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1. Harmonising IV Oxycodone with Paediatric Perioperative Medications: A Compatibility Study Through Y-Type Connectors

Author

Youssef SH, Garg A, Song Y, Wylie NE, and Garg S

Subjects
analgesia, physical compatibility, co-administration, intravenous fluid, oxycodone, y-connector, Therapeutics. Pharmacology, RM1-950
Abstract

Souha H Youssef,1 Alka Garg,2 Yunmei Song,1 Nicole E Wylie,3 Sanjay Garg1 1Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; 2SA Pharmacy, Women’s and Children’s Hospital, Adelaide, SA, Australia; 3Department of Paediatric Anaesthesia, Women’s and Children’s Hospital, Adelaide, SA, AustraliaCorrespondence: Sanjay Garg, University of South Australia, Adelaide, SA, 5000, Australia, Tel +618 8302 1575, Email sanjay.garg@unisa.edu.auPurpose: Co-administering multiple intravenous (IV) agents via Y-connectors is a common practice in hospitalised and fasting surgical patients. However, there is a lack of reliable data confirming the physical compatibility of some combinations including IV oxycodone, a drug that is gaining increasing popularity in the perioperative period. Concern regarding physical drug incompatibilities precludes concurrent coadministration with other common drugs through a single lumen. This can result in the cessation of infusions to allow the administration of other medications, resulting in exacerbation of acute pain. This study aims to evaluate the physical compatibility of IV oxycodone with some commonly co-administered drugs and IV fluids.Methods: Mixtures of oxycodone (1mg.mL− 1) and the tested drugs and IV fluids were prepared in a ratio of 1:1. The mixtures were examined at 0 and 60 minutes from mixing and assessed using the European Conference Consensus Standards. This involved visual inspection (precipitation, turbidity, colour change, gas formation), spectrophotometry, and pH change. The tested drugs included ketamine, tramadol, clonidine, vancomycin, piperacillin/tazobactam, dexmedetomidine, cefotaxime, gentamicin, and paracetamol. In addition, the commonly used IV fluids tested included glucose 5% + sodium chloride 0.9% + 60 mmol potassium chloride, plasmalyte + dextrose 5%;plasmalyte + dextrose 5% + 55 mmol potassium chloride, plasmalyte + dextrose 5% + 55mmol potassium acetate, plasmalyte + dextrose 5% + 55mmol potassium dihydrogen phosphate, Hartmann’s solution, Standard pediatric Total Parenteral Nutrition (TPN) 20/100 and TPN 25/150.Results: IV oxycodone (1 mg.mL− 1) showed no visual changes; no spectrophotometric absorption variability at 350, 410, or 550nm; and no pH changes of > 0.5 at 0 or 60 minutes with any of the tested drugs or fluids in the concentrations tested.Conclusion: According to European Consensus Conference Standards, IV Oxycodone at 1 mg.mL− 1 is physically compatible in a ratio of 1:1 v/v with all investigated drugs and fluids tested for at least 60 minutes. Keywords: analgesia, physical compatibility, co-administration, intravenous fluid, oxycodone, Y-connector

Published
2024

2. The purpose, plan, and progress of the Giant Magellan Telescope primary mirror off-axis segment test cell

Author

Fischer, Barbara M., primary, Ranka, Trupti, additional, Aguayo, Francisco F., additional, Ashby, David S., additional, Bugueno, Erich F., additional, Everman, Austin, additional, Ford, John P., additional, Kechichian, Zaven, additional, Kenagy, Kurt L., additional, Krasuski, Tomas, additional, Muller, Gary, additional, Rosenthal, Wylie N., additional, Schwartz, David M., additional, Soto, Jose, additional, Swett, Hector, additional, Thanasekaran, Divya, additional, and Wadhavkar, Abhijit, additional

Published
2020
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3. The Tristan legend, 1804-1914

Author

Wylie, N. V.

Subjects
820.9008
Abstract

The thesis traces the emergence and development of the Tristan legend during the 19th century as a subject for both scholarly research and creative reinterpretfktion, the latter being ultimately dependent on the former. In addition, a context of 19th century Arthurian literature is included, together with a discussion of the growth of studies in mediaeval literature. As Tristan scholarship declined in England due attention has been paid to its Continental development. After a consideration of the unique qualities of the legend and a summary of current scholarly ideas on its development, the thesis continues with an enquiry into the state of mediaeval studies at the beginning of the 19th century, out of which arose Scott's edition of Sir Tristrem. The genesis of this work is traced as an example of contemporary academic method, and is followed by an overall view of British and French scholarship in the first half of the century, including the work of Southey, Guest and la Villermarqué, who provided source material for Tennyson, Arnold and the Pre-Raphaelites. From the early Continental work with its developing Celtic affiliations came Arnold's Tristram and Iseult. This forme the subject of the third chapter and is set against a background of nascent Arthurian literature in England, which mostly drew on previous English scholarship for material. The poem is seen as an uneasy work originating from unfamiliar subject matter on the one hand, and Arnold's recoil from Marguerite on the other. The artistry of the work, its revisions and contemporary reception are discussed, and it is finally seen as remaining outside the mainstream of Arthurian literature, but having affinities with the later Pre-Raphaelite ethos. The more usual moralistic attitudes adopted towards the Arthurian legend are discussed in Chapter IV, where the antithetical heroes of Lancelot and Galahad are seen as the heroes of the mid-century. Tennyson's Idylls of the King is then considered as a reflection and development of those attitudes, thus illuminating his treatment of the Tristan story in 'The Last Tournament'. After dealing with the genesis of the Idylls and the 1859 aud 1869 publications, the chapter continues with a consideration Of 'The Last Tournament' from its inception in the draft of the Gareth Idyll to its cool reception in 1872. Tennyson's treatment of Malory, the significance of the Idyll in relation to the overall conception and as analysis of its structural and symbolic qualities are included. Swinburne's Tristram of Lyonesse is seen in the following chapter as embodying the Pre-Raphaelite revolt against this interpretation of the Arthurian material. It is prefigured in Queen Yseult and the early fragments, where is also seen Swinburne's concern with an accurate representation of the sources, together with the stylistic influence of Morris. The prolonged composition of Tristram of Lyonesse, contemporary reaction, Swinburne's use of sources and a discussion of the artistic anomaly this creates within the poem, lead up to a comparison with Wagner's Tristan und Isolde. Chapter VI begins with an examination of English scholarship and current attitudes to Malory which anticipated the Wagnerite reaction against Gottfried's Tristan. It then continues with a survey of the academic enthusiasm for Tristan on the Continent, tracing its progress from the work of Bossert to that of Bédier and Schoepperle. As the Tristan legend was thus established academically, so it came to be established on a creative level. The coinciding of Wagner's Tristan and the new cultural mood saw an outcrop of Tristan re-workings which reflect the Aesthetic climate in their Wagner-based projections of transcendental passion. This, together with a discussion of the backward-looking Arthurian dramas, is the subject of chapter VII. Finally, the last chapter summarizes ths emergence of the legend in three forms: the academic form, the popular narrative form and lastly, through the Wagner enthusiasm, as a symbol of rarefied passion. It also considers 19th century attitudes towards the romantic Middle Ages in conjunction with the artistic flaws which occur in mediaevalistic works of the period.

