Change in Patterns of Failure After Image-Guided Brachytherapy for Cervical Cancer: Analysis From the RetroEMBRACE Study.

Purpose: Image guided adaptive brachytherapy (IGABT) for cervical cancer improves pelvic control and survival across all stages. Improvement in pelvic control is larger in advanced stages, but improvement in survival is similar across stages. This paper analyzes the patterns of failure in the RetroEMBRACE cohort to investigate this discrepancy.

Morbidity and health-related quality of life of patients accessing laparoscopic sleeve gastrectomy: a single-centre cross-sectional study in one province of Canada.

Background: In Canada, severe obesity (BMI ≥ 35 kg/m) affects 5% or 1.2 million adults. Bariatric surgery is the only effective treatment for severe obesity, but the demand for publicly funded procedures is high and capacity limited.

Preoperative and Postoperative Assessments of Biochemical Parameters in Patients with Severe Obesity Undergoing Laparoscopic Sleeve Gastrectomy.

Background: The study aim was to determine the prevalence of abnormal serum biochemistries associated with micronutrient deficiencies before and after laparoscopic sleeve gastrectomy (LSG).

Methods: Two hundred and one patients had LSG surgery between May 2011 and May 2014. Using a prospective cohort study design, data were collected on ferritin, hemoglobin (Hgb), mean cell volume (MCV), calcium, albumin, 25-hydroxyvitamin D (25-OH-D), PTH, and vitamin B with follow-up of 75.

Pre-operative and post-operative changes in CRP and other biomarkers sensitive to inflammatory status in patients with severe obesity undergoing laparoscopic sleeve gastrectomy.

Introduction: C-reactive protein (CRP) is often elevated in patients living with severe obesity (BMI≥35kg/m). However, there is limited information on how CRP, and other inflammation responsive biomarkers, change in response to weight loss following laparoscopic sleeve gastrectomy (LSG). We studied how CRP, ferritin and albumin change following LSG surgery in relation to obesity, metabolic syndrome (MetS) ATPIII risk components and diabetes mellitus (DM).

The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks.

Background: Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure's morbidity and mortality. Many centres performing LSG routinely obtain contrast studies on postoperative day 1 for early detection of staple line leaks. We examined the usefulness of Gastrografin swallow as an early detection test for staple line leaks on postoperative day 1 after LSG as well as the associated costs.

The Relationship between Body Mass Index and the Severity of Coronary Artery Disease in Patients Referred for Coronary Angiography.

. Obesity is associated with an increased risk of cardiovascular disease and may be associated with more severe coronary artery disease (CAD); however, the relationship between body mass index [BMI (kg/m)] and CAD severity is uncertain and debatable. The aim of this study was to examine the relationship between BMI and angiographic severity of CAD.

The Newfoundland and Labrador Bariatric Surgery Cohort Study: Rational and Study Protocol.

Background: In Canada, there has been a disproportionate increase in adults with Class II (BMI 35.0-39.9 kg/m) or Class III obesity (BMI ≥ 40 kg/m) affecting 9 % of Canadians with increases projected.

Impact of Body Mass Index on Short-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Newfoundland and Labrador, Canada.

Background and Aim. Obesity (BMI ≥ 30 kg/m(2)) is associated with advanced cardiovascular disease requiring procedures such as percutaneous coronary intervention (PCI). Studies report better outcomes in obese patients having these procedures but results are conflicting or inconsistent.

Laparoscopic sleeve gastrectomy at a new bariatric surgery centre in Canada: 30-day complication rates using the Clavien-Dindo classification.

Background: Newfoundland and Labrador (NL) has the highest rate of obesity in Canada, prompting the establishment of a bariatric surgery program at the Health Sciences Centre in NL. This retrospective study examined 30-day complication rates in more than 200 consecutive patients who underwent laparoscopic sleeve gastrectomy (LSG) between May 2011 and February 2014.

Methods: We performed a chart review and collected data on 30-day postoperative complications.

