المؤلفون: Janeve Desy, Adrian Harvey, Kerri Martin, Christopher Naugler, Kevin Mclaughlin

المصدر: Canadian Medical Education Journal (2024)

مصطلحات موضوعية: Education (General), L7-991, Medicine (General), R5-920

وصف الملف: electronic resource

العلاقة: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/77957Test; https://doaj.org/toc/1923-1202Test

الوصول الحر: https://doaj.org/article/d878a485699d46d0a4551cc2b8b3bf52Test

المؤلفون: Janeve Desy, Adrian Harvey, Sarah Weeks, Kevin D Busche, Kerri Martin, Michael Paget, Christopher Naugler, Kevin Mclaughlin

المصدر: Canadian Medical Education Journal (2024)

مصطلحات موضوعية: Education (General), L7-991, Medicine (General), R5-920

الوصف: At our centre, we introduced a continuous quality improvement (CQI) initiative during academic year 2018-19 targeting for repair multiple choice question (MCQ) items with discrimination index (D) < 0.1. The purpose of this study was to assess the impact of this initiative on reliability/internal consistency of our assessments. Our participants were medical students during academic years 2015-16 to 2020-21 and our data were summative MCQ assessments during this time. Since the goal was to systematically review and improve summative assessments in our undergraduate program on an ongoing basis, we used interrupted time series analysis to assess the impact on reliability. Between 2015-16 and 2017-18 there was a significant negative trend in the mean alpha coefficient for MCQ exams (regression coefficient -0.027 [-0.008, -0.047], p = 0.024). In the academic year following the introduction of our initiative (2018-19) there was a significant increase in the mean alpha coefficient (regression coefficient 0.113 [0.063, 0.163], p = 0.010) which was then followed by a significant positive post-intervention trend (regression coefficient 0.056 [0.037, 0.075], p = 0.006). In conclusion, our CQI intervention resulted in an immediate and progressive improvement reliability of our MCQ assessments.

وصف الملف: electronic resource

العلاقة: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/77596Test; https://doaj.org/toc/1923-1202Test

الوصول الحر: https://doaj.org/article/67feeeeecbfa45dab3e4e8e6e410a3aaTest

المؤلفون: Steven Craig, Cynthia Stretch, Farshad Farshidfar, Dropen Sheka, Nikolay Alabi, Ashar Siddiqui, Karen Kopciuk, Young Joo Park, Moosa Khalil, Faisal Khan, Adrian Harvey, Oliver F. Bathe

المصدر: Frontiers in Endocrinology, Vol 14 (2023)

مصطلحات موضوعية: prognosis, biomarker, papillary thyroid cancer, machine learning, risk stratification, EZH2, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: Clinical management of papillary thyroid cancer depends on estimations of prognosis. Standard care, which relies on prognostication based on clinicopathologic features, is inaccurate. We applied a machine learning algorithm (HighLifeR) to 502 cases annotated by The Cancer Genome Atlas Project to derive an accurate molecular prognostic classifier. Unsupervised analysis of the 82 genes that were most closely associated with recurrence after surgery enabled the identification of three unique molecular subtypes. One subtype had a high recurrence rate, an immunosuppressed microenvironment, and enrichment of the EZH2-HOTAIR pathway. Two other unique molecular subtypes with a lower rate of recurrence were identified, including one subtype with a paucity of BRAFV600E mutations and a high rate of RAS mutations. The genomic risk classifier, in addition to tumor size and lymph node status, enabled effective prognostication that outperformed the American Thyroid Association clinical risk stratification. The genomic classifier we derived can potentially be applied preoperatively to direct clinical decision-making. Distinct biological features of molecular subtypes also have implications regarding sensitivity to radioactive iodine, EZH2 inhibitors, and immune checkpoint inhibitors.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fendo.2023.1220617/fullTest; https://doaj.org/toc/1664-2392Test

