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1. The unrestricted global effort to complete the COOL trial

Author

Andrew W. Kirkpatrick, Federico Coccolini, Matti Tolonen, Samuel Minor, Fausto Catena, Emanuel Gois, Christopher J. Doig, Michael D. Hill, Luca Ansaloni, Massimo Chiarugi, Dario Tartaglia, Orestis Ioannidis, Michael Sugrue, Elif Colak, S. Morad Hameed, Hanna Lampela, Vanni Agnoletti, Jessica L. McKee, Naisan Garraway, Massimo Sartelli, Chad G. Ball, Neil G. Parry, Kelly Voght, Lisa Julien, Jenna Kroeker, Derek J. Roberts, Peter Faris, Corina Tiruta, Ernest E. Moore, Lee Anne Ammons, Elissavet Anestiadou, Cino Bendinelli, Konstantinos Bouliaris, Rosemarry Carroll, Marco Ceresoli, Francesco Favi, Angela Gurrado, Joao Rezende-Neto, Arda Isik, Camilla Cremonini, Silivia Strambi, Georgios Koukoulis, Mario Testini, Sandy Trpcic, Alessandro Pasculli, Erika Picariello, Fikri Abu-Zidan, Ademola Adeyeye, Goran Augustin, Felipe Alconchel, Yuksel Altinel, Luz Adriana Hernandez Amin, José Manuel Aranda-Narváez, Oussama Baraket, Walter L. Biffl, Gian Luca Baiocchi, Luigi Bonavina, Giuseppe Brisinda, Luca Cardinali, Andrea Celotti, Mohamed Chaouch, Maria Chiarello, Gianluca Costa, Nicola de’Angelis, Nicolo De Manzini, Samir Delibegovic, Salomone Di Saverio, Belinda De Simone, Vincent Dubuisson, Pietro Fransvea, Gianluca Garulli, Alessio Giordano, Carlos Gomes, Firdaus Hayati, Jinjian Huang, Aini Fahriza Ibrahim, Tan Jih Huei, Ruhi Fadzlyana Jailani, Mansoor Khan, Alfonso Palmieri Luna, Manu L. N. G. Malbrain, Sanjay Marwah, Paul McBeth, Andrei Mihailescu, Alessia Morello, Francesk Mulita, Valentina Murzi, Ahmad Tarmizi Mohammad, Simran Parmar, Ajay Pak, Michael Pak-Kai Wong, Desire Pantalone, Mauro Podda, Caterina Puccioni, Kemal Rasa, Jianan Ren, Francesco Roscio, Antonio Gonzalez-Sanchez, Gabriele Sganga, Maximilian Scheiterle, Mihail Slavchev, Dmitry Smirnov, Lorenzo Tosi, Anand Trivedi, Jaime Andres Gonzalez Vega, Maciej Waledziak, Sofia Xenaki, Desmond Winter, Xiuwen Wu, Andee Dzulkarnean Zakaria, and Zaidi Zakaria

Subjects
Intraperitoneal sepsis, Septic shock, Peritonitis, Open abdomen, Multiple organ dysfunction, Laparotomy, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. Methods The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. Discussion OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of “damage control”; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. Trial registration: National Institutes of Health ( https://clinicaltrials.gov/ct2/show/NCT03163095 ).

Published
2023
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2. Protecting study participants in emergency research: is community consultation before trial commencement enough?

