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Search Results: 1 - 10 of 19418 matches for " Anna McGuire "
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Clinical outcomes of polymeric sealant use in pulmonary resection: a systematic review and meta-analysis of randomized controlled trials
Anna L. McGuire,John Yee
- , 2018, DOI: 10.21037/jtd.2018.10.48
Abstract: Prolonged alveolar air leak (PAL) is the most common complication following pulmonary resection, both anatomic (lobectomy, segmentectomy) and non-anatomic (wedge resection). High volume thoracic surgical institutions report a PAL incidence of at least 15% annually (1-3). PAL has known significant associated morbidity for lung resection patients, in the form of pain from prolonged chest tube drainage, an increased empyema risk (3-5). Even if a thoracic surgical service has a program whereby PAL patients can be safely discharged with a Pneumostat? or Heimlich valve enabling the air leak to be followed and chest drain removed as an outpatient, PAL still represents an additional hospital expense (6,7). The metric of additional cost for hospital administration is captured not only with increased length of index stay (LOS) related to the lung resection, but also for additional outpatient follow-up visits for chest tube trouble-shooting, and potential hospital readmission for management of pleural sepsis (5)
A New Approach for Safe Tube Thoracostomy Insertion: An Objective and Subjective Comparison versus Established Techniques  [PDF]
Alex Doyle, Thomas White, Anna Hutton, Karen Mcguire, Parvez Moondi, Peter Young
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.52010
Abstract:

Introduction: Tube thoracostomy is an invasive procedure, which may result in life-threatening injury to major organs and blood vessels. We propose a new approach for inserting tube thoracostomies to improve the safety of this procedure, termed guided blunt dissection. In this article, we compared the safety of this new approach with traditional blunt dissection and two commercially available Seldinger tube thoracostomy kits in an ex vivo model. Methods: We recruited 32 clinicians from a variety of medical specialties with a range of experience in performing tube thoracostomy. Each clinician was required to perform tube thoracostomy using all four approaches in a randomised order. Objectively, each insertion was categorised as “safe” if the lung remained intact and “unsafe” if the lung deflated. Subjectively, participants were asked to rank each approach in order of perceived safety on a four-point scale. Statistical analysis was performed using a Fisher’s exact test. Results: Objectively, guided blunt dissection was significantly safer than both Seldinger approaches (p < 0.0001), but not traditional blunt dissection (p = 0.71). Subjectively, none of the approaches were felt to be superior. Conclusions: These data support the conclusions that, in this

Incidence Risk and Independent Predictors of Prolonged Air Leak in 269 Consecutive Pulmonary Resection Patients over Nine Months: A Single-Center Retrospective Cohort Study  [PDF]
Connie Drewbrook, Samarpita Das, Dorsa Mousadoust, Dorsa Mousadoust, Dorsa Mousadoust, Basil Nasir, John Yee, Anna McGuire
Open Journal of Thoracic Surgery (OJTS) , 2016, DOI: 10.4236/ojts.2016.64006
Abstract: Introduction: Prolonged air leak (PAL) is a common complication following pulmonary resection. It is associated with pneumonia, empyema, increased length of hospital stay and health-care costs. Intraoperative techniques have been developed to mitigate the risk of developing a PAL, but for their use to be efficient, identification of patients at risk for PAL is necessary. Aim: To determine the incidence of PAL following lobectomy and lesser pulmonary resections, risk factors for development of PALs, and the impact of PAL on hospital stay and readmission rates. Methods: The following variables were analyzed as PAL risk factors: patient characteristics of age, sex, body mass index (BMI), forced minute expiratory volume and capacity ratio (FEV1 and FEV1/FVC), diffusion capacity (DCLO), and transplant recipient status. Validated scoring systems included the Charlson Comorbidity Index (CCI), Medical Research Council (MRC) dyspnea score, and Eastern Cooperative Oncology Group (EGOC) score. Surgical factors included surgical technique, unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy, location and extent of resection, presence of adhesions, completeness of fissures, and method of fissure completion. Length of hospital stay and readmission rates were analyzed. Statistical tests performed on the data include univariate and multivariate logistic regression analyses. Results: Over the 9-month study duration there were 269 lung resections, of which 31 (11.52%) had an air leak lasting longer than 5 days. Mean length of stay in hospital was significantly longer in patients with PAL compared to the control group (13 vs 5 days, P < 0.001). Significant risk factors for PAL from multivariate analysis include normal BMI (P = 0.009), right upper lobectomy (P = 0.001), and unplanned conversion from video-assisted thoracoscopic surgery (VATS) to thoracotomy (P = 0.023). Conclusion: The incidence of PAL in our study population is similar to that found in previous studies. PAL prolongs hospital length of stay. Normal BMI, right upper lobectomy, and unplanned conversion from VATS to thoracotomy are risk factors for PAL.