Published
1973

6. The Tristan legend, 1804-1914

Author

Wylie, N

Abstract

The thesis traces the emergence and development of the Tristan legend during the 19th century as a subject for both scholarly research and creative reinterpretfktion, the latter being ultimately dependent on the former. In addition, a context of 19th century Arthurian literature is included, together with a discussion of the growth of studies in mediaeval literature. As Tristan scholarship declined in England due attention has been paid to its Continental development. After a consideration of the unique qualities of the legend and a summary of current scholarly ideas on its development, the thesis continues with an enquiry into the state of mediaeval studies at the beginning of the 19th century, out of which arose Scott's edition of Sir Tristrem. The genesis of this work is traced as an example of contemporary academic method, and is followed by an overall view of British and French scholarship in the first half of the century, including the work of Southey, Guest and la Villermarqué, who provided source material for Tennyson, Arnold and the Pre-Raphaelites. From the early Continental work with its developing Celtic affiliations came Arnold's Tristram and Iseult. This forme the subject of the third chapter and is set against a background of nascent Arthurian literature in England, which mostly drew on previous English scholarship for material. The poem is seen as an uneasy work originating from unfamiliar subject matter on the one hand, and Arnold's recoil from Marguerite on the other. The artistry of the work, its revisions and contemporary reception are discussed, and it is finally seen as remaining outside the mainstream of Arthurian literature, but having affinities with the later Pre-Raphaelite ethos. The more usual moralistic attitudes adopted towards the Arthurian legend are discussed in Chapter IV, where the antithetical heroes of Lancelot and Galahad are seen as the heroes of the mid-century. Tennyson's Idylls of the King is then considered as a reflection and development of those attitudes, thus illuminating his treatment of the Tristan story in 'The Last Tournament'. After dealing with the genesis of the Idylls and the 1859 aud 1869 publications, the chapter continues with a consideration Of 'The Last Tournament' from its inception in the draft of the Gareth Idyll to its cool reception in 1872. Tennyson's treatment of Malory, the significance of the Idyll in relation to the overall conception and as analysis of its structural and symbolic qualities are included. Swinburne's Tristram of Lyonesse is seen in the following chapter as embodying the Pre-Raphaelite revolt against this interpretation of the Arthurian material. It is prefigured in Queen Yseult and the early fragments, where is also seen Swinburne's concern with an accurate representation of the sources, together with the stylistic influence of Morris. The prolonged composition of Tristram of Lyonesse, contemporary reaction, Swinburne's use of sources and a discussion of the artistic anomaly this creates within the poem, lead up to a comparison with Wagner's Tristan und Isolde. Chapter VI begins with an examination of English scholarship and current attitudes to Malory which anticipated the Wagnerite reaction against Gottfried's Tristan. It then continues with a survey of the academic enthusiasm for Tristan on the Continent, tracing its progress from the work of Bossert to that of Bédier and Schoepperle. As the Tristan legend was thus established academically, so it came to be established on a creative level. The coinciding of Wagner's Tristan and the new cultural mood saw an outcrop of Tristan re-workings which reflect the Aesthetic climate in their Wagner-based projections of transcendental passion. This, together with a discussion of the backward-looking Arthurian dramas, is the subject of chapter VII. Finally, the last chapter summarizes ths emergence of the legend in three forms: the academic form, the popular narrative form and lastly, through the Wagner enthusiasm, as a symbol of rarefied passion. It also considers 19th century attitudes towards the romantic Middle Ages in conjunction with the artistic flaws which occur in mediaevalistic works of the period.

Published
2017

7. Plant Community and Soil Microbial Carbon and Nitrogen Responses to Fire and Clipping in a Southern Mixed Grassland

Author

Wylie N. Harris, R.J. Ansley, and Thomas W. Boutton

Subjects
Biomass (ecology), geography, geography.geographical_feature_category, Ecology, food and beverages, Plant community, Management, Monitoring, Policy and Law, complex mixtures, Grassland, Nutrient, Agronomy, Grazing, Litter, Environmental science, Animal Science and Zoology, Ecosystem, Cycling, Nature and Landscape Conservation
Abstract

Disturbances, such as fire and grazing, play important roles in determining grassland plant community composition and soil microbial dynamics, as well as regulating the flows of carbon (C) and nitrogen (N) between the two groups of organisms. In a mixed grassland of the southern Great Plains, we tested the hypotheses that spring-season fire would increase the absolute biomass and relative proportion of C4 grasses in the plant community, and decrease soil microbial biomass N, thereby increasing microbial C∶N ratios. We also tested the hypothesis that clipping (to simulate grazing) would reduce effects of fire, with a greater reduction of fire effect corresponding to an increased frequency of clipping. Contrary to our hypothesis, C4 grasses showed no significant treatment responses. Treatment effects were limited to C3 grasses, and clipping was more important than fire in terms of effects on plant community composition. However, because of its greater capacity to reduce aboveground litter, fire had the greater impact on soil microbial C. Contrary to the hypothesized outcome, no significant effects of disturbance on soil microbial N were observed. This suggests that control of N cycling in this ecosystem is primarily microbial in nature, though dependent on inputs of plant C via litter. Interactions between fire and clipping were observed in litter mass, highlighting the importance of litter inputs for plant–soil nutrient feedbacks.

Published
2008
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8. Fire and grazing in grasslands of the Argentine Caldenal: Effects on plant and soil carbon and nitrogen

Author

Roberto Alejandro Distel, R.M. Bóo, Alicia Moretto, Wylie N. Harris, and Thomas W. Boutton

Subjects
geography, geography.geographical_feature_category, Ecology, food and beverages, chemistry.chemical_element, Soil carbon, Mineralization (soil science), complex mixtures, Nitrogen, Intraspecific competition, Grassland, chemistry, Grazing, Soil water, Environmental science, Cycling, Ecology, Evolution, Behavior and Systematics, Nature and Landscape Conservation
Abstract

Fire and grazing can modulate feedbacks between pools of carbon and nitrogen of plant and soil, altering cycles of these elements in grassland ecosystems. The magnitude of these effects may be limited by climate and by limited plasticity in tissue chemistry within a given photosynthetic pathway. We tested the hypotheses that (1) fire reduces rates of C and N cycling, while grazing increases them, and (2) these changes are due to intraspecific changes in plant tissue chemistry rather than competitive replacements by species with differing tissue chemistry. Plant and soil C and N content and isotopic ratios, soil microbial biomass C, and potential C mineralization were measured in areas of the southern Caldenal region of central Argentina with known histories of fire and grazing. Results support the hypothesis that fire reduces rates of N cycling via intraspecific increases in plant tissue C/N. Contrary to our first hypothesis, grazing also reduced plant tissue N. Fire and grazing effects on plant tissue chemistry resulted primarily from changes in dynamics of soil inorganic N. These changes were due to intraspecific changes in plant tissue chemistry, which was in agreement with our second hypothesis. Potential C mineralization experiments revealed little difference between treatments in pool sizes and mean residence times of labile soil organic carbon. Livestock grazing and fire have significant influences on soil N dynamics, particularly as mediated by soil microbes, in managed grasslands of the southern Caldenal in Argentina.

