Jenny Lam-mcculloch - Academia.edu (original) (raw)

Papers by Jenny Lam-mcculloch

Research paper thumbnail of Consensus and controversy in hepatic surgery: A survey of Canadian surgeons

Journal of Surgical Oncology, 2014

Heterogeneity in practice provides an opportunity for further study, as it may [IRT Rev 1] reflec... more Heterogeneity in practice provides an opportunity for further study, as it may [IRT Rev 1] reflect deficiencies in knowledge translation or knowledge gaps. This survey aimed to assess practice patterns for the surgical treatment of malignancies of the liverwith the goal of identifying areas of variability. We created a web-based survey focusing on scope of surgical practice, pre-and post-operative measures and practice patterns for liver and biliary surgery. We piloted the survey for clarity and made changes as needed. All members of the Canadian Hepato-Pancreatico-Biliary Association (CHPBA) were invited to participate. Descriptive statistics were used to analyze the results. The survey was sent to sixty-nine surgeons and thirty-six (52%) completed the survey in its entirety. Areas of agreement include defining the resectability of a tumourand in imaging modalities used to determine resectability. Variability surrounded utlilization of blood conservation strategies, withlow CVP anesthesia frequently used and all other strategies (autologous blood donation, acute normovolemic hemodilution, cell-saver, and tranexamic acid) rarely used. Post-operative analgesic technique was variable with epidural analgesia (50%) and IV-PCA (35.3%) nearly equally preferred. There is variability in some techniques and approaches used by hepatobiliary surgeons. Future research focusing on areas of uncertainty including techniques of blood conservation and post-operative analgesia are needed.

Research paper thumbnail of Medial open transversus abdominis plane (MOTAP) catheters for analgesia following open liver resection: study protocol for a randomized controlled trial

Trials, 2014

Background: The current standard for pain control following liver surgery is intravenous, patient... more Background: The current standard for pain control following liver surgery is intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. We have developed a modification of a regional technique called medial open transversus abdominis plane (MOTAP) catheter analgesia. The MOTAP technique involves surgically placed catheters through the open surgical site into a plane between the internal oblique muscle and the transverse abdominis muscle superiorly. The objective of this trial is to assess the efficacy of this technique. Methods/design: This protocol describes a multicentre, prospective, blinded, randomized controlled trial. One hundred and twenty patients scheduled for open liver resection through a subcostal incision will be enrolled. All patients will have two MOTAP catheters placed at the conclusion of surgery. Patients will be randomized to one of two parallel groups: experimental (local anaesthetic through MOTAP catheters) or placebo (normal saline through MOTAP catheters). Both groups will also receive IV PCA. The primary endpoint is mean cumulative postoperative opioid consumption over the first 2 postoperative days (48 hours). Secondary outcomes include pain intensity, patient functional outcomes, and the incidence of complications. Discussion: This trial has been approved by the ethics boards at participating centres and is currently enrolling patients. Data collection will be completed by the end of 2014 with analysis mid-2015 and publication by the end of 2015. Trial registration: The study is registered with http://clinicaltrials.gov (NCT01960049;

Research paper thumbnail of L’inhibition du système rénine-angiotensine est lié à une augmentation de la mortalité suite à une chirurgie vasculaire

Research paper thumbnail of Impact of Fluid Resuscitation on Major Adverse Events Following Pancreaticoduodenectomy

