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Watt JA, Porter J, Tavilsup P, Chowdhury M, Hatch S, Ismail Z, Kumar S, Kirkham J, Goodarzi Z, Seitz D. Guideline Recommendations on Behavioral and Psychological Symptoms of Dementia: A Systematic Review. J Am Med Dir Assoc 2024:S1525-8610(24)00223-8. [PMID: 38640961 DOI: 10.1016/j.jamda.2024.03.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To synthesize recommendations on assessing and managing behavioral and psychological symptoms of dementia (BPSDs) in existing clinical guidelines on dementia care to learn from and adapt recommendations to a Canadian context and language for describing BPSDs. DESIGN Systematic review. SETTING AND PARTICIPANTS Moderate to high-quality clinical practice guidelines on dementia care that made 1 or more recommendations on BPSD assessment or management. METHODS We searched MEDLINE, Embase, JBI EBM, PsycINFO, AgeLine, and gray literature for clinical guidelines on dementia care making recommendations on BPSD, published between January 1, 2011, and October 13, 2022. Two independent reviewers conducted study screening and data abstraction. Four independent reviewers completed quality appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool; included guidelines had a mean overall AGREE II score ≥4. RESULTS Our systematic review identified 23 moderate to high-quality guidelines (264 recommendations). The mean overall quality score on the AGREE II tool ranged from 4 to 6.5. Recommendations were clearly presented (mean clarity of presentation score 73.5%), but guideline applicability was not consistently addressed (mean applicability score 39.3%). BPSD was the most prevalent term describing neuropsychiatric symptoms (number of guidelines [n] = 14). People with lived experience contributed to 6 guidelines (26.1%). Ten guidelines (43.5%) described 1 or more health equity considerations. Guidelines made recommendations for assessing and managing agitation (n = 12), aggression (n = 10), psychosis (n = 11), depression (n = 9), anxiety (n = 5), apathy (n = 6), inappropriate sexual behavior (n = 3), nighttime behavior (n = 5), and eating disturbances (n = 3). There was substantial variability in recommendation statements, evidence quality assigned to each statement, and strength of recommendations. CONCLUSIONS AND IMPLICATIONS There are several moderate to high-quality guidelines making recommendations on BPSD assessment and management, but variability in recommendation statements across guidelines and insufficient consideration of guideline applicability may hamper guideline dissemination and implementation in clinical practice.
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Affiliation(s)
- Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Wong B, Ismail Z, Watt J, Holroyd-Leduc J, Goodarzi Z. Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care. BMC Geriatr 2024; 24:330. [PMID: 38600482 PMCID: PMC11008022 DOI: 10.1186/s12877-024-04919-0] [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: 10/23/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Agitation and/or aggression affect up to 60% of persons living with dementia in long-term care (LTC). It can be treated via non-pharmacological and pharmacological interventions, but the former are underused in clinical practice. In the literature, there is currently a lack of understanding of the challenges to caring for agitation and/or aggression among persons living with dementia in LTC. This study assesses what barriers and facilitators across the spectrum of care exist for agitation and/or aggression among people with dementia in LTC across stakeholder groups. METHODS This was a qualitative study that used semi-structured interviews among persons involved in the care and/or planning of care for people with dementia in LTC. Participants were recruited via purposive and snowball sampling, with the assistance of four owner-operator models. Interviews were guided by the Theoretical Domains Framework and transcribed and analyzed using Framework Analysis. RESULTS Eighteen interviews were conducted across 5 stakeholder groups. Key identified barriers were a lack of agitation and/or aggression diagnostic measures, limited training for managing agitation and/or aggression in LTC, an overuse of physical and chemical restraints, and an underuse of non-pharmacological interventions. Facilitators included using an interdisciplinary team to deliver care and having competent and trained healthcare providers to administer non-pharmacological interventions. CONCLUSIONS This study advances care for persons living with dementia in LTC by drawing attention to unique and systemic barriers present across local and national Canadian LTC facilities. Findings will support future implementation research endeavours to eliminate these identified barriers across the spectrum of care, thus improving care outcomes among people with dementia in LTC.
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Affiliation(s)
- Britney Wong
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
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Belji Kangarlou M, Khavanin A, Nadri F, Goodarzi Z, Karami E, Rashidy-Pour A, Kiani M, Hashemi Habybabady R. Noise and silver nanoparticles induce hepatotoxicity via CYP450/NF-Kappa B 2 and p53 signaling pathways in a rat model. Toxicol Ind Health 2024; 40:206-219. [PMID: 38358440 DOI: 10.1177/07482337241233317] [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] [Indexed: 02/16/2024]
Abstract
Co-exposure to noise and nanomaterials, such as silver nanoparticles (Silver-NPs), is a common occurrence in today's industries. This study aimed to investigate the effects of exposure to noise and the administration of silver-NPs on the liver tissue of rats. Thirty-six adult male albino Wistar rats were randomly divided into six groups: a control group (administered saline intraperitoneally), two groups administered different doses of Silver-NPs (50 mg/kg and 100 mg/kg, 5 days a week for 28 days), two groups exposed to noise in addition to Silver-NPs (at the same doses as mentioned before), and a group exposed only to noise (104 dB, 6 hours a day, 5 days a week for 4 weeks). Blood samples were taken to assess hepatic-functional alterations, such as serum ALP, ALT, and AST levels. Additionally, biochemical parameters (MDA, GPX, and CAT) and the silver concentration in the liver were measured. Histopathological analysis, mRNA expression (P53 and NF-κB), protein expression (CYP450), and liver weight changes in rats were also documented. The study found that the administration of Silver-NPs and exposure to noise resulted in elevated levels of ALP, ALT, AST, and MDA (p < .01). Conversely, GPX and CAT levels decreased in all groups compared with the control group (p < .0001). There was a significant increase (p < .05) in liver weight and silver concentration in the liver tissues of groups administered Silver-NPs (50 mg/kg) plus noise exposure, Silver-NPs (100 mg/kg), and Silver-NPs (100 mg/kg) plus noise exposure, respectively. The expression rate of P53, NF-κB, and cytochromes P450 (CYPs-450) was increased in the experimental groups (p < .05). These findings were further confirmed by histopathological changes. In conclusion, this study demonstrated that exposure to noise and the administration of Silver-NPs exacerbated liver damage by increasing protein and gene expression, causing hepatic necrosis, altering biochemical parameters, and affecting liver weight.
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Affiliation(s)
- Marzieh Belji Kangarlou
- Department of Occupational Health Engineering, Faculty of Medical Sciences, Tarbiat Modarres University, Tehran, Iran
| | - Ali Khavanin
- Department of Occupational Health Engineering, Faculty of Medical Sciences, Tarbiat Modarres University, Tehran, Iran
| | - Farshad Nadri
- Department of Occupational Health Engineering, Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Goodarzi
- Department of Occupational Health Engineering, Faculty of Medical Sciences, Tarbiat Modarres University, Tehran, Iran
| | - Esmaeil Karami
- Department of Occupational Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Rashidy-Pour
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Mehrafarin Kiani
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Raheleh Hashemi Habybabady
- Health Promotion Research Centre, Department of Occupational Health Engineering, Zahedan University of Medical Sciences, Zahedan, Iran
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Atchison K, Toohey AM, Ismail Z, Goodarzi Z. Understanding the Barriers to and Facilitators of Anxiety Management in Residents of Long-Term Care. Can J Aging 2024; 43:57-74. [PMID: 37665029 DOI: 10.1017/s0714980823000417] [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] [Indexed: 09/05/2023] Open
Abstract
Older adults, 65 years of age and older, living in long-term care (LTC) commonly experience anxiety. This study aimed to understand care providers' perspectives on the barriers to and facilitators of managing anxiety in residents of LTC. Ten semi-structured interviews with care providers in LTC were completed. Framework analysis methods were used to code, thematically analyze, designate codes as barriers or facilitators, and map the codes to the Theoretical Domains Framework. Themes were categorized as acting at the resident, provider, or system level, and were labelled as either barriers to or facilitators of anxiety care. Key barriers to anxiety care at each level were resident cognitive impairment or co-morbidities; lack of staff education, staff treatment uptake and implementation; as well as the care delivery environment and access to resources. There is a need to prioritize measurement-based care for anxiety, have increased access to non-pharmacological treatments, and have a care delivery environment that supports anxiety management to improve the care for anxiety that is delivered to residents.
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Affiliation(s)
- Kayla Atchison
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Ann M Toohey
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Brenda Strafford Centre on Aging, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Reich KM, Gill SS, Eckenhoff R, Berger M, Austin PC, Rochon PA, Nguyen P, Goodarzi Z, Seitz DP. Association between surgery and rate of incident dementia in older adults: A population-based retrospective cohort study. J Am Geriatr Soc 2024. [PMID: 38165146 DOI: 10.1111/jgs.18736] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/09/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The risk of incident dementia after surgery in older adults is unclear. The study objective was to examine the rate of incident dementia among older adults after elective surgery compared with a matched nonsurgical control group. METHODS We conducted a population-based, propensity-matched retrospective cohort study using data from linked administrative databases in Ontario, Canada. All community-dwelling individuals aged 66 years and older who underwent one of five major elective surgeries between April 1, 2007 and March 31, 2011 were included. Each surgical patient was matched 1:1 on surgical specialty of the surgeon at consultation, age, sex, fiscal year of entry, and propensity score with a patient who attended an outpatient visit with a surgeon of the same surgical specialty but did not undergo surgery. Patients were followed for up to 5 years after cohort entry for the occurrence of a new dementia diagnosis, defined from administrative data. Cause-specific hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between surgery and the hazard of incident dementia. Subgroup and sensitivity analyses were performed. RESULTS A total of 27,878 individuals (13,939 matched pairs) were included in the analysis. A total of 640 (4.6%) individuals in the surgical group and 965 (6.9%) individuals in the control group developed dementia over the 5-year follow-up period. Individuals who underwent surgery had a reduced rate of incident dementia compared with their matched nonsurgical controls (HR 0.88; 95% CI 0.80-0.97; p = 0.01). This association was persistent in most subgroups and after sensitivity analyses. CONCLUSIONS Elective surgery did not increase the rate of incident dementia when compared with matched nonsurgical controls. This could be an important consideration for patients and surgeons when elective surgery is considered.
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Affiliation(s)
- Krista M Reich
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sudeep S Gill
- Division of Geriatric Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
- ICES Queen's, Queen's University, Kingston, Ontario, Canada
| | - Roderic Eckenhoff
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Miles Berger
- Department of Anesthesiology, Duke Center for the Study of Aging and Human Development, and the Duke/UNC Alzheimer's Disease Research Center, Duke University Medical Centre, Durham, North Carolina, USA
| | - Peter C Austin
- ICES, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paula A Rochon
- ICES, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Paul Nguyen
- ICES Queen's, Queen's University, Kingston, Ontario, Canada
| | - Zahra Goodarzi
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Dallas P Seitz
- ICES Queen's, Queen's University, Kingston, Ontario, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Goodarzi Z, James MT. Changes in Residence, Changes in Outcomes? What It Means and Why It Matters. Can J Cardiol 2024; 40:28-30. [PMID: 37879439 DOI: 10.1016/j.cjca.2023.10.014] [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] [Received: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Zahra Goodarzi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mathew T James
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Goodarzi Z, Khavanin A, Karami E, Rashidy-Pour A, Belji Kangarlou M, Kiani M, Razmjouei J. Otoprotective Effects of Quercetin Against Oxidative Damage in the Rat's Cochlea Induced by Noise and Silver Nanoparticles. Neuroscience 2023; 531:99-116. [PMID: 37714258 DOI: 10.1016/j.neuroscience.2023.09.004] [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: 06/14/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
The aim of this study was to investigate the otoprotective effects of Quercetin (Que) against both noise-induced hearing loss (NIHL) and the ototoxicity of silver nanoparticles (SNPs) in rats. Forty-two male Wistar rats were divided into seven groups (n = 6): control, SNPs, Que (100 mg/kg) plus SNPs (100 mg/kg), noise (104 dB), Que plus noise, noise plus SNPs, and noise plus Que plus SNPs. In the weight change results, there was no significant difference between the groups exposed to noise plus SNPs and SNPs compared to the control group. However, animals had significant changes in DPOAE amplitude at 1 and 3 days post-exposure when compared to baseline. Additionally, the DPOAE value of rats administered with Que plus SNPs was higher than in all other groups. Que also decreased the levels of TACT, MDA, IL-6, TNF-α, and NOX3 in the groups exposed to noise and SNPs and increased the SOD level and expression of myosin heavy chain VII (MYH7) and β-tubulin III (TUBB3) proteins. Furthermore, Que decreased structural changes in the animals' cochlea. Our findings indicate that pretreatment with Que efficiently counteracted the adverse effects of noise and SNPs on inner hair cell, outer hair cell, and nerve cells, which are responsible for high-frequency perception.
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Affiliation(s)
- Zahra Goodarzi
- Department of Occupational Health Engineering, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Ali Khavanin
- Department of Occupational Health Engineering, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Esmaeil Karami
- Department of Occupational Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Rashidy-Pour
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran.
| | - Marzieh Belji Kangarlou
- Department of Occupational Health Engineering, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Mehrafarin Kiani
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Jaleh Razmjouei
- Masters of Health, Safety & Environment (HSE), Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran.
