Paediatric Surgical Outcomes Across Ontario, Damian Dylkowski

Electronic Thesis and Dissertation Repository

BACKGROUND: The purpose of this study was to determine the volume of three complex paediatric procedures at the tertiary care centres in Ontario over the last 20 years in three disciplines, analyze outcomes and explore the possibility of an outcome volume relationship.

METHODS: A population based cohort study of patients undergoing TEF repair, Pyeloplasty and V-P shunt insertion at 4 paediatric centres in Ontario between 1993 and 2013 was carried out. Administrative data sets were linked using unique encoded identifiers and analyzed at the Institute for Clinical Evaluative Sciences (ICES).

RESULTS: In TEF repair and Pyeloplasty, there was significant difference …

The Role Of Scapular Morphology In Reverse Shoulder Arthroplasty, Ashish Gupta

Electronic Thesis and Dissertation Repository

Baseplate fixation in a reverse shoulder arthroplasty depends on adequate bone stock. In cases of severe glenoid bone loss and revision shoulder arthroplasty, deficiency of the glenoid vault compels the surgeon to attain screw fixation in the three columns of the scapula. The relationship of these columns demonstrated that the coracoid is closer to the lateral scapular pillar in females than in males. Significant gender dimorphism exists between the orientations of the three columns. The gender dimorphism is further evaluated by anthropometric measurements of the scapular body and the glenoid. The clinical significance lies in the ability to reconstruct the …

Physical Activity Levels In Total Hip Arthroplasty Comparing The Direct Anterior Approach To The Direct Lateral Approach: A Prospective Cohort Study, Abdulaziz N. Aljurayyan

Electronic Thesis and Dissertation Repository

Total hip arthroplasty (THA) is a cost-effective surgical procedure to treat patients with end-stage hip arthritis with high patient satisfaction. Different surgical approaches to the hip have been used to successfully perform THA. However, the role of these surgical approaches on physical activity and early functional recovery in THA patients remains controversial.

In this thesis, we prospectively evaluated physical activity levels in patients with end-stage hip OA whom are undergoing elective THA. The primary focus was to evaluate the impact of different surgical approaches on physical activity levels as a measure of functional recovery in the immediate postoperative period.

Due …

Translational Study Of Liver Cancer And Hypertrophy: Translich, Mauro Enrique Tun Abraham

Electronic Thesis and Dissertation Repository

Abstract

Background: Associating liver partition with portal vein ligation for staged-hepatectomy (ALPPS) is a technique for inducing accelerated hypertrophy in patients with insufficient future liver remnant (FLR). It remains unknown whether this hypertrophy may lead to rapid cancer cell dissemination and/or alteration of immune cell/function reconstitution in the FLR. We aimed to determine if the rapid hypertrophy during ALPPS procedure results in more circulating tumour cell (CTCs) dissemination and whether the FLR remains immunologically competent in patients with CRLM.

Methods: In our prospective, observational, 2-arm study, we assessed the utility of CTCs as an evaluation tool for disease dissemination. Moreover, …

Cost-Effectiveness Of Selective Laser Trabeculoplasty (Slt) Versus Argon Laser Trabeculoplasty (Alt) In Uncontrolled Open Angle Glaucoma Patients Having At Least One Full Previous Slt: An Economic Evaluation Alongside An Ongoing Randomized Controlled Clinical Trial, Muhammad Rakibuz-Zaman

Electronic Thesis and Dissertation Repository

Background and objective: ALT and SLT are both safe and effective for glaucoma treatment. We performed a cost-effectiveness analysis (CEA) of SLT versus ALT for a six-month follow-up period in uncontrolled open angle glaucoma patients having at least one full previous SLT from an ongoing RCT. Methods: Trial based treatment costing and IOP reduction at 6-month follow-up from baseline for both intervention arms were calculated. A decision tree model was developed considering possible clinical pathways of patients undergoing repeat laser trabeculoplasty. CEA among ALT and SLT was done, and ICERs were calculated from both societal and ministry perspective. One way …

Early Experimental Results Of Using A Novel Delivery Carrier, Hyaluronan-Phosphatidylethanolamine (Ha-Pe) Which May Allow Simple Bladder Instillation Of Botulinum Toxin A As Effectively As Direct Detrusor Muscle Injection., Mohamed G. El Shatoury

