Wilma M Hopman

Queen's University Belfast, Béal Feirste, Northern Ireland, United Kingdom

Are you Wilma M Hopman?

Claim your profile

Publications (172)475.07 Total impact

  • Applied Physiology Nutrition and Metabolism 11/2015; DOI:10.1139/apnm-2015-0176 · 2.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: The goal of this study was to identify factors associated with the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) measures of health-related quality of life (HRQOL) in former Canadian Armed Forces (CAF) Veterans after transition to civilian life. Methods: Data were taken from the 2010 Survey on Transition to Civilian Life, a national computer-assisted telephone survey of CAF Regular Force personnel who released during 1998–2007. Multivariate linear regression models were developed using a variety of socio-economic, military, health, and disability characteristics. Results: Mean age was 46 years (range 20–67 y), and 12% of the participants were women. Higher age was associated with lower PCS but higher MCS scores. High ratings of mastery and high satisfaction with life were strongly associated with higher scores on both the PCS and the MCS. Most chronic physical health conditions were associated with poorer PCS scores, in particular chronic pain, musculoskeletal conditions, cancer, gastrointestinal conditions, hearing problems and, to a lesser degree, chronic mental health conditions. The only chronic condition associated with poorer MCS scores was presence of one or more mental health conditions. Both activity limitation in major life domains and needing assistance with activities of daily living were negatively associated with PCS scores, whereas only the latter was negatively associated with MCS scores. Discussion: The models suggested protective factors and identified characteristics of subgroups vulnerable to poor HRQOL after accounting for confounding. Findings can be used to identify those at high risk who may benefit from targeted interventions and to develop health promotion and prevention strategies for Canadian Armed Forces personnel in transition to civilian life.
    10/2015; 1(2):61-70. DOI:10.3138/jmvfh.2986
  • [Show abstract] [Hide abstract]
    ABSTRACT: Using thromboelastography (TEG) and standard laboratory haemostatic tests we examined the influence of the menstrual cycle and monophasic oral contraceptive (OC) use on haemostasis in healthy women. Tests were performed on citrated whole-blood and plasma (respectively) collected from 33 healthy non-pregnant women (18 non-OC users and 15 OC users) during menses, the follicular phase and the luteal phase of non-OC users, and the placebo, early-medicated phase, and late-medicated phase of OC users. Results for various coagulation parameters determined by TEG and standard laboratory haemostatic tests were compared within and between groups. TEG detected significantly increased coagulability in OC users during the late-medicated phase when compared to the placebo and early-medicated phases, whereas standard laboratory haemostatic tests failed to reveal significant differences in haemostasis within the OC steroid medication cycle. Neither TEG nor standard laboratory haemostatic tests detected significant differences in haemostasis within the menstrual cycle in non-OC users. When compared to non-OC users, TEG revealed that OC users had significantly increased coagulability only during the late-medicated phase; whereas standard laboratory haemostatic tests detected significant differences between all individual phases of the steroid medication cycle of OC users and the combined phases of the menstrual cycle in non-OC users. In conclusion, TEG provides additional insight into haemostatic function not identifiable using standard laboratory haemostatic tests.
    Thrombosis Research 09/2015; DOI:10.1016/j.thromres.2015.08.011 · 2.45 Impact Factor
  • Cameal Sinclair · Nicole Brunton · Wilma M. Hopman · Len Kelly ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To understand the postoperative acute-care physiotherapy course for First Nations people returning after total hip replacement (THR) to remote communities with limited rehabilitation services and to evaluate length of stay and attainment of functional milestones after THR to determine to what extent an urban-based clinical pathway is transferrable to and effective for First Nations patients in a rural setting. Methods: Data were collected retrospectively by reviewing charts of patients who underwent THR in the Northwest Ontario catchment area from 2007 through 2012. Results: For the 36 patient charts reviewed, median length of stay (LOS) at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) was 7.5 days (range 2–335); median LOS from time of surgery at the regional hospital (Thunder Bay Regional Health Centre) to discharge from SLMHC was 13.5 days; and median time for mobilizing and stairs was 9 days (range 1–93). Conclusion: Commonly accepted urban clinical pathways are not a good fit for smaller rural hospitals from which First Nations patients return to remote communities without rehabilitation services. LOS in a rural acute-care facility is similar to LOS in an urban rehabilitation facility.