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Jelinski D, Arimoro OI, Shukalek C, Furlong KR, Lang E, Reich K, Holroyd-Leduc J, Goodarzi Z. Rates of 30-day revisit to the emergency department among older adults living with dementia: a systematic review and meta-analysis. CAN J EMERG MED 2023; 25:884-892. [PMID: 37659987 DOI: 10.1007/s43678-023-00578-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/18/2023] [Accepted: 08/09/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE Older adults visit emergency departments (EDs) at higher rates than their younger counterparts. However, less is known about the rate at which older adults living with dementia visit and revisit EDs. We conducted a systematic review and meta-analysis to quantify the revisit rate to the ED among older adults living with a dementia diagnosis. METHODS We searched MEDLINE, Embase, and CINAHL, as well as gray literature, to identify observational studies reporting on older adults living with dementia that revisited an ED within 30 days of a prior ED visit. We calculated pooled rates of 30-day revisit as percentages using random effects models, and conducted stratified analyses by study data source, study population, and study period. We assessed between-studies heterogeneity using the I2 statistic and considered [Formula: see text] > 50% to indicate substantial heterogeneity. All analyses were performed in R software. RESULTS We identified six articles for inclusion. Percentages of 30-day ED revisit among older adults living with dementia ranged widely from 16.1% to 58.0%. The overall revisit rate of 28.6% showed significant heterogeneity. Between-studies heterogeneity across all stratified analyses was also high. By data source, 30-day revisit percentages were 52.3% (public hospitals) and 20.0% (administrative databases); by study population, revisit percentages were 33.5% (dementia as main population) and 19.8% (dementia as a subgroup). By study period, revisit percentages were 41.2% (5 years or greater) and 18.9% (5 years or less). CONCLUSION Existing literature on ED revisits among older adults living with dementia highlights the medical complexities and challenges surrounding discharge and follow-up care that may cause these patients to seek ED care at an increased rate. ED personnel may play an important role in connecting patients and caregivers to more appropriate medical and social resources in order to deliver an efficient and more rounded approach to care.
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Affiliation(s)
- Dana Jelinski
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada.
| | - Olayinka I Arimoro
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
| | - Caley Shukalek
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
| | - Kayla R Furlong
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
| | - Krista Reich
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services - Calgary zone, Calgary, AB, Canada
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Karami E, Goodarzi Z, Shahtaheri SJ, Kiani M, Faridan M, Ghazi-Khansari M. The aqueous extract of Artemisia Absinthium L. stimulates HO-1/MT-1/Cyp450 signaling pathway via oxidative stress regulation induced by aluminium oxide nanoparticles (α and γ) animal model. BMC Complement Med Ther 2023; 23:310. [PMID: 37670294 PMCID: PMC10478434 DOI: 10.1186/s12906-023-04121-6] [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: 01/12/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND This research aimed to evaluate the protective effects of Artemisia Absinthium L. (Abs) against liver damage induced by aluminium oxide nanoparticles (Al2O3 NPs) in rats, including both structural and functional changes associated with hepatotoxicity. METHODS Thirty-six rats were randomly divided into six groups (n = 6). The first group received no treatment. The second group was orally administered Abs at a dose of 200 mg/kg/b.w. The third and fifth groups were injected intraperitoneally with γ-Al2O3 NPs and α-Al2O3 NPs, respectively, at a dose of 30 mg/kg/b.w. The fourth and sixth groups were pre-treated with oral Abs at a dose of 200 mg/kg/b.w. along with intraperitoneal injection of γ-Al2O3 NPs and α-Al2O3 NPs, respectively, at a dose of 30 mg/kg/b.w. RESULTS Treatment with γ-Al2O3 NPs resulted in a significant decrease (P < 0.05) in total body weight gain, relative liver weight to body weight, and liver weight in rats. However, co-administration of γ-Al2O3 NPs with Abs significantly increased body weight gain (P < 0.05). Rats treated with Al2O3 NPs (γ and α) exhibited elevated levels of malondialdehyde (MDA), inducible nitric oxide synthase (iNOS), alanine transaminase (ALT), and aspartate aminotransferase (AST). Conversely, treatment significantly reduced glutathione peroxidase (GPx), catalase (CAT), total superoxide dismutase (T-SOD), and total antioxidant capacity (TAC) levels compared to the control group. Furthermore, the expression of heme oxygenase-1 (HO-1) and metallothionein-1 (MT-1) mRNAs, cytochrome P450 (CYP P450) protein, and histopathological changes were significantly up-regulated in rats injected with Al2O3 NPs. Pre-treatment with Abs significantly reduced MDA, AST, HO-1, and CYP P450 levels in the liver, while increasing GPx and T-SOD levels compared to rats treated with Al2O3 NPs. CONCLUSION The results indicate that Abs has potential protective effects against oxidative stress, up-regulation of oxidative-related genes and proteins, and histopathological alterations induced by Al2O3 NPs. Notably, γ-Al2O3 NPs exhibited greater hepatotoxicity than α-Al2O3 NPs.
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Affiliation(s)
- Esmaeil Karami
- Department of Occupational Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- Department of Occupational Health Engineering, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Seyed Jamaleddin Shahtaheri
- Department of Occupational Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran.
- Center for Water Quality Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehrafarin Kiani
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Faridan
- Department of Occupational Health and Safety at Work Engineering, Environmental Health Research CenterLorestan University of Medical Sciences, Khorramabad, Iran
| | - Mahmoud Ghazi-Khansari
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Shahtaheri SJ, Goodarzi Z, Karami E, Khavanin A, Khansari MG, Kiani M, Rashidy-Pour A. Effects of acute exposure to Al 2O 3-NPs (α and γ) and white noise and their combination on cochlea structure and function in Wistar rats. Environ Sci Pollut Res Int 2023; 30:89859-89876. [PMID: 37460886 DOI: 10.1007/s11356-023-28745-w] [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: 12/30/2022] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
Hearing loss induced by noise and combinations of factors is a common occupational disease among workers. This study aimed to investigate the impact of acute exposure to white noise and Al2O3 NPs, alone and in combination, on changes in the hearing and structural functions of the cochlea in rats. Thirty-six rats were randomly assigned to one of six groups: Control, acute exposure to white noise, exposure to γ-Al2O3 NPs, exposure to noise plus γ-Al2O3 NPs, exposure to α-Al2O3 NPs, and exposure to the combination of noise plus α-Al2O3 NPs. TTS and PTS were examined using DPOAE, while oxidative index (MDA, GSH-Px), gene expression (NOX3, TGF-ß, CYP1A1), protein expression (ß-Tubulin, Myosin VII), and histopathological changes were examined in the cochlea. The morphology of Al2O3 NPs was examined by TEM. The results of the DPOAE test showed a significant increase in TTS in all groups and an increase in PTS in the groups exposed to noise, γ-Al2O3 NPs, and a combination of noise plus Al2O3 NPs (P < 0.05). In the group exposed to white noise plus Al2O3 NPs, the MDA levels increased, the level of GSH-Px decreased, and the expression percentage of ß-Tubulin and Myosin VII decreased, while the expression of NOX3, TGF-ß, and CYP1A1 (except for the α-Al2O3 NPs group) significantly increased (P < 0.05). Histopathological changes of the cochlea indicated damage to hair and ganglion cells, which was more severe in the combined exposure group. The combined and independent exposure to white noise and Al2O3 NPs damaged hair and ganglion cells for high-frequency perception, affecting the function and structure of the cochlea and leading to TTS and PTS.
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Affiliation(s)
- Seyed Jamaleddin Shahtaheri
- Department of Occupational Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- Department of Occupational Health Engineering, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Esmaeil Karami
- Department of Occupational Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Khavanin
- Department of Occupational Health Engineering, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mahmoud Ghazi Khansari
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrafarin Kiani
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Rashidy-Pour
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
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11
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Watt JA, Veroniki AA, Goodarzi Z, Straus SE. Reader Response: Effect of Cholinesterase Inhibitors on Mortality in Patients With Dementia: A Systematic Review of Randomized and Nonrandomized Trials. Neurology 2023; 100:736-737. [PMID: 37037609 PMCID: PMC10103115 DOI: 10.1212/wnl.0000000000207226] [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: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 04/12/2023] Open
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12
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Huang YQ, Liu L, Goodarzi Z, Watt JA. Diagnostic accuracy of eHealth literacy measurement tools in older adults: a systematic review. BMC Geriatr 2023; 23:181. [PMID: 36978033 PMCID: PMC10049781 DOI: 10.1186/s12877-023-03899-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In Canada, virtual health care rapidly expanded during the COVID-19 pandemic. There is substantial variability between older adults in terms of digital literacy skills, which precludes equitable participation of some older adults in virtual care. Little is known about how to measure older adults' electronic health (eHealth) literacy, which could help healthcare providers to support older adults in accessing virtual care. Our study objective was to examine the diagnostic accuracy of eHealth literacy tools in older adults. METHODS We completed a systematic review examining the validity of eHealth literacy tools compared to a reference standard or another tool. We searched MEDLINE, EMBASE, CENTRAL/CDSR, PsycINFO and grey literature for articles published from inception until January 13, 2021. We included studies where the mean population age was at least 60 years old. Two reviewers independently completed article screening, data abstraction, and risk of bias assessment using the Quality Assessment for Diagnostic Accuracy Studies-2 tool. We implemented the PROGRESS-Plus framework to describe the reporting of social determinants of health. RESULTS We identified 14,940 citations and included two studies. Included studies described three methods for assessing eHealth literacy: computer simulation, eHealth Literacy Scale (eHEALS), and Transactional Model of eHealth Literacy (TMeHL). eHEALS correlated moderately with participants' computer simulation performance (r = 0.34) and TMeHL correlated moderately to highly with eHEALS (r = 0.47-0.66). Using the PROGRESS-Plus framework, we identified shortcomings in the reporting of study participants' social determinants of health, including social capital and time-dependent relationships. CONCLUSIONS We found two tools to support clinicians in identifying older adults' eHealth literacy. However, given the shortcomings highlighted in the validation of eHealth literacy tools in older adults, future primary research describing the diagnostic accuracy of tools for measuring eHealth literacy in this population and how social determinants of health impact the assessment of eHealth literacy is needed to strengthen tool implementation in clinical practice. PROTOCOL REGISTRATION We registered our systematic review of the literature a priori with PROSPERO (CRD42021238365).
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Affiliation(s)
- Yu Qing Huang
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, ON, M5G 2C4, Canada
| | - Laura Liu
- Temerty Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON, M5S 3H2, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Foothills Medical Centre - North Tower, 9Th Floor, 1403 - 29th Street NW, Calgary, AB, T2N 2T9, Canada
- Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- O'Brien Institute of Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Jennifer A Watt
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, ON, M5G 2C4, Canada.
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
- St. Michael's Hospital, 36 Queen St East, Toronto, ON, M5B 1W8, Canada.
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13
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Martino D, Nosratmirshekarlou E, Cothros N, Medina Escobar A, Goodarzi Z. Development of a New Care Pathway for Depression and Anxiety in Adult-Onset Isolated Dystonia. Mov Disord Clin Pract 2023; 10:415-426. [PMID: 36949792 PMCID: PMC10026302 DOI: 10.1002/mdc3.13655] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023] Open
Abstract
Background Recently, we identified barriers and facilitators to the screening and treatment of depressive and anxiety symptoms in adult-onset isolated dystonia (AOID). These symptoms are common, functionally impairing, and often underdetected and undertreated. Objectives To develop a care pathway for mood symptoms in AOID. Methods We used a multistep modified Delphi approach to seek consensus among healthcare professionals with experience of AOID on the screening, diagnosis, and treatment of mood symptoms. A combination of face-to-face meetings and online surveys was performed from 2019 to 2020. We created the survey and then reviewed with stakeholders before 2 rounds of Delphi surveys, all of which was finally reviewed in a consensus meeting. A purposive sample of 41 expert stakeholders from 4 Canadian provinces, including neurologists, nurses, psychiatrists, psychologists, and family physicians, was identified by the research team. Results The Delphi process led to consensus on 12 statements that operationalized a pathway of care to screen for and manage depression and anxiety in people with AOID. Key actions of the pathway included yearly screening with self-rated instruments, multidisciplinary involvement in management involving local networks of providers coordinated by movement disorders neurologists, and access to educational resources. The Delphi panel indicated the 2 core steps as the documentation of the most recent screening outcome and the documentation of a management plan for patients who were positive at the last screening. Conclusions This new care pathway represents a potentially useful intervention that can be used to build an integrated model of care for AOID.