Author

Adic Perez, Sandro Rizoli, Blair Henry, Sandy Trpcic, and Barto Nascimento

Subjects
Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Background This article presents the results of a community consultation (CC) process completed in Toronto, Ontario, using a random digit dialling technique, on the attitudes and perceptions of the public toward the use of exception from informed consent when conducting emergency research involving the use of massive blood transfusions.Methods In 2012, our hospital conducted a CC, using a random digit dialling technique, to elicit the attitudes and perceptions of the public toward the use of an exemption from informed consent for an upcoming clinical trial. A total of 500 participants from high violent crime areas were interviewed as part of this consultation.Results The response rate for the telephone survey was 54%. Participants indicated a personal acceptance rate of 76%, acceptance of the justification for the exception to consent at 81%, thatthe study would meet the best interest of patients and the community at 81% and that youth (between 15 and 18 years) could be enrolled at 71%. When offered, no participant requested an opt-out wrist band to avoid being enrolled in this study.Discussion The use of violent crime neighborhoods to locate at risk communities was not effective in identifying the appropriate community of interest for this study. Though only representing a small subpopulation from a large Canadian city, the attitudes noted here is suggestive that Canadians may have a similar level of acceptance as the US based on published studies. However, given the resources needed to undertake this process and that in the end it did not elicit any useful feedback or recommendations for enhancing the safety of participants, the future use of phone surveys as a means of engaging communities should be reconsidered.Level of evidence (Level V) This is a retrospective subanalysis of a CC using a randomized phone dialling technique from a site prior to the start of the Pragmatic Randomized Optimal Platelet and Plasma Ratios Trial. The CC was not designed specifically for research purposes and as such reflect only a case study from a single center.Trial registration number Pre-result, NCT01545232.

Published
2017
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3. Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial

Author

Thomas Geng, Alice Piccinini, Joshua Farnsworth, Sarah A. Moore, Katelyn Young, Kenji Inaba, Vaidehi Agrawal, Kelly L. Lightwine, Donald H. Jenkins, Priya Prakash, Sandy Trpcic, Tim Schwartz, Mark J. Seamon, Forrest O. Moore, Jeanne Lee, Kaushik Mukherjee, Brittany Smoot, Christopher M. Dodgion, Tatiana Cardenas, Thomas Schroeppel, Jeanette G. Ward, Joao B Rezende-Neto, David Skarupa, Brian Gooley, Matthew M. Carrick, James M. Haan, David Lapham, Julie A Dunn, Jennifer Burris, Sarrina Shraga, Michel J Sabra, Raul Coimbra, Jeremy W. Cannon, and Jeffrey Wild

Subjects
Adult, Male, medicine.medical_specialty, Thoracic Injuries, Thoracostomy, Critical Care and Intensive Care Medicine, Risk Assessment, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Trauma Centers, Interquartile range, medicine, Humans, Prospective Studies, Prospective cohort study, Hemothorax, business.industry, 030208 emergency & critical care medicine, Pneumonia, Odds ratio, Length of Stay, Middle Aged, medicine.disease, United States, Confidence interval, Surgery, Logistic Models, Treatment Outcome, Chest Tubes, Multivariate Analysis, Drainage, Female, Tomography, X-Ray Computed, business
Abstract

BACKGROUND The natural history of traumatic hemothorax (HTX) remains unclear. We aimed to describe outcomes of HTX following tube thoracostomy drainage and to delineate factors that predict progression to a retained hemothorax (RH). We hypothesized that initial large-volume HTX predicts the development of an RH. METHODS We conducted a prospective, observational, multi-institutional study of adult trauma patients diagnosed with an HTX identified on computed tomography (CT) scan with volumes calculated at time of diagnosis. All patients were managed with tube thoracostomy drainage within 24 hours of presentation. Retained hemothorax was defined as blood-density fluid identified on follow-up CT scan or need for additional intervention after initial tube thoracostomy placement for HTX. RESULTS A total of 369 patients who presented with an HTX initially managed with tube thoracostomy drainage were enrolled from 17 trauma centers. Retained hemothorax was identified in 106 patients (28.7%). Patients with RH had a larger median (interquartile range) HTX volume on initial CT compared with no RH (191 [48-431] mL vs. 88 [35-245] mL, p = 0.013) and were more likely to be older with a higher burden of thoracic injury. After controlling for significant differences between groups, RH was independently associated with a larger HTX on presentation, with a 15% increase in risk of RH for each additional 100 mL of HTX on initial CT imaging (odds ratio, 1.15; 95% confidence interval, 1.08-1.21; p < 0.001). Patients with an RH also had higher rates of pneumonia and longer hospital length of stay than those with successful initial management. Retained hemothorax was also associated with worse functional outcomes at discharge and first outpatient follow-up. CONCLUSION Larger initial HTX volumes are independently associated with RH, and unsuccessful initial management with tube thoracostomy is associated with worse patient outcomes. Future studies should use this experience to assess a range of options for reducing the risk of unsuccessful initial management. LEVEL OF EVIDENCE Therapeutic/care management study, level III.