    Physiotherapy Canada 08/2015; 67(3):268-272. DOI:10.3138/ptc.2014-45 · 0.77 Impact Factor
  • M Deforest · J Grabell · S Albert · J Young · A Tuttle · W M Hopman · P D James ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Our aim was to generate, optimize and validate a self-administered bleeding assessment tool (self-BAT) for von Willebrand disease (VWD). In Phase 1, medical terminology in the expert-administered International Society on Thrombosis and Haemostasis (ISTH)-BAT was converted into a Grade 4 reading level to produce the first version of the Self-BAT which was then optimized to ensure agreement with the ISTH-BAT. In Phase 2, the normal range of bleeding scores (BSs) was determined and test-retest reliability analysed. In Phase 3, the optimized Self-BAT was tested as a screening tool for first time referrals to the Haematology clinic. Bleeding score from the final optimized version of the Self-BAT showed an excellent intra-class correlation coefficient (ICC) of 0.87 with ISTH-BAT BS in Phase 1. In Phase 2, the normal range of BSs for the optimized Self-BAT was determined to be 0 to +5 for females and 0 to +3 for males and excellent test-retest reliability was shown (ICC = 0.95). In Phase 3, we showed that a positive Self-BAT BS (≥6 for females, ≥4 for males) has a sensitivity of 78%, specificity of 23%, positive predictive value (PPV) of 0.15 and negative predictive value (NPV) of 0.86 for VWD; these figures improved when just the females were analysed; sensitivity of 100%, specificity of 21%, PPV = 0.17 and NPV = 1.0. We show an optimized Self-BAT can generate comparable BS to the expert-administered ISTH-BAT and is a reliable, effective screening tool to incorporate into the assessment of individuals, particularly women, referred for a possible bleeding disorder. © 2015 John Wiley & Sons Ltd.
    Haemophilia 07/2015; DOI:10.1111/hae.12747 · 2.60 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The Consolidated Standards of Reporting Trials statement requires detailed reporting of interventions for randomized controlled trials. We hypothesized that there was variable reporting of chemotherapy compliance in published randomized controlled trials in breast cancer, and therefore surveyed the literature to assess this parameter and determine the study characteristics associated with reporting quality. Methods: Published Phase III randomized controlled trials (January 2005-December 2011; English language) evaluating chemotherapy in breast cancer were identified through a systematic literature search. Articles scored 1 point each for reporting of the four measures: number of chemotherapy cycles, dose modification, early treatment discontinuation and relative dose intensity. Logistic regression identified study characteristics associated with reporting quality score of ≥ 2. Results: Of the 115 eligible randomized controlled trials, 79 (69%) were published in high-impact journals, 66 (57%) were published since 2008, 43 (37%) reported advanced-stage disease and 37 (32%) were industry sponsored. Relative dose intensity, number of cycles, dose modification and early treatment discontinuation were reported in 70 (61%), 53 (46%), 65 (57%) and 81 (70%) articles, respectively. Eighty-two (71%) articles showed a quality score of ≥ 2; 25 (22%) articles reported all four compliance measures. Articles published since 2008 (P = 0.035) and those reporting advanced-stage disease (P < 0.001) showed significantly higher quality of compliance. Conclusions: Our results demonstrate variable reporting of chemotherapy compliance in published randomized controlled trials with a modest improvement noted in recent years. Incorporating standards for reporting chemotherapy compliance in scientific guidelines or the journal peer review process may decrease the variability and improve the quality of reporting.
    Japanese Journal of Clinical Oncology 06/2015; 45(6):520-6. DOI:10.1093/jjco/hyv043 · 2.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Urban centres often perform audits of vancomycin use as they face outbreaks of resistant organisms. We undertook this study to understand the indications and duration of intravenous vancomycin in a rural setting. We conducted a retrospective chart audit for all patients who received intravenous vancomycin over a 3-year period at a rural hospital in northwestern Ontario. Vancomycin was used intravenously in 180 patients during the study period. It was used for short courses (median 3 d), and serum levels were below target 72% of the time. High rates of invasive methicillin-resistant Staphylococcus aureus bacteremia and limited antibiotic choices in the field likely contributed to short courses of this antibiotic. Further study on clinical severity and antibiotic choice is needed. Additionally, weight-based dosing may result in target serum levels being achieved more frequently.
