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Piette Y, Van den Bossche F, Aerts J, Aerts N, Ajeganova S, Badot V, Berghen N, Blockmans D, Brusselle G, Caeyers N, De Decker M, De Haes P, De Cock C, De Keyser F, De Langhe E, Delcroix M, De Nutte H, De Pauw M, Depicker A, De Sutter A, De Sutter J, Du Four T, Frank C, Goubau J, Guiot J, Gutermuth J, Heeman L, Houssiau F, Hennes I, Lenaerts J, Lintermans A, Loeys B, Luyten H, Maeyaert B, Malfait F, Moeyersoons A, Mostmans Y, Nijs J, Poppe B, Polfliet K, Ruttens D, Sabato V, Schoeters E, Slabbynck H, Stuer A, Tamirou F, Thevissen K, Van Kersschaever G, Vanneuville B, Van Offel J, Vanthuyne M, Van Wabeke J, Verbist C, Vos I, Westhovens R, Wuyts W, Yserbyt J, Smith V. Flemish network on rare connective tissue diseases (CTD): patient pathways in systemic sclerosis. First steps taken. Acta Clin Belg 2024; 79:26-33. [PMID: 38108332 DOI: 10.1080/17843286.2023.2280737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023]
Abstract
Despite the low prevalence of each rare disease, the total burden is high. Patients with rare diseases encounter numerous barriers, including delayed diagnosis and limited access to high-quality treatments. In order to tackle these challenges, the European Commission launched the European Reference Networks (ERNs), cross-border networks of healthcare providers and patients representatives. In parallel, the aims and structure of these ERNs were translated at the federal and regional levels, resulting in the creation of the Flemish Network of Rare Diseases. In line with the mission of the ERNs and to ensure equal access to care, we describe as first patient pathways for systemic sclerosis (SSc), as a pilot model for other rare connective and musculoskeletal diseases. Consensus was reached on following key messages: 1. Patients with SSc should have multidisciplinary clinical and investigational evaluations in a tertiary reference expert centre at baseline, and subsequently every three to 5 years. Intermediately, a yearly clinical evaluation should be provided in the reference centre, whilst SSc technical evaluations are permissionably executed in a centre that follows SSc-specific clinical practice guidelines. In between, monitoring can take place in secondary care units, under the condition that qualitative examinations and care including interactive multidisciplinary consultations can be provided. 2. Patients with early diffuse cutaneous SSc, (progressive) interstitial lung disease and/or pulmonary arterial hypertension should undergo regular evaluations in specialised tertiary care reference institutions. 3. Monitoring of patients with progressive interstitial lung disease and/or pulmonary (arterial) hypertension will be done in agreement with experts of ERN LUNG.
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Affiliation(s)
- Y Piette
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Department of Rheumatology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | | | - J Aerts
- Flemish Association for Hereditary Connective Tissue Disorders (Bindweefsel.be), Koersel, Belgium
| | - N Aerts
- Department of Rheumatology, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - S Ajeganova
- Department of Clinical Sciences, Rheumatology Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - V Badot
- Department of Rheumatology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - N Berghen
- Department of Rheumatology, AZ Klina, Brasschaat, Belgium
| | - D Blockmans
- Department of general internal medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, Laboratory of clinical infectious and inflammatory disorders, KU Leuven, Leuven, Belgium
| | - G Brusselle
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Department of Respiratory Medicine, Ghent University Hospital, C. Heymanslaan, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N Caeyers
- Patiëntexpert ReumaNet, Zaventem, Belgium
| | - M De Decker
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - P De Haes
- Department of Dermatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - C De Cock
- Department of Pneumology, Maria Middelares, Ghent, Belgium
| | | | - E De Langhe
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - M Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | | | - M De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - A Depicker
- Department of Rheumatology, Maria Middelares, Ghent, Belgium
| | - A De Sutter
- Department of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium
| | - J De Sutter
- Department of Cardiology, Hartcentrum, AZ Maria Middelares, Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - T Du Four
- Department of Dermatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - C Frank
- Department of Rheumatology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J Goubau
- Department of Orthopaedics and Traumatology, AZ Maria Middelares, Ghent, Belgium; Department of Orthopedics and Traumatology, UZ Brussel, Brussels, Belgium
| | - J Guiot
- Department of Respiratory Medicine, Universitary hospital of Liège, Liège, Belgium
| | - J Gutermuth
- Department of Dermatology, University Hospital Brussels, Brussels, Belgium
| | - L Heeman
- Huisartspraktijk De Zwaene, Bruges, Belgium
| | - F Houssiau
- Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain; Service de Rhumatologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - I Hennes
- CIB-Liga; Patiëntexpert ReumaNet, Zaventem, Belgium
| | - J Lenaerts
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium; Reumainstituut and Jessa Hospital, Hasselt, Belgium; Department of Rheumatology, AZ Vesalius, Tongeren, Belgium
| | | | - B Loeys
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, The Netherlands; Center for Medical Genetics, Antwerp University Hospital & University of Antwerp, Antwerp, Belgium
| | - H Luyten
- Department of Rheumatology, AZ Sint-Lucas, Ghent, Belgium
| | - B Maeyaert
- Department of Rheumatology, AZ Sint-Lucas, Bruges, Belgium
| | - F Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium; Department for Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - A Moeyersoons
- Department of Rheumatology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Y Mostmans
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Department of Dermatology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J Nijs
- Department of Cardiac Surgery, UZ Brussels, Brussels, Belgium
| | - B Poppe
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium; Department for Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - K Polfliet
- Sclero'ken VZW; Patiëntexpert ReumaNet, Zaventem, Belgium
| | - D Ruttens
- Department of Respiratory Medicine, Ziekenhuis Oost Limburg, Genk, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | - V Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | | | - H Slabbynck
- Department of Pneumology, ZNA Middelheim, Antwerpen, Belgium
| | - A Stuer
- Department of Rheumatology, AZ Delta, Roeselare, Belgium
| | - F Tamirou
- Huisartspraktijk De Zwaene, Bruges, Belgium
| | - Kristof Thevissen
- Department of Rheumatology, ZOL Genk, Genk, Belgium; Reumacentrum Genk, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - B Vanneuville
- Department of Rheumatology, Sint-Andries Hospital, Tielt, Belgium; Department of Rheumatology, AZ Groeninge, Kortrijk, Belgium
| | - J Van Offel
- Department of Rheumatology, University Hospital of Antwerp, Antwerp, Belgium
| | - M Vanthuyne
- Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain; Service de Rhumatologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - J Van Wabeke
- Department of Rheumatology, AZ Sint-Lucas, Ghent, Belgium
| | - C Verbist
- Department of Rheumatology, AZ Delta, Roeselare, Belgium
| | - I Vos
- Department of Rheumatology, GZA Hospitals, Antwerp, Belgium
| | - R Westhovens
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - W Wuyts
- Department of Pneumology, UZ Leuven, Leuven, Belgium
| | - J Yserbyt
- Department of Pneumology, UZ Leuven, Leuven, Belgium
| | - V Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
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Chen L, Sethi S, Poland C, Frank C, Tengelitsch E, Goldstick J, Sussman JB, Bohnert ASB, Lin L(A. Prescriptions for Buprenorphine in Michigan Following an Education Intervention. JAMA Netw Open 2023; 6:e2349103. [PMID: 38127344 PMCID: PMC10739087 DOI: 10.1001/jamanetworkopen.2023.49103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Importance Buprenorphine is an underused treatment for opioid use disorder (OUD) that can be prescribed in general medical settings. Founded in 2017, the Michigan Opioid Collaborative (MOC) is an outreach and educational program that aims to address clinician and community barriers to buprenorphine access; however, the association between the MOC and buprenorphine treatment is unknown. Objective To evaluate the association between MOC service use and county-level temporal trends of density of buprenorphine prescribers and patients receiving buprenorphine. Design, Setting, and Participants This cohort study exploited staggered implementation of MOC services across all Michigan counties. Difference-in-difference analyses were conducted by applying linear fixed-effects regression across all counties to estimate the overall association of MOC engagement with outcomes and linear regression for each MOC-engaged county separately to infer county-specific results using data from May 2015 to August 2020. Analyses were conducted from September 2021 to November 2023. Exposures MOC engagement. Main Outcomes and Measures County-level monthly numbers of buprenorphine prescribers and patients receiving buprenorphine (per 100 000 population). Results Among 83 total counties, 57 counties (68.7%) in Michigan were engaged by MOC by 2020, with 3 (3.6%) initiating engagement in 2017, 19 (22.9%) in 2018, 27 (32.5%) in 2019, and 8 (9.6%) in 2020. Michigan is made up of 83 counties with a total population size of 9 990 000. A total of 5 070 000 (50.8%) were female, 1 410 000 (14.1%) were African American or Black, 530 000 (5.3%) were Hispanic or Latino, and 7 470 000 (74.7%) were non-Hispanic White. The mean (SD) value of median age across counties was 44.8 (6.4). The monthly increases in buprenorphine prescriber numbers in the preengagement (including all time points for nonengaged counties) and postengagement periods were 0.07 and 0.39 per 100 000 population, respectively, with the absolute difference being 0.33 (95% CI, 0.12-0.53) prescribers per 100 000 population (P = .002). The numbers of patients receiving buprenorphine increased by an average of 0.6 and 7.15 per 100 000 population per month in preengagement and postengagement periods, respectively, indicating an estimated additional 6.56 (95% CI, 2.09-11.02) patients receiving buprenorphine per 100 000 population (P = .004) monthly increase after engagement compared with before. Conclusions and Relevance In this cohort study measuring buprenorphine prescriptions in Michigan over time, counties' engagement in OUD-focused outreach and clinician education services delivered by a multidisciplinary team was associated with a temporal increase in buprenorphine prescribers and patients receiving buprenorphine.
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Affiliation(s)
- Liying Chen
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Sheba Sethi
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Cara Poland
- Department of Obstetrics, Gynecology and Reproductive Health, Michigan State University, East Lansing
| | - Christopher Frank
- Department of Family Medicine, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Jason Goldstick
- Injury Prevention Center, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor
| | - Jeremy B. Sussman
- Division of General Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Amy S. B. Bohnert
- Department of Anesthesiology, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Lewei (Allison) Lin
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
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Frank C, Gyawali B, Booth CM. Common sense cancer care for older adults: Outcomes that matter. J Am Geriatr Soc 2023; 71:3977-3980. [PMID: 37539843 DOI: 10.1111/jgs.18529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 08/05/2023]
Affiliation(s)
| | - Bishal Gyawali
- Department of Oncology, Queen's University, Kingston, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Christopher M Booth
- Department of Medicine, Queen's University, Kingston, Canada
- Department of Oncology, Queen's University, Kingston, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Canada
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Wagenbauer KF, Pham N, Gottschlich A, Kick B, Kozina V, Frank C, Trninic D, Stömmer P, Grünmeier R, Carlini E, Tsiverioti CA, Kobold S, Funke JJ, Dietz H. Programmable multispecific DNA-origami-based T-cell engagers. Nat Nanotechnol 2023; 18:1319-1326. [PMID: 37591933 PMCID: PMC10656288 DOI: 10.1038/s41565-023-01471-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/26/2023] [Indexed: 08/19/2023]
Abstract
Multispecific antibodies have emerged as versatile therapeutic agents, and therefore, approaches to optimize and streamline their design and assembly are needed. Here we report on the modular and programmable assembly of IgG antibodies, F(ab) and scFv fragments on DNA origami nanocarriers. We screened 105 distinct quadruplet antibody variants in vitro for the ability to activate T cells in the presence of target cells. T-cell engagers were identified, which in vitro showed the specific and efficient T-cell-mediated lysis of five distinct target cell lines. We used these T-cell engagers to target and lyse tumour cells in vivo in a xenograft mouse tumour model. Our approach enables the rapid generation, screening and testing of bi- and multispecific antibodies to facilitate preclinical pharmaceutical development from in vitro discovery to in vivo proof of concept.