Electronic Thesis and Dissertation Repository

Intra-detrusor Botulinum Toxin-A (BTX-A) injection is the gold standard treatment for detrusor overactivity in clinical practice when medical treatment fails. Despite satisfactory results of BTX-A injection, the endoscopic procedure still has risks of anaesthetic and operative complications. Several studies have investigated more simple ways to deliver BTX-A to the detrusor muscle but with limited success. In our study, we assessed the evidence of BTX-A delivery using a newly modulated hyaluronan-phosphatidylethanolamine (HA-PE) carrier in a rat model through BTX-A-HA-PE bladder instillations. We used histological evidence of SNAP-25 protein cleavage and detection of Alexa FluorÒ594-labelled BTX-A as a proof of physical BTX-A …

The Role Of Postural Stability And Other Factors In Distal Radius Fracture, Sheena Saju Philip

Electronic Thesis and Dissertation Repository

The objective of the thesis was to describe the factors leading to falls in distal radius fracture (DRF) events, explore patient perceived risk of falls, and postural stability. A mixed method study described the type of fall in DRF patients (n= 1454) and patient perceived contributing factors (n=29). A prospective cohort study examined the postural stability and related fall risk of DRF participants (n=137) in Biodex Balance System (BBS) and compared to normative values. Environmental factors were a major contributor to DRF events. Older adults (44 to 65 years) had the highest rate of DRF (female: male ratio of 2:1). …

Reliability And Validity Of The Star Excursion Balance Test For Patients With Chronic Patellar Instability, Andrew D. Firth

Electronic Thesis and Dissertation Repository

The Star Excursion Balance Test (SEBT) is an eight-direction, maximal-reach balance test whose measurement properties are unknown in participants with chronic patellar instability. We designed an observational study with repeated measures to evaluate the test-retest reliability, cross-sectional and longitudinal construct validity, sensitivity to change and responsiveness of the SEBT in this population. Fifteen patients completed the SEBT and reported outcomes at baseline and two weeks and four patients completed testing three months later at the Fowler Kennedy Sports Medicine Clinic.

Intra-class correlation coefficients (ICC) for the SEBT were fair to good, ranging from 0.66-0.84. The SEBT demonstrates good cross-sectional construct …

Drop Vertical Jump Landing Mechanics Following Anterior Cruciate Ligament Reconstruction With And Without Lateral Extra-Articular Tenodesis, Michal Daniluk

Electronic Thesis and Dissertation Repository

The use of combined anterior cruciate ligament (ACL) plus lateral extra-articular tenodesis (LET) reconstruction has shown promising results during clinical testing, however, no studies have examined its effectiveness during a dynamic functional task. We used the drop vertical jump (DVJ) to compare in vivo biomechanics of ACL reconstructed patients with and without LET.

Our primary outcome was peak knee abduction moment during stance phase. Secondary kinetic and kinematic outcomes included peak initial contact and stance values for knee abduction angle, knee flexion moment and angle, knee internal rotation moment and angle, and vertical ground reaction force. We also assessed fear …

A Randomized Controlled Trial To Establish Realistic Patient Expectations Following Total Knee Replacement Surgery, Sharon E. Culliton

Electronic Thesis and Dissertation Repository

Objectives: To evaluate whether e-learning videos can affect whether patients felt their expectations were met and were satisfied with surgery 1 year following primary total knee replacement (TKR) (Chapter 3). In Chapter 4, we described characteristics of users and utilization patterns of the e-learning tool. In Chapter 5, we evaluated the internal consistency and construct validity of the new Knee Society Knee Scoring System (KSS) in a sample of TKR patients.

Methods: We recruited consecutive patients with osteoarthritis from the London Health Sciences Centre, Ontario, Canada (Chapter 3). We randomized patients with osteoarthritis to either control (n=207) they received our …

Clinical And Cost-Effectiveness Of A Locking Versus Non-Locking Fixation Plate In Medial Opening Wedge High Tibial Osteotomy, Codie Primeau

Electronic Thesis and Dissertation Repository

We investigated the clinical and cost-effectiveness of using a locking versus non-locking fixation plate in medial opening wedge high tibial osteotomy (HTO) for patients with medial compartment knee osteoarthritis. Medical charts were retrospectively reviewed up to 12 months following HTO for 144 patients who received a locking plate and 105 patients who received a non-locking plate. Surgeon notes provided the time to return to full weight- bearing. Participants had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively, six and 12 months postoperatively. Hospital and provincial administrative databases provided direct and indirect cost data. Improvements in KOOS scores were …

Evaluating The Effects Of Patellofemoral Offset Changes And Trochlear Design In Total Knee Arthroplasty: A Radiographic, Visual, And Topographical Analysis, Jacob Matz

Electronic Thesis and Dissertation Repository

Total knee arthroplasty (TKA) is a common procedure for the treatment of advanced knee osteoarthritis. Complications involving the patellofemoral joint (PFJ) are common following TKA, and the etiology is controversial. The purpose of this thesis was to evaluate two potentially modifiable factors affecting the PFJ: (i) changes in patellofemoral offset (PFO) and (ii) trochlear design.