    Canadian journal of rural medicine: the official journal of the Society of Rural Physicians of Canada = Journal canadien de la medecine rurale: le journal officiel de la Societe de medecine rurale du Canada 04/2015; 20(2):56-62.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Obstructive Sleep Apnea (OSA) results in intermittent hypoxia leading to atrial remodeling, which, among other things, facilitates development of atrial fibrillation. While much data exists on the macrostructural changes in cardiac physiology induced by OSA, there is a lack of studies looking for histologic changes in human atrial tissue induced by OSA which might lead to the observed macrostructural changes. Methods: A case control study was performed. Patients undergoing coronary artery bypass grafting (CABG) were evaluated for OSA and categorized as high-risk or low-risk. The right atrial tissue samples were obtained during CABG and both microscopic histological analysis and Sirius Red staining were performed. Results: 18 patients undergoing CABG were included; 10 high-risk OSA and 8 low-risk OSA in evenly matched populations. No statistically significant difference between the two groups was observed in amount of myocytolysis ( p= 0.181), nuclear hypertrophy ( p= 0.671), myocardial inflammation ( p= n/a), amyloid deposition ( p= n/a), or presence of thrombi ( p= n/a), as measured through routine H&E staining. As well, no statistically significant difference in interstitial and epicardial collagen was observed, as measured by Sirius Red staining (for total tissue: p= 0.619: for myocardium: p= 0.776). Conclusions: In this pilot study there were no observable histological differences in human right atrial tissue from individuals at high- and low-risk for OSA. Further investigation would be required for more definitive results.
    03/2015; 6:71-75. DOI:10.1016/j.ijcha.2015.01.008
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A significant proportion of patients develop atrial fibrillation (AF) following cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFl). The objective of this study was to assess whether the presence of advanced interatrial block (aIAB) was associated with an elevated risk of AF after CTI ablation in patients with typical AFl and no prior history of AF. This study included patients with typical AFl and no prior history of AF that were referred for CTI ablation. Patients were excluded when they had received repeat ablations or did not demonstrate a bidirectional block. In all patients, a post-ablation electrocardiogram (ECG) in sinus rhythm was evaluated for the presence of aIAB, defined as a P-wave duration ≥120 ms and biphasic morphology in the inferior leads. New-onset AF was identified from 12-lead ECGs, Holter monitoring, and device interrogations. The cohort comprised 187 patients (age 67 ± 10.7 years; ejection fraction 55.8 ± 11.2%). Advanced interatrial block was detected in 18.2% of patients, and left atrium was larger in patients with aIAB compared with those without aIAB (46.2 ± 5.9 vs. 43.1 ± 6.0 mm; P = 0.01). Over a median follow-up of 24.2 months, 67 patients (35.8%) developed new-onset AF. The incidence of new-onset AF was greater in patients with aIAB compared with those without aIAB (64.7 vs. 29.4%; P < 0.001). After a comprehensive multivariate analysis, aIAB emerged as the strongest predictor of new-onset AF [odds ratio (OR) 4.2, 95% confidence interval (CI): 1.9-9.3; P < 0.001]. Advanced interatrial block is a key predictor for high risk of new-onset AF after a successful CTI ablation in patients with typical AFl. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    Europace 02/2015; 17(8). DOI:10.1093/europace/euu379 · 3.67 Impact Factor
  • Source
    Katya M. Herman · Wilma M. Hopman · Catherine M. Sabiston ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Physical activity (PA) and screen time (ST) are associated with self-rated health (SRH) in adults; however, SRH has been less studied among youth, and information about self-rated mental health (SRMH) is lacking. This study examined the associations of PA and ST with SRH and SRMH among adolescents. Methods: Cross-sectional data from the 2011-2012 Canadian Community Health Survey included 7725 participants aged 12-17years, representing 1,820,560 Canadian adolescents. Associations of self-reported PA and ST to SRH and SRMH were assessed, controlling for age, race/ethnicity, smoking, highest household education and weight status. Results: Excellent/very good SRH was reported by 78% of active vs. 62% of inactive adolescents, and 77% of those meeting vs. 70% of those exceeding ST guidelines (both p<0.001). Excellent/very good SRMH was reported by 81% of active vs. 76% of inactive adolescents, and 84% of those meeting vs. 78% of those exceeding ST guidelines (both p<0.001). Inactive adolescents had twice higher odds of sub-optimal SRH, and inactive girls had 30% greater odds of sub-optimal SRMH. Adolescents exceeding 2h/day ST had 30% greater odds of sub-optimal SRH, and 30-50% greater odds of sub-optimal SRMH. Conclusion: PA and ST are independently associated with health perceptions among Canadian adolescents. Interventions should consider health perceptions in addition to biomedical outcomes.
