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Kraft R, Mercuri M, Clayton N, Worster A, Mercier E, Emond M, Varner C, McLeod SL, Eagles D, Stiell I, Barbic D, Morris J, Jeanmonod R, Kagoma YK, Shoamanesh A, Engels PT, Sharma S, Papaioannou A, Parpia S, Buchanan I, Ali M, de Wit K. Emergency physician gender and head computed tomography orders for older adults who have fallen. Acad Emerg Med 2024. [PMID: 38644592 DOI: 10.1111/acem.14928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE Physicians vary in their computed tomography (CT) scan usage. It remains unclear how physician gender relates to clinical practice or patient outcomes. The aim of this study was to assess the association between physician gender and decision to order head CT scans for older emergency patients who had fallen. METHODS This was a secondary analysis of a prospective observational cohort study conducted in 11 hospital emergency departments (EDs) in Canada and the United States. The primary study enrolled patients who were 65 years and older who presented to the ED after a fall. The analysis evaluated treating physician gender adjusted for multiple clinical variables. Primary analysis used a hierarchical logistic regression model to evaluate the association between treating physician gender and the patient receiving a head CT scan. Secondary analysis reported the adjusted odds ratio (OR) for diagnosing intracranial bleeding by physician gender. RESULTS There were 3663 patients and 256 physicians included in the primary analysis. In the adjusted analysis, women physicians were no more likely to order a head CT than men (OR 1.26, 95% confidence interval 0.98-1.61). In the secondary analysis of 2294 patients who received a head CT, physician gender was not associated with finding a clinically important intracranial bleed. CONCLUSIONS There was no significant association between physician gender and ordering head CT scans for older emergency patients who had fallen. For patients where CT scans were ordered, there was no significant relationship between physician gender and the diagnosis of clinically important intracranial bleeding.
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Affiliation(s)
- Rhys Kraft
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Mathew Mercuri
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Philosophy, University of Johannesburg, Auckland Park, Gauteng, South Africa
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Clayton
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
- Emergency Department, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Andrew Worster
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Eric Mercier
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- VITAM-Centre de Recherche en Santé Durable, Université Laval, Québec, Quebec, Canada
| | - Marcel Emond
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- VITAM-Centre de Recherche en Santé Durable, Université Laval, Québec, Quebec, Canada
| | - Catherine Varner
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Debra Eagles
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Stiell
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Barbic
- Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Judy Morris
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Québec, Québec, Canada
| | - Rebecca Jeanmonod
- Emergency Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Yoan K Kagoma
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Ashkan Shoamanesh
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul T Engels
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sunjay Sharma
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario, Canada
| | - Ian Buchanan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mariyam Ali
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kerstin de Wit
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Pelizzari-Raymundo D, Maltret V, Nivet M, Pineau R, Papaioannou A, Zhou X, Caradec F, Martin S, Le Gallo M, Avril T, Chevet E, Lafont E. IRE1 RNase controls CD95-mediated cell death. EMBO Rep 2024; 25:1792-1813. [PMID: 38383861 PMCID: PMC11014915 DOI: 10.1038/s44319-024-00095-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 02/23/2024] Open
Abstract
Signalling by the Unfolded Protein Response (UPR) or by the Death Receptors (DR) are frequently activated towards pro-tumoral outputs in cancer. Herein, we demonstrate that the UPR sensor IRE1 controls the expression of the DR CD95/Fas, and its cell death-inducing ability. Both genetic and pharmacologic blunting of IRE1 activity increased CD95 expression and exacerbated CD95L-induced cell death in glioblastoma (GB) and Triple-Negative Breast Cancer (TNBC) cell lines. In accordance, CD95 mRNA was identified as a target of Regulated IRE1-Dependent Decay of RNA (RIDD). Whilst CD95 expression is elevated in TNBC and GB human tumours exhibiting low RIDD activity, it is surprisingly lower in XBP1s-low human tumour samples. We show that IRE1 RNase inhibition limited CD95 expression and reduced CD95-mediated hepatic toxicity in mice. In addition, overexpression of XBP1s increased CD95 expression and sensitized GB and TNBC cells to CD95L-induced cell death. Overall, these results demonstrate the tight IRE1-mediated control of CD95-dependent cell death in a dual manner through both RIDD and XBP1s, and they identify a novel link between IRE1 and CD95 signalling.
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Affiliation(s)
- Diana Pelizzari-Raymundo
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Victoria Maltret
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Manon Nivet
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Raphael Pineau
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Alexandra Papaioannou
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Xingchen Zhou
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Flavie Caradec
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Sophie Martin
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Matthieu Le Gallo
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Tony Avril
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Eric Chevet
- Inserm U1242, University of Rennes, Rennes, France
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France
| | - Elodie Lafont
- Inserm U1242, University of Rennes, Rennes, France.
- Centre de Lutte Contre le Cancer Eugène Marquis, Rennes, France.
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Hassanabadi N, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D, Morin SN. Geographic variation in bone mineral density and prevalent fractures in the Canadian longitudinal study on aging. Osteoporos Int 2024; 35:599-611. [PMID: 38040857 DOI: 10.1007/s00198-023-06975-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Awareness of the prevalence of osteoporosis and fractures across jurisdictions can guide the development of local preventive programs and healthcare policies. We observed geographical variations in total hip bone mineral density and in the prevalence of major osteoporotic fractures across Canadian provinces, which persisted after adjusting for important covariates. PURPOSE We aimed to describe sex-specific total hip bone mineral density (aBMD) and prevalent major osteoporotic fractures (MOF) variation between Canadian provinces. METHODS We used baseline data from 21,227 Canadians (10,716 women, 10,511 men) aged 50-85 years in the Canadian Longitudinal Study on Aging (CLSA; baseline: 2012-2015). Linear and logistic regression models were used to examine associations between province of residence and total hip aBMD and self-reported MOF, stratified by sex. CLSA sampling weights were used to generate the prevalence and regression estimates. RESULTS The mean (SD) age of participants was 63.9 (9.1) years. The mean body mass index (kg/m2) was lowest in British Columbia (27.4 [5.0]) and highest in Newfoundland and Labrador (28.8 [5.3]). Women and men from British Columbia had the lowest mean total hip aBMD and the lowest prevalence of MOF. Alberta had the highest proportion of participants reporting recent falls (12.0%), and Manitoba (8.4%) the fewest (p-value=0.002). Linear regression analyses demonstrated significant differences in total hip aBMD: women and men from British Columbia and Alberta, and women from Manitoba and Nova Scotia had lower adjusted total hip aBMD than Ontario (p-values<0.02). Adjusted odds ratios (95% confidence intervals, CI) for prevalent MOF were significantly lower in women from British Columbia (0.47 [95% CI: 0.32; 0.69]) and Quebec (0.68 [95% CI: 0.48; 0.97]) and in men from British Columbia (0.40 [95% CI:0.22; 0.71]) compared to Ontario (p-values<0.03). Results were similar when adjusting for physical performance measures and when restricting the analyses to participants who reported White race/ethnicity. CONCLUSION Geographical variations in total hip aBMD and in the prevalence of MOF between provinces persisted after adjusting for important covariates which suggests an association with unmeasured individual and environmental factors.