الوصول الحر: https://doaj.org/article/8e7460e596574c6d98e9212285200400Test

المؤلفون: Navjit Dharampal, Kristine Smith, Adrian Harvey, Ralf Paschke, Luke Rudmik, Shamir Chandarana

المصدر: Journal of Otolaryngology - Head and Neck Surgery, Vol 51, Iss 1, Pp 1-9 (2022)

مصطلحات موضوعية: Cost-effectiveness analysis, Molecular testing, Afirma, Indeterminate thyroid nodule, Surgery, RD1-811

الوصف: Abstract Background Thyroid nodules affect up to 65% of the population. Although fine needle aspirate (FNA) cytology is the gold standard for diagnosis, 15–30% of results are indeterminate. Molecular testing may aid in the diagnosis of nodules and potentially reduce unnecessary surgery. However, these tests are associated with significant costs. The objective of this study was to evaluate the cost-effectiveness of Afirma, a commercially available molecular test, in cytologically indeterminate thyroid nodules. Methods The base case was a solitary thyroid nodule with no additional high-risk features and an indeterminate FNA. Decision tree analysis was performed from the single payer perspective with a 1-year time horizon. Costing data were collected through micro-costing methodology. A probabilistic sensitivity analysis was performed. The primary outcome was the incremental cost effectiveness ratio (ICER) of cost per thyroid surgery avoided. Results Over 1 year, mean cost estimates were $8176.28 with 0.58 effectiveness for the molecular testing strategy and $6016.83 with 0.07 effectiveness for current standard management. The ICER was $4234.22 per surgery avoided. At a willingness-to-pay (WTP) threshold of $5000 per surgery avoided, molecular testing is cost-effective with 63% certainty. Conclusion This cost-effectiveness analysis suggests utilizing Afirma for indeterminate solitary thyroid nodules is a cost-effective strategy for avoiding unnecessary thyroid surgery. With a $5000 WTP threshold, molecular testing has a 63% chance of being the more cost-effective strategy. The cost effectiveness varies based on the cost of the molecular test and the value of Afirma for patients with indeterminate thyroid nodules depends on the WTP threshold to avoid unnecessary thyroid surgery. Graphical Abstract

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1916-0216Test

الوصول الحر: https://doaj.org/article/bf15c7ce08f244aaa7fcebbcddf332e1Test

المؤلفون: Samira Al-Nasser, Siamak Noroozi, Adrian Harvey, Navid Aslani, Roya Haratian

المصدر: Sensors, Vol 24, Iss 2, p 585 (2024)

مصطلحات موضوعية: joint force sensor, intraoperative load measuring, artificial intelligence, total knee replacement, Chemical technology, TP1-1185

الوصف: Using tibial sensors in total knee replacements (TKRs) can enhance patient outcomes and reduce early revision surgeries, benefitting hospitals, the National Health Services (NHS), stakeholders, biomedical companies, surgeons, and patients. Having a sensor that is accurate, precise (over the whole surface), and includes a wide range of loads is important to the success of joint force tracking. This research aims to investigate the accuracy of a novel intraoperative load sensor for use in TKRs. This research used a self-developed load sensor and artificial intelligence (AI). The sensor is compatible with Zimmer’s Persona Knee System and adaptable to other knee systems. Accuracy and precision were assessed, comparing medial/lateral compartments inside/outside the sensing area and below/within the training load range. Five points were tested on both sides (medial and lateral), inside and outside of the sensing region, and with a range of loads. The average accuracy of the sensor was 83.41% and 84.63% for the load and location predictions, respectively. The highest accuracy, 99.20%, was recorded from inside the sensing area within the training load values, suggesting that expanding the training load range could enhance overall accuracy. The main outcomes were that (1) the load and location predictions were similar in accuracy and precision (p > 0.05) in both compartments, (2) the accuracy and precision of both predictions inside versus outside of the triangular sensing area were comparable (p > 0.05), and (3) there was a significant difference in the accuracy of load and location predictions (p < 0.05) when the load applied was below the training loading range. The intraoperative load sensor demonstrated good accuracy and precision over the whole surface and over a wide range of load values. Minor improvements to the software could greatly improve the results of the sensor. Having a reliable and robust sensor could greatly improve advancements in all joint surgeries.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/1424-8220/24/2/585Test; https://doaj.org/toc/1424-8220Test