    Preventive Medicine 02/2015; 73. DOI:10.1016/j.ypmed.2015.01.030 · 3.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Advanced interatrial block (aIAB) on the surface electrocardiogram (ECG), defined as a P-wave duration ≥120 milliseconds with biphasic (±) morphology in inferior leads, is frequently associated with atrial fibrillation (AF). The aim of this study was to determine whether preoperative aIAB could predict new-onset AF in patients with severe congestive heart failure (CHF) requiring cardiac resynchronization therapy (CRT). Retrospective analysis of consecutive patients with CHF and no prior history of AF undergoing CRT for standard indications. A baseline 12-lead ECG was obtained prior to device implantation and analyzed for the presence of aIAB. ECGs were scanned at 300 DPI and maximized 8×. Semiautomatic calipers were used to determine P-wave onset and offset. The primary outcome was the occurrence of AF identified through analyses of intracardiac electrograms on routine device follow-up. Ninety-seven patients were included (74.2% male, left atrial diameter 45.5 ± 7.8 mm, 63% ischemic). Mean P-wave duration was 138.5 ± 18.5 milliseconds and 37 patients (38%) presented aIAB at baseline. Over a mean follow-up of 32 ± 18 months, AF was detected in 29 patients (30%) and the incidence was greater in patients with aIAB compared to those without it (62% vs 28%; P < 0.003). aIAB remained a significant predictor of AF occurrence after multivariate analysis (OR 4.1; 95% CI, 1.6-10.7; P < 0.003). The presence of aIAB is an independent predictor of new-onset AF in patients with severe CHF undergoing CRT. © 2015 Wiley Periodicals, Inc.
    Annals of Noninvasive Electrocardiology 02/2015; DOI:10.1111/anec.12258 · 1.13 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To document the management of and outcomes for patients receiving narcotic replacement and tapering with long-acting morphine preparations during pregnancy. A prospective cohort study over 18 months. Northwestern Ontario. All 600 births at Meno Ya Win Health Centre in Sioux Lookout, Ont, from January 1, 2012, to June 30, 2013, including 166 narcotic-exposed pregnancies. Narcotic replacement and tapering of narcotic use with long-acting morphine preparations. Prenatal management of maternal narcotic use, incidence of neonatal abstinence syndrome, and other neonatal outcomes. The incidence of neonatal abstinence syndrome fell significantly to 18.1% of pregnancies exposed to narcotics (from 29.5% in a previous 2010 study, P = .003) among patients using narcotic replacement and tapering with long-acting morphine preparations. Neonatal outcomes were otherwise equivalent to those of the nonexposed pregnancies. In many patients, long-acting morphine preparations can be safely used and tapered in pregnancy, with a subsequent decrease in observed neonatal withdrawal symptoms.
    Canadian family physician Medecin de famille canadien 02/2015; 61(2):e88-95. · 1.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Little is known about the prevalence of chronic pain among Veterans outside the United States. OBJECTIVE: To describe the prevalence of chronic pain and associated sociodemographic, health behaviour, employment/income, disability, and physical and mental health factors in Canadian Veterans. METHODS: The 2010 Survey on Transition to Civilian Life included a nationally representative sample of 3154 Canadian Armed Forces Regular Force Veterans released from service between 1998 and 2007. Data from a telephone survey of Veterans were linked with Department of National Defence and Veterans Affairs Canada administrative databases. Pain was defined as constant/reoccurring pain (chronic pain) and as moderate/severe pain interference with activities. RESULTS: Forty-one percent of the population experienced constant chronic pain and 23% experienced intermittent chronic pain. Twenty-five percent reported pain interference. Needing help with tasks of daily living, back problems, arthritis, gastrointestinal conditions and age ≥30 years were independently associated with chronic pain. Needing help with tasks of daily living, back problems, arthritis, mental health conditions, age ≥30 years, gastrointestinal conditions, low social support and noncommissioned member rank were associated with pain interference. CONCLUSIONS: These findings provide evidence for agencies and those supporting the well-being of Veterans, and inform longitudinal studies to better understand the determinants and life course effects of chronic pain in military Veterans.
    01/2015; 20(2).
