Search

Your search keyword '"Skinner, Stewart"' showing total 12 results
Start Over Author "Skinner, Stewart" Search Limiters Available in Library Collection
12 results on '"Skinner, Stewart"'

4. Colorectal Surgery in Critically Unwell Patients: A Multidisciplinary Approach

Author

Subramaniam, Ashwin, Wengritzky, Robert, Skinner, Stewart, Shekar, Kiran, Subramaniam, Ashwin, Wengritzky, Robert, Skinner, Stewart, and Shekar, Kiran

Abstract

A proportion of patients require critical care support following elective or urgent colorectal procedures. Similarly, critically ill patients in intensive care units may also need colorectal surgery on occasions. This patient population is increasing in some jurisdictions given an aging population and increasing societal expectations. As such, this population often includes elderly, frail patients or patients with significant comorbidities. Careful stratification of operative risks including the need for prolonged intensive care support should be part of the consenting process. In high-risk patients, especially in setting of unplanned surgery, treatment goals should be clearly defined, and appropriate ceiling of care should be established to minimize care that is not in the best interest of the patient. In this article we describe approaches to critically unwell patients requiring colorectal surgery and how a multidisciplinary approach with proactive intensive care involvement can help achieve the best outcomes for these patients.

Published
2022

7. The effect of dried distillers grains with solubles on swine ration choice and environmental quality

Author

Skinner, Stewart, Weersink, Alfons, and De Lange, Kees

Subjects
solubles, manure composition, dried distillers grains, Ontario swine producers, feed costs, health care economics and organizations
Abstract

This study examines how the inclusion of dried distillers grains with solubles (DDGS) in rations for Ontario swine producers impacts the cost of feeding swine and the cost of meeting environmental regulations associated with an alteration in manure composition. This study focuses on the grower finisher phase of hog production. Using a least cost blending model, it was found that DDGS lowers feed costs by approximately 12% depending on the growth phase through the substitution of DDGS for energy, protein, and phosphorus. The inclusion of DDGS increase the nitrogen and phosphorus content of the manure. For small farms not subject to the Ontario Nutrient Management Act (NMA) or for a large farms with sufficient land base to spread their manure. The increase nutrient content of organic fertilizer lowers the need and thus the cost of inorganic fertilizer. The cost savings stemming from reduced inorganic fertilizer use is significantly less than the feed cost savings. There is the potential for abatement costs for large farmer facing a stocking density restriction however this is dependant on the location of the farm and its size.

Published
2010

12. Randomized Trial of Surgically-Induced Weight Loss for Obese Subjects with Type-2 Diabetes.

Author

Dixon, John B., O'brien, Paul E., Playfair, Julie, Prioetto, Joe, Schachter, Linda M., Skinner, Stewart, Chapman, Leon, and Anderson, Margaret

Subjects
WEIGHT loss, BARIATRIC surgery, OVERWEIGHT persons, TYPE 2 diabetes, RANDOMIZED controlled trials
Abstract

Background: Type-2 diabetes is strongly driven by obesity. Observational studies suggest that weight loss through bariatric surgery is more effective than conventional therapy for the management of type-2 diabetes, but no randomized controlled trial has been performed. Methods: We conducted a 2-year randomized controlled trial involving 60 obese (BMI > 30 and < 40 kg/m2) subjects with recently diagnosed (<2years) typo-2 diabetes. Subjects drawn from the general community were randomly allocated to either a program of conventional diabetes therapy with an intensive lifestyle change to induce weight loss or had substantial weight loss induced by the placement of a laparoscopic adjustable gastric band (LAGB; LAP-BAND®, Allergan Health) in addition to conventional care. The intensity of programs was similar. Key outcome measures were diabetes remission (fasting plasma glucose <7mmol/l, plus HbA1c <6.2% while taking no hypoglycaemic drug therapy or insulin), HbA1c levels, indirect measures of insulin resistance, and presence of metabolic syndrome. Results: At 2 years, the LAGB group and conventional groups had lost mean (SD) of 20.7 (8.6) % and 1.7 (5.2) % of weight respectively (P <0.001). Remission of diabetes was achieved by 22 of 29 (76%) the LAGB, and 4 of 26 (15%) of the conventional 2-year completers (p<0.001). Weight loss was the major driver of remission (R2 =0.46, p<0.001), with a 13% weight loss cutoff providing an 85% sensitivity and 86% specificity for remission. HbA1c levels fell 22.5 (11.6) % in the LAGB and 5.4 (15.2) % in the conventionally treated groups. The surgical group also had greater improvements in fasting plasma glucose, insulin, triglycerides and HDL-cholesterol. The metabolic syndrome was present in 29 of 30 in each group initially and in 8 of 29 LAGB and 22 of 26 conventional groups at 2 years. There were no serious complications in either treatment group. Conclusions: There is a direct relationship between weight loss and remission of type 2 diabetes in obese subjects. Substantial weight loss induced by LAGB is associated with a significantly better outcome than conventional therapy. LAGB placement should be considered when planning a treatment program for obese subjects diagnosed with type-2 diabetes. [ABSTRACT FROM AUTHOR]

Published
2007

Catalog

Books, media, physical & digital resources
See catalog results