Published
2007
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11. Fire and grazing in the Caldenal of Argentina: Effects on plant and soil carbon and nitrogen

Author

Harris, Wylie N., Moretto, Alicia Susana, Distel, Roberto Alejandro, Boutton, Thomas W., and Bóo, Roberto M.

Subjects
CARBON, NITROGEN, GRAZING, CIENCIAS AGRÍCOLAS, Otras Ciencias Agrícolas, FIRE
Abstract

Fire and grazing can modulate feedbacks between pools of carbon and nitrogen of plant and soil, altering cycles of these elements in grassland ecosystems. The magnitude of these effects may be limited by climate and by limited plasticity in tissue chemistry within a given photosynthetic pathway. We tested the hypotheses that (1) fire reduces rates of C and N cycling, while grazing increases them, and (2) these changes are due to intraspecific changes in plant tissue chemistry rather than competitive replacements by species with differing tissue chemistry. Plant and soil C and N content and isotopic ratios, soil microbial biomass C, and potential C mineralization were measured in areas of the southern Caldenal region of central Argentina with known histories of fire and grazing. Results support the hypothesis that fire reduces rates of N cycling via intraspecific increases in plant tissue C/N. Contrary to our first hypothesis, grazing also reduced plant tissue N. Fire and grazing effects on plant tissue chemistry resulted primarily from changes in dynamics of soil inorganic N. These changes were due to intraspecific changes in plant tissue chemistry, which was in agreement with our second hypothesis. Potential C mineralization experiments revealed little difference between treatments in pool sizes and mean residence times of labile soil organic carbon. Livestock grazing and fire have significant influences on soil N dynamics, particularly as mediated by soil microbes, in managed grasslands of the southern Caldenal in Argentina Fil: Harris, Wylie N.. Texas A&M University; Estados Unidos Fil: Moretto, Alicia Susana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; Argentina Fil: Distel, Roberto Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Centro de Recursos Naturales Renovables de la Zona Semiarida. Universidad Nacional del Sur. Centro de Recursos Naturales Renovables de la Zona Semiarida; Argentina Fil: Boutton, Thomas W.. Texas A&M University; Estados Unidos Fil: Bóo, Roberto M.. Universidad Nacional del Sur. Departamento de Agronomía; Argentina

Published
2007

12. Surgical Management in Patients With Pancreatic Cancer: a Queensland Perspective

Author

Wylie, N., Adib, R., Barbour, A., Fawcett, J., Hill, A., Lynch, S., Martin, I., O'Rourke, T., Puhalla, H., Rutherford, L., Slater, K., Whiteman, D., Neale, R., Fritschi, Lin, Wylie, N., Adib, R., Barbour, A., Fawcett, J., Hill, A., Lynch, S., Martin, I., O'Rourke, T., Puhalla, H., Rutherford, L., Slater, K., Whiteman, D., Neale, R., and Fritschi, Lin

Abstract

Background: Little has been published regarding presenting symptoms, investigations and outcomes for patients with pancreatic cancer in Australia. Data from a series of patients undergoing attempted resection in Queensland, Australia, are presented with the aim of assisting development of consistent strategies in disease management.Methods: We reviewed the medical records of 121 patients who underwent attempted surgical resection and who took part in a case-control study between 2007 and 2009. Information relating to symptoms, investigations, surgical procedures and outcomes was captured.Results: The mean age was 63 years and 60% were men. The most common presenting symptoms were jaundice (64%) and pain (63%). Over 80% of patients had multiple imaging investigations or laparoscopy prior to surgery. Seventy-eight patients (64%) had a completed resection and 23% of these had involved margins. The presence of metastases and/or involvement of vessels or adjacent structures precluded resection in the remaining patients. The 1-year survival for patients whose resections were completed was 77% compared with 51% for those whose tumours were notresectable (P = 0.004). There was no 30-day mortality and 68% of patients were alive 1 year after diagnosis. Resections were performed in 11 different hospitals but over 90% of patients underwent their surgery in one of five high-volume centres.Conclusion: The Queensland experience is consistent with that reported internationally. A significant proportion of attempted resections was not completed because preoperative staging underestimated disease extent. Most patients with potentially resectable disease are being treated in high-volume centres.

Published
2013

13. Management innovation through standardization: Management consultants as standardizers of organizational practice

Author

Wright, C, Sturdy, A, Wylie, N, Wright, C, Sturdy, A, and Wylie, N

Abstract

Management innovation and the consultants who promote and support it are both typically associated with the ‘new’, with departures from the norm and from standard approaches. Indeed, standardization is often seen as an impediment to innovation, especially in the current ‘post-bureaucratic’ era. This article challenges such a view, arguing that consultant-led management innovation is often highly standardized. Based upon qualitative research into internal consultancy in large business organizations, both standardizing agendas and standardized methods are identified from a range of consultant-led management innovation programs. The analysis then points to some of the structural and cultural features of organizations that lead to managers favouring incremental, standardized approaches to change, even if these are often contested. In conclusion, the article points to the need to consider a range of different dimensions in the relationship between standardization and management innovation.

Published
2012

15. The Hydrogen Economy: The Creation of the Worldwide Energy Web and the Redistribution of Power on Earth, By Jeremy Rifkin. Tarcher/Putnam, 2002, 285 pp., US $24.95. ISBN 1-58542-193-6 (paperback)

Author

Wylie N. Harris

Subjects
Power (social and political), Energy (psychological), Environmental Engineering, business.industry, Hydrogen economy, Economics, Earth (chemistry), Redistribution (cultural anthropology), Management, Monitoring, Policy and Law, Economic system, business, Nature and Landscape Conservation
Published
2003
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26. OAK.

Author

WYLIE, N.

Published
1958

32. Finding what works-Patients' long-term experiences of weight maintenance post bariatric surgery: A systematic review and thematic synthesis of qualitative studies.

Author

MacAskill W, Gillanders T, Wylie N, and Pinidiyapathirage J

Subjects
Humans, Weight Loss, Obesity surgery, Health Behavior, Qualitative Research, Body Weight Maintenance, Bariatric Surgery
Abstract

Individuals with obesity can attain significant weight loss in a relatively short timeframe following bariatric surgery; however, new healthy behaviors must be sustained in perpetuity to maintain weight loss. This study investigates patients' views on the facilitators and barriers to long-term weight loss maintenance following bariatric surgery. Systematic searches of Medline, PsycINFO, and CINAHL databases identified 403 studies with 15 fitting the study inclusion criteria. Included studies were independently appraised using Critical Appraisal Skills Program (CASP). Data extraction and thematic synthesis generated three themes: changing food relationships, navigating inter- and intrapersonal influences, and caring health professionals. These appeared across six organizing sub-themes: building new food relationships, creating healthy habits, relationships with others, internalized stressors, finding and defining success, and ongoing patient education. Patients experienced a variety of barriers and facilitators to weight loss maintenance, with some facilitators diminishing over time. The findings demonstrate the importance of considering patients' perspectives and individual contexts to assist them to negotiate and overcome challenges to long-term weight loss maintenance post-bariatric surgery., (© 2023 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Published
2023
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33. Consistency of remifentanil concentrations in propofol-Remifentanil infusions. A laboratory-based study.