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Grants
- This work was supported by a European Research Council Consolidator Grant to H.D. (grant agreement 724261), the Deutsche Forschungsgemeinschaft through grants provided within the Gottfried Wilhelm Leibniz Program (to H.D.), the Medical Valley Award, the M4 Award, a GO-Bio initial award (Federal Ministry of Education and Research (BMBF) of Germany), and a Funding by the ForTra gGmbH für Forschungstransfer der Else Kröner-Fresenius Stiftung all to KFW, JJF, BK and HD. The work has received support from the Max Planck School Matter to Life (to H.D.) jointly financed by the Federal Ministry of Education and Research (BMBF) of Germany and the Max Planck Society
- This study was further supported by the international doctoral program the Förderprogramm für Forschung und Lehre der Medizinischen Fakultät der LMU (A.G, grant number 1139), the Deutsche Forschungsgemeinschaft (A.G. – grant number: GO 3823/1-1); S.K. - grant number: KO 5055/3-1), ‘i-Target: immunotargeting of cancer’ (funded by the Elite Network of Bavaria; to S.K.), Melanoma Research Alliance (grant number 409510 to S.K.), Marie Sklodowska-Curie Training Network for Optimizing Adoptive T Cell Therapy of Cancer (funded by the Horizon 2020 programme of the European Union; grant 955575 to S.K.), Else Kröner-Fresenius-Stiftung (to S.K.), German Cancer Aid (AvantCAR.de to S. Kobold), Ernst Jung Stiftung (to S.K.), the Wilhelm-Sander Stiftung (to S. Kobold), Institutional Strategy LMUexcellent of LMU Munich (within the framework of the German Excellence Initiative; to S.K.), Bundesministerium für Bildung und Forschung (S.K.), European Research Council (Starting Grant 756017 and Proof of Concept Grant 101100460 to S. Kobold), Deutsche Forschungsgemeinschaft (DFG; KO5055-2-1 and 510821390 to S.K.), by the SFB-TRR 338/1 2021–452881907 (to S.K.), Fritz-Bender Foundation (to S.K.), Deutsche José Carreras Leukämie Stiftung (to S.K.) and Hector Foundation (to S.K.).
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Affiliation(s)
- Klaus F Wagenbauer
- Department of Biosciences, School of Natural Sciences, Technical University of Munich, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
| | - Nhi Pham
- Department of Biosciences, School of Natural Sciences, Technical University of Munich, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
| | - Adrian Gottschlich
- Division of Clinical Pharmacology, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Benjamin Kick
- Department of Biosciences, School of Natural Sciences, Technical University of Munich, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
| | - Viktorija Kozina
- Department of Biosciences, School of Natural Sciences, Technical University of Munich, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
| | - Christopher Frank
- Department of Biosciences, School of Natural Sciences, Technical University of Munich, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
| | - Daniela Trninic
- Department of Biosciences, School of Natural Sciences, Technical University of Munich, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
| | - Pierre Stömmer
- Department of Biosciences, School of Natural Sciences, Technical University of Munich, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
| | - Ruth Grünmeier
- Division of Clinical Pharmacology, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Emanuele Carlini
- Division of Clinical Pharmacology, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christina Angeliki Tsiverioti
- Division of Clinical Pharmacology, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sebastian Kobold
- Division of Clinical Pharmacology, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
- Einheit für Klinische Pharmakologie (EKLiP), Helmholtz Munich, Research Center for Environmental Health (HMGU), Neuherberg, Germany.
| | - Jonas J Funke
- Department of Biosciences, School of Natural Sciences, Technical University of Munich, Garching, Germany.
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany.
| | - Hendrik Dietz
- Department of Biosciences, School of Natural Sciences, Technical University of Munich, Garching, Germany.
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany.
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Rasiah J, Prorok JC, Adekpedjou R, Barrie C, Basualdo C, Burns R, De Paul V, Donnelly C, Doyle A, Frank C, Dolsen S(G, Giguère A, Hsiung S, Kim P, McDonald EG, O’Grady H, Patey A, Puxty J, Racey M, Resin J, Sims-Gould J, Stewart S, Theou O, Webster S, Muscedere J. Enabling Healthy Aging to AVOID Frailty in Community Dwelling Older Canadians. Can Geriatr J 2022; 25:202-211. [PMID: 35747405 PMCID: PMC9156415 DOI: 10.5770/cgj.25.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Canadian population is aging. With aging, biological and social changes occur increasing the risk of developing chronic conditions and functional loss leading to frailty. Older adults living with frailty are more vulnerable to minor stressors, take longer to recover from illness, and have difficulty participating in daily activities. The Canadian Frailty Network's (CFN) mission is to improve the lives of older adults living with frailty. In September 2019, CFN launched the Activity & Exercise, Vaccination, Optimization of medications, Interaction & Socialization, and Diet & Nutrition (AVOID) Frailty public health campaign to promote assessing and reducing risk factors leading to the development of frailty. As part of the campaign, CFN held an Enabling Healthy Aging Symposium with 36 stakeholders from across Canada. Stakeholders identified individual and community-level opportunities and challenges for the enablement of healthy aging and frailty mitigation, as part of a focused consultative process. Stakeholders ranked the three most important challenges and opportunities at the individual and community levels for implementing AVOID Frailty recommendations. Concrete actions, further research areas, policy changes, and existing resources/programs to enhance the AVOID Frailty campaign were identified. The results will help inform future priorities and behaviour change strategies for healthy aging in Canada.
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Affiliation(s)
| | | | - Rheda Adekpedjou
- Centre de Recherche du Centre Hospitalier Universitaire de Montréal, Montreal, QC
| | | | | | - Rachel Burns
- Department of Psychology, Carleton University, Ottawa, ON
| | - Vincent De Paul
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON
| | | | - Amy Doyle
- Canadian Frailty Network, Kingston, ON
| | | | | | - Anik Giguère
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
| | - Sonia Hsiung
- Alliance for Healthier Communities, North York, ON
| | - Perry Kim
- Canadian Frailty Network, Kingston, ON
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON
| | - Emily G. McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, QC
| | - Heather O’Grady
- School of Rehabilitation Science, McMaster University, Hamilton, ON
| | - Andrea Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON
| | - John Puxty
- Department of Medicine, Queen’s University, Kingston, ON
| | - Megan Racey
- McMaster Evidence Review and Synthesis Team; School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | | | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Susan Stewart
- Kingston Frontenac Lennox & Addington Public Health, Kingston, ON
| | - Olga Theou
- Physiotherapy and Geriatric Medicine, Dalhousie University, Halifax, NS
| | - Sarah Webster
- Centre for Studies in Aging and Health, Province Care Hospital, Toronto, ON
| | - John Muscedere
- Canadian Frailty Network, Kingston, ON
- Department of Critical Care Medicine, Queen’s University, Kingston, ON
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Laurent MDB, Sandrone A, Silvana DR, Frank C, Renaud P, Galant C, Lauwerys B, Durez P. AB0761 HISTOPATHOLOGY OF CHECKPOINT INHIBITORS INDUCED ARTHRITIS: RETROSPECTIVE ANALYSIS OF 3 CASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Induced arthritis (IA) is a rare immune related adverse event occurring in 0.5 to 2% of patients exposed to Immune (irAEs) Checkpoint Inhibitors (CPI). In some patients, this condition may be severe and long lasting even after CPI cessation. Cross-reactivity between tumor- and self-antigens was considered in the etiology of several cases of irAEs but disease mechanisms in IA remain elusive.We systematically collect synovial tissue of patients with IA (Ethical Committee B403201942386).Objectives:Here, we report the histopathological findings from ultrasound guided (USG) synovial biopsies from the 3 first patients of our cohort. The immune cell infiltration in CPI IA patients is compared to the histopathological findings in rheumatoid arthritis.Methods:Patients were referred through their oncologist after the onset of an arthritis in the context of a CPI therapy. The diagnostic of arthritis was confirmed by a rheumatologist and by ultrasound assessment. USG biopsies were performed before initiation of specific therapies.Pathological and immunohistochemical analyses include semi quantitative scoring of the following: synovial hyperplasia, fibrinoid necrosis, chorion cellular infiltrate, vascular hyperplasia, CD3-, CD20-, CD68- and CD138-positive cells.All patients gave written informed consent.Results:Three patients went through the USG biopsy procedure: 2 males and 1 female. No adverse events were recorded.All patients had metastatic neoplasms and time-to-arthritis was on average 6.7 months after CPI initiation. The USG biopsies were performed from 1 week after the onset of the IA to 16 months. The target joints displayed strong synovial thickening on ultrasound. Histological and immunohistochemistry studies showed light to moderate synovial hyperplasia and inflammatory cell infiltration of the sublining by macrophages and T cells, but no or little B cells (Table 1).Table 1.Clinical Characteristics and histopathological analyses on synovial biopsies.Patient 1Patient 2Patient 3CanceruterusbladderlungsBiopsied jointfirst metatarsophalangial jointwristkneeTime-to-synovial biopsy1 week2 months16 monthsGrey scale on ultrasound3/33/33/3Hematoxylin-eosin staining:synovial hyperplasiafibrinoid necrosischorion cellular infiltratevascular hyperplasia++++0+++++++00/+++Immunochemistry staining:CD3CD20CD68CD138++++000/+++0/+++000/+Conclusion:USG synovial biopsies have been safely performed and the histopathological analysis have confirmed the synovitis with mainly a macrophage infiltrate (myeloid pattern). IA synovitis is characterized by synovial hyperplasia and macrophage and T cell infiltration of the sublining. Increased collaboration between oncologists and rheumatologists is needed to create opportunities for referral of patients between the two specialties and optimize treatment. Further analyses (such as global or single-cell RNA sequencing) are needed to learn more about IA physiopathology.References:[1]Humby F, Lewis M, Ramamoorthi N & al. Synovial cellular and molecular signatures stratify clinical response to csDMARD therapy and predict radiographic progression in early rheumatoid arthritis patients. Ann Rheum Dis. 2019 Jun;78(6):761-772. doi: 10.1136/annrheumdis-2018-214539.[2]Postow MA, Sidlow R, Hellmann MD. Immune-Related Adverse Events Associated with Immune Checkpoint Blockade. N Engl J Med. 2018 Jan 11;378(2):158-168. doi: 10.1056/NEJMra1703481. PMID: 29320654.Disclosure of Interests:Meric de Bellefon Laurent: None declared, Aspeslagh Sandrone: None declared, Di Romana Silvana: None declared, Cornelis Frank: None declared, Poncin Renaud: None declared, Christine Galant: None declared, Bernard Lauwerys Employee of: Bernard Lauwerys is currently employed at UCB Biopharma, Patrick Durez: None declared
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Bilici M, Morgenstern M, Frank C, Alispahic N, Müller A, Sauermann M, Eckardt H, Rikli D. Outcome measurement in trauma surgery with a fracture database and clinical and patient-reported outcome measures (PROMs). Br J Surg 2021. [DOI: 10.1093/bjs/znab202.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Patient-Reported Outcome Measures (PROMs) gain growing attention. The Food and Drug Administration suggested in 2009 to have PROMs for every new treatment and technology. The use of PROMs was further promoted by the Patient Protection and Affordable Care Act of 2010 in the USA. Recommendations from other national and international organizations include the OECD's Project of Patient-Reported Indicator Surveys (PaRIS) and the International Consortium for Health Outcomes Measurement (ICHOM). Our development and initiation of a Fracture Database started early in 2018. We orientated our database on the role model of the Swedish Fracture Registry.
