erdem, Ali Fuat; Palabıyık, Onur

    2014-02-01

    Thoracic paravertebral block (TPVB) can be performed with or without general anaesthesia for various surgical procedures. TPVB is a popular anaesthetic technique due to its low side effect profile and high analgesic potency. We used 20 mL of 0.5% levobupivacaine for a single injection of unilateral TPVB at the T7 level with neurostimulator in a 63 year old patient with co-morbid disease who underwent cholecystectomy. Following the application patient lost consciousness, and was intubated. Haemodynamic instability was normalised with rapid volume replacement and vasopressors. Anaesthetic drugs were stopped at the end of the surgery and muscle relaxant was antagonised. Return of mucle strenght was shown with neuromuscular block monitoring. Approximately three hours after TPVB, spontaneous breathing started and consciousness returned. A total spinal block is a rare and life-threatening complication. A total spinal block is a complication of spinal anaesthesia, and it can also occur after peripheral blocks. Clinical presentation is characterised by hypotension, bradicardia, apnea, and cardiac arrest. An early diagnosis and appropriate treatment is life saving. In this case report, we want to present total spinal block after TPVB.

  7. Cytomegalovirus Immunoglobulin After Thoracic Transplantation: An Overview.

    Science.gov (United States)

    Grossi, Paolo; Mohacsi, Paul; Szabolcs, Zoltán; Potena, Luciano

    2016-03-01

    Cytomegalovirus (CMV) is a highly complex pathogen which, despite modern prophylactic regimens, continues to affect a high proportion of thoracic organ transplant recipients. The symptomatic manifestations of CMV infection are compounded by adverse indirect effects induced by the multiple immunomodulatory actions of CMV. These include a higher risk of acute rejection, cardiac allograft vasculopathy after heart transplantation, and potentially bronchiolitis obliterans syndrome in lung transplant recipients, with a greater propensity for opportunistic secondary infections. Prophylaxis for CMV using antiviral agents (typically oral valganciclovir or intravenous ganciclovir) is now almost universal, at least in high-risk transplants (D+/R-). Even with extended prophylactic regimens, however, challenges remain. The CMV events can still occur despite antiviral prophylaxis, including late-onset infection or recurrent disease, and patients with ganciclovir-resistant CMV infection or who are intolerant to antiviral therapy require alternative strategies. The CMV immunoglobulin (CMVIG) and antiviral agents have complementary modes of action. High-titer CMVIG preparations provide passive CMV-specific immunity but also exert complex immunomodulatory properties which augment the antiviral effect of antiviral agents and offer the potential to suppress the indirect effects of CMV infection. This supplement discusses the available data concerning the immunological and clinical effects of CMVIG after heart or lung transplantation.

  8. III Brazilian Thoracic Association Guidelines on tuberculosis.

    Science.gov (United States)

    Conde, Marcus Barreto; Melo, Fernando Augusto Fiuza de; Marques, Ana Maria Campos; Cardoso, Ninarosa Calzavara; Pinheiro, Valeria Goes Ferreira; Dalcin, Paulo de Tarso Roth; Machado Junior, Almério; Lemos, Antonio Carlos Moreira; Netto, Antônio Ruffino; Durovni, Betina; Sant'Anna, Clemax Couto; Lima, Dinalva; Capone, Domenico; Barreira, Draurio; Matos, Eliana Dias; Mello, Fernanda Carvalho de Queiroz; David, Fernando Cezar; Marsico, Giovanni; Afiune, Jorge Barros; Silva, José Roberto Lapa e; Jamal, Leda Fátima; Telles, Maria Alice da Silva; Hirata, Mário Hiroyuki; Dalcolmo, Margareth Pretti; Rabahi, Marcelo Fouad; Cailleaux-Cesar, Michelle; Palaci, Moises; Morrone, Nelson; Guerra, Renata Leborato; Dietze, Reynaldo; Miranda, Silvana Spíndola de; Cavalcante, Solange Cesar; Nogueira, Susie Andries; Nonato, Tatiana Senna Galvão; Martire, Terezinha; Galesi, Vera Maria Nader; Dettoni, Valdério do Valle

    2009-10-01

    New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.

  9. Quantitative normal thoracic anatomy at CT.

    Science.gov (United States)

    Matsumoto, Monica M S; Udupa, Jayaram K; Tong, Yubing; Saboury, Babak; Torigian, Drew A

    2016-07-01

    Automatic anatomy recognition (AAR) methodologies for a body region require detailed understanding of the morphology, architecture, and geographical layout of the organs within the body region. The aim of this paper was to quantitatively characterize the normal anatomy of the thoracic region for AAR. Contrast-enhanced chest CT images from 41 normal male subjects, each with 11 segmented objects, were considered in this study. The individual objects were quantitatively characterized in terms of their linear size, surface area, volume, shape, CT attenuation properties, inter-object distances, size and shape correlations, size-to-distance correlations, and distance-to-distance correlations. A heat map visualization approach was used for intuitively portraying the associations between parameters. Numerous new observations about object geography and relationships were made. Some objects, such as the pericardial region, vary far less than others in size across subjects. Distance relationships are more consistent when involving an object such as trachea and bronchi than other objects. Considering the inter-object distance, some objects have a more prominent correlation, such as trachea and bronchi, right and left lungs, arterial system, and esophagus. The proposed method provides new, objective, and usable knowledge about anatomy whose utility in building body-wide models toward AAR has been demonstrated in other studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Us, them, and others: reflections on Canadian multiculturalism and national identity at the turn of the twenty-first century.

    Science.gov (United States)

    Winter, Elke

    2014-05-01

    The John Porter Lecture at the annual meeting of the Canadian Sociological Association in Victoria 2013 draws upon my book Us, Them, and Others: Pluralism and National Identity in Diverse Societies. Incorporating the findings from an analysis of Canadian English-language newspaper discourses during the 1990s into a theoretical framework inspired by Weberian sociology, the book argues that pluralism is best understood as a dynamic set of triangular relations where the compromise between unequal groups--"us" and "others"--is rendered meaningful through the confrontation with real or imagined outsiders ("them"). The lecture summarizes the theoretical contribution and explains how multiculturalism became consolidated in dominant Canadian discourses in the late 1990s. The lecture then discusses changes to Canadian multicultural identity at the beginning of the twenty-first century.

  11. Indian Vacuum Society: The Indian Vacuum Society

    Science.gov (United States)

    Saha, T. K.

    2008-03-01

    The Indian Vacuum Society (IVS) was established in 1970. It has over 800 members including many from Industry and R & D Institutions spread throughout India. The society has an active chapter at Kolkata. The society was formed with the main aim to promote, encourage and develop the growth of Vacuum Science, Techniques and Applications in India. In order to achieve this aim it has conducted a number of short term courses at graduate and technician levels on vacuum science and technology on topics ranging from low vacuum to ultrahigh vacuum So far it has conducted 39 such courses at different parts of the country and imparted training to more than 1200 persons in the field. Some of these courses were in-plant training courses conducted on the premises of the establishment and designed to take care of the special needs of the establishment. IVS also regularly conducts national and international seminars and symposia on vacuum science and technology with special emphasis on some theme related to applications of vacuum. A large number of delegates from all over India take part in the deliberations of such seminars and symposia and present their work. IVS also arranges technical visits to different industries and research institutes. The society also helped in the UNESCO sponsored post-graduate level courses in vacuum science, technology and applications conducted by Mumbai University. The society has also designed a certificate and diploma course for graduate level students studying vacuum science and technology and has submitted a syllabus to the academic council of the University of Mumbai for their approval, we hope that some colleges affiliated to the university will start this course from the coming academic year. IVS extended its support in standardizing many of the vacuum instruments and played a vital role in helping to set up a Regional Testing Centre along with BARC. As part of the development of vacuum education, the society arranges the participation of

  12. Intraoperative transfusion of small amounts of blood heralds worse postoperative outcome in patients having noncardiac thoracic operations.

