Publications (49) View all
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Article: Quality of life and survival analysis of patients undergoing transarterial chemoembolization for primary hepatic malignancies: a prospective cohort study.
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ABSTRACT: Transarterial chemoembolization (TACE) is indicated for primary hepatic tumours when resection or local ablation are not feasible. Patients undergoing TACE have a better survival than best supportive therapy. However, there is paucity of prospective studies on the quality of life (QOL) after TACE for primary hepatic malignancies, especially in the Western world. The primary aim of the present study was to determine if TACE impacts on the QOL of patients affected by primary hepatic tumours, and to assess treatment efficacy in a prospective cohort of patients treated at a tertiary Canadian university medical centre. From September 2005 to December 2010, 48 candidates for TACE underwent at least one TACE session. Data on their QOL, tumour response, serum alpha fetoprotein (AFP) and survival were prospectively collected every 3-4 months. The overall QOL of patients undergoing TACE did not decline during the first 12 months after treatment. A decline was observed in the physical health domain after the third TACE that coincided with the increasing size of the largest tumour and a rise in the serum AFP levels. Psychological, social and environmental domains remained stable throughout the treatment period. Multivariate analysis revealed that tumour focality, AFP levels and model of end-stage liver disease (MELD) scores were associated with long-term survival (P= 0.001, P= 0.01, P= 0.02, respectively). The overall survival at 12, 36 and 48 months were 72%, 28% and 12%, respectively. TACE is an effective palliative intervention for unresectable and non-ablatable primary liver tumours without affecting the QOL of patients even when repeated interventions are performed.HPB 05/2012; 14(5):341-50. · 1.60 Impact Factor -
Article: Parental comprehension following informed consent for pediatric cataract surgery.
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ABSTRACT: To investigate the effectiveness of information transfer by the pediatric cataract surgeon to the parents or guardians of children during the informed-consent process. Prospective observational case series. Parents of 31 children undergoing cataract surgery. Parents were enrolled from the clinical practice of 1 pediatric cataract surgeon. Using a checklist developed in consultation with other pediatric cataract surgeons, the surgeon discussed the nature of the disease, the course without surgical intervention, the surgical procedure, the risks and benefits, and the postoperative care. Immediately after the discussion, parents were invited to complete a questionnaire assessing information recall. Analysis of variance and the t test were used to determine associations between questionnaire scores and demographic variables. The surgeon subsequently called parents and discussed again the issues that they had not remembered correctly, as identified by the questionnaire responses. The study and data accumulation were carried out with the approval of the Research Ethics Board at The Hospital for Sick Children, Toronto, Ont. Informed consent for the research was obtained from the parents or legal guardians of the children enrolled in the study. The study adhered to the tenets of the Declaration of Helsinki. Of 31 parents, 18 (58%) overestimated their understanding of the informed-consent discussion. Parents scored well on questions about the nature of the disease and the postoperative follow-up but scored lower on questions regarding surgical risks and outcomes. Parents identified several barriers to understanding, including the large amount of information, stress, and preoccupation with the child. No association was noted between the level of understanding and demographic factors. Parents may overestimate their understanding of informed-consent discussions. Some parents may be overly optimistic about risks and outcomes. The surgeon's follow-up communication with parents that addressed aspects insufficiently understood during the initial discussion provided a way of improving comprehension.Canadian Journal of Ophthalmology 04/2012; 47(2):107-12. · 1.47 Impact Factor -
Article: Analysis of survival predictors in a prospective cohort of patients undergoing transarterial chemoembolization for hepatocellular carcinoma in a single Canadian centre.
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ABSTRACT: Despite advances in the treatment of hepatocellular carcinoma (HCC), a great proportion of patients are eligible only for palliative therapy for reasons of advanced-stage disease or poor hepatic reserve. The use of transarterial chemoembolization (TACE) in the palliation of non-resectable HCC has shown a survival benefit in European and Asian populations. The aim of this study was to assess the efficacy of TACE by analysing overall 5-year survival, interval changes of tumour size and serum alpha-fetoprotein (AFP) levels in a prospective North American cohort. From September 2005 to December 2010, 46 candidates for TACE were enrolled in the study. Collectively, they underwent 102 TACE treatments. Data on tumour response, serum AFP and survival were prospectively collected. In compensated cirrhotic patients, serial treatment with TACE had a stabilizing effect on tumour size and reduced serum AFP levels during the first 12 months. Overall survival rates at 1, 2 and 3 years were 69%, 58% and 20%, respectively. Younger individuals and patients with a lower body mass index, affected by early-stage HCC with involvement of a single lobe, had better survival in univariate analysis. After adjustment for risk factors, early tumour stage (T1 and T2 vs. T3 and T4) at diagnosis was the only statistically significant predictor for survival. In compensated cirrhotic patients, TACE is an effective palliative intervention and HCC stage at diagnosis seems to be the most important predictor of longterm outcomes.HPB 03/2012; 14(3):162-70. · 1.60 Impact Factor -
Article: Do family physicians request ultrasound scans appropriately?