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Affiliation(s)
- N Hassanabadi
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - C Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, Canada
| | - A M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - E Rahme
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - D Goltzman
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montreal, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
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Beaudart C, Sharma M, Clark P, Fujiwara S, Adachi JD, Messina OD, Morin SN, Kohlmeier LA, Sangan CB, Nogues X, Cruz-Priego GA, Cavallo A, Cooper F, Grier J, Leckie C, Montiel-Ojeda D, Papaioannou A, Raskin N, Yurquina L, Wall M, Bruyère O, Boonen A, Dennison E, Harvey NC, Kanis JA, Kaux JF, Lewiecki EM, Lopez-Borbon O, Paskins Z, Reginster JY, Silverman S, Hiligsmann M. Patients' preferences for fracture risk communication: the Risk Communication in Osteoporosis (RICO) study. Osteoporos Int 2024; 35:451-468. [PMID: 37955683 PMCID: PMC10866759 DOI: 10.1007/s00198-023-06955-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
The RICO study indicated that most patients would like to receive information regarding their fracture risk but that only a small majority have actually received it. Patients globally preferred a visual presentation of fracture risk and were interested in an online tool showing the risk. PURPOSE The aim of the Risk Communication in Osteoporosis (RICO) study was to assess patients' preferences regarding fracture risk communication. METHODS To assess patients' preferences for fracture risk communication, structured interviews with women with osteoporosis or who were at risk for fracture were conducted in 11 sites around the world, namely in Argentina, Belgium, Canada at Hamilton and with participants from the Osteoporosis Canada Canadian Osteoporosis Patient Network (COPN), Japan, Mexico, Spain, the Netherlands, the UK, and the USA in California and Washington state. The interviews used to collect data were designed on the basis of a systematic review and a qualitative pilot study involving 26 participants at risk of fracture. RESULTS A total of 332 women (mean age 67.5 ± 8.0 years, 48% with a history of fracture) were included in the study. Although the participants considered it important to receive information about their fracture risk (mean importance of 6.2 ± 1.4 on a 7-point Likert scale), only 56% (i.e. 185/332) had already received such information. Globally, participants preferred a visual presentation with a traffic-light type of coloured graph of their FRAX® fracture risk probability, compared to a verbal or written presentation. Almost all participants considered it important to discuss their fracture risk and the consequences of fractures with their healthcare professionals in addition to receiving information in a printed format or access to an online website showing their fracture risk. CONCLUSIONS There is a significant communication gap between healthcare professionals and patients when discussing osteoporosis fracture risk. The RICO study provides insight into preferred approaches to rectify this communication gap.
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Affiliation(s)
- Charlotte Beaudart
- Department of Health Services Research, Care & Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
- Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium.
| | | | - Patricia Clark
- Clinical Epidemiology Unit, Children's Hospital of Mexico, Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | | | - Osvaldo D Messina
- Investigaciones Reumatológicas y Osteológicas (IRO), Collaborating Centre WHO, Buenos Aires, Argentina
- IRO Medical Center, Investigaciones Reumatologicas y Osteologicas SRL, Buenos Aires, Argentina
| | | | | | | | - Xavier Nogues
- Internal Medicine Department, CIBERFES (ISCIII), Hospital del Mar Medical Research Institute, Pompeu Fabra University, Barcelona, Spain
| | - Griselda Adriana Cruz-Priego
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico, Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Andrea Cavallo
- Investigaciones Reumatológicas y Osteológicas (IRO), Collaborating Centre WHO, Buenos Aires, Argentina
| | | | | | | | - Diana Montiel-Ojeda
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico, Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | | | - Nele Raskin
- Department of Health Services Research, Care & Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Michelle Wall
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Olivier Bruyère
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Annelies Boonen
- Department of Health Services Research, Care & Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine and Sport Traumatology Department, University Hospital of Liège, Liège, Belgium
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - Oscar Lopez-Borbon
- Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium
| | - Zoé Paskins
- School of Medicine, Keele University, Stoke-On-Trent, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Stoke-On-Trent, UK
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Stuart Silverman
- Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care & Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Lee A, McArthur C, Ioannidis G, Mayhew A, Adachi JD, Griffith LE, Thabane L, Papaioannou A. Correction: Associations between Social Isolation Index and changes in grip strength, gait speed, bone mineral density (BMD), and self-reported incident fractures among older adults: Results from the Canadian Longitudinal Study on Aging (CLSA). PLoS One 2024; 19:e0298923. [PMID: 38346037 PMCID: PMC10861052 DOI: 10.1371/journal.pone.0298923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0292788.].
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Siva P, Wong A, Hewston P, Ioannidis G, Adachi J, Rabinovich A, Lee AW, Papaioannou A. Automatic Radar-Based Step Length Measurement in the Home for Older Adults Living with Frailty. Sensors (Basel) 2024; 24:1056. [PMID: 38400215 PMCID: PMC10891707 DOI: 10.3390/s24041056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
With an aging population, numerous assistive and monitoring technologies are under development to enable older adults to age in place. To facilitate aging in place, predicting risk factors such as falls and hospitalization and providing early interventions are important. Much of the work on ambient monitoring for risk prediction has centered on gait speed analysis, utilizing privacy-preserving sensors like radar. Despite compelling evidence that monitoring step length in addition to gait speed is crucial for predicting risk, radar-based methods have not explored step length measurement in the home. Furthermore, laboratory experiments on step length measurement using radars are limited to proof-of-concept studies with few healthy subjects. To address this gap, a radar-based step length measurement system for the home is proposed based on detection and tracking using a radar point cloud followed by Doppler speed profiling of the torso to obtain step lengths in the home. The proposed method was evaluated in a clinical environment involving 35 frail older adults to establish its validity. Additionally, the method was assessed in people's homes, with 21 frail older adults who had participated in the clinical assessment. The proposed radar-based step length measurement method was compared to the gold-standard Zeno Walkway Gait Analysis System, revealing a 4.5 cm/8.3% error in a clinical setting. Furthermore, it exhibited excellent reliability (ICC(2,k) = 0.91, 95% CI 0.82 to 0.96) in uncontrolled home settings. The method also proved accurate in uncontrolled home settings, as indicated by a strong consistency (ICC(3,k) = 0.81 (95% CI 0.53 to 0.92)) between home measurements and in-clinic assessments.
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Affiliation(s)
- Parthipan Siva
- Chirp Inc., Waterloo, ON N2J 4R2, Canada
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Alexander Wong
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Patricia Hewston
- Geras Centre for Aging Research, St. Peter’s Hospital, Hamilton Health Sciences, Hamilton, ON L8M 1W9, Canada; (P.H.); (G.I.); (J.A.); (A.P.)
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - George Ioannidis
- Geras Centre for Aging Research, St. Peter’s Hospital, Hamilton Health Sciences, Hamilton, ON L8M 1W9, Canada; (P.H.); (G.I.); (J.A.); (A.P.)
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Jonathan Adachi
- Geras Centre for Aging Research, St. Peter’s Hospital, Hamilton Health Sciences, Hamilton, ON L8M 1W9, Canada; (P.H.); (G.I.); (J.A.); (A.P.)
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Alexander Rabinovich
- Department of Surgery, McMaster University, Hamilton, ON L8S 4L8, Canada
- ArthroBiologix Inc., Hamilton, ON L8L 5G4, Canada
| | - Andrea W. Lee
- Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada;
| | - Alexandra Papaioannou
- Geras Centre for Aging Research, St. Peter’s Hospital, Hamilton Health Sciences, Hamilton, ON L8M 1W9, Canada; (P.H.); (G.I.); (J.A.); (A.P.)
