Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in paediatric acut... more Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in paediatric acute myeloid leukaemia (AML). This study describes risk factors for IFI and IFI-related sepsis in this population. We conducted a population-based, retrospective cohort study of children with AML in Canada. IFIs during chemotherapy and prior to haematopoietic stem cell transplantation, relapse, persistent disease or death were identified. Risk factors for proven or probable IFI were examined. Among courses complicated by IFI, risk factors for sepsis were also evaluated. There were 341 children with AML included of which 41 (12.0%) experienced 46 different episodes of IFI. Candida species accounted for 23 (50.0%) of IFIs and Aspergillus spp. accounted for 14 (30.4%). Days of broad-spectrum antibiotics, days of corticosteroids and neutropenia at start of the course were independently associated with IFI. Only days of fever were independently associated with IFI-related sepsis. Invasive fungal infections occurred in 12.0% of paediatric AML patients. Risk factors for IFI and IFI-related sepsis were identified. This knowledge may help to consider targeted strategies.
Attendance at scheduled learning activities enhances medical students' education and demonstrates... more Attendance at scheduled learning activities enhances medical students' education and demonstrates professionalism. This study explores the relationship between attendance and psychological distress in a cohort of medical learners. We recorded the attendance of pre-clinical students at compulsory activities over two years. Counselors in our learner support program were asked to anonymously indicate whether individual learners had sought assistance for psychological distress. The study protocol was approved by the University of Alberta's Research Ethics and Privacy Offices. One hundred and seventy students recorded 965 absences. The mean (SD) of absences per student was 5.68 (5.56). Twenty one (12%) students had significant psychological distress. There was a negative correlation (r =-0.33) between absences and academic performance. The correlation between absences and psychological distress was moderate (r = 0.63). The mean (SD) number of absences among students without distress was 4.37 (3.46). Among those with distress, the mean (SD) number of absences was 14.95 (8.32). The difference was significant (p < 0.0001) with an effect size of Cohen's d = 3.06. In the culture of medical school, absences are often interpreted as a lack of moral fitness for the profession, and attendance policies are designed accordingly. However, absenteeism may be symptomatic of psychological distress. If so, institutional regulations could be modified to address this more effectively.
Implication Statement COVID-19 pandemic restrictions abruptly changed the way interviews for medi... more Implication Statement COVID-19 pandemic restrictions abruptly changed the way interviews for medical school admissions have been conducted. This study is unique as it highlights the first successful virtual synchronous multiple mini interview (MMI) in Canada. Our low technical incident rate, troubleshooting strategies and approach may reassure other medical schools considering conducting a virtual MMI. Success was achieved with collaboration, a strong organizational and communication strategy, learning along the way and a priori contingency plans. Virtual interviewing in academic medicine is likely here to stay, and future work to highlight the impact on applicants will help to build on the diversity mission in undergraduate medicine admissions.
While change is acknowledged as integral to all action research, literature linking the theories ... more While change is acknowledged as integral to all action research, literature linking the theories of change theoretically merits exploration. Are some theories of change more congruent to principles of action research than others? Does congruence depend on which type of action research and which change theory are being compared? During the implementation of a four-cycle community-based participatory action research (CBPR) project in nursing education in Ghana, such questions arose. This paper is an attempt to grapple with those questions. While Kotter’s eight-step theory of organizational change was chosen to guide this study, it became obvious that various elements of change theories were integrated in the study as it progressed. For Kotter’s organizational change theory to serve as an effective guide for the implementation cycles in the CBPR project, it must be conducted through the lens of critical social theory and a perspective on social and cultural change.