A Cross-Sectional Study: Chest Tube Drainage Practice Patterns among Canadian Thoracic Surgeons Following Pulmonary Surgery  [PDF]
Samarpita Das, Kyle Grant, Connie Drewbrook, Dorsa Mousadoust, Renelle Myers, Basil Nasir, John Yee, Anna McGuire
Open Journal of Thoracic Surgery (OJTS) , 2017, DOI: 10.4236/ojts.2017.71003
Abstract: Background: High chest tube drainage following lung surgery is a rate-limiting step to discharge, increasing length of hospital stay. There is a paucity of evidence-based clinical research on safe maximal daily chest tube drainage prior to removal. Objectives: To describe the practice patterns of Canadian thoracic surgeons with respect to daily chest tube drainage after routine pulmonary surgery. Methods: A self-reported electronic questionnaire was administered to members of the Canadian Association of Thoracic Surgeons (CATS). Data was tabulated on the primary outcome of acceptable maximal daily pleural output prior to chest tube removal, and secondary outcomes of: years in clinical practice, academic versus community setting and rational for chest tube management. Descriptive and univariate analysis was conducted for each response by maximal daily pleural drainage category. Results: A total of 124 surveys were distributed. Response rate was 56%, with a 93% completion rate. Acceptable maximal pleural drainage among surgeons was highly variable. Rationale for tube removal was also variable, including individual clinical experiences (n = 23, 33%), evidence based guidelines (n = 18, 26%), and group practice pattern (n = 12, 17%). Academic surgeons comprised 72% of respondents. Community based surgeons were more likely to remove tubes at a lower mean volume. Years in clinical practice did not influence acceptable daily pleural drainage. Conclusion: There is great variability in post-operative management of chest tube fluid output among Canadian thoracic surgeons. Future research on this topic is warranted, with the aim of developing an evidence-based chest tube management algorithm incorporating daily chest tube drainage volumes as a key variable.
Food Production Engineering Efficiency: A Critical Analysis of the Conventional Metrics Used in Measuring Agricultural Efficiency  [PDF]
Mark McGuire
Engineering (ENG) , 2017, DOI: 10.4236/eng.2017.95025
Abstract: An analysis is reported of conventional vs. alternative metrics used in measuring food production efficiency. Economic efficiency is driven by marketplace economics, while engineering efficiency is driven by useful energy conservation. As farming systems are optimized for maximum efficiency, how “efficiency” is defined will dictate the methods used in food production. Farming methods that are optimized in terms of economic efficiency have environmental consequences that are not inherent of engineering efficiency; however, farming methods optimized in terms of engineering efficiency have labor requirements not inherent of economic efficiency. A shift from optimizing food production in terms of economic efficiency to engineering efficiency may be necessary in order to feed a growing human population.
Predictors of Malignant Pathology and the Role of Trans-Thoracic Needle Biopsy in Management of Solitary Fibrous Tumors of the Pleura: A 30-Year Review of a Tertiary Care Center Patient Cohort  [PDF]
Anna McGuire, Patrick J. Villeneuve, Harman Sekhon, Sebastien Gilbert, Sudhir Sundaresan, Donna E. Maziak, Andrew E. J. Seely, Farid M. Shamji
Open Journal of Thoracic Surgery (OJTS) , 2016, DOI: 10.4236/ojts.2016.64008
Abstract: Background: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms with unpredictable behavior. Lack of unifying criteria for benign or malignant SFTP has resulted in reports of SFTP exhibiting malignant behavior years after complete surgical resection (despite benign initial diagnosis). Additionally, the role of trans-thoracic needle biopsy in initial management of SFTP is unclear. Understanding predictors of malignancy identifies patients at unacceptably high risk for non-surgical primary therapy, and for recurrence despite complete surgical resection. Objectives: The primary objectives were to identify clinicopathological predictors of malignancy & recurrence in SFTP. The secondary aim was to determine the role of trans-thoracic needle biopsy in the management decision algorithm of SFTP. Methods: Retrospective chart review was conducted (Jan. 1983-Dec. 2013) at the Ottawa Hospital for pathologically confirmed SFTP. Data were collected on biopsy-related, clinical, histopathological & immunohistochemistry (IHC) variables. Appropriate tests of statistical inference were conducted for all variables. Results: Pathologically confirmed SFTP was identified in 26 cases. Transthoracic needle biopsy was conducted in 22 (84.6%); with 16 (72.7%) biopsies diagnostic of SFTP with IHC; 3 (13.6%) being malignant. Primary management was surveillance in 3 and complete surgical resection in 23. Surgical pathology reported 15 (65.2%) benign and 8 (34.8%) malignant cases. Local recurrence occurred in 3 and distant recurrence in 1. Initial pathology was benign in 3 (75%) with recurrence. Clinicopathologic variables analyzed did not predict recurrent disease. IHC features did not differ between malignant & benign pathology significantly. Predictors of malignant pathology included: infiltrative cellular pattern (p = 0.042), nuclear crowding (p = 0.006), tumour necrosis (p < 0.001) and >4 mitoses/ 10 high power field (p < 0.003). Conclusion: Because numerous variables analyzed did not predict recurrent disease, long-term follow-up is warranted regardless of benign or malignant initial histology. Histologic not IHC features predicted malignant pathology. Trans-thoracic needle biopsy did identify malignant SFTP; however its main use should be to differentiate SFTP from other pleural neoplasms using IHC.