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
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Lee A, McArthur C, Ioannidis G, Duque G, Adachi JD, Griffith LE, Thabane L, Papaioannou A. Associations between Osteosarcopenia and Falls, Fractures, and Frailty in Older Adults: Results From the Canadian Longitudinal Study on Aging (CLSA). J Am Med Dir Assoc 2024; 25:167-176.e6. [PMID: 37925161 DOI: 10.1016/j.jamda.2023.09.027] [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: 06/06/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To explore if older adults with osteosarcopenia are at a greater risk of falls, fractures, frailty, and worsening life satisfaction and activities of daily living (ADL) compared to those with normal bone mineral density (BMD) and without sarcopenia. DESIGN The baseline and 3-year follow-up of a longitudinal study. SETTING AND PARTICIPANTS Community-dwelling people aged 65 years or older in Canada. METHODS Caucasian participants 65 years or older that completed the Canadian Longitudinal Study on Aging (CLSA) 2015 baseline interview, physical measurements and 3-year follow-up were included. Osteopenia/osteoporosis was defined as BMD T score below -1 SD according to the World Health Organization, and sarcopenia was defined as low grip strength and/or low gait speed according to the Sarcopenia Definition Outcomes Consortium. Osteosarcopenia was defined as the coexistence of osteopenia/osteoporosis and sarcopenia. Self-reported incident falls and fractures in the last 12 months before the 3-year follow-up were measured. Frailty was assessed through the Rockwood Frailty Index (FI); life satisfaction through the Satisfaction With Life Scale (SWLS); and ADL through the Older American Resources and Services modules. Multivariable logistic and linear regression, including subgroup analyses by sex, were conducted. RESULTS The sample of 8888 participants (49.1% females) had a mean age (SD) of 72.7 (5.6) years. At baseline, neither osteopenia/osteoporosis nor sarcopenia (reference group) was present in 30.1%, sarcopenia only in 18.4%, osteopenia/osteoporosis only in 29.2%, and osteosarcopenia in 22.3%. Osteosarcopenia was significantly associated with incident falls and fractures in males [adjusted odds ratio (aOR), 1.90, 95% CI 1.15, 3.14, and aOR 2.60, 95% CI 1.14, 5.91, respectively] compared to males without osteopenia/osteoporosis or sarcopenia. Participants with osteosarcopenia had worsening ADL of 0.110 (estimated β coefficient 0.110, 95% CI 0.029, 0.192) and a decrease in their SWLS by 0.660 (estimated β coefficient -0.660, 95% CI -1.133, -0.187), compared to those without. Osteosarcopenia was not associated with frailty for both males and females. CONCLUSIONS AND IMPLICATIONS Osteosarcopenia was associated with self-reported incident falls and fractures in males and worse life satisfaction and ADL for all participants. Assessing and identifying osteosarcopenia is essential for preventing falls and fractures. Furthermore, it improves life satisfaction and ADL.
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Affiliation(s)
- Ahreum Lee
- Geras Centre for Aging Research, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - George Ioannidis
- Geras Centre for Aging Research, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gustavo Duque
- Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill university Health Centre, Montreal, Quebec, Canada
| | - Jonathan D Adachi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- Geras Centre for Aging Research, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Tam K, Wong-Pack M, Liu T, Adachi J, Lau A, Ma J, Papaioannou A, Rodrigues IB. Risk Factors and Clinical Outcomes Associated With Sarcopenia in Rheumatoid Arthritis: A Systematic Review and Meta-analysis. J Clin Rheumatol 2024; 30:18-25. [PMID: 37092889 DOI: 10.1097/rhu.0000000000001980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
ABSTRACT Sarcopenia is underrecognized in patients with rheumatoid arthritis (RA). Risk factors of sarcopenia and its impact on outcomes in RA patients are relatively unknown. We conducted a systematic review to identify factors and outcomes associated with sarcopenia in RA. We conducted this review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. We searched PubMed, Embase, CINAHL, and Web of Science databases by combining the following search concepts: (1) RA and (2) sarcopenia. Articles were included if they included RA patients, assessed for sarcopenia using a consensus working group definition, and assessed for clinical outcomes. Meta-analysis was performed using studies that shared the same sarcopenia definition and consistency in reporting patient or disease variables. Our search identified 3602 articles. After removal of duplicates, title and abstract screen, and full-text review, 16 articles were included for final analysis. All studies had observational study designs. The pooled prevalence of sarcopenia ranged from 24% to 30%, depending on the criteria for sarcopenia used. Factors associated with sarcopenia included higher 28-joint Disease Activity Scale scores (+0.39; 95% confidence interval, +0.02 to +0.77) and baseline methotrexate use (odds ratio, 0.70; 95% confidence interval, 0.51-0.97). Baseline glucocorticoid use had a positive correlation with sarcopenia in multiple studies. Several studies found lower bone mineral density and higher incidence of falls and fractures in patients with sarcopenia. Sarcopenia is prevalent in RA, and it may be associated with higher RA disease activity, lower bone mineral density, and increased falls and fractures. Therefore, early screening of sarcopenia in RA patients is important to incorporate into clinical rheumatology practice.
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Affiliation(s)
- Keith Tam
- From the Department of Rheumatology, McMaster University, Hamilton
| | | | | | | | | | - Jinhui Ma
- GERAS Centre for Aging Research, Hamilton Health Sciences
| | | | - Isabel B Rodrigues
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston ZJ, Wideman TH, Giangregorio LM. Development, Acceptability, and Usability of a Virtual Intervention for Vertebral Fractures. Phys Ther 2023; 103:pzad098. [PMID: 37555708 DOI: 10.1093/ptj/pzad098] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This project aimed to develop a virtual intervention for vertebral fractures (VIVA) to implement the international recommendations for the nonpharmacological management of osteoporotic vertebral fractures and to test its acceptability and usability. METHODS VIVA was developed in accordance with integrated knowledge translation principles and was informed by the Behavioral Change Wheel, the Theoretical Domains Framework, and the affordability, practicability, effectiveness and cost-effectiveness, acceptability, side effects/safety, and equity (APEASE) criteria. The development of the prototype of VIVA involved 3 steps: understanding target behaviors, identifying intervention options, and identifying content and implementation options. The VIVA prototype was delivered to 9 participants to assess its acceptability and usability. RESULTS VIVA includes 7 1-on-1 virtual sessions delivered by a physical therapist over 5 weeks. Each session lasts 45 minutes and is divided in 3 parts: education, training, and behavioral support/goal setting. Four main themes emerged from the acceptability evaluation: perceived improvements in pain, increased self-confidence, satisfaction with 1-on-1 sessions and resources, and ease of use. All of the participants believed that VIVA was very useful and were very satisfied with the 1-on-1 sessions. Four participants found the information received very easy to practice, 4 found it easy to practice, and 1 found it somewhat difficult to practice. Five participants were satisfied with the supporting resources, and 4 were very satisfied. Potential for statistically significant improvements was observed in participants' ability to make concrete plans about when, how, where, and how often to exercise. CONCLUSION VIVA was acceptable and usable to the participants, who perceived improvements in pain and self-confidence. IMPACT The virtual implementation of the recommendations for the nonpharmacological management of vertebral fractures showed high acceptability and usability. Future trials will implement the recommendations on a larger scale to evaluate their effectiveness.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, Montreal, QC, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Judi Laprade
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Zachary J Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa Ontario, Canada
- Faculty of Human and Social Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Timothy H Wideman
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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10
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de Wit K, Mercuri M, Clayton N, Mercier É, Morris J, Jeanmonod R, Eagles D, Varner C, Barbic D, Buchanan IM, Ali M, Kagoma YK, Shoamanesh A, Engels P, Sharma S, Worster A, McLeod S, Émond M, Stiell I, Papaioannou A, Parpia S. Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen. CMAJ 2023; 195:E1614-E1621. [PMID: 38049159 PMCID: PMC10699318 DOI: 10.1503/cmaj.230634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Ground-level falls are common among older adults and are the most frequent cause of traumatic intracranial bleeding. The aim of this study was to derive a clinical decision rule that safely excludes clinically important intracranial bleeding in older adults who present to the emergency department after a fall, without the need for a computed tomography (CT) scan of the head. METHODS This prospective cohort study in 11 emergency departments in Canada and the United States enrolled patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed. We collected data on 17 potential predictor variables. The primary outcome was the diagnosis of clinically important intracranial bleeding within 42 days of the index emergency department visit. An independent adjudication committee, blinded to baseline data, determined the primary outcome. We derived a clinical decision rule using logistic regression. RESULTS The cohort included 4308 participants, with a median age of 83 years; 2770 (64%) were female, 1119 (26%) took anticoagulant medication and 1567 (36%) took antiplatelet medication. Of the participants, 139 (3.2%) received a diagnosis of clinically important intracranial bleeding. We developed a decision rule indicating that no head CT is required if there is no history of head injury on falling; no amnesia of the fall; no new abnormality on neurologic examination; and the Clinical Frailty Scale score is less than 5. Rule sensitivity was 98.6% (95% confidence interval [CI] 94.9%-99.6%), specificity was 20.3% (95% CI 19.1%-21.5%) and negative predictive value was 99.8% (95% CI 99.2%-99.9%). INTERPRETATION We derived a Falls Decision Rule, which requires external validation, followed by clinical impact assessment. Trial registration: ClinicalTrials. gov, no. NCT03745755.
