Factors associated with durable response to infliximab in Crohn's disease 5 years and beyond : a multicenter international cohort

BACKGROUND: Infliximab (IFX) has been used for over a decade worldwide. Less is known about the natural history of IFX use beyond a few years and which patients are more likely to sustain benefits. METHODS: Patients with Crohn's disease (CD) exposed to IFX from Massachusetts General Hospital, Boston, Saint-Antoine Hospital, Paris, and the Swiss IBD Cohort Study were identified through retrospective and prospective data collection, complemented by chart abstraction of electronic medical records. We compared long-term users of IFX (>5 yr of treatment, long-term users of infliximab [LTUI]), with non-LTUI patients to identify prognostic factors. RESULTS: We pooled data on 1014 patients with CD from 3 different databases, of whom 250 were defined as LTUI. The comparison group comprised 290 patients with CD who discontinued IFX: 48 primary nonresponses, 95 loss of responses, and 147 adverse events. Factors associated with LTUI were colonic involvements and an earlier age at the start of IFX. The prevalence of active smokers and obese patients differed markedly, but inversely, between American and European centers but did not impact outcome. The discontinuation rate was stable around 3% to 6%, each year from years 3 to 10. CONCLUSIONS: Young age at start of IFX and colonic CD are factors associated with a beneficial long-term use of IFX. After 5 years of IFX, there is still a 3% to 5% discontinuation rate annually. Several factors associated with a good initial response such as nonsmoker and shorter disease duration at IFX initiation do not seem associated with a longer term response.

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks.

OBJECTIVE: The objective was to compare a brief interdisciplinary psychotherapeutic intervention to standard care as treatments for patients recently diagnosed with severe motor conversion disorder or nonepileptic attacks. METHODS: This randomized controlled trial of 23 consecutive patients compared (a) an interdisciplinary psychotherapeutic intervention group receiving four to six sessions by a consultation liaison psychiatrist, the first and last sessions adding a neurological consultation and a joint psychiatric and neurological consultation, and (b) a standard care group. After intervention, patients were assessed at 2, 6 and 12 months with the Somatoform Dissociation Questionnaire (SDQ-20), Clinical Global Impression scale, Rankin scale, use of medical care, global mental health [Montgomery and Asberg Depression Rating Scale, Beck Depression Inventory, mental health component of Short Form (SF)-36] and quality of life (SF-36). We calculated linear mixed models. RESULTS: Our intervention brought a statistically significant improvement of physical symptoms [as measured by the SDQ-20 (P<.02) and the Clinical Global Impression scale (P=.02)] and psychological symptoms [better scores on the mental health component of the SF-36 (P<.05) and on the Beck Depression Inventory (P<.05)] and a reduction in new hospital stays after intervention (P<.05). CONCLUSION: A brief psychotherapeutic intervention taking advantage of a close collaboration with neurology consultants in the setting of consultation liaison psychiatry appears effective.

Lateral periodontal cysts: a retrospective study of 11 cases

Objective: To describe the clinical, radiological and histopathological features of lateral periodontal cysts among patients diagnosed in different centers (Vall d"Hebron General Hospital, Granollers General Hospital, the Teknon Medical Center, and the Master of Oral Surgery and Implantology of the University of Barcelona Dental School; Barcelona, Spain). Study design: A retrospective observational study was made of 11 lateral periodontal cysts, all of which were diagnosed following a thorough clinical examination, radiological study and posterior histological study. Results: The mean patient age was 37 years, and males predominated over females. The mean lesion size was 1.25 cm. A single relapse was recorded 7 years after removal of the initial lesion. All the cysts were surgically removed. Discussion and conclusions: Lateral periodontal cysts are very infrequent, and are characterized by the preserved vitality of the adjacent teeth. Identification of the lesion is initially based on the clinical findings, though histological study is required to confirm the diagnosis. The treatment of choice is the surgical removal, though occasional relapses have been documented

Cytomegalovirus infection in renal transplant recipients diagnosed by nested-PCR

A prospective study of cytomegalovirus (CMV) infection was carried out on 34 renal transplant recipients managed at a General Hospital in Ribeirão Preto, SP, Brazil. Serologic tests showed that all patients were infected with CMV before renal transplantation. Two nested-PCR techniques with primers that recognize sequences of the glycoprotein B (gB) and H (gH) genes were used for CMV detection in blood and urine samples during the post-transplantation period. CMV was detected more frequently in blood samples than in urine samples (P<0.001). Thirty-three patients had CMV detected at least once in blood and/or urine samples. Seven of these patients (21.2%) were diagnosed as having symptomatic CMV infection and showed a worse clinical outcome, with a higher death rate (P = 0.03). No association between CMV viremia and graft rejection was observed. Nested-PCR was not useful to identify patients at risk for symptomatic CMV infection since only 21.2% of the patients with CMV infection were symptomatic.