Published
2020
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4. Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients: Secondary Analysis of the PROPPR Trial

Author

Allison R. Jones, Rakesh P. Patel, Marisa B. Marques, John P. Donnelly, Russell L. Griffin, Jean-Francois Pittet, Jeffrey D. Kerby, Shannon W. Stephens, Stacia M. DeSantis, John R. Hess, Henry E. Wang, John B. Holcomb, Charles E. Wade, Deborah J. del Junco, Erin E. Fox, Nena Matijevic, Jeanette Podbielski, Angela M. Beeler, Barbara C. Tilley, Sarah Baraniuk, Hongjian Zhu, Joshua Nixon, Roann Seay, Savitri N. Appana, Hui Yang, Michael O. Gonzalez, Lisa Baer, Yao-Wei W. Wang, Brittany S. Hula, Elena Espino, An Nguyen, Nicholas Pawelczyk, Kisha D. Arora-Nutall, Rishika Sharma, Jessica C. Cardenas, Elaheh Rahbar, Tyrone Burnett, David Clark, Gerald van Belle, Susanne May, Brian Leroux, David Hoyt, Judy Powell, Kellie Sheehan, Alan Hubbard, Adam P. Arkin, Jeanne Callum, Bryan A. Cotton, Laura Vincent, Timothy Welch, Tiffany Poole, Evan G. Pivalizza, Sam D. Gumbert, Yu Bai, James J. McCarthy, Amy Noland, Rhonda Hobbs, Eileen M. Bulger, Patricia Klotz, Lindsay Cattin, Keir J. Warner, Angela Wilson, David Boman, Nathan White, Andreas Grabinsky, Jennifer A. Daniel-Johnson, Mitchell J. Cohen, Rachael A. Callcut, Mary Nelson, Brittney Redick, Amanda Conroy, Marc P. Steurer, Preston C. Maxim, Eberhard Fiebig, Joanne Moore, Eireen Mallari, Peter Muskat, Jay A. Johannigman, Bryce R.H. Robinson, Richard D. Branson, Dina Gomaa, Christopher Barczak, Suzanne Bennett, Patricia M. Carey, Christopher N. Miller, Helen Hancock, Carolina Rodriguez, Kenji Inaba, Jay G. Zhu, Monica D. Wong, Michael Menchine, Kelly Katzberg, Sean O. Henderson, Rodney McKeever, Ira A. Shulman, Janice M. Nelson, Christopher W. Tuma, Cheryl Y. Matsushita, Thomas M. Scalea, Deborah M. Stein, Cynthia K. Shaffer, Christine Wade, Anthony V. Herrera, Seeta Kallam, Sarah E. Wade, Samuel M. Galvagno, Magali J. Fontaine, Janice M. Hunt, Rhonda K. Cooke, Timothy C. Fabian, Jordan A. Weinberg, Martin A. Croce, Suzanne Wilson, Stephanie Panzer-Baggett, Lynda Waddle-Smith, Sherri Flax, Karen J. Brasel, Pamela Walsh, David Milia, Allia Nelson, Olga Kaslow, Tom P. Aufderheide, Jerome L. Gottschall, Erica Carpenter, Terence O’Keeffe, Laurel L. Rokowski, Kurt R. Denninghoff, Daniel T. Redford, Deborah J. Novak, Susan Knoll, Patrick L. Bosarge, Albert T. Pierce, Carolyn R. Williams, Martin A. Schreiber, Jennifer M. Watters, Samantha J. Underwood, Tahnee Groat, Craig Newgard, Matthias Merkel, Richard M. Scanlan, Beth Miller, Sandro Rizoli, Homer Tien, Barto Nascimento, Sandy Trpcic, Skeeta Sobrian-Couroux, Marciano Reis, Adic Pérez, Susan E. Belo, Lisa Merkley, and Connie Colavecchia