الوصول الحر: https://doaj.org/article/cbc11c456a5b47cba5e651907b5f624dTest

المؤلفون: Janeve Desy, Adrian Harvey, Kevin Busche, Sarah Weeks, Michael Paget, Christopher Naugler, Lisa Welikovitch, Kevin Mclaughlin

المصدر: Canadian Medical Education Journal, Vol 11, Iss 6 (2020)

مصطلحات موضوعية: Education (General), L7-991, Medicine (General), R5-920

وصف الملف: electronic resource

العلاقة: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/70432Test; https://doaj.org/toc/1923-1202Test

الوصول الحر: https://doaj.org/article/92a8826eb33f4e908d26471d1949784eTest

المؤلفون: Elijah Dixon, Janice L. Pasieka, Hassan Al-Bisher, Adrian Harvey

المصدر: Cancers, Vol 4, Iss 1, Pp 130-140 (2012)

مصطلحات موضوعية: gastrinoma, primary hepatic gastrinoma, Zollinger-Ellison syndrome, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282

الوصف: The majority of gastrinomas causing Zollinger-Ellison syndrome (ZES) are located in the duodenum or the pancreas. Primary hepatic gastrinomas (PHG) are extremely rare and difficult to diagnose because the liver is the commonest site of metastatic disease and gastrinomas can be very small. Furthermore, gastrinomas are typically slow-growing thus a missed, occult primary tumour may not become evident for many years. The diagnosis of PHG is therefore dependent on a careful search for a primary and long-term biochemical follow-up following curative hepatic resection. We report a case of a 7 cm PHG in a 48 year old man with ZES. Preoperatively, both a basal and stimulated gastrin levels were elevated. Surgical exploration including intraoperative ultrasound and duodenotomy, failed to reveal a primary. Patient underwent a right hepatectomy. Yearly, gastrin and secretin stimulation tests remain normal 6 years following surgery. He remains symptom free off all medication. An additional 26 cases of PHG were found. Including this case, 21 had at least 1 year follow-up, however only eight had greater than 5 years (median 24 months). Post-op gastrin levels were reported in 25, however provocative testing was done in only 10. Persistence and recurrence occurred in one and four, respectively. PHG causing ZES is extremely rare. Although the current literature claims to include 26 additional cases of PHG, without a thorough search for the primary and long-term follow-up data including provocative testing, this diagnosis remains a challenge.

وصف الملف: electronic resource

العلاقة: http://www.mdpi.com/2072-6694/4/1/130Test/; https://doaj.org/toc/2072-6694Test

الوصول الحر: https://doaj.org/article/6b5efa0e24d9425ab074d3123a749d63Test

المؤلفون: Jiahui Wu, Xun Yang Hu, Sana Ghaznavi, Susan Kinnear, Christopher John Symonds, Peter Grundy, Vicky M. Parkins, Priyanka Sharma, Debbie Lamb, Moosa Khalil, Martin Hyrcza, Shamir P. Chandarana, Janice L. Pasieka, Adrian Harvey, Joseph Warshawski, Robert Hart, Michael Deutschman, Derrick R. Randall, Ralf Paschke

المصدر: Thyroid. 32:1509-1518

مصطلحات موضوعية: Endocrinology, Endocrinology, Diabetes and Metabolism

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::58d551fec15fcc549c00ff823601d567Test
https://doi.org/10.1089/thy.2022.0055Test

المؤلفون: Caitlin T. Yeo, Janice L. Pasieka, Golpira Elmi Assadzadeh, Adrian Harvey

