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Article ; Online: Heart failure with improved ejection fraction: Beyond diagnosis to trajectory analysis.

Pensa, Anthony V / Khan, Sadiya S / Shah, Ravi V / Wilcox, Jane E

2024 Volume 82, Page(s) 102–112

Abstract: Left ventricular (LV) systolic dysfunction represents a highly treatable cause of heart failure (HF). A substantial proportion of patients with HF with reduced ejection fraction (EF;HFrEF) demonstrate improvement in LV systolic function (termed HF with ... ...

Abstract	Left ventricular (LV) systolic dysfunction represents a highly treatable cause of heart failure (HF). A substantial proportion of patients with HF with reduced ejection fraction (EF;HFrEF) demonstrate improvement in LV systolic function (termed HF with improved EF [HFimpEF]), either spontaneously or when treated with guideline-directed medical therapy (GDMT). Although it is a relatively new HF classification, HFimpEF has emerged in recent years as an important and distinct clinical entity. Improvement in LVEF leads to decreased rates of mortality and adverse HF-related outcomes compared to patients with sustained LV systolic dysfunction (HFrEF). While numerous clinical and imaging factors have been associated with HFimpEF, identification of which patients do and do not improve requires further investigation. In addition, patients improve at different rates, and what determines the trajectory of HFimpEF patients after improvement is incompletely characterized. A proportion of patients maintain improvement in LV systolic function, while others experience a recrudescence of systolic dysfunction, especially with GDMT discontinuation. In this review we discuss the contemporary guideline-recommended classification definition of HFimpEF, the epidemiology of improvement in LV systolic function, and the clinical course of this unique patient population. We also offer evidence-based recommendations for the clinical management of HFimpEF and provide a roadmap for future directions in understanding and improving outcomes in the care of patients with HFimpEF.
MeSH term(s)	Humans ; Heart Failure/diagnosis ; Heart Failure/therapy ; Stroke Volume ; Ventricular Function, Left ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/therapy ; Echocardiography
Language	English
Publishing date	2024-01-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	209312-1
ISSN	1873-1740 ; 1532-8643 ; 0033-0620
ISSN (online)	1873-1740 ; 1532-8643
ISSN	0033-0620
DOI	10.1016/j.pcad.2024.01.014
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Article ; Online: Driving the life course approach to vaccination through the lens of key global agendas.

Stancu, Andra / Khan, Anusheh / Barratt, Jane

Frontiers in aging

2023 Volume 4, Page(s) 1200397

Abstract: Globally, our population is ageing at an unprecedented rate and by 2030, which marks the end of the United Nations (UN) Decade of Healthy Ageing, the number of people aged 60 years and older will be 34% higher than today, reaching 1.4 billion. ... ...

Abstract	Globally, our population is ageing at an unprecedented rate and by 2030, which marks the end of the United Nations (UN) Decade of Healthy Ageing, the number of people aged 60 years and older will be 34% higher than today, reaching 1.4 billion. Vaccination is one of the most effective public health interventions of modern times and a key action in fostering healthy ageing throughout the life-course. To promote wellbeing at all ages, global agendas including the WHO Immunization Agenda 2030, the UN Decade of Healthy Ageing and the World Health Organization (WHO) Global Report on Ageism outline strategic actions and guidance to help implement policies and programs. Yet, the linkages between healthy ageing, functional ability and adult vaccination are not substantively recognized or integrated as cross-cutting themes, which impacts operationalization into national immunization plans. When aligned and connected strategically, these agendas have potential to substantially contribute to policy change to prioritize life-course immunization and support the preservation of function at all stages of life. This article describes the intersecting goals and visions of these strategic agendas and identifies specific elements of overlap, which when connected, could strengthen the development of comprehensive and effective national immunization policies.
Language	English
Publishing date	2023-07-31
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	3076785-4
ISSN	2673-6217 ; 2673-6217
ISSN (online)	2673-6217
ISSN	2673-6217
DOI	10.3389/fragi.2023.1200397
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Article: An Unusual Case of Deep Vein Thrombosis and Concurrent Necrotizing Fasciitis Following a Fall.

Rohail, Muhammad U / Khan, Ayub / Maloof, Jane

Cureus

2023 Volume 15, Issue 1, Page(s) e33934

Abstract: A 74-year-old male patient presented to the emergency department following a fall with signs and symptoms consistent with right lower extremity (RLE) deep vein thrombosis (DVT) and non-specific skin changes. Further imaging confirmed the initial ... ...