The American Journal of Surgery, 2015

Pancreaticoduodenectomy remains a major undertaking with substantial perioperative morbidity and ... more Pancreaticoduodenectomy remains a major undertaking with substantial perioperative morbidity and mortality. Previous studies in the colorectal population have noted a correlation between excessive postoperative fluid resuscitation and anastomotic complications. This study sought to assess the relationship between perioperative fluid management and clinical outcomes in patients undergoing pancreaticoduodenectomy. Data from a single institution, prospective database over a 10-year period (2002 to 2012) were reviewed. Patients were compared for perioperative fluid balance and postoperative outcomes. Multivariable analysis was performed to assess the relationship between perioperative fluid administration and incidence of major adverse events. Higher positive fluid balance on postoperative day 0, postoperative day 1, and postoperative day 2 was associated with increased incidence of major adverse events, increased postoperative intensive care unit admission, and longer hospital stay. Higher positive fluid balance on postoperative day 0 was most strongly associated with postoperative morbidity (odds ratio 1.39, confidence interval 1.16 to 1.66, P = .0003). Fluid balance on postoperative day 3 was not associated with adverse events. Increased early perioperative fluid resuscitation is associated with major adverse events in patients undergoing pancreaticoduodenectomy. More restrictive fluid administration may improve postoperative outcomes; further prospective clinical trials focused on fluid resuscitation and goal-directed therapy are needed.

Research paper thumbnail of Canadian practice patterns for pancreaticoduodenectomy

Canadian journal of surgery. Journal canadien de chirurgie, 2014

Discordant practice patterns may be a consequence of evidence-practice gaps or deficiencies in kn... more Discordant practice patterns may be a consequence of evidence-practice gaps or deficiencies in knowledge translation. We examined the current strategies used by hepato-pancreatico-biliary (HPB) surgeons in Canada for the perioperative management of pancreaticoduodenectomy (PD). We generated a web-based survey that focused on the perioperative measures surrounding PD. The survey was distributed to all members of the Canadian Hepato-Pancreatico-Biliary Association. The survey was distributed to 74 surgeons and received a response rate of 50%. Many similarities in surgical techniques were reported; for example, most surgeons (86.5%) reconstruct the pancreas with pancreaticojejunostomy rather than pancreaticogastrostomy. In contrast, variable techniques regarding the use of peritoneal drainage tubes, anastomotic stents, octreotide and other intraoperative modalities were reported. Most surgeons (75.7%) reported that their patients frequently required preoperative biliary drainage, yet t...

Research paper thumbnail of Sacroiliac Joint Complex Pain Syndrome; A Comparative Pilot Prospective Cohort Study of Conventional (RF)Radiofrequency Versus Cooled RF ʼSinergyʼ

Regional Anesthesia and Pain Medicine, 2008

Research paper thumbnail of 611: Sacroiliac Joint Complex Pain Syndrome; A Comparative Pilot Prospective Cohort Study of Conventional (RF)Radiofrequency Versus Cooled RF ′Sinergy′

Regional Anesthesia and Pain Medicine, 2008

Research paper thumbnail of 505: Cooled Radiofrequency Denervation “Sinergy′, as a Novel Treatment of Sacroiliac Joint Complex Pain Syndrome; A Pilot Study

Regional Anesthesia and Pain Medicine, 2008

Research paper thumbnail of Anaesthesia concerns in the management of the trauma patient

Current Orthopaedics, 2004

... Anita Sarmah Corresponding Author Contact Information , E-mail The Corresponding Author , Jen... more ... Anita Sarmah Corresponding Author Contact Information , E-mail The Corresponding Author , Jenny Lam-McCulloch, Doreen Yee. ... Patients with laryngeal fracture, airway burn, or head and neck injury are likely to require a secure airway to prevent upper airway obstruction. ...

Research paper thumbnail of Applying theory to practice in undergraduate education using high fidelity simulation

Medical Teacher, 2006

High-fidelity patient simulation allows students to apply their theoretical knowledge of pharmaco... more High-fidelity patient simulation allows students to apply their theoretical knowledge of pharmacology and physiology to practice. The purpose of this study was to determine if experiential education using high-fidelity simulation improves undergraduate performance scores on simulation-based and written examinations. After receiving research ethics board approval, students completed a consent form and then answered a ten question multiple-choice quiz to identify their knowledge regarding the management of cardiac arrhythmias. Four simulation scenarios were presented and students worked through each scenario as a team. Faculty facilitated the sessions and feedback was given using students' videotaped performances as a template for discussion. Performance evaluation scores using predetermined checklists and global rating scales were completed. Students then reviewed the American Heart Association guidelines for the management of unstable cardiac arrhythmias. The afternoon session involved repetition of the four case scenarios with the same teams involved but different team leaders. Students then repeated the quiz they received in the morning. Descriptive statistics, paired t-test and repeated measures analysis of variance (ANOVA) were used to analyse results. Two hundred and ninety-nine students completed the study. There was a statistically significant improvement in performance on the pharmacology written test. Simulation team performance also statistically improved and a good correlation between checklist and global rating scores were demonstrated in all but one scenario. Student evaluation of the experience was extremely positive. High-fidelity simulation can be used to allow students to apply theoretical knowledge to practice in a safe and realistic environment. Results of this study indicate that simulation is a valuable learning experience and bridges the gap between theory and practice. Simulation technology has the potential to provide an enriching venue to examine the role of communication and dynamics of novice learners in team environments.