Author

Wylie N, Beale L, and Westley I

Subjects
Anesthesia, Intravenous methods, Anesthetics, Intravenous, Child, Humans, Infusions, Intravenous, Piperidines, Remifentanil, Anesthesia, Propofol
Abstract

Background: There is increasing interest in two-agent single-pump intravenous infusions for anesthesia and sedation in pediatric patients. Propofol-remifentanil is one such mixture. The poor miscibility of such admixtures when remifentanil is added in very high concentrations and when the admixtures are maintained in static conditions has been demonstrated; however, these physiochemical properties have not been examined in clinically relevant concentrations or settings., Aim: To examine if propofol-remifentanil admixtures maintain consistent remifentanil delivery when mixed in clinically relevant remifentanil concentrations and subjected to the physical effects of an actively infusing, directly-engaged syringe driver system with an extension line, as occurs when propofol-remifentanil is administered to a patient., Methods: A propofol 10 mg.ml -1 combined with remifentanil 5 mcg.ml -1 solution was run using a Paedfusor ® propofol target-controlled infusion model for 10 kg and 20 kg children for 57 min at a target plasma concentration of 3 mcg.ml -1 through a 30 ml syringe, 180 cm minimum volume extension line, lever lock cannula, interlink injection site, and 22 g intravenous cannula into sample pots. Samples were taken at the completion of the loading bolus, 1 and 2 min postcompletion of loading bolus, and every 5 min thereafter. The remifentanil concentration in these samples was then assayed using chromatography., Results: There was no difference in the concentration of remifentanil in the samples based on the duration of infusion to the endpoint of 1 h, or on the patient weight model used. The concentration remained 5 mcg.ml -1 +/- 0.5 mcg.ml -1 per sample. The measurement uncertainty for the assay at 0.5 mcg.ml -1 is +/- 0.2 mcg.ml -1 ., Conclusion: The concentration of remifentanil was 5 mcg.ml -1 +/- 0.5 mcg.ml -1 and was consistent across 57 min of infusion, and two different pediatric weight profiles., (© 2022 John Wiley & Sons Ltd.)

Published
2022
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34. Cell-Free Tumor DNA Dominant Clone Allele Frequency Is Associated With Poor Outcomes in Advanced Biliary Cancers Treated With Platinum-Based Chemotherapy.

Author

Uson Junior PLS, Majeed U, Yin J, Botrus G, Sonbol MB, Ahn DH, Starr JS, Jones JC, Babiker H, Inabinett SR, Wylie N, Boyle AWR, Bekaii-Saab TS, Gores GJ, Smoot R, Barrett M, Nagalo B, Meurice N, Elliott N, Petit J, Zhou Y, Arora M, Dumbauld C, Barro O, Baker A, Bogenberger J, Buetow K, Mansfield A, Mody K, and Borad MJ

Subjects
Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bile Ducts, Intrahepatic pathology, Cisplatin, Clone Cells pathology, Gene Frequency, Humans, Platinum therapeutic use, Retrospective Studies, Bile Duct Neoplasms drug therapy, Biliary Tract Neoplasms drug therapy, Cholangiocarcinoma drug therapy, Circulating Tumor DNA
Abstract