Immunogenicity of a 23-valent pneumococcal polysaccharide vaccine in Brazilian elderly

Serum antibodies specific for the capsular polysaccharides of Streptococcus pneumoniae provide protection against invasive pneumococcal infection. In Brazil, this vaccine has been used for people over 65 years with clinical risk to develop pneumococcal infection since 1999. We evaluated the immune response of 102 elderly subjects (75.5% females and 24.5% males) with a mean age of 71 years, and 19 young healthy adults (63.2% females and 36.8% males) with a mean age of 27 years. The elderly study group consisted of outpatients who received follow-up care in the Geriatric Department of General Hospital, Faculty of Medicine, University of São Paulo. None had acute illness at the time of vaccination. Both groups were immunized with one intra-deltoid injection with 0.5 ml of a 23-valent pneumococcal polysaccharide vaccine. The total IgG specific antibody concentrations to capsular polysaccharides 1, 3, 5, 6B, 8, and 14 were determined against pre- and 1-month post-vaccination sera. All samples were analyzed according to the second-generation pneumococcal polysaccharide ELISA protocol. We observed that the pneumococcal polysaccharide vaccine evoked consistent antibody increase for serotypes 1, 5, 6B, 8, and 14 (geometric mean concentration increase of 2.46 in the elderly and 2.84 in the young adults). Otherwise, we observed no increase in antibody concentration for serotype 3 in both groups.

Transcranial direct current stimulation and repetitive transcranial magnetic stimulation in consultation-liaison psychiatry

Patients with clinical diseases often present psychiatric conditions whose pharmacological treatment is hampered due to hazardous interactions with the clinical treatment and/or disease. This is particularly relevant for major depressive disorder, the most common psychiatric disorder in the general hospital. In this context, nonpharmacological interventions could be useful therapies; and, among those, noninvasive brain stimulation (NIBS) might be an interesting option. The main methods of NIBS are repetitive transcranial magnetic stimulation (rTMS), which was recently approved as a nonresearch treatment for some psychiatric conditions, and transcranial direct current stimulation (tDCS), a technique that is currently limited to research scenarios but has shown promising results. Therefore, our aim was to review the main medical conditions associated with high depression rates, the main obstacles for depression treatment, and whether these therapies could be a useful intervention for such conditions. We found that depression is an important and prevalent comorbidity in a variety of diseases such as epilepsy, stroke, Parkinson's disease, myocardial infarction, cancer, and in other conditions such as pregnancy and in patients without enteral access. We found that treatment of depression is often suboptimal within the above contexts and that rTMS and tDCS therapies have been insufficiently appraised. We discuss whether rTMS and tDCS could have a significant impact in treating depression that develops within a clinical context, considering its unique characteristics such as the absence of pharmacological interactions, the use of a nonenteral route, and as an augmentation therapy for antidepressants.

Computerized Tomography Contrast Induced Nephropathy (CIN) among adult inpatients

Introduction: Contrast induced nephropathy (CIN) is one of the complications of the use of intravascular contrast agents, being defined as a reduction of the glomerular filtration rate caused by the iodinated contrast. Most CIN data derive from the cardiovascular literature, which identified as the most consistent risk factors pre-existing chronic renal insufficiency and diabetes mellitus. However, these studies limit their conclusions to a more specific patient population. Computerized tomography as a cause of CIN has been studied less often. Objective: To report on the incidence of computerized tomography contrast induced nephropathy (CIN) in an inpatient population of a tertiary general hospital, identifying potentially avoidable risk factors. Methods: We performed a prospective cohort study with inpatients admitted at a tertiary hospital requiring contrast-induced CT. The primary outcome was the development of CIN, measure by the alteration of serum creatinine or glomerular filtration rate in 48 or 72 hours. Through clinical interview, we verified possible risk factors and preventive measures instituted by the medical team and their association with development of CIN. Results: Of a total of 410 patients, 35 (8.5%) developed CIN. There was a positive correlation between CIN and the presence of diabetes mellitus (OR = 2.15; 95%CI 1.35-4.06; p = 0.02), heart failure (OR = 2.23; 95%CI 1.18-8.8; p = 0.022), and renal failure (OR = 3.36; 95%CI 1.57- 7.17; p = 0.002) Conclusion: Incidence of CIN varies according to the population. Diabetes mellitus, heart failure and renal failure were independent risk factors for the development of CT-associated CIN. Further studies are needed to better understand and treat CT-associated CIN.