    Science.gov (United States)

    Ferraris, Victor A; Davenport, Daniel L; Saha, Sibu P; Bernard, Alethea; Austin, Peter C; Zwischenberger, Joseph B

    2011-06-01

    Massive intraoperative transfusion is associated with increased morbidity and mortality in patients undergoing noncardiac thoracic operations. We examined whether this association carries over to patients who receive only 1 to 2 units of packed red blood cells (PRBCs) during their operation. We queried the American College of Surgeon's National Surgical Quality Improvement Project database for patients undergoing noncardiac, nonvascular thoracic operations during a 5-year period. Patient 30-day morbidity (1 or more of 20 complications) and mortality were evaluated. We used propensity-score matching to minimize confounding when estimating the effect of transfusion on postoperative morbidity. We analyzed 8728 nonvascular thoracic operations in patients from 173 hospitals. Of these, 7875 (90.2%) did not receive intraoperative transfusions. The 579 patients (6.6%) who received 1 to 2 units of intraoperative PRBCs had higher unadjusted rates of wound problems, pulmonary complications, sepsis/shock, composite morbidity, mortality, and length of stay than those who did not receive transfusions. These rates further increased with postoperative transfusion of more than 2 units of intraoperative PRBC. After propensity adjustment, transfusion of 1 or 2 units of PRBCs increased the multivariate risk of composite morbidity, pulmonary complications, systemic sepsis, wound complications, and the postoperative length of stay compared with those who did not receive transfusions. In patients undergoing noncardiac thoracic operations, there is a dose-dependent adverse effect of intraoperative blood transfusion on outcomes, with even seemingly small amounts of blood (1 or 2 units of PRBCs) increasing morbidity and resource utilization. Clinicians should be cautious with intraoperative transfusions of 1 or 2 units of PRBC for mildly hypovolemic or anemic patients. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Civil Society and Governance

    DEFF Research Database (Denmark)

    Hulgård, Lars

    An illustration of how important the relationship is between civil society anbd governance. A short historic journey with four snapshots of times and situations that have provided interesting evidence about the connection between civil society and governance. My goal for the short historic journey...... is to make clear and hopefully even verify that providing knowledge about the impact of civil society and citizens’ participation on governance is one of the most urgent research tasks in the current period of time....

  14. Factors affecting food selection in Canadian population.

    Science.gov (United States)

    Ree, M; Riediger, N; Moghadasian, M H

    2008-11-01

    To establish health-related reasons behind Canadian food choices, and how variables such as education, income, gender, ethnicity and age may affect food selection. Approximately 98 733 Canadians responded to the 12 questions regarding food choices in the Canadian Community Health Survey (CCHS) cycle 2.1, conducted by the Canadian Government in 2003. These included 13 727 adolescents (12-19 years), 19 089 young adults (20-34 years), 31 039 middle-aged adults (35-54 years), 25 338 older adults (55-74 years) and 9580 elderly (75+ years). Approximately 70% of Canadian adolescents in the sample indicated that their food choices were independent of health concerns. Body weight management was a major concern for food selection by adolescents and adults, while the elderly stated heart disease as their main concern. Among all participants, females, and individuals with high levels of education and income reported the highest response to choosing or avoiding foods due to health concerns and food content. Our data indicate that several factors significantly affect food choices for health-related reasons in the Canadian population. Among them, age- and gender-related gaps, particularly between adolescents and adults, are profound. This observation may urge authorities to implement effective strategies to educate Canadians, especially adolescents, that selection of appropriate foods may prevent chronic diseases.

  15. Anterior Cervical Incision and Thoracotomy for Cervico-thoracic, Thoracic, and Thoracolumbar Spine Surgery: A Clinical Series

    OpenAIRE

    Seyyed Hossein Fattahi Masoom; Babak Ganjeifar

    2016-01-01

    Introduction:Surgical treatment of diseases in cervicothoracic, thoracic and thoracolumbar regions can be a challenging issue. Cooperation of the thoracic surgeons and spine surgeons can improve the outcomes and decrease the complications of patients who underwent these approaches.Materials & Methods: The participants of this study consisted of seventeenpatients suffering from different types of vertebral lesions such as spinal TB, primary tumor, metastasis, and scoliosis. These patients were...

  16. Factors associated with lack of awareness and uncontrolled high blood pressure among Canadian adults with hypertension.

    Science.gov (United States)

    Gee, Marianne E; Bienek, Asako; McAlister, Finlay A; Robitaille, Cynthia; Joffres, Michel; Tremblay, Mark S; Johansen, Helen; Campbell, Norm R C

    2012-05-01

    Approximately 17% of Canadians with high blood pressure were unaware of their condition, and of Canadians aware of having the condition, approximately 1 in 5 have uncontrolled high blood pressure despite high rates of pharmacotherapy. The objectives of the current study are to estimate the prevalence of resistant hypertension and examine factors associated with (1) lack of awareness and (2) uncontrolled hypertension despite pharmacotherapy. Using the 2007-2009 Canadian Health Measures Survey (N = 3473, aged 20-79 years) and logistic regression, we quantified relationships between characteristics and (1) presence of hypertension, (2) lack of awareness (among those with hypertension), and (3) uncontrolled high blood pressure (among those treated for hypertension). Older age, lowest income, and less than high school education were associated with presence of hypertension. Men (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2) and adults high blood pressure (OR, 2.4; 95% CI, 1.1-5.2) despite treatment. Elevated systolic blood pressure was the issue in over 90% of women and 80% of men with uncontrolled hypertension. Depending on the definition employed, 4.4% (95% CI, 2.4-6.4) to 7.8% (95% CI, 6.0-9.6) of the population with hypertension had resistant hypertension. Messaging or interventions encouraging screening may be helpful for all younger Canadian adults and men; programs encouraging blood pressure control may help older women. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  17. Nuclear communications : A Canadian perspective

    Energy Technology Data Exchange (ETDEWEB)

    Macpherson, John A. [Atomic Energy of Canada Limited, Ottawa (Canada)

    1994-04-15

    Times have changed since the early days of nuclear energy when it was a symbol of a brave new world, Public information strategies have evolved to meet increasing public concerns, and have shifted from being a largely unfocused attempt at publicity to being more concerned with managing issues and solving problems. This paper describes some of the salient features of the Canadian experience in nuclear communications and examines four key aspects: opinion and attitude research; media relations; coeducation; and advertising. It also addresses the challenge of responding to the allegations and tactics of those who are actively hostile to nuclear energy, and recommends that the principles of Total Quality Management and of organizational effectiveness be applied more thorough and more consistently to the public affairs function.