Through a retrospective radiographic review, we demonstrated that PFO changes occur frequently post-TKA, and that the PFJ can tolerate these changes without adverse clinical outcomes. Retrieval analysis provided additional evidence that PFO changes are not associated with femoral component surface damage or wear.

In order …

Body And Organ Measurements In Infants And Neonates: An Autopsy Study, Audrey-Ann M. Evetts

Electronic Thesis and Dissertation Repository

Abstract

Introduction: A pathologist doing a pediatric autopsy will commonly assess child’s development by comparing the postmortem data to standardized population parameters using body and organ measurement charts. Although a number of resources are available, many are outdated and have significant limitations.

Objectives: To create Ontario population-specific organ and body measurement mean charts for infants and to explore relationships between body measurements/organ weights and cause of death, age, and gender of the deceased.

Methods: A database of 900 cases of infant and neonatal deaths that were investigated by Ontario coroners from 2000 to 2010 was retrospectively analyzed.

Results and Conclusions: …

Protective Benefits Of Hydrogen Sulfide Treatment During Renal Transplantation, Ian Lobb

Electronic Thesis and Dissertation Repository

Ischemia/reperfusion injury (IRI) is inherent to renal transplantation (RTx) and is initiated when blood supply is necessarily removed during organ procurement (ischemia) and subsequently restored upon engraftment (reperfusion). During renal ischemia, ATP depletion causes tubular epithelial cell (TEC) injury and subsequent release of pro-inflammatory mediators. Upon reperfusion, influx of O₂ causes reactive oxygen species (ROS) production and infiltration of innate immune cells which release damaging ROS and proteases. Prolonged periods of IRI are associated with increased risk of delayed graft function (DGF) and decreased long-term graft survival. The endogenously produced gasotransmitter, hydrogen sulfide (H₂S), has recently been …

Investigating Stromal Contributions To The Regulation Of Cancer Progression, Krista M. Vincent

Electronic Thesis and Dissertation Repository

Tumours are not insular masses of proliferating cells, rather tumour cells evolve within a complex local environment complete with matrix, stromal, and immune components. Therefore, successful tumour growth and eventual metastasis is not determined solely by tumour cells themselves, but also by the fitness advantage or disadvantage conferred by their local environment. However, many of our current cancer models are composed solely of tumour cell isolates. As tumour fitness is dependent on the entire local cellular context, we were interested in characterizing the accuracy of cell lines as models of the tumour microenvironment, with a focus on the secreted Frizzled-related …

Measuring Engagement Of The Executive Control Network From 3 Months Of Age, Michelle Tran

Electronic Thesis and Dissertation Repository

The executive control network (ECN) is critical for higher cognition and executive function (EF). Despite its importance, no scientific consensus has been reached on how and when it begins to function. In the present study, we assessed the development of the ECN in awake infants less than a year old by employing functional magnetic resonance imaging (fMRI) and naturalistic stimuli. First, we identified evocative movies that engaged infant attention. We then transferred them into adult imaging to test for which movie evoked the highest ECN response. Strong ECN responses were evoked while viewing Despicable Me, therefore we implemented this …

Beta Blocker Dialyzability And Effectiveness In Chronic Hemodialysis Patients, Alvin Tieu

Electronic Thesis and Dissertation Repository

Of the minimal information describing drug dialyzability, the majority was obtained prior to modern hemodialysis membranes. This study characterized the dialyzability of the most commonly prescribed beta blockers in patients undergoing high-flux hemodialysis. Eight subjects were recruited to a pharmacokinetic, 4-way crossover trial. Drug concentrations were measured using mass spectrometry and dialyzability determined by the arterial-venous difference and recovery clearance methods. A provincial-wide retrospective cohort study was designed to determine the effect of dialyzability on adverse clinical outcomes. Beta blocker efficacy can be hindered if substantial clearance occurs during dialysis. Our results demonstrate atenolol and metoprolol are extensively cleared during …

Inpatient Versus Outpatient Total Hip Arthroplasty, Michael Pollock

Electronic Thesis and Dissertation Repository

We conducted a randomized controlled trial to evaluate patients undergoing a total hip arthroplasty (THA) who were discharged from the hospital either on the day of surgery (outpatient) or were admitted overnight following surgery (inpatient). Our primary outcome was the rate of serious adverse events during the first three months postoperatively. Secondary outcome measures included cost, patient satisfaction, functional outcomes, quality of life and pain. We found no statistically significant difference between the two groups in serious adverse events. We found that outpatient THA was less expensive from the perspectives of the hospital and ministry of health; but the difference …