John Smith, M.P fonds, 1930, 1949-1950, 1954, 1957-1962, n.d.

John Smith (1894-1977), son of Daniel Smith and Annie Douglas was a native of Scotland, immigrating to Canada in 1913. He first worked as a coach builder, then as a carpenter, finally developing his own contracting business. During WWI he served overseas with the 10th Battery, RCA as a sergeant. In 1924 Smith married Jean Wood, and together they had a daughter Irene (Hugh Langley). Smith first entered politics in 1940 serving as an alderman for the next 11 years. In 1954 he was elected mayor of the city of St. Catharines, and was twice returned to office by acclamation, serving until 1957 when he successfully ran as the Progressive Conservative candidate representing Lincoln County in the federal election. He won the election by a 10 000 vote majority. He served his constituents in Ottawa until he was defeated in the 1962 election. After leaving politics Mr. Smith was active in his community. He spearheaded the establishment of the St. Catharines Museum, and then was appointed its first director in 1966, serving in that capacity until 1972. He was an active member of the board of governors of the St. Catharines General Hospital and a life member and former president of the Lincoln County Humane Society. In 1971 he was voted Citizen of the Year for the city of St. Catharines. John Smith died on February 8, 1977 and was buried at Victoria Lawn Cemetery. Source: The St. Catharines Standard, February 9, 1977, page 1

Rick Bell Family fonds, 1874-1875, 1879, 1884, 1886, 1888-1889, 1896, 1898, 1909-1910, 1939, 1945, n.d.

Lewis Tyrell married Jane Gains on August 31, 1849 in Culpeper Court House, Virginia. Jane Gains was a spinster. Lewis Tyrell died September 25, 1908 at his late residence, Vine St. and Welland Ave., St. Catharines, Ont. at the age of 81 years, 5 months. Jane Tyrell died March 1, 1886, age 64 years. Their son? William C. Tyrell died January 15, 1898, by accident in Albany, NY, age 33 years, 3 months. John William Taylor married Susan Jones were married in St. Catharines, Ont. on August 10, 1851 by William Wilkinson, a Baptist minister. On August 9, 1894 Charles Henry Bell (1871-1916), son of Stephen (1835?-1876) and Susan Bell, married Mary E. Tyrell (b. 1869?) daughter of Lewis and Alice Tyrell, in St. Catharines Ontario. By 1895 the Bell’s were living in Erie, Pennsylvania where children Delbert Otto (b. 1895) and Edna Beatrice (b. 1897) were born. By 1897 the family was back in St. Catharines where children Lewis Tyrell (b. 1899), Gertrude Cora (b. 1901), Bessie Jane (b. 1902), Charles Henry (b. 1906), Richard Nelson (b. 1911) and William Willoughby (b. 1912) were born. Charles Henry Bell operated a coal and ice business on Geneva Street. In the 1901 Census for St. Catharines, the Bell family includes the lodger Charles Henry Hall. Charles Henry Hall was born ca. 1824 in Maryland, he died in St. Catharines on November 11, 1916 at the age of 92. On October 24, 1889 Charles Hall married Susan Bell (1829-1898). The 1911 Census of Canada records Charles Henry Hall residing in the same household as Charles Henry and Mary Bell. The relationship to the householder is step-father. It is likely that after Stephen Bell’s death in 1876, his widow, Susan Bell married Hall. In 1939, Richard Nelson Bell, son of Charles Henry and Mary Tyrell Bell, married Iris Sloman. Iris (b. 22 May 1912 in Biddulph Township, Middlesex, Ontario) was the daughter of Albert (son of Joseph b. 1870 and Elizabeth Sloman, b. 1872) and Josie (Josephine Ellen) Butler Sloman of London, Ont. Josie (b. 1891) was the daughter of Everett Richard and Elizabeth McCarthy (or McCarty) Butler, of Lucan Village, Middlesex North. According to the 1911 Census of Canada, Albert, a Methodist, was a porter on the railroad. His wife, Josephine, was a Roman Catholic. Residing with Albert and Josie were Sanford and Sadie Butler and Sidney Sloman, likely siblings of Albert and Josephine. The Butler family is descended from Peter Butler, a former slave, who had settled in the Wilberforce Colony in the 1830s. Rick Bell b. 1949 in Niagara Falls, Ont. is the son of Richard Nelson Bell. In 1979, after working seven years as an orderly at the St. Catharines General Hospital while also attending night school at Niagara College, Rick Bell was hired by the Thorold Fire Dept. He became the first Black professional firefighter in Niagara. He is a founding member of the St. Catharines Junior Symphony; attended the Banff School of Fine Arts in 1966 and also performed with the Lincoln & Welland Regimental Band and several other popular local groups. Upon the discovery of this rich archive in his mothers’ attic he became passionate about sharing his Black ancestry and the contributions of fugitive slaves to the heritage Niagara with local school children. He currently resides in London, Ont.