Research paper thumbnail of Medial Open Transversus Abdominal Plane Catheter Analgesia: A Simple, Safe, Effective Technique after Open Liver Resection

Journal of the American College of Surgeons, 2014

Research paper thumbnail of Assessment of disability

The Journal of Pain, 2004

Research paper thumbnail of Barriers to communication regarding end-of-life care: perspectives of care providers

Journal of Critical Care, 2005

Communication regarding end-of-life care is frequently perceived as suboptimal, despite the inten... more Communication regarding end-of-life care is frequently perceived as suboptimal, despite the intent of both health care providers and patients. We interviewed health care providers to determine their perspective regarding these barriers to communication. Eleven focus groups with a total of 10 attending physicians, 24 residents, and 33 nurses were convened to explore barriers to end-of-life discussions on the Internal Medicine service at a 600-bed tertiary care hospital in Toronto, Canada. An interview schedule was designed to elicit information regarding the process of end-of-life discussions, barriers to these discussions, and possible interventions for limiting such barriers. Transcripts were qualitatively analyzed by 6 raters who independently identified "themes." Themes were refined using the Delphi technique and classified under broader "categories." Four main categories of barriers emerged, relating to (1) patients, (2) the health care system, (3) health care providers, and (4) the nature of this dialogue. Attending physicians and residents most frequently identified patient-related factors as barriers to discussions, followed by system, dialogue, and provider barriers (43%, 39%, 10%, and 8%, respectively, for attending physicians; 40%, 34%, 13%, and 13%, respectively, for residents). Nurses similarly identified patient-related and system barriers most frequently, but provider barriers were discussed more often than dialogue barriers (46%, 28%, 22%, and 4%, respectively). Attending physicians, residents, and nurses perceive the recipients of their care, and the system within which they provide this care, to be the major source of barriers to communication regarding end-of-life care. This finding may impact on the effectiveness of quality-improvement initiatives in end-of-life care.

Research paper thumbnail of Renin-angiotensin blockade is associated with increased mortality after vascular surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2010

Purpose The outcome of patients with preoperative renin-angiotensin system (RAS) blockade, achiev... more Purpose The outcome of patients with preoperative renin-angiotensin system (RAS) blockade, achieved either by angiotensin converting enzyme inhibitors or angiotensin receptor blocking agents, was assessed using 30-day mortality as a primary end point. Methods An observational cohort study of 883 consecutive patients undergoing elective open abdominal aortic aneurysm repair (AAA) was undertaken and analyzed using a propensity score matched study. The data collected included medical history, anesthetic techniques, and postoperative outcomes. Logistic regression analysis identified predictors of RAS blockade: hypertension, stroke, congestive heart failure, diabetes, and heart disease. A propensity score for RAS blockade was calculated for each subject using several factors: age, sex, serum creatinine, hypertension, heart disease, congestive heart failure, stroke, diabetes, and exposure to cardiovascular medications. Subjects and controls were matched using the calculated propensity score.

Research paper thumbnail of Assessment of a new technique of glidescope intubation

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2006

Page 1. 26456 - PERIOPERATIVE TRANSFUSION INCREASES MORTALITY Rachel O'Farrell MD, Dumin... more Page 1. 26456 - PERIOPERATIVE TRANSFUSION INCREASES MORTALITY Rachel O'Farrell MD, Duminda Wijeysundera, MD; Keyvan, MD; Scott Beattie, Toronto General Hospital, UHN, Toronto, ONTARIO, Canada INTRODUCTION ...