  • Source
    Natalia M Pittman · Wilma M Hopman · Mihaela Mates ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Curative chemotherapy for breast cancer is associated with significant toxicities including emergency room (ER) visits and hospital admissions (HAs), events that are underreported in clinical trials. This study examined the reasons for, and factors associated with, ER visits and HA after curative chemotherapy for breast cancer in a tertiary Ontario hospital. A retrospective study of all patients who completed at least one cycle of curative chemotherapy for breast cancer in 2011 and 2012 was conducted. We recorded ER visits and HAs within 30 days of any chemotherapy. We collected demographics, comorbidities, surgical data, tumor characteristics, chemotherapy type and cycles, and use of granulocyte colony-stimulating factors (G-CSF). A total of 149 patients underwent curative chemotherapy. Mean age was 58.6 years. Adjuvant chemotherapy was received by 85% of patients and G-CSF by 88.6%. At least one ER visit occurred in 53% of patients, and 13% required HA. The most common causes of ER visits were fever without neutropenia (23.3%), pain (12.8%), and febrile neutropenia (9%). Stage of breast cancer was the only factor statistically significantly associated with ER visits (P = .045); tumor size (P = .019), adjuvant chemotherapy (P = .045), and lower number of chemotherapy cycles (P = .005) were significantly associated with HA. Future research should focus on identifying the patient, provider, and health system factors associated with ER visits and HAs after chemotherapy for breast cancer, to minimize them and lessen the burden on the health care system. Copyright © 2015 by American Society of Clinical Oncology.
    Journal of Oncology Practice 01/2015; 11(2). DOI:10.1200/JOP.2014.000257
  • [Show abstract] [Hide abstract]
    ABSTRACT: Review question/objective: The objective of this systematic review is to examine the evidence on the prevalence of, and risk factors associated with, chronic pain in military veterans. The specific review question is: What is the prevalence of chronic pain and what are the related risk factors in military veterans? Inclusion criteria: Types of participants: In this review we will consider studies that include military veterans conducted worldwide. Studies that include participants on active duty will be excluded unless the data is separated and analyzed by veterans vs. active duty service personnel. Focus of the review: In this review we will consider studies that evaluate the prevalence and/or contributing factors associated with the occurrence of chronic pain in the general military veteran population. Studies which focus solely on a specific subset of veterans (e.g. amputees only) or conducted at specialty care centres (e.g. pain management clinic) will be excluded because these samples will inflate the overall prevalence of chronic pain. If numbers permit, subgroup analysis may be conducted on specific subgroups within the population level studies. Type of outcomes: This review will consider studies that measure the outcome of chronic pain Types of independent variables: This review will also consider studies that identify factors that increase the risk of chronic pain.
    JBI Database of Systematic Reviews and Implementation Reports 12/2014; 12(10):152-186. DOI:10.11124/jbisrir-2014-1720
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To document the incidence and outcomes of narcotic use during pregnancy in northwestern Ontario. Design: Three-year prospective cohort study. Setting: Sioux Lookout and surrounding communities in northwestern Ontario. Participants: A total of 1206 consecutive births in a catchment area of 28 000 First Nations patients. Main outcome measures: Incidence of narcotic use, and maternal and neonatal outcomes. Results: Incidence of narcotic use in pregnancy has risen to 28.6% (P < .001) and incidence of neonatal abstinence syndrome has fallen to 18.0% of narcotic-exposed births (P = .003). Daily intravenous drug use is now a common pattern of abuse. Conclusion: Narcotic abuse in pregnancy has dramatically increased in northwestern Ontario. Neonatal outcomes have improved as a result of a family medicine-based prenatal and obstetric program that includes a narcotic replacement and tapering program.