Welland County Records, 1961-1989

The origins of the Welland County Fair date back to the founding of the County of Welland in 1852. A provincial charter was issued in 1853 to create the Welland County Agricultural Society that was to operate the Fair. In 1970, the Welland County Fair became the Niagara Regional Exhibition, and the Society became known as the Niagara Regional Agriculture Society. The Society seeks to “encourage interest, promote improvements in and advance the standards of agriculture, domestic industry and rural life”. The Welland Festival of Arts was developed in 1986 in order to revitalize the town’s economy. An “outdoor art gallery” was created by painting murals on buildings that depicted the town’s heritage, a concept successfully adopted by the town of Chemainus, B.C. The first mural was completed in the summer of 1988, and by 1991 there were a total of 28 murals around the city. The endeavour proved successful: in the years that followed the creation of the Festival, two new hotels were constructed, a third was expanded, and there was an addition to the Seaway Mall to accommodate the increased tourist traffic. Optimist International is a non-profit organization that strives to “bring out the best in kids” . The first Canadian club was formed in Toronto in 1924. The Welland branch of the Optimist Club was founded in 1937. The first Welland County General Hospital opened in 1908. As the population increased, it became necessary to expand the existing facilities. Additions were made to the original structure with an East wing in 1930 and a children’s ward in 1931. However, in the 1950’s, the hospital was operating beyond optimum capacity and the need for a larger facility was clear. It was decided that a new hospital would be built, which opened in April 1960. The new hospital had 259 beds and 51 bassinets. Further additions were made in 1967 and 1978. The County of Welland was formed in 1850 when it was officially separated from Lincoln County, however, the two counties continued to operate together until 1856 when a new County building and jail for Welland County were completed. That same year, the first meeting of the Council of the Corporation of Welland County took place. The final meeting of the Council took place on December 18, 1969. The following year, the County of Welland merged with Lincoln County to form the Regional Municipality of Niagara. The Welland Mills in Thorold, Ont., was built in 1846-1847 by Jacob Keefer and is thought to have been one of the largest flour mills in Upper Canada. Ownership of the mill changed several times over the years and previous owners include the Howland family, the Hedley Shaw Milling Company and the Maple Leaf Milling Company. In 1986, the building received a heritage plaque from the Ontario Heritage Foundation, an agency of the Ontario Ministry of Culture and Recreation. At this time, the mill was no longer in operation and was being used for storage by Fraser, Inc. By 2006, the dilapidated building had been redeveloped into18 apartments and 2 floors of commercial space, while maintaining many heritage features. The building is currently known as the Welland Mills Centre.

Fair of Nations (1906)

Official program "Fair of Nations" for the benefit of the Niagara Falls General Hospital.