Subjects
Adult, Male, medicine.medical_specialty, Critical Illness, Logistic regression, law.invention, 03 medical and health sciences, 0302 clinical medicine, Trauma Centers, Randomized controlled trial, law, Secondary analysis, Internal medicine, Odds Ratio, medicine, Humans, Blood Transfusion, Hospital Mortality, 030212 general & internal medicine, Adverse effect, business.industry, 030208 emergency & critical care medicine, Odds ratio, Middle Aged, Revised Trauma Score, Confidence interval, Blood Preservation, Emergency Medicine, Injury Severity Score, Female, business
Abstract

Study objective The transfusion of older packed RBCs may be harmful in critically ill patients. We seek to determine the association between packed RBC age and mortality among trauma patients requiring massive packed RBC transfusion. Methods We analyzed data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Subjects in the parent trial included critically injured adult patients admitted to 1 of 12 North American Level I trauma centers who received at least 1 unit of packed RBCs and were predicted to require massive blood transfusion. The primary exposure was volume of packed RBC units transfused during the first 24 hours of hospitalization, stratified by packed RBC age category: 0 to 7 days, 8 to 14 days, 15 to 21 days, and greater than or equal to 22 days. The primary outcome was 24-hour mortality. We evaluated the association between transfused volume of each packed RBC age category and 24-hour survival, using random-effects logistic regression, adjusting for total packed RBC volume, patient age, sex, race, mechanism of injury, Injury Severity Score, Revised Trauma Score, clinical site, and trial treatment group. Results The 678 patients included in the analysis received a total of 8,830 packed RBC units. One hundred patients (14.8%) died within the first 24 hours. On multivariable analysis, the number of packed RBCs greater than or equal to 22 days old was independently associated with increased 24-hour mortality (adjusted odds ratio [OR] 1.05 per packed RBC unit; 95% confidence interval [CI] 1.01 to 1.08): OR 0.97 for 0 to 7 days old (95% CI 0.88 to 1.08), OR 1.04 for 8 to 14 days old (95% CI 0.99 to 1.09), and OR 1.02 for 15 to 21 days old (95% CI 0.98 to 1.06). Results of sensitivity analyses were similar only among patients who received greater than or equal to 10 packed RBC units. Conclusion Increasing quantities of older packed RBCs are associated with increased likelihood of 24-hour mortality in trauma patients receiving massive packed RBC transfusion (≥10 units), but not in those who receive fewer than 10 units.

Published
2019
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5. Elevated Syndecan-1 after Trauma and Risk of Sepsis: A Secondary Analysis of Patients from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial

Author

Albert Pierce, Roann Seay, David Boman, David E. Clark, Mitchell J. Cohen, Christopher W. Tuma, John B. Holcomb, Connie Colavecchia, Shannon W. Stephens, Deborah J. Novak, Evan G. Pivalizza, Richard D. Branson, Sarah E. Wade, Angela M. Beeler, Suzanne Bennett, Amanda S. Conroy, Eireen Mallari, Bryan A. Cotton, Kenji Inaba, Eberhard W. Fiebig, Lillian S. Kao, An Nguyen, Yu Bai, Karen J. Brasel, Sean O. Henderson, Kisha D. Arora-Nutall, Savitri N. Appana, Suzanne Wilson, Elaheh Rahbar, Tiffany Poole, David Milia, Adic Pérez, Skeeta Sobrian-Couroux, Lisa A. Baer, Keir J. Warner, Deborah M. Stein, Matthias Merkel, Magali J. Fontaine, Olga Kaslow, Monica D. Wong, Tahnee Groat, Dina Gomaa, Tyrone Burnett, Samantha J. Underwood, Lindsay Cattin, Amy Noland, Janice M. Hunt, Marisa B. Marques, Deborah J. del Junco, Henry E. Wang, Rhonda Hobbs, Eileen M. Bulger, Adam P. Arkin, Sam D. Gumbert, Elena Espino, Kelly Katzberg, Carolyn Williams, Marciano Reis, Martin A. Schreiber, Samuel M. Galvagno, Lisa Merkley, Christopher Barczak, Richard M. Scanlan, Allia Nelson, Rachael A. Callcut, John R. Hess, Thomas M. Scalea, Patrick L. Bosarge, Kellie Sheehan, Yao-Wei Willa Wang, Patricia Klotz, Marc P. Steurer, Nena Matijevic, Angela Wilson, Cynthia K. Shaffer, Jay A. Johannigman, Charles E. Wade, Preston C. Maxim, James J. McCarthy, Rodney McKeever, Jeanette M. Podbielski, Jean-Francois Pittet, Tom P. Aufderheide, Jordan A. Weinberg, Nathan J. White, Lynda Waddle-Smith, Peter Muskat, Jay G. Zhu, Susan E. Belo, Helen Hancock, Stephanie Panzer-Baggett, Craig D. Newgard, Jessica C. Cardenas, Sandro Rizoli, Judy Powell, Cheryl Y. Matsushita, Susanne May, Jennifer M. Watters, Seeta Kallam, Sandy Trpcic, Daniel T. Redford, Homer Tien, Sherri Flax, Laura Vincent, Pamela Walsh, Patricia M. Carey, Carolina Rodriguez, Christopher N. Miller, Erica Carpenter, Brittany S. Hula, Erika Gonzalez Rodriguez, David B. Hoyt, Ronald Chang, Joshua Nixon, Gerald van Belle, Mary F. Nelson, Ira A. Shulman, Jerome L. Gottschall, Nicholas Pawelczyk, Barto Nascimento, Erin E. Fox, Hongjian Zhu, Michael O. Gonzalez, Joanne Moore, Jennifer A. Daniel-Johnson, Brian G. Leroux, Janice M. Nelson, Anthony V. Herrera, Timothy J. Welch, Jeanne Callum, Terence O'Keeffe, Rhonda K. Cooke, Susan Knoll, Timothy C. Fabian, Bryce R.H. Robinson, Christine Wade, Andreas Grabinsky, Laurel L. Rokowski, Jeffrey D. Kerby, Alan Hubbard, Brittney J. Redick, Shuyan Wei, Hui Yang, Barbara C. Tilley, Sarah Baraniuk, Martin A. Croce, Kurt R. Denninghoff, Beth Miller, Rishika Sharma, and Michael Menchine

Subjects
Adult, Male, Blood transfusion, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Article, law.invention, Sepsis, 03 medical and health sciences, Plasma, 0302 clinical medicine, Injury Severity Score, Randomized controlled trial, law, Interquartile range, Medicine, Humans, Platelet, Blood Transfusion, Retrospective Studies, Univariate analysis, business.industry, Platelet Count, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, medicine.disease, Hospitalization, Logistic Models, Anesthesia, Wounds and Injuries, Surgery, Female, Syndecan-1, business
Abstract

Endotheliopathy of trauma is characterized by breakdown of the endothelial glycocalyx. Elevated biomarkers of endotheliopathy, such as serum syndecan-1 (Synd-1) ≥ 40 ng/mL, have been associated with increased need for transfusions, complications, and mortality. We hypothesized that severely injured trauma patients who exhibit elevated Synd-1 levels shortly after admission have an increased likelihood of developing sepsis.We analyzed a subset of patients from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial who survived at least 72 hours after hospital admission, and we determined elevated Synd-1 levels (≥ 40 ng/mL) 4 hours after hospital arrival. Sepsis was defined a priori as meeting systemic inflammatory response criteria and having a known or suspected infection. Univariate analysis was performed to identify variables associated with elevated Synd-1 levels and sepsis. Significant variables at a value of p0.2 in the univariate analysis were chosen by purposeful selection and analyzed in a mixed effects multivariate logistic regression model to account for the 12 different study sites.We included 512 patients. Of these, 402 (79%) had elevated Synd-1 levels, and 180 (35%) developed sepsis. Median Synd-1 levels at 4 hours after admission were 70 ng/dL (interquartile range [IQR] 36 to 157 ng/dL) in patients who did not develop sepsis, and 165 ng/dL [IQR 67 to 336 ng/dL] in those who did (p0.001). Adjusting for treatment arm and site, multivariable analyses revealed that elevated Synd-1 status, Injury Severity Score (ISS), and total blood transfused were significantly associated with an increased likelihood of developing sepsis.Elevated Synd-1 levels 4 hours after admission in severely injured adult trauma patients who survived the initial 72 hours after hospital admission are associated with subsequent sepsis.