Research paper thumbnail of Systemic effects of subcutaneous and topical epinephrine administration during burn surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2002

fed into the esophagus. The laryngoscope was then removed and the PLMA railroaded into position u... more fed into the esophagus. The laryngoscope was then removed and the PLMA railroaded into position using the digital technique with a midline approach. On this occasion, ventilation was easy with no air leakage and the bite block was correctly located between the teeth. The GEB was removed whilst holding the PLMA. Subsequent passage of a gastric tube was easy.

Research paper thumbnail of Simulation: Theory to practice in undergraduate medical education

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

Page 1. SIMULATION: THEORY TO PRACTICE IN UNDERGRADUATE MEDICAL EDUCATION Pamela J Morgan* MD, FR... more Page 1. SIMULATION: THEORY TO PRACTICE IN UNDERGRADUATE MEDICAL EDUCATION Pamela J Morgan* MD, FRCPC, Doreen Cleave-HoggΨ PhD, Susan DeSousa* BSc, RRCP, Jenny Lam-McCulloch* MSc. *Department ...

Research paper thumbnail of Comparison of maternal satisfaction between epidural and spinal anesthesia for elective Cesarean section

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2000

CAN J ANESTH 2000 / 47: 10 / pp [956][957][958][959][960][961] Purpose: Epidural anesthesia was a... more CAN J ANESTH 2000 / 47: 10 / pp [956][957][958][959][960][961] Purpose: Epidural anesthesia was a commonly used technique for elective Cesarean section. Recently, because of the availability of non-cutting spinal needles, many institutions have changed from epidural to spinal anesthesia. The purpose of this study was to compare maternal satisfaction between epidural and spinal anesthesia for elective Cesarean section with a new satisfaction tool.

Research paper thumbnail of Anesthetic and Pharmaco-economic Outcomes in Prostate Brachytherapy

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

... Jenny Lam-McCulloch MSc,* Joseph Kay MD FRCPC* AFFILIATIONS: *Department of Anesthesia, Sunny... more ... Jenny Lam-McCulloch MSc,* Joseph Kay MD FRCPC* AFFILIATIONS: *Department of Anesthesia, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 †Department of Anesthesia, Belleville ...

Research paper thumbnail of Rectal indomethacin reduces postoperative pain and morphine use after cardiac surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 1999

To evaluate the combination of rectal indomethacin with patient controlled intravenous morphine a... more To evaluate the combination of rectal indomethacin with patient controlled intravenous morphine analgesia (PCA) on postoperative pain relief and opioid use after cardiac surgery. With institutional ethics approval, 57 consenting adults undergoing elective aortocoronary bypass surgery were randomly assigned preoperatively in a double-blind fashion to receive either placebo (n = 26) or indomethacin 100 mg suppositories (n = 31), 2-3 hr postoperatively, and 12 hr later. Both groups utilized PCA morphine. Pain scores in the two treatment groups were assessed on a 10-cm visual analogue scale (VAS) (at rest and with cough) at 4, 6, 12, 18 and 24 hr after initial dosing, and were analyzed through a 2 x 5 repeated measures of variance. The 24 hr analgesic consumption, 12 and 24 hr chest tube blood loss, and time to tracheal extubation were also recorded, and compared for the two treatment arms through Student's t test on independent samples. Postoperative morphine consumption in the first 24 hr was 38% less in the indomethacin group (22.40 +/- 12.55 mg) than the placebo group (35.99 +/- 25.84 mg), P = 0.019. Pain scores, measured with a VAS, were 26% to 66% lower in the indomethacin vs placebo group at rest (P = 0.006), but not with cough, for all times assessed. There was no difference in blood loss (at 12 hr) or time to tracheal extubation for both groups. The combination of indomethacin with morphine after cardiac surgery results in reduced postoperative pain scores and opioid use without an increase in side effects.