Assessing waiting times in the clinical trajectory of patients with lung cancer

Le cancer du poumon a une incidence et une létalité parmi les plus hautes de tous les cancers diagnostiqués au Canada. En considérant la gravité du pronostic et des symptômes de la maladie, l’accès au traitement dans les plus brefs de délais est essentiel. Malgré l’engagement du gouvernement fédéral et les gouvernements provinciaux de réduire les délais de temps d’attente, des balises pour les temps d’attente pour le traitement d’un cancer ne sont toujours pas établis. En outre, le compte-rendu des indicateurs des temps d’attente n’est pas uniforme à travers les provinces. Une des solutions proposées pour la réduction des temps d’attente pour le traitement du cancer est les équipes interdisciplinaires. J’ai complété un audit du programme interdisciplinaire traitant le cancer du poumon à l’Hôpital général juif (l’HGJ) de 2004 à 2007. Les objectifs primaires de l’étude étaient : (1) de faire un audit de la performance de l’équipe interdisciplinaire à l’HGJ en ce qui concerne les temps d’attente pour les intervalles critiques et les sous-groupes de patients ; (2) de comparer les temps d’attente dans la trajectoire clinique des patients traités à l’HGJ avec les balises qui existent ; (3) de déterminer les facteurs associés aux délais plus longs dans cette population. Un objectif secondaire de l’étude était de suggérer des mesures visant à réduire les temps d’attente. Le service clinique à l’HGJ a été évalué selon les balises proposées par le British Thoracic Society, Cancer Care Ontario, et la balise pan-canadienne pour la radiothérapie. Les patients de l’HGJ ont subi un délai médian de 9 jours pour l’intervalle «Ready to treat to first treatment», et un délai médian de 30 jours pour l’intervalle entre le premier contact avec l’hôpital et le premier traitement. Les patients âgés de plus de 65 ans, les patients avec une capacité physique diminuée, et les patients avec un stade de tumeur limité étaient plus à risque d’échouer les balises pour les temps d’attente.

Un modèle global et intégré de la performance : application à l’urgence d’un hôpital au Mexique

À cause de la nature complexe et non linéaire de leurs opérations, les salles d’urgence (SU) constituent des entités organisationnelles uniques dans le domaine de la santé. Les SU subissent des pressions accrues résultant des dynamiques des sociétés contemporaines et de leurs systèmes de santé, et font face ainsi à des défis uniques comme l’engorgement. Contrairement aux croyances dominantes sur le phénomène, le présent travail de recherche établit que ce problème est en réalité une manifestation de pauvre performance systémique plutôt qu’une faillite opérationnelle. Alors, pour les SU, la performance organisationnelle relève une importance incontestable. En effet, l’étude de la performance organisationnelle est un sujet de recherche qui intéresse de nombreux chercheurs des services de santé. Il s’agit, néanmoins, d’un concept historiquement difficile à définir à cause de son caractère complexe, multidimensionnel et paradoxal. Le modèle EGIPSS, basé sur la théorie de l’action sociale de Parsons, est capable de saisir cette complexité et constitue un cadre conceptuel robuste et exhaustif, pouvant s’adapter à des contextes divers. Ce mémoire adopte le modèle EGIPSS pour présenter un outil global et intégré d’évaluation de la performance organisationnelle de la salle d’urgences de l’Hôpital Général Régional 46 à Guadalajara, au Mexique. Cet instrument est conçu pour prendre en compte spécifiquement les particularités propres des SU, ainsi que les caractéristiques organisationnelles uniques de l'Hôpital Général Régional 46. Enfin, le développement de ce projet de mémoire contribue aux efforts d’amélioration continue de la performance de cet établissement, et enrichit les connaissances sur les urgences en tant qu’unités organisationnelles.

Comparative costs and outcomes of traumatic brain injury from biking accidents with or without helmet use

Contexte: Évaluer les déterminants de maladies évitables et leurs coûts est nécessaire dans le contexte d’assurance maladie universelle. Le moment d’évaluer les impacts des traumatismes crâniocérébraux (TCC) survenus lors d’accidents de vélo est idéal vu la popularité récente du cyclisme au Québec. Objectifs: Comparer les caractéristiques démographiques et médicales, ainsi que les coûts sociétaux qu’engendrent les TCC de cyclistes portant ou non un casque. Méthodologie: Étude rétrospective de 128 cyclistes avec TCC admis à l’Hôpital Général de Montréal entre 2007 et 2011. Les variables indépendantes sont sociodémographiques, cliniques et le port du casque. Les variables dépendantes sont la durée de séjour, l’échelle GOS-E, l’échelle ISS, l’orientation au congé, les décès et les coûts à la société. Résultats: Le groupe portant un casque était plus vieux, plus éduqué, retraité et marié; au niveau médical, ils avaient des TCCs moins sévères à l’imagerie, des hospitalisations aux soins intensifs plus courtes et moins de neurochirurgies. Les coûts médians à la société pour les TCC isolés de cyclistes avec casque étaient significativement moindres. Conclusion: Dans cette étude, le port du casque semblait prévenir certaines complications des TCC et permettait de faire économiser de l’argent à l’état. Le port de casque est recommandé.

Stratégies à privilégier pour permettre aux infirmières et infirmiers de déployer pleinement leur étendue de pratique.

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de Maître ès sciences (M. Sc.) en sciences infirmières option administration des services infirmiers