Abstract	A 74-year-old male patient presented to the emergency department following a fall with signs and symptoms consistent with right lower extremity (RLE) deep vein thrombosis (DVT) and non-specific skin changes. Further imaging confirmed the initial diagnosis of DVT, and the patient was appropriately treated. However, his condition continued to deteriorate with worsening overlying skin changes, which prompted a computed tomography (CT) scan of his right femur without intravenous (IV) contrast. This revealed fluid tracking along the lateral compartment muscles, which raised suspicion of an abscess. Suspicion for necrotizing fasciitis (NF) was raised with a subsequent CT of the right femur with IV contrast that demonstrated a considerable increase in rim-enhancing fluid collections intramuscularly and extending into both the anterior and posterior compartments, likely correlating with increasing intermuscular abscesses. On imaging, no subcutaneous emphysema or gas accumulation was found, which is a common finding in NF. However, necrotic-appearing muscle was found on surgical debridement and wound cultures confirmed the diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) NF. The patient was then treated with appropriate IV antibiotics and was discharged to long-term inpatient wound care. Similar presentations of DVT and NF made a prompt diagnosis of NF difficult, and it highlights the need for further imaging to rule out NF when a patient has a confirmed diagnosis of DVT.
Language	English
Publishing date	2023-01-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.33934
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Personalizing Risk for Sudden Cardiac Death Among Patients With Dilated Cardiomyopathies: Moving Beyond Ejection Fraction With Genomics.

Khan, Sadiya S / Wilcox, Jane E

JAMA cardiology

2021 Volume 6, Issue 8, Page(s) 873–874

MeSH term(s)	Cardiomyopathy, Dilated/complications ; Cardiomyopathy, Dilated/genetics ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/etiology ; Genomics ; Humans ; Stroke Volume ; Ventricular Function, Left
Language	English
Publishing date	2021-05-24
Publishing country	United States
Document type	Editorial ; Comment
ISSN	2380-6591
ISSN (online)	2380-6591
DOI	10.1001/jamacardio.2021.1116
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Article: Subacute thyroiditis post-Pfizer-BioNTech mRNA vaccination for COVID-19.

Khan, Farooq / Brassill, Mary Jane

Endocrinology, diabetes & metabolism case reports

2021 Volume 2021

Abstract: Summary: There is emerging evidence of an association between COVID-19 vaccination and subacute thyroiditis. We present the case of a 42-year-old female healthcare worker who was diagnosed with subacute thyroiditis 4 days after receiving her second dose ...

Abstract	Summary: There is emerging evidence of an association between COVID-19 vaccination and subacute thyroiditis. We present the case of a 42-year-old female healthcare worker who was diagnosed with subacute thyroiditis 4 days after receiving her second dose of Pfizer-BioNTech vaccine. Her clinical course followed the classical pattern for thyroiditis with spontaneous return to euthyroidism at 6 months post-presentation. The autoimmune/inflammatory syndrome induced by adjuvants has been implicated as a cause of autoimmune conditions post-vaccination and is a potential mechanism for subacute thyroiditis in our case. Learning points: Subacute thyroiditis should be considered in all patients who receive any kind of vaccine for COVID-19 and subsequently develop symptoms or signs of hyperthyroidism or neck pain. Subacute thyroiditis is a self-limiting condition, and recognising it is important as no specific thyroid treatment (antithyroid drugs or thyroid hormone replacement) is necessary for most patients. The autoimmune/inflammatory syndrome induced by adjuvants may be an under-recognised cause of endocrinopathies and should particularly be considered post-vaccination.
Language	English
Publishing date	2021-12-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2785530-2
ISSN	2052-0573
ISSN	2052-0573
DOI	10.1530/EDM-21-0142
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Article ; Online: Financial Capability and Financial Well-Being Challenges and Vulnerabilities of Adults Living With Acquired Brain Injury: A Pilot Survey.

Engel, Lisa / Ewesesan, Roheema / Arowolo, Ibiyemi / Latulipe, Celine / Karpa, Jane / Khan, Mohammad N

Archives of rehabilitation research and clinical translation

2024 Volume 6, Issue 1, Page(s) 100324

Abstract: Objective: To describe the financial capability (FC) and financial well-being (FWB) of adults living with acquired brain injury (ABI) from a lived experience perspective.: Design: People living with ABI completed a 32-item and close others a 22-item ... ...