Research paper thumbnail of Consensus and controversy in hepatic surgery: A survey of Canadian surgeons

Journal of Surgical Oncology, 2014

Heterogeneity in practice provides an opportunity for further study, as it may [IRT Rev 1] reflec... more Heterogeneity in practice provides an opportunity for further study, as it may [IRT Rev 1] reflect deficiencies in knowledge translation or knowledge gaps. This survey aimed to assess practice patterns for the surgical treatment of malignancies of the liverwith the goal of identifying areas of variability. We created a web-based survey focusing on scope of surgical practice, pre-and post-operative measures and practice patterns for liver and biliary surgery. We piloted the survey for clarity and made changes as needed. All members of the Canadian Hepato-Pancreatico-Biliary Association (CHPBA) were invited to participate. Descriptive statistics were used to analyze the results. The survey was sent to sixty-nine surgeons and thirty-six (52%) completed the survey in its entirety. Areas of agreement include defining the resectability of a tumourand in imaging modalities used to determine resectability. Variability surrounded utlilization of blood conservation strategies, withlow CVP anesthesia frequently used and all other strategies (autologous blood donation, acute normovolemic hemodilution, cell-saver, and tranexamic acid) rarely used. Post-operative analgesic technique was variable with epidural analgesia (50%) and IV-PCA (35.3%) nearly equally preferred. There is variability in some techniques and approaches used by hepatobiliary surgeons. Future research focusing on areas of uncertainty including techniques of blood conservation and post-operative analgesia are needed.

Research paper thumbnail of Medial open transversus abdominis plane (MOTAP) catheters for analgesia following open liver resection: study protocol for a randomized controlled trial

Trials, 2014

Background: The current standard for pain control following liver surgery is intravenous, patient... more Background: The current standard for pain control following liver surgery is intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. We have developed a modification of a regional technique called medial open transversus abdominis plane (MOTAP) catheter analgesia. The MOTAP technique involves surgically placed catheters through the open surgical site into a plane between the internal oblique muscle and the transverse abdominis muscle superiorly. The objective of this trial is to assess the efficacy of this technique. Methods/design: This protocol describes a multicentre, prospective, blinded, randomized controlled trial. One hundred and twenty patients scheduled for open liver resection through a subcostal incision will be enrolled. All patients will have two MOTAP catheters placed at the conclusion of surgery. Patients will be randomized to one of two parallel groups: experimental (local anaesthetic through MOTAP catheters) or placebo (normal saline through MOTAP catheters). Both groups will also receive IV PCA. The primary endpoint is mean cumulative postoperative opioid consumption over the first 2 postoperative days (48 hours). Secondary outcomes include pain intensity, patient functional outcomes, and the incidence of complications. Discussion: This trial has been approved by the ethics boards at participating centres and is currently enrolling patients. Data collection will be completed by the end of 2014 with analysis mid-2015 and publication by the end of 2015. Trial registration: The study is registered with http://clinicaltrials.gov (NCT01960049;

Research paper thumbnail of L’inhibition du système rénine-angiotensine est lié à une augmentation de la mortalité suite à une chirurgie vasculaire

Research paper thumbnail of Impact of Fluid Resuscitation on Major Adverse Events Following Pancreaticoduodenectomy

The American Journal of Surgery, 2015

Pancreaticoduodenectomy remains a major undertaking with substantial perioperative morbidity and ... more Pancreaticoduodenectomy remains a major undertaking with substantial perioperative morbidity and mortality. Previous studies in the colorectal population have noted a correlation between excessive postoperative fluid resuscitation and anastomotic complications. This study sought to assess the relationship between perioperative fluid management and clinical outcomes in patients undergoing pancreaticoduodenectomy. Data from a single institution, prospective database over a 10-year period (2002 to 2012) were reviewed. Patients were compared for perioperative fluid balance and postoperative outcomes. Multivariable analysis was performed to assess the relationship between perioperative fluid administration and incidence of major adverse events. Higher positive fluid balance on postoperative day 0, postoperative day 1, and postoperative day 2 was associated with increased incidence of major adverse events, increased postoperative intensive care unit admission, and longer hospital stay. Higher positive fluid balance on postoperative day 0 was most strongly associated with postoperative morbidity (odds ratio 1.39, confidence interval 1.16 to 1.66, P = .0003). Fluid balance on postoperative day 3 was not associated with adverse events. Increased early perioperative fluid resuscitation is associated with major adverse events in patients undergoing pancreaticoduodenectomy. More restrictive fluid administration may improve postoperative outcomes; further prospective clinical trials focused on fluid resuscitation and goal-directed therapy are needed.