  18. Tritium technology. A Canadian overview

    Energy Technology Data Exchange (ETDEWEB)

    Hemmings, R.L. [Canatom NPM (Canada)

    2002-10-01

    An overview of the various tritium research and operational activities in Canada is presented. These activities encompass tritium processing and recovery, tritium interactions with materials, and tritium health and safety. Many of these on-going activities form a sound basis for the tritium use and handling aspects of the ITER project. Tritium management within the CANDU heavy water reactor, associated detritiation facilities, research and development facilities, and commercial industry and improving the understanding of tritium behaviour in humans and the environment remain the focus of a long-standing Canadian interest in tritium. While there have been changes in the application of this knowledge and experience over time, the operating experience and the supporting research and development continue to provide for improved plant and facility operations, an improved understanding of tritium safety issues, and improved products and tools that facilitate tritium management. (author)

  19. Canadian orthodontist Internet user profile.

    Science.gov (United States)

    Palmer, Neal G; Yacyshyn, James R; Northcott, Herbert C; Nebbe, Brian; Flores-Mir, Carlos; Major, Paul W

    2006-01-01

    An anonymous, self-administered, mail-out survey of Canadian Orthodontists was conducted to evaluate the characteristics of orthodontic Internet use. The response rate was 45.6% (304 of 667). A total of 76.6% of orthodontists reported having Internet access at work, and an additional 12.4% reported having Internet access from a different location. Statistically significant associations between Internet usage and office staff size (P < .001) and years of practice (P = .046) were observed. Offices with larger staffs had greater Internet access. Number of staffs and number of case starts were positively correlated (P < .001, r = 0.498). The odds ratio for having Internet access on the basis of increased case starts from the less than 100 to 300-399 categories was 5.67. Although not statistically significant, there was a trend for greater Internet access by younger practitioners.

  20. Canadian Cardiovascular Society/Canadian Heart Rhythm Society joint position statement on the use of remote monitoring for cardiovascular implantable electronic device follow-up.

    Science.gov (United States)

    Yee, Raymond; Verma, Atul; Beardsall, Marianne; Fraser, Jennifer; Philippon, Francois; Exner, Derek V

    2013-06-01

    Remote monitoring (RM) is a form of telemedicine technology that permits implanted pacemakers and implantable cardioverter-defibrillators to transmit diagnostic information for review by health care professionals without patients needing to visit the device follow-up clinic. A bedside transmitter in the patient's home conveys the device data using standard telecommunication protocol to a protected internet-accessible RM data server, which authorized health care professionals can access at any time using standard web browser software. Evidence indicates it can accelerate identification of clinical events and potential device problems. RM raises important medicolegal issues concerning the protection of a patient's rights and the safeguarding of patient health information related to the collection, storage, and use of patient device information that must be addressed by follow-up centres. This position statement recommends that remote monitoring be available at all device follow-up clinics as an integral part of the standard of care of device patients and also provides helpful advice to centres for the proper design, implementation, and integration of a remote monitoring system into the clinic. Copyright © 2013. Published by Elsevier Inc.

  1. COMPARISON BETWEEN THORACIC RADIOGRAPHIC FINDINGS AND POSTMORTEM DIAGNOSIS OF THORACIC DISEASES IN DYSPNEIC COMPANION RATS (RATTUS NORVEGICUS).

    Science.gov (United States)

    Fouriez-Lablée, Virginie; Vergneau-Grosset, Claire; Kass, Philip H; Zwingenberger, Allison L

    2017-03-01

    Companion rats are often presented to veterinarians for respiratory difficulties. Dyspnea in rats is most commonly due to infectious pneumonia, and thoracic neoplasia can go undiagnosed ante mortem due to a mistaken interpretation of pneumonia. In domestic carnivores, pulmonary nodular patterns have been shown to correlate with lung neoplastic diseases and infectious diseases. The main objective of this retrospective case series study was to determine whether certain radiographic criteria could be correlated with the presence of thoracic infectious disease and neoplastic disease in companion rats. A secondary objective was to determine whether the patient's sex and age were different between rats diagnosed with infectious versus neoplastic disease. Medical records and thoracic radiographs of dyspneic companion rats presented to the University of California at Davis, William R. Pritchard Veterinary Medical Teaching Hospital during the time period from January 2000 to December 2014 were reviewed. Rats with postmortem confirmation of thoracic lesions were included in the study. Thoracic radiographs were evaluated for positioning, lesion distribution, lung lobe involved, pulmonary pattern, mediastinal and pleural lesions by three observers blinded to diagnosis. Thirty rats were included in the study, including 23 rats with an infectious disease and seven with neoplasia. Mediastinal lesions were significantly more prevalent in the group diagnosed with thoracic neoplasia (P = 0.031), in particular cranially (P = 0.048). Although there was an overlap between the two groups, findings indicated that the presence of cranial mediastinal lesions may be helpful for differentiating neoplastic from infectious disease in rats. © 2016 American College of Veterinary Radiology.

  2. Research productivity of Canadian ophthalmology departments in top 10 ophthalmology and vision science journals from 2001 to 2010.

    Science.gov (United States)

    Schlenker, Matthew B; Manalo, Elbert; Wong, Agnes M F

    2013-02-01

    To evaluate the research productivity of Canadian ophthalmology departments in terms of research volume, impact, funding, and cost-efficiency, and compare these measures with the top 6 U.S. departments. Systemic review. Using the Web of Science, we obtained the number of peer-reviewed research articles and citations in which an author listed an ophthalmology department (or affiliated university or hospital) from 2001 to 2010 in the top 10 ophthalmology and vision sciences journals, as well as the Canadian Journal of Ophthalmology. Federal research funding received from the Canadian Institutes of Health Research and National Institutes of Health was also obtained. The 3 universities that produced the highest number of articles were the University of Toronto (UofT), McGill University, and the University of British Columbia (UBC). UofT also produced the largest number of citations, followed by UBC and Dalhousie University. For the number of citations per article, the top 3 were the University of Ottawa, Dalhousie University, and the University of Calgary. McGill University, the University of Montreal, and UofT received the most federal funding. The 3 Canadian universities with the lowest funding (cost) per article were UofT, UBC, and McMaster University. The top contributors to the Canadian Journal of Ophthalmology from 2001 to 2010 were UofT, the University of Ottawa, and McGill University. Larger Canadian departments tended to generate higher research volume and obtained more federal funding, but smaller departments also contributed significantly, and sometimes surpassed larger departments, in terms of research impact and cost-efficiency. The top 6 U.S. departments generated higher research volume and received more federal research funding than their Canadian counterparts. However, when research impact and cost-efficiency were examined, Canadian departments performed similar to the top U.S. departments. Copyright © 2013 Canadian Ophthalmological Society. Published

  3. Does an Internal Thoracoplasty Correct and Prevent a Reassertion of the Rib Cage Deformity After Spine Surgery for an Adolescent Idiopathic Thoracic Scoliosis Greater Than 70 Degrees.

    Science.gov (United States)

    McMaster, Michael J; McMaster, Marianne E

    2016-01-01

    Prospective observational study. To evaluate the effect of internal thoracoplasty and anterior spine release combined with posterior spinal instrumentation in correcting and preventing a reoccurrence of the rib cage deformity in adolescent idiopathic thoracic scoliosis >70 degrees. The rib cage deformity rather than the lateral curvature of the spine is usually the major cosmetic deformity in severe adolescent idiopathic thoracic scoliosis. This can be difficult to treat and assess the effect of surgery. The Integrated Shape Imaging System was used to assess rib cage deformity before surgery and during follow-up for more than 2 years in 37 patients with an adolescent idiopathic thoracic scoliosis (Lenke 1) >70° (mean 81°) treated by internal thoracoplasty and anterior spine release combined with posterior spinal instrumentation using a hybrid construct. The mean Cobb angle was reduced from 81° to 30° (63% correction). The rib cage deformity was improved in 30 patients (81%) because of a combination of both a reduction of the convex rib hump and an elevation of the concave rib depression. However, the effect on patients with an angle of thoracic inclination deformity had occurred in 9 patients. In none of the 37 patients was there any further progression of the rib cage deformity. An internal thoracoplasty was effective in improving and/or stabilizing the rib cage deformity as well as achieving good correction of the scoliosis in patients with adolescent idiopathic thoracic scoliosis and severe deformity. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  4. Canadian Contraception Consensus (Part 2 of 4).