Purpose: This investigation sought to evaluate the prognostic value of pretreatment of circulating tumor DNA (ctDNA) in metastatic biliary tract cancers (BTCs) treated with platinum-based first-line chemotherapy treatment., Materials and Methods: We performed a retrospective analysis of 67 patients who underwent ctDNA testing before platinum-based chemotherapy for first-line treatment for metastatic BTC. For analysis, we considered the detected gene with highest variant allele frequency as the dominant clone allele frequency (DCAF). Results of ctDNA analysis were correlated with patients' demographics, progression-free survival (PFS), and overall survival (OS)., Results: The median age of patients was 67 (27-90) years. Fifty-four (80.6%) of 67 patients evaluated had intrahepatic cholangiocarcinoma; seven had extrahepatic cholangiocarcinoma, and six gallbladder cancers. Forty-six (68.6%) of the patients were treated with cisplatin plus gemcitabine, and 16.4% of patients received gemcitabine and other platinum (carboplatin or oxaliplatin) combinations, whereas 15% of patients were treated on a clinical trial with gemcitabine and cisplatin plus additional agents (CX4945, PEGPH20, or nab-paclitaxel). TP53, KRAS, FGFR2, ARID1A, STK11, and IDH1 were the genes with highest frequency as DCAF. The median DCAF was 3% (0%-97%). DCAF > 3% was associated with worse OS (median OS: 10.8 v 18.8 months, P = .032). Stratifying DCAF in quartiles, DCAF > 10% was significantly related to worse PFS (median PFS: 3 months, P = .014) and worse OS (median OS: 7.0 months, P = .001). Each 1% increase in ctDNA was associated with a hazard ratio of 13.1 in OS when adjusting for subtypes, metastatic sites, size of largest tumor, age, sex, and CA19-9., Conclusion: DCAF at diagnosis of advanced BTC can stratify patients who have worse outcomes when treated with upfront platinum-based chemotherapy. Each increase in %ctDNA decreases survival probabilities., Competing Interests: Jun YinEmployment: Mayo Clinic Mohamad Bassam SonbolResearch Funding: Lilly (Inst), Taiho Oncology (Inst) Daniel H. AhnStock and Other Ownership Interests: NateraConsulting or Advisory Role: Eisai, Exelixis, Genentech/Roche, Advanced Accelerator Applications, Novartis, Daiichi Sankyo/Astra ZenecaResearch Funding: Bayer, AstraZeneca Jason S. StarrConsulting or Advisory Role: Natera, Ipsen, Pfizer, Taiho Oncology, TerSera, Advanced Accelerator ApplicationsResearch Funding: Incyte (Inst), Merus (Inst), Rafael Pharmaceuticals (Inst), Molecular Templates (Inst), MacroGenics (Inst), Vedanta Biosciences (Inst), Leap Therapeutics Hani BabikerConsulting or Advisory Role: Endocyte, Celgene, Idera, Myovant Sciences, NovocureSpeakers' Bureau: Guardant Health Tanios S. Bekaii-SaabConsulting or Advisory Role: Amgen (Inst), Ipsen (Inst), Lilly (Inst), Bayer (Inst), Roche/Genentech (Inst), AbbVie, Incyte (Inst), Immuneering, Seattle Genetics (Inst), Pfizer (Inst), Boehringer Ingelheim, Janssen, Eisai, Eisai, Daiichi Sankyo/UCB Japan, AstraZeneca, Exact Sciences, Natera, Treos Bio, Celularity, SOBI, BeiGene, Foundation Medicine, Arcus Biosciences (Inst), Stemline Therapeutics, Kanaph Therapeutics, Deciphera, Illumina, Foundation MedicinePatents, Royalties, Other Intellectual Property: Patent WO/2018/183488, Patent WO/2019/055687Other Relationship: Exelixis, Merck (Inst), AstraZeneca, Lilly, Pancreatic Cancer Action Network, FibroGen, Suzhou Kintor Pharmaceuticals, 1-Globe, Imugene, Xilis, Replimune, Sun Biopharma, UpToDateOpen Payments Link: https://openpaymentsdata.cms.gov/physician/636276 Gregory J. GoresHonoraria: Sagimet Biosciences Rory SmootConsulting or Advisory Role: AstraZeneca Bolni NagaloPatents, Royalties, Other Intellectual Property: Patent “Chimeric Vesiculoviruses and Methods of Use” Mitesh J. Borad, and Bolni M. Nagalo James BogenbergerStock and Other Ownership Interests: Xpecting Diagnostics IncResearch Funding: Agios, RedHill Biopharma, Tolero Pharmaceuticals, Lexicon Aaron MansfieldHonoraria: RocheConsulting or Advisory Role: Genentech (Inst), Bristol Myers Squibb (Inst), AbbVie (Inst), AstraZeneca (Inst)Research Funding: Novartis (Inst)Travel, Accommodations, Expenses: AbbVie, Roche Kabir ModyStock and Other Ownership Interests: CytoDyn, ONCOtherapeuticsConsulting or Advisory Role: Celgene, Genentech/Roche, Merrimack, Eisai, AstraZeneca, Vicus Therapeutics, Ipsen, Boston Scientific, BTG, BTG, Exelixis, Exelixis, Incyte (Inst), QED TherapeuticsResearch Funding: FibroGen (Inst), Senhwa Biosciences (Inst), ARIAD (Inst), TRACON Pharma (Inst), MedImmune (Inst), Agios (Inst), ArQule (Inst), Taiho Pharmaceutical (Inst), Gritstone Bio (Inst), Incyte (Inst), Merck (Inst), Vyriad (Inst), Turnstone Bio (Inst), AstraZeneca (Inst), Basilea (Inst) Mitesh J. BoradStock and Other Ownership Interests: Gilead Sciences, AVEO, Intercept Pharmaceuticals, Spectrum PharmaceuticalsConsulting or Advisory Role: G1 Therapeutics, Fujifilm (Inst), Agios (Inst), Insys Therapeutics (Inst), Novartis (Inst), ArQule (Inst), Celgene (Inst), Inspyr Therapeutics, Halozyme (Inst), Pieris Pharmaceuticals (Inst), Taiho Pharmaceutical (Inst), Immunovative Therapies, Exelixis, Lynx Group, Genentech, Western Oncolytics, Klus Pharma, De Novo Pharmaceuticals, Merck, ImvaxResearch Funding: Boston Biomedical (Inst), miRNA Therapeutics (Inst), Senhwa Biosciences (Inst), MedImmune (Inst), BioLineRx (Inst), Agios (Inst), Halozyme (Inst), Celgene (Inst), Threshold Pharmaceuticals (Inst), Toray Industries (Inst), Dicerna (Inst), SillaJen (Inst), Eisai (Inst), Taiho Pharmaceutical (Inst), EMD Serono (Inst), Isis Pharmaceuticals (Inst), Incyte (Inst), Sun Biopharma (Inst), ARIAD (Inst), ImClone Systems (Inst), QED Therapeutics (Inst), Incyte (Inst), Puma Biotechnology (Inst), Adaptimmune (Inst), Merck Serono (Inst), RedHill Biopharma (Inst), Basilea (Inst), AstraZeneca (Inst)Travel, Accommodations, Expenses: ArQule, Celgene, AstraZenecaNo other potential conflicts of interest were reported.

Published
2022
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35. Humoral Responses After SARS-CoV-2 mRNA Vaccination and Breakthrough Infection in Cancer Patients.

Author

Chumsri S, Advani PP, Pai TS, Li Z, Mummareddy A, Acampora M, Reynolds GA, Wylie N, Boyle AW, Lou Y, Mody K, Moreno-Aspitia A, Swift MD, Virk A, Bharucha AE, Marquez CP, Patel TC, Gores GJ, and Knutson KL

Abstract

Objective: To evaluate the magnitude of humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients with cancer receiving active therapies., Patients and Methods: Patients 18 years or older in whom SARS-CoV-2 spike antibody (anti-S Ab) levels were measured after 2 doses of SARS-CoV-2 mRNA vaccines were included. Patients with prior coronavirus disease 2019 (COVID-19) infection or receiving other immunosuppressive therapy were excluded., Results: Among 201 patients who met the criteria, 61 were immunocompetent, 91 had a hematologic malignancy, and 49 had a solid malignancy while receiving treatments associated with cytopenia, including chemotherapy or cyclin-dependent kinase 4 and 6 inhibitors. A significantly greater proportion of immunocompetent patients (96.7% [59 of 61]) had anti-S Ab titers of 500 U/mL or greater compared to patients with hematologic (7.7% [7 of 91) and solid (55.1% [27 of 49]) malignancy ( P <.001). Despite 2 doses of SARS-CoV-2 mRNA vaccines, 52.7% of patients with hematologic malignancy (48 of 91) and 8.2% of those with solid malignancy (4 of 49) receiving cytopenic therapy had no seroconversion (spike antibody titers <0.8 U/mL). Two patients subsequently had development of breakthrough COVID-19 infection after full vaccination., Conclusion: A substantial proportion of patients with hematologic and solid malignancies receiving chemotherapies and CDK4/6i had poor humoral responses after SARS-CoV-2 mRNA vaccination. Our study adds to a growing body of literature suggesting that immunosuppressed patients have a suboptimal humoral response to COVID-19 vaccination. Our study also underscores the importance of assessing antibody response after COVID-19 vaccines in these vulnerable patients., (© 2021 The Authors.)

Published
2022
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36. Atypical Lung Carcinoid With EML4/ALK Fusion Detected With Circulating Tumor DNA.

Author

Gococo-Benore DA, Boyle A, Wylie N, Drusbosky L, Khoor A, and Starr JS

Abstract

Atypical carcinoids are a rare subset of neuroendocrine tumors that originate from cells within the bronchopulmonary tree. Compared to typical carcinoids, atypical carcinoids are associated with a worse prognosis. EML4-ALK fusions are reported in 5% of non-small cell lung carcinoma, but are rare in atypical carcinoids with only five previously reported cases. We report a case of a 70-year-old female with atypical carcinoid with metastasis to the liver and axial skeleton. She did not respond to standard of care chemotherapy with carboplatin and etoposide and was elected to enroll in hospice because of worsening clinical status. However, a circulating tumor DNA (ctDNA) sample was obtained the same day which revealed an EML4-ALK fusion gene. She immediately began therapy with the second-generation ALK inhibitor alectinib, with a remarkable symptomatic and radiographic response. Seven months later, the disease progression was demonstrated in the liver and the patient was switched to the third-generation ALK inhibitor lorlatinib. At the time of writing, the patient has continued to demonstrate sustained clinical, radiographic, and biochemical responses while on lorlatnib for two years. The dramatic treatment results highlighted in this case make the argument to consider ctDNA after the diagnosis of locally advanced or metastatic atypical carcinoid., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2022, Gococo-Benore et al.)

