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 & Breast cancer. The organization has 7689 authors who have published 15236 publications receiving 523019 citations. The organization is also known as: Sunnybrook.

The Role of Limb Movements in Maintaining Upright Stance: The “Change-in-Support” Strategy

Abstract: Change-in-support strategies, involving stepping or grasping movements of the limbs, are prevalent reactions to instability and appear to play a more important functional role in maintaining upright stance than has generally been appreciated. Contrary to traditional views, change-in-support reactions are not just strategies of last resort, but are often initiated well before the center of mass is near the stability limits of the base of support. Furthermore, it appears that subjects, when given the option, will select these reactions in preference to the fixed-support "hip strategy" that has been purported to be of functional importance. The rapid speed of compensatory change-in-support reactions distinguishes them from "volitional" arm and leg movements. In addition, compensatory stepping reactions often lack the anticipatory control elements that are invariably present in non-compensatory stepping, such as gait initiation. Even when present, these anticipatory adjustments appear to have little functional value during rapid compensatory movements. Lateral destabilization complicates the control of compensatory stepping, a finding that may be particularly relevant to the problem of falls and hip fractures in elderly people. Older adults appear to have problems in controlling lateral stability when stepping to recover balance, even when responding to anteroposterior perturbation. Increased understanding and awareness of change-in-support reactions should lead to development of new diagnostic and therapeutic approaches for detecting and treating specific causes of imbalance and falling in elderly people and in patients with balance impairments.

Updated Analysis From KEYNOTE-189: Pembrolizumab or Placebo Plus Pemetrexed and Platinum for Previously Untreated Metastatic Nonsquamous Non-Small-Cell Lung Cancer.

Abstract: PURPOSEIn KEYNOTE-189, first-line pembrolizumab plus pemetrexed-platinum significantly improved overall survival (OS) and progression-free survival (PFS) compared with placebo plus pemetrexed-plati...

Fear of falling and postural performance in the elderly

Abstract: A cross-sectional study was performed to investigate the association between fear of falling and postural performance in the elderly. One hundred ambulatory and independent volunteers (aged 62-96) were subjected to five types of balance tests: (a) spontaneous postural sway, (b) induced anterior-posterior sway, (c) induced medial-lateral sway, (d) one-leg stance, and (e) a clinical balance assessment scale. Pseudorandom platform motions were used in the induced-sway tests. The subjects were classified into both "faller"/"nonfaller" and "fear"/"no-fear" categories, to allow the influence of fear of falling and falling history to be separated in the analyses. Subjects who expressed a fear of falling were found to exhibit significantly poorer performance in blindfolded spontaneous-sway tests and in eyes-open, one-leg stance tests. The clinical scale was the only balance measure that showed a significant association with retrospective, self-reported falling history. We could not ascertain whether the fear of falling affected balance-test performance in an artifactual manner, or whether the fear and poorer performance were related to a true deterioration in postural control. Until this issue can be resolved, balance-test performance should be interpreted with caution when testing apprehensive individuals. Furthermore, studies of postural control and falling should allow for the potentially confounding influence of fear of falling.

Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes.

Abstract: BACKGROUND An increased incidence of neuroendocrine tumors (NETs) has been reported worldwide, but the reasons underlying this rise have not been identified By assessing patterns of metastatic presentation, this study sought to examine the epidemiologic characteristics of NETs and the contribution of early-stage detection to the rising incidence METHODS A population-based retrospective cohort study was conducted with prospectively maintained databases linked at the Institute for Clinical Evaluative Sciences Adult patients with a NET diagnosis from 1994 to 2009 in Ontario, Canada were included The main outcomes included the overall and site-specific incidence, proportion of metastatic disease, overall survival (OS), and recurrence-free survival (RFS) RESULTS Five thousand six hundred nineteen NET cases were identified The incidence of NETs increased from 248 to 586 per 100,000 per year Metastases were found in 208% at presentation and in another 38% after the initial diagnosis The proportion of metastases at presentation decreased from 1994 to 2009 (from 29% to 13%) Therefore, although the incidence of all NETs increased, the overall incidence of metastases did not change (063-069 per 100,000 per year) The 10-year OS rate was 465%, and the RFS rate was 646% In addition to the primary tumor site, independent predictors of worse OS included an advanced age (P < 0001), male sex (P < 0001), a low socioeconomic status (P < 0001), and rural living (P = 0049) CONCLUSIONS The incidence of NETs has markedly increased over the course of 15 years This is the first study to provide evidence suggesting that the increase in the incidence of NETs may be due to increased detection In addition to tumor characteristics, low income and rural residency portend worse survival for patients with NETs Cancer 2015;121:589–597 © 2014 American Cancer Society

The airway: problems and predictions in 18,500 patients

Abstract: The purpose of this study was to describe methods, risk factors, and outcomes of airway management in all patients (obstetrics excluded) attended by anaesthetists over 27 months. Preoperatively, anaesthetists recorded patient factors and assessed four airway characteristics. Methods of tracheal intubation and ease of direct laryngoscopy following general anaesthesia (easy, awkward, difficult) were noted. Factors predictive of poor outcome and the value of the preoperative airway examination were determined. For 18,205 patients following a direct laryngoscopy, (GA), tracheal intubation was difficult (> 2 laryngoscopies) in 1.8% and awkward ( 200 mm Hg) and dental damage on induction of anaesthesia. It is concluded that difficult tracheal intubations occurred infrequently but were associated with increased morbidity. Patient factors and four physical airway characteristics were useful predictors but limited in identifying all problems.