Research paper thumbnail of Canadian practice patterns for pancreaticoduodenectomy

Canadian journal of surgery. Journal canadien de chirurgie, 2014

Discordant practice patterns may be a consequence of evidence-practice gaps or deficiencies in kn... more Discordant practice patterns may be a consequence of evidence-practice gaps or deficiencies in knowledge translation. We examined the current strategies used by hepato-pancreatico-biliary (HPB) surgeons in Canada for the perioperative management of pancreaticoduodenectomy (PD). We generated a web-based survey that focused on the perioperative measures surrounding PD. The survey was distributed to all members of the Canadian Hepato-Pancreatico-Biliary Association. The survey was distributed to 74 surgeons and received a response rate of 50%. Many similarities in surgical techniques were reported; for example, most surgeons (86.5%) reconstruct the pancreas with pancreaticojejunostomy rather than pancreaticogastrostomy. In contrast, variable techniques regarding the use of peritoneal drainage tubes, anastomotic stents, octreotide and other intraoperative modalities were reported. Most surgeons (75.7%) reported that their patients frequently required preoperative biliary drainage, yet t...

Research paper thumbnail of Sacroiliac Joint Complex Pain Syndrome; A Comparative Pilot Prospective Cohort Study of Conventional (RF)Radiofrequency Versus Cooled RF ʼSinergyʼ

Regional Anesthesia and Pain Medicine, 2008

Research paper thumbnail of 611: Sacroiliac Joint Complex Pain Syndrome; A Comparative Pilot Prospective Cohort Study of Conventional (RF)Radiofrequency Versus Cooled RF ′Sinergy′

Regional Anesthesia and Pain Medicine, 2008

Research paper thumbnail of 505: Cooled Radiofrequency Denervation “Sinergy′, as a Novel Treatment of Sacroiliac Joint Complex Pain Syndrome; A Pilot Study

Regional Anesthesia and Pain Medicine, 2008

Research paper thumbnail of Anaesthesia concerns in the management of the trauma patient

Current Orthopaedics, 2004

... Anita Sarmah Corresponding Author Contact Information , E-mail The Corresponding Author , Jen... more ... Anita Sarmah Corresponding Author Contact Information , E-mail The Corresponding Author , Jenny Lam-McCulloch, Doreen Yee. ... Patients with laryngeal fracture, airway burn, or head and neck injury are likely to require a secure airway to prevent upper airway obstruction. ...

Research paper thumbnail of Applying theory to practice in undergraduate education using high fidelity simulation

Medical Teacher, 2006

High-fidelity patient simulation allows students to apply their theoretical knowledge of pharmaco... more High-fidelity patient simulation allows students to apply their theoretical knowledge of pharmacology and physiology to practice. The purpose of this study was to determine if experiential education using high-fidelity simulation improves undergraduate performance scores on simulation-based and written examinations. After receiving research ethics board approval, students completed a consent form and then answered a ten question multiple-choice quiz to identify their knowledge regarding the management of cardiac arrhythmias. Four simulation scenarios were presented and students worked through each scenario as a team. Faculty facilitated the sessions and feedback was given using students' videotaped performances as a template for discussion. Performance evaluation scores using predetermined checklists and global rating scales were completed. Students then reviewed the American Heart Association guidelines for the management of unstable cardiac arrhythmias. The afternoon session involved repetition of the four case scenarios with the same teams involved but different team leaders. Students then repeated the quiz they received in the morning. Descriptive statistics, paired t-test and repeated measures analysis of variance (ANOVA) were used to analyse results. Two hundred and ninety-nine students completed the study. There was a statistically significant improvement in performance on the pharmacology written test. Simulation team performance also statistically improved and a good correlation between checklist and global rating scores were demonstrated in all but one scenario. Student evaluation of the experience was extremely positive. High-fidelity simulation can be used to allow students to apply theoretical knowledge to practice in a safe and realistic environment. Results of this study indicate that simulation is a valuable learning experience and bridges the gap between theory and practice. Simulation technology has the potential to provide an enriching venue to examine the role of communication and dynamics of novice learners in team environments.

