Neil Skjodt - Academia.edu (original) (raw)

Papers by Neil Skjodt

Annals of Emergency Medicine, May 1, 2008

This is a systematic review abstract, a regular feature of the Annals' Evidence-Based Emergency M... more This is a systematic review abstract, a regular feature of the Annals' Evidence-Based Emergency Medicine (EBEM) series. Each features an abstract of a systematic review from the Cochrane Database of Systematic Reviews and a commentary by an emergency physician knowledgeable in the subject area. The source for this systematic review abstract is: Ducharme F, Schwartz Z, Kakuma R. Addition of anti-leukotriene agents to inhaled corticosteroids for chronic asthma. Cochrane

Canadian Journal Of Anesthesia/journal Canadien D'anesthésie, Dec 1, 2004

S St tr ru uc ct tu ur re ed d a ab bs st tr ra ac ct t Question: Does vasodilatation in symptoma... more S St tr ru uc ct tu ur re ed d a ab bs st tr ra ac ct t Question: Does vasodilatation in symptomatic patients with severe aortic stenosis and congestive heart failure improve cardiac index? Design: Prospective, non-randomized, non-blinded trial. Patients, physicians, and nurses were aware of treatment regimens. Setting: Cardiac Intensive Care Unit at the Cleveland Clinic Foundation from August 1, 2000 to May 15, 2002. Patients: 29 consecutive patients met the inclusion criteria for the study. Four patients had hypotension and were excluded. Twenty-five patients began the

Clinical Pharmacokinetics

Cardiovascular diseases are the leading cause of death worldwide. Although there have been substa... more Cardiovascular diseases are the leading cause of death worldwide. Although there have been substantial advances over the last decades, recurrent adverse cardiovascular events after myocardial infarction are still frequent, particularly during the first year of the index event. For decades, high-density lipoprotein (HDL) has been among the therapeutic targets for longterm prevention after an ischemic event. However, early trials focusing on increasing HDL circulating levels showed no improvement in clinical outcomes. Recently, the paradigm has shifted to increasing the functionality of HDL rather than its circulating plasma levels. For this purpose, apolipoprotein-AI-based infusion therapies have been developed, including reconstituted HDL, such as CSL112. During the last decade, CSL112 has been extensively studied in Phase 1 and 2 trials and has shown promising results. In particular, CSL112 has been studied in the Phase 2b AEGIS trial exhibiting good safety and tolerability profiles, which has led to the ongoing large-scale Phase 3 AEGIS-II trial. This systematic overview will provide a comprehensive summary of the CSL112 drug development program focusing on its pharmacodynamic, pharmacokinetic, and safety profiles.

04.02 - Clinical and epidemiological respiratory sleep medicine, Sep 4, 2022

Meloxicam [4-hydroxy-2-methyl-N-(5-methyl-2-thiazolyl)-2H-1,2-benzothiazine-3-carboxamide-1,1-dio... more Meloxicam [4-hydroxy-2-methyl-N-(5-methyl-2-thiazolyl)-2H-1,2-benzothiazine-3-carboxamide-1,1-dioxide] is a nonsteroidal anti-inflammatory drug (NSAID) of the oxicam class which shows preferential inhibition of cyclo-oxygenase-2. Meloxicam has a plasma half-life of approximately 20 hours, making it convenient for once-daily administration. Meloxicam is eliminated after biotransformation to 4 pharmacologically inactive metabolites, which are excreted in urine and faeces. Meloxicam and its metabolites bind extensively to plasma albumin. Substantial concentrations of meloxicam are attained in synovial fluid, the proposed site of action in chronic inflammatory arthropathies. Neither moderate renal nor hepatic insufficiency significantly alter the pharmacokinetics of meloxicam. Dosage adjustment is not required in the elderly. Drug-drug interaction studies are available for some commonly co-prescribed medications. Concentration-dependent therapeutic and toxicological effects have yet to ...

Sleep, 2020

Introduction Agreement between automated standard respiratory event scoring and a novel, validate... more Introduction Agreement between automated standard respiratory event scoring and a novel, validated, and patented oximetry-based algorithm was assessed. Methods The standard apnea-hypopnea index (AHI) was derived by adding apneas (flow drop >= 90% for 10 to 30 s) and hypopneas (flow drop >= 30% for 10 to 60 s with oxygen saturation (SpO2) dropping >=3%). The novel oxygen index (ODI4) was derived by scoring events where SpO2 dropped in each of three successive samples and cumulatively by >= 4%. Agreement was assessed by Bland-Altman analysis Results AHI versus ODI4 and Bland-Altman plots showed a high prevalence of AHI > ODI4 when AHI was< 30/h. Negative difference outliers were frequent when mean index difference was > 30/h. There was a bias of 2.83/h in the difference between AHI and ODI4 with upper and lower confidence limits of 22.0/h and -16.3/h. Conclusion Standard respiratory event scoring overestimates respiratory disturbance compared to a novel oximetric ...