Methods
REDCap (Research Electronic Data Capture) is a web interface for a SQL (Structured Query Language)-Database. We used it to program the Fracture Registry. We collect data about demographics, diagnosis, treatment, adverse events, clinical outcomes, and PROMs. The PROMS are recorded with the Software 'Heartbeat ONE' vs. 6.15.4. Inclusion criteria are all patients with fractures of the upper and lower extremity, including the pelvis and multiple injuries, treated surgically. Excluded are all patients with fractures of the hand as monotrauma and non-surgical treatment. We established questionnaire sets for each anatomical region. Every hospitalized patient is screened for inclusion criteria to get the baseline PROMs. Follow-up PROMs are collected at 3-months and 12-months in our outpatient clinic.
Results
In five months of collecting PROMs, we have evaluated 599 patients, 521 fulfilling the inclusion criteria. 329 (63%) questionnaire sets were completed. The mean time for answering the questions was 11-20 minutes. The input rate of 63% for PROMs accounts for the start of the process, with 22 (4%) patients being dismissed before answering the questionnaires. 93 (18%) patients denied participation. 52 (10%) patients were not able to participate (dementia, delirium). Other causes for missing data were language barriers (n = 28; 5%), medical reasons like polytraumatized patients (n = 4; 0.8%), and deceased patients (n = 15; 2.9%).
Conclusion
Most Orthopaedic Trauma centers publish data about PROMs from surgically treated patients. Starting in the first quarter of 2021, we will include non-surgically treated patients. We have optimized the process of including patients. Our aim is a response rate of more than 80% within this year to get representing data.
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Affiliation(s)
- M Bilici
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - M Morgenstern
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - C Frank
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - N Alispahic
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - A Müller
- Quality Management, University Hospital Basel, Basel, Switzerland
| | - M Sauermann
- Department of Clinical Research for Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - H Eckardt
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - D Rikli
- Department for Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
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Pezzanite L, Frank C, Koch D, Moss A, Landolt G. Abdominal aortic thromboembolism and subsequent pelvic limb myositis secondary to colitis and septicaemia in a 5‐day‐old Oldenburg colt. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Pezzanite
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins ColoradoUSA
| | - C. Frank
- Department of Microbiology, Immunology, and Pathology College of Veterinary Medicine and Biological Sciences Colorado State University Fort Collins Colorado USA
| | - D. Koch
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins ColoradoUSA
| | - A. Moss
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins ColoradoUSA
| | - G. Landolt
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins ColoradoUSA
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Wetscherek M, Rutschke W, Frank C, Stehning C, Lurz P, Grothoff M, Thiele H, Gutberlet M, Lücke C. High inter- and intra-observer agreement in mapping sequences compared to classical Lake Louise Criteria assessment of myocarditis by inexperienced observers. Clin Radiol 2020; 75:796.e17-796.e26. [DOI: 10.1016/j.crad.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 05/08/2020] [Indexed: 11/24/2022]
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10
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Conn DK, Hogan DB, Amdam L, Cassidy KL, Cordell P, Frank C, Gardner D, Goldhar M, Ho JMW, Kitamura C, Vasil N. Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder Among Older Adults Title. Can Geriatr J 2020; 23:116-122. [PMID: 32226570 PMCID: PMC7067147 DOI: 10.5770/cgj.23.419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Benzodiazepine receptor agonist (BZRA) use disorder among older adults is a relatively common and challenging clinical condition. Method The Canadian Coalition for Seniors’ Mental Health, with financial support from Health Canada, has produced evidence-based guidelines on the prevention, identification, assessment, and management of this form of substance use disorder. Results Inappropriate use of BZRAs should be avoided by considering non-pharmacological approaches to the management of late life insomnia, anxiety, and other common indications for the use of BZRA. Older persons should only be prescribed BZRAs after they are fully informed of alternatives, benefits, and risks associated with their use. Clinicians should have a high index of suspicion for the presence of BZRA use disorders. The full version of these guidelines can be accessed at www.ccsmh.ca Conclusions A person-centred, stepped care approach utilizing gradual dose reductions should be used in the management of BZRA use disorder.
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Affiliation(s)
- David K Conn
- Baycrest Health Sciences, North York, ON.,Department of Psychiatry, University of Toronto, Toronto, ON
| | - David B Hogan
- Brenda Strafford Centre on Aging, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Lori Amdam
- Canadian Coalition for Seniors Mental Health, Markham, ON
| | | | - Peter Cordell
- Department of Psychiatry, McMaster University, Hamilton, ON
| | | | - David Gardner
- Department of Psychiatry, Dalhousie University, Halifax, NS
| | - Morris Goldhar
- Baycrest Health Sciences, North York, ON.,Department of Psychiatry, University of Toronto, Toronto, ON.,Brenda Strafford Centre on Aging, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB.,Canadian Coalition for Seniors Mental Health, Markham, ON.,Department of Psychiatry, Dalhousie University, Halifax, NS.,Department of Psychiatry, McMaster University, Hamilton, ON.,Department of Family Medicine, Queen's University, Kingston, ON.,Department of Medicine, McMaster University, Hamilton, ON.,Department of Psychiatry, University of Montreal, Montreal, QC
| | - Joanne M-W Ho
- Department of Medicine, McMaster University, Hamilton, ON
| | | | - Nancy Vasil
- Department of Psychiatry, University of Montreal, Montreal, QC
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11
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Cordeiro M, Caskey S, Frank C, Martin S, Srivastava A, Atkinson T. Hybrid triad provides fracture plane stability in a computational model of a Pauwels Type III hip fracture. Comput Methods Biomech Biomed Engin 2020; 23:476-483. [PMID: 32160804 DOI: 10.1080/10255842.2020.1738404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The study utilized finite element method to determine displacements and stresses in a set of Pauwels Type III femoral neck fractures repaired using 3 techniques (cannulated screws (Triad), sliding hip screw (SHS), and a Hybrid (SHS + cannulated screws). The research found that shear displacement doubled between the 65° and 75° fracture angles regardless of fixation construct. The SHS alone was the least stable construct, with highest construct stresses and shear displacement along the fracture plane. The stability of the Hybrid and Triad constructs were similar, but stress in the Hybrid was lower suggesting it would provide a higher load to failure than the Triad.
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Affiliation(s)
- M Cordeiro
- Orthopaedic Surgery, McLaren-Flint, Flint, MI, USA
| | - S Caskey
- Orthopaedic Surgery, McLaren-Flint, Flint, MI, USA
| | - C Frank
- Orthopaedic Surgery, McLaren-Flint, Flint, MI, USA
| | - S Martin
- Orthopaedic Surgery, McLaren-Flint, Flint, MI, USA
| | - A Srivastava
- Orthopaedic Surgery, McLaren-Flint, Flint, MI, USA
| | - T Atkinson
- Orthopaedic Surgery, McLaren-Flint, Flint, MI, USA.,Department of Mechanical Engineering, Kettering University, Flint, MI, USA
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12
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Frank C, Winter G, Rensei F, Samper V, Brooks AF, Hockley BG, Henderson BD, Rensch C, Scott PJH. Development and implementation of ISAR, a new synthesis platform for radiopharmaceutical production. EJNMMI Radiopharm Chem 2019; 4:24. [PMID: 31659546 PMCID: PMC6751239 DOI: 10.1186/s41181-019-0077-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/30/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND PET radiopharmaceutical development and the implementation of a production method on a synthesis module is a complex and time-intensive task since new synthesis methods must be adapted to the confines of the synthesis platform in use. Commonly utilized single fluid bus architectures put multiple constraints on synthesis planning and execution, while conventional microfluidic solutions are limited by compatibility at the macro-to-micro interface. In this work we introduce the ISAR synthesis platform and custom-tailored fluid paths leveraging up to 70 individually addressable valves on a chip-based consumable. The ISAR synthesis platform replaces traditional stopcock valve manifolds with a fluidic chip that integrates all fluid paths (tubing) and valves into one consumable and enables channel routing without the single fluid bus constraint. ISAR can scale between the macro- (10 mL), meso- (0.5 mL) and micro- (≤0.05 mL) domain seamlessly, addressing the macro-to-micro interface challenge and enabling custom tailored fluid circuits for a given application. In this paper we demonstrate proof-of-concept by validating a single chip design to address the challenge of synthesizing multiple batches of [13N]NH3 for clinical use throughout the workday. RESULTS ISAR was installed at an academic PET Center and used to manufacture [13N]NH3 in > 96% radiochemical yield. Up to 9 batches were manufactured with a single consumable chip having parallel paths without the need to open the hot-cell. Quality control testing confirmed the ISAR-based [13N]NH3 met existing clinical release specifications, and utility was demonstrated by imaging a rodent with [13N]NH3 produced on ISAR. CONCLUSIONS ISAR represents a new paradigm in radiopharmaceutical production. Through a new system architecture, ISAR integrates the principles of microfluidics with the standard volumes and consumables established in PET Centers all over the world. Proof-of-concept has been demonstrated through validation of a chip design for the synthesis of [13N]NH3 suitable for clinical use.