    Science.gov (United States)

    Black, Amanda; Guilbert, Edith; Costescu, Dustin; Dunn, Sheila; Fisher, William; Kives, Sari; Mirosh, Melissa; Norman, Wendy V; Pymar, Helen; Reid, Robert; Roy, Geneviève; Varto, Hannah; Waddington, Ashley; Wagner, Marie-Soleil; Whelan, Anne Marie; Ferguson, Carrie; Fortin, Claude; Kielly, Maria; Mansouri, Shireen; Todd, Nicole

    2015-11-01

    To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general well-being; contraceptive counselling methods; and access to, and availability of, cited contraceptive methods in Canada. Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Chapter 1: Contraception in Canada Summary Statements  1. Canadian women spend a significant portion of their lives at risk of an unintended pregnancy. (II-2)  2. Effective contraceptive methods are underutilized in Canada, particularly among vulnerable populations. (II-2)  3. Long-acting reversible contraceptive methods, including contraceptive implants and intrauterine contraception (copper-releasing and levonorgestrel

  5. Canadian Contraception Consensus (Part 1 of 4).

    Science.gov (United States)

    Black, Amanda; Guilbert, Edith; Costescu, Dustin; Dunn, Sheila; Fisher, William; Kives, Sari; Mirosh, Melissa; Norman, Wendy V; Pymar, Helen; Reid, Robert; Roy, Geneviève; Varto, Hannah; Waddington, Ashley; Wagner, Marie-Soleil; Whelan, Anne Marie; Ferguson, Carrie; Fortin, Claude; Kielly, Maria; Mansouri, Shireen; Todd, Nicole

    2015-10-01

    To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general well-being; contraceptive counselling methods; and access to, and availability of, cited contraceptive methods in Canada. Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Chapter 1: Contraception in Canada Summary Statements 1. Canadian women spend a significant portion of their lives at risk of an unintended pregnancy. (II-2) 2. Effective contraceptive methods are underutilized in Canada, particularly among vulnerable populations. (II-2) 3. Long-acting reversible contraceptive methods, including contraceptive implants and intrauterine contraception (copper-releasing and levonorgestrel

  6. A perspective on Canadian shale gas

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Mike; Davidson, Jim; Mortensen, Paul

    2010-09-15

    In a relatively new development over just the past few years, shale formations are being targeted for natural gas production. Based on initial results, there may be significant potential for shale gas in various regions of Canada, not only in traditional areas of conventional production but also non-traditional areas. However, there is much uncertainty because most Canadian shale gas production is currently in experimental or early developmental stages. Thus, its full potential will not be known for some time. If exploitation proves to be successful, Canadian shale gas may partially offset projected long-term declines in Canadian conventional natural gas production.

  7. MRI findings in thoracic outlet syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Aralasmak, Ayse; Sharifov, Rasul; Kilicarslan, Rukiye; Alkan, Alpay [Bezmialem Vakif University, Department of Radiology, Fatih/Istanbul (Turkey); Cevikol, Can; Karaali, Kamil; Senol, Utku [Akdeniz University, Department of Radiology, Antalya (Turkey)

    2012-11-15

    We discuss MRI findings in patients with thoracic outlet syndrome (TOS). A total of 100 neurovascular bundles were evaluated in the interscalene triangle (IS), costoclavicular (CC), and retropectoralis minor (RPM) spaces. To exclude neurogenic abnormality, MRIs of the cervical spine and brachial plexus (BPL) were obtained in neutral. To exclude compression on neurovascular bundles, sagittal T1W images were obtained vertical to the longitudinal axis of BPL from spinal cord to the medial part of the humerus, in abduction and neutral. To exclude vascular TOS, MR angiography (MRA) and venography (MRV) of the subclavian artery (SA) and vein (SV) in abduction were obtained. If there is compression on the vessels, MRA and MRV of the subclavian vessels were repeated in neutral. Seventy-one neurovascular bundles were found to be abnormal: 16 arterial-venous-neurogenic, 20 neurogenic, 1 arterial, 15 venous, 8 arterial-venous, 3 arterial-neurogenic, and 8 venous-neurogenic TOS. Overall, neurogenic TOS was noted in 69%, venous TOS in 66%, and arterial TOS in 39%. The neurovascular bundle was most commonly compressed in the CC, mostly secondary to position, and very rarely compressed in the RPM. The cause of TOS was congenital bone variations in 36%, congenital fibromuscular anomalies in 11%, and position in 53%. In 5%, there was unilateral brachial plexitis in addition to compression of the neurovascular bundle. Severe cervical spondylosis was noted in 14%, contributing to TOS symptoms. For evaluation of patients with TOS, visualization of the brachial plexus and cervical spine and dynamic evaluation of neurovascular bundles in the cervicothoracobrachial region are mandatory. (orig.)

  8. Education Societies in London.

    Science.gov (United States)

    Scottish Educational Review, 1985

    1985-01-01

    Describes origins, membership criteria, activities, and publications of the Scottish branches of six educational societies: British Association of Early Childhood Education, British Psychological Society, National Association for Gifted Children, National Council for Special Education, United Kingdom Reading Association, and Education Otherwise.…

  9. Fieldwork in Transforming Societies

    DEFF Research Database (Denmark)

    Clark, Ed; Michailova, Snejina

    The contributors to this text discuss the personal and professional challenges of conducting fieldwork in the difficult, sometimes threatening contexts of the transforming societies of post-socialist Europe and China.......The contributors to this text discuss the personal and professional challenges of conducting fieldwork in the difficult, sometimes threatening contexts of the transforming societies of post-socialist Europe and China....

  10. Refractions of Civil Society

    DEFF Research Database (Denmark)

    Kuzmanovic, Daniella

    The thesis investigates various perceptions of civil society among civic activists in Turkey, and how these perceptions are produced and shaped. The thesis is an anthropological contribution to studies of civil society in general, as well as to studies on political culture in Turkey....

  11. Glaciers and society

    DEFF Research Database (Denmark)

    Gagné, Karine; Rasmussen, Mattias Borg; Orlove, Ben

    2014-01-01

    toward technological methodologies. Yet, as elements of the landscape, glaciers are strongly integrated to various societies around the world in ways that exceed their role as provider of fundamental sources of water. The relation between glaciers and societies is therefore marked by processes...

  12. World Society and Globalisation

    Science.gov (United States)

    Wittmann, Veronika

    2014-01-01

    Purpose: The purpose of this paper is to illustrate discourses on globalisation and world society and to disclose the commonalities and differences of both scientific debates. In particular, it draws attention to theoretical concepts of globalisation and world society. This is considered fruitful for comprehending the complex mechanisms of…

  13. Skin-Color Preferences and Body Satisfaction among South Asian-Canadian and European-Canadian Female University Students.