Assessment Of Post-Treatment Imaging Changes Following Radiotherapy Using Magnetic Susceptibility Techniques, Jean-Guy Belliveau

Electronic Thesis and Dissertation Repository

Radiation therapy (RT) is a common treatment for brain neoplasms and is used alone or in combination with other therapies. The use of RT has been found to be successful in controlling tumors and extending the overall survival of patients; however, there are many unanswered questions regarding radiotherapy effects in the normal brain surrounding or infiltrated by tumor. Changes to the vascular and parenchyma have been documented, and more recently inflammatory mechanisms have been postulated to play a role in radiation injury. Traditional imaging techniques used within the clinic (CT and MRI) are often lacking in their ability to differentiate …

Optimizing Respiratory Gated Intensity Modulated Radiation Therapy Planning And Delivery Of Early-Stage Non-Small Cell Lung Cancer, Ilma Xhaferllari

Electronic Thesis and Dissertation Repository

Stereotactic ablative body radiotherapy (SABR) is the standard of care for inoperable early-stage non-small cell lung cancer (NSCLC) patients. However, thoracic tumours are susceptible to respiratory motion and, if unaccounted for, can potentially lead to dosimetric uncertainties. Respiratory gating is one method that limits treatment delivery to portions of the respiratory cycle, but when combined with intensity-modulated radiotherapy (IMRT), requires rigorous verification. The goal of this thesis is to optimize respiratory gated IMRT treatment planning and develop image-guided strategies to verify the dose delivery for future early-stage NSCLC patients.

Retrospective treatment plans were generated for various IMRT delivery techniques, including …

Development Of Holistic Classification Systems For Children With Cerebral Palsy, Deepa Jeevanantham

Electronic Thesis and Dissertation Repository

Cerebral palsy (CP) is a complex disorder. There is a gap in the literature in classifying children with CP broadly. The purpose of this thesis was to develop holistic classification systems for children with CP. As a first step, a search was conducted to explore the strategies used to classify children with developmental co-ordination disorder and autism-spectrum disorder. Two versions of holistic classification systems named the body function index in cerebral palsy (BFI-CP) versions I and II were developed using two methods. Then, the relationship and differences among the developed classification systems and the Gross Motor Function Classification System (GMFCS) …

Regulation Of Phosphatase And Tensin Homolog Expression And Activity By Transforming Growth-Factor Beta In The Trabecular Meshwork Cells: Implications For Primary Open Angle Glaucoma, Nikoleta Tellios

Electronic Thesis and Dissertation Repository

Glaucoma is a multifactorial condition caused, in part, by fibrosis of the sieve-like trabecular meshwork (TM) tissue, which impedes drainage of aqueous humor (AH), leading to increased intraocular pressure and associated optic nerve damage and blindness. Fibrosis of the TM is mainly caused by the increased levels of active transforming growth factor-β 2 (TGFβ2) in the AH of glaucoma patients.

Previous reports have shown that TGFβ decreases the expression of Phosphatase and Tensin Homolog (PTEN) gene and that PTEN is a major regulator of ECM deposition. In this study we investigate the regulation of PTEN protein expression and …

Non-Invasive Imaging For The Assessment Of Cardiac Dose And Function Following Focused External Beam Irradiation, Omar El-Sherif

Electronic Thesis and Dissertation Repository

Technological advances in imaging and radiotherapy have led to significant improvement in the survival rate of breast cancer patients. However, a larger proportion of patients are now exhibiting the less understood, latent effects of incidental cardiac irradiation that occurs during left-sided breast radiotherapy. Here, we examine the utility of four-dimensional computed tomography (4D-CT) for the accurate assessment of cardiac dose; and a hybrid positron emission tomography (PET) magnetic resonance imaging (MRI) system to longitudinally study radiation-induced cardiac effects in a canine model.