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Affiliation(s)
| | - Georg Winter
- GE Healthcare, Oskar-Schlemmer-Str. 11, 80807 Munich, Germany
| | | | | | - Allen F. Brooks
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI 48109 USA
| | - Brian G. Hockley
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI 48109 USA
| | - Bradford D. Henderson
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI 48109 USA
| | | | - Peter J. H. Scott
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI 48109 USA
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Slonim T, Jacobson A, Haase-Alasantro L, Marvin M, Frank C, Murphy C. A-19 Inhibition in Metabolic Syndrome and its Relationship to Orbitofrontal Cortex Activation During Sucrose Evaluation. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Metabolic syndrome(MetS) is associated with disinhibited eating,executive dysfunction,and increased risk of dementia. The orbitofrontal cortex(OFC) has been implicated in literature as an area involved with decision making and reward. Decreased OFC volume has been linked to disinhibited eating and poorer executive functioning skills.However,research examining executive functioning in individuals with MetS fails to address the role of inhibition as it pertains to consumption and risk of developing MetS. We examined the relationship between neuropsychological performance and OFC activation after receiving and rating a sucrose stimulus to determine if OFC activation is associated with executive functioning deficits that may lead to developing MetS.
Method
Participants were categorized by MetS status(n = 46) and Control(n = 34) with mean age of 49.13±20.29years. During an fMRI session, the Blood-Oxygenation-Level-Dependent(BOLD) response of OFC was recorded while participants rated the pleasantness of an aqueous sucrose solution. Participants were administered the Color-Word Interference Test outside the scanner. Partial Correlation analyses controlling for age examined the relationship between OFC activation during hedonic ratings of sucrose and cognitive performance.
Results
There was a significant negative relationship between left OFC activity and Color-Word Interference:Inhibition performance for Controls(r(42) = -.365, p = .015) as compared to MetS(r(30) = .141,p > .05).
Conclusions
Less activity in the OFC during sucrose hedonic rating was associated with better performance on the Inhibition condition for Controls. We speculate that decreased activation in the OFC after sucrose consumption reflects intact executive functioning and perhaps even a preventative factor to developing MetS. Alternatively, it could indicate that Controls are actively inhibiting hedonic responses to sucrose which improves their ability on a test of inhibition.
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Affiliation(s)
- Christopher Frank
- Palliative Care, St. Mary's of the Lake Hospital, Kingston, Ontario, Canada
| | - Neil R. Hobbs
- Palliative Care, St. Mary's of the Lake Hospital, Kingston, Ontario, Canada
| | - G. Ivan Stewart
- Palliative Care, St. Mary's of the Lake Hospital, Kingston, Ontario, Canada
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15
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Kreinest M, Goller S, Rauch G, Gliwitzky B, Frank C, Matschke S, Wölfl CG, Münzberg M. [Parameters influencing the preclinical application of cervical collars]. Unfallchirurg 2019; 120:675-682. [PMID: 27357352 DOI: 10.1007/s00113-016-0207-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The application of cervical collars is a standard procedure in emergency care of trauma patients. It is often observed that the application of cervical collars is performed incorrectly, which may lead to reduced immobilization of the cervical spine. OBJECTIVES The objective of this study was to analyze the practical skills of professional emergency care providers concerning the application of cervical collars. MATERIALS AND METHODS Emergency care professionals (n = 104) were asked to apply a cervical collar to a training doll. Each performance step was assessed separately. Furthermore, personal and occupational data of all study participants were collected using a questionnaire. RESULTS The study participants included professional rescue personnel and emergency physicians. The average occupational experience of all study participants in out-of-hospital emergency care was 11.1 ± 8.9 years. Most participants had already received training on trauma care (61 %) and felt "very confident" in handling a cervical collar (84 %). The application of the cervical collar was performed correctly in 11 % of the performances. The most common error was incorrect size adjustment of the cervical collar (66 %). No association was found between the correct application of the cervical collar and possible parameters of influence, such as working experience in emergency care or participation in trauma courses. CONCLUSIONS Despite pronounced subjective confidence regarding the application of cervical collars, this study shows that there are general deficits in the practical skills of applying cervical collars. Therefore, a critical assessment of the current training contents on the subject of trauma care must be demanded.
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Affiliation(s)
- M Kreinest
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - S Goller
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - G Rauch
- Institut für Medizinische Biometrie und Informatik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - B Gliwitzky
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - C Frank
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Mittelbaden, Baden-Baden, Deutschland
| | - S Matschke
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
| | - C G Wölfl
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - M Münzberg
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland.
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Heyland DK, Frank C, Tranmer J, Paul N, Pichora D, Jiang X, Day AG. Satisfaction with End-Of-Life Care: A Longitudinal study of Patients and Their Family Caregivers in the Last months of Life. J Palliat Care 2018. [DOI: 10.1177/082585970902500402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To determine whether and how ratings of satisfaction with end-of-life (EOL) care change over time and across settings, we administered a satisfaction questionnaire to patients 55 years and older with advanced medical disease and their family caregivers (FCGs). We re-interviewed approximately every two months for a maximum of four visits. Overall, 97 patients and 68 FCGs completed a baseline interview; 57 and 40 completed two interviews, 35 and 22 completed three, and 15 and 10 completed four. Patient satisfaction increased over time and in three of the six questionnaire domains, but this was largely confounded with the location of interview. Satisfaction scores were greater among patients whose baseline interviews occurred at home. FCGs reported increased satisfaction over time; members of the subgroup that cared for patients who died during the study were less satisfied in the spirituality domain during bereavement than prior to their relative's death. Satisfaction with care tends to vary based on location of interview and may vary across time with respect to certain aspects of EOL care.
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Affiliation(s)
- Daren K. Heyland
- D Heyland (corresponding author): Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, Canada K7L 2V7
| | - Christopher Frank
- N Paul, X Jiang, A Day: Clinical Evaluation Research Unit, Kingston General Hospital
| | - Joan Tranmer
- D Heyland: Department of Medicine, Kingston General Hospital
| | - Nancy Paul
- D Heyland, J Tranmer, D Pichora: Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Deborah Pichora
- C Frank: Department of Medicine, Division of Geriatric Medicine, St. Mary's of the Lake Hospital, Queen's University
| | - Xuran Jiang
- J Tramer, D Pichora: School of Nursing, Kingston General Hospital
| | - Andrew G. Day
- N Paul, X Jiang, A Day: Clinical Evaluation Research Unit, Kingston General Hospital
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Miller T, Brockmann S, Spackova M, Wetzig J, Frank C, Pfeifer Y, Braun P, Prager R, Rabsch W. Recurrent outbreaks caused by the same Salmonella enterica serovar Infantis clone in a German rehabilitation oncology clinic from 2002 to 2009. J Hosp Infect 2018; 100:e233-e238. [DOI: 10.1016/j.jhin.2018.03.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/27/2018] [Indexed: 11/26/2022]
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Moore A, Frank C, Chambers LW. [Not Available]. Can Fam Physician 2018; 64:e418-e421. [PMID: 30315030 PMCID: PMC6184956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ainsley Moore
- Professeure clinicienne agrégée au Département de médecine familiale de l'Université McMaster à Hamilton (Ontario).
| | - Christopher Frank
- Professeur au Département de médecine de l'Université Queen's à Kingston (Ontario)
| | - Larry W Chambers
- Professeur émérite en méthodes de recherche, données probantes et impacts à l'Université McMaster, et directeur de la recherche au Campus régional de Niagara de la Faculté de médecine Michael G. DeGroote à l'Université McMaster
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Moore A, Frank C, Chambers LW. Role of the family physician in dementia care. Can Fam Physician 2018; 64:717-719. [PMID: 30315013 PMCID: PMC6184977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ainsley Moore
- Associate Clinical Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
| | - Christopher Frank
- Professor in the Department of Medicine at Queen's University in Kingston, Ont
| | - Larry W Chambers
- Professor Emeritus of Research Methods, Evidence and Impact at McMaster University and Research Director of the Niagara Regional Campus of the Michael G. DeGroote School of Medicine at McMaster University
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Cheung B, Wong CL, Gardhouse A, Frank C, Budd L. #CGS2015: An Evaluation of Twitter Use at the Canadian Geriatrics Society Annual Scientific Meeting. Can Geriatr J 2018; 21:166-172. [PMID: 29977432 PMCID: PMC6028172 DOI: 10.5770/cgj.21.302] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Twitter is a microblogging platform increasingly used in medicine to overcome geographic barriers and promote international connections. Tweets, the 280-character microblogs, are catalogued by hashtags (#). This study evaluates and describes the participation, content, and impact of Twitter at the 2015 Canadian Geriatrics Society (CGS) Annual Scientific Meeting, during which #CGS2015 was the official conference hashtag. Methods Twitter transcripts of #CGS2015 were obtained from Symplur to prospectively analyze tweets for content and quantitative metrics. TweetReach was used to retrospectively analyze tweets with the hashtag #CGS2014 from the 2014 meeting for growth analysis. The impact of Twitter on the conference experience was derived from questionnaires. Results There were 1,491 #CGS2015 tweets, 40% of which were original. Tweet content was categorized into conference sessions (38.8%), networking (29.2%), resource sharing (17.6%), and conference promotion (14.3%). Of the 279 participants, 60% were non-Canadian. The questionnaire data from 86 respondents demonstrated generally positive experiences with Twitter, particularly with facilitating collegial interactions, resource sharing, and insight into sessions not attended live. The most cited drawback was divided attention when using personal devices. Analysis comparing #CGS2014 to #CGS2015 demonstrated increases in total participants (50 to 279), number of tweets (434 to 1,491) and impressions (155,600 to 943,825). Conclusions Twitter engagement at the CGS 2015 annual meeting enabled international participation in networking, resource sharing, and online discussions of sessions. Future conferences may benefit from a workshop on Twitter basics for attendees and presenters.