    Science.gov (United States)

    Sahay, Sarita; Piran, Niva

    1997-01-01

    Examines skin-color preferences and body satisfaction among South Asian-Canadian and European-Canadian female university students. Hypothesizes that South Asian-Canadians would display a greater wish to be lighter in skin color than would European-Canadians and that the discrepancy would be greater the darker their skin color. Reports that the…

  14. RADIOGRAPHIC THORACIC ANATOMY OF THE RED PANDA (AILURUS FULGENS).

    Science.gov (United States)

    Makungu, Modesta; du Plessis, Wencke M; Barrows, Michelle; Groenewald, Hermanus B; Koeppel, Katja N

    2016-09-01

    The red panda ( Ailurus fulgens ) is classified as an endangered species by the International Union for Conservation of Nature and Natural Resources. The natural distribution of the red panda is in the Himalayas and southern China. Thoracic diseases such as dirofilariasis, hypertrophic cardiomyopathy, tracheal obstruction, lung worm infestation, and pneumonia have been reported in the red panda. The aim of this study was to describe the normal radiographic thoracic anatomy of captive red pandas as a species-specific reference for routine health examinations and clinical cases. Right lateral (RL) and dorsoventral (DV) inspiratory phase views of the thorax were obtained in 11 adult captive red pandas. Measurements were made and ratios calculated to establish reference ranges for the mean vertebral heart score on the RL (8.34 ± 0.25) and DV (8.78 ± 0.34) views and the mean ratios of the caudal vena cava diameter to the vertebral body length above tracheal bifurcation (0.67 ± 0.05) and tracheal diameter to the width of the third rib (2.75 ± 0.24). The majority of animals (10/11) had 14 thoracic vertebrae, except for one animal that had 15 thoracic vertebrae. Rudimentary clavicles were seen in 3/11 animals. The ovoid, oblique cardiac silhouette was more horizontally positioned and elongated in older animals. A redundant aortic arch was seen in the oldest animal. The trachea was seen with mineralized cartilage rings in all animals. The carina was clearly seen in the majority of animals (10/11). Variations exist in the normal radiographic thoracic anatomy of different species. Knowledge of the normal radiographic thoracic anatomy of the red panda should prove useful for routine health examinations and in the diagnosis of thoracic diseases.

  15. Dextrocardia and coronal alignment of thoracic curve: a population study.

    Science.gov (United States)

    Tallroth, Kaj; Lohman, Martina; Heliövaara, Markku; Aromaa, Arpo; Knekt, Paul; Standertskjöld-Nordenstam, Carl-Gustaf

    2009-12-01

    The objective of this study was to evaluate the coronal alignment of the thoracic spine in persons with dextrocardia. Generally, the thoracic spine is slightly curved to the right. It has been suggested that the curve could be triggered by pulsation forces from the descending aorta. Since no population study has focused on the alignment of the thoracic spine in persons with situs inversus, dextrocardia, and right-sided descending aorta, we compared the radiographs of the thoracic spine in persons with dextrocardia to those having normal levocardia. Among 57,440 persons in a health survey, 11 cases of dextrocardia were identified through standard radiological screening. The miniature chest radiographs of eight persons were eligible for the present study. The study was carried out as a nested case-control study. Four individually matched (age, gender, and municipality) controls with levocardia were chosen for each case. Coronal alignment of the thoracic spine was analyzed without knowledge of whether the person had levo- or dextrocardia. A mild convexity to the left was found in all persons with dextrocardia and right-sided descending aorta (mean Cobb angle 6.6 degrees to the left, SD 2.9). Of the 32 normal levocardia persons, 29 displayed a convexity to the right, and the remaining three had a straight spine (mean Cobb angle 5.2 degrees to the right, SD 2.3). The difference (mean 11.8 degrees , SD 3.5) differed significantly from unity (P = 0.00003). In conclusion, it seems that a slight left convexity of the thoracic spine is frequent in dextrocardia. We assume that the effect of the repetitive pulsatile pressure of the descending thoracic aorta, and the mass effect of the heart may cause the direction of the convexity to develop opposite to the side of the aortic arch.

  16. The SCRAP Rule: The derivation and internal validation of a clinical decision rule for computed tomography of the chest in blunt thoracic trauma.

    Science.gov (United States)

    Payrastre, Julien; Upadhye, Suneel; Worster, Andrew; Lin, Daren; Kahnamoui, Kamyar; Patterson, Heather; Sanaee, Layli; Clayden, Rob

    2012-11-01

    To derive and internally validate a clinical decision rule that will rule out major thoracic injury in adult blunt trauma patients, reducing the unnecessary use of chest computed tomographic (CT) scans. Data were retrospectively obtained from a chart review of all trauma patients presenting to a Canadian tertiary trauma care centre from 2005 to 2008, with those from April 2006 to March 2007 being used for the validation phase. Patients were included if they had an Injury Severity Score > 12 and chest CT at admission or a documented major thoracic injury noted in the trauma database. Patients with penetrating injury, a Glasgow Coma Scale (GCS) score ≤ 8, paralysis, or age SCRAP). In the validation group, the same five variables had a sensitivity of 100% (95% CI 96.2-100%), a specificity of 44.7% (95% CI 39.5-44.7%), and negative likelihood ratio of 0.00 (95% CI 0.00-0.10). In major blunt trauma with a GCS score > 8, the SCRAP variables have a 100% sensitivity for major thoracic injury in this retrospective study. These findings need to be prospectively validated prior to use in a clinical setting.

  17. Islam dan Civil Society

    Directory of Open Access Journals (Sweden)

    Imam Sukardi

    2010-05-01

    Full Text Available The article tries to address the concept of civil society from varied perspectives. From a historical point of view, civil society demands not only the absent domination of state but also liberates individuals from the hegemony of state. The article shows that in Indonesia and Malaysian discourse, masyarakat madani is often used to represent the term of civil society. Using this conception, major values of civil society also share with basic ideas within the Medina Treaty in the history of Islam. These ideas include egalitarianism, human rights protection, participation, law and justice enforcement and pluralism. In this frame, the question on whether or not Islam is compatible with the concept of civil society is clearly answered. Muslims could benefit such a concept to build their awareness of being progressive and adaptive to social changes.

  18. Findings on Thoracic Computed Tomography Scans and Respiratory Outcomes in Persons with and without Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Wan C Tan

    Full Text Available Thoracic computed tomography (CT scans are widely performed in clinical practice, often leading to detection of airway or parenchymal abnormalities in asymptomatic or minimally symptomatic individuals. However, clinical relevance of CT abnormalities is uncertain in the general population.We evaluated data from 1361 participants aged ≥40 years from a Canadian prospective cohort comprising 408 healthy never-smokers, 502 healthy ever-smokers, and 451 individuals with spirometric evidence of chronic obstructive pulmonary disease (COPD who had thoracic CT scans. CT images of subjects were visually scored for respiratory bronchiolitis(RB, emphysema(E, bronchial-wall thickening(BWT, expiratory air-trapping(AT, and bronchiectasis(B. Multivariable logistic regression models were used to assess associations of CT features with respiratory symptoms, dyspnea, health status as determined by COPD assessment test, and risk of clinically significant exacerbations during 12 months follow-up.About 11% of life-time never-smokers demonstrated emphysema on CT scans. Prevalence increased to 30% among smokers with normal lung function and 36%, 50%, and 57% among individuals with mild, moderate or severe/very severe COPD, respectively. Presence of emphysema on CT was associated with chronic cough (OR,2.11; 95%CI,1.4-3.18; chronic phlegm production (OR,1.87; 95% CI,1.27-2.76; wheeze (OR,1.61; 95% CI,1.05-2.48; dyspnoea (OR,2.90; 95% CI,1.41-5.98; CAT score≥10(OR,2.17; 95%CI,1.42-3.30 and risk of ≥2 exacerbations over 12 months (OR,2.17; 95% CI, 1.42-3.0.Burden of thoracic CT abnormalities is high among Canadians ≥40 years of age, including never-smokers and smokers with normal lung function. Detection of emphysema on CT scans is associated with pulmonary symptoms and increased risk of exacerbations, independent of smoking or lung function.