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Affiliation(s)
- Kerstin de Wit
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont.
| | - Mathew Mercuri
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Natasha Clayton
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Éric Mercier
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Judy Morris
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Rebecca Jeanmonod
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Debra Eagles
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Catherine Varner
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - David Barbic
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Ian M Buchanan
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Mariyam Ali
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Yoan K Kagoma
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Ashkan Shoamanesh
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Paul Engels
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Sunjay Sharma
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Andrew Worster
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Shelley McLeod
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Marcel Émond
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Ian Stiell
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Alexandra Papaioannou
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Sameer Parpia
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
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11
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Morin SN, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D. Author response to letter to editor OSIN-D-23-00809: ALDH2 polymorphism rs671 and alcohol consumption: possible explanatory factors for race/ethnic differences in bone density. Osteoporos Int 2023; 34:2137-2138. [PMID: 37695338 DOI: 10.1007/s00198-023-06911-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Suzanne N Morin
- McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the, McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, QC, H4A 3S5, Canada.
| | - Claudie Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the, McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, QC, H4A 3S5, Canada
| | | | | | - Elham Rahme
- McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the, McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, QC, H4A 3S5, Canada
| | | | - David Goltzman
- McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the, McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, QC, H4A 3S5, Canada
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12
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Huang A, Wang E, Sanger S, Papaioannou A, Rodrigues IB. Comparison of national and international sedentary behaviour and physical activity guidelines for older adults: A systematic review and quality appraisal with AGREE II. PLoS One 2023; 18:e0294784. [PMID: 38011139 PMCID: PMC10681178 DOI: 10.1371/journal.pone.0294784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Most older adults 65 years and older accumulate over 8.5 hours/day of sedentary time, which is associated with increased risk of metabolic syndromes and falls. The impact of increased sedentary time in older adults has prompted development of sedentary behaviour guidelines. The purpose of our review was to compare national and international sedentary behaviour and physical activity guidelines for older adults and appraise the quality of guidelines using AGREE II. We conducted our search in Medline, Embase, Global Health, Web of Science, CINAHL, and relevant grey literature. We included the most recent guidelines for older adults written in English. We identified 18 national and international guidelines; ten of the 18 guidelines included sedentary behaviour recommendations while all 18 included physical activity recommendations for older adults. The ten sedentary behaviour guidelines were developed using cohort studies, knowledge users' opinions, systematic reviews, or other guidelines while the physical activity guidelines were developed using randomized controlled trials, systematic reviews, meta-analysis, and overview of reviews. The definition of sedentary behaviour and the recommendations were inconsistent between the guidelines and were based on very low to low quality and certainty of evidence. All guidelines provided consistent recommendations for aerobic and resistance training; the recommendations were developed using moderate to high quality and certainty of evidence. Only eight physical activity guidelines provided recommendations for balance training and six on flexibility training; the balance training recommendations were consistent between guidelines and based on moderate quality evidence. Further work is needed to develop evidenced-based sedentary behaviour recommendations and flexibility training recommendations for older adults.
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Affiliation(s)
- Amy Huang
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ellen Wang
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Stephanie Sanger
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Isabel B. Rodrigues
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Knowledge Translation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
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13
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Morin SN, Feldman S, Funnell L, Giangregorio L, Kim S, McDonald-Blumer H, Santesso N, Ridout R, Ward W, Ashe MC, Bardai Z, Bartley J, Binkley N, Burrell S, Butt D, Cadarette SM, Cheung AM, Chilibeck P, Dunn S, Falk J, Frame H, Gittings W, Hayes K, Holmes C, Ioannidis G, Jaglal SB, Josse R, Khan AA, McIntyre V, Nash L, Negm A, Papaioannou A, Ponzano M, Rodrigues IB, Thabane L, Thomas CA, Tile L, Wark JD. Actualisation 2023 des lignes directrices de pratique clinique pour la prise en charge de l’ostéoporose et la prévention des fractures au Canada. CMAJ 2023; 195:E1585-E1603. [PMID: 38011931 PMCID: PMC10681677 DOI: 10.1503/cmaj.221647-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Contexte: Au Canada, plus de 2 millions de personnes vivent avec l’ostéoporose, une maladie qui accroît le risque de fracture, ce qui fait augmenter la morbidité et la mortalité, et entraîne une perte de qualité de vie et d’autonomie. La présente actualisation des lignes directrices vise à accompagner les professionnelles et professionnels de la santé au Canada dans la prestation de soins visant à optimiser la santé osseuse et à prévenir les fractures chez les femmes ménopausées et les hommes de 50 ans et plus. Méthodes: Le présent document fournit une actualisation des lignes directrices de pratique clinique de 2010 d’Ostéoporose Canada sur le diagnostic et la prise en charge de l’ostéoporose au pays. Nous avons utilisé l’approche GRADE (Grading of Recommendations Assessment, Development and Evaluation) et effectué l’assurance de la qualité conformément aux normes de qualité et de présentation des rapports de la grille AGREE II (Appraisal of Guidelines for Research & Evaluation). Les médecins de premier recours et les patientes et patients partenaires ont été représentés à tous les niveaux des comités et des groupes ayant participé à l’élaboration des lignes directrices, et ont participé à toutes les étapes du processus pour garantir la pertinence des informations pour les futurs utilisateurs et utilisatrices. Le processus de gestion des intérêts concurrents a été entamé avant l’élaboration des lignes directrices et s’est poursuivi sur toute sa durée, selon les principes du Réseau international en matière de lignes directrices. Dans la formulation des recommandations, nous avons tenu compte des avantages et des risques, des valeurs et préférences de la patientèle, des ressources, de l’équité, de l’acceptabilité et de la faisabilité; la force de chacune des recommandations a été déterminée en fonction du cadre GRADE. Recommandations: Les 25 recommandations et les 10 énoncés de bonne pratique sont répartis en sections : activité physique, alimentation, évaluation du risque de fracture, instauration du traitement, interventions pharmacologiques, durée et séquence du traitement, et monitorage. La prise en charge de l’ostéoporose devrait se fonder sur le risque de fracture, établi au moyen d’une évaluation clinique réalisée avec un outil d’évaluation du risque de fracture validé. L’activité physique, l’alimentation et la pharmacothérapie sont des éléments essentiels à la stratégie de prévention des fractures, qui devraient être personnalisés. Interprétation: Les présentes lignes directrices ont pour but d’outiller les professionnelles et professionnels de la santé et la patientèle afin qu’ensemble ils puissent parler de l’importance de la santé osseuse et du risque de fracture tout au long de la vie adulte avancée. La détection et la prise en charge efficace de la fragilité osseuse peuvent contribuer à réduire les fractures et à préserver la mobilité, l’autonomie et la qualité de vie.