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Affiliation(s)
- Bonnie Cheung
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Camilla L Wong
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Research Institute, University of Toronto, Toronto, ON, Canada
| | - Amanda Gardhouse
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Frank
- Division of Geriatric Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Laura Budd
- Li Ka Shing Research Institute, University of Toronto, Toronto, ON, Canada
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21
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Rapoport MJ, Zucchero Sarracini C, Kiss A, Lee L, Byszewski A, Seitz DP, Vrkljan B, Molnar F, Herrmann N, Tang-Wai DF, Frank C, Henry B, Pimlott N, Masellis M, Naglie G. Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial. J Med Internet Res 2018; 20:e194. [PMID: 29802093 PMCID: PMC5993977 DOI: 10.2196/jmir.9126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/10/2018] [Accepted: 03/08/2018] [Indexed: 11/25/2022] Open
Abstract
Background Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. Methods The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=−0.19, P=.85). Two variables predicted algorithm-based reporting—caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001). Conclusions On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. Trial Registration ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8)
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Affiliation(s)
- Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna Byszewski
- Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Geriatric Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dallas P Seitz
- Seniors Mental Health Program, Providence Care, Kingston, ON, Canada.,Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Frank Molnar
- Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Geriatric Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David F Tang-Wai
- Memory Clinic, University Health Network, Toronto, ON, Canada.,Division of Neurology, Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Frank
- Specialized Geriatric Services, Providence Care, Kingston, ON, Canada.,Division of Geriatric Medicine, Queen's University, Kingston, ON, Canada
| | - Blair Henry
- Clinical Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicholas Pimlott
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Mario Masellis
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Gary Naglie
- Department of Medicine, Baycrest Health Sciences, Toronto, ON, Canada.,Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
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Wenzel F, Brackmann HH, Oldenburg J, Frank C. Influence of treatment with haemostatic agents on ETP in patients with haemophilia and VWD. Hamostaseologie 2018. [DOI: 10.1055/s-0037-1621430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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23
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Mittal S, Frank C, Bari Z, Al Hebaishi Y, Hodgkin DD, Palmisano P, Klepfer R, Tsintzos SI, Plummer C. P1541A comparison of two novel algorithms to acutely increase delivery of effective left ventricular pacing during atrial fibrillation in patients undergoing cardiac resynchronization therapy. Europace 2017. [DOI: 10.1093/ehjci/eux158.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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24
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Lorch C, Novák J, Banerjee R, Weimer S, Dieterle J, Frank C, Hinderhofer A, Gerlach A, Carla F, Schreiber F. Influence of C60 co-deposition on the growth kinetics of diindenoperylene–From rapid roughening to layer-by-layer growth in blended organic films. J Chem Phys 2017; 146:052807. [DOI: 10.1063/1.4966583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- C. Lorch
- Universität Tübingen, Institut für Angewandte Physik, Auf der Morgenstelle 10, 72076 Tübingen, Germany
| | - J. Novák
- Universität Tübingen, Institut für Angewandte Physik, Auf der Morgenstelle 10, 72076 Tübingen, Germany
- Central European Institute of Technology, Masaryk University, Kamenice 5, CZ-62500 Brno, Czech Republic
- Department of Condensed Matter Physics, Faculty of Science, Masaryk University, Kotlarska 2, CZ-611 37 Brno, Czech Republic
| | - R. Banerjee
- Universität Tübingen, Institut für Angewandte Physik, Auf der Morgenstelle 10, 72076 Tübingen, Germany
- Department of Physics, Indian Institute of Technology Gandhinagar, Palaj, Gandhinagar 382355, India
| | - S. Weimer
- Universität Tübingen, Institut für Angewandte Physik, Auf der Morgenstelle 10, 72076 Tübingen, Germany
| | - J. Dieterle
- Universität Tübingen, Institut für Angewandte Physik, Auf der Morgenstelle 10, 72076 Tübingen, Germany
| | - C. Frank
- Universität Tübingen, Institut für Angewandte Physik, Auf der Morgenstelle 10, 72076 Tübingen, Germany
| | - A. Hinderhofer
- Universität Tübingen, Institut für Angewandte Physik, Auf der Morgenstelle 10, 72076 Tübingen, Germany
| | - A. Gerlach
- Universität Tübingen, Institut für Angewandte Physik, Auf der Morgenstelle 10, 72076 Tübingen, Germany
| | - F. Carla
- ESRF-The European Synchrotron, 71 Avenue des Martyrs, 38000 Grenoble, France
| | - F. Schreiber
- Universität Tübingen, Institut für Angewandte Physik, Auf der Morgenstelle 10, 72076 Tübingen, Germany
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25
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Frank C, Forbes RF. [Not Available]. Can Fam Physician 2017; 63:e3-e8. [PMID: 28115451 PMCID: PMC5257230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objectif Permettre aux médecins de famille de comprendre « l’expérience vécue » de la démence de la bouche d’une personne atteinte de démence—Faye Forbes, ministre anglicane de 64 ans atteinte de la maladie d’Alzheimer, qui donne son point de vue sur comment vivre avec la démence—et utiliser cette information pour améliorer les soins et les résultats. Sources d’information Une recherche a été effectuée dans MEDLINE sur Ovid entre janvier 2005 et février 2015, à l’aide des mots-clés anglais suivants : dementia, caregiver, perspectives et quality of health care. Les articles qui s’adressaient aux médecins de famille ont été sélectionnés. Des revues pertinentes et des articles de recherche originaux ont été utilisés, le cas échéant, s’ils s’appliquaient aux personnes atteintes de démence et à leurs soignants. Message principal Plusieurs cadres de référence organisent les principales expériences décrites par les patients et leurs soignants. Nous avons utilisé une revue de la littérature qualitative pour fournir un cadre de référence résumant l’expérience de Faye, en fonction des thèmes suivants : tenter d’obtenir un diagnostic, accéder au soutien et aux services, besoins en matière d’information, prise en charge de la maladie, et communication et attitudes. Conclusion Les médecins doivent tenir compte de ces thèmes lorsqu’ils planifient la prise en charge des personnes atteintes de démence. Il importe de tenter de comprendre l’expérience et le point de vue des personnes atteintes de démence et de leurs soignants afin de pouvoir dispenser des soins optimaux.
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Affiliation(s)
- Christopher Frank
- Professeur agrégé au Département de médecine de l'Université Queen's à Kingston, en Ontario, et chef clinique de la gériatrie spécialisée au Providence Care à Kingston.
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Frank C, Forbes RF. A patient's experience in dementia care: Using the "lived experience" to improve care. Can Fam Physician 2017; 63:22-26. [PMID: 28115436 PMCID: PMC5257215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To give FPs an understanding of the "lived experience" of dementia via the words of a person with dementia (PWD)- Faye Forbes, a 64-year-old Anglican priest with Alzheimer disease who provides her perspectives on living with dementia-and to use these thoughts to improve care and outcomes. SOURCES OF INFORMATION Ovid MEDLINE was searched from January 2005 to February 2015 using subject headings for dementia, caregiver, perspectives, and quality of health care. Articles geared toward FPs were selected. Relevant review articles and original research articles were used when appropriate and if they were applicable to PWDs and their caregivers. MAIN MESSAGE There are several frameworks that organize the main experiences described by patients and caregivers. We used a review of the qualitative literature to provide the framework to summarize Faye's experience under the following headings: seeking a diagnosis, accessing supports and services, information needs, disease management, and communication and attitudes. CONCLUSION Physicians should consider these themes when developing a management plan for PWDs. Trying to understand the experiences and perspectives of PWDs and their caregivers is important in providing optimal care.
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Affiliation(s)
- Christopher Frank
- Associate Professor in the Department of Medicine at Queen's University in Kingston, Ont, and Clinical Lead of Specialized Geriatrics at Providence Care.
| | - Rev Faye Forbes
- Associate Priest at St Francis by the Lakes Anglican Church in Lower Sackville, NS
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27
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Maier M, Abraham S, Frank C, Feucht N, Lohmann CP. [Ocriplasmin as a treatment option for symptomatic vitreomacular traction with and without macular hole. First clinical experiences]. Ophthalmologe 2016; 112:990-4. [PMID: 26062717 DOI: 10.1007/s00347-015-0073-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the resolution rate in patients with symptomatic vitreomacular traction (≤ 1500 μm) with or without macular holes (≤ 400 μm) after therapy with intravitreal ocriplasmin (Jetrea®) injection in a clinical setting. METHODS Until now we have prospectively examined 21 eyes of 21 consecutive patients with symptomatic vitreomacular traction with or without macular holes who underwent intravitreal operative injection of 0.1 ml ocriplasmin. The best corrected visual acuity and high-resolution optical coherence tomography (SD-OCT) ultrastructural parameters were measured before injection and again 1, 3 and 4 months after treatment. The numbers of resolved vitreomacular traction and closed macular holes were documented. RESULTS Vitreomacular traction was resolved in 15 out of 21 (71 %) eyes. Of the five eyes which initially presented with vitreomacular traction with macular holes, all showed resolution of vitreomacular traction but only two of the macular holes were closed. The average best corrected visual acuity was 0.38 logMAR (± 0.23) at baseline and 0.43 logMAR (± 0.28), 0.38 logMAR (± 0.27) and 0.36 logMAR (± 0.24) 1, 3 and 4 months after injection, respectively. The average foveal thickness was 355.95 μm (± 114.53 μm) at baseline, reducing to 304.61 μm (± 100.91 μm), 308.00 μm (±76.17 μm) and 277.50 μm (± 26.24 μm) after 1, 3 and 4 months, respectively. CONCLUSION In this ongoing study there was a high percentage of resolution of vitreomacular traction (71 %) 1 month after intravitreal operative injection of Jetrea® and closure of two out of five macular holes. This was further associated with stabilization of visual acuity and reduction of foveal thickness. Further investigations are necessary to document the effectiveness of the pharmacological vitreolysis in a clinical setting.
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Affiliation(s)
- M Maier
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - S Abraham
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - C Frank
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - N Feucht
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - C P Lohmann
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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28
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Rapoport MJ, Sarracini CZ, Rozmovits L, Kiss A, Grigoriev I, Taylor R, Herrmann N, Mulsant BH, Cameron D, Frank C, Seitz D, Byszewski A, Tang-Wai DF, Masellis M, Molnar F, Naglie G. P2‐376: A Driving in Dementia Decision Tool: Preliminary Analysis. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Alex Kiss
- Sunnybrook Research InstituteTorontoON Canada
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29
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Maier M, Abraham S, Frank C, Lohmann CP, Feucht N. [Therapeutic Options in Vitreomacular Traction With or Without a Macular Hole]. Klin Monbl Augenheilkd 2016; 233:622-30. [PMID: 27187883 DOI: 10.1055/s-0042-101349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Treatment is usually indicated for symptomatic vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) and without spontaneous resolution. Ultrastructural parameters are evaluated by SD-OCT, in order to classify the vitreoretinal interface and to estimate the success rate of treatment. The resolution rate after therapy with intravitreal Jetrea® (Ocriplasmin) is high (up to 70 %) in patients with symptomatic focal vitreomacular traction (≤ 1500 µm) with or without a macular hole (≤ 250 µm) and with no epiretinal membrane (ERM), but depends on the exact baseline analysis. All other patients with idiopathic traction retinopathy should be treated by minimal invasive pars plana vitrectomy (MIVI). Vitreoretinal surgery effectively removes traction and gives a high closure rate of a full thickness macular hole (FTMH, 90 to 100 %). It is now a very safe procedure with few side effects. Despite a low risk profile (cataract, retinal tear etc.) the indication for surgery needs to take the safety profile into account. Therefore vitrectomy is only indicated in symptomatic patients complaining of blurred vision, VA reduction and metamorphopsia. Vitrectomy is also indicated in patients whose treatment by pharmacologic vitreolysis has failed.