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Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Mathison Centre for Mental Health Research and EducationCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Elaheh Nosratmirshekarlou
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Nicholas Cothros
- Department of MedicineQueen's University School of MedicineKingstonOntarioCanada
| | - Alex Medina Escobar
- Department of Clinical Neurosciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Division of NeurologyThe Moncton HospitalMonctonNew BrunswickCanada
| | - Zahra Goodarzi
- Mathison Centre for Mental Health Research and EducationCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of MedicineUniversity of Calgary, Foothills Medical CentreCalgaryAlbertaCanada
- O'Brien Institute of Public HealthUniversity of CalgaryCalgaryAlbertaCanada
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14
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Karami E, Goodarzi Z, Ghanbari A, Dehdashti A, Bandegi AR, Yosefi S. Atorvastatin prevents cadmium-induced renal toxicity in a rat model. Toxicol Ind Health 2023; 39:218-228. [PMID: 36802990 DOI: 10.1177/07482337231157150] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
In many industrial processes, worker exposure to cadmium causes kidney damage; thus, protection against cadmium toxicity is important in workplace health. Cadmium toxicity involves oxidative stress by increasing the levels of reactive oxygen species. Statins have shown antioxidant effects that might prevent this increase in oxidative stress. We investigated the potential effects of atorvastatin pretreatment in protecting experimental rats against kidney toxicity caused by cadmium. Experiments were performed on 56 adult male Wistar rats (200 ± 20 g), randomly assigned to eight groups. Atorvastatin was administered by oral gavage for 15 days at 20 mg/kg/day, starting 7 days before cadmium chloride intra-peritoneal administration (at 1, 2, and 3 mg/kg) for 8 days. On day 16, blood samples were collected, and kidneys were excised to evaluate the biochemical and histopathological changes. Cadmium chloride significantly increased malondialdehyde, serum creatinine, blood urea nitrogen, and decreased superoxide dismutase, glutathione, and glutathione peroxidase levels. Pre-administration of rats with atorvastatin at a dose of 20 mg/kg decreased blood urea nitrogen, creatinine, and lipid peroxidation, increased the activities of antioxidant enzymes, and prevented changes in physiological variables compared with animals that were not pretreated. Atorvastatin pretreatment prevented kidney damage following exposure to toxic doses of cadmium. In conclusion, atorvastatin pretreatment in rats with cadmium chloride-induced kidney toxicity could reduce oxidative stress by changing biochemical functions and thereby decreasing damage to kidney tissue.
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Affiliation(s)
- Esmaeil Karami
- Department of Occupational Health, School of Health, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- Department of Occupational Health, School of Health, 154203Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Ghanbari
- Department of Physiology and Pharmacology, 89245Pasteur Institute of Iran, Tehran, Iran
| | - Alireza Dehdashti
- Department of Occupational Health, School of Health, 154203Semnan University of Medical Sciences, Semnan, Iran.,Research Center of Health Sciences and Technologies, Department of Occupational Health, 154203Semnan University of Medical Sciences, Semnan, Iran
| | - Ahmad Reza Bandegi
- Department of Physiology and Pharmacology, 89245Pasteur Institute of Iran, Tehran, Iran
| | - Sedighe Yosefi
- Department of Biochemistry, Faculty of Medicine, 154203Semnan University of Medical Sciences, Semnan, Iran
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15
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Naveed K, Goldberg N, Shore E, Dhoot A, Gabrielson D, Goodarzi Z, Lin Y, Pai M, Pardy NA, Robinson S, Andreou R, Sood M, Price V, Storm S, Verduyn A, Parker ML, Fralick M, Beriault D, Sholzberg M. Defining ferritin clinical decision limits to improve diagnosis and treatment of iron deficiency: A modified Delphi study. Int J Lab Hematol 2023; 45:377-386. [PMID: 36602151 DOI: 10.1111/ijlh.14016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Iron deficiency is highly prevalent worldwide and is an issue of health inequity. Despite its high prevalence, uncertainty on the clinical applicability and evidence-base of iron-related lab test cut-offs remains. In particular, current ferritin decision limits for the diagnosis of iron deficiency may not be clinically appropriate nor scientifically grounded. METHODS A modified Delphi study was conducted with various clinical experts who manage iron deficiency across Canada. Statements about ferritin decision limits were generated by a steering committee, then distributed to the expert panel to vote on agreement with the aim of achieving consensus and acquiring feedback on the presented statements. Consensus was reached after two rounds, which was defined as 70% of experts rating their agreement for a statement as 5 or higher on a Likert scale from 1 to 7. RESULTS Twenty-six clinical experts across 10 different specialties took part in the study. Consensus was achieved on 28 ferritin decision limit statements in various populations (including patients with multiple comorbid conditions, pediatric patients, and pregnant patients). For example, there was consensus that a ferritin <30 μg/L rules in iron deficiency in all adult patients (age ≥ 18 years) and warrants iron replacement therapy. CONCLUSION Consensus statements generated through this study corresponded with current evidence-based literature and guidelines. These statements provide clarity to facilitate clinical decisions around the appropriate detection and management of iron deficiency.
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Affiliation(s)
- Kanza Naveed
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicola Goldberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Eliane Shore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arti Dhoot
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Denise Gabrielson
- Division of Hematology/Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Zahra Goodarzi
- Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Menaka Pai
- Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Natasha A Pardy
- Department of Hematology, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Sue Robinson
- Division of Hematology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Roseann Andreou
- Division of Hematology/Oncology, Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | - Manish Sood
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sherri Storm
- Academic Family Health Team & Women's and Children's Health Program, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashley Verduyn
- Department of Rehabilitative Care, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle L Parker
- DynaLIFE Medical Labs and Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Fralick
- Department of Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daniel Beriault
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
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16
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Gauthier S, Ismail Z, Goodarzi Z, Ng KP, Rosa-Neto P. Viewpoint: Clinicians' Perspectives on How Disease Modifying Drugs for Alzheimer's Disease Impact Specialty Care. J Prev Alzheimers Dis 2023; 10:339-341. [PMID: 37357267 DOI: 10.14283/jpad.2023.72] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Clinicians specialized in the diagnosis and management of persons living with early-stage Alzheimer's disease need to enable access, for those meeting criteria, to the new class of disease modifying drugs (DMDs). These drugs act on amyloid β42 and delay progression of symptoms. Thus, there will be interest from patients and families. Over the short term, the use of antibodies administered intravenously with serial MRIs to detect amyloid-related imaging abnormalities (ARIA) may require participation in structured phase 4 studies or in registries with third party funding for support staff and MRI scans. In the mid term, the availability of oral anti-amyloid therapy, likely with lower risk of ARIA, may transform clinical practice to a model of screening suitable patients using plasma biomarkers, with a subsequent rapid referral to a specialized memory clinic. Eventually, the biological profile of patients for amyloid, tau, and inflammation will determine which type of DMD to use. We are optimistic that clinicians will gain confidence with the use DMDs and answer the increasing needs of our aging population.
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Affiliation(s)
- S Gauthier
- Serge Gauthier, Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, 6875 La Salle Blvd - FBC room 3149, Montreal, QC, Canada H4H 1R3,
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17
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Ghahremani M, Smith EE, Chen HY, Creese B, Goodarzi Z, Ismail Z. Vitamin D supplementation and incident dementia: Effects of sex, APOE, and baseline cognitive status. Alzheimers Dement (Amst) 2023; 15:e12404. [PMID: 36874594 PMCID: PMC9976297 DOI: 10.1002/dad2.12404] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 03/06/2023]
Abstract
Introduction Despite the association of vitamin D deficiency with incident dementia, the role of supplementation is unclear. We prospectively explored associations between vitamin D supplementation and incident dementia in 12,388 dementia-free persons from the National Alzheimer's Coordinating Center. Methods Baseline exposure to vitamin D was considered D+; no exposure prior to dementia onset was considered D-. Kaplan-Meier curves compared dementia-free survival between groups. Cox models assessed dementia incidence rates across groups, adjusted for age, sex, education, race, cognitive diagnosis, depression, and apolipoprotein E (APOE) ε4. Sensitivity analyses examined incidence rates for each vitamin D formulation. Potential interactions between exposure and model covariates were explored. Results Across all formulations, vitamin D exposure was associated with significantly longer dementia-free survival and lower dementia incidence rate than no exposure (hazard ratio = 0.60, 95% confidence interval: 0.55-0.65). The effect of vitamin D on incidence rate differed significantly across the strata of sex, cognitive status, and APOE ε4 status. Discussion Vitamin D may be a potential agent for dementia prevention. Highlights In a prospective cohort study, we assessed effects of Vitamin D on dementia incidence in 12,388 participants from the National Alzheimer's Coordinating Center dataset.Vitamin D exposure was associated with 40% lower dementia incidence versus no exposure.Vitamin D effects were significantly greater in females versus males and in normal cognition versus mild cognitive impairment.Vitamin D effects were significantly greater in apolipoprotein E ε4 non-carriers versus carriers.Vitamin D has potential for dementia prevention, especially in the high-risk strata.
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Affiliation(s)
- Maryam Ghahremani
- Department of Psychiatry Cumming School of Medicine University of Calgary Calgary Alberta Canada.,Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Eric E Smith
- Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Calgary Alberta Canada.,Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Hung-Yu Chen
- Department of Psychiatry Cumming School of Medicine University of Calgary Calgary Alberta Canada.,Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Byron Creese
- College of Medicine and Health University of Exeter Medical School University of Exeter Exeter UK
| | - Zahra Goodarzi
- Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Calgary Alberta Canada.,O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | - Zahinoor Ismail
- Department of Psychiatry Cumming School of Medicine University of Calgary Calgary Alberta Canada.,Hotchkiss Brain Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada.,Department of Community Health Sciences University of Calgary Calgary Alberta Canada.,Department of Clinical Neurosciences Cumming School of Medicine University of Calgary Calgary Alberta Canada.,College of Medicine and Health University of Exeter Medical School University of Exeter Exeter UK.,O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
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18
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Karami E, Goodarzi Z, Ghanbari A, Bandegi AR, Yosefi S, Dehdashti A. In vivo antioxidant and kidney protective potential of Atorvastatin against cadmium chloride-induced kidney injury in male Wistar rat. All Life 2022. [DOI: 10.1080/26895293.2022.2126900] [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: 10/14/2022] Open
Affiliation(s)
- Esmaeil Karami
- Department of Occupational Health, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- Department of Occupational Health, School of Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Al Ghanbari
- Department of Physiology and Pharmacology, Pasteur Institute of Iran, Tehran, Iran
| | - Ahmad Reza Bandegi
- Department of Physiology and Pharmacology, Pasteur Institute of Iran, Tehran, Iran
| | - Sedighe Yosefi
- Department of Biochemistry, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Alireza Dehdashti
- Department of Occupational Health, School of Health, Semnan University of Medical Sciences, Semnan, Iran
- Department of Occupational Health, Research Center of Health Sciences and Technologies, Semnan University of Medical Sciences, Semnan, Iran
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19
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Vellone D, Ghahremani M, Goodarzi Z, Forkert ND, Smith EE, Ismail Z. Apathy and APOE in mild behavioral impairment, and risk for incident dementia. Alzheimers Dement (N Y) 2022; 8:e12370. [PMID: 36544988 PMCID: PMC9763783 DOI: 10.1002/trc2.12370] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
Introduction Mild behavioral impairment (MBI) is a high-risk state for incident dementia and comprises five core domains including affective dysregulation, impulse dyscontrol, social inappropriateness, psychotic symptoms, and apathy. Apathy is among the most common neuropsychiatric symptoms (NPS) in dementia but can also develop in persons with normal cognition (NC) or mild cognitive impairment (MCI). The later-life emergence and persistence of apathy as part of the MBI syndrome may be a driving factor for dementia risk. Therefore, we investigated MBI-apathy-associated progression to dementia, and effect modification by sex, race, cognitive diagnosis, and apolipoprotein E (APOE) genotype. Methods Dementia-free National Alzheimer's Coordinating Center participants were stratified by persistent apathy status, based on Neuropsychiatric Inventory (NPI)-Questionnaire scores at two consecutive visits. Hazard ratios (HRs) for incident dementia for MBI-apathy and NPI-apathy relative to no NPS, and MBI-apathy relative to no apathy, were determined using Cox proportional hazards regressions, adjusted for baseline age, sex, years of education, race, cognitive diagnosis, and APOE genotype. Interactions with relevant model covariates were explored. Results Of the 3932 participants (3247 with NC), 354 had MBI-apathy. Of all analytic groups, MBI-apathy had the greatest dementia incidence (HR = 2.69, 95% confidence interval [CI]: 2.15-3.36, P < 0.001). Interaction effects were observed between cognitive diagnosis and APOE genotype with the NPS group. The contribution of apathy to dementia risk was greater in NC (HR = 5.91, 95% CI: 3.91-8.93) than in MCI (HR = 2.16, 95% CI: 1.69-2.77, interaction P < 0.001) and in all APOE genotypes, was greatest in APOE ɛ3 (HR = 4.25, 95% CI: 3.1-5.82, interaction P < 0.001). Discussion Individuals with MBI-apathy have a markedly elevated risk for future dementia, especially when symptoms emerge in those with NC. Both cognitive status and APOE genotype are important moderators in the relationship between MBI-apathy and incident dementia. MBI-apathy may represent a group in whom apathy is a preclinical or prodromal manifestation of dementia and identify a precision medicine target for preventative interventions.
