Sunnybrook Health Sciences Centre

About: Sunnybrook Health Sciences Centre is a healthcare organization based out in Toronto, Ontario, Canada. It is known for research contribution in the topics: Population & Medicine. The organization has 7689 authors who have published 15236 publications receiving 523019 citations. The organization is also known as: Sunnybrook.

Hypotension after blunt abdominal trauma: the role of emergent abdominal sonography in surgical triage

Abstract: Objective : Trauma victims with hypotension require a rapid and reliable localization of bleeding and expedient surgical tri-age. Our hypothesis is that emergent abdominal sonography (EAS) is a rapid and accurate test of the need for urgent laparotomy in blunt trauma victims with hypotension. Methods : Among 400 blunt trauma victims entered in a prospective blind study of EAS, a subgroup of 69 (17%) patients had a systolic blood pressure ≤90 mm Hg during their initial assessment. Although the EAS results [(+) = fluid, (-) = no fluid] were not used in clinical decision making, the potential contribution of EAS to patient care was examined. Results : The mean Injury Severity Score was 32. Twenty-two (32%) patients were EAS (+), of which 19 required an acute laparotomy. No laparotomies were performed in the 47 EAS (-) patients. The EASs required 19 ± 5 seconds in the EAS (+) group and 154 ± 13 seconds in the EAS (-) group. Twenty of the 22 positive EASs had free fluid in Morison's pouch. All 13 patients with an ultrasound score ≥3 had a laparotomy. The primary etiology of hypotension was blood loss in 42 patients, hemoperitoneum in 18, and retroperitoneal hemorrhage in 12. Conclusion : EAS is a rapid and accurate indicator of the need for urgent laparotomy in the hypotensive blunt trauma victim. Further, a negative EAS can hasten the search for other causes of hypotension. Diagnostic peritoneal lavage may become obsolete in centers with EAS capabilities.

Proton pump inhibitors and the risk of hospitalisation for community-acquired pneumonia: replicated cohort studies with meta-analysis

Abstract: Objective Previous observational studies suggest that the use of proton pump inhibitors (PPIs) may increase the risk of hospitalisation for community-acquired pneumonia (HCAP). However, the potential presence of confounding and protopathic biases limits the conclusions that can be drawn from these studies. Our objective was, therefore, to examine the risk of HCAP with PPIs prescribed prophylactically in new users of non-steroidal anti-inflammatory drugs (NSAIDs). Design We formed eight restricted cohorts of new users of NSAIDs, aged ≥40 years, using a common protocol in eight databases (Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, US MarketScan and the UK’s General Practice Research Database (GPRD)). This specific patient population was studied to minimise bias due to unmeasured confounders. Highdimensional propensity scores were used to estimate site-specific adjusted ORs (aORs) for HCAP at 6 months in PPI patients compared with unexposed patients. Fixed-effects meta-analytic models were used to estimate overall effects across databases. Results Of the 4 238 504 new users of NSAIDs, 2.3% also started a PPI. The cumulative 6-month incidence of HCAP was 0.17% among patients prescribed PPIs and 0.12% in unexposed patients. After adjustment, PPIs were not associated with an increased risk of HCAP (aOR=1.05; 95% CI 0.89 to 1.25). Histamine-2 receptor antagonists yielded similar results (aOR=0.95, 95% CI 0.75 to 1.21). Conclusions Our study does not support the proposition of a pharmacological effect of gastric acid suppressors on the risk of HCAP.

Applications of focused ultrasound in the brain: from thermoablation to drug delivery.

Abstract: Focused ultrasound (FUS) is a disruptive medical technology, and its implementation in the clinic represents the culmination of decades of research. Lying at the convergence of physics, engineering, imaging, biology and neuroscience, FUS offers the ability to non-invasively and precisely intervene in key circuits that drive common and challenging brain conditions. The actions of FUS in the brain take many forms, ranging from transient blood-brain barrier opening and neuromodulation to permanent thermoablation. Over the past 5 years, we have seen a dramatic expansion of indications for and experience with FUS in humans, with a resultant exponential increase in academic and public interest in the technology. Applications now span the clinical spectrum in neurological and psychiatric diseases, with insights still emerging from preclinical models and human trials. In this Review, we provide a comprehensive overview of therapeutic ultrasound and its current and emerging indications in the brain. We examine the potential impact of FUS on the landscape of brain therapies as well as the challenges facing further advancement and broader adoption of this promising minimally invasive therapeutic alternative.

Using technology to deliver mental health services to children and youth: a scoping review.

Abstract: aThe search was completed in January, 2013 results were limited to “2000 to 2012 inclusive.” bKey search terms included: mental disease, mental health care or home mental health care or mental health service, psychiatric nursing or community psychiatric nursing, psychiatric treatment, or psychiatry mental health services or emergency services, psychiatric or social work, community psychiatry, mental disorders, community mental health services, community mental health, community mental health centers, community psychiatry mental health programs, primary mental health prevention, psychiatric clinics, mental health services, psychiatric hospital programs, psychiatry, teleconferencing, telemedicine, computer assisted diagnosis, computer assisted therapy, computer mediated communication, internet, (telepsychiatry or telepsychology or “telemental health”), electronic communication, social media, computer peripheral devices, internet usage, messages, online social networks, online therapy, mobile devices, cellular phones, websites, computers, computer assisted therapy, (“social media” or facebook or twitter or youtube or you-tube), childhood or neonatal or infancy or preschool age or school age or adolescence or young adulthood limit to english language limit to yr= 2000–2012. cVarious terms are used throughout the literature to describe videoconferencing and Internet based applications. In this paper, we adhere to the terms used in particular articles when describing them. dBoydell, K. M., Hodgins, M., Pignatiello, A., Teshima, J., Edwards, H., & Willis, D. (2012). Using technology to deliver mental health services to children and youth in Ontario. Ottawa, ON, The Ontario Centre of Excellence for Child and Youth Mental Health. http://www.excellenceforchildandyouth.ca/resource-hub/policy-papers.