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Affiliation(s)
- Suzanne N Morin
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Sidney Feldman
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Larry Funnell
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Lora Giangregorio
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Sandra Kim
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Heather McDonald-Blumer
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Nancy Santesso
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Rowena Ridout
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Wendy Ward
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Maureen C Ashe
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Zahra Bardai
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Joan Bartley
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Neil Binkley
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Steven Burrell
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Debra Butt
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Suzanne M Cadarette
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Angela M Cheung
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Phil Chilibeck
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Sheila Dunn
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Jamie Falk
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Heather Frame
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - William Gittings
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Kaleen Hayes
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Carol Holmes
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - George Ioannidis
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Susan B Jaglal
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Robert Josse
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Aliya A Khan
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Virginia McIntyre
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Lynn Nash
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Ahmed Negm
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Alexandra Papaioannou
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Matteo Ponzano
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Isabel B Rodrigues
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Lehana Thabane
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Christine A Thomas
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Lianne Tile
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - John D Wark
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
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14
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Fleet JL, McIntyre A, Janzen S, Saikaley M, Qaqish M, Cianfarani R, Papaioannou A. A systematic review examining the effect of vitamin D supplementation on functional outcomes post-stroke. Clin Rehabil 2023; 37:1451-1466. [PMID: 37166229 PMCID: PMC10492437 DOI: 10.1177/02692155231174599] [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: 09/17/2022] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The objective of this systematic review was to explore the effect of vitamin D supplementation on functional outcomes (motor function, mobility, activities of daily living and stroke impairment) among individuals post-stroke (PROSPERO CRD42022296462). DATA SOURCES MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for all articles published up to March 5, 2023. METHODS Only interventional studies assessing vitamin D supplementation compared to placebo or usual care in adult stroke patients were selected. After duplicate removal, 2912 studies were screened by two independent reviewers. A total of 43 studies underwent full text review; 10 studies met inclusion criteria (8 randomized controlled trials and 2 non-randomized studies of intervention). Data were extracted by two independent reviewers using Covidence software. Motor function (Brunnstrom Recovery Stage, Berg Balance Score), mobility (Functional Ambulation Category), activities of daily living (Barthel Index, Functional Independence Measure) and stroke impairment (modified Rankin Scale, National Institutes for Health Stroke Severity, Scandinavian Stroke Severity) were the outcome measures of interest reported in the included studies. RESULTS In total, 691 patients were studied for which 11 of 13 outcome measures showed improvement with vitamin D supplementation. CONCLUSIONS The majority of studies showed a statistical improvement in motor function, mobility, and stroke impairment with vitamin D supplementation; however, the evidence did not support an improvement in activities of daily living with treatment. Despite this, there may not be clinical significance. Strong, methodologically sound, randomized controlled trials are required to verify these findings.
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Affiliation(s)
- Jamie L Fleet
- Department of Physical Medicine and Rehabilitation, Western University, London, Canada
- St. Joseph's Health Care London, London, Canada
- Lawson Health Research Institute, London, Canada
| | - Amanda McIntyre
- Lawson Health Research Institute, London, Canada
- Arthur Labatt School of Nursing, Western University, London, Canada
| | | | | | - Michael Qaqish
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Robert Cianfarani
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Alexandra Papaioannou
- Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Medicine, Division of Geriatrics, McMaster University, Hamilton, Canada
- Department of Medicine, Division of Rheumatology, McMaster University, Hamilton, Canada
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15
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Lee A, McArthur C, Ioannidis G, Mayhew A, Adachi JD, Griffith LE, Thabane L, Papaioannou A. Associations between Social Isolation Index and changes in grip strength, gait speed, bone mineral density (BMD), and self-reported incident fractures among older adults: Results from the Canadian Longitudinal Study on Aging (CLSA). PLoS One 2023; 18:e0292788. [PMID: 37851659 PMCID: PMC10584182 DOI: 10.1371/journal.pone.0292788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The aim is to investigate whether social isolation and loneliness are associated with changes in grip strength, gait speed, BMD, and fractures. METHODS Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort participants aged 65 years and older at baseline (2012-2015) who completed the three-year follow-up interview (2015-2018) were included in this analysis (n = 11,344). Social isolation and loneliness were measured using the CLSA social isolation index (CLSA-SII, range 0-10). We calculated absolute and percent change in grip strength (kg) and gait speed (m/s) and annualized absolute (g/cm2) and percent change in femoral neck and total hip BMD during the three-year follow-up. Self-reported incident fractures of all skeletal sites in the previous 12 months were measured at three-year follow-up. Multivariable analyses were conducted. Odd ratio (OR) and 95% confidence interval (CI) are reported. RESULTS The mean age (standard deviation [SD]) was 72.9 (5.6) years and 49.9% were female. The mean (SD) of CLSA-SII at baseline was 3.5 (1.4). Mean absolute and percentage change (SD) in grip strength (kg) and gait speed (m/s) were -1.33 (4.60), -3.02% (16.65), and -0.05 (0.17), -3.06% (19.28) during the three-year follow-up, respectively. Mean annualized absolute (g/cm2) and percentage change (SD) in femoral neck and total hip BMD were -0.004 (0.010), -0.47% (1.43) and -0.005 (0.009), -0.57% (1.09), respectively. 345 (3.1%) participants had incident fractures. As CLSA-SII increased (per one unit change), participants had 1.13 (adjusted OR 1.13, 95% CI 1.01-1.27) times greater odds for incident fractures. The interaction term between the CLSA-SII and centre for epidemiology studies depression 9 scale (CES-D 9) for self-reported incident fractures was shown (interaction OR 1.02, 95% CI 1.00-1.04). CONCLUSIONS Socially isolated and lonely older adults were more likely to have had incident fractures, but social isolation was not associated with the three-year changes in grip strength, gait speed, or BMD.
