Brown, Ruth. Monkey’s Friends. [London, England], Andersen Press Ltd, 2012. Print. Prolific Engl... more Brown, Ruth. Monkey’s Friends. [London, England], Andersen Press Ltd, 2012. Print. Prolific English children’s author/illustrator Ruth Brown has created a delightful book in Monkey’s Friends. It is a simple rhymed text telling the story of monkey going through the forest, meeting different animals and greeting them. Each two page spread shows monkey greeting an animal whom we can see peeking out of the bushes. Every facing page is covered by a half-page flap. When the half-page is turned, the hidden animal is revealed and the animal’s name is printed on the flap. Brown’s acrylic paintings are fun. Monkey is doing something different in each image. Sometimes he hangs by his tail. Other times he is sitting on a branch or a rock or peering through grass. Each time his expression is alive. Brown also does an excellent job of communicating motion in her paintings. When you lift the flap to see crocodile, he seems to explode out of the water and you see water flying in all directions. W...
We explored how investments in housing for vulnerable populations (including those experiencing h... more We explored how investments in housing for vulnerable populations (including those experiencing homelessness) are described as leading to cost containment for the health, justice, and social service systems; the nature of any costs and benefits; and variations by housing type and over time. A structured search of peer-reviewed academic research focused on the core concepts of economic benefit, public housing programs, and vulnerable populations. Findings from 42 articles reporting on cost containment specific to health, justice, and social service systems at the municipal, regional, and/or state/provincial level were synthesized. Most of the studies focused on supportive housing interventions, targeted adults (mainly men) experiencing chronic homelessness in the USA, and reported results over 1–5 years. Approximately half of the articles reported on the costs required to house vulnerable populations. About half reported on funding sources, which is critical information for leadership decisions in cost containment for supportive housing. Most of the studies assessing program cost or cost-effectiveness reported a reduction in service costs and/or greater cost-effectiveness. Studies mostly reported impacts on health services, with hospital/inpatient care and emergency service use typically decreasing across the intervention types. All the studies that assessed cost impacts on the justice system reported a decrease in expenditures. Housing vulnerable populations was also found to decrease shelter service use and engagement with the foster care/welfare systems. Housing interventions may offer cost-savings in the short- and medium-term, with a limited evidence base also demonstrating long term benefit.
Objective: This study aims to provide a focused and detailed assessment of the validity evidence ... more Objective: This study aims to provide a focused and detailed assessment of the validity evidence supporting procedure-specific operative assessment tools in general surgery. Summary of Background Data: Competency-based assessment tools should be supported by robust validity evidence to be used reliably for evaluation of operative skills. The contemporary framework of validity relies on five sources of evidence: content, response process, internal structure, relation to other variables, and consequences. Methods: A systematic search of 8 databases was conducted for studies containing procedure-specific operative assessment tools in general surgery. The validity evidence supporting each tool was assessed and scored in alignment with the contemporary framework of validity. Methodological rigour of studies was assessed with the Medical Education Research Study Quality Instrument. The educational utility of each tool was assessed with the Accreditation Council for Graduate Medical Education framework. Results: There were 28 studies meeting inclusion criteria and 23 unique tools were assessed. Scores for validity evidence varied widely between tools, ranging from 3 – 14 (maximum 15). Medical Education Research Study Quality Instrument scores assessing the quality of study methodology were also variable (8.5–15.5, maximum 16.5). Direct reporting of educational utility criteria was limited. Conclusions: This study has identified a small group of procedure-specific operative assessment tools in general surgery. Many of these tools have limited validity evidence and have not been studied sufficiently to be used reliably in high-stakes summative assessments. As general surgery transitions to competency-based training, a more robust library of operative assessment tools will be required to support resident education and evaluation.