Rationale Prescribed opioids are major contributors to the current international public health op... more Rationale Prescribed opioids are major contributors to the current international public health opioid crisis. Such iatrogenic calamities usually result from collective decision failures of healthcare organizations rather than solely of individual organizations or professionals. Findings from a system-wide safety analysis of the iatrogenic opioid crisis that includes roles of pertinent healthcare organizations may help avoid or mitigate similar future tragedies. In this exploratory study, we report on such an analysis. Methods Root cause analysis, incorporating recent suggestions for improvement, was used to retrospectively identify possible causal factors from the literature. Based on their mandated roles and potential influences to prevent or mitigate the iatrogenic crisis, relevant organizations were grouped and stratified from most to least influential. Results The analysis identified a chain of multiple interrelated causal factors within and between organizations. The most influential organizations were: pharmaceutical, political and drug regulatory; next: experts and their related societies, and publications. Less influential:
Introduction: One of the current approaches to managing persons with hemophilia entails the use o... more Introduction: One of the current approaches to managing persons with hemophilia entails the use of prophylactic treatment with clotting factor concentrates (CFC) to prevent bleeds and bleeding related complications. However, this process is not practiced in all countries, or is based on the synthesis of evidence from data of all trials. Objective: To conduct a systematic review/meta-analysis (SR/MA) regarding the effectiveness of clotting factor concentrate prophylaxis in the management of people with hemophilia A or B. Methods: We conducted a SR of all randomized controlled trials (RCTs) that studied the effect of prophylactic CFCs in people with hemophilia A or B. We searched all major electronic databases (MEDLINE, LILACS, EMBASE, and the Cochrane Cystic Fibrosis and Genetic Disorders Group’s Controlled Trials Register) as well as performing handsearches of journals and relevant meeting abstract books. We included RCTs that that compared the use of prophylactic CFCs to a control ...
Journal of evaluation in clinical practice, Jan 23, 2017
Although patient safety has improved steadily, harm remains a substantial global challenge. Addit... more Although patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care-related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement. A model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive-affective biases plus cascade could advance the understanding of cognitive-affective processes that underlie decisions and organizational cultures across the continuum of care. Thematic analysis, qualitative information from several sources being used to support argumentation. Complex covert cognitive phenomena underlie decisions influencing health care. In the integrated model, the Swiss cheese slices represent dynamic cognitive-affective (mental) gates: Reason's successive layers of defence. Like ...
Background: A 2010 study of preceptorship as a clinical teaching model in Ghana revealed weakness... more Background: A 2010 study of preceptorship as a clinical teaching model in Ghana revealed weaknesses related to high student-preceptor ratios and inadequate support from faculty in the educational institution. A four-cycle community-based participatory action research study was designed to further delineate clinical teaching and learning issues and partner with Ghanaian stakeholders in critical analysis of possibilities for positive change in clinical nursing education. The purpose of this paper, taken from Cycle One of the study, is to provide understanding of the challenges of the current clinical teaching model(s) used in the study institution from the perspectives of students and faculty. Early engagement of external stakeholders is described.Methods: Each university target group was invited to complete a semi-structured questionnaire. Interviews were conducted with representatives from the Ministry of Health, the Nursing and Midwifery Council of Ghana, and the Ghana Registered N...
Background: With current emphasis on leadership in medicine, this study explores Goleman's leader... more Background: With current emphasis on leadership in medicine, this study explores Goleman's leadership styles of medical education leaders at different hierarchical levels and gain insight into factors that contribute to the appropriateness of practices. Methods: Forty two leaders (28 first-level with limited formal authority, eight middle-level with wider program responsibility and six senior-level with higher organizational authority) rank ordered their preferred Goleman's styles and provided comments. Eight additional senior leaders were interviewed in-depth. Differences in ranked styles within groups were determined by Friedman tests and Wilcoxon tests. Based upon style descriptions, confirmatory template analysis was used to identify Goleman's styles for each interviewed participant. Content analysis was used to identify themes that affected leadership styles. Results: There were differences in the repertoire and preferred styles at different leadership levels. As a group, first-level leaders preferred democratic, middle-level used coaching while the senior leaders did not have one preferred style and used multiple styles. Women and men preferred democratic and coaching styles respectively. The varied use of styles reflected leadership conceptualizations, leader accountabilities, contextual adaptations, the situation and its evolution, leaders' awareness of how they themselves were situated, and personal preferences and discomfort with styles. The not uncommon use of pace-setting and commanding styles by senior leaders, who were interviewed, was linked to working with physicians and delivering quickly on outcomes. Conclusions: Leaders at different levels in medical education draw from a repertoire of styles. Leadership development should incorporate learning of different leadership styles, especially at first-and mid-level positions.