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Affiliation(s)
- Ahreum Lee
- Geras Centre for Aging Research, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Master University, Hamilton, Ontario, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - George Ioannidis
- Geras Centre for Aging Research, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Master University, Hamilton, Ontario, Canada
| | - Alexandra Mayhew
- Department of Health Research Methods, Evidence and Impact, Master University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
| | - Jonathan D. Adachi
- Department of Health Research Methods, Evidence and Impact, Master University, Hamilton, Ontario, Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence and Impact, Master University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, Master University, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- Geras Centre for Aging Research, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Master University, Hamilton, Ontario, Canada
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16
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Ntalouka MP, Karakosta A, Aretha D, Papaioannou A, Nyktari V, Chloropoulou P, Koraki E, Pistioli E, Matsota PK, Tzimas P, Arnaoutoglou EM. GReek Anaesthesiologists's Burnout EPidemic within the COVID-19 pandemic (GRABEP study); a multicenter study on burn out prevalence among Greek anesthesiologists and association with personality traits. Psychiatriki 2023; 34:193-203. [PMID: 37212802 DOI: 10.22365/jpsych.2023.010] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
COVID-19 pandemic resulted in an unprecedented crisis with extreme distress for the frontline physicians and increased risk of developing burnout. Burnout has a negative impact on patients and physicians, posing a substantial risk in patient safety, quality of care and physicians' overall wellbeing. We evaluated burnout prevalence and possible predisposing factors among anaesthesiologists in the COVID-19 referral university/tertiary hospitals in Greece. In this multicenter, cross-sectional study we have included anaesthesiologists, involved in the care of patients with COVID-19, during the fourth peak of the pandemic (11/2021), in the 7 referral hospitals in Greece. The validated Maslach Burnout Inventory (MBI) and Eysenck Personality Questionnaire (EPQ) were used. The response rate was 98% (116/118). More than half of the respondents were females (67.83%, median age 46 years). The overall Cronbach's alpha for MBI and EPQ was 0.894 and 0.877, respectively. The majority (67.24%) of anaesthesiologists were assessed as "high risk for burnout" and 21.55% were diagnosed with burnout syndrome. Almost half participants experienced high levels of all three dimensions of burnout; high emotional exhaustion (46.09%), high depersonalization (49.57%) and high levels of low personal accomplishment (43.49%). Multivariate logistic analysis revealed that neuroticism was an independent factor predicting "high risk for burnout" as well as burnout syndrome, whereas the "Lie scale" of EPQ exhibited a protective effect against burnout. Burnout prevalence in Greek anaesthesiologists working in COVID-19 referral hospitals during the fourth peak of the pandemic was high. Neuroticism was predictive of both "high risk for burnout" and "burnout syndrome".
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Affiliation(s)
- Maria P Ntalouka
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, Larissa University Hospital, Larissa, Greece
| | - Agathi Karakosta
- Department of Anaesthesiology and Postoperative Intensive Care, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Diamanto Aretha
- University Hospital of Patras, Department of Anaesthesiology & Intensive Care, Rion, Patras, Greece
| | - Alexandra Papaioannou
- Faculty of Medicine, University of Crete, Anaesthesia Department of University Hospital of Heraklion, Crete, Greece
| | - Vasileia Nyktari
- Faculty of Medicine, University of Crete, Anaesthesia Department of University Hospital of Heraklion, Crete, Greece
| | - Pelagia Chloropoulou
- School of Medicine, Democritus University of Thrace, Department of Anaesthesiology, Alexandroupolis, Greece
| | - Eleni Koraki
- George Papanikolaou Hospital, Department of Anaesthesiology, Thessaloniki, Greece
| | - Efstathia Pistioli
- 2nd Department of Anaesthesiology, School of Medicine, National and Kapodistrian, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Paraskevi K Matsota
- 2nd Department of Anaesthesiology, School of Medicine, National and Kapodistrian, University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Petros Tzimas
- Department of Anaesthesiology and Postoperative Intensive Care, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Eleni M Arnaoutoglou
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, Larissa University Hospital, Larissa, Greece
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17
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Morin SN, Feldman S, Funnell L, Giangregorio L, Kim S, McDonald-Blumer H, Santesso N, Ridout R, Ward W, Ashe MC, Bardai Z, Bartley J, Binkley N, Burrell S, Butt D, Cadarette SM, Cheung AM, Chilibeck P, Dunn S, Falk J, Frame H, Gittings W, Hayes K, Holmes C, Ioannidis G, Jaglal SB, Josse R, Khan AA, McIntyre V, Nash L, Negm A, Papaioannou A, Ponzano M, Rodrigues IB, Thabane L, Thomas CA, Tile L, Wark JD. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ 2023; 195:E1333-E1348. [PMID: 37816527 PMCID: PMC10610956 DOI: 10.1503/cmaj.221647] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND In Canada, more than 2 million people live with osteoporosis, a disease that increases the risk for fractures, which result in excess mortality and morbidity, decreased quality of life and loss of autonomy. This guideline update is intended to assist Canadian health care professionals in the delivery of care to optimize skeletal health and prevent fractures in postmenopausal females and in males aged 50 years and older. METHODS This guideline is an update of the 2010 Osteoporosis Canada clinical practice guideline on the diagnosis and management of osteoporosis in Canada. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and quality assurance as per Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards. Primary care physicians and patient partners were represented at all levels of the guideline committees and groups, and participated throughout the entire process to ensure relevance to target users. The process for managing competing interests was developed before and continued throughout the guideline development, informed by the Guideline International Network principles. We considered benefits and harms, patient values and preferences, resources, equity, acceptability and feasibility when developing recommendations; the strength of each recommendation was assigned according to the GRADE framework. RECOMMENDATIONS The 25 recommendations and 10 good practice statements are grouped under the sections of exercise, nutrition, fracture risk assessment and treatment initiation, pharmacologic interventions, duration and sequence of therapy, and monitoring. The management of osteoporosis should be guided by the patient's risk of fracture, based on clinical assessment and using a validated fracture risk assessment tool. Exercise, nutrition and pharmacotherapy are key elements of the management strategy for fracture prevention and should be individualized. INTERPRETATION The aim of this guideline is to empower health care professionals and patients to have meaningful discussions on the importance of skeletal health and fracture risk throughout older adulthood. Identification and appropriate management of skeletal fragility can reduce fractures, and preserve mobility, autonomy and quality of life.
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Affiliation(s)
- Suzanne N Morin
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI.