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Affiliation(s)
- Daniella Vellone
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Maryam Ghahremani
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahra Goodarzi
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Mathison Centre for Mental Health Research and EducationCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of MedicineCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,O'Brien Institute for Public HealthCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Nils D. Forkert
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of RadiologyCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Eric E. Smith
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahinoor Ismail
- Hotchkiss Brain InstituteCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Mathison Centre for Mental Health Research and EducationCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of MedicineCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,O'Brien Institute for Public HealthCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Department of Clinical NeurosciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,College of Medicine and HealthUniversity of ExeterExeterUK
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Goodarzi Z, Asad S, Mehrshad M. Genome-resolved insight into the reservoir of antibiotic resistance genes in aquatic microbial community. Sci Rep 2022; 12:21047. [PMID: 36473884 PMCID: PMC9726936 DOI: 10.1038/s41598-022-25026-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Aquatic microbial communities are an important reservoir of antibiotic resistance genes (ARGs). However, distribution and diversity of different ARG categories in environmental microbes with different ecological strategies is not yet well studied. Despite the potential exposure of the southern part of the Caspian Sea to the release of antibiotics, little is known about its natural resistome profile. We used a combination of Hidden Markov model (HMM), homology alignment and a deep learning approach for comprehensive screening of the diversity and distribution of ARGs in the Caspian Sea metagenomes at genome resolution. Detected ARGs were classified into five antibiotic resistance categories including prevention of access to target (44%), modification/protection of targets (30%), direct modification of antibiotics (22%), stress resistance (3%), and metal resistance (1%). The 102 detected ARG containing metagenome-assembled genomes of the Caspian Sea were dominated by representatives of Acidimicrobiia, Gammaproteobacteria, and Actinobacteria classes. Comparative analysis revealed that the highly abundant, oligotrophic, and genome streamlined representatives of taxa Acidimicrobiia and Actinobacteria modify the antibiotic target via mutation to develop antibiotic resistance rather than carrying extra resistance genes. Our results help with understanding how the encoded resistance categories of each genome are aligned with its ecological strategies.
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Affiliation(s)
- Zahra Goodarzi
- grid.46072.370000 0004 0612 7950Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran
| | - Sedigheh Asad
- grid.46072.370000 0004 0612 7950Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran
| | - Maliheh Mehrshad
- grid.6341.00000 0000 8578 2742Department of Aquatic Sciences and Assessment, Swedish University of Agricultural Sciences (SLU), Box 7050, 75007 Uppsala, Sweden
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Golbabaei F, Azrah K, Goodarzi Z, Ahmadi O, Karami E. Risk assessment of cold stress in petroleum transfer station in the northwestern regions of Iran: Subjective and field measurements. J Therm Biol 2022; 110:103335. [DOI: 10.1016/j.jtherbio.2022.103335] [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] [Received: 03/18/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 10/06/2022]
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22
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Jones A, Goodarzi Z, Lee J, Norman R, Wong E, Dasgupta M, Liu B, Watt J. Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis. PLoS One 2022; 17:e0276504. [PMID: 36288382 PMCID: PMC9604990 DOI: 10.1371/journal.pone.0276504] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background Chemical and physical restraints are associated with harm in older adults, but our understanding of their use during acute care hospitalizations is limited. Objectives To (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic compared to pre-pandemic levels and (2) describe between-hospital variability in restraint use. Design Retrospective cohort study with a time series analysis. Participants Acute care hospital inpatients, aged 65 years or older, who were discharged from one of four Alberta hospitals or six Ontario hospitals in Canada, between November 1, 2019, and June 30, 2020. Main measures We used autoregressive linear models with restricted cubic splines to compare proportions of chemical restraint (that is, psychotropic medications, namely antipsychotics, benzodiazepines, and trazodone) and physical restraint (e.g., mittens) use immediately after the onset of the COVID-19 pandemic with pre-pandemic levels. We describe between-hospital variability in restraint use using intraclass correlation coefficients (ICC) and median odds ratios (OR). Key results We included 71,004 hospitalizations. Adjusted for the prevalence of dementia and psychotic disorders, chemical restraint use increased in Ontario hospitals from a pre-pandemic average of 27.1% to 30.8% (p<0.001) before returning to pre-pandemic levels within eight weeks. Physical restraint orders in Ontario increased from 5.9% to 8.3% (p = 0.012) and remained elevated at eight weeks. No significant changes in restraint use were observed in Alberta. There was moderate between-hospital variability in chemical restraint use (ICC 0.041 and median OR 1.43). Variability in physical restraint use was higher (ICC 0.11 and median OR 1.83). Conclusions The COVID-19 pandemic impacted in-hospital use of chemical and physical restraints among older adults in Ontario but not Alberta. Substantial differences in chemical and physical restraint use by region and hospital suggests there are opportunities to improve best practices in geriatric care. Future research must support implementation of evidence-informed interventions that standardize appropriate restraint use.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University Hamilton, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- * E-mail: (AJ); (JW)
| | - Zahra Goodarzi
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Justin Lee
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard Norman
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric Wong
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Monidipa Dasgupta
- Division of Geriatric Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Barbara Liu
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Watt
- ICES, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- * E-mail: (AJ); (JW)
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23
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Delara M, Murray L, Jafari B, Bahji A, Goodarzi Z, Kirkham J, Chowdhury M, Seitz DP. Correction: Prevalence and factors associated with polypharmacy: a systematic review and meta-analysis. BMC Geriatr 2022; 22:742. [PMID: 36096733 PMCID: PMC9469608 DOI: 10.1186/s12877-022-03388-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mahin Delara
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Ontario, Canada
| | - Lauren Murray
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Ontario, Canada
| | - Behnaz Jafari
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Anees Bahji
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Zahra Goodarzi
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,Departments of Medicine and Community Health Sciences, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Julia Kirkham
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Mohammad Chowdhury
- Department of Psychiatry, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Dallas P Seitz
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. .,Departments of Medicine and Community Health Sciences, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, Calgary, Alberta, Canada.
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Atchison K, Watt JA, Ewert D, Toohey AM, Ismail Z, Goodarzi Z. Non-pharmacologic and pharmacologic treatments for anxiety in long-term care: a systematic review and meta-analysis. Age Ageing 2022; 51:6691375. [PMID: 36057989 DOI: 10.1093/ageing/afac195] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND older adults living in long-term care (LTC) commonly suffer from anxiety symptoms and disorders. We completed a systematic review and meta-analysis to identify efficacious treatments for anxiety symptoms for older adults living in LTC. METHODS we searched five electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials) to identify treatments for anxiety that have been trialled in LTC. Included studies had to be randomised trials, include residents of LTC, and measure anxiety symptoms as an outcome. RESULTS the electronic search returned 6,617 articles, 519 were reviewed in full text, and 80 were included in the descriptive synthesis. Limited studies were meta-analysed (n = 10) due to differences in described treatment and comparator conditions. Limited clinically relevant evidence supporting the use of pharmacologic treatments for symptoms of anxiety in LTC was identified. Of the treatments trialled, music compared with usual care (standardised mean difference, SMD: -0.82; 95% confidence interval (CI): -1.31, -0.34), music compared with social interaction (SMD: -0.41; 95% CI: -0.72, -0.10) and massage compared with usual care (SMD: -4.32; 95% CI: -7.44, -1.19) were found to improve anxiety symptoms, however, significant heterogeneity was detected in two comparisons. CONCLUSIONS a range of non-pharmacologic treatments that improved anxiety symptoms were identified for use in LTC. Although limited evidence exists to support the use of particular treatments, most non-pharmacologic treatments were low-risk interventions that may be readily implemented. Further research is required to assess the treatment effect on residents of LTC with anxiety disorders or clinically relevant symptoms at baseline.
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Affiliation(s)
- Kayla Atchison
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Delaney Ewert
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ann M Toohey
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Brenda Strafford Centre on Aging, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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25
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Karami E, Goodarzi Z, Ghanbari A, Dehdashti A, Bandegi AR, Yosefi S. Dataset on biochemical markers and histological alterations in rat kidney intoxicated with cadmium chloride and treated with antioxidant. Data Brief 2022; 43:108394. [PMID: 35789907 PMCID: PMC9249603 DOI: 10.1016/j.dib.2022.108394] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
This dataset demonstrates the in vivo renal histology and biochemical activity of Atorvastatin (AT) in cadmium-induced nephrotoxic rat model. Fifty-six adult male Wistar rats assigned to eight groups. Rats were treated with physiologic saline at a volume of 4 mg/kg, contained Atorvastatin at a dose of 20 mg/kg body weight for 15 days. The intraperitoneal administration of cadmium chloride at doses of 1, 2, 1 and 3 mg/kg started on day 8. On day 16, samples were collected for biochemical and histological analyses. Data of renal function were estimated in the serum and organ. Cadmium chloride increased malondialdehyde (MDA), blood urea nitrogen (BUN), and creatinine (Cr) serum level and decreased superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione (GSH) levels. Administration of Atorvastatin significantly increased lipid peroxidation and renal decreased glutathione and antioxidant enzymes activity and significantly decreased BUN and Creatinine levels. Data were supported by histological examination indicated improved changes and kidney protective potential following cadmium chloride-induced oxidative stress.
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Affiliation(s)
- Esmaeil Karami
- Department of Occupational Health, Engineering, School of Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Zahra Goodarzi
- Department of Occupational Health, Engineering, School of Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Ghanbari
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
| | - Alireza Dehdashti
- Research Center of Health Sciences and Technologies, Semnan University of Medical Sciences, Semnan, Iran
- Corresponding author.
| | - Ahmad Reza Bandegi
- Department of Biochemistry, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Sedighe Yosefi
- Department of Biochemistry, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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26
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Delara M, Murray L, Jafari B, Bahji A, Goodarzi Z, Kirkham J, Chowdhury Z, Seitz DP. Prevalence and factors associated with polypharmacy: a systematic review and Meta-analysis. BMC Geriatr 2022; 22:601. [PMID: 35854209 PMCID: PMC9297624 DOI: 10.1186/s12877-022-03279-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [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] [Received: 11/19/2021] [Accepted: 07/06/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction Polypharmacy is commonly associated with adverse health outcomes. There are currently no meta-analyses of the prevalence of polypharmacy or factors associated with polypharmacy. We aimed to estimate the pooled prevalence of polypharmacy and factors associated with polypharmacy in a systematic review and meta-analysis. Methods MEDLINE, EMBASE, and Cochrane databases were searched for studies with no restrictions on date. We included observational studies that reported on the prevalence of polypharmacy among individuals over age 19. Two reviewers extracted study characteristics including polypharmacy definitions, study design, setting, geography, and participant demographics. The risk of bias was assessed using the Newcastle-Ottawa Scales. The main outcome was the prevalence of polypharmacy and factors associated with polypharmacy prevalence. The pooled prevalence estimates of polypharmacy with 95% confidence intervals were determined using random effects meta-analysis. Subgroup analyses were undertaken to evaluate factors associated with polypharmacy such as polypharmacy definitions, study setting, study design and geography. Meta-regression was conducted to assess the associations between polypharmacy prevalence and study year. Results 106 full-text articles were identified. The pooled estimated prevalence of polypharmacy in the 54 studies reporting on polypharmacy in all medication classes was 37% (95% CI: 31-43%). Differences in polypharmacy prevalence were reported for studies using different numerical thresholds, study setting, and publication year. Sex, study geography, study design and geographical location were not associated with differences in polypharmacy prevalence. Discussion Our review highlights that polypharmacy is common particularly among older adults and those in inpatient settings. Clinicians should be aware of populations who have an increased likelihood of experiencing polypharmacy and efforts should be made to review the appropriateness of prescribed medications and occurrence of adverse effects potentially associated with polypharmacy. Conclusions and implications Clinicians should be aware of the common occurrence of polypharmacy and undertake efforts to minimize inappropriate polypharmacy whenever possible. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03279-x.
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Affiliation(s)
- Mahin Delara
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Ontario, Canada
| | - Lauren Murray
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Ontario, Canada
| | - Behnaz Jafari
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Anees Bahji
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Zahra Goodarzi
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,Departments of Medicine and Community Health Sciences, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Julia Kirkham
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Zia Chowdhury
- Department of Psychiatry, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Dallas P Seitz
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Ontario, Canada.
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Mohamadi E, Kiani MM, Olyaeemanesh A, Takian A, Majdzadeh R, Hosseinzadeh Lotfi F, Sharafi H, Sajadi HS, Goodarzi Z, Noori Hekmat S. Two-Step Estimation of the Impact of Contextual Variables on Technical Efficiency of Hospitals: The Case Study of Public Hospitals in Iran. Front Public Health 2022; 9:785489. [PMID: 35071166 PMCID: PMC8770937 DOI: 10.3389/fpubh.2021.785489] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamination and management that is very important for any healthcare system for having an efficient system. Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals. Methods: This was a quantitative and descriptive-analytical study conducted in two steps. First, we measured the efficiency score of teaching and non-teaching hospitals by using the Data Envelopment Analysis (DEA) method. Second, the relationship between efficiency score and contextual factors was analyzed. We used median statistics (first and third quarters) to describe the concentration and distribution of each variable in teaching and non-teaching hospitals, then the Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province population, population density, and the number of beds per hospital). Results: On average, the efficiency score in non-teaching hospitals in 31 provinces was 0.67 and for teaching hospitals was 0.54. Results showed that there is no significant relationship between the efficiency score and the number of hospitals in the provinces (p = 0.1 and 0.15, respectively). The relationship between the number of hospitals and the population of the province was significant and positive. Also, there was a positive relationship between the number of beds and the area of the province in both types of teaching and non-teaching hospitals. Conclusion: Multilateral factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its context should be developed. It is necessary to pay attention to contextual factors and organizational architecture to improve efficiency.