Clinical and investigative medicine. Médecine clinique et experimentale, 2000

To investigate how consulting physicians attempt to modify perioperative cardiac risk for patient... more To investigate how consulting physicians attempt to modify perioperative cardiac risk for patients who undergo noncardiac surgery by comparing the preoperative cardiac recommendations of consulting physicians in 2 university centres. Retrospective cross-sectional analysis. Five hospitals affiliated with 2 Canadian universities. Three hundred and eight preoperative consultations were evaluated in 297 patients who were 40 years of age or older and scheduled for noncardiac surgery. Cardiac drug recommendations at the preoperative consultation [corrected]; overall recommendations and practice variation between the 2 centres. The greatest changes in drug management suggested by consultants were the initiation of nitrates in 13% of the patients and a decrease in acetylsalicylic acid administration from 27% to 17%. Centre A physicians recommended adding an angiotensin-converting enzyme inhibitor 11% of the time, whereas centre B physicians recommended such an inhibitor in only 1% of the pa...

American Journal of Potato Research, 2007

Glycemic index (GI) ranks carbohydrate foods according to the postprandial impact on blood glucos... more Glycemic index (GI) ranks carbohydrate foods according to the postprandial impact on blood glucose. High glycemic index carbohydrates cause a rapid rise in blood glucose and are not recommended for consumption by diabetics, who have inadequate insulin production and are susceptible to hyperglycemia. The clinical AMERICAN JOURNAL OF POTATO RESEARCH Vol. 84 tidad real de carbohidratos consumidos por raci6n, pero la GL de la papa es generalmente moderada y raramente alta debido a su alto contenido de humedad. GI y GL proporcionan gulas tithes para el control de la respuesta glic~mica asociada con el consumo de fuentes carbohidratadas. GI y GL difieren entre cultivares y pueden set modificadas por los m~todos de procesamiento. E1 GI estti tambi~n influenciado por otros componentes del alimento y adn de alimentos consumidos con anterioridad. Se requiere mayor investigaci6n para definir adecuadamente los GI y GL de cultivares de papa, identificar el impacto de la composici6n del almiddn (proporci6n amilosa] amilopectina) y las t~cnicas de procesamiento que contribuyan a disminulr el GI y el impacto de los componentes de otros alimentos sobre el GI de la papa.

The mechanisms of respiratory compensation and compromise following acute spinal paralysis remain... more The mechanisms of respiratory compensation and compromise following acute spinal paralysis remain poorly described. To overcome previous limitations of clinical observation and animal experimentation an injury free model of spinal paralysis using reversible epidural anesthesia was developed. The utility of the model was enhanced by novel fluoroscopically guided catheter insertion. repositioning to prevent asymmetrical onset of anesthesia, and the use of chronic subjects. Diaphragm sparing ascending spinal paralysis produced bradypnea. decreased minute ventilation, increased end tidal capnometer values, and decreased average inspiratory flows with preserved tidal volumes. Diaphragm. but not parasternal intercostal. muscle activity and shortening increased with ascending paralysis. With ascending paralysis greater diaphragm activation was required to maintain peak inspiratory flow, and this recruitment was sustained into expiration. Respiratory compromise secondary to an abnormal vent...

American Journal of Critical Care, 2006

Despite multiple reminders, education sessions, and multidisciplinary team involvement, adherence... more Despite multiple reminders, education sessions, and multidisciplinary team involvement, adherence to an evidence-based mechanical ventilation weaning protocol had been less than 1% in a general systems intensive care unit since implementation. To assess the effectiveness of using an implementation program, the Model for Accelerating Improvement, to improve adherence and clinical outcomes after restarting a mechanical ventilation weaning protocol in an adult general systems intensive care unit. A prospective comparative design, before and after implementation of the Model for Accelerating Improvement, was used with a consecutive sample of 129 patients and 112 multidisciplinary team members. Clinical outcomes were rate of unsuccessful extubations, rate of ventilator-associated pneumonia, and duration of mechanical ventilation; practice outcomes were staff&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s understanding of the mechanical ventilation weaning protocol, perceptions of the practice safety climate, and adherence to the weaning protocol. After the intervention, the rate of unsuccessful extubations decreased, and staff&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s understanding of and adherence to the weaning protocol increased significantly. The rate of ventilator-associated pneumonia, duration of mechanical ventilation, and staff&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s perceptions of the practice safety climate did not change significantly. Implementing the Model for Accelerating Improvement improved understanding of and adherence to protocol-directed weaning and reduced the rate of unsuccessful extubations.