Published
2022
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37. Circulating Tumor DNA-Based Testing and Actionable Findings in Patients with Advanced and Metastatic Pancreatic Adenocarcinoma.

Author

Botrus G, Kosirorek H, Sonbol MB, Kusne Y, Uson Junior PLS, Borad MJ, Ahn DH, Kasi PM, Drusbosky LM, Dada H, Surapaneni PK, Starr J, Ritter A, McMillan J, Wylie N, Mody K, and Bekaii-Saab TS

Subjects
Biomarkers, Tumor genetics, High-Throughput Nucleotide Sequencing, Humans, Mutation, Adenocarcinoma diagnosis, Adenocarcinoma genetics, Carcinoma, Pancreatic Ductal diagnosis, Carcinoma, Pancreatic Ductal genetics, Circulating Tumor DNA genetics, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms genetics
Abstract

Purpose: Recent advances in molecular diagnostic technologies allow for the evaluation of solid tumor malignancies through noninvasive blood sampling, including circulating tumor DNA profiling (ctDNA). Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, often because of late presentation of disease. Diagnosis is often made using endoscopic ultrasound or endoscopic retrograde cholangiopancreatography, which often does not yield enough tissue for next-generation sequencing. With this study, we sought to characterize the ctDNA genomic alteration landscape in patients with advanced PDAC with a focus on actionable findings., Materials and Methods: From December 2014 through October 2019, 357 samples collected from 282 patients with PDAC at Mayo Clinic underwent ctDNA testing using a clinically available assay. The majority of samples were tested using the 73-gene panel which includes somatic genomic targets, including complete or critical exon coverage in 30 and 40 genes, respectively, and in some, amplifications, fusions, and indels. Clinical data and outcome variables were available for 165 patients; with 104 patients at initial presentation., Results: All patients included in this study had locally advanced or metastatic PDAC. Samples having at least one alteration, when variants of unknown significance (VUS) were excluded, numbered 266 (75%). After excluding VUS, therapeutically relevant alterations were observed in 170 (48%) of the total 357 cohort, including KRAS (G12C), EGFR, ATM, MYC, BRCA, PIK3CA, and BRAF mutations. KRAS, SMAD, CCND2, or TP53 alterations were seen in higher frequency in patients with advanced disease., Conclusion: Our study is the largest cohort to date that demonstrates the feasibility of ctDNA testing in PDAC. We provide a benchmark landscape upon which the field can continue to grow. Future applications may include use of ctDNA to guide treatment and serial monitoring of ctDNA during disease course to identify novel therapeutic targets for improved prognosis., Implications for Practice: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis often due to late presentation of disease. Biopsy tissue sampling is invasive and samples are often inadequate, requiring repeated invasive procedures and delays in treatment. Noninvasive methods to identify PDAC early in its course may improve prognosis in PDAC. Using ctDNA, targetable genes can be identified and used for treatment., (© 2021 AlphaMed Press.)

Published
2021
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39. Outcomes of liver resection for hepatocellular carcinoma in octogenarians.

Author

Sanyal S, Kron P, Wylie N, Hildalgo E, Toogood GJ, and Lodge P

Subjects
Aged, 80 and over, Hepatectomy adverse effects, Humans, Retrospective Studies, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery
Abstract

Background: There is a dearth of information about operative outcomes in patients ≥80 years for hepatocellular carcinoma (HCC) from Western institutions. We compare the result of HCC resections in patients <80 years vs. patients ≥80 years from our institution in the UK., Methods: We conducted a retrospective review of all patients undergoing liver resections for HCC between 2005 and 2015. Demographics, comorbidities, morbidity, mortality and survival were compared between the two age groups., Results: 200 patients underwent resection for HCC in this time period. Nineteen patients were ≥80 years and 181 were <80 years. Comorbidities measured by the Charlson Comorbidity Index were significantly higher in the ≥80 group (p < 0.0001). There was no significant difference in the extent of resection in the two groups. Morbidity and mortality between the <80 years and the ≥80 years group were not significantly different (morbidity 27% vs.16%; p = 0.29) (mortality 7% vs. 0%; p = 0.11). The one-year (83.4% vs. 88.2%; p = 0.83), five-year (56.3% vs. 55.8%; p = 0.83) and the overall survival rate rates (887 days vs. 1035 days; p = 0.66) were not significantly different between the groups., Discussion: Liver resection should not be precluded based on age alone; with good outcomes in patients ≥80 years justifying surgery., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Published
2020
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40. The volume, cost and outcomes of pancreatic resection in a regional centre in New Zealand.

Author

Wylie N, Hider P, Armstrong D, Srinivasa S, Rodgers M, Brown A, and Koea J

Subjects
Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, New Zealand epidemiology, Pancreatic Neoplasms economics, Pancreatic Neoplasms epidemiology, Postoperative Complications economics, Prospective Studies, Time Factors, Hospital Costs, Hospitals, Pancreatectomy statistics & numerical data, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy statistics & numerical data, Postoperative Complications epidemiology
Abstract

Background: The frequency, costs and outcome of pancreatic resection (both pancreaticoduodenectomy and distal pancreatectomy) were reviewed in our own institution and correlated with regional population growth as well as national resection rates and locations., Methods: Demographic, pathological and outcome data on pancreaticoduodenectomy and distal pancreatectomy were obtained from a prospectively maintained database for the years 2005-2009 and 2010-2014. During this period, the catchment population grew from 460 000 to 567 000. Costing information was obtained from the hospital-independent costing and coding committee, and the locations and rates of pancreatic resection were obtained by interrogating the national minimum dataset., Results: A total of 41 pancreatectomies (29 pancreaticoduodenectomy, 12 distal pancreatectomy) were performed between 2005 and 2009, increasing to 84 pancreatectomies (55 pancreaticoduodenectomies, 27 distal pancreatectomies and two total pancreatectomies) between 2010 and 2014. This constituted one sixth of the national volume of pancreatic resections. There was no difference in patient demographics or indications for resection between the two time periods; however, portal vein resection was used more frequently in the second period. Margin positivity rate decreased (7 of 41 versus 8 of 84) and lymph node harvest increased (median 8 nodes versus median 15 nodes) between the two time periods. Overall 30-day mortality was 1.6%., Conclusion: In New Zealand, regional rates of pancreatic resection reflect regional population demands, and institutional growth is driven by local population requirements. Institutional growth can be achieved with the maintenance of internationally accepted outcomes and quality indicators., (© 2017 Royal Australasian College of Surgeons.)