  19. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair.

    Science.gov (United States)

    Patterson, Benjamin O; Holt, Peter J; Nienaber, Christoph; Fairman, Ronald M; Heijmen, Robin H; Thompson, Matt M

    2014-12-01

    Thoracic endovascular aortic repair (TEVAR) of various pathologies has been associated with peri-interventional neurologic complication rates of up to 15%. The objective of this study was to determine the influence of the management of the left subclavian artery (LSA) on neurologic complications and to define subgroups that might benefit from LSA revascularization. The Medtronic Thoracic Endovascular Registry (MOTHER; Medtronic, Santa Rosa, Calif), consists of data from five sponsored trials and one institutional series incorporating 1010 patients undergoing TEVAR from 2002 to 2010. Perioperative stroke and spinal cord injury (SCI) rates were described according to the management of the LSA and presenting pathology. Multivariate analysis was performed to determine factors associated with perioperative neurologic complications. Of 1002 patients included in the analysis, stroke occurred in 48 (4.8%), and SCI developed in 42 (4.2%) ≤ 30 days of surgery. The stroke rate was 2.2% in patients with no coverage of the LSA vs 9.1% with coverage alone and 5.1% in patients who underwent LSA revascularization before coverage (P < .001). This relationship was strongest in the aneurysm group. Coverage of the LSA without revascularization was independently associated with stroke (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7-7.1), specifically in the posterior territory (OR, 11.7; 95% CI, 2.5-54.6), as was previous cerebrovascular accident (OR, 7.1; 95% CI, 2.2-23.1; P = .001), whereas a covered LSA was not associated with an increased risk of SCI. Coverage of the LSA without revascularization is an important modifiable risk factor for stroke in patients undergoing TEVAR for a thoracic aortic aneurysm. Prior revascularization appears to protect against posterior circulation territory stroke. Copyright © 2014 Society for Vascular Surgery. All rights reserved.

  20. Impact of Moodle-Based Online Curriculum on Thoracic Surgery In-Training Examination Scores.

    Science.gov (United States)

    Antonoff, Mara B; Verrier, Edward D; Allen, Mark S; Aloia, Lauren; Baker, Craig; Fann, James I; Iannettoni, Mark D; Yang, Stephen C; Vaporciyan, Ara A

    2016-10-01

    The feasibility and efficacy of a web-based curriculum in supplementing thoracic surgical training was previously shown. However, the impact of curricular participation on validated knowledge tests remains unknown. We compared in-service training examination (ITE) results among trainees, stratified by curricular use. The national online curriculum was implemented in August 2013. We retrospectively reviewed trainees who participated in thoracic surgical training programs in both 2012 to 2013 and 2013 to 2014. Scores from the 2013 and 2014 ITEs were obtained, and curricular usage data were collected from site analytics. Trainees were separated into three groups according to 2013 ITE scores; within each group, changes in score for high- versus low-volume users were compared. 187 trainees took the ITE both years, with exposure to the online curriculum during only the second year. High-volume users' scores trended toward greater improvement than scores of low-volume users (+18.2% versus +13.0%, p = 0.199). When stratified by 2013 score, the lowest scoring quartile improved substantially, and the highest scoring quartile improved modestly, regardless of curricular use. However, for those individuals who achieved mid-range scores in 2013, there was a trend toward much greater improvement in score with heavier use of the curriculum (+17.0% versus +7.0%, p = 0.094). Among trainees who had access to the novel online curriculum during the second of 2 consecutive years, we evaluated the impact of curricular participation on ITE scores. The effect appears to be most pronounced in individuals with mid-range scores, in whom high curricular use led to the greatest improvement. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Outcomes of thoracic endovascular aortic repair in adult coarctation patients.

    Science.gov (United States)

    Lala, Salim; Scali, Salvatore T; Feezor, Robert J; Chandrekashar, Satish; Giles, Kristina A; Fatima, Javairiah; Berceli, Scott A; Back, Martin R; Huber, Thomas S; Beaver, Thomas M; Beck, Adam W

    2017-09-22

    Aortic coarctation (AC) is most commonly identified in pediatric patients; however, adults can present with late sequelae of untreated coarctation or complications of prior open repair. To date, there are limited data about the role of thoracic endovascular aortic repair (TEVAR) in this group of patients. The purpose of this analysis was to describe our experience with management of adult coarctation patients using TEVAR. All TEVAR patients treated for primary coarctation or late sequelae of previous open repair (eg, pseudoaneurysm, recurrent coarctation or anastomotic stenosis related to index open coarctation repair) were reviewed. Demographics, comorbidities, procedure-related variables, postoperative outcomes, and reintervention were recorded. Computed tomography centerline assessments of endograft morphology were completed to delineate stent anatomy at the coarctation site. Survival and reintervention were estimated using life-table analysis. A total of 21 patients were identified (median age, 46 years [range, 33-71 years]; 67% male [n = 14]). Nine patients (43%) were treated for symptomatic primary (n = 6) or recurrent (n = 3) coarctation. Other indications included degenerative thoracic aneurysm (n = 6), pseudoaneurysm (n = 4), and dissection (n = 2). Technical success was 100% (95% confidence interval [CI], 84%-100%). No 30-day mortality or paraplegia events occurred; however, two patients (10%) experienced postoperative nondisabling stroke. In primary or recurrent coarctation patients with available computed tomography imaging (n = 8 of 9), nominal stent graft diameters were achieved proximal and distal to the coarctation (range, -0.4 to -1.2 mm of desired final stent diameter). Specific to the coarctation site, there was a significant increase in aortic diameter after TEVAR (before stenting, 11.5 [95% CI, 6.8-12.3] mm; after stenting, 15 [95% CI, 13.7-15.7] mm; P = .004). Concurrently, systolic arterial blood pressure at time of discharge was

  2. Nonoperative management of grade III blunt thoracic aortic injuries.

    Science.gov (United States)

    Gandhi, Sagar S; Blas, Joseph V; Lee, Stewart; Eidt, John F; Carsten, Christopher G

    2016-12-01

    Blunt thoracic aortic injuries (BTAIs) have historically been treated with open surgery; thoracic endovascular aortic repair (TEVAR), however, is rapidly becoming the standard of care for all grades of injury. Previous studies have shown successful, conservative management of low-grade (I and II) BTAI, but limited literature exists regarding nonoperative management (NOM) for high-grade BTAI. The purpose of this study was to evaluate NOM for grade III BTAI compared with TEVAR. There were 75 patients diagnosed with BTAI between January 2004 and June 2015. Of these, 40 were excluded for different grades of BTAI (17), death before any treatment (6), and need for urgent open repair (17). The remaining 35 patients were divided into two groups by treatment approach: NOM (n = 18) and TEVAR (n = 17). Primary end points were complications and mortality. The secondary end point was difference in pseudoaneurysm and aortic diameter measurements between groups. The groups of patients were similar in age, gender, Injury Severity Score, length of stay, in-hospital mortality, and hospital-associated complications. There were four TEVAR-related complications: graft involutions (2), type I endoleak (1), and distal embolization (1). All TEVAR-related complications required either an adjunctive procedure at the time of the primary procedure or an additional procedure. No patients from the NOM group required operative intervention. There were seven in-hospital mortalities: two in the TEVAR group (11.8%) and five in the NOM group (27.8%; P = .402). One death in the NOM group was related to aortic disease. Follow-up computed tomography imaging revealed similar aortic-related outcomes between groups, with a high proportion showing resolved or improved aortic injury (NOM, 87.5%; TEVAR, 92.9%; P = .674). Initial computed tomography imaging showed similar aortic diameters between groups. The average diameter of the aorta distal to the subclavian artery was 22.6 mm in the NOM group vs 22