Introduction: Hypertrophic cardiomyopathy (HCM) is a genetic disorder often complicated by heart ... more Introduction: Hypertrophic cardiomyopathy (HCM) is a genetic disorder often complicated by heart failure, embolic stroke, and sudden cardiac death. Pregnancy causes hemodynamic changes which may be deleterious in patients with HCM. Existing cohort studies of maternal and fetal outcomes of pregnant patients with HCM are limited by small sample sizes. We performed a systematic review of maternal and fetal outcomes of pregnancy in patients with established HCM. Methods: We searched MEDLINE, EMBASE, and Cochrane Library databases for studies reporting maternal or fetal outcomes in pregnant patients with HCM. The primary outcomes were maternal death, stillbirth, and fetal death. Secondary maternal outcomes included: sustained ventricular tachycardia (VT), any VT (including sustained and non-sustained), atrial fibrillation (AF), syncope, caesarean delivery, and pre-eclampsia or eclampsia. The secondary fetal outcome was preterm birth. We used a random effects model to determine pooled incidences of outcomes. Results: A total of 18 studies with 5236 pregnancies were included. The incidence of maternal death was 0.2%. Similarly, the incidence of neonatal death was 0.2%. The incidence of maternal and neonatal death was too low across studies to derive pooled estimates. The rate of stillbirth was low at 1% (95% CI, 0-3%) and rate of preterm birth was 22% (95% CI, 18-25%). The rates of sustained VT, any VT, AF, heart failure, and syncope were 1% (0-1%), 6% (4-8%), 4% (2-6%), 5% (3-8%), and 9% (3-14%), respectively. Postpartum hemorrhage, preeclampsia or eclampsia, and cesarean section complicated 2% (1-4%), 4% (2-6%), and 43% (32-54%) of pregnancies, respectively. Conclusions: Women with HCM looking to become pregnant can be reassured that the risk of death, stillbirth, or neonatal demise are low. However, they are at risk for several non-fatal cardiac and pregnancy related complications.
OBJECTIVES This systematic review identified and assessed psychometric properties of the availabl... more OBJECTIVES This systematic review identified and assessed psychometric properties of the available screening tools to identify patients with unmet palliative care (PC) needs in the emergency department (ED). METHODS A comprehensive search of electronic databases and the grey literature was conducted. Two independent reviewers completed study screening and inclusion, data extraction and quality assessment. A descriptive summary of the results was reported using median of medians and interquartile ranges (IQR). RESULTS A total of 34 studies were included, involving the assessment of 14 unique screening tools. The most commonly used screening tool was the surprise question (SQ; n=11 studies), followed by the palliative care and rapid emergency screening (P-CaRES) tool (n=8), and the screening for palliative and end-of-life care needs in the emergency department (SPEED) instrument (n=4). Eleven of the included studies reported on the psychometric properties of the screening tools, of which eight of these studies assessed the performance of the SQ to predict patient mortality. Overall, the median sensitivity (73%, IQR: 32%, 79%) and specificity (64%, IQR: 56%, 85%) of the SQ to predict mortality was moderate. While the median positive predictive value (PPV) of the SQ was low (32%, IQR: 11%, 43%), the median negative predictive value (NPV) was high (91%, IQR: 87%, 96%). Across the studies, the proportion of patients identified as having unmet PC based on the criteria of the screening tools ranged from 5% to 83%. CONCLUSIONS This review identified 14 unique screening tools used to identify adult patients with unmet PC needs in the ED. One screening tool, the SQ, was found to have moderate sensitivity and specificity to accurately predict future patient mortality. Additional research is needed to better understand the clinical value of this and the other available tools prior to their widespread implementation.