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Affiliation(s)
- Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Mehdi Kiani
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirhossein Takian
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Majdzadeh
- Community Based Participatory Research Centre and Knowledge Utilization Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Hamid Sharafi
- Department of Mathematics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.,University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Somayeh Noori Hekmat
- Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Mele B, Watt J, Wu P, Azeem F, Lew G, Holroyd–Leduc J, Goodarzi Z. Detecting depression in persons living in long-term care: a systematic review and meta-analysis of diagnostic test accuracy studies. Age Ageing 2022; 51:6540127. [PMID: 35231088 DOI: 10.1093/ageing/afac039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Depressive disorders are common in long-term care (LTC), however, there is no one process used to detect depressive disorders in this setting. Our goal was to describe the diagnostic accuracy of depression detection tools used in LTC settings. METHODS We conducted a systematic review and meta-analysis of diagnostic accuracy measures. The databases PubMed, EMBASE, PsycINFO and CINAHL were searched from inception to 10 September 2021. Studies involving persons living in LTC, assisted living residences or facilities, comparing diagnostic accuracy of depression tools with a reference standard, were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess risk of bias. RESULTS We identified 8,463 citations, of which 20 studies were included in qualitative synthesis and 19 in meta-analysis. We identified 23 depression detection tools (including different versions) that were validated against a reference standard. At a cut-off point of 6 on the Geriatric Depression Scale-15 (GDS-15), the pooled sensitivity was 73.6% (95% confidence interval (CI) 43.9%-76.5%), specificity was 76.5% (95% CI 62.9%-86.7%), and an area under the curve was 0.83. There was significant heterogeneity in these analyses. There was insufficient data to conduct meta-analysis of other screening tools. The Nursing Homes Short Depression Inventory (NH-SDI) had a sensitivity ranging from 40.0% to 98.0%. The 4-item Cornell Scale for Depression in Dementia (CSDD) had the highest sensitivity (67.0%-90.0%) for persons in LTC living with dementia. CONCLUSIONS There are 23 tools validated for detection of depressive disorders in LTC, with the GDS-15 being the most studied. Tools developed specifically for use in LTC settings include the NH-SDI and CSDD-4, which provide briefer options to screen for depression. However, more studies of both are needed to examine tool accuracy using meta-analyses.
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Affiliation(s)
- Bria Mele
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Pauline Wu
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Canada
| | - Feeha Azeem
- Business Management Masters Program, York University, Toronto, Ontario M3J 1P3, Canada
| | - Grace Lew
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd–Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
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Herrmann N, Ismail Z, Collins R, Desmarais P, Goodarzi Z, Henri‐Bhargava A, Iaboni A, Kirkham J, Massoud F, Moser A, Silvius J, Watt J, Seitz D. CCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementia. Alzheimers Dement (N Y) 2022; 8:e12099. [PMID: 35128025 PMCID: PMC8802736 DOI: 10.1002/trc2.12099] [Citation(s) in RCA: 2] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cognitive enhancers (ie, cholinesterase inhibitors and memantine) can provide symptomatic benefit for some individuals with dementia; however, there are circumstances in which the risks of continuing treatment may potentially outweigh benefits. The decision to deprescribe cognitive enhancers must consider each patient's preferences, treatment indications, current clinical status and symptoms, prognosis, and dementia type. METHODS The 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) established a subcommittee of experts to review current evidence on the deprescribing of cognitive enhancers. The questions answered by this group included: When should cognitive enhancers be deprescribed in persons with dementia and mild cognitive impairment? How should cognitive enhancers be deprescribed? And, what clinical factors should be considered when deprescribing cognitive enhancers? RESULTS Patient and care-partner preferences should be incorporated into all decisions to deprescribe cognitive enhancers. Cognitive enhancers should be discontinued in individuals without ongoing evidence of benefit or when the indication for cognitive enhancer use was inappropriate (eg, mild cognitive impairment). Deprescribing should occur gradually and cognitive enhancers should be reinitiated if patients' cognition or function deteriorates. Cognitive enhancers should be continued in individuals whose neuropsychiatric symptoms improve in response to treatment. Clinicians should not deprescribe cognitive enhancers in individuals with significant neuropsychiatric symptoms until symptoms have stabilized. CONCLUSION CCCDTD5 deprescribing recommendations provide evidence-informed recommendations related to cognitive enhancer deprescribing that will facilitate shared decision making among patients, care partners, and clinicians.
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Affiliation(s)
- Nathan Herrmann
- Department of PsychiatrySunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Cumming School of Medicine; Hotchkiss Brain Institute and O'Brien Institute of Public HealthUniversity of Calgary, Calgary, Alberta, Canada
| | - Rhonda Collins
- Department of Family MedicineMcMaster UniversityChief Medical Officer, Revera IncHamiltonOntarioCanada
| | - Philippe Desmarais
- Department of MedicineDivision of Geriatrics and Department of NeurosciencesCentre de Recherche du Centre Hospitalier de l'Université de MontréalMontréalQuébecCanada
| | - Zahra Goodarzi
- Division of Geriatrics, Department of Medicine, Cumming School of Medicine; Hotchkiss Brain Institute; O'Brien Institute of Public HealthUniversity of CalgaryCalgaryCanada
| | - Alexandre Henri‐Bhargava
- Division of Neurology, Faculty of MedicineUniversity of British Columbia; Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Andrea Iaboni
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Kite Research Institute, Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Julia Kirkham
- Department of PsychiatryCumming School of Medicine, University of Calgary
| | - Fadi Massoud
- Department of MedicineUniversity of SherbrookeSherbrookeQuebecCanada
| | - Andrea Moser
- Department of Family and Community MedicineUniversity of Toronto, Associate Medical Director, Jewish Home for the Aged, BaycrestTorontoOntarioCanada
| | - James Silvius
- Division of Geriatric Medicine, Department of Medicine, Cumming School of MedicineUniversity of Calgary, Calgary, Alberta, Canada
| | - Jennifer Watt
- Division of Geriatric MedicineDepartment of Medicine, University of TorontoTorontoOntarioCanada
| | - Dallas Seitz
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Cumming School of Medicine; Hotchkiss Brain Institute and O'Brien Institute of Public HealthUniversity of Calgary, Calgary, Alberta, Canada
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Song Y, Mohamed Nassur A, Rupasinghe V, Haq F, Boström AM, Reid C, Andersen E, Wagg A, Hoben M, Goodarzi Z, Squires JE, Estabrooks CA, Weeks LE. Factors associated with residents’ responsive behaviours towards staff in long-term care homes: A systematic review. The Gerontologist 2022; 63:674-689. [PMID: 35094085 PMCID: PMC10167766 DOI: 10.1093/geront/gnac016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
When staff experience responsive behaviors from residents, this can lead to decreased quality of work-life and lower quality of care in long-term care homes. We synthesised research on factors associated with resident responsive behaviours directed towards care staff and characteristics of interventions to reduce the behaviours.
Research Design and Methods
We conducted a mixed-methods systematic review with quantitative and qualitative research. We searched 12 bibliographic databases and “grey” literature, using two keywords (long-term care, responsive behaviours) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. We developed a coding scheme using the ecological model as an organising structure and prepared narrative summaries for each factor.
Results
From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level); staff approaches to care (interpersonal level); leadership and staffing resources (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviours, and quantitative findings on the impact of staff approaches to care on behaviours. Effects of interventions (n=14) to reduce the behaviours were inconclusive.
Discussion and Implications
We identified the need for enhanced understanding of the interrelationships among factors associated with resident responsive behaviours towards staff and processes leading to the behaviours. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviours, we suggest intervention studies with systematic process evaluations.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | | | | | - Fajr Haq
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Colin Reid
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Elizabeth Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary Alberta, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Watt JA, Fahim C, Straus SE, Goodarzi Z. Barriers and facilitators to virtual care in a geriatric medicine clinic: a semi-structured interview study of patient, caregiver and healthcare provider perspectives. Age Ageing 2022; 51:6427233. [PMID: 34794177 DOI: 10.1093/ageing/afab218] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND COVID-19-related physical distancing measures necessitated widespread adoption of virtual care (i.e. telephone or videoconference), but patients, caregivers and healthcare providers raised concerns about its implementation and sustainability given barriers faced by older adults. OBJECTIVE To describe barriers and facilitators experienced by people accessing and providing virtual care in a geriatric medicine clinic. DESIGN Qualitative semi-structured interview study. SETTING AND PARTICIPANTS We recruited and interviewed 20 English-speaking patients, caregivers and healthcare providers who participated in virtual care at St. Michael's Hospital's geriatric medicine clinic, Toronto, Canada, between 22 October 2020 and 23 January 2021. METHODS We analyzed data in two stages: framework analysis and deductive coding to the Theoretical Domains Framework. RESULTS We included six healthcare providers, seven patients and seven caregivers. We identified eight themes: impact of the COVID-19 pandemic on virtual care uptake, complexity of virtually caring for older adults, uncertain accuracy of virtual assessments, inequity in access to virtual care, importance of caring for the patient-caregiver dyad, assimilating technology into the lives of older adults, impact of technology-related factors on virtual care uptake and impact of clinic processes on integration of virtual care into outpatient care. Further, we identified knowledge, skills, belief in capabilities, and environmental context and resources as key barriers and facilitators to uptake. CONCLUSIONS Patients, caregivers and healthcare providers believe that there is a role for virtual care after COVID-19-related physical distancing measures relax, but we must tailor implementation of virtual care programs for older adults based on identified barriers and facilitators.
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Affiliation(s)
- Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Toronto, Ontario M5B 1W8, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Toronto, Ontario M5B 1W8, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Toronto, Ontario M5B 1W8, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario M5T 3M6, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, Alberta T2N 2T9, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 4N1, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
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Lunny C, Zarin W, Chaudhry S, Thomas SM, LeBlanc A, Desroches S, Horsley T, Colquhoun H, Sanon PN, Downey M, Goodarzi Z, Baxter NN, English K, PausJenssen E, McQuitty S, Wilhelm L, McKinnon A, Hoens AM, Li LC, Clement F, Curran JA, Abou-Setta AM, Godfrey C, Moher D, Moffitt P, Walker J, Jull J, Koehn C, Isaranuwatchai W, Straus SE, Tricco AC. An inclusive and diverse governance structure of the strategy for patient-oriented research (SPOR) Evidence Alliance. Facets (Ott) 2022. [DOI: 10.1139/facets-2021-0129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Strategy for Patient Oriented Research (SPOR) Evidence Alliance is a research initiative in Canada whose mission is to promote the synthesis, dissemination, and integration of research results into health care and public health decision-making and clinical practice. The aim of this paper is to ( i) outline the governance and committee structure of the SPOR Evidence Alliance, ( ii) outline the procedures for patient and health system decision-maker engagement, and ( iii) present the capacity-building strategy for governance members. The governance structure includes the following six standing committees: the International Advisory Committee, Steering Committee, Executive Committee, Knowledge Translation Committee, Partnerships Committee, and Training and Capacity Development Committee. The guiding principles embrace inclusiveness, support, mutual respect, transparency, and co-building. There are currently 64 committee members across the six committees, 13 patient and public partners, 8 health system decision-makers, 7 research trainees, and 36 researchers. A multi-disciplinary and diverse group of people in Canada are represented from all regions and at various levels of training in knowledge generation, exchange, and translation. This collaborative model makes the SPOR Evidence Alliance strong and sustainable by leveraging the knowledge, lived experiences, expertise, skills, and networks among its 342 members and 12 principal investigators.