| | - Sidney Feldman
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Larry Funnell
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Lora Giangregorio
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Sandra Kim
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Heather McDonald-Blumer
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Nancy Santesso
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Rowena Ridout
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Wendy Ward
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Maureen C Ashe
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Zahra Bardai
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Joan Bartley
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Neil Binkley
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Steven Burrell
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Debra Butt
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Suzanne M Cadarette
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Angela M Cheung
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Phil Chilibeck
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Sheila Dunn
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Jamie Falk
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Heather Frame
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - William Gittings
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Kaleen Hayes
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Carol Holmes
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - George Ioannidis
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Susan B Jaglal
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Robert Josse
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Aliya A Khan
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Virginia McIntyre
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Lynn Nash
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Ahmed Negm
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Alexandra Papaioannou
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Matteo Ponzano
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Isabel B Rodrigues
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Lehana Thabane
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Christine A Thomas
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Lianne Tile
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - John D Wark
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller HH, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: health-care professional perspectives and experiences. Disabil Rehabil 2023:1-8. [PMID: 37493172 DOI: 10.1080/09638288.2023.2239146] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs). DESIGN AND SETTING We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a post-positivism perspective. RESULTS Two themes were identified: acuity matters when selecting appropriate interventions; and roadblocks to receiving non-pharmacological interventions. We found that treatment options were dependent on the acuity/stability of fracture and were individualized accordingly. Pain medication was perceived as important, but non-pharmacological strategies were also considered helpful in supporting recovery. Participants discussed barriers related to the timely identification of fracture, referral to physiotherapy, and lack of knowledge among HCPs on how to manage osteoporosis and vertebral fractures. HCPs reported positive use of virtual-care, but had concerns related to patient access, cost, and comprehensive assessments. CONCLUSION HCPs used and perceived non-pharmacological interventions as helpful and selected specific treatments based on the recency of fracture and patient symptoms. HCPs' also believed that virtual-care that included an educational component, an assessment by a physiotherapist, and an exercise group was a feasible alternative, but concerns exist and may require further evaluation.Implications for RehabilitationNon-pharmacological strategies in combination with pain medication may be a more effective strategy to support recovery than pain medication alone but should be informed by fracture acuity and patient symptoms.To improve access to physiotherapy and other non-pharmacological treatment options during the acute or chronic management of vertebral fractures, it may be worthwhile to explore the effectiveness and feasibility of virtual-care.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, North York, Canada
| | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
| | - Judi Laprade
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Suzanne N Morin
- McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | | | - Zach Weston
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Waterloo, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
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19
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Okpara C, Adachi J, Papaioannou A, Ioannidis G, Thabane L. Exploring participant attrition in a longitudinal follow-up of older adults: the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort. BMJ Open 2023; 13:e066594. [PMID: 37491101 PMCID: PMC10373724 DOI: 10.1136/bmjopen-2022-066594] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE We explored the magnitude of attrition, its pattern and risk factors for different forms of attrition in the cohort from the Global Longitudinal Study of Osteoporosis in Women. DESIGN Prospective cohort study. SETTING Participants were recruited from physician practices in Hamilton, Ontario. PARTICIPANTS Postmenopausal women aged ≥55 years who had consulted their primary care physician within the last 2 years. OUTCOME MEASURES Time to all-cause, non-death, death, preventable and non-preventable attrition. RESULTS All 3985 women enrolled in the study were included in the analyses. The mean age of the cohort was 69.4 (SD: 8.9) years. At the end of the follow-up, 30.2% (1206/3985) of the study participants had either died or were lost to follow-up. The pattern of attrition was monotone with most participants failing to return after a missed survey. The different types of attrition examined shared common risk factors including age, smoking and being frail but differed on factors such as educational level, race, hospitalisation, quality of life and being prefrail. CONCLUSION Attrition in this ageing cohort was selective to some participant characteristics. Minimising potential bias associated with such non-random attrition would require targeted measures to achieve maximum possible follow-rates among the high-risk groups identified and dealing with specific reasons for attrition in the study design and analysis.
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Affiliation(s)
- Chinenye Okpara
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - George Ioannidis
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- The Research Institute of St Joseph's Healthcare, Hamilton, Ontario, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Okpara C, Ioannidis G, Thabane L, Adachi JD, Rabinovich A, Hewston P, Lee J, McArthur C, Kennedy C, Woo T, Boulos P, Bobba R, Wang M, Thrall S, Mangin D, Marr S, Armstrong D, Patterson C, Bray S, de Wit K, Maharaj S, Misiaszek B, Sookhoo JB, Thompson K, Papaioannou A. The Geras virtual frailty rehabilitation program to build resilience in older adults with frailty during COVID-19: a randomized feasibility trial. Pilot Feasibility Stud 2023; 9:124. [PMID: 37461117 PMCID: PMC10351184 DOI: 10.1186/s40814-023-01346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic. METHODS Participants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5 × STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component. RESULTS The program enrolled 33% (n = 72) of referrals to the study (n = 220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant's adherence levels included virtual exercise sessions 81% (95% CI: 75-88%), home-based exercise 50% (95% CI: 38-62%), protein supplements consumption 68% (95% CI: 55-80%), and medication optimization 38% (95% CI: 21-59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms. CONCLUSION The GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant's intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change. TRIAL REGISTRATION ClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366.
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Affiliation(s)
- Chinenye Okpara
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - George Ioannidis
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
- The Research Institute of St Joseph’s Healthcare, Hamilton, ON Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | | | | | - Patricia Hewston
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Justin Lee
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Caitlin McArthur
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS Canada
| | - Courtney Kennedy
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Tricia Woo
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Pauline Boulos
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Raja Bobba
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Mimi Wang
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Samuel Thrall
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Derelie Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Sharon Marr
- Department of Medicine, University of Toronto, Hamilton, ON Canada
| | - David Armstrong
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Steven Bray
- Department of Kinesiology, McMaster University, Hamilton, ON Canada
| | - Kerstin de Wit
- Department of Emergency Medicine, Queen’s University, Kingston, ON Canada
| | - Shyam Maharaj
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Brian Misiaszek
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Karen Thompson
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
| | - Alexandra Papaioannou
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
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21
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Farooqi M, Papaioannou A, Bangdiwala S, Rangarajan S, Leong D. How regional versus global thresholds for physical activity and grip strength influence physical frailty prevalence and mortality estimates in PURE: a prospective multinational cohort study of community-dwelling adults. BMJ Open 2023; 13:e066848. [PMID: 37270191 DOI: 10.1136/bmjopen-2022-066848] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVES Handgrip strength and physical activity are commonly used to evaluate physical frailty; however, their distribution varies worldwide. The thresholds that identify frail individuals have been established in high-income countries but not in low-income and middle-income countries. We created two adaptations of physical frailty to study how global versus regional thresholds for handgrip strength and physical activity affect frailty prevalence and its association with mortality in a multinational population. DESIGN, SETTING AND PARTICIPANTS Our sample included 137 499 adults aged 35-70 years (median age: 61 years, 60% women) from Population Urban Rural Epidemiology Studies community-dwelling prospective cohort across 25 countries, covering the following geographical regions: China, South Asia, Southeast Asia, Africa, Russia and Central Asia, North America/Europe, Middle East and South America. PRIMARY AND SECONDARY OUTCOME MEASURES We measured and compared frailty prevalence and time to all-cause mortality for two adaptations of frailty. RESULTS Overall frailty prevalence was 5.6% using global frailty and 5.8% using regional frailty. Global frailty prevalence ranged from 2.4% (North America/Europe) to 20.1% (Africa), while regional frailty ranged from 4.1% (Russia/Central Asia) to 8.8% (Middle East). The HRs for all-cause mortality (median follow-up of 9 years) were 2.42 (95% CI: 2.25 to 2.60) and 1.91 (95% CI: 1.77 to 2.06) using global frailty and regional frailty, respectively, (adjusted for age, sex, education, smoking status, alcohol consumption and morbidity count). Receiver operating characteristic curves for all-cause mortality were generated for both frailty adaptations. Global frailty yielded an area under the curve of 0.600 (95% CI: 0.594 to 0.606), compared with 0.5933 (95% CI: 0.587 to 5.99) for regional frailty (p=0.0007). CONCLUSIONS Global frailty leads to higher regional variations in estimated frailty prevalence and stronger associations with mortality, as compared with regional frailty. However, both frailty adaptations in isolation are limited in their ability to discriminate between those who will die during 9 years' follow-up from those who do not.