BackgroundMicrosurgical free tissue transfers are a mainstay of lower extremity reconstruction. D... more BackgroundMicrosurgical free tissue transfers are a mainstay of lower extremity reconstruction. Despite being a reliable source of soft tissue, complications do arise. Venous congestion is among the most common causes of flap failure in lower extremity reconstruction, an issue that is attributed to venous stasis and impaired venous return in this region. There remains significant debate whether dual venous drainage improves outcomes. The aim of this study was thus to compare one versus two venous anastomoses in lower limb free flap reconstruction.MethodsA systematic review of Medline, EMBASE, EBSCO CINAHL, SCOPUS, Proquest Dissertations and Theses Global, Cochrane Library, and PROSPERO from inception to May 20, 2020, was conducted. Two independent reviewers screened titles and extracted data. Our primary outcome was total free flap necrosis. Secondary outcomes were partial flap necrosis, minor complications, flap reoperation, venous thrombosis, and amputation. Methodological quality was assessed using the MINORS criteria and level of evidence.ResultsThree‐hundred and fourteen unique titles were identified. All studies were level VI evidence and had a mean MINORS score of 16.1/24. Seven studies (comprising 1499 patients, 910 single venous anastomoses, and 579 double venous anastomoses) met criteria for inclusion. The mean (SD) patient age was 46.5 (7.1) years. Double venous anastomoses did not reduce the rate of minor complications, flap takeback, venous thrombosis, total flap necrosis, or partial flap necrosis when compared to a single vein (all p > .05).ConclusionIn microvascular lower extremity reconstruction, two venous anastomoses did not reduce the rate of minor or major complications.
Background Long-term noninvasive positive airway pressure (PAP) treatment is effective treatment ... more Background Long-term noninvasive positive airway pressure (PAP) treatment is effective treatment for sleep-related breathing disorders and chronic hypercarbic respiratory failure secondary to chronic obstructive pulmonary disease (COPD). PAP treatment may be delivered as continuous positive airway pressure or noninvasive ventilation. Success in initiating PAP treatment and barriers to its use in adult patients with COPD are largely unknown. This systematic review aims to identify the acceptance of and adherence to PAP treatment prescribed for long-term use in adult patients with COPD and to summarize variables associated with these measures. Methods Seven online electronic databases will be searched by an experienced medical librarian to identify records containing the concepts “obstructive airways disease” and “noninvasive positive airway pressure” and “acceptance” or “adherence”. Randomized and non-randomized studies of interventions will be included. Citation lists from relevant ...
Brown, Ruth. Monkey’s Friends. [London, England], Andersen Press Ltd, 2012. Print. Prolific Engl... more Brown, Ruth. Monkey’s Friends. [London, England], Andersen Press Ltd, 2012. Print. Prolific English children’s author/illustrator Ruth Brown has created a delightful book in Monkey’s Friends. It is a simple rhymed text telling the story of monkey going through the forest, meeting different animals and greeting them. Each two page spread shows monkey greeting an animal whom we can see peeking out of the bushes. Every facing page is covered by a half-page flap. When the half-page is turned, the hidden animal is revealed and the animal’s name is printed on the flap. Brown’s acrylic paintings are fun. Monkey is doing something different in each image. Sometimes he hangs by his tail. Other times he is sitting on a branch or a rock or peering through grass. Each time his expression is alive. Brown also does an excellent job of communicating motion in her paintings. When you lift the flap to see crocodile, he seems to explode out of the water and you see water flying in all directions. W...
We explored how investments in housing for vulnerable populations (including those experiencing h... more We explored how investments in housing for vulnerable populations (including those experiencing homelessness) are described as leading to cost containment for the health, justice, and social service systems; the nature of any costs and benefits; and variations by housing type and over time. A structured search of peer-reviewed academic research focused on the core concepts of economic benefit, public housing programs, and vulnerable populations. Findings from 42 articles reporting on cost containment specific to health, justice, and social service systems at the municipal, regional, and/or state/provincial level were synthesized. Most of the studies focused on supportive housing interventions, targeted adults (mainly men) experiencing chronic homelessness in the USA, and reported results over 1–5 years. Approximately half of the articles reported on the costs required to house vulnerable populations. About half reported on funding sources, which is critical information for leadership decisions in cost containment for supportive housing. Most of the studies assessing program cost or cost-effectiveness reported a reduction in service costs and/or greater cost-effectiveness. Studies mostly reported impacts on health services, with hospital/inpatient care and emergency service use typically decreasing across the intervention types. All the studies that assessed cost impacts on the justice system reported a decrease in expenditures. Housing vulnerable populations was also found to decrease shelter service use and engagement with the foster care/welfare systems. Housing interventions may offer cost-savings in the short- and medium-term, with a limited evidence base also demonstrating long term benefit.