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Affiliation(s)
- Carole Lunny
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC V6T 1Z3, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada
| | - Wasifa Zarin
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada
| | - Sabrina Chaudhry
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada
| | - Sonia M. Thomas
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada
| | - Annie LeBlanc
- VITAM Research Center on Sustainable Health, CIUSSS de la Capitale Nationale, Quebec City, QC G1J 0A4, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada
| | - Sophie Desroches
- School of Nutrition, Université Laval, Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, 2440 Blvd Hochelaga, Quebec City, QC G1V 0A6, Canada
| | - Tanya Horsley
- Research Unit, Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, ON K1S 5N8, Canada
- North Slave Research Centre, Aurora College, Bag 9700, 5004-54th St, Yellowknife, NT X1A 2R3, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada
| | - Priscille-Nice Sanon
- Sickle Cell Anemia Association of Quebec, 333, Saint-Denis Street, office 3, Montréal, QC H2R 2E5, Canada
| | - Minnie Downey
- BC SUPPORT Unit, Suite 420, 1367 West Broadway, Vancouver, BC V6H 4A7, Canada
| | - Zahra Goodarzi
- Department of Medicine and Community Health Sciences, Hotchkiss Brain Institute and O’Brien Institute of Public Health, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Nancy N. Baxter
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, VIC 3053, Australia
| | - Kelly English
- Arthritis Patients Advisory Board, 5591 No. 3 Rd., Richmond, BC V6X 2C7, Canada
| | - Elliot PausJenssen
- Saskatoon Council on Aging, 2020 College Dr, Saskatoon, SK S7N 2W4, Canada
| | - Shanon McQuitty
- Arthritis Patient Advisory Board of Arthritis Research Canada, 2238 Yukon Street, Vancouver, BC V5Y 3P2, Canada
| | | | | | - Alison M. Hoens
- BC SUPPORT Unit, Suite 420, 1367 West Broadway, Vancouver, BC V6H 4A7, Canada
- Arthritis Patient Advisory Board of Arthritis Research Canada, 2238 Yukon Street, Vancouver, BC V5Y 3P2, Canada
- Arthritis Research Canada, 230 – 2238 Yukon Street, Vancouver, BC V5Y 3P2, Canada
| | - Linda C. Li
- Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
- Arthritis Research Canada, 230 – 2238 Yukon Street, Vancouver, BC V5Y 3P2, Canada
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB T2N 4N6, Canada
| | - Janet A. Curran
- School of Nursing, Faculty of Health, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
| | - Ahmed M. Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, 367-753 McDermot Ave, Winnipeg, MB R3E 0T6, Canada
| | - Christina Godfrey
- Queen’s Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen’s University School of Nursing, 92 Barrie Street, Kingston, ON K7L 3J8, Canada
| | - David Moher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada
| | - Pertice Moffitt
- North Slave Research Centre, Aurora College, Bag 9700, 5004-54th St, Yellowknife, NT X1A 2R3, Canada
| | - Jennifer Walker
- Associate Professor, Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, 31 George Street, Kingston, ON K7L 3N6, Canada
| | - Cheryl Koehn
- Arthritis Consumer Experts, 1529 West 6th Ave, Vancouver, BC V6J 1R1, Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7, Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada
- Queen’s Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen’s University School of Nursing, 92 Barrie Street, Kingston, ON K7L 3J8, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7, Canada
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Hoang P, Torbiak L, Goodarzi Z, Schmaltz HN. A Qualitative and Quantitative Analysis of the Geriatrics Update: Clinical Pearls Course. Can Geriatr J 2021; 24:304-311. [PMID: 34912484 PMCID: PMC8629497 DOI: 10.5770/cgj.24.503] [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: 11/30/2022] Open
Abstract
Background The University of Calgary Cumming School of Medicine Annual Geriatrics Update: Clinical Pearls Course (Geriatrics Update) is a one-day, continuing medical education (CME) course designed to enhance geriatrics competency for family physicians (FPs), given increasing population age and complexity. We aimed to evaluate how the course meets FPs’ perceived learning needs and identify modifications that may better support FPs. Methods Descriptive data from 2018–2019 course evaluation surveys including demographic data, evaluations, and narrative feedback from participating FPs. Semi-structured phone and video-conferenced interviews with FPs were thematically analyzed each year. Results Evaluation surveys had high response rates of FPs (52 or 61% in 2018; 39 or 58% in 2019). Most FP respondents (84% in 2018 and 82% in 2019) intended to make practice changes. FPs were significantly (p=.001) more confident on course objectives after the course in both years. All interviewees (n=20) described fulfilled perceived and unperceived learning needs and planned to return. The Geriatrics Update course is the primary source of Geriatrics CME for 60% of interviewees. Conclusions Iterative evaluation of Geriatrics Update identified that the course is well received, and often FPs primary source of geriatric CME. Interviews provided additional context and descriptive feedback to improve course delivery and better meet FP learning needs.
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Affiliation(s)
- Peter Hoang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Lindsay Torbiak
- Department of Medicine, University of Manitoba, Winnipeg, MB
| | - Zahra Goodarzi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB
| | - Heidi N Schmaltz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB.,Seniors' Health, Calgary Zone, Alberta Health Services, Edmonton, AB
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Fernandes B, Goodarzi Z, Holroyd-Leduc J. Optimizing the diagnosis and management of dementia within primary care: a systematic review of systematic reviews. BMC Fam Pract 2021; 22:166. [PMID: 34380424 PMCID: PMC8359121 DOI: 10.1186/s12875-021-01461-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023]
Abstract
Background To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care. Methods Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews, either quantitative or qualitative, were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework. Results Twenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100 %, 95 % CI: 70-100 %) and specificity (82 %, 95 % CI: 72-90 %) within the shortest amount of time (3.16 to 5 min) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer’s Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers. Conclusions There are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01461-5.
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Affiliation(s)
| | - Zahra Goodarzi
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, Foothills Medical Centre, University of Calgary, North Tower (Rm 930), 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, Foothills Medical Centre, University of Calgary, North Tower (Rm 930), 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
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Medina Escobar A, Martino D, Goodarzi Z. The prevalence of anxiety in adult-onset isolated dystonia: A systematic review and meta-analysis. Eur J Neurol 2021; 28:4238-4250. [PMID: 34363292 DOI: 10.1111/ene.15050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/29/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Clinically relevant anxiety and anxiety disorders are commonly associated with adult-onset isolated dystonia, contributing substantially to quality-of-life impairment in patients with this movement disorder. However, the prevalence of anxiety symptoms and disorders in adult-onset isolated dystonia remains unclear. We aimed to conduct a systematic review and meta-analysis of the prevalence of anxiety symptoms/disorders in adult-onset isolated dystonia. METHODS Studies reporting the prevalence of anxiety disorders determined through diagnostic interviews or from clinically relevant anxiety symptoms detected with rating scales were identified in three databases (MEDLINE, EMBASE and PsycINFO). The gray literature was also examined to detect studies not captured through the search strategy. RESULTS The search strategy yielded 6535 citations; 34 studies met the inclusion criteria. The overall prevalence of clinically relevant anxiety symptoms and anxiety disorders for cervical dystonia was 40% (95% confidence interval [CI] 20% to 60%); for studies examining cranial dystonia it was 25% (95% CI 21% to 30%); for studies exploring mixed populations of adult-onset isolated dystonia it was 33.3% (95% CI 22% to 43%), 26% (95% CI 12% to 40%) for laryngeal dystonia, and 32% (95% CI 21% to 43%) for upper limb dystonia. Social phobia was the most prevalent anxiety disorder across the different forms of adult-onset isolated dystonia. Between-study statistical heterogeneity was high for most prevalence estimates. CONCLUSIONS Clinically relevant anxiety and anxiety disorders are common across all forms of adult-onset isolated dystonia. New research avenues should explore and plan the development of pathways of care targeting these important non-motor features.
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Affiliation(s)
- Alex Medina Escobar
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
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Liu L, Goodarzi Z, Jones A, Posno R, Straus SE, Watt JA. Factors associated with virtual care access in older adults: a cross-sectional study. Age Ageing 2021; 50:1412-1415. [PMID: 33625475 PMCID: PMC7929426 DOI: 10.1093/ageing/afab021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Received: 10/14/2020] [Indexed: 11/14/2022] Open
Abstract
Background virtual care has been critical during the COVID-19 pandemic, but there may be inequities in accessing different virtual modalities (i.e. telephone or videoconference). Objective to describe patient-specific factors associated with receiving different virtual care modalities. Design cross-sectional study. Setting and Subjects we reviewed medical records of all patients assessed virtually in the geriatric medicine clinic at St. Michael’s Hospital, Toronto, Canada, between 17 March and 13 July 2020. Methods we derived adjusted odds ratios (OR), risk differences (RDs) and marginal and predicted probabilities, with 95% confidence intervals, from a multivariable logistic regression model, which tested the association between having a videoconference assessment (vs. telephone) and patient age, sex, computer ability, education, frailty (Clinical Frailty Scale score), history of cognitive impairment and immigration history; language of assessment and caregiver involvement in assessment. Results our study included 330 patients (227 telephone and 103 videoconference assessments). The median population age was 83 (Q1–Q3, 76–88) and 45.2% were male. Frailty (adjusted OR 0.62, 0.45–0.85; adjusted RD −0.08, −0.09 to −0.06) and absence of a caregiver (adjusted OR 0.12, 0.06–0.24; adjusted RD −0.35, −0.43 to −0.26) were associated with lower odds of videoconference assessment. Only 32 of 98 (32.7%) patients who independently use a computer participated in videoconference assessments. Conclusions older adults who are frail or lack a caregiver to attend assessments with them may not have equitable access to videoconference-based virtual care. Future research should evaluate interventions that support older adults in accessing videoconference assessments.
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Affiliation(s)
- Laura Liu
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- O’Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ron Posno
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, ON M5B 1W8, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, ON M5B 1W8, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, ON M5B 1W8, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
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McMillan JM, Michalchuk Q, Goodarzi Z. Frailty in Parkinson's disease: A systematic review and meta-analysis. Clin Park Relat Disord 2021; 4:100095. [PMID: 34316672 PMCID: PMC8299963 DOI: 10.1016/j.prdoa.2021.100095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 03/04/2021] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Frailty and Parkinson's disease (PD) are common conditions that increase with age. Independently, frailty and PD lead to increased morbidity and mortality for patients. Few studies report on frailty in patients with PD. We performed a systematic review and meta-analysis of the prevalence, associations and outcomes of frailty in persons with PD. METHODS We searched four electronic databases and grey literature from inception to May 19, 2020, for articles which reported the prevalence, associations and outcomes of frailty in persons with PD. RESULTS One-thousand and sixty-three citations were identified, of which 127 articles were reviewed. Thirty studies were included. Twenty-eight studies were observational and the settings varied including 25 community and 5 inpatient studies.The most common frailty screening measures were the frailty phenotype and clinical frailty scale. The prevalence of frailty in PD using the FP was 0.38 (0.24-0.55) with I2 = 92.6% (p < 0.01). Frailty was associated with recurrent falls, cognitive impairment, dementia, orthostatic hypotension, fatigue, hallucinations, nursing home placement, dependency in activities of daily living and in-patient mortality. PD disease duration, motor impairment, non-tremor dominant PD (postural instability/gait difficulty dominant phenotype) and total daily levodopa dose were associated with frailty. CONCLUSION Frailty is common in PD. There is no agreed upon tool for identifying frailty, however, the importance of its identification is apparent given the high prevalence and the association between frailty and adverse outcomes in persons with PD. Future studies are required to guide clinicians in how best to identify and manage frail patients with PD.
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Affiliation(s)
- Jacqueline M. McMillan
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Zahra Goodarzi
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Mele B, Ismail Z, Goodarzi Z, Pringsheim T, Lew G, Holroyd–Leduc J. Non-pharmacologic interventions to treat apathy in Parkinson's disease: A realist review. Clin Park Relat Disord 2021; 4:100096. [PMID: 34316673 PMCID: PMC8299975 DOI: 10.1016/j.prdoa.2021.100096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 10/14/2020] [Revised: 03/01/2021] [Accepted: 05/10/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION There is a diverse body of evidence investigating non-pharmacological treatment options for apathy in Parkinson's disease (PD). We aimed to better understand the context and mechanisms by which non-pharmacological interventions may improve apathy in persons with PD. METHODS We conducted a realist review of the body of evidence investigating treatment options for apathy in PD. Study authors used findings from a preceding scoping review to identify initial program theory. We then update the scoping review, which was originally conducted in 2017. Two authors independently reviewed and extracted data from studies that discussed non-pharmacological treatment options for apathy in PD. Any data concerning context, mechanisms, and outcomes of interventions for apathy in PD were extracted, synthesized, and analyzed. RESULTS Our review included nine studies. We categorized studies into two categories, exercise and mindfulness. There were seven exercise interventions included. Exercise interventions evaluated group exercise compared to individual exercise, aerobic exercise, dance, Nordic walking, and an equine program. There were two mindfulness interventions. CONCLUSION Exercise interventions work best for persons with PD and apathy who are not significantly physically or cognitively impaired, and who have access to transportation, adapted programs, and specialized coaches. Exercise may improve apathy through goal-directed behaviour change and engagement in social interactions. Mindfulness interventions work best for persons with PD and apathy who are not significantly cognitively impaired, have caregiver support, and may improve apathy by targeting the emotional, cognitive, and goal-directed domains that define apathy.
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Affiliation(s)
- Bria Mele
- Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Cumming School of Medicine, University of Calgary, Health Sciences Centre, Foothills Campus, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Cumming School of Medicine, University of Calgary, Health Sciences Centre, Foothills Campus, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
- Department of Psychiatry, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
- Department of Clinical Neuroscience, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
- Hotchkiss Brain Institute, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
- O'Brien Institute for Public Health, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Hotchkiss Brain Institute, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
- O'Brien Institute for Public Health, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
- Department of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Tamara Pringsheim
- Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Department of Clinical Neuroscience, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
- Hotchkiss Brain Institute, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Grace Lew
- Faculty of Health Sciences, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Jayna Holroyd–Leduc
- Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
- Department of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
- Alberta Health Services, Foothills Medical Centre, South Tower, Room 1104, 1403–29 St. NW, Calgary, Alberta, T2N 2T9, Canada
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Watt JA, Lane NE, Veroniki AA, Vyas MV, Williams C, Ramkissoon N, Thompson Y, Tricco AC, Straus SE, Goodarzi Z. Diagnostic accuracy of virtual cognitive assessment and testing: Systematic review and meta-analysis. J Am Geriatr Soc 2021; 69:1429-1440. [PMID: 33948937 DOI: 10.1111/jgs.17190] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND/OBJECTIVES Virtual (i.e., telephone or videoconference) care was broadly implemented because of the COVID-19 pandemic. Our objectives were to compare the diagnostic accuracy of virtual to in-person cognitive assessments and tests and barriers to virtual cognitive assessment implementation. DESIGN Systematic review and meta-analysis. SETTING MEDLINE, EMBASE, CDSR, CENTRAL, PsycINFO, and gray literature (inception to April 1, 2020). PARTICIPANTS AND INTERVENTIONS Studies describing the accuracy or reliability of virtual compared with in-person cognitive assessments (i.e., reference standard) for diagnosing dementia or mild cognitive impairment (MCI), identifying virtual cognitive test cutoffs suggestive of dementia or MCI, or describing correlations between virtual and in-person cognitive test scores in adults. MEASUREMENTS Reviewer pairs independently conducted study screening, data abstraction, and risk of bias appraisal. RESULTS Our systematic review included 121 studies (15,832 patients). Two studies demonstrated that virtual cognitive assessments could diagnose dementia with good reliability compared with in-person cognitive assessments: weighted kappa 0.51 (95% confidence interval [CI] 0.41-0.62) and 0.63 (95% CI 0.4-0.9), respectively. Videoconference-based cognitive assessments were 100% sensitive and specific for diagnosing dementia compared with in-person cognitive assessments in a third study. No studies compared telephone with in-person cognitive assessment accuracy. The Telephone Interview for Cognitive Status (TICS; maximum score 41) and modified TICS (maximum score 50) were the only virtual cognitive tests compared with in-person cognitive assessments in >2 studies with extractable data for meta-analysis. The optimal TICS cutoff suggestive of dementia ranged from 22 to 33, but it was 28 or 30 when testing was conducted in English (10 studies; 1673 patients). Optimal modified TICS cutoffs suggestive of MCI ranged from 28 to 31 (3 studies; 525 patients). Sensory impairment was the most often voiced condition affecting assessment. CONCLUSION Although there is substantial evidence supporting virtual cognitive assessment and testing, we identified critical gaps in diagnostic certainty.