Long-term health-related quality of life in bariatric surgery patients: A systematic review and meta-analysis.

Objective: Bariatric surgery results in significant weight loss in the majority of patients. Improvement in health-related quality of life (HRQoL) is an equally important outcome; however, there are few studies reporting long-term (≥5 years) HRQoL outcomes. This study assesses the quality of evidence and effectiveness of surgery on HRQoL ≥ 5 years.

Rapid Reduction in Use of Antidiabetic Medication after Laparoscopic Sleeve Gastrectomy: The Newfoundland and Labrador Bariatric Surgery Cohort (BaSCo) Study.

Background: Patients who have undergone bariatric surgery generally need fewer medications as they experience improvement in, or even resolution of, various medical conditions, including type 2 diabetes mellitus, hypertension, and dyslipidemia. Published data on changes in medication use after laparoscopic sleeve gastrectomy, a type of bariatric surgery that is growing in popularity, are limited.

Objective: To determine whether patients took fewer medications for management of type 2 diabetes, hypertension, and dyslipidemia after laparoscopic sleeve gastrectomy, relative to preprocedure medications.

Deletion of the MC4R gene in a 9-year-old obese boy.

Background: The most common monogenic form of obesity is caused by mutations in the melanocortin 4 receptor (MC4R) gene. More than 150 mutations have been reported in the MC4R gene, the majority being point mutations. Most individuals with MC4R gene mutations have early-onset obesity, hyperphagia, and increased longitudinal growth.

Evidence-based decision-making 5: Translational research.

The delay in turning research into practice for the benefit of patient care has been compared to a "leaky pipeline." In the early 2000s, this delay raised concerns among governmental agencies and other sponsors of health services in many countries. Facilitating the translation of basic and clinical research into clinical practice through evidence-based decision-making and improving population health is now a major goal of health research investment agencies.

Qualitative research in clinical epidemiology.

This chapter has been written to specifically address the usefulness of qualitative research for the practice of clinical epidemiology. The methods of grounded theory to facilitate understanding of human behavior and construction of monitoring scales for use in quantitative studies are discussed. In end-stage renal disease patients receiving long-term hemodialysis, a qualitative study used grounded theory to generate a multilayered classification system, which culminated in a substantive theory on living with end-stage renal disease and hemodialysis.

'Fat girls' and 'big guys': gendered meanings of weight loss surgery.

Over 80% of weight loss surgery (WLS) patients are women, yet gender is overwhelmingly absent in WLS research. This article discusses the findings of 54 interviews with twenty-one women and six men waiting for WLS in Newfoundland and Labrador, Canada. We critically examine the ways that gender shapes the meaning of WLS in these narratives.

Current and predicted prevalence of obesity in Canada: a trend analysis.

Background: The prevalence of obesity has increased over the past 3 decades, with a disproportionate growth in excessive weight categories (body mass index [BMI] 35.0-39.9 and BMI ≥ 40.

Body shape expectations and self-ideal body shape discrepancy in women seeking bariatric surgery: a cross-sectional study.

Background: Postoperative body shape expectations (BSE) of bariatric surgery candidates remain relatively unexplored, and may have important implications for weight loss outcomes, treatment satisfaction, and education.

Methods: The 'Silhouette Figure Rating Scale' was administered to 69 consecutive female candidates. Self-perceived current and goal body shape and postoperative BSE in four categories; "dream, "happy", "acceptable", and "disappointed" were examined.

Patients' perceptions of waiting for bariatric surgery: a qualitative study.

Background: In Canada waiting lists for bariatric surgery are common, with wait times on average > 5 years. The meaning of waiting for bariatric surgery from the patients' perspective must be understood if health care providers are to act as facilitators in promoting satisfaction with care and quality care outcomes. The aims of this study were to explore patients' perceptions of waiting for bariatric surgery, the meaning and experience of waiting, the psychosocial and behavioral impact of waiting for treatment and identify health care provider and health system supportive measures that could potentially improve the waiting experience.