المصدر: The American Journal of Surgery. 224:703-709

مصطلحات موضوعية: Adrenal Glands, Adrenal Gland Neoplasms, Humans, Adrenalectomy, Laparoscopy, Surgery, Prospective Studies, General Medicine, Length of Stay, Retrospective Studies

الوصف: Minimally invasive adrenalectomy includes laparoscopic transperitoneal (LA) and retroperitoneoscopic (RP) approaches. This study reviewed the local adrenalectomy practice to identify characteristics and outcomes between patients undergoing adrenalectomy via LA, RP, and RP requiring conversion (RPC).Adrenalectomies documented in a prospective surgical database were reviewed. Demographics, diagnosis, surgical approach/conversion, body mass index (BMI), radiographic body measurements (RBM), tumor size, operative time (OT), length of stay (LOS), and 30-day post-operative emergency (ED) visits were collected.203 adrenalectomies were reviewed from 2015 to 2020. The RP group had the shortest OT (124 ± 54 min, p = 0.281 vs LA, p 0.001 vs RPC) and LOS (1.6 ± 1.0 days, p 0.001 vs LA and RPC). There was an 18% conversion rate from RP to LA, and in one case to laparotomy. The RPC group had greater BMI, OT, LOS, and ED visits than LA and RP. The RPC group had less favorable RBM (p 0.001). On multivariate analysis, RBM impacted OT, LOS, and ED visits (p 0.05).The RP approach had shorter OT and LOS. BMI and RBM may increase risk of conversion, OT, LOS, and ED visits. Preoperative RBM may aid in appropriate patient selection for a RP approach.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f561b4770505b719df447b5468fb2075Test
https://doi.org/10.1016/j.amjsurg.2022.03.057Test

المؤلفون: Alexander A. Leung, Christopher J. Symonds, Gregory L. Hundemer, Paul E. Ronksley, Diane L. Lorenzetti, Janice L. Pasieka, Adrian Harvey, Gregory A. Kline

المصدر: Hypertension. 79:1835-1844

مصطلحات موضوعية: Captopril, ROC Curve, Fludrocortisone, Hyperaldosteronism, Internal Medicine, Humans, Sensitivity and Specificity

الوصف: Background: Confirmatory tests are recommended for diagnosing primary aldosteronism, but the supporting evidence is unclear. Methods: We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials. Studies evaluating any guideline-recommended confirmatory test (ie, saline infusion test, salt loading test, fludrocortisone suppression test, and captopril challenge test), compared with a reference standard were included. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the risk of bias. Meta-analyses were conducted using hierarchical summary receiver operating characteristic models. Results: Fifty-five studies were included, comprising 26 studies (3654 participants) for the recumbent saline infusion test, 4 studies (633 participants) for the seated saline infusion test, 2 studies (99 participants) for the salt loading test, 7 studies (386 participants) for the fludrocortisone suppression test, and 25 studies (2585 participants) for the captopril challenge test. Risk of bias was high, affecting more than half of studies, and across all domains. Studies with case-control sampling overestimated accuracy by 7-fold (relative diagnostic odds ratio, 7.26 [95% CI, 2.46–21.43]) and partial verification or use of inconsistent reference standards overestimated accuracy by 5-fold (5.12 [95% CI, 1.48–17.77]). There were large variations in how confirmatory tests were conducted, interpreted, and verified. Under most scenarios, confirmatory testing resulted in an excess of missed cases. The certainty of evidence underlying each test (Grading of Recommendations, Assessment, Development, and Evaluations) was very low. Conclusions: Recommendations for confirmatory testing in patients with abnormal screening tests and high probability features of primary aldosteronism are based on very low-quality evidence and their routine use should be reconsidered.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f8997fb04d1f5695b626f4394fb5edc1Test
https://doi.org/10.1161/hypertensionaha.122.19377Test