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Affiliation(s)
- M Maier
- Augenklinik, Klinikum rechts der Isar, Technische Universität München
| | - S Abraham
- Augenklinik, Klinikum rechts der Isar, Technische Universität München
| | - C Frank
- Augenklinik, Klinikum rechts der Isar, Technische Universität München
| | - C P Lohmann
- Augenklinik, Klinikum rechts der Isar, Technische Universität München
| | - N Feucht
- Augenklinik, Klinikum rechts der Isar, Technische Universität München
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Abstract
Background and Purpose To foster interest in geriatric care, the Queen’s Geriatrics Interest Group (QGIG) collaborated with the Division of Geriatric Medicine to arrange a Geriatrics Pre-Clerkship Observership Program. Methods Forty-two pre-clerkship medical students participated in the program between October 2013 and May 2014. Participants were paired with a resident and/or attending physician for a four-hour weekend observership on an inpatient geriatric rehabilitation unit. The program was assessed using: (1) internally developed Likert scales assessing student’s experiences and interest in geriatric medicine before and after the observership; (2) University of California Los Angeles–Geriatric Attitudes Scale (UCLA-GAS); and (3) narrative feedback. Results All participants found the process of setting up the observership easy. Some 72.7% described the observership experience as leading to positive changes in their attitude toward geriatric medicine and 54.5% felt that it stimulated their interest in the specialty. No statistically significant change in UCLA–GAS scores was detected (mean score pre- versus post-observership: 3.5 ± 0.5 versus 3.7 ± 0.4; p=.35). All participants agreed that the program should continue, and 90% stated that they would participate again. Conclusions The observership program was positively received by students. Structured pre-clerkship observerships may be a feasible method for increasing exposure to geriatric medicine.
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Affiliation(s)
- Peng You
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Marie Leung
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Victoria Y Y Xu
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Alexander Astell
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Sudeep S Gill
- School of Medicine, Division of Geriatric Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Michelle Gibson
- School of Medicine, Division of Geriatric Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Christopher Frank
- School of Medicine, Division of Geriatric Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON
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Frank C. Models of primary care for frail patients. Can Fam Physician 2015; 61:601-606. [PMID: 26380850 PMCID: PMC4501602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To discuss models of care for frail seniors provided in primary care settings and those developed by Canadian FPs. SOURCES OF INFORMATION Ovid MEDLINE and the Cochrane database were searched from 2010 to January 2014 using the terms models of care, family medicine, elderly, and geriatrics. MAIN MESSAGE New models of funding for primary care have opened opportunities for ways of caring for complex frail older patients. Severity of frailty is an important factor, and more severe frailty should prompt consideration of using an alternate model of care for a senior. In Canada, models in use include integrated care systems, shared care models, home-based care models, and family medicine specialty clinics. No one model should take precedence but FPs should be involved in developing and implementing strategies that meet the needs of individual patients and communities. Organizational and remunerative supports will need to be put in place to achieve widespread uptake of such models. CONCLUSION Given the increased numbers of frail seniors and the decrease in access to hospital beds, prioritized care models should include ones focused on optimizing health, decreasing frailty, and helping to avoid hospitalization of frail and well seniors alike. The Health Care of the Elderly Program Committee at the College of Family Physicians of Canada is hosting a repository for models of care used by FPs and is asking physicians to submit their ideas for how to best care for frail seniors.
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Andersson Å, Frank C, Willman AML, Sandman PO, Hansebo G. Adverse events in nursing: A retrospective study of reports of patient and relative experiences. Int Nurs Rev 2015; 62:377-85. [PMID: 26109381 DOI: 10.1111/inr.12192] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patient safety is an important global issue. While it is well known that patients can suffer from adverse events in nursing care, there is a lack of knowledge as to how they experience them. AIM To examine adverse events in nursing care as they are experienced by patients and relatives. METHODS This was a retrospective study taking both a qualitative and a quantitative approach. It was based on data regarding 242 adverse events in nursing care, as reported by patients and relatives to Sweden's Medical Responsibility Board, content analysis was used to analyse the reports. RESULTS Patients' and relatives' experiences were analysed into four categories of adverse events, as concerning participation, clinical judgement, nursing intervention and the essentials of care. LIMITATIONS The reports were classified by the Medical Responsibility Board, without a standardized system. The adverse events reported were few in number and were reported by patients and relatives only. CONCLUSION Lack of participation has negative consequences and contributes to adverse events. Adverse events occur through missed care as well as through carer errors. IMPLICATIONS ON NURSING AND HEALTH PRACTICE Nurses need to improve their skills that support patient participation. Patient participation needs to be incorporated into nurses' duties. IMPLICATIONS FOR NURSING AND HEALTH POLICY Resources for patients to participate in their own care needs to be a priority underpinning policy-making in health systems. Nursing education systems need to teach students about the value and benefits of involving patients in their care.
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Affiliation(s)
- Å Andersson
- Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - C Frank
- Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - A M L Willman
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - P-O Sandman
- Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - G Hansebo
- Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Health Care Sciences, Ersta Sköndal University Collage, Stockholm, Sweden
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Sinuff T, Dodek P, You JJ, Barwich D, Tayler C, Downar J, Hartwick M, Frank C, Stelfox HT, Heyland DK. Improving End-of-Life Communication and Decision Making: The Development of a Conceptual Framework and Quality Indicators. J Pain Symptom Manage 2015; 49:1070-80. [PMID: 25623923 DOI: 10.1016/j.jpainsymman.2014.12.007] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/27/2014] [Accepted: 12/20/2014] [Indexed: 11/23/2022]
Abstract
CONTEXT The goal of end-of-life (EOL) communication and decision making is to create a shared understanding about a person's values and treatment preferences that will lead to a plan of care that is consistent with these values and preferences. Improvements in communication and decision making at the EOL have been identified as a high priority from a patient and family point of view. OBJECTIVES The purpose of this study was to develop quality indicators related to EOL communication and decision making. METHODS We convened a multidisciplinary panel of experts to develop definitions, a conceptual framework of EOL communication and decision making, and quality indicators using a modified Delphi method. We generated a list of potential items based on literature review and input from panel members. Panel members rated the items using a seven-point Likert scale (1 = very little importance to 7 = extremely important) over four rounds of review until consensus was achieved. RESULTS About 24 of the 28 panel members participated in all four rounds of the Delphi process. The final list of quality indicators comprised 34 items, divided into the four categories of our conceptual framework: Advance care planning (eight items), Goals of care discussions (13 items), Documentation (five items), and Organization/System aspects (eight items). Eleven items were rated "extremely important" (median score). All items had a median score of five (moderately important) or greater. CONCLUSION We have developed definitions, a conceptual framework, and quality indicators that researchers and health care decision makers can use to evaluate and improve the quality of EOL communication and decision making.
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Affiliation(s)
- Tasnim Sinuff
- Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Dodek
- Center for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - John J You
- Departments of Medicine, and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Doris Barwich
- BC Center for Palliative Care, Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carolyn Tayler
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - James Downar
- Divisions of Critical Care and Palliative Care, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Hartwick
- Divisions of Critical Care and Palliative Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Frank
- Division of Geriatric Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Calgary, and Alberta Health Services-Calgary Zone, Calgary, Alberta, Canada
| | - Daren K Heyland
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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34
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Gladstone DJ, Dorian P, Spring M, Panzov V, Mamdani M, Healey JS, Thorpe KE, Aviv R, Boyle K, Blakely J, Cote R, Hall J, Kapral M, Kozlowski N, Laupacis A, O’Donnell M, Sabihuddin K, Sharma M, Shuaib A, Vaid H, Pinter A, Abootalebi S, Chan R, Crann S, Fleming L, Frank C, Hachinski V, Hesser K, Kumar B, Soros P, Wright M, Basile V, Boyle K, Hopyan J, Rajmohan Y, Swartz R, Vaid H, Valencia G, Ween J, Aram H, Barber P, Coutts S, Demchuk A, Fischer K, Hill M, Klein G, Kenney C, Menon B, McClelland M, Russell A, Ryckborst K, Stys P, Smith E, Watson T, Chacko S, Sahlas D, Sancan J, Côté R, Durcan L, Ehrensperger E, Minuk J, Wein T, Wadup L, Asdaghi N, Beckman J, Esplana N, Masigan P, Murphy C, Tang E, Teal P, Villaluna K, Woolfenden A, Yip S, Bussière M, Dowlatshahi D, Sharma M, Stotts G, Robert S, Ford K, Hackam D, Miners L, Mabb T, Spence JD, Buck B, Griffin-Stead T, Jassal R, Siddiqui M, Hache A, Lessard C, Lebel F, Mackey A, Verreault S, Astorga C, Casaubon LK, del Campo M, Jaigobin C, Kalman L, Silver FL, Atkins L, Coles K, Penn A, Sargent R, Walter C, Gable Y, Kadribasic N, Schwindt B, Shuaib A, Kostyrko P, Selchen D, Saposnik G, Christie P, Jin A, Hicklin D, Howse D, Edwards E, Jaspers S, Sher F, Stoger S, Crisp D, Dhanani A, John V, Levitan M, Mehdiratta M, Wong D. Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke. Stroke 2015; 46:936-41. [DOI: 10.1161/strokeaha.115.008714] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- David J. Gladstone
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Paul Dorian
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Melanie Spring
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Val Panzov
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Muhammad Mamdani
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Jeff S. Healey
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Kevin E. Thorpe
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - R. Chan
- London Health Sciences Centre; London, Ontario
| | - S. Crann
- London Health Sciences Centre; London, Ontario
| | - L. Fleming
- London Health Sciences Centre; London, Ontario
| | - C. Frank
- London Health Sciences Centre; London, Ontario
| | | | - K. Hesser
- London Health Sciences Centre; London, Ontario
| | - B.S. Kumar
- London Health Sciences Centre; London, Ontario
| | - P. Soros
- London Health Sciences Centre; London, Ontario
| | - M. Wright
- London Health Sciences Centre; London, Ontario
| | - V. Basile
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - K. Boyle
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - J. Hopyan
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - Y. Rajmohan
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - R. Swartz
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - H. Vaid
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - G. Valencia
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - J. Ween
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - H. Aram
- Foothills Hospital; Calgary, Alberta
| | | | - S. Coutts
- Foothills Hospital; Calgary, Alberta
| | | | | | - M.D. Hill
- Foothills Hospital; Calgary, Alberta
| | - G. Klein
- Foothills Hospital; Calgary, Alberta
| | - C. Kenney
- Foothills Hospital; Calgary, Alberta
| | - B. Menon
- Foothills Hospital; Calgary, Alberta
| | | | | | | | - P. Stys
- Foothills Hospital; Calgary, Alberta
| | | | | | - S. Chacko
- Hamilton Health Sciences Centre; Hamilton, Ontario
| | - D. Sahlas
- Hamilton Health Sciences Centre; Hamilton, Ontario
| | - J. Sancan
- Hamilton Health Sciences Centre; Hamilton, Ontario
| | - R. Côté
- Montreal General Hospital; Montreal, Québec
| | - L. Durcan
- Montreal General Hospital; Montreal, Québec
| | | | - J. Minuk
- Montreal General Hospital; Montreal, Québec
| | - T. Wein
- Montreal General Hospital; Montreal, Québec
| | - L. Wadup
- Montreal General Hospital; Montreal, Québec
| | - N. Asdaghi
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - J. Beckman
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - N. Esplana
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - P. Masigan
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - C. Murphy
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - E. Tang
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - P. Teal
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - K. Villaluna
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - A. Woolfenden
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - S. Yip
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | | | | | - M. Sharma
- The Ottawa Hospital; Ottawa, Ontario
| | - G. Stotts
- The Ottawa Hospital; Ottawa, Ontario
| | - S. Robert
- The Ottawa Hospital; Ottawa, Ontario
| | - K. Ford
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - D. Hackam
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - L. Miners
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - T. Mabb
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - J. D. Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - B. Buck
- Grey Nuns Hospital; Edmonton Alberta
| | | | - R. Jassal
- Grey Nuns Hospital; Edmonton Alberta
| | | | - A. Hache
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - C. Lessard
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - F. Lebel
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - A. Mackey
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - S. Verreault
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - C. Astorga
- University Health Network; Toronto, Ontario
| | | | | | | | - L. Kalman
- University Health Network; Toronto, Ontario
| | - FL Silver
- University Health Network; Toronto, Ontario
| | - L. Atkins
- Vancouver Island Health Authority; Victoria, British Columbia
| | - K. Coles
- Vancouver Island Health Authority; Victoria, British Columbia
| | - A. Penn
- Vancouver Island Health Authority; Victoria, British Columbia
| | - R. Sargent
- Vancouver Island Health Authority; Victoria, British Columbia
| | - C. Walter
- Vancouver Island Health Authority; Victoria, British Columbia
| | - Y. Gable
- Mackenzie Health Sciences Centre; Edmonton, Alberta
| | | | - B. Schwindt
- Mackenzie Health Sciences Centre; Edmonton, Alberta
| | - A. Shuaib
- Mackenzie Health Sciences Centre; Edmonton, Alberta
| | | | - D. Selchen
- St. Michael’s Hospital; Toronto, Ontario
| | | | - P. Christie
- Kingston General Hospital; Kingston, Ontario
| | - A. Jin
- Kingston General Hospital; Kingston, Ontario
| | - D. Hicklin
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - D. Howse
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - E. Edwards
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - S. Jaspers
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - F. Sher
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - S. Stoger
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
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Abstract
Ageing is a common subject in arts and literature as it is a universal experience. The use of the humanities in medical education may have a positive effect on trainees' attitude to caring for seniors and on geriatrics as a career choice. This paper summarizes the role of humanities in medical education and provides some examples and thoughts on how humanities curriculum can be used in geriatric teaching.