Objective: This study aims to provide a focused and detailed assessment of the validity evidence ... more Objective: This study aims to provide a focused and detailed assessment of the validity evidence supporting procedure-specific operative assessment tools in general surgery. Summary of Background Data: Competency-based assessment tools should be supported by robust validity evidence to be used reliably for evaluation of operative skills. The contemporary framework of validity relies on five sources of evidence: content, response process, internal structure, relation to other variables, and consequences. Methods: A systematic search of 8 databases was conducted for studies containing procedure-specific operative assessment tools in general surgery. The validity evidence supporting each tool was assessed and scored in alignment with the contemporary framework of validity. Methodological rigour of studies was assessed with the Medical Education Research Study Quality Instrument. The educational utility of each tool was assessed with the Accreditation Council for Graduate Medical Education framework. Results: There were 28 studies meeting inclusion criteria and 23 unique tools were assessed. Scores for validity evidence varied widely between tools, ranging from 3 – 14 (maximum 15). Medical Education Research Study Quality Instrument scores assessing the quality of study methodology were also variable (8.5–15.5, maximum 16.5). Direct reporting of educational utility criteria was limited. Conclusions: This study has identified a small group of procedure-specific operative assessment tools in general surgery. Many of these tools have limited validity evidence and have not been studied sufficiently to be used reliably in high-stakes summative assessments. As general surgery transitions to competency-based training, a more robust library of operative assessment tools will be required to support resident education and evaluation.
Introduction: Hypertrophic cardiomyopathy (HCM) is a genetic disorder often complicated by heart ... more Introduction: Hypertrophic cardiomyopathy (HCM) is a genetic disorder often complicated by heart failure, embolic stroke, and sudden cardiac death. Pregnancy causes hemodynamic changes which may be deleterious in patients with HCM. Existing cohort studies of maternal and fetal outcomes of pregnant patients with HCM are limited by small sample sizes. We performed a systematic review of maternal and fetal outcomes of pregnancy in patients with established HCM. Methods: We searched MEDLINE, EMBASE, and Cochrane Library databases for studies reporting maternal or fetal outcomes in pregnant patients with HCM. The primary outcomes were maternal death, stillbirth, and fetal death. Secondary maternal outcomes included: sustained ventricular tachycardia (VT), any VT (including sustained and non-sustained), atrial fibrillation (AF), syncope, caesarean delivery, and pre-eclampsia or eclampsia. The secondary fetal outcome was preterm birth. We used a random effects model to determine pooled incidences of outcomes. Results: A total of 18 studies with 5236 pregnancies were included. The incidence of maternal death was 0.2%. Similarly, the incidence of neonatal death was 0.2%. The incidence of maternal and neonatal death was too low across studies to derive pooled estimates. The rate of stillbirth was low at 1% (95% CI, 0-3%) and rate of preterm birth was 22% (95% CI, 18-25%). The rates of sustained VT, any VT, AF, heart failure, and syncope were 1% (0-1%), 6% (4-8%), 4% (2-6%), 5% (3-8%), and 9% (3-14%), respectively. Postpartum hemorrhage, preeclampsia or eclampsia, and cesarean section complicated 2% (1-4%), 4% (2-6%), and 43% (32-54%) of pregnancies, respectively. Conclusions: Women with HCM looking to become pregnant can be reassured that the risk of death, stillbirth, or neonatal demise are low. However, they are at risk for several non-fatal cardiac and pregnancy related complications.