Journal of the Canadian Health Libraries Association, 2004
Abstract: Objective To design and implement peer-reviewed comprehensive search strategies to re... more Abstract: Objective To design and implement peer-reviewed comprehensive search strategies to revise the clinical practice guidelines for hemophilia and von Willebrand disease (http://www.ahcdc.ca/publications.htm). Methods Nine-teen systematic search ...
Journal of the Pediatric Infectious Diseases Society, 2014
Background. The risk of second bacteremia during antibiotic treatment for initial bacteremia is u... more Background. The risk of second bacteremia during antibiotic treatment for initial bacteremia is unknown in high-risk populations. Our objectives were to describe the prevalence of second bacteremia during treatment and identify risk factors in children with acute myeloid leukemia (AML). Methods. We conducted a retrospective, population-based cohort study that included children and adolescents with de novo, non-M3 AML who were diagnosed and treated between January 1, 1995 and December 31, 2004 at 15 Canadian centers. Patients were monitored for bacteremia during chemotherapy until completion of treatment, hematopoietic stem cell transplantation, relapse, refractory disease, or death. Results. There were 290 episodes of bacteremia occurring in 185 (54.3%) of 341 children. Eighteen (6.2%) had a second bacteremia while receiving antibiotic treatment. Two episodes of second bacteremia were complicated by sepsis; there were no infection-related deaths. Eleven episodes (61.1%) had either an initial Gram-positive and subsequent Gram-negative bacteremia or initial Gram-negative followed by Gram-positive bacteremia. Days receiving corticosteroids (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07-1.12; P < .0001), cumulative dose of corticosteroids (OR, 1.04; 95% CI, 1.00-1.08; P = .035), and days of neutropenia from start of course to initial bacteremia (OR, 1.07; 95% CI, 1.02-1.12; P = .007) were significantly associated with second bacteremia. Conclusions. In pediatric AML, 6% of patients will experience a second bacteremia during antibiotic treatment; duration of corticosteroid exposure and neutropenia are risk factors. These patients remain at high risk for second bacteremia after identification of the initial bacteremia and warrant continued broad-spectrum treatment during profound neutropenia.
The main purpose of this study is to estimate the medical care costs of childhood and adolescent ... more The main purpose of this study is to estimate the medical care costs of childhood and adolescent cancer in Manitoba, and to determine the elements that influence these costs. Retrospective chart reviews were done to obtain all the information. A total of 118 childhood (age 0-14 years) and 41 adolescent (age 15-19 years) cancer patients were included. For childhood cancer, in-patient hospitalizations accounted for 59% of the total cost, followed by bone marrow transplant (BMT) (9%), medications (8%), laboratory investigations (7%) and physician fees (7%). For adolescent cancer, in-patient hospitalization accounted for 37% of the total cost, followed by bone marrow transplant (BMT) (25%), physicians' fees (11%), medications (9%) and laboratory investigations (7%). Overall, the average cost for the first, second and third year following diagnosis was $50,902 (median 35,708), $13,939 (4,127) and $6,769 (2,565) respectively for childhood cancer patients, and $57,354 (24,192), $16,888...
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2009
Background:The onset of progressive cerebellar ataxia in early childhood is considered a key feat... more Background:The onset of progressive cerebellar ataxia in early childhood is considered a key feature of ataxiatelangiectasia (A-T), accompanied by ocular apraxia, telangiectasias, immunodeficiency, cancer susceptibility and hypersensitivity to ionizing radiation.Methods:We describe the clinical features and course of three Mennonite children who were diagnosed with A-T following the completion of therapy for lymphoid malignancies.Results:Prior to cancer therapy, all had non-progressive atypical neurological abnormalities, with onset by age 30 months, including dysarthria, dyskinesia, hypotonia and/or dystonia, without telangiectasias. Cerebellar ataxia was noted in only one of the children and was mild until his death at age eight years. None had severe infections. All three children were “cured” of their lymphoid malignancies, but experienced severe adverse effects from the treatments administered. The two children who received cranial irradiation developed supratentorial primitive...
Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in paediatric acut... more Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in paediatric acute myeloid leukaemia (AML). This study describes risk factors for IFI and IFI-related sepsis in this population. We conducted a population-based, retrospective cohort study of children with AML in Canada. IFIs during chemotherapy and prior to haematopoietic stem cell transplantation, relapse, persistent disease or death were identified. Risk factors for proven or probable IFI were examined. Among courses complicated by IFI, risk factors for sepsis were also evaluated. There were 341 children with AML included of which 41 (12.0%) experienced 46 different episodes of IFI. Candida species accounted for 23 (50.0%) of IFIs and Aspergillus spp. accounted for 14 (30.4%). Days of broad-spectrum antibiotics, days of corticosteroids and neutropenia at start of the course were independently associated with IFI. Only days of fever were independently associated with IFI-related sepsis. Invasive fungal infections occurred in 12.0% of paediatric AML patients. Risk factors for IFI and IFI-related sepsis were identified. This knowledge may help to consider targeted strategies.
Attendance at scheduled learning activities enhances medical students' education and demonstrates... more Attendance at scheduled learning activities enhances medical students' education and demonstrates professionalism. This study explores the relationship between attendance and psychological distress in a cohort of medical learners. We recorded the attendance of pre-clinical students at compulsory activities over two years. Counselors in our learner support program were asked to anonymously indicate whether individual learners had sought assistance for psychological distress. The study protocol was approved by the University of Alberta's Research Ethics and Privacy Offices. One hundred and seventy students recorded 965 absences. The mean (SD) of absences per student was 5.68 (5.56). Twenty one (12%) students had significant psychological distress. There was a negative correlation (r =-0.33) between absences and academic performance. The correlation between absences and psychological distress was moderate (r = 0.63). The mean (SD) number of absences among students without distress was 4.37 (3.46). Among those with distress, the mean (SD) number of absences was 14.95 (8.32). The difference was significant (p < 0.0001) with an effect size of Cohen's d = 3.06. In the culture of medical school, absences are often interpreted as a lack of moral fitness for the profession, and attendance policies are designed accordingly. However, absenteeism may be symptomatic of psychological distress. If so, institutional regulations could be modified to address this more effectively.
Implication Statement COVID-19 pandemic restrictions abruptly changed the way interviews for medi... more Implication Statement COVID-19 pandemic restrictions abruptly changed the way interviews for medical school admissions have been conducted. This study is unique as it highlights the first successful virtual synchronous multiple mini interview (MMI) in Canada. Our low technical incident rate, troubleshooting strategies and approach may reassure other medical schools considering conducting a virtual MMI. Success was achieved with collaboration, a strong organizational and communication strategy, learning along the way and a priori contingency plans. Virtual interviewing in academic medicine is likely here to stay, and future work to highlight the impact on applicants will help to build on the diversity mission in undergraduate medicine admissions.
While change is acknowledged as integral to all action research, literature linking the theories ... more While change is acknowledged as integral to all action research, literature linking the theories of change theoretically merits exploration. Are some theories of change more congruent to principles of action research than others? Does congruence depend on which type of action research and which change theory are being compared? During the implementation of a four-cycle community-based participatory action research (CBPR) project in nursing education in Ghana, such questions arose. This paper is an attempt to grapple with those questions. While Kotter’s eight-step theory of organizational change was chosen to guide this study, it became obvious that various elements of change theories were integrated in the study as it progressed. For Kotter’s organizational change theory to serve as an effective guide for the implementation cycles in the CBPR project, it must be conducted through the lens of critical social theory and a perspective on social and cultural change.