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Affiliation(s)
- Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, G1 06, Toronto, Ontario, Canada
| | - Natasha E Lane
- ICES, G1 06, Toronto, Ontario, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.,Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Manav V Vyas
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chantal Williams
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Naveeta Ramkissoon
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Yuan Thompson
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
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Watt JA, Goodarzi Z, Veroniki AA, Nincic V, Khan PA, Ghassemi M, Lai Y, Treister V, Thompson Y, Schneider R, Tricco AC, Straus SE. Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis. BMJ 2021; 372:n532. [PMID: 33762262 PMCID: PMC7988455 DOI: 10.1136/bmj.n532] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia who experience depression as a neuropsychiatric symptom of dementia or have a diagnosis of a major depressive disorder. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, the Cochrane Library, CINAHL, PsycINFO, and grey literature between inception and 15 October 2020. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised trials comparing drug or non-drug interventions with usual care or any other intervention targeting symptoms of depression in people with dementia. MAIN OUTCOME MEASURES Pairs of reviewers screened studies, abstracted aggregate level data, and appraised risk of bias with the Cochrane risk of bias tool, which facilitated the derivation of standardised mean differences and back transformed mean differences (on the Cornell scale for depression in dementia) from bayesian random effects network meta-analyses and pairwise meta-analyses. RESULTS Of 22 138 citations screened, 256 studies (28 483 people with dementia) were included. Missing data posed the greatest risk to review findings. In the network meta-analysis of studies including people with dementia without a diagnosis of a major depressive disorder who were experiencing symptoms of depression (213 studies; 25 177 people with dementia; between study variance 0.23), seven interventions were associated with a greater reduction in symptoms of depression compared with usual care: cognitive stimulation (mean difference -2.93, 95% credible interval -4.35 to -1.52), cognitive stimulation combined with a cholinesterase inhibitor (-11.39, -18.38 to -3.93), massage and touch therapy (-9.03, -12.28 to -5.88), multidisciplinary care (-1.98, -3.80 to -0.16), occupational therapy (-2.59, -4.70 to -0.40), exercise combined with social interaction and cognitive stimulation (-12.37, -19.01 to -5.36), and reminiscence therapy (-2.30, -3.68 to -0.93). Except for massage and touch therapy, cognitive stimulation combined with a cholinesterase inhibitor, and cognitive stimulation combined with exercise and social interaction, which were more efficacious than some drug interventions, no statistically significant difference was found in the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia without a diagnosis of a major depressive disorder. Clinical and methodological heterogeneity precluded network meta-analysis of studies comparing the efficacy of interventions specifically for reducing symptoms of depression in people with dementia and a major depressive disorder (22 studies; 1829 patients). CONCLUSIONS In this systematic review, non-drug interventions were found to be more efficacious than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017050130.
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Affiliation(s)
- Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Paul A Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Victoria Treister
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Yuan Thompson
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Raphael Schneider
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- St Michael's Hospital, Toronto, ON, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Abstract
OBJECTIVE To conduct a scoping review of the literature on apathy in Parkinson's disease (PD), to better understand how apathy in Parkinson's disease is diagnosed, treated and managed. METHODS MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Central Register of Control Trials and Cochrane Database of Systematic Reviews were searched to 17 May 2017. An updated review was run from 17 May 2017 to 28 January 2019. The grey literature was searched using the CADTH Grey Matters tool. Original peer-reviewed research was included if it included individuals with PD and apathy. Non-original data was only included if it was in the form of meta-analysis. All information regarding diagnosis, treatment and management of PD was extracted. Citation screening and extraction were performed in duplicate. RESULTS From 11 375 citations, 362 articles were included in the final review. The majority of included studies focussed on prevalence, with few studies examining treatment. Twenty screening tools for apathy were identified. Fifty per cent of treatment studies were randomised control trials (RCTs). RCTs applied treatment methods including: exercise, mindfulness, rotigotine (Neupro) transdermal patch and rivastigmine (Exelon). CONCLUSIONS This review identified a large body of literature describing current knowledge on diagnosing, treating and managing apathy in PD. Future research should aim to detect an ideal screening tool for apathy in PD, to identify the best treatment options for apathy and the variety of comorbidities it may present with and finally aim to better understand postoperative apathy in those with deep brain stimulation.
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Affiliation(s)
- Bria Mele
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shinia Van
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Tamara Pringsheim
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
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Mohamadi E, Olyaee Manesh A, Takian A, Majdzadeh R, Hosseinzadeh Lotfi F, Sharafi H, Jowett M, Kiani MM, Hosseini Qavam Abadi L, Fazaeli AA, Goodarzi Z, Sajadi HS, Noori Hekmat S, Freidoony L. Technical efficiency in health production: A comparison between Iran and other upper middle-income countries. Health Policy and Technology 2020. [DOI: 10.1016/j.hlpt.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Speranzini N, Goodarzi Z, Casselman L, Pringsheim T. Barriers and Facilitators Associated with the Management of Aggressive and Disruptive Behaviour in Children: A Qualitative Study with Pediatricians. J Can Acad Child Adolesc Psychiatry 2020; 29:177-187. [PMID: 32774400 PMCID: PMC7391873] [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] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Aggressive and disruptive behaviours are frequently observed in children. Short-term use of antipsychotics with monitoring for adverse effects is recommended when first-line interventions fail (e.g. psychosocial therapies and psychostimulants for ADHD). This study aimed to understand the barriers and facilitators to behavioural change for the management of aggressive and disruptive behaviours by pediatricians. METHODS This was a qualitative study with twenty community-based pediatricians. An interview guide was developed to elicit beliefs associated with practice behaviours. We used thematic content analysis with the Theoretical Domains Framework to inform knowledge translation interventions, by helping to determine what behavioural barriers and facilitators to practice exist. Key domains which influenced behaviour were identified by evaluating the frequency of beliefs across interviews, conflicting beliefs, and the strength of beliefs impacting behaviour. RESULTS Pediatricians described evaluating the impact of aggressive and disruptive behaviours, attempting to determine their cause, and using an approach that prioritized psychosocial therapies and psychostimulants. Pediatricians reported that antipsychotics were effective but that they experienced anxiety about harms, and there was a need to accept the adverse effects as a trade-off for improved function. Discontinuing antipsychotics was problematic. Despite awareness of antipsychotic-induced movement disorders and metabolic effects, there were limitations in physician skills, knowledge and resources and social influences that were a barrier to routine implementation of recommended monitoring procedures. CONCLUSIONS This study identifies barriers and facilitators to evidence-based practice that can be used for knowledge translation interventions to ensure a high standard of care for children prescribed antipsychotics.
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Affiliation(s)
- Nicholas Speranzini
- Research Assistant, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Zahra Goodarzi
- Assistant Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | - Tamara Pringsheim
- Associate Professor, Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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Sajadi HS, Goodarzi Z, Takian A, Mohamadi E, Olyaeemanesh A, Hosseinzadeh Lotfi F, Sharafi H, Noori Hekmat S, Jowett M, Majdzadeh R. Assessing the efficiency of Iran health system in making progress towards universal health coverage: a comparative panel data analysis. Cost Eff Resour Alloc 2020; 18:20. [PMID: 32612458 PMCID: PMC7324989 DOI: 10.1186/s12962-020-00215-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/06/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Building upon decades of continuous reforms, Iran has been implementing various initiatives to reach universal health coverage (UHC). Improving efficiency is a crucial intermediate policy objective for UHC. Therefore, this article aimed to measure the efficiency and productivity changes of the Iranian health system in making progress towards UHC during 2010-2015 in comparison with 36 selected other upper-middle-income countries. METHODS We used panel data to measure the variations in technical efficiency (TE) and total factor productivity (TFP) through an extended data envelopment analysis (EDEA) and Malmquist productivity index, respectively. General government health expenditure (GGHE) per capita (International dollar) was selected as the input variable. Service coverage of diphtheria, tetanus and pertussis; family planning; antiretroviral therapy; skilled attendants at birth; Tuberculosis treatment success rate; and GGHE as % of total health expenditure (THE) were considered as output variables. The data for each indicator were taken from the Global Health Observatory data repository and World Development Indicator database, for 6 years (2010-2015). RESULTS The TE scores of Iran's health system were 0.75, 0.77, 0.74, 0.74, 0.97, and 0.84 in the period 2010-2015, respectively. TFP improved in 2011 (1.02), 2013 (1.01), and 2014 (1.30, generally). The overall efficiency and TFP increased in 2014. Changes made in CCHE per capita and GGHE/THE attributed to the increase of efficiency. CONCLUSION There is a growing demand for efficiency improvements in the health systems to achieve UHC. While there are no defined set of indicators or precise methods to measure health system efficiency, EDEA helped us to draw the picture of health system efficiency in Iran. Our findings highlighted the essential need for targeted and sustained interventions, i.e., allocation of enough proportion of public funds to the health sector, to improve universal financial coverage against health costs aiming to enhance the future performance of Iran's health system, ultimately. Such tailored interventions may also be useful for settings with similar context to speed up their movement towards improving efficiency, which in turn might lead to more resources to reach UHC.
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Affiliation(s)
- Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Global Health & Public Policy, Department of Management Sciences & Health Economics, School of Public Health, Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Efat Mohamadi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- National Institute for Health Research, Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamid Sharafi
- Department of Mathematics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Somayeh Noori Hekmat
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Matthew Jowett
- Department of Health Systems Governance & Financing, World Health Organization, Geneva, Switzerland
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Community-Based Participatory-Research Center,and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Watt JA, Goodarzi Z, Veroniki AA, Nincic V, Khan PA, Ghassemi M, Thompson Y, Lai Y, Treister V, Tricco AC, Straus SE. Safety of pharmacologic interventions for neuropsychiatric symptoms in dementia: a systematic review and network meta-analysis. BMC Geriatr 2020; 20:212. [PMID: 32546202 PMCID: PMC7298771 DOI: 10.1186/s12877-020-01607-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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] [Received: 01/30/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background Prescribing trends suggest that pharmacologic alternatives to antipsychotics are gaining in popularity, but randomized trial (RCT) data of their comparative safety is scarce. Our objective was to describe the comparative safety of pharmacologic interventions for treating neuropsychiatric symptoms in dementia. Methods We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and PsycINFO, from inception to May 28, 2019, for studies of pharmacologic interventions used to treat neuropsychiatric symptoms in dementia. Dementia care partners selected fracture risk as our primary outcome. Pairs of reviewers, working independently, conducted all study screening, data abstraction, and risk of bias appraisal. We conducted Bayesian random-effects network meta-analyses (NMAs) using data from RCTs to derive odds ratios (ORs). In secondary analyses, we conducted frequentist random-effects NMAs using data from RCTs and Bayesian three-level hierarchical random-effects NMAs incorporating data from RCTs and non-randomized studies. Results Our systematic review included 209 randomized and non-randomized studies (889,378 persons with dementia). In NMAs of data from randomized trials, there were no increased odds of fracture associated with any intervention in primary analyses; however, data were sparse. We found increased odds of cerebrovascular events associated with antipsychotics (odds ratio [OR] 2.12, 95% credible interval [CrI] 1.29 to 3.62; number needed to harm [NNH] = 99) and increased odds of falls associated with dextromethorphan-quinidine (OR 4.16, 95% CrI 1.47 to 14.22; NNH = 55) compared to placebo in persons with dementia. In a subgroup of persons with Alzheimer disease, antipsychotics were associated with increased odds of fracture compared to anticonvulsants (OR 54.1, 95% CrI 1.15 to 38,300; NNH = 18). In older persons (mean age ≥ 80 years) with dementia, anticonvulsants were associated with increased odds of death compared to placebo (OR 8.36, 95% CrI 1.17 to 203.4; NNH = 35) and antipsychotics were associated with increased odds of death compared to antidepressants (OR 5.28, 95% CrI 1.06 to 3.51; NNH = 47). Conclusion Although antipsychotics were associated with greater harm than antidepressants and anticonvulsants in subgroups of persons with dementia, medications used in lieu of antipsychotics for treating neuropsychiatric symptoms in dementia, such as anticonvulsants and dextromethorphan-quinidine, were also associated with harm. Decision-making concerning treatments prescribed in lieu of antipsychotics should include potential harms. PROSPERO registration CRD42017050130.