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Affiliation(s)
| | - Ruth Elwood Martin
- Department of Family Medicine, University of British Columbia, Vancouver, BC
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36
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Affiliation(s)
- Christopher Frank
- Providence Care Centre, St. Mary's of the Lake Hospital Site; Division of Geriatrics, Department of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ont.
| | - Erica Weir
- Providence Care Centre, St. Mary's of the Lake Hospital Site; Division of Geriatrics, Department of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ont
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Rapoport MJ, Naglie G, Herrmann N, Zucchero Sarracini C, Mulsant BH, Frank C, Kiss A, Seitz D, Vrkljan B, Masellis M, Tang-Wai D, Pimlott N, Molnar F. Developing physician consensus on the reporting of patients with mild cognitive impairment and mild dementia to transportation authorities in a region with mandatory reporting legislation. Am J Geriatr Psychiatry 2014; 22:1530-43. [PMID: 24406250 DOI: 10.1016/j.jagp.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 11/27/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To establish consensus among dementia experts about which patients with mild cognitive impairment (MCI) or mild dementia should be reported to transportation authorities. METHODS We conducted a literature review of predictors of driving safety in patients with dementia and combined these into 26 case scenarios. Using a modified Delphi technique, case scenarios were reviewed by 38 dementia experts (geriatric psychiatrists, geriatricians, cognitive neurologists and family physicians with expertise in elder care) who indicated whether or not they would report the patient in each scenario to regional transportation authorities and recommend a specialized on-road driving test. Scenarios were presented up to five times to achieve consensus, defined as 85% agreement, and discrepancies were discussed anonymously online. RESULTS By the end of the fifth iteration, there was cumulative consensus on 18 scenarios (69%). The strongest predictors of decision to report were the combination of caregiver concern about the patient's driving and abnormal Clock Drawing Test, which accounted for 62% of the variance in decision to report at the same time as or without a road test (p <0.01). Based on these data, an algorithm was developed to guide physician decision-making about reporting patients with MCI or mild dementia to transportation authorities. CONCLUSION This study supports existing international guidelines that recommend specialized on-road testing when driving safety is uncertain for patients with MCI and emphasizes the importance of assessing executive dysfunction and caregiver concern about driving.
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Affiliation(s)
- Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Gary Naglie
- Institute of Health Policy Management & Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Rotman Research Scientist, Baycrest Geriatric Health Care Centre, University of Toronto, Toronto, Ontario, Canada; Research Department, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Carla Zucchero Sarracini
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Frank
- Division of Geriatric Medicine, Providence Care, Queen's University, Kingston, Ontario, Canada
| | - Alex Kiss
- Institute of Health Policy Management & Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dallas Seitz
- Division of Geriatric Psychiatry, Providence Care, Queen's University, Kingston, Ontario, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Mario Masellis
- Department of Neurology, Sunnybrook Health Sciences Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Tang-Wai
- Department of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Pimlott
- Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Frank Molnar
- Division of Geriatric Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Marshall D, Vanderby S, Carter M, Wasylak T, Mosher DP, Noseworthy T, Maxwell C, MacDonald K, Frank C. What Could the Future Hold? Simulating the Demand for Osteoarthritis (oa) Care in Alberta to Plan a Sustainable Oa Care System. Value Health 2014; 17:A389. [PMID: 27200891 DOI: 10.1016/j.jval.2014.08.2664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- D Marshall
- University of Calgary, Calgary, AB, Canada
| | - S Vanderby
- University of Saskatchewan, Saskatoon, SK, Canada
| | - M Carter
- University of Toronto, Toronto, ON, Canada
| | - T Wasylak
- Alberta Health Services, Calgary, AB, Canada
| | - D P Mosher
- University of Calgary, Calgary, AB, Canada
| | - T Noseworthy
- University of Calgary, Alberta Health Services, Calgary, AB, Canada
| | - C Maxwell
- University of Waterloo, Waterloo, ON, Canada
| | | | - C Frank
- Alberta Innovates Health Solutions, Calgary, AB, Canada
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Long CJ, Butler S, Fesi J, Frank C, Canning DA, Zderic SA. Genetic or pharmacologic disruption of the calcineurin-nuclear factor of activated T-cells axis prevents social stress-induced voiding dysfunction in a murine model. J Pediatr Urol 2014; 10:598-604. [PMID: 24909609 DOI: 10.1016/j.jpurol.2014.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/09/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Social stress can suppress the voiding reflex, with resultant diminished voiding frequency and increased volumes. The calcineurin-NFAT (nuclear factor of activated T cells) pathway is important in memory development. It was hypothesized that interruption of the calcineurin-NFAT pathway might prevent social stress-induced voiding dysfunction. METHODS Mice were subjected to social stress in an established resident-intruder model for 1 h, followed by 23 h of barrier separation. NFATc3, NFATc4 knockout (KO) and wild-type (WT) mice were studied. At two weeks, voiding patterns were collected; this was followed by sacrifice. Corticotropin-releasing factor (CRF) mRNA expression in Barrington's nucleus (BN) was determined by in-situ hybridization. RESULTS Social stress decreased voiding frequency and increased voided volumes in WT strains. At baseline, NFATc3 KO mice showed decreased voids and increased volumes, while the NFATc4 KO mice resisted social stress. However, CRF mRNA increased in WT mice following social stress and was increased at baseline in NFATc3 KO mice. It was found that CRF mRNA did not increase following social stress in NFATc4 KO mice. The administration of CsA to WT mice normalized voiding patterns following social stress, albeit with no effect on CRF mRNA in BN. CONCLUSION Disrupting the calcineurin-NFAT axis by either genetic or pharmacologic approaches confers resistance to the development of social stress-induced voiding and dysfunction.
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Affiliation(s)
- C J Long
- John W. Duckett Center for Pediatric Urology at The Children's Hospital of Philadelphia, USA; The Perelman School of Medicine at The University of Pennsylvania, USA.
| | - S Butler
- John W. Duckett Center for Pediatric Urology at The Children's Hospital of Philadelphia, USA; The Perelman School of Medicine at The University of Pennsylvania, USA.
| | - J Fesi
- John W. Duckett Center for Pediatric Urology at The Children's Hospital of Philadelphia, USA; The Perelman School of Medicine at The University of Pennsylvania, USA.
| | - C Frank
- John W. Duckett Center for Pediatric Urology at The Children's Hospital of Philadelphia, USA; The Perelman School of Medicine at The University of Pennsylvania, USA.
| | - D A Canning
- John W. Duckett Center for Pediatric Urology at The Children's Hospital of Philadelphia, USA; The Perelman School of Medicine at The University of Pennsylvania, USA.
| | - S A Zderic
- John W. Duckett Center for Pediatric Urology at The Children's Hospital of Philadelphia, USA.
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Lücke C, Rutschke W, Frank C, Lurz P, Grothoff M, Eitel I, Thiele H, Lehmkuhl L, Gutberlet M. Interobservervariabilität von T1- und T2-Mapping Sequenzen der kardialen MRT bei Patienten mit klinischem Verdacht auf Myokarditis. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Frank C, Milde-Busch A, Werber D. Results of surveillance for infections with Shiga toxin-producing Escherichia coli (STEC) of serotype O104:H4 after the large outbreak in Germany, July to December 2011. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.14.20760] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- C Frank
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - A Milde-Busch
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - D Werber
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Schwarz NG, Kreuels B, Stark K, Frank C, Schmidt-Chanasit J. Authors reply: Diagnosis of a single imported dengue case who had travelled to Japan – how serious is it for travellers? Euro Surveill 2014; 19:20716. [DOI: 10.2807/1560-7917.es2014.19.8.20716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N G Schwarz
- Bernhard Nocht Institute for Tropical Medicine, Infectious Disease Epidemiology, Hamburg, Germany
- These authors contributed equally to this work
| | - B Kreuels
- These authors contributed equally to this work
- German Centre for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel, Hamburg, Germany
- Division of Tropical Medicine, 1. Department of Internal Medicine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
- Bernhard Nocht Institute for Tropical Medicine, Infectious Disease Epidemiology, Hamburg, Germany
| | - K Stark
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Berlin, Germany
| | - C Frank
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Berlin, Germany
| | - J Schmidt-Chanasit
- Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, Hamburg, Germany
- German Centre for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel, Hamburg, Germany
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Frank C. Pharmacologic treatment of depression in the elderly. Can Fam Physician 2014; 60:121-126. [PMID: 24522673 PMCID: PMC3922554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To discuss pharmacologic treatment of depression in the elderly, including choice of antidepressants, titration of dose, monitoring of response and side effects, and treatment of unresponsive cases. SOURCES OF INFORMATION The 2006 Canadian Coalition for Seniors' Mental Health guideline on the assessment and treatment of depression was used as a primary source. To identify articles published since the guideline, MEDLINE was searched from 2007 to 2012 using the terms depression, treatment, drug therapy, and elderly. MAIN MESSAGE The goal of treatment should be remission of symptoms. Improvement of symptoms can be monitored by identifying patient goals or by use of a clinical tool such as the Patient Health Questionnaire-9. Treatment should be considered in 3 phases: an acute treatment phase to achieve remission of symptoms, a continuation phase to prevent recurrence of the same episode of illness (relapse), and a maintenance (prophylaxis) phase to prevent future episodes (recurrence). Initial dosing should be half of the usual adult starting dose and be titrated regularly until the patient responds, until the maximum dose is reached, or until side effects limit further increases. Common side effects of medications include falls, nausea, dizziness, headaches, and, less commonly, hyponatremia and QT interval changes. Strategies for switching or augmenting antidepressants are discussed. Older patients should be treated for at least a year from when clinical improvement is noted, and those with recurrent depression or severe symptoms should continue treatment indefinitely. Treatment of specific situations such as severe depression or depression with psychosis is discussed, including the use of electroconvulsive therapy. Criteria for referral to geriatric psychiatry are provided; however, many family physicians do not have easy access to this resource or to other nonpharmacologic clinical strategies. CONCLUSION The effectiveness of pharmacologic treatment of depression is not substantially affected by age. Identification of depression, choice of appropriate treatment, titration of medications, monitoring of side effects, and adequate duration of treatment will improve outcomes for older patients.