Published
2018

6. Trauma Association of Canada Annual Scientific Meeting, Westin Calgary Calgary, Alberta, Apr. 10–11, 2015

Author

Nick Nash, Khaled Almansoori, Kaitlyn Gillard, Amber Menezes, Joao Rezende Neto, Jagadish Rao, Mostafa Alhabboubi, Alex Di Battista, Paul McBeth, Bernard Lawless, S. Logsetty, Candis Kokoski, Melissa McGowan, Barto Nascimento, Fadi Hamadani, Deng Mapiour, Annette Marie Pascual Marrero, Anam Younus, Jaimini Thakore, Alanna Keenan, Tanya Charyk Stewart, Jamie Appel, Sarah Curtis, Salman Khan, Philippe Dufrsne, Tara Grenier, Dennis Kim, Donna Collins, Carlos Semprun, Jessica Mckee, Jessica McKee, Alreem Al Hinai, Safiya Al-Masrouri, Melissa Waggott, Asim Alam, Desiree Young, Heather Knight, Fatma Alhinai, Meagan Mucciaccio, Jane Harrington, Benoit Phelan, Arimie Min, Aziza Al Rawahi, Annie LaLande, Saptarshi Biswas, Muhamad Elhusseini Hassan, Brad Moffat, Saeed Alshlwi, Homer Tien, Alghalya Almaawali, Deanna Fong, Eiman Zargaran, Zahra Hussein, Shahram Yazdani, Madiba Omar, Pedro Padim, David Bracco, Omar Bekdache, Ruben Peralta, Niv Sne, M. Firdaus Mydeen, Michele Masson-Trottier, Hassan Al-Thani, Colin Rouse, Leanne Hewitson, Ann Hogan, Ian Watson, Allison Chisholm, Eileen Bernal, Monica Hinton, Natalie Yanchar, Kaitlin Cyr, Sami Hossri, Lawrence Gillman, Sean Bennett, Karen Bailey, Annette Marie Pascual Marrer, Irada Ibrahim-Zada, Muhammad Younus, Isabelle Hardy, Nina Neuhaus, Nicholas Sowers, N. Karthik Divya Charan, Julien Clement, Michael Driedger, Robert Green, Christopher Lee, Carolyn Snider, John Kortbeek, Paul Engels, Simon Taylor, Matthew Laviolette, Andrew Kirkpatric, Andrew Kirkpatrick, Samir Faidim, Farid Muakkassa, Brett Mador, Jameel Ali, Patrick Murphy, Luis Teodoro Da Luz, Kelly Vogt, Abdulaziz Alali, Rachel Rae, Nancy Tze, Maher Matar, Teegwende Valerie Porgo, Pier-Alexandre Tardif, Anissa Addioui, Sherry MacGillivray, Timothy Rice, Abdul Mohsin Babsail, Patrick Goeres, Shelina Babul, Jimmy Xiao, Morgan Schellenberg, Lynn Moore, Precilla Veigas, Brittany Greene, Joanne Banfield, Chad Ball, Derek Roberts, Gilgamesh Eamer, Daniel Roizblatt, AbdulMohsin Babsail, David Benyayer, Christian Malo, Dan Deckelbaum, Kosar Khwaja, Andrew Beckett, Tarek Razek, Paola Fata, Ioana Bratu, Jenne Craig, Peter Faris, Corina Tiruta, Paul McBeath, Paul Kubes, Christoher Doig, Jacinthe Lampron, Sandro Rizoli, Jeannie Callum, François Lauzier, Simon Berthelot, Henry Thomas Stelfox, Richard Simons, Gilles Bourgeois, Kent Stevens, Amber Mehmood, Subash Gautam, Imran Zafarm, Anne Sorvari, Rasheed Adam, Hari