Rationale Prescribed opioids are major contributors to the current international public health op... more Rationale Prescribed opioids are major contributors to the current international public health opioid crisis. Such iatrogenic calamities usually result from collective decision failures of healthcare organizations rather than solely of individual organizations or professionals. Findings from a system-wide safety analysis of the iatrogenic opioid crisis that includes roles of pertinent healthcare organizations may help avoid or mitigate similar future tragedies. In this exploratory study, we report on such an analysis. Methods Root cause analysis, incorporating recent suggestions for improvement, was used to retrospectively identify possible causal factors from the literature. Based on their mandated roles and potential influences to prevent or mitigate the iatrogenic crisis, relevant organizations were grouped and stratified from most to least influential. Results The analysis identified a chain of multiple interrelated causal factors within and between organizations. The most influential organizations were: pharmaceutical, political and drug regulatory; next: experts and their related societies, and publications. Less influential:
Introduction: One of the current approaches to managing persons with hemophilia entails the use o... more Introduction: One of the current approaches to managing persons with hemophilia entails the use of prophylactic treatment with clotting factor concentrates (CFC) to prevent bleeds and bleeding related complications. However, this process is not practiced in all countries, or is based on the synthesis of evidence from data of all trials. Objective: To conduct a systematic review/meta-analysis (SR/MA) regarding the effectiveness of clotting factor concentrate prophylaxis in the management of people with hemophilia A or B. Methods: We conducted a SR of all randomized controlled trials (RCTs) that studied the effect of prophylactic CFCs in people with hemophilia A or B. We searched all major electronic databases (MEDLINE, LILACS, EMBASE, and the Cochrane Cystic Fibrosis and Genetic Disorders Group’s Controlled Trials Register) as well as performing handsearches of journals and relevant meeting abstract books. We included RCTs that that compared the use of prophylactic CFCs to a control ...
Journal of evaluation in clinical practice, Jan 23, 2017
Although patient safety has improved steadily, harm remains a substantial global challenge. Addit... more Although patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care-related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement. A model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive-affective biases plus cascade could advance the understanding of cognitive-affective processes that underlie decisions and organizational cultures across the continuum of care. Thematic analysis, qualitative information from several sources being used to support argumentation. Complex covert cognitive phenomena underlie decisions influencing health care. In the integrated model, the Swiss cheese slices represent dynamic cognitive-affective (mental) gates: Reason's successive layers of defence. Like ...
Background: A 2010 study of preceptorship as a clinical teaching model in Ghana revealed weakness... more Background: A 2010 study of preceptorship as a clinical teaching model in Ghana revealed weaknesses related to high student-preceptor ratios and inadequate support from faculty in the educational institution. A four-cycle community-based participatory action research study was designed to further delineate clinical teaching and learning issues and partner with Ghanaian stakeholders in critical analysis of possibilities for positive change in clinical nursing education. The purpose of this paper, taken from Cycle One of the study, is to provide understanding of the challenges of the current clinical teaching model(s) used in the study institution from the perspectives of students and faculty. Early engagement of external stakeholders is described.Methods: Each university target group was invited to complete a semi-structured questionnaire. Interviews were conducted with representatives from the Ministry of Health, the Nursing and Midwifery Council of Ghana, and the Ghana Registered N...
Background: With current emphasis on leadership in medicine, this study explores Goleman's leader... more Background: With current emphasis on leadership in medicine, this study explores Goleman's leadership styles of medical education leaders at different hierarchical levels and gain insight into factors that contribute to the appropriateness of practices. Methods: Forty two leaders (28 first-level with limited formal authority, eight middle-level with wider program responsibility and six senior-level with higher organizational authority) rank ordered their preferred Goleman's styles and provided comments. Eight additional senior leaders were interviewed in-depth. Differences in ranked styles within groups were determined by Friedman tests and Wilcoxon tests. Based upon style descriptions, confirmatory template analysis was used to identify Goleman's styles for each interviewed participant. Content analysis was used to identify themes that affected leadership styles. Results: There were differences in the repertoire and preferred styles at different leadership levels. As a group, first-level leaders preferred democratic, middle-level used coaching while the senior leaders did not have one preferred style and used multiple styles. Women and men preferred democratic and coaching styles respectively. The varied use of styles reflected leadership conceptualizations, leader accountabilities, contextual adaptations, the situation and its evolution, leaders' awareness of how they themselves were situated, and personal preferences and discomfort with styles. The not uncommon use of pace-setting and commanding styles by senior leaders, who were interviewed, was linked to working with physicians and delivering quickly on outcomes. Conclusions: Leaders at different levels in medical education draw from a repertoire of styles. Leadership development should incorporate learning of different leadership styles, especially at first-and mid-level positions.