Complications with Angio-Seal™ vascular closure devices compared with manual compression after diagnostic cardiac catheterization and percutaneous coronary intervention.

Objectives: This study assessed and compared vascular complications in CATHs and PCIs using an Angio-Seal™ vascular closure device (VCD) versus manual compression (MC).

Methods: Secondary data analysis of a population-based multiyear cohort database was conducted to compare femoral access-related vascular outcomes in cardiac procedures using VCD and MC between May 1, 2006 and December 31, 2010. The primary outcome was any vascular complication.

Weight loss expectations of laparoscopic sleeve gastrectomy candidates compared to clinically expected weight loss outcomes 1-year post-surgery.

Background: Laparoscopic sleeve gastrectomy (LSG) results in significant, sustainable weight loss in obese individuals (body mass index (BMI) ≥ 40 kg/m(2) or BMI 35.0-39.9 kg/m(2) with major comorbidity).

Tumour bed delineation for partial breast/breast boost radiotherapy: what is the optimal number of implanted markers?

Purpose: International consensus has not been reached regarding the optimal number of implanted tumour bed (TB) markers for partial breast/breast boost radiotherapy target volume delineation. Four common methods are: insertion of 6 clips (4 radial, 1 deep and 1 superficial), 5 clips (4 radial and 1 deep), 1 clip at the chest wall, and no clips. We compared TB volumes delineated using 6, 5, 1 and 0 clips in women who have undergone wide-local excision (WLE) of breast cancer (BC) with full-thickness closure of the excision cavity, in order to determine the additional margin required for breast boost or partial breast irradiation (PBI) when fewer than 6 clips are used.

Development and preliminary testing of the psychosocial adjustment to hereditary diseases scale.

Background: The presence of Lynch syndrome (LS) can bring a lifetime of uncertainty to an entire family as members adjust to living with a high lifetime cancer risk. The research base on how individuals and families adjust to genetic-linked diseases following predictive genetic testing has increased our understanding of short-term impacts but gaps continue to exist in knowledge of important factors that facilitate or impede long-term adjustment. The failure of existing scales to detect psychosocial adjustment challenges in this population has led researchers to question the adequate sensitivity of these instruments.

Effect of PET/CT on management of patients with non-small cell lung cancer: results of a prospective study with 5-year survival data.

Unlabelled: We investigated the incremental management impact and prognostic value of staging with (18)F-FDG PET/CT in patients with non-small cell lung cancer (NSCLC) being considered for potentially curative therapies.

Methods: Information on 168 consecutive patients with NSCLC being considered for surgery or definitive radiotherapy with curative intent before PET/CT was entered into a prospective database. The pre-PET/CT management plan, based on conventional imaging (conventional CT, appropriately supplemented by bone scintigraphy or other modalities), was defined prospectively by referring clinicians before PET/CT results became available.

The breast cancer hormone receptor retesting controversy in Newfoundland and Labrador, Canada: lessons for the health system.

The treatment of newly diagnosed breast cancer patients with hormonal treatment is determined by the presence of estrogen receptor and progesterone receptor status in breast cancer. In Newfoundland and Labrador (NL), 425 of 1088 (39.1%) patients who had original "negative" receptor tests conducted between 1997 and 2005, had positive results upon retesting in a specialized laboratory.

Predictors of perceived health care quality for registered nurses during and after health care reform.

Background: Limited research has focused on the predictive nature of organizational culture and trust on registered nurses' perceived health care quality in reformed health care systems.

Purposes: The purpose of this article was to investigate nurses' perceptions of organizational culture factors, trust in employer, and perceived health care quality during and 5 years after major organizational reform in the acute care setting and to test a model linking culture to perceived health care quality.

Methodology: Survey data collected from two samples of nurses (N = 222,343) during and 5 years after major organizational reform in the acute care setting of one Canadian province were analyzed, and an exploratory model linking aspects of culture, trust, and quality was tested.