Published
2018
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41. Using a sedimentation scanner to determine mangrove health responses to sedimentation derived from dredging. An example from northwestern Australia.

Author

Mellor P, Willson N, Claydon N, Paling EI, Parker B, Wylie N, Mackey P, and Houridis H

Subjects
Australia, Geologic Sediments, Plant Leaves, Avicennia, Ecosystem, Rhizophoraceae
Abstract

A sedimentation scanner was used to measure daily sediment height at 10 sites associated with a 14 million cubic metre dredging project in Port Hedland harbour, Western Australia, between July 2011 and May 2012. Data were collected from seven potential impact sites, where up to 35 mm of additional sedimentation was predicted via modelling to result from dredging and at three reference sites, where background variation was monitored. A variety of mangrove habitat health indices from each site (including leaf area and health, pneumatophore and faunal burrow density) were collected before, during and after dredging. Despite predictions, most impact sites received between 0 and 10 mm over the dredging period, with one site experiencing a gain of 28 mm. Reference sites received between 2 and 28 mm which was attributed to natural processes. It was concluded that the health of Avicennia marina (Forssk.) Vierh. and Rhizophora stylosa Griff., the most common mangroves, were neither affected by a net sedimentation up to 28 mm of over a period of 11 months (i.e. 30.5 mm y -1 ) nor rapid changes over shorter time periods such as 14 mm over two days. This technology could be deployed in any tidally influenced sedimentary environment where short-term processes were of interest.

Published
2018
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42. From scratch: developing a hepatic resection service for metastatic colorectal cancer.

Author

Wylie N, Hider P, Armstrong D, Rajkomar K, Srinivasa S, Rodgers M, Brown A, and Koea J

Subjects
Adult, Aged, Aged, 80 and over, Colorectal Neoplasms mortality, Colorectal Neoplasms surgery, Facilities and Services Utilization, Female, Health Care Costs, Hepatectomy economics, Humans, Length of Stay, Liver Neoplasms mortality, Male, Margins of Excision, Middle Aged, New Zealand, Operative Time, Procedures and Techniques Utilization, Quality Indicators, Health Care statistics & numerical data, Colorectal Neoplasms pathology, Hepatectomy statistics & numerical data, Liver Neoplasms secondary, Liver Neoplasms surgery, Needs Assessment statistics & numerical data, Regional Health Planning
Abstract

Background: Waitemata District Health Board has New Zealand's largest catchment and busiest colorectal unit. The upper gastrointestinal unit was established in 2005, in part to provide a hepatic resection service for patients with colorectal carcinoma metastatic to the liver. The aim of this investigation was to report on quality indicators for the hepatic resection of colorectal carcinoma in the development of a regional resection service., Methods: Prospectively collected data on patients undergoing hepatic resection for colorectal carcinoma between 2005 and 2014 was reviewed and correlated with costing data and national hepatic resection rates., Results: A total of 123 patients underwent 138 hepatic resections for metastatic colorectal cancer with a median hospital stay of 8 days (range 4-37 days), a zero 30-day mortality and a median cost of NZ$21 374 for minor hepatectomy and NZ$43 133 for major hepatectomy. Actuarial 5-year disease-free survival was 44%, with 28 patients alive and disease free at 5 years post-resection. Median overall survival was not reached. Review of national hepatic resection rates indicate that Waitemata District Health Board performs one sixth of all hepatic resections in New Zealand and that this treatment modality may be underutilized in the management of patients with metastatic colorectal cancer., Conclusion: A regional hepatic resection centre for colorectal metastases can be established in areas of population need and can provide a high-quality, cost-effective service., (© 2016 Royal Australasian College of Surgeons.)

Published
2018
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43. Hepatic splenosis.

Author

Aramoana J, Wylie N, and Koea JB

Subjects
Abdominal Pain diagnosis, Abdominal Pain etiology, Humans, Incidental Findings, Liver diagnostic imaging, Liver Neoplasms diagnostic imaging, Liver Neoplasms surgery, Magnetic Resonance Imaging methods, Male, Middle Aged, Splenectomy adverse effects, Splenosis surgery, Tomography, X-Ray Computed methods, Liver pathology, Liver Neoplasms pathology, Splenosis pathology
Published
2018
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44. Development and initial outcomes of an upper gastrointestinal multidisciplinary clinic.

Author

Brown A, Wylie N, Rodgers M, Casement J, McIlree N, Gray L, Mulholland G, Volkova V, van der Watt E, Booth M, and Koea J

Subjects
Appointments and Schedules, Humans, New Zealand epidemiology, Patient Satisfaction statistics & numerical data, Referral and Consultation, Gastrointestinal Neoplasms epidemiology, Outpatient Clinics, Hospital, Patient Care Team organization & administration, Patient-Centered Care organization & administration
Abstract

Introduction: Patients with upper gastrointestinal cancer are often comorbid and require complex surgical treatments for their cancers, meaning that their preoperative assessment can be based around numerous outpatient assessments with multiple services. A multidisciplinary clinic (MDC) was developed for the assessment of patients with confirmed or suspected upper gastrointestinal cancers., Methods: Face-to-face meetings were held between stakeholder services at Waitemata District Health Board, and clinic resource allocated. Significant IT modification of existing clinic booking software was required., Results: Between September 2014, and September 2015, there were a total of 165 new patient, and 710 follow-up appointments. All new patients were seen by a surgeon and then other specialties. Of the 165 new patient appointments, 146 (88%) patients had a definitive treatment plan in place and were cleared by anaesthesia and intensive care at the end of the clinic. Staff and patients report high levels of satisfaction for the clinic., Conclusion: A dedicated MDC has provided a single forum where complex patients can be reviewed, and a definitive treatment plan formulated in nearly 90% of patients, even when this involves multiple medical and paramedical specialties with high levels of patient and clinician satisfaction.

Published
2016

45. Implementing Integrative Care as a DNP to Increase Patient Health Outomes.

Author

Wylie N

Subjects
Curriculum, Humans, Nursing Education Research, Outcome Assessment, Health Care, Patient Care Team organization & administration, United States, Education, Nursing, Graduate organization & administration, Holistic Health, Holistic Nursing education, Professional Autonomy
Published
2016

46. Prediction in pancreatic cancer.

Author

Wylie N and Koea JB

Subjects
Female, Humans, Male, Carcinoma, Pancreatic Ductal mortality, Carcinoma, Pancreatic Ductal pathology, Pancreatectomy, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Pancreaticoduodenectomy
Published
2015
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47. Surgical management in patients with pancreatic cancer: a Queensland perspective.