Ondiveeran, Henry Bedaysie, Ernest Ali, Susan Briggs, Crystal Wilson, Helen Lee Robertson, Frederick Zeiler, Bertram Unger, Badar Alhadhrami, Muhamad Elhusseini, Mostafa Alhalbboubi, Mohamed Abdulla, Talat Chughtai, Jeffrey Rice, Susan Reid, Jennifer Li, Frank Baillie, Andrea Somers, Traci Robinson, Andrea Boone, Naminder Sandhu, Ian Wishart, Dickens Saint-Vil, Louis Crevier, Marianne Beaudinn, Lynne Moore, Andre Lavoie, Leon Nshimyumukiza, Alexis Turgeon, Jean Lapointe, Brahim Cisse, Julie Duplantie, Alexandre Tran, Olivia Margie, Jean-Denis Yelle, Giuseppe Pagliarello, Hasham Bakry, Ali Malla, Samir Faidi, Angela Coates, Antonio Capone Neto, Leo Dante DaCosta, Kenji Inaba, Shawn Rhind, William Leeper, Tanya Charyk-Stewart, Richard Malthaner, Daryl Gray, Neil Parry, Carlos Eduardo Semprum Pena, Avery Nathens, Niroshan Sothilingam, Brandon Batey, Anne Sovari, Sharon Henry, Robert Marley, Ann Salvator, Zachary Yetmar, Ileana Horattas, Daniel Erck, Bret A. Landry, Michael Patlas, Anthony LaPorta, Heather Wright-Beatty, Jocelyn Keillorn, Sue Brien, John Wong, Deon Louw, Ian McKee, Nova Panebianco, RJ Parfitt, Douglas Hamilton, Bill Sevcik, Jamie Boyd, Mete Erdogan, Sandy Widder, Michael Butler, Nelofar Kureshi, Kate Martin, Charles Fasanya, Nicole Barrett, Paola Camorlinga, Stephen Quigley, Nelofar Kureschi, S. Longsetty, Depeng Jian, Dean Fergusson, Alex Turgeon, Lauralyn McIntyre, George Kovacs, Donald Griesdale, Shelley McLeod, Michelle Klingel, Kristine Van Aarsen, Jeffrey Franc, Michael Peddle, Arjun Gupta, Bryan Wells, Elijah Dixon, Krubaganesh Rajaram, Patrick Froese, Denise Torres, Kenneth Widom, DiAnne Leonard, Susan Baro, James Dove, Joseph Blansfield, Mohsen Shabahang, Shelly Timmons, Jeffrey Wild, Steven McFaull, Marianne Beaudin, Randall Friese, Peter Rhee, Gary Veercruysse, Bellal Joseph, Alice Wang, Helena Pelletier, Diana Calligan, Aysah Amath, Peter Brindley, Damian Paton-Gay, Jason Park, Adam Cheng, Angelo Mikrogianakis, Sonny Dhanani, Farhan Bhanji, Amina Lalani, Fayez Al-Harthi, Sanjay Mehta, Steven Wolf, Brett Arnoldo, Karen Kowalske, Herb Phelan, Susan Benjamin, Shelley Woodford, Richard Louis, Erik St. Pierre, Paul Atkinson, Jay Mekwan, Glenn Verheul, David Lewis, Jefferson Hayre, James French, Jacqueline Fraser, Beth Sealy, Ayman El-Menyar, R. Consunji, Ahmad Zarour, H. Abdulrahman, A. Parchani, Catherine-Edith Cyr, Caroline Arbour, Nadia Gosselin, Karine Marcotte, Antonia Johnson, Edward Passos, Jerome Fan, Draga Jichici, Andew Healey, Ayman El Menyar, H. Shaltout, H. Abdi, H. Tarakieh, H