Research paper thumbnail of Medial Open Transversus Abdominal Plane Catheter Analgesia: A Simple, Safe, Effective Technique after Open Liver Resection

Journal of the American College of Surgeons, 2014

Research paper thumbnail of Assessment of disability

The Journal of Pain, 2004

Research paper thumbnail of Barriers to communication regarding end-of-life care: perspectives of care providers

Journal of Critical Care, 2005

Communication regarding end-of-life care is frequently perceived as suboptimal, despite the inten... more Communication regarding end-of-life care is frequently perceived as suboptimal, despite the intent of both health care providers and patients. We interviewed health care providers to determine their perspective regarding these barriers to communication. Eleven focus groups with a total of 10 attending physicians, 24 residents, and 33 nurses were convened to explore barriers to end-of-life discussions on the Internal Medicine service at a 600-bed tertiary care hospital in Toronto, Canada. An interview schedule was designed to elicit information regarding the process of end-of-life discussions, barriers to these discussions, and possible interventions for limiting such barriers. Transcripts were qualitatively analyzed by 6 raters who independently identified "themes." Themes were refined using the Delphi technique and classified under broader "categories." Four main categories of barriers emerged, relating to (1) patients, (2) the health care system, (3) health care providers, and (4) the nature of this dialogue. Attending physicians and residents most frequently identified patient-related factors as barriers to discussions, followed by system, dialogue, and provider barriers (43%, 39%, 10%, and 8%, respectively, for attending physicians; 40%, 34%, 13%, and 13%, respectively, for residents). Nurses similarly identified patient-related and system barriers most frequently, but provider barriers were discussed more often than dialogue barriers (46%, 28%, 22%, and 4%, respectively). Attending physicians, residents, and nurses perceive the recipients of their care, and the system within which they provide this care, to be the major source of barriers to communication regarding end-of-life care. This finding may impact on the effectiveness of quality-improvement initiatives in end-of-life care.

Research paper thumbnail of Renin-angiotensin blockade is associated with increased mortality after vascular surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2010

Purpose The outcome of patients with preoperative renin-angiotensin system (RAS) blockade, achiev... more Purpose The outcome of patients with preoperative renin-angiotensin system (RAS) blockade, achieved either by angiotensin converting enzyme inhibitors or angiotensin receptor blocking agents, was assessed using 30-day mortality as a primary end point. Methods An observational cohort study of 883 consecutive patients undergoing elective open abdominal aortic aneurysm repair (AAA) was undertaken and analyzed using a propensity score matched study. The data collected included medical history, anesthetic techniques, and postoperative outcomes. Logistic regression analysis identified predictors of RAS blockade: hypertension, stroke, congestive heart failure, diabetes, and heart disease. A propensity score for RAS blockade was calculated for each subject using several factors: age, sex, serum creatinine, hypertension, heart disease, congestive heart failure, stroke, diabetes, and exposure to cardiovascular medications. Subjects and controls were matched using the calculated propensity score.

Research paper thumbnail of Assessment of a new technique of glidescope intubation

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2006

Page 1. 26456 - PERIOPERATIVE TRANSFUSION INCREASES MORTALITY Rachel O'Farrell MD, Dumin... more Page 1. 26456 - PERIOPERATIVE TRANSFUSION INCREASES MORTALITY Rachel O'Farrell MD, Duminda Wijeysundera, MD; Keyvan, MD; Scott Beattie, Toronto General Hospital, UHN, Toronto, ONTARIO, Canada INTRODUCTION ...