  3. Dysplastic Nevus: Management by Canadian Dermatologists.

    Science.gov (United States)

    Sapra, Priya; Rosen, Cheryl; Siddha, Sanjay; Lynde, Charles W

    2015-01-01

    The management of dysplastic nevi is controversial. No studies have collected data regarding management of the lesion amongst Canadian dermatologists. To provide a comprehensive review of what the prevailing opinions are, regarding treatment and terminology of dysplastic nevi, amongst Canadian dermatologists. An online survey of 25 questions was e-mailed to 613 members of the Canadian Dermatology Association, in French and English. A total of 179 responses were received. Varying numbers of participants completed each question. The majority of participants think that the term dysplastic nevus should not be abandoned, and they indicated that they never reexcise lesions with mild to moderate atypia even when the margins are positive. The majority of Canadian dermatologists retain the use of the term dysplastic nevus and do not reexcise lesions with mild to moderate atypia even when the margins are positive. © The Author(s) 2015.

  4. Freezing at sea: a Canadian opportunity

    National Research Council Canada - National Science Library

    Bollivar, D.R; Cadegan, E; Demone, E.H; Matthew, P; Nicholson, P.J; Shannon, C.P; Stirling, R.C

    This report was prepared for the Nova Scotia Fish Packers Association in an effort to set out as clearly as possible the issues relating to introduction of freezing at sea technology to the Canadian...

  5. The Canadian Forces Recruitment/Attrition Model

    National Research Council Canada - National Science Library

    Wait, Tracey

    1998-01-01

    ...), as part of its mandate to provide analysis of potential impacts of trends and change on defense and defense related issues, has designed a prototype model of recruitment and attrition of the Canadian Forces (C F...

  6. Canadian shellfish sanitation program: manual of operations

    National Research Council Canada - National Science Library

    1992-01-01

    This manual outlines the authorities (acts and regulations), policies and procedures which apply to the Canadian program and which will be used to evaluate regional activities associated with the shellfish Sanitation Program...

  7. Canadian Business Schools: Going out of Business?

    Science.gov (United States)

    Dobni, Dawn; Dobni, Brooke

    1996-01-01

    Using Porter's five-forces model (potential entrants, suppliers, buyers, rivalry, substitutes) to analyze competition in Canadian university business schools, the authors conclude that schools are becoming increasingly vulnerable to competitive pressures and that strategic reorientation is necessary. (SK)

  8. Thoracic pedicle morphometry in vertebrae from scoliotic spines.

    Science.gov (United States)

    Parent, Stefan; Labelle, Hubert; Skalli, Wafa; de Guise, Jacques

    2004-02-01

    A morphometric analysis of thoracic pedicles in vertebrae from scoliotic specimens. The objective of this study was to quantify the changes occurring in thoracic pedicles affected by a scoliotic deformity. There exists a lot of controversy in the literature concerning the shape and size of thoracic pedicles in idiopathic scoliosis. In recent years, thoracic pedicle screws are being used more frequently in corrective spine surgery, but few studies have evaluated the morphology of scoliotic thoracic pedicles. Thirty scoliotic specimens with curves presenting various degrees of severity were studied using a three-dimensional digitizing protocol developed to create a precise three-dimensional reconstruction of the vertebrae. Twenty-two parameters describing specifically the pedicles were then calculated for each vertebra from these reconstructions. Every scoliotic specimen was then matched with a normal specimen to provide for a representative control group and comparisons were made on pedicle width, length, height, surface, and orientation. A total of 683 thoracic vertebrae were measured (325 scoliotic and 358 normal vertebrae). Pedicles located on the concavity of typical right thoracic curves were found to be significantly thinner than their normal counterparts with a maximal mean difference of 1.37 mm at T8. The pedicles on the concavity of the high thoracic compensatory curve were also found to be significantly diminished with a maximal mean difference of 1.68 mm at T4. Mean left pedicle width at T8 (concavity) and mean right pedicle width at T4 (concavity) were found to be 4.08 mm and 2.60 mm, respectively. Pedicle length was found to be slightly increased, and pedicle height was found to be slightly decreased in pedicles from scoliotic spines with no preference for concavity or convexity. Pedicle orientation and inclination were unchanged with respect to each corresponding vertebral body. These results are of critical importance for clinicians performing spinal

  9. Canadian Art Partnership Program in Finland

    OpenAIRE

    Ketovuori, Mikko Mr.

    2011-01-01

    This article is about a multidisciplinary R&D project in which a Canadian Learning Through The Arts (LTTA) program was imported to Finland in 2003–2004. Cultural differences in arts education in Finland and Canada are discussed. While Finland has a national school curriculum with all the arts included. Canada relies more on partnerships to ensure arts education for children in the schools. Despite the fact that Canadian learning methods appeared to be quite similar to the ones Finnish teacher...

  10. Canadian Multiculturalism, Same as it ever Was?

    OpenAIRE

    Kathleen Hoyos

    2014-01-01

    After the Second World War ended, Canada was no longer mainly composed of its two dominant ethnocultural groups, French and English, but rather constituted by polyethnicity; meaning, Canadian culture was made up of many different ethnic groups. Since then, Canada has actively embraced multiculturalism and on 12 July 1988, the House of Commons passed Bill C-93, ‘An Act for the preservation and enhancement of multiculturalism in Canada’. The Canadian multicultural experience has been much portr...

  11. Predictive factors for cerebrovascular accidents after thoracic endovascular aortic repair.

    Science.gov (United States)

    Mariscalco, Giovanni; Piffaretti, Gabriele; Tozzi, Matteo; Bacuzzi, Alessandro; Carrafiello, Giampaolo; Sala, Andrea; Castelli, Patrizio

    2009-12-01

    Cerebrovascular accidents are devastating and worrisome complications after thoracic endovascular aortic repair. The aim of this study was to determine cerebrovascular accident predictors after thoracic endovascular aortic repair. Between January 2001 and June 2008, 76 patients treated with thoracic endovascular aortic repair were prospectively enrolled. The study cohort included 61 men; mean age was 65.4 +/- 16.8 years. All patients underwent a specific neurologic assessment on an hourly basis postoperatively to detect neurologic deficits. Cerebrovascular accidents were diagnosed on the basis of physical examination, tomography scan or magnetic resonance imaging, or autopsy. Cerebrovascular accidents occurred in 8 (10.5%) patients, including 4 transient ischemic attack and 4 major strokes. Four cases were observed within the first 24-hours. Multivariable analysis revealed that anatomic incompleteness of the Willis circle (odds ratio [OR] 17.19, 95% confidence interval [CI] 2.10 to 140.66), as well as the presence of coronary artery disease (OR 6.86, 95 CI% 1.18 to 40.05), were independently associated with postoperative cerebrovascular accident development. Overall hospital mortality was 9.2%, with no significant difference for patients hit by cerebrovascular accidents (25.0% vs 7.3%, p = 0.102). Preexisting coronary artery disease, reflecting a severe diseased aorta and anomalies of Willis circle are independent cerebrovascular accident predictors after thoracic endovascular aortic repair procedures. A careful evaluation of the arch vessels and cerebral vascularization should be mandatory for patients suitable for thoracic endovascular aortic repair.