Author

Wylie N, Adib R, Barbour AP, Fawcett J, Hill A, Lynch S, Martin I, O'Rourke TR, Puhalla H, Rutherford L, Slater K, Whiteman DC, and Neale RE

Subjects
Aged, Aged, 80 and over, Carcinoma, Pancreatic Ductal diagnosis, Carcinoma, Pancreatic Ductal mortality, Female, Humans, Male, Middle Aged, Pancreatectomy, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms mortality, Queensland epidemiology, Carcinoma, Pancreatic Ductal surgery, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy
Abstract

Background: Little has been published regarding presenting symptoms, investigations and outcomes for patients with pancreatic cancer in Australia. Data from a series of patients undergoing attempted resection in Queensland, Australia, are presented with the aim of assisting development of consistent strategies in disease management., Methods: We reviewed the medical records of 121 patients who underwent attempted surgical resection and who took part in a case-control study between 2007 and 2009. Information relating to symptoms, investigations, surgical procedures and outcomes was captured., Results: The mean age was 63 years and 60% were men. The most common presenting symptoms were jaundice (64%) and pain (63%). Over 80% of patients had multiple imaging investigations or laparoscopy prior to surgery. Seventy-eight patients (64%) had a completed resection and 23% of these had involved margins. The presence of metastases and/or involvement of vessels or adjacent structures precluded resection in the remaining patients. The 1-year survival for patients whose resections were completed was 77% compared with 51% for those whose tumours were not resectable (P = 0.004). There was no 30-day mortality and 68% of patients were alive 1 year after diagnosis. Resections were performed in 11 different hospitals but over 90% of patients underwent their surgery in one of five high-volume centres., Conclusion: The Queensland experience is consistent with that reported internationally. A significant proportion of attempted resections was not completed because preoperative staging underestimated disease extent. Most patients with potentially resectable disease are being treated in high-volume centres., (© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.)

Published
2013
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48. Who needs a palliative care consult?: the Hamilton Chart Audit tool.

Author

Slaven M, Wylie N, Fitzgerald B, Henderson N, and Taylor S

Subjects
Communication, Concurrent Review, Hospitals, University, Humans, Needs Assessment, Ontario, Pain Measurement, Patient Care Planning, Patient Care Team, Terminal Care methods, Medical Audit methods, Oncology Service, Hospital standards, Palliative Care statistics & numerical data, Psychometrics instrumentation, Referral and Consultation
Abstract

Although palliative care services are becoming increasingly prevalent in acute care hospitals only a minority of patients who die in hospital or in the community have seen palliative care teams. There are large numbers of patients who might benefit from palliative care who are not receiving it. That said, identification of patients who are eligible for these services, and of those who would most benefit is problematic. Limitations in our ability to accurately predict prognosis as well as lack of universal agreement as to what constitutes a terminal illness, or "end of life" are important considerations. Another significant challenge faced by our health care systems is whether or not all "end-of-life" patients require specialized care by trained palliative care providers. Even if this were the ideal model of care, this would be unfeasible given the relatively small number of trained providers compared to the aging and dying population. Therefore it is critical that health care systems begin to standardize their approach to the identification of patients who are most in need of, and/or most likely to benefit from interventions by interdisciplinary palliative care teams. Institutions that are planning to develop new services, or expand their current services will require some method/tool to assess specific population needs at their site. The Hamilton Chart Audit (H-CAT) was developed at our institution to help identify potential palliative care needs of patients and their families. We report on development of the tool and use of the tool for a retrospective audit of 222 patients who died at our institution.

Published
2007
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49. HIV resistance testing in the USA--a model for the application of pharmacogenomics in the clinical setting.

Author

Blum RA, Wylie N, England T, and French C

Subjects
Acquired Immunodeficiency Syndrome genetics, Acquired Immunodeficiency Syndrome virology, Antiviral Agents pharmacology, Genomics methods, Genotype, HIV-1 genetics, HLA Antigens genetics, Humans, Pharmacogenetics economics, United States, Acquired Immunodeficiency Syndrome drug therapy, Antiviral Agents therapeutic use, Drug Resistance, Viral genetics, HIV-1 drug effects, Pharmacogenetics methods
Abstract

Although there is debate about how and when the medical community will readily adopt pharmacogenomics into clinical practice, HIV genotyping has become an integral part of AIDS patient management in the USA since 1996. Genotyping for HIV-1 drug resistance serves as a paradigm for the way pharmacogenomics is likely to be introduced into patient care. This review discusses the unique role that HIV-1 genotype testing plays in identifying resistance in patients and how that information is used to modify therapy selection and impact the progression of disease. In addition, the important issues relating to reimbursement and the cost-effectiveness of genotyping are also discussed.

Published
2005
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50. A biomarker of n-3 compliance in patients taking fish oil for rheumatoid arthritis.

Author

Cleland LG, Proudman SM, Hall C, Stamp LK, McWilliams L, Wylie N, Neumann M, Gibson RA, and James MJ

Subjects
Arachidonic Acid blood, Biomarkers blood, Dietary Supplements, Docosahexaenoic Acids blood, Eicosapentaenoic Acid blood, Eicosapentaenoic Acid pharmacokinetics, Erythrocytes chemistry, Fatty Acids, Omega-3, Fatty Acids, Unsaturated blood, Fish Oils blood, Humans, Leukocytes, Mononuclear chemistry, Longitudinal Studies, Phospholipids blood, Phospholipids chemistry, Phospholipids pharmacokinetics, Triglycerides blood, Arthritis, Rheumatoid blood, Arthritis, Rheumatoid diet therapy, Fatty Acids, Unsaturated therapeutic use, Fish Oils administration & dosage, Patient Compliance statistics & numerical data, Triglycerides therapeutic use
Abstract

Dietary fish oil supplements have been shown to have benefits in rheumatoid arthritis (RA), other inflammatory diseases, and in cardiovascular disease. As with any medical advice, variability will exist with regard to adherence and consequent biochemical or pharmacophysiologic effects. The aim was to explore the utility of plasma phospholipid EPA as a measure of n-3 PUFA intake and response to standardized therapeutic advice given in an outpatient or office practice setting, to increase dietary n-3 PUFA, including a fish oil supplement. Patients with early RA were given verbal and written advice to alter their dietary n-3 PUFA intake, including ingestion of 20 mL of bottled fish oil on juice daily. The advice included instructions to increase n-3 PUFA and to avoid foods rich in n-6 PUFA. Every 3 mon, blood samples were obtained for analysis of plasma phospholipid FA. Plasma phospholipid EPA was used as the primary index of n-3 PUFA intake. A diverse response was seen, with about one-third of patients achieving a substantial elevation of plasma phospholipid EPA over the 12-mon study period. A third had little change, with the remainder achieving intermediate levels. Data obtained longitudinally from individual patients indicated that substantial elevations of EPA (> 5% total plasma phospholipid FA) could be maintained for more than 3 yr. Plasma phospholipid EPA is a convenient measure of adherence to advice to take a dietary n-3 PUFA-rich fish oil supplement This measure may prove a useful adjunct to intention to treat analyses in determining the effect of dietary fish oil supplements on long-term outcomes in arthritis and other chronic inflammatory diseases. It may also provide a guide to the effectiveness of therapeutic and preventive messages designed to increase n-3 PUFA intake.

Published
2003
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