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Affiliation(s)
- Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada. .,Division of Geriatric Medicine, Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, Ontario, M5G 2C4, Canada.
| | - Zahra Goodarzi
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, 6 Queen's Park Cres W, Toronto, Ontario, M5S 3H2, Canada.,Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, T2N 4N1, Canada.,O'Brien Institute of Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.,Department of Primary Education, School of Education, University of Ioannina, 45110, Ioannina, Greece.,Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, W12 0NN, London, UK
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada
| | - Paul A Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada
| | - Yuan Thompson
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada
| | - Victoria Treister
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, 4th floor, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.,Division of Geriatric Medicine, Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, Ontario, M5G 2C4, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, 4th floor, 155 College St, Toronto, Ontario, M5T 3M6, Canada
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Hoben M, Heninger A, Holroyd-Leduc J, Knopp-Sihota J, Estabrooks C, Goodarzi Z. Depressive symptoms in long term care facilities in Western Canada: a cross sectional study. BMC Geriatr 2019; 19:335. [PMID: 31791250 PMCID: PMC6889648 DOI: 10.1186/s12877-019-1298-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Received: 10/16/2018] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The main objective is to better understand the prevalence of depressive symptoms, in long-term care (LTC) residents with or without cognitive impairment across Western Canada. Secondary objectives are to examine comorbidities and other factors associated with of depressive symptoms, and treatments used in LTC. METHODS 11,445 residents across a random sample of 91 LTC facilities, from 09/2014 to 05/2015, were stratified by owner-operator model (private for-profit, public or voluntary not-for-profit), size (small: < 80 beds, medium: 80-120 beds, large > 120 beds), location (Calgary and Edmonton Health Zones, Alberta; Fraser and Interior Health Regions, British Columbia; Winnipeg Health Region, Manitoba). Random intercept generalized linear mixed models with depressive symptoms as the dependent variable, cognitive impairment as primary independent variable, and resident, care unit and facility characteristics as covariates were used. Resident variables came from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0 records (the RAI-MDS version routinely collected in Western Canadian LTC). Care unit and facility variables came from surveys completed with care unit or facility managers. RESULTS Depressive symptoms affects 27.1% of all LTC residents and 23.3% of LTC resident have both, depressive symptoms and cognitive impairment. Hypertension, urinary and fecal incontinence were the most common comorbidities. Cognitive impairment increases the risk for depressive symptoms (adjusted odds ratio 1.65 [95% confidence interval 1.43; 1.90]). Pain, anxiety and pulmonary disorders were also significantly associated with depressive symptoms. Pharmacologic therapies were commonly used in those with depressive symptoms, however there was minimal use of non-pharmacologic management. CONCLUSIONS Depressive symptoms are common in LTC residents -particularly in those with cognitive impairment. Depressive symptoms are an important target for clinical intervention and further research to reduce the burden of these illnesses.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Abigail Heninger
- Faculty of Science, University of British Columbia, Vancouver, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,O'Brien Institute of Public Health, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Zahra Goodarzi
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. .,O'Brien Institute of Public Health, Calgary, AB, Canada. .,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Rios P, Cardoso R, Morra D, Nincic V, Goodarzi Z, Farah B, Harricharan S, Morin CM, Leech J, Straus SE, Tricco AC. Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews. Syst Rev 2019; 8:281. [PMID: 31730011 PMCID: PMC6857325 DOI: 10.1186/s13643-019-1163-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/13/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This review aimed to assess the existing evidence regarding the clinical effectiveness and safety of pharmacological and non-pharmacological interventions in adults with insomnia and identify where research or policy development is needed. METHODS MEDLINE, Embase, PsycINFO, The Cochrane Library, and PubMed were searched from inception until June 14, 2017, along with relevant gray literature sites. Two reviewers independently screened titles/abstracts and full-text articles, and a single reviewer with an independent verifier completed charting, data abstraction, and quality appraisal. RESULTS A total of 64 systematic reviews (35 with meta-analysis) were included after screening 5024 titles and abstracts and 525 full-text articles. Eight of the included reviews were rated as high quality using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) tool, and over half of the included articles (n = 40) were rated as low or critically low quality. Consistent evidence of effectiveness across multiple outcomes based on more than one high- or moderate quality review with meta-analysis was found for zolpidem, suvorexant, doxepin, melatonin, and cognitive behavioral therapy (CBT), and evidence of effectiveness across multiple outcomes based on one high-quality review with meta-analysis was found for temazepam, triazolam, zopiclone, trazodone, and behavioral interventions. These interventions were mostly evaluated in the short term (< 16 weeks), and there was very little harms data available for the pharmacological interventions making it difficult to evaluate their risk-benefit ratio. CONCLUSIONS Assuming non-pharmacological interventions are preferable from a safety perspective CBT can be considered an effective first-line therapy for adults with insomnia followed by other behavioral interventions. Short courses of pharmacological interventions can be supplements to CBT or behavioral therapy; however, no evidence regarding the appropriate duration of pharmacological therapy is available from these reviews. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017072527.
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Affiliation(s)
- Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
| | - Roberta Cardoso
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
| | - Deanna Morra
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
| | - Zahra Goodarzi
- Division of Geriatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Bechara Farah
- The Canadian Agency for Drugs and Technologies in Health, 865 Carling Ave., Suite 600, Ottawa, Ontario K1S 5S8 Canada
| | - Sharada Harricharan
- The Canadian Agency for Drugs and Technologies in Health, 865 Carling Ave., Suite 600, Ottawa, Ontario K1S 5S8 Canada
| | - Charles M. Morin
- École de Psychologie, 2325, rue des Bibliothèques, Québec, Québec G1V 0A6 Canada
| | - Judith Leech
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Ontario Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario M5B 1W8 Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
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Watt JA, Goodarzi Z, Veroniki AA, Nincic V, Khan PA, Ghassemi M, Thompson Y, Tricco AC, Straus SE. Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-analysis. Ann Intern Med 2019; 171:633-642. [PMID: 31610547 DOI: 10.7326/m19-0993] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [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: 11/22/2022] Open
Abstract
BACKGROUND Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia. PURPOSE To summarize the comparative efficacy of pharmacologic and nonpharmacologic interventions for treating aggression and agitation in adults with dementia. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO between inception and 28 May 2019 without language restrictions; gray literature; and reference lists scanned from selected studies and systematic reviews. STUDY SELECTION Randomized controlled trials comparing interventions for treating aggression and agitation in adults with dementia. DATA EXTRACTION Pairs of reviewers independently screened studies, abstracted data, and appraised risk of bias. DATA SYNTHESIS After screening of 19 684 citations, 163 studies (23 143 patients) were included in network meta-analyses. Analysis of interventions targeting aggression and agitation (148 studies [21 686 patients]) showed that multidisciplinary care (standardized mean difference [SMD], -0.5 [95% credible interval {CrI}, -0.99 to -0.01]), massage and touch therapy (SMD, -0.75 [CrI, -1.12 to -0.38]), and music combined with massage and touch therapy (SMD, -0.91 [CrI, -1.75 to -0.07]) were clinically more efficacious than usual care. Recreation therapy (SMD, -0.29 [CrI, -0.57 to -0.01]) was statistically but not clinically more efficacious than usual care. LIMITATIONS Forty-six percent of studies were at high risk of bias because of missing outcome data. Harms and costs of therapies were not evaluated. CONCLUSION Nonpharmacologic interventions seemed to be more efficacious than pharmacologic interventions for reducing aggression and agitation in adults with dementia. PRIMARY FUNDING SOURCE Alberta Health Services Critical Care Strategic Clinical Network. (PROSPERO: CRD42017050130).
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Affiliation(s)
- Jennifer A Watt
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (J.A.W., A.C.T., S.E.S.)
| | | | - Areti Angeliki Veroniki
- St. Michael's Hospital, Toronto, Ontario, Canada, University of Ioannina, Ioannina, Greece, and Imperial College, London, United Kingdom (A.A.V.)
| | - Vera Nincic
- St. Michael's Hospital, Toronto, Ontario, Canada (V.N., P.A.K., M.G., Y.T.)
| | - Paul A Khan
- St. Michael's Hospital, Toronto, Ontario, Canada (V.N., P.A.K., M.G., Y.T.)
| | - Marco Ghassemi
- St. Michael's Hospital, Toronto, Ontario, Canada (V.N., P.A.K., M.G., Y.T.)
| | - Yuan Thompson
- St. Michael's Hospital, Toronto, Ontario, Canada (V.N., P.A.K., M.G., Y.T.)
| | - Andrea C Tricco
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (J.A.W., A.C.T., S.E.S.)
| | - Sharon E Straus
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (J.A.W., A.C.T., S.E.S.)
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Mele B, Merrikh D, Ismail Z, Goodarzi Z. Detecting Apathy in Individuals with Parkinson's Disease: A Systematic Review. J Parkinsons Dis 2019; 9:653-664. [PMID: 31424418 DOI: 10.3233/jpd-191619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Individuals experiencing apathy in Parkinson's disease (PD) have a lack of emotion and motivation. Apathy often overlaps with comorbidities such as depression, and is sometimes difficult to detect. OBJECTIVE To examine diagnostic accuracy of apathy-screening tools compared with a gold standard (clinician diagnosis) among adult outpatients with PD. METHODS A systematic review was conducted. Six research databases were searched to May 23, 2018. Diagnostic accuracy measures, including sensitivity and specificity were gathered. RESULTS 1,007 full-text articles were reviewed with seven full-text articles included. The gold standard was considered a clinician diagnosis as apathy is not defined in the DSM/ICD. Diagnostic accuracy measures were reported for the Lille Apathy Rating Scale (LARS) both informant- and observer-rated, Unified Parkinson's Disease Rating Scale (UPDRS), Apathy Scale (AS), Apathy Evaluation Scale (AES), Non-Motor Symptoms Questionnaire (NMS-Q), and Dimensional Apathy Scale (DAS). The AES had the best reported sensitivity and specificity values, both 90%. The AS had the highest reported specificity at 100%, with 66% sensitivity. Pooled prevalence of apathy was 29.1% (95% CI 21.5%-36.6%). CONCLUSIONS While 18 screening tools exist to screen for apathy in PD, only six have been validated against clinician diagnosis. The AES had the highest reported sensitivity and specificity and is a brief, easy to use tool. The AS was designed specifically for use in PD populations and has the highest reported specificity. Future research should focus on the development of an accepted gold standard, to further understand accuracy measures of all available apathy screening tools.
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Affiliation(s)
- Bria Mele
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Daria Merrikh
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mele B, Goodarzi Z, Hanson HM, Holroyd-Leduc J. Barriers and facilitators to diagnosing and managing apathy in Parkinson's disease: a qualitative study. BMC Neurol 2019; 19:101. [PMID: 31126259 PMCID: PMC6533742 DOI: 10.1186/s12883-019-1329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 05/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Apathy is a prominent non-motor symptom in Parkinson's disease (PD). People with apathy show a lack of emotion, passion, and motivation. Between 17 and 70% of persons with PD have apathy; the extreme heterogeneity in these estimates is due to limited heterogeneous knowledge concerning how to diagnose PD. The lack of a widely utilized diagnostic process limits understandings on how to treat and manage apathy in PD. A scoping review of apathy in PD identified only one qualitative study investigating this symptom. It was our objective to assess perceived barriers and facilitators to diagnosing, treating, and managing apathy in PD, as described by key stakeholders. METHODS This research applied qualitative methodology, utilizing focus groups and interviews with health care practitioners (HCPs), persons with PD, and caregivers. Evidence gathered from a scoping review on apathy in PD informed discussions that took place with participants. Data collection and analysis was conducted using framework analysis, applying the Theoretical Domains Framework and Behaviour Change Wheel. RESULTS Eleven HCPs and five persons with PD/caregivers participated. Themes included interdisciplinary teams and communication with family to facilitate diagnosis and treatment, and the use of education and increased awareness of apathy to facilitate management. Themes surrounding barriers included lack of initiative and motivation to maintain treatment plans, and a lack of evidence for apathy specific interventions. While a key barrier identified was the lack of information HCPs have access to, persons with PD and caregivers would prefer to receive a diagnosis of apathy even with limited management methods. Thus, education and awareness were noted as two of the most important facilitators, overall. CONCLUSION These findings suggest that diagnosing, treating, and managing apathy in PD requires interdisciplinary teams, that include family and caregivers. We identified that where HCPs perceive lack of knowledge as a barrier to diagnosis, persons with PD and caregivers find being given a diagnosis facilitates understanding. These findings highlight the importance of qualitative research involving persons with PD and apathy, caregivers, and HCPs who aid in management of this symptom. Barriers reported suggest future research must aim to identify apathy specific treatments, both pharmacologic and non-pharmacologic.
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Affiliation(s)
- Bria Mele
- Department of Community Health Sciences, University of Calgary, Foothills Medical Centre, South Tower, Room 1104, 1403-29 St. NW, Calgary, AB T2N 2T9 Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, Alberta Canada
- Alberta Health Services, Calgary, Alberta Canada
| | - Heather M. Hanson
- Department of Community Health Sciences, University of Calgary, Foothills Medical Centre, South Tower, Room 1104, 1403-29 St. NW, Calgary, AB T2N 2T9 Canada
- Seniors Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta Canada
| | - Jayna Holroyd-Leduc
- Alberta Health Services, Calgary, Alberta Canada
- Departments of Medicine and Community Health Sciences, University of Calgary, Hotchkiss Brain Institute, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta Canada
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