  12. Regional interdependence and manual therapy directed at the thoracic spine.

    Science.gov (United States)

    McDevitt, Amy; Young, Jodi; Mintken, Paul; Cleland, Josh

    2015-07-01

    Thoracic spine manipulation is commonly used by physical therapists for the management of patients with upper quarter pain syndromes. The theoretical construct for using thoracic manipulation for upper quarter conditions is a mainstay of a regional interdependence (RI) approach. The RI concept is likely much more complex and is perhaps driven by a neurophysiological response including those related to peripheral, spinal cord and supraspinal mechanisms. Recent evidence suggests that thoracic spine manipulation results in neurophysiological changes, which may lead to improved pain and outcomes in individuals with musculoskeletal disorders. The intent of this narrative review is to describe the research supporting the RI concept and its application to the treatment of individuals with neck and/or shoulder pain. Treatment utilizing both thrust and non-thrust thoracic manipulation has been shown to result in improvements in pain, range of motion and disability in patients with upper quarter conditions. Research has yet to determine optimal dosage, techniques or patient populations to which the RI approach should be applied; however, emerging evidence supporting a neurophysiological effect for thoracic spine manipulation may negate the need to fully answer this question. Certainly, there is a need for further research examining both the clinical efficacy and effectiveness of manual therapy interventions utilized in the RI model as well as the neurophysiological effects resulting from this intervention.

  13. The Influence of Canadian Intellectuals’ Ideological Views on the Political Culture in Canada at the Beginning of the 20th Century

    Directory of Open Access Journals (Sweden)

    SOKOV I.A.

    2014-06-01

    Full Text Available The article analyses the political views of Canadian intellectuals which had influence on the formation of Canadian political culture at the turn of the 20th century. The author confirms that the Canadian intellectual thought was the main ideological factor in the conditions of the formation of Canadian statehood, undeveloped party and political system, the lack of deep traditions of the parliamentary system, insufficient political practice and the lack of distinct ideology of basic political parties in the process of forming the Canadian nation. On the basis of studied Canadian sources, the author makes conclusion that the most of Canadian intellectuals did not participate directly in the political process and they considered themselves its bystanders. Besides, the Canadian intellectuals promoted the British political culture of the Victorian epoch. Although all of them were familiar wih the British socialistic thought – Fabianism, they insisted that the social transformation in the Canadian society is possible only through the improvement of moral system, the education of lower social classes and the maintenance of elite monarch traditions. The American influence on Canadian political culture was peripheral at the beginning of the 20th century. The ideas of the Chicago Sociological School and the European continental thought were not used. The Victorian intellectuals understood their time as the social crisis and their political discussions were often devoted to the problems of imperialism, religion, education and feminism. They undoubtedly influenced the Canadian political elite in the matter of further development of the Canadian nation and state, but they expressed their own unique views on the contemporary society in academic press and in elite clubs discussions. They did not share the opinion of publicity about contemporary social processes, because their position was far from the direct party policy. Though some of them participated as

  14. Information society studies

    CERN Document Server

    Duff, Alistair S

    2013-01-01

    We are often told that we are ""living in an information society"" or that we are ""information workers."" But what exactly do these claims mean, and how might they be verified? In this important methodological study, Alistair S. Duff cuts through the rhetoric to get to the bottom of the ""information society thesis."" Wide-ranging in coverage, this study will be of interest to scholars in information science, communication and media studies and social theory. It is a key text for the newly-unified specialism of information society studies, and an indispensable guide to the future of this disc

  15. Climate and Ancient Societies

    DEFF Research Database (Denmark)

    Climate, and human responses to it, have a strongly interconnected relationship. This when climate change occurs, the result of either natural or human causes, societies should react and adapt to these. But do they? If so, what is the nature of that change, and are the responses positive...... or negative for the long-term survival of social groups? In this volume, scholars from diverse disciplines including archaeology, geology and climate sciences explore scientific and material evidence for climate changes in the past, their causes, their effects on ancient societies and how those societies...

  16. Emergency thoracic ultrasound and clinical risk management

    Directory of Open Access Journals (Sweden)

    Interrigi MC

    2017-02-01

    Full Text Available Maria Concetta Interrigi,1 Francesca M Trovato,2,3 Daniela Catalano,3,4 Guglielmo M Trovato3,5 1Accident and Emergency Department, Ospedale Cannizzaro, Catania, 2Accident and Emergency Department, Ospedale Civile, Ragusa, 3Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania, 4Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania, 5Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy Purpose: Thoracic ultrasound (TUS has been proposed as an easy-option replacement for chest X-ray (CXR in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. Patients and methods: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. Results: Three hundred and seventy emergency TUS scans (excluding trauma patients were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion; in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed

  17. Clinical highlights from the 2016 European Respiratory Society International Congress

    Directory of Open Access Journals (Sweden)

    Nicolas Kahn

    2017-04-01

    Full Text Available This article contains highlights and a selection of the scientific advances from the European Respiratory Society (ERS Clinical Assembly (Assembly 1 and its six respective groups (Groups 1.1–1.6 that were presented at the 2016 ERS International Congress in London, UK. The most relevant topics for clinicians will be discussed, covering a wide range of areas including clinical problems, rehabilitation and chronic care, thoracic imaging, interventional pulmonology, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, the newest research and actual data will be discussed and put into perspective.

  18. Presented at the 64th Annual Scientific Meeting of the Japanese Association for thoracic surgery: wet-lab training for thoracic surgery at the laboratory animal facilities.

    Science.gov (United States)

    Noda, Masafumi; Mizuma, Masamichi; Maeda, Sumiko; Sakurada, Akira; Hoshikawa, Yasushi; Endo, Chiaki; Okada, Yoshinori; Unno, Michiaki; Kasai, Noriyuki; Kondo, Takashi

    2012-11-01

    The purpose of this study was to describe the animal thoracic training program for the thoracic surgery at the laboratory animal facilities The training was provided for 78 surgical students under the direction of thoracic medical specialists. Students attended lectures and then performed venipuncture, injection, intubation, tracheostomy, surgical cut-down, and thoracic and abdominal surgical approaches. We estimated the detailed surgical skills in two groups (67 residents and 11 thoracic fellows). All students demonstrated satisfactory impressions after training. We found significant difference between the skills of residents and fellows with regard to the haemostasis and suturing techniques. Wet-lab training for thoracic surgery at the laboratory animal facilities is useful for surgical residents and thoracic fellows.

  19. Ethnocultural Groups--The Making of Canada: Economic Contributions to Canadian Life. Report 2: Seven Successful Small Business Entrepreneurs.

    Science.gov (United States)

    Dutt, S.; And Others

    Immigrants and refugees come to Canada for many reasons and are often risk-takers. Some ethnic groups follow identifiable patterns of distinctive economic development, while others meld and blend into Canadian society so that no discernible pattern can be identified. This publication provides an overview of the contributions made by seven…

  20. Paraplegia After Thoracic Epidural Steroid Injection.

    Science.gov (United States)

    Loomba, Vivek; Kaveeshvar, Hirsh; Dwivedi, Samvid

    2016-09-01

    Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case.