Abdulrahman, A. Zarour, Hassan Al Thani, Respicious Boniface, Lawrence Museru, Annie Lalande, Judith Marcoux, Mohammed Maleki, Sergio Canestrini, Mazin Tuma, Amanda McFarlan, Caio Cesar Gabrielli Belmont, Philippe Dufresne, Paule Lessard Bonaventure, Nasira Lakha, Damon Ramsey, Morad Hameed, Andrew Nicol, Richard Spence, Pradeep Navsaria, Heather Wong, Rociio Martinez, Erin Shangguan, Jenn Asselstine, Fred Brenneman, Jeremy Grush, Mahvareh Ahghari, Russell MacDonald, Sameena Iqbal, Nancy Fong, Jeremy Grushka, Lyne St-Laurent, Eleanor Eckert, Victoria Munthali, Christopher Doig, Adic Perez, Pang Shek, Richard Grodecki, Henry Peng, Tushar Pishe, Joanna Middeton, Alyssa Penney, Cathie Hedges, Adam Dukelow, Paul Bradford, Donald Levy, Chip Doig, Sukhi Lally, Alma Rados, Anita Williams, Christine Vis, Ryan Perlman, Jocelyn Keillor, Naisan Garraway, Tyler Smith, Dennis Filips, Ian Mckee, Melanie Bouclin, Ian Atkinson, Gloria Kim, Brant Putnam, Chris de Virgilio, James Maciel, Angela Neville, Fred Bongard, Scott Bricker, David Plurad, Jeffrey Odenbach, Rebecca Grokiert, Cathy Falconer, Craig Courchesne, Sandra Campbell, Amanda Newton, Lindy VanRiper, Heidi Wilkes, Abbeir Hussein, Eva Alisc, Claire Hoysted, Markus Landolt, Niccolo Parri, Mark Lytle, Rachel Stanley, Anupam Kharbanda, Franz Babl, Nancy Kassam-Adams, Kim Fichter, Yvonne Harris, Desiree Nahachewsky, Tim Fleiszer, Douglas D. Fraser, Barbara Klassen, Yvonne Briereley, Jennifer McMillan, Scott Robinson, Dori Williams, Haytham Qosa, Sandy Trpcic, Neill Adhikari, Francois Lamontagne, Annabelle Cumyn, Karen Burns, Damon Scales, Mark Duffett, Blair Henry, Tanya Zakrison, Aynsley Young, David MacKinnon, Katie Dainty, Jodi Denbok, Melissa Mcgowan, Alexander Blight, Alicia Bakker, Lee Barratt, Elizabeth Butorac, Karen Gaunt, J. Gawaziuk, Stephanie Lim, D. Chateau, Sazzadul Khan, M. Doupe, J. Sareen, Mypinder Sekhon, Nadine Schuurman, Peter Dodek, Najib Ayas, Erik Vu, Sayed Hassan, Adi Perez, Jane Topolovec-Vranic, null Kenjilnaba, Leo Dante Da Costa, Andrew Baker, Kish Lyster, AbdulMohsin Baabsail, Najma Ahmed, Ori Rotstein, Zu-Hua Gao, Minh Duong, Dominique Shum-Tim, Emanuelle Abreu, Carla Machado, Mario Pastore Neto, Joao Godinho, Athos Bernardes, Nicholas Fry, Michael Liang, Michael Bleszynski, Andrzej Buczkowski, Robert Martindale, David Evans, Shannon Fraser, Mary Stephens, Lisa Knowlton, Dena Almansorri, Vincent Mutiso, Abdullah Saleh, Harvey Hawes, Jessica Hogan, Julie Kromm, Matthew Menon, and Matt Benns

Subjects
Surgery
Published
2015
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