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ABSTRACT: To review family physicians' requests for abdominal, thyroid, pelvic, soft tissue, and carotid ultrasound (US) scans, and to determine whether 5% or more of these tests were not clearly indicated based on the clinical history provided. Analysis of 620 randomly chosen requests for US scans. The Radiology Department at the Capital District Health Authority in Halifax, NS, between October 1, 2008, and June 30, 2009. Two radiologists and 2 family physicians with clinical expertise and familiarity with the Canadian Association of Radiologists' 2005 guidelines. Whether US requests were "indicated," "not clearly indicated," or "not legible" according to the Canadian Association of Radiologists' 2005 guidelines. Those that were illegible were discarded and replaced. Results More than 5% of requests for abdominal, thyroid, or carotid US scans were not clearly indicated. The percentages of requests for pelvic and soft tissue scans that were not clearly indicated were not significant. The reviewers found only 5 illegible request forms. Percentages of abdominal, thyroid, and carotid US scans not clearly indicated were 12.1%, 18.8%, and 25.2%, respectively. Reasons for inappropriate US requests included the following: wrong tests (3.2%), vague clinical questions (4.8%), and unfocused examinations (4.8%) for abdominal scans; wrong tests (3.2%), vague clinical questions (3.2%), unnecessary investigations (5.6%), and unnecessary follow-up examinations (5.6%) for thyroid scans; and unnecessary tests (10.5%), vague clinical questions (5.6%), and unnecessary tests for "dizziness" (10.5%) for carotid scans. More than 5% of the abdominal, thyroid, and carotid US scans requested by family physicians were not clearly indicated based on the clinical history provided. Common trends in requesting these examinations reinforce the need to improve guidelines for requesting scans and for managing many presenting complaints in family practice.Canadian family physician Medecin de famille canadien 08/2011; 57(8):e299-304. · 1.19 Impact Factor -
Article: Comparison of clinical-pathologic characteristics and outcomes of true interval and screen-detected invasive breast cancer among participants of a Canadian breast screening program: a nested case-control study.
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ABSTRACT: Previous analyses of interval breast cancers have been limited because of a lack of control for screening interval length and patient age, failure to restrict the interval group to 'true' intervals, and incomplete descriptions of pathology, adjuvant therapies and clinical outcomes. A nested case-control study within the population-based Nova Scotia Breast Screening Program was performed. All true interval cases between 1991 and 2004 were identified, matched 1:2 to screen-detected cases (age, screening interval, time period), and compared in terms of pathologic characteristics and adjuvant therapies via logistic regression. Disease-free and overall survival was estimated, controlling for pathology and adjuvant chemotherapy receipt. A total of 241 true interval invasive cases were matched to 481 screen-detected cases. Interval cases were more likely to be > 1 cm (odds ratio [OR] = 1.76; 95% CI, 1.10-2.83), grade 3 (OR = 2.71; 95% CI, 1.49-4.92), and have lymphovascular invasion (OR = 3.06; 95% CI, 1.85-5.07). Interval cases received more adjuvant chemotherapy (OR = 4.37; 95% CI, 3.03-6.30) and radiation (OR = 1.43; 95% CI, 1.02-2.00). The 5-year Kaplan-Meier estimates of disease-free and overall survival rates for true intervals and screens were 0.830 (95% CI, 0.770-0.875) versus 0.926 (95% CI, 0.898-0.947) and 0.860 (95% CI, 0.804-0.901) versus 0.937 (95% CI, 0.910-0.956), respectively. True interval breast cancers have more adverse prognostic factors compared with screen-detected cases and, despite receiving more adjuvant chemotherapy, are associated with significantly poorer survival outcomes.Clinical Breast Cancer 03/2011; 11(1):27-32. · 2.38 Impact Factor