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Schmidt-Chanasit J, Emmerich P, Tappe D, Gunther S, Schmidt S, Wolff D, Hentschel K, Sagebiel D, Schoneberg I, Stark K, Frank C. Autochthonous dengue virus infection in Japan imported into Germany, September 2013. ACTA ACUST UNITED AC 2014; 19. [PMID: 24480059 DOI: 10.2807/1560-7917.es2014.19.3.20681] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In September 2013, dengue virus (DENV) infection was diagnosed in a German traveller returning from Japan. DENV-specific IgM and IgG and DENV NS1 antigen were detected in the patient’s blood, as were DENV serotype 2-specific antibodies. Public health authorities should be aware that autochthonous transmission of this emerging virus may occur in Japan. Our findings also highlight the importance of taking a full travel history, even from travellers not returning from tropical countries, to assess potential infection risks of patients.
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Affiliation(s)
- J Schmidt-Chanasit
- Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, Hamburg, Germany
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Rapoport MJ, Herrmann N, Haider S, Sarracini CZ, Molnar F, Frank C, Masellis M, Tang-Wai D, Kiss A, Pimlott N, Naglie G. Physician Sex Is a Predictor of Reporting Drivers with Mild Cognitive Impairment and Mild Dementia to Transportation Authorities. J Am Geriatr Soc 2014; 62:201-3. [DOI: 10.1111/jgs.12627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mark J. Rapoport
- Department of Psychiatry; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - Nathan Herrmann
- Department of Psychiatry; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | | | | | - Frank Molnar
- Division of Geriatric Medicine; The Ottawa Hospital; Ottawa Ontario Canada
| | - Christopher Frank
- Division of Geriatric Medicine; Providence Care; Kingston Ontario Canada
| | - Mario Masellis
- Department of Neurology; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - David Tang-Wai
- Department of Neurology; University Health Network; Toronto Ontario Canada
| | - Alex Kiss
- Institute of Health Policy Management & Evaluation; University of Toronto; Toronto Ontario Canada
| | - Nicholas Pimlott
- Department of Family and Community Medicine; Women's College Hospital; Toronto Ontario Canada
| | - Gary Naglie
- Baycrest Health Sciences; Toronto Ontario Canada
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Bayer C, Bernard H, Prager R, Rabsch W, Hiller P, Malorny B, Pfefferkorn B, Frank C, de Jong A, Friesema I, Stark K, Rosner BM. An outbreak of Salmonella Newport associated with mung bean sprouts in Germany and the Netherlands, October to November 2011. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.1.20665] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- C Bayer
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
- Postgraduate Training for Applied Epidemiology (PAE, German Field Epidemiology Training Programme), Robert Koch Institute, Berlin, Germany
| | - H Bernard
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - R Prager
- Robert Koch Institute, Division of Bacterial Infections and National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode, Germany
| | - W Rabsch
- Robert Koch Institute, Division of Bacterial Infections and National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode, Germany
| | - P Hiller
- Federal Institute for Risk Assessment, Department of Biological Safety, Berlin, Germany
| | - B Malorny
- Federal Institute for Risk Assessment, Department of Biological Safety, Berlin, Germany
| | - B Pfefferkorn
- Federal Office of Consumer Protection and Food Safety, Berlin, Germany
| | - C Frank
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - A de Jong
- Dutch Food and Consumer Product Safety Authority (NVWA), Utrecht, the Netherlands
| | - I Friesema
- The National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - K Stark
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - B M Rosner
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
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Krause G, Frank C, Gilsdorf A, Mielke M, Schaade L, Stark K, Burger R. [The 2011 HUS epidemic in Germany. Challenges for disease control: what should be improved?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:56-66. [PMID: 23275957 DOI: 10.1007/s00103-012-1585-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
From May to July 2011 [corrected] the world's largest outbreak of hemolytic uremic syndrome (HUS) occurred in northern Germany with dramatic consequences for the population, the health care system and the food industry. In the following we examine the detection of the outbreak, epidemic management and related public communication aspects based on scientific publications, media reports as well as own and new data analyses. The subsequent 17 recommendations concern issues such as participation in and implementation of existing and new surveillance systems particularly with respect to physicians, broad application of finely tuned microbiological typing, improved personnel capacity and crisis management structures within the public health service and evidence-based communication by administrations and scientific associations. Outbreaks of similar dimensions can inevitably occur again and result in costs which will far exceed investments needed for early detection and control. This societal balance should be taken into account in spite of limited resources in the public health sector.
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Affiliation(s)
- G Krause
- Robert Koch-Institut, DGZ-Ring 1, 13086, Berlin, Deutschland.
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Soda T, Frank C, Ishizuka K, Baccarella A, Park YU, Flood Z, Park SK, Sawa A, Tsai LH. DISC1-ATF4 transcriptional repression complex: dual regulation of the cAMP-PDE4 cascade by DISC1. Mol Psychiatry 2013; 18:898-908. [PMID: 23587879 PMCID: PMC3730299 DOI: 10.1038/mp.2013.38] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 01/12/2013] [Accepted: 01/31/2013] [Indexed: 02/08/2023]
Abstract
Disrupted-In-Schizophrenia 1 (DISC1), a risk factor for major mental illnesses, has been studied extensively in the context of neurodevelopment. However, the role of DISC1 in neuronal signaling, particularly in conjunction with intracellular cascades that occur in response to dopamine, a neurotransmitter implicated in numerous psychiatric disorders, remains elusive. Previous data suggest that DISC1 interacts with numerous proteins that impact neuronal function, including activating transcription factor 4 (ATF4). In this study, we identify a novel DISC1 and ATF4 binding region in the genomic locus of phosphodiesterase 4D (PDE4D), a gene implicated in psychiatric disorders. We found that the loss of function of either DISC1 or ATF4 increases PDE4D9 transcription, and that the association of DISC1 with the PDE4D9 locus requires ATF4. We also show that PDE4D9 is increased by D1-type dopamine receptor dopaminergic stimulation. We demonstrate that the mechanism for this increase is due to DISC1 dissociation from the PDE4D locus in mouse brain. We further characterize the interaction of DISC1 with ATF4 to show that it is regulated via protein kinase A-mediated phosphorylation of DISC1 serine-58. Our results suggest that the release of DISC1-mediated transcriptional repression of PDE4D9 acts as feedback inhibition to regulate dopaminergic signaling. Furthermore, as DISC1 loss-of-function leads to a specific increase in PDE4D9, PDE4D9 itself may represent an attractive target for therapeutic approaches in psychiatric disorders.
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Affiliation(s)
- T Soda
- Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA,Howard Hughes Medical Institute, Cambridge, MA, USA,Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA,Daniel Tosteson Medical Education Center, Boston, MA, USA
| | - C Frank
- Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA,Howard Hughes Medical Institute, Cambridge, MA, USA,Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA
| | - K Ishizuka
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Baccarella
- Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Y-U Park
- Division of Molecular and Life Science, Department of Life Science, Biotechnology Research Center, Pohang University of Science and Technology, Pohang, Korea
| | - Z Flood
- Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA,Howard Hughes Medical Institute, Cambridge, MA, USA,Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA
| | - S K Park
- Division of Molecular and Life Science, Department of Life Science, Biotechnology Research Center, Pohang University of Science and Technology, Pohang, Korea
| | - A Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L-H Tsai
- Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA,Howard Hughes Medical Institute, Cambridge, MA, USA,Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA,Howard Hughes Medical Institute, 77 Massachusetts Avenue, Room 46-4235, Cambridge, MA 02139, USA. E-mail:
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Mattei TA, Frank C, Bailey J, Lesle E, Macuk A, Lesniak M, Patel A, Morris MJ, Nair K, Lin JJ. Design of a synthetic simulator for pediatric lumbar spine pathologies. J Neurosurg Pediatr 2013; 12:192-201. [PMID: 23705840 DOI: 10.3171/2013.4.peds12540] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Simulation has become an important tool in neurosurgical education as part of the complex process of improving residents' technical expertise while preserving patient safety. Although different simulators have already been designed for a variety of neurosurgical procedures, spine simulators are still in their infancy and, at present, there is no available simulator for lumbar spine pathologies in pediatric neurosurgery. In this paper the authors describe the peculiarities and challenges involved in developing a synthetic simulator for pediatric lumbar spine pathologies, including tethered spinal cord syndrome and open neural tube defects. METHODS The Department of Neurosurgery of the University of Illinois at Peoria, in a joint program with the Mechanical Engineering Department of Bradley University, designed and developed a general synthetic model for simulating pediatric neurosurgical interventions on the lumbar spine. The model was designed to be composed of several sequential layers, so that each layer might closely mimic the tensile properties of the natural tissues under simulation. Additionally, a system for pressure monitoring was developed to enable precise measurements of the degree of manipulation of the spinal cord. RESULTS The designed prototype successfully simulated several scenarios commonly found in pediatric neurosurgery, such as tethered spinal cord, retethered spinal cord, and fatty terminal filum, as well as meningocele, myelomeningocele, and lipomyelomeningocele. Additionally, the formulated grading system was able to account for several variables involved in the qualitative evaluation of the technical performance during the training sessions and, in association with an expert qualitative analysis of the recorded sessions, proved to be a useful feedback tool for the trainees. CONCLUSIONS Designing and building a synthetic simulator for pediatric lumbar spine pathologies poses a wide variety of unique challenges. According to the authors' experience, a modular system composed of separable layers that can be independently replaced significantly enhances the applicability of such a model, enabling its individualization to distinctive but interrelated pathologies. Moreover, the design of a system for pressure monitoring (as well as a general score that may be able to account for the overall technical quality of the trainee's performance) may further enhance the educational applications of a simulator of this kind so that it can be further incorporated into the neurosurgical residency curriculum for training and evaluation purposes.
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Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, University of Illinois College of Medicine, Illinois Neurological Institute, Peoria, Illinois 61637, USA.
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