Abstract	Objective: To describe the financial capability (FC) and financial well-being (FWB) of adults living with acquired brain injury (ABI) from a lived experience perspective. Design: People living with ABI completed a 32-item and close others a 22-item anonymous survey using either online or print/mail-in options. Setting: Responses were collected from adults in the province of Manitoba (Canada) during August-October 2021. Participants: Respondents were adults (18+) living with ABI (n=38) or close others of ABI survivors (n=19). Adults living with ABI experienced traumatic brain injury (n=22; 58%), stroke (n=8; 21%), or other ABI mechanisms (n=8; 21%). Nineteen (50%) respondents with ABI were men, 17 (45%) were women, and 1 (2.5%) was nonbinary; 95% were more than 1-year post-ABI. Close others were spouses/partners, parents, other family, and paid caregivers. Three of the 19 close others self-reported as men and 16 as women. Interventions: n/a. Main outcome measures: n/a. Results: For key FC indicators, 13 (34%) people living with ABI felt their current knowledge and skills were insufficient, and 26 (70%) felt that ABI had affected their ability to make financial decisions or complete financial activities. Fourteen of the 19 close others have worried about the finance-related choices, skills, or behaviors of the person living with ABI, and 17 felt that ABI symptoms had affected the FC of the person living with ABI. For key FWB indicators, 22 (58%) adults living with ABI felt stressed or anxious about finances at least some of the time. Seventeen (45%) of the adults living with ABI reported having trouble making ends meet at least some of the time. Conclusions: Respondents reported FC limitations and FWB challenges for people living with ABI, which can be indicative of financial vulnerabilities and unmet needs. Future research should explore optimal ways to address these financial-related challenges after ABI.
Language	English
Publishing date	2024-02-02
Publishing country	United States
Document type	Journal Article
ISSN	2590-1095
ISSN (online)	2590-1095
DOI	10.1016/j.arrct.2024.100324
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Article ; Online: Prioritizing the primary prevention of heart failure: Measuring, modifying and monitoring risk.

Patel, Ruchi / Peesay, Tejasvi / Krishnan, Vaishnavi / Wilcox, Jane / Wilsbacher, Lisa / Khan, Sadiya S

Progress in cardiovascular diseases

2024 Volume 82, Page(s) 2–14

Abstract: With the rising incidence of heart failure (HF) and increasing burden of morbidity, mortality, and healthcare expenditures, primary prevention of HF targeting individuals in at-risk HF (Stage A) and pre-HF (Stage B) Stages has become increasingly ... ...

Abstract	With the rising incidence of heart failure (HF) and increasing burden of morbidity, mortality, and healthcare expenditures, primary prevention of HF targeting individuals in at-risk HF (Stage A) and pre-HF (Stage B) Stages has become increasingly important with the goal to decrease progression to symptomatic (Stage C) HF. Identification of risk based on traditional risk factors (e.g., cardiovascular health which can be assessed with the American Heart Association's Life's Essential 8 framework), adverse social determinants of health, inherited risk of cardiomyopathies, and identification of risk-enhancing factors, such as patients with viral disease, exposure to cardiotoxic chemotherapy, and history of adverse pregnancy outcomes should be the first step in evaluation for HF risk. Next, use of guideline-endorsed risk prediction tools such as Pooled Cohort Equations to Prevent Heart Failure provide quantification of absolute risk of HF based in traditional risk factors. Risk reduction through counseling on traditional risk factors is a core focus of implementation of prevention and may include the use of novel therapeutics that target specific pathways to reduce risk of HF, such as mineralocorticoid receptor agonists (e.g., fineronone), angiotensin-receptor/neprolysin inhibitors, and sodium glucose co-transporter-2 inhibitors. These interventions may be limited in at-risk populations who experience adverse social determinants and/or individuals who reside in rural areas. Thus, strategies like telemedicine may improve access to preventive care. Gaps in the current knowledge base for risk-based prevention of HF are highlighted to outline future research that may target approaches for risk assessment and risk-based prevention with the use of artificial intelligence, genomics-enhanced strategies, and pragmatic trials to develop a guideline-directed medical therapy approach to reduce risk among individuals with Stage A and Stage B HF.
MeSH term(s)	Humans ; United States ; Artificial Intelligence ; Heart Failure/diagnosis ; Heart Failure/epidemiology ; Heart Failure/prevention & control ; Risk Factors ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use ; Primary Prevention
Chemical Substances	Sodium-Glucose Transporter 2 Inhibitors
Language	English
Publishing date	2024-01-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	209312-1
ISSN	1873-1740 ; 1532-8643 ; 0033-0620
ISSN (online)	1873-1740 ; 1532-8643
ISSN	0033-0620
DOI	10.1016/j.pcad.2024.01.001
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Article: Futility considerations in surgical ethics.