Research paper thumbnail of Systemic effects of subcutaneous and topical epinephrine administration during burn surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2002

fed into the esophagus. The laryngoscope was then removed and the PLMA railroaded into position u... more fed into the esophagus. The laryngoscope was then removed and the PLMA railroaded into position using the digital technique with a midline approach. On this occasion, ventilation was easy with no air leakage and the bite block was correctly located between the teeth. The GEB was removed whilst holding the PLMA. Subsequent passage of a gastric tube was easy.

Research paper thumbnail of Simulation: Theory to practice in undergraduate medical education

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

Page 1. SIMULATION: THEORY TO PRACTICE IN UNDERGRADUATE MEDICAL EDUCATION Pamela J Morgan* MD, FR... more Page 1. SIMULATION: THEORY TO PRACTICE IN UNDERGRADUATE MEDICAL EDUCATION Pamela J Morgan* MD, FRCPC, Doreen Cleave-HoggΨ PhD, Susan DeSousa* BSc, RRCP, Jenny Lam-McCulloch* MSc. *Department ...

Research paper thumbnail of Comparison of maternal satisfaction between epidural and spinal anesthesia for elective Cesarean section

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2000

CAN J ANESTH 2000 / 47: 10 / pp [956][957][958][959][960][961] Purpose: Epidural anesthesia was a... more CAN J ANESTH 2000 / 47: 10 / pp [956][957][958][959][960][961] Purpose: Epidural anesthesia was a commonly used technique for elective Cesarean section. Recently, because of the availability of non-cutting spinal needles, many institutions have changed from epidural to spinal anesthesia. The purpose of this study was to compare maternal satisfaction between epidural and spinal anesthesia for elective Cesarean section with a new satisfaction tool.

Research paper thumbnail of Anesthetic and Pharmaco-economic Outcomes in Prostate Brachytherapy

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

... Jenny Lam-McCulloch MSc,* Joseph Kay MD FRCPC* AFFILIATIONS: *Department of Anesthesia, Sunny... more ... Jenny Lam-McCulloch MSc,* Joseph Kay MD FRCPC* AFFILIATIONS: *Department of Anesthesia, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 †Department of Anesthesia, Belleville ...

Research paper thumbnail of Rectal indomethacin reduces postoperative pain and morphine use after cardiac surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 1999

To evaluate the combination of rectal indomethacin with patient controlled intravenous morphine a... more To evaluate the combination of rectal indomethacin with patient controlled intravenous morphine analgesia (PCA) on postoperative pain relief and opioid use after cardiac surgery. With institutional ethics approval, 57 consenting adults undergoing elective aortocoronary bypass surgery were randomly assigned preoperatively in a double-blind fashion to receive either placebo (n = 26) or indomethacin 100 mg suppositories (n = 31), 2-3 hr postoperatively, and 12 hr later. Both groups utilized PCA morphine. Pain scores in the two treatment groups were assessed on a 10-cm visual analogue scale (VAS) (at rest and with cough) at 4, 6, 12, 18 and 24 hr after initial dosing, and were analyzed through a 2 x 5 repeated measures of variance. The 24 hr analgesic consumption, 12 and 24 hr chest tube blood loss, and time to tracheal extubation were also recorded, and compared for the two treatment arms through Student's t test on independent samples. Postoperative morphine consumption in the first 24 hr was 38% less in the indomethacin group (22.40 +/- 12.55 mg) than the placebo group (35.99 +/- 25.84 mg), P = 0.019. Pain scores, measured with a VAS, were 26% to 66% lower in the indomethacin vs placebo group at rest (P = 0.006), but not with cough, for all times assessed. There was no difference in blood loss (at 12 hr) or time to tracheal extubation for both groups. The combination of indomethacin with morphine after cardiac surgery results in reduced postoperative pain scores and opioid use without an increase in side effects.