Journal of the Canadian Health Libraries Association, 2004
Abstract: Objective To design and implement peer-reviewed comprehensive search strategies to re... more Abstract: Objective To design and implement peer-reviewed comprehensive search strategies to revise the clinical practice guidelines for hemophilia and von Willebrand disease (http://www.ahcdc.ca/publications.htm). Methods Nine-teen systematic search ...
Journal of the Pediatric Infectious Diseases Society, 2014
Background. The risk of second bacteremia during antibiotic treatment for initial bacteremia is u... more Background. The risk of second bacteremia during antibiotic treatment for initial bacteremia is unknown in high-risk populations. Our objectives were to describe the prevalence of second bacteremia during treatment and identify risk factors in children with acute myeloid leukemia (AML). Methods. We conducted a retrospective, population-based cohort study that included children and adolescents with de novo, non-M3 AML who were diagnosed and treated between January 1, 1995 and December 31, 2004 at 15 Canadian centers. Patients were monitored for bacteremia during chemotherapy until completion of treatment, hematopoietic stem cell transplantation, relapse, refractory disease, or death. Results. There were 290 episodes of bacteremia occurring in 185 (54.3%) of 341 children. Eighteen (6.2%) had a second bacteremia while receiving antibiotic treatment. Two episodes of second bacteremia were complicated by sepsis; there were no infection-related deaths. Eleven episodes (61.1%) had either an initial Gram-positive and subsequent Gram-negative bacteremia or initial Gram-negative followed by Gram-positive bacteremia. Days receiving corticosteroids (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07-1.12; P < .0001), cumulative dose of corticosteroids (OR, 1.04; 95% CI, 1.00-1.08; P = .035), and days of neutropenia from start of course to initial bacteremia (OR, 1.07; 95% CI, 1.02-1.12; P = .007) were significantly associated with second bacteremia. Conclusions. In pediatric AML, 6% of patients will experience a second bacteremia during antibiotic treatment; duration of corticosteroid exposure and neutropenia are risk factors. These patients remain at high risk for second bacteremia after identification of the initial bacteremia and warrant continued broad-spectrum treatment during profound neutropenia.
The main purpose of this study is to estimate the medical care costs of childhood and adolescent ... more The main purpose of this study is to estimate the medical care costs of childhood and adolescent cancer in Manitoba, and to determine the elements that influence these costs. Retrospective chart reviews were done to obtain all the information. A total of 118 childhood (age 0-14 years) and 41 adolescent (age 15-19 years) cancer patients were included. For childhood cancer, in-patient hospitalizations accounted for 59% of the total cost, followed by bone marrow transplant (BMT) (9%), medications (8%), laboratory investigations (7%) and physician fees (7%). For adolescent cancer, in-patient hospitalization accounted for 37% of the total cost, followed by bone marrow transplant (BMT) (25%), physicians' fees (11%), medications (9%) and laboratory investigations (7%). Overall, the average cost for the first, second and third year following diagnosis was $50,902 (median 35,708), $13,939 (4,127) and $6,769 (2,565) respectively for childhood cancer patients, and $57,354 (24,192), $16,888...
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2009
Background:The onset of progressive cerebellar ataxia in early childhood is considered a key feat... more Background:The onset of progressive cerebellar ataxia in early childhood is considered a key feature of ataxiatelangiectasia (A-T), accompanied by ocular apraxia, telangiectasias, immunodeficiency, cancer susceptibility and hypersensitivity to ionizing radiation.Methods:We describe the clinical features and course of three Mennonite children who were diagnosed with A-T following the completion of therapy for lymphoid malignancies.Results:Prior to cancer therapy, all had non-progressive atypical neurological abnormalities, with onset by age 30 months, including dysarthria, dyskinesia, hypotonia and/or dystonia, without telangiectasias. Cerebellar ataxia was noted in only one of the children and was mild until his death at age eight years. None had severe infections. All three children were “cured” of their lymphoid malignancies, but experienced severe adverse effects from the treatments administered. The two children who received cranial irradiation developed supratentorial primitive...
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Papers by Kent Stobart