Using 4D-CT and deformable dose accumulation, we assessed the variation caused by breathing motion in the estimated dose …

Infants Born Large For Gestational Age And Developmental Attainment In Early Childhood, Cairina E. Frank

Electronic Thesis and Dissertation Repository

Birth weight is a strong predictor of neonatal health outcomes. The majority of literature has focused on those infants born SGA. Infants born LGA have been shown to be at higher risk of immediate obstetrical complications and metabolic deficits, yet less research has focused on subsequent development. This study aims to investigate whether LGA is associated with developmental attainment and to examine the attribution of upstream factors and variables along the causal pathway. Data from the NLSCY was used. LGA was defined as a BW >90^th percentile. Outcomes were poor verbal ability (scoring <15^th percentile on the PPVT-R) and …

Acute Kidney Injury Biomarkers: A Prospective Cohort Study In Urological Patients, Daniel Olvera-Posada

Electronic Thesis and Dissertation Repository

Several recent studies have assessed the use of biomarkers of Acute Kidney Injury (AKI), but the information among patients with stone disease and those with obstructive uropathy is limited. For this reason, we conducted a prospective cohort study to determine the urinary levels of KIM-1, Total and Monomeric NGAL in patients with hydronephrosis secondary to renal stone disease, congenital ureteropelvic junction obstruction or ureteral stricture, and in a group of healthy controls in our health care center. Urinary biomarker concentrations were evaluated before and after surgical treatment. Patients with hydronephrosis showed significantly higher baseline levels of KIM-1 compared to those …

Intra-Abdominal Hypertension And Abdominal Compartment Syndrome, Patrick B. Murphy

Electronic Thesis and Dissertation Repository

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized in critically ill patients; no non operative treatments exist, and mortality remains high.

The purpose of this thesis was to prospectively characterize the incidence of IAH in a mixed medical-surgical intensive care unit, and to test the potential therapeutic benefit of carbon monoxide (CO) and hydrogen sulphide (H2S) using an animal model of ACS. IAH was diagnosed in 30% of patients on admission; further 15% developed IAH during ICU stay. Incidence of ACS was 3%, with obesity, sepsis, mechanical ventilation and 24-hour fluid balance as independent predictors, also predicting …

Oncolytic Virus Therapy For The Treatment Of Metastatic Ovarian Cancer, Jessica Tong

Electronic Thesis and Dissertation Repository

The management of patients with epithelial ovarian cancer (EOC) faces two major challenges which standard treatments fail to effectively address: 1) Diffuse metastasis as a consequence of late stage diagnosis and 2) intra-tumoral heterogeneity, which fuels tumor evolution and drives the acquisition of chemotherapeutic resistance. In this thesis, we tested new therapeutic strategies using a 3-dimensional in vitro spheroid culture model that mimics key steps of epithelial ovarian cancer metastasis; and another model that mimics both temporal and cellular heterogeneity by establishing multiple cell lines from a single patient over the course of disease progression. Using these models, we investigated …

Platelet Rich Plasma In Musculoskeletal Pathologies, Nicole L. Kaniki

Electronic Thesis and Dissertation Repository

Purpose: To evaluate the effectiveness of platelet rich plasma (PRP) in musculoskeletal injuries.

Methods: We completed a review of the literature on the use of PRP in tendon, muscle, bone, and intra-articular injuries (Chapter 2). We completed a systematic review and meta-analysis on the effectiveness of PRP in ultrasound guided versus palpation guided injections of PRP in non-operative treatment of tendon and muscle injuries using an indirect analysis method (Chapter 3). We conducted a randomized controlled trial to determine the effectiveness of PRP versus corticosteroid (CS) injections in patients with plantar fasciitis (Chapter 4).

Results: Most studies …

Optimizing The Rehabilitation Of Elbow Lateral Collateral Ligament Injuries, Ranita Harpreet Kaur Manocha

Electronic Thesis and Dissertation Repository

Elbow lateral collateral ligament (LCL) injuries frequently arise following trauma, and can result in disabling instability. Typically such injuries are managed with immobilization followed by a graduated exercise regime; however there is minimal biomechanical evidence to support current treatment protocols. This investigation examines the in vitro effectiveness of several rehabilitation techniques using a custom elbow motion simulator. It was found that active range of motion is safest in the overhead position (n = 7). Early motion in this position may reduce the incidence of elbow stiffness without compromising ligament healing following LCL injury. Forearm pronation and active motion stabilize …

An Evaluation Of The Determinants Of Job Satisfaction In Canadian Family Physicians, Jana L. Malhotra

Electronic Thesis and Dissertation Repository

Physicians as a group appear to be satisfied with their work. However, there are some gaps in our current understanding of the determinants that impact the job satisfaction of Canadian family physicians. This thesis examined determinants of family physician job satisfaction using in-depth interviews with family physicians to achieve a broad perspective on their job satisfaction. This was complemented by a multivariate analysis that examined the professional and work-life balance satisfaction of physicians across this country. The findings from this research confirm the significance of a number of factors to the professional and work-life balance satisfaction of family physicians. Novel …