Early Children’s Literature and Aging  [PDF]
Sandra L. McGuire
Creative Education (CE) , 2016, DOI: 10.4236/ce.2016.717245
Abstract: Increased longevity is a worldwide phenomenon placing emphasis on the need for preparation for life’s later years and for maximizing the potentials of these years. Today’s children will be the older adults of tomorrow. A resource that can help to educate them about aging and prepare them for the long life ahead is early children’s literature (Preschool-Primary). This literature can provide children with a holistic view of aging, teach them about aging and the aging process, promote positive attitudes about aging, and promote positive aging. Selecting early children’s literature for aging content, resources for finding early children’s literature to promote positive aging, and examples of early children’s literature to promote positive aging are presented.
Aging Education: A Worldwide Imperative  [PDF]
Sandra L. McGuire
Creative Education (CE) , 2017, DOI: 10.4236/ce.2017.812128
Abstract: Life expectancy is increasing worldwide. Unfortunately, people are generally not prepared for this long life ahead and have ageist attitudes that inhibit maximizing the “longevity dividend” they have been given. Aging education can prepare people for life’s later years and combat ageism. It can reimage aging as a time of continued growth, development?and?fulfillment. Unfortunately, aging education is not a common occurrence. This education needs to begin with children and continue throughout life. This article discusses why we need to teach about aging?and?aging education content, suggests a conceptual framework for aging education, and presents aging education resources. The concept of ageism is discussed and suggestions for combating ageism are proposed.
Ectopic thymoma managed by neck dissection & video-assisted thoracoscopic thymectomy
Anna L. McGuire,Eitan Prisman,John K. Peel,Tony L. Ng
- , 2017, DOI: 10.21037/jtd.2017.10.141
Abstract: Thymomas are uncommon epithelial neoplasms of thymic origin, usually arising in the anterosuperior mediastinum, and are classically associated with myasthenia gravis (MG) (1). Ectopic thymoma in the neck is a rare phenomenon, likely a result of aberrant tissue migration during embryonic development, and comprises fewer than 2% of all thymoma cases (2). Ectopic cervical thymoma has been reported in 19 cases worldwide, with the bulk of this literature addressing the challenge of accurate diagnosis in an atypical neck mass
Language: Functionalism versus Authenticity
Peter McGuire
Indo-Pacific Journal of Phenomenology , 2006,
Abstract: This paper sets out to demonstrate that a phenomenological reflection on language highlights the possibilities of authenticity in communication, and as such provides a very necessary complement to the dominant linguistic perspectives: the syntactic and grammatical perspective, Saussurean linguistics, and systemic functional linguistics. While the syntactic and grammatical perspective, which predominates in the educational context, presents language as an institutionalized, authoritarian and self-contained system, Saussurean linguistics provides a view of language as a complex, self-contained, technical system, as such reflecting the nature of modern society. The third perspective, systemic functional linguistics, describes templates of specific genre, models which aid students to construct their own, while simultaneously discouraging individual selfexpression. In contrast, a reflective phenomenological perspective identifies and encourages authentic self-expression. The paper concludes by considering ways to reconcile the impetus in language teaching towards, on the one hand, the language of institutional authority, and, on the other, individual self-expression. Indo-Pacific Journal of Phenomenology, Volume 6, Edition 2 August 2006
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