OBJECTIVES This systematic review identified and assessed psychometric properties of the availabl... more OBJECTIVES This systematic review identified and assessed psychometric properties of the available screening tools to identify patients with unmet palliative care (PC) needs in the emergency department (ED). METHODS A comprehensive search of electronic databases and the grey literature was conducted. Two independent reviewers completed study screening and inclusion, data extraction and quality assessment. A descriptive summary of the results was reported using median of medians and interquartile ranges (IQR). RESULTS A total of 34 studies were included, involving the assessment of 14 unique screening tools. The most commonly used screening tool was the surprise question (SQ; n=11 studies), followed by the palliative care and rapid emergency screening (P-CaRES) tool (n=8), and the screening for palliative and end-of-life care needs in the emergency department (SPEED) instrument (n=4). Eleven of the included studies reported on the psychometric properties of the screening tools, of which eight of these studies assessed the performance of the SQ to predict patient mortality. Overall, the median sensitivity (73%, IQR: 32%, 79%) and specificity (64%, IQR: 56%, 85%) of the SQ to predict mortality was moderate. While the median positive predictive value (PPV) of the SQ was low (32%, IQR: 11%, 43%), the median negative predictive value (NPV) was high (91%, IQR: 87%, 96%). Across the studies, the proportion of patients identified as having unmet PC based on the criteria of the screening tools ranged from 5% to 83%. CONCLUSIONS This review identified 14 unique screening tools used to identify adult patients with unmet PC needs in the ED. One screening tool, the SQ, was found to have moderate sensitivity and specificity to accurately predict future patient mortality. Additional research is needed to better understand the clinical value of this and the other available tools prior to their widespread implementation.
BackgroundMicrosurgical free tissue transfers are a mainstay of lower extremity reconstruction. D... more BackgroundMicrosurgical free tissue transfers are a mainstay of lower extremity reconstruction. Despite being a reliable source of soft tissue, complications do arise. Venous congestion is among the most common causes of flap failure in lower extremity reconstruction, an issue that is attributed to venous stasis and impaired venous return in this region. There remains significant debate whether dual venous drainage improves outcomes. The aim of this study was thus to compare one versus two venous anastomoses in lower limb free flap reconstruction.MethodsA systematic review of Medline, EMBASE, EBSCO CINAHL, SCOPUS, Proquest Dissertations and Theses Global, Cochrane Library, and PROSPERO from inception to May 20, 2020, was conducted. Two independent reviewers screened titles and extracted data. Our primary outcome was total free flap necrosis. Secondary outcomes were partial flap necrosis, minor complications, flap reoperation, venous thrombosis, and amputation. Methodological quality was assessed using the MINORS criteria and level of evidence.ResultsThree‐hundred and fourteen unique titles were identified. All studies were level VI evidence and had a mean MINORS score of 16.1/24. Seven studies (comprising 1499 patients, 910 single venous anastomoses, and 579 double venous anastomoses) met criteria for inclusion. The mean (SD) patient age was 46.5 (7.1) years. Double venous anastomoses did not reduce the rate of minor complications, flap takeback, venous thrombosis, total flap necrosis, or partial flap necrosis when compared to a single vein (all p > .05).ConclusionIn microvascular lower extremity reconstruction, two venous anastomoses did not reduce the rate of minor or major complications.
Background Long-term noninvasive positive airway pressure (PAP) treatment is effective treatment ... more Background Long-term noninvasive positive airway pressure (PAP) treatment is effective treatment for sleep-related breathing disorders and chronic hypercarbic respiratory failure secondary to chronic obstructive pulmonary disease (COPD). PAP treatment may be delivered as continuous positive airway pressure or noninvasive ventilation. Success in initiating PAP treatment and barriers to its use in adult patients with COPD are largely unknown. This systematic review aims to identify the acceptance of and adherence to PAP treatment prescribed for long-term use in adult patients with COPD and to summarize variables associated with these measures. Methods Seven online electronic databases will be searched by an experienced medical librarian to identify records containing the concepts “obstructive airways disease” and “noninvasive positive airway pressure” and “acceptance” or “adherence”. Randomized and non-randomized studies of interventions will be included. Citation lists from relevant ...
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Papers by Sandy (Sandra M.) Campbell