Food Chemistry, 2007

In this study dry matter and starch were isolated from three potato cultivars (AC Stempede Russet... more In this study dry matter and starch were isolated from three potato cultivars (AC Stempede Russet, Russet Burbank and Karnico) grown at two locations (Fredericton and Benton) in New Brunswick, Canada. The chemical composition including total starch, dietary fibre, free glucose and protein content in potato dry matter and apparent amylose and total phosphorus content in potato starch were determined. Differential scanning calorimetry (DSC) was used to determine the thermal properties of gelatinization and retrogradation of potato dry matter and starch. The pasting properties of potato dry matter and starch were investigated by rapid visco analyzer (RVA). The resistant starch measurement method was employed to evaluate the digestibility in vitro of native and gelatinized potato starch. Molecular characteristics including chain length and chain length distribution of potato starch were also analyzed using high performance anion exchange chromatography (HPAEC). The analytical results suggest that differences in chemical composition and molecular chain length of potato starch may contribute to different functional properties of potato dry matter and starch of individual cultivars.

Clinical Pharmacokinetics, 2009

Etravirine is a next-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) developed ... more Etravirine is a next-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) developed for the treatment of HIV-1 infection. It has a high genetic barrier to the emergence of viral resistance, and maintains its antiviral activity in the presence of common NNRTI mutations. The pharmacokinetics of etravirine in HIV-infected patients at the recommended dosage of 200 mg twice daily demonstrates moderate intersubject variability and no time dependency. Due to substantially lower exposures when taken on an empty stomach, etravirine should be administered following a meal. The drug is highly protein bound (99.9%) to albumin and alpha(1)-acid glycoprotein and shows a relatively long elimination half-life of 30-40 hours. Etravirine is metabolized by cytochrome P450 (CYP) 3A, 2C9 and 2C19; the metabolites are subsequently glucuronidated by uridine diphosphate glucuronosyltransferase. Renal elimination of etravirine is negligible. Etravirine has the potential for interactions by inducing CYP3A and inhibiting CYP2C9 and 2C19; it is a mild inhibitor of P-glycoprotein but not a substrate. The drug interaction profile of etravirine has been well characterized and is manageable. No dosage adjustments are needed in patients with renal impairment or mild to moderate hepatic impairment. Race, sex, bodyweight and age do not affect the pharmacokinetics of etravirine. In the two phase III trials DUET-1 and DUET-2, no relationship was demonstrated between the pharmacokinetics of etravirine and the primary efficacy endpoint of viral load below 50 copies/mL or the safety profile of etravirine.

Biomedical Instrumentation & Technology, 2008

The effectiveness of high-frequency chest wall oscillation (HF-CWO) is directly related to the le... more The effectiveness of high-frequency chest wall oscillation (HF-CWO) is directly related to the level of oscillated flow (vosc) in the airways. We used the Vest™ system to investigate the effects of HFCWO on chest wall and pleural pressures and we correlated these pressures to the resultant vosc. We also compared the latest HFCWO device with it predecessor. Different combinations of vest inflation pressure (background pressure) and oscillation frequency were randomly applied to 10 healthy volunteers. Chest wall pressure was determined using an air-filled bag under the vest and pleural pressure was estimated using an esophageal balloon. Reverse plethysmography was used to measure vosc at the mouth and a spirometer was used to measure changes in end-expired lung volume. We found a significant correlation between chest wall and pleural pressure with approximately one-third of the chest wall pressure transmitted into the pleural space. Mean esophageal pressure remained negative at all...

Respiration Physiology, 2001

The respiratory effects of acute spinal injury and paralysis are difficult to study. Urgent medic... more The respiratory effects of acute spinal injury and paralysis are difficult to study. Urgent medical needs of human spinal cord injury victims usually preclude study, while induction of spinal cord lesions in awake animals is not feasible ethically. We utilized controlled, segmental infusion of epidural anesthetic in awake, highly trained, implanted canines to reversibly simulate the effects of thoracic and cervical (paraplegic and quadriplegic) spinal cord injury. We studied six animals, an average of 29 days after implantation with electromyogram and sonomicrometry transducers in transversus abdominis, external intercostal, parasternal intercostal and costal diaphragm muscles. Anesthetic was infused through an epidural catheter inserted percutaneously, under fluoroscopic guidance. Asymmetrical motor blockade was prevented using repositioning during epidural infusions. By sequential infusion we were able to induce three distinct, functional levels of spinal paralysis showing cumulative paralysis of abdominal, external intercostal, and parasternal intercostal muscles. Paralysis of the abdomen and chest wall, sparing only the diaphragm, showed unexpected bradypnea and failure to maintain minute ventilation.

Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Société canadienne des sciences pharmaceutiques

Non-steroidal anti-inflammatory drugs (NSAIDs) may cause damage distal to the duodenum. We review... more Non-steroidal anti-inflammatory drugs (NSAIDs) may cause damage distal to the duodenum. We reviewed the prevalence, clinical spectrum, assessment, pathogenesis, and treatment of adverse effects of NSAIDs on the small intestine. NSAIDs can cause small intestinal perforation, ulcers, and strictures requiring surgery. NSAIDs produce inflammation of the small intestine in 40 to 70% in long-term users, and the associated complications of blood loss and protein loss are difficult management problems. The pathogenesis of NSAID enteropathy is a multi-stage process involving specific biochemical and subcellular organelle damage followed by inflammatory tissue reaction. Various suggested treatments of NSAID-induced enteropathy (e.g., sulphasalazine, misoprostol, and metronidazole) have yet to undergo rigorous clinical trials. Cyclo-oxygenase-2 inhibitors appear to be safer to the small intestine than traditional NSAIDs. Pre-clinical and clinical data suggests meloxicam, celecoxib, nimesulide ...

Clinical Pharmacokinetics, 1998

Lornoxicam (chlorotenoxicam) is a nonsteroidal anti-inflammatory drug (NSAID) of the oxicam class... more Lornoxicam (chlorotenoxicam) is a nonsteroidal anti-inflammatory drug (NSAID) of the oxicam class. Unlike other oxicams, lornoxicam has a relatively short plasma half-life (3 to 5 hours). Lornoxicam is eliminated following biotransformation to 5′-hydroxy-lornoxicam, which does not undergo enterohepatic recirculation. Glucoroconjugated metabolites are excreted in urine and faeces with a half-life of about 11 hours. Lornoxicam and its metabolites bind extensively to plasma albumin. Substantial concentrations of lornoxicam are attained in synovial fluid, the proposed site of action in chronic inflammatory arthropathies. The effects of lornoxicam concentration on its therapeutic and toxicological properties have not yet been extensively reported. Lornoxicam, like other NSAIDs, appears to interact with warfarin, sulphonylureas, digoxin and furosemide.

Canadian family physician Médecin de famille canadien, 2008

To describe an approach to sleep apnea for family physicians based on a review of current practic... more To describe an approach to sleep apnea for family physicians based on a review of current practice limitations for Canadian family physicians, validated risk prediction tools, and ambulatory sleep apnea technologies. Published epidemiologic studies focused on family practice management of sleep apnea, clinical practice guidelines, risk prediction tools for sleep apnea, randomized controlled treatment trials, and the author's community practice audit. Evidence was levels I, II, and III. Sleep apnea is commonly encountered in family practice, but many family physicians are unfamiliar with sleep medicine. The pretest probability of sleep apnea can be accurately predicted using any one of several simple risk prediction tools. Screening for other common sleep disorders is important, especially when the pretest probability of sleep apnea is low to intermediate; one-third of sleep apnea patients have additional sleep disorders. The use of home-based rather than laboratory-based diagnos...

European Respiratory Journal, 2014

BACKGROUND : Multiple authors have shown paediatric sleep apnoea is seasonal reflecting respirato... more BACKGROUND : Multiple authors have shown paediatric sleep apnoea is seasonal reflecting respiratory infections. Other authors have speculated from animal data that obesity may reflect seasonal changes in leptin metabolism. AIMS: To determine seasonality, if any, in sleep polygraphy referral rates, body mass index, neck circumference, clinical risk of sleep apnea, perceived sleepiness, and sleep apnea severity in adult subjects. METHODS: A convenience sample of 1000+ adults referred for screening sleep polygraphy (www.sagatech.ca) were categorized by month of referral, body mass index (BMI), neck circumference, pre-test probability of sleep apnoea, Epworth score, and estimated sleep apnoea severity. Visual trends in monthly variation were confirmed if monthly variables were outside the sample interquartile range. RESULTS: Polygraphy referrals were triphasic with March, June, and September peaks. Synchronous March to April and September to October increases in BMI (1.5 to 2 kg/m2) and...

Sleep and control of breathing, 2020