    Canadian family physician Medecin de famille canadien 10/2014; 60(10):e493-8. · 1.34 Impact Factor
  • Source

    The Canadian journal of cardiology 10/2014; 30(10):S311. DOI:10.1016/j.cjca.2014.07.555 · 3.71 Impact Factor
  • Sarah Ferrara · Wilma M. Hopman · Michael Leveridge ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction We assess how urologists are rated online by patients and which factors influence these ratings. Methods We created an anonymous database of urologists’ ratings from Ontario, Canada using a popular rating website (RateMDs.com). Comments were assessed for mention of diagnosis, bedside manner and nonlinguistic emphasis devices, and the impact of these variables was analyzed. Results A total of 3,288 ratings were identified for 224 urologists (median 15 ratings per urologist, range 1 to 35), representing 75.4% of practicing urologists in the province. Mean rating was 3.96/5 (median 4.75, range 1 to 5). Overall 2,215 ratings (67.4%) were 4/5 or greater. Comment on good bedside manner was associated with higher ratings (mean 4.74 vs 3.92, p <0.001) and comment on poor bedside manner was associated with lower ratings (mean 2.45 vs 4.01, p <0.001). Patients mentioning surgery rated urologists higher than those who did not (4.28 vs 3.85, p <0.001). A specific diagnosis was mentioned in 1,056 cases (32.1%). Mean rating was highest for kidney cancer (4.67) and lowest for vasectomy (3.77, p <0.001). Comments with at least 1 word in full capital letters and those with a word or phrase in quotation marks were accompanied by lower ratings (mean 3.11 vs 4.03 and 3.13 vs 4.02, respectively, p <0.001). Longer comments were also associated with lower ratings (word count 1 to 50—mean rating 4.24, word count 51 to 100—mean rating 3.88, word count greater than 100—mean rating 3.29; p <0.001). Conclusions Urologists are reviewed favorably online. Patients who note surgery, a cancer diagnosis or good bedside manner rate urologists highly, while longer comments, the use of all caps or quotation marks, or mention of a poor bedside manner are associated with lower ratings.
    Urology Practice 09/2014; 1(3). DOI:10.1016/j.urpr.2014.05.005
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Adjuvant chemotherapy (AC) improves survival among patients with colon cancer (CC). Two meta-analyses have demonstrated a decrease in survival with increasing time to AC (TTAC). Here, we examine the predominant factors leading to delay in TTAC. Methods: Individual medical records of 580 patients with CC who initiated AC August 2005-November 2010 at two large academic cancer centers in Eastern Ontario were reviewed. Information regarding patient, disease, and treatment characteristics, including time intervals between each step in the cancer care pathway from surgery to AC, was captured. Patients were then categorized into three groups for comparison: (I) postoperative complication, (II) oncologist- or patient-initiated delay, (III) no delay. These groups were compared using χ(2) tests and one-way analysis of variance. A multivariable logistic regression model was used to determine factors associated with TTAC > 8 weeks in all patients and in group III alone. Results: TTAC among the three groups was (I) 10.1 ± 2.7 weeks, (II) 10.5 ± 3.6 weeks, (III) 8.5 ± 2.1 weeks (P < .001). The only significant predictor of TTAC > 8 weeks on multivariable analysis in group III was route of AC via central venous catheter (odds ratio [OR] = 2.4; 95% CI, 1.2 to 4.9). When multivariable analysis was performed on all patients, the presence of postoperative complications (OR = 2.4; 95% CI, 1.6 to 3.8) and oncologist- or patient-initiated delay were the strongest predictors of delay (OR = 3.5; 95% CI, 2.1 to 6.0). The percentages of patients with TTAC > 8 weeks were (I) 76.4% (n = 110), (II) 81.4% (n = 92), (III) 57.9% (n = 187). Conclusions: In patients with no reason for delay, most experienced TTAC > 8 weeks. This likely reflects delays in referral, consultation, and chemotherapy booking. These health-system factors are modifiable, and future quality improvement initiatives should focus on how to reduce them.
    Journal of Oncology Practice 08/2014; 11(1). DOI:10.1200/JOP.2014.001531
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. METHODS: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. FINDINGS: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. INTERPRETATION: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases.
    The Lancet Diabetes & Endocrinology 08/2014; 2(8):634-47. DOI:10.1016/S2213-8587(14)70102-0 · 9.19 Impact Factor

Publication Stats

4k Citations
475.07 Total Impact Points


  • 2015
    • Queen's University Belfast
      Béal Feirste, Northern Ireland, United Kingdom
  • 1996-2015
    • Kingston General Hospital
      Kingston, Ontario, Canada
    • Queen's University
      • • Division of Cardiology
      • • Department of Community Health and Epidemiology
      • • Department of Medicine
      • • Department of Family Medicine
      Kingston, Ontario, Canada
  • 2014
    • University of Ottawa
      Ottawa, Ontario, Canada
  • 2009-2013
    • Queens University of Charlotte
      New York, United States
  • 2012
    • University of Toronto
      • Department of Anesthesia
      Toronto, Ontario, Canada
  • 2007
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States