Udwadia, Farhad R / Zhu, Jane / Khan, Haaris M / Das, Sunit

Annals of medicine and surgery (2012)

2023 Volume 85, Issue 1, Page(s) 1–5

Abstract: The topic of futility has been intensely debated in bioethical discourse. Surgical futility encompasses considerations across a continuum of care, from decision-making during initial triage, to the choice to operate or refrain from operating on the ... ...

Abstract	The topic of futility has been intensely debated in bioethical discourse. Surgical futility encompasses considerations across a continuum of care, from decision-making during initial triage, to the choice to operate or refrain from operating on the critically ill, to withdrawal of life-supporting care. Determinations over futility may result in discord between providers and patients or their families, who might insist that treatment be provided at all costs to sustain life. In this manuscript, we will explore some of the possible sources for and manifestations of these disputes, and describe approaches by which to resolve them. Part I will briefly address some of the reasons that families ask for life-sustaining measures against medical advice in the surgical setting. These include variable determinations of both the quality of life and the inherent value of life (stemming from religious, cultural, and personal beliefs). Part II will detail some general instances in which physicians and surgeons can override requests to provide futile treatment, namely: instances of resource scarcity, interventions which carry a high probability of harm, and those that carry significant moral distress. To conclude, Part III will provide concrete guidelines for navigating futility, making an argument for individual case-based communication models in surgical decision-making.
Language	English
Publishing date	2023-01-23
Publishing country	England
Document type	Editorial
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1097/MS9.0000000000000114
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Article ; Online: Management of conjunctivitis during the COVID-19 pandemic 2020.

Khan, Jane / Mack, Heather G

Australian journal of general practice

2020 Volume 49

Abstract: Conjunctivitis may be a feature of COVID-19, with tears containing SARS-CoV-2 virus, and a source of potential transmission via aerosols. ...

Abstract	Conjunctivitis may be a feature of COVID-19, with tears containing SARS-CoV-2 virus, and a source of potential transmission via aerosols.
Keywords	covid19
Language	English
Publishing date	2020-05-01
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2924889-9
ISSN	2208-7958 ; 2208-794X
ISSN (online)	2208-7958
ISSN	2208-794X
DOI	10.31128/AJGP-COVID-18
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Article ; Online: Are family medicine residents trained to counsel patients on physical activity? The Canadian experience and a call to action.

Thornton, Jane / Khan, Karim / Weiler, Richard / Mackie, Christopher / Petrella, Robert

Postgraduate medical journal

2023 Volume 99, Issue 1169, Page(s) 207–210

Abstract: Physical inactivity is a leading risk factor for non-communicable diseases (NCDs) and early mortality. Family physicians have an important role in providing physical activity counselling to patients to help prevent and treat NCDs. Lack of training on ... ...

Abstract	Physical inactivity is a leading risk factor for non-communicable diseases (NCDs) and early mortality. Family physicians have an important role in providing physical activity counselling to patients to help prevent and treat NCDs. Lack of training on physical activity counselling is a barrier in undergraduate medical education, yet little is known regarding physical activity teaching in postgraduate family medicine residency. We assessed the provision, content and future direction of physical activity teaching in Canadian postgraduate family medicine residency programs to address this data gap. Fewer than half of Canadian Family Medicine Residency Programme directors reported providing structured physical activity counselling education to residents. Most directors reported no imminent plans to change the content or amount of teaching. These results reflect significant gaps between the recommendations of WHO, which calls on doctors to prescribe physical activity, and the current curricular content and needs of family medicine residents. Almost all directors agreed that online educational resources developed to assist residents in physical activity prescription would be beneficial. By describing the provision, content and future direction of physical activity training in family medicine, physicians and medical educators can develop competencies and resources to meet this need. When we equip our future physicians with the necessary tools, we can improve patient outcomes and do our part to reduce the global epidemic of physical inactivity and chronic disease.
MeSH term(s)	Humans ; Family Practice ; Canada ; Physicians, Family ; Educational Status ; Exercise ; Noncommunicable Diseases
Language	English
Publishing date	2023-05-24
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1136/postgradmedj-2021-140829
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