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Affiliation(s)
- Maheen Farooqi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shrikant Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Darryl Leong
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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22
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: Patient perspectives and experiences. Clin Rehabil 2023; 37:713-724. [PMID: 36510450 DOI: 10.1177/02692155221144370] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/15/2022]
Abstract
OBJECTIVE To understand perceptions on rehabilitation after vertebral fracture, non-pharmacological strategies, and virtual care from the perspective of individuals living with vertebral fractures. DESIGN AND SETTING We conducted semi-structured interviews online and performed a thematic and content analysis from a post-positivism perspective. PARTICIPANTS Ten individuals living with osteoporotic vertebral fractures (9F, 1 M, aged 71 ± 8 years). RESULTS Five themes emerged: pain is the defining limitation of vertebral fracture recovery; delayed diagnosis impacts recovery trajectory; living with fear; being dissatisfied with fracture management; and "getting back into the game of life" using non-pharmacological strategies. CONCLUSION Participants reported back pain and an inability to perform activities of daily living, affecting psychological and social well-being. Physiotherapy, education, and exercise were considered helpful and important to patients; however, issues with fracture identification and referral limited the use of these options. Participants believed that virtual rehabilitation was a feasible and effective alternative to in-person care, but perceived experience with technology, cost, and individualization of programs as barriers.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | | | | | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, ON, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
| | | | - Suzanne N Morin
- 5620McGill University, Montréal, QC, Canada
- Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | | | - Zach Weston
- 8431Wilfrid Laurier University, Waterloo, ON, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
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23
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio LM. Publisher Correction: International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:1139. [PMID: 37036475 DOI: 10.1007/s00198-023-06717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada.
- International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - N Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
| | - S Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - L Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - J C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J Laprade
- Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada
| | - S N Morin
- Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada
| | - Z Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada
- Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada
| | - T H Wideman
- School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Khan AA, AbuAlrob H, Al-Alwani H, Ali DS, Almonaei K, Alsarraf F, Bogoch E, Dandurand K, Gazendam A, Juby AG, Mansoor W, Marr S, Morgante E, Myslik F, Schemitsch E, Schneider P, Thain J, Papaioannou A, Zalzal P. Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators. Osteoporos Int 2023; 34:1011-1035. [PMID: 37014390 DOI: 10.1007/s00198-022-06640-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/12/2022] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. OBJECTIVE A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. METHODS A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. CONCLUSION Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided.
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Affiliation(s)
- Aliya A Khan
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada.
| | - Hajar AbuAlrob
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Hatim Al-Alwani
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Dalal S Ali
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Khulod Almonaei
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Farah Alsarraf
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Earl Bogoch
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Karel Dandurand
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Angela G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wasim Mansoor
- Trillium Health Partners, University of Toronto, Toronto, ON, Canada
| | - Sharon Marr
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Emmett Morgante
- Bone Research and Education Center Patient Support Program and Education Coordinator, Oakville, ON, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Emil Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Prism Schneider
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Jenny Thain
- Department of Medicine, Division of Geriatric Medicine, Western University, London, ON, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul Zalzal
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Coletta G, Jakubowski J, Phillips SM, Atkinson SA, Papaioannou A, Pritchard J. Prevalence of sarcopenia indicators and sub-optimal protein intake among elective total joint replacement patients. Appl Physiol Nutr Metab 2023. [PMID: 36898129 DOI: 10.1139/apnm-2022-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Sarcopenia is associated with falls, and can complicate recovery following total joint replacement (TJR) surgery. We examined: 1) the prevalence of sarcopenia indicators and lower-than-recommended protein intake among TJR patients and non-TJR community participants and 2) the relationships between dietary protein intake and sarcopenia indicators. We recruited adults ≥65 years of age who were undergoing TJR, and adults from the community not undergoing TJR (controls). We assessed grip strength and appendicular lean soft-tissue mass (ALSTMBMI) using DXA, and applied the original Foundation for the National Institutes of Health Sarcopenia Project cut-points for sarcopenia indicators (grip strength: <26kg for men and <16kg for women; ALSTM: <0.789m2 for men and <0.512m2 for women) and less conservative cut-points (grip strength: <31.83kg for men and <19.99kg for women; ALSTM: <0.725m2 for men and <0.591m2 for women). Total daily and per-meal protein intakes were derived from five-day diet records. Sixty-seven participants (30 TJR, 37 controls) were enrolled. Using less conservative cut-points for sarcopenia, more control participants were weak compared to TJR participants (46% vs. 23%, p=0.055), and more TJR participants had low ALSTMBMI (40% vs. 13%, p=0.013). Approximately 70% of controls and 76% of TJR participants consumed <1.2g protein/kg/day (p=0.559). Total daily dietary protein intake was positively associated with grip strength (r=0.44, p=0.001) and ALSTMBMI (r=0.29, p=0.03). Using less conservative cut-points, low ALSTMBMI, but not weakness, was more common in TJR patients. Both groups may benefit from a dietary intervention to increase protein intake, which may improve surgical outcomes in TJR patients.
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Affiliation(s)
- Giulia Coletta
- McMaster University, 3710, Kinesiology, Hamilton, Ontario, Canada;
| | | | | | - Stephanie Ann Atkinson
- McMaster University Faculty of Health Sciences, 62703, Pediatrics , Hamilton, Ontario, Canada;
| | | | - Janet Pritchard
- McMaster University, 3710, School of Interdisciplinary Science, Hamilton, Ontario, Canada;
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Kartsonaki MG, Georgopoulos D, Kondili E, Nieri AS, Alevizaki A, Nyktari V, Papaioannou A. Prevalence and factors associated with compassion fatigue, compassion satisfaction, burnout in health professionals. Nurs Crit Care 2023; 28:225-235. [PMID: 35315181 DOI: 10.1111/nicc.12769] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 12/19/2021] [Accepted: 03/08/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Constant exposure of health professionals to the pain and suffering of patients can adversely affect their emotional wellbeing. AIM The study aimed to investigate the prevalence and the factors affecting the levels of secondary traumatic stress/compassion fatigue (STS/CF), burnout (BO) and compassion satisfaction (CS) of health professionals working in adult and paediatric Intensive Care Units (ICU) as well as in departments treating patients with serious illness in five hospitals in Crete. STUDY DESIGN A descriptive cross-sectional survey with the use of the Professional Quality of Life Scale (ProQOL-CSF-R-IV) questionnaire. METHODS We enrolled medical, nursing and support staff working in the adult and paediatric ICU, emergency, oncology, haematology and neurosurgical departments, haemodialysis unit and operating theatre. RESULTS 598 health professionals completed the questionnaire (response rate 73.2%). Significantly increased levels of STS/CF were observed in non - ICU as compared to ICU staff (p = .009) females compared to males (p < .001), those who have previously experienced a traumatic event (p < .004), nurses and support staff compared to doctors (p = .007 and p = .028 respectively), and people not working in a department by choice (p < .001). CS was higher for older professionals, personnel subjected to stress reduction techniques (p < .019) and professionals working with children or mixed adults and children population (p = .009). Rolling schedule and bad working conditions negatively affected CS (p = .02, p = .001). Increased BO levels were associated with younger age (p = .029) and showed a positive correlation with STS/CF (r = .356, p < .001). CONCLUSIONS STS/CF is common in health professionals regardless of their profession, working department or hospital level. Non-ICU staff displayed higher STS/CF levels. Working in a department by choice ameliorates CS, BO and STS/CF. RELEVANCE TO CLINICAL PRACTICE Health professionals need to be informed about the risks of projecting patients' suffering on themselves. Hospital managers and department heads are responsible to provide appropriate support.
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Affiliation(s)
- Maria George Kartsonaki
- Department of Intensive Care Medicine, University Hospital of Heraklion, Heraklion, Greece.,School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitris Georgopoulos
- Department of Intensive Care Medicine, University Hospital of Heraklion, Heraklion, Greece.,School of Medicine, University of Crete, Heraklion, Greece
| | - Eumorfia Kondili
- Department of Intensive Care Medicine, University Hospital of Heraklion, Heraklion, Greece.,School of Medicine, University of Crete, Heraklion, Greece
| | | | - Afroditi Alevizaki
- Department of Intensive Care Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Vasileia Nyktari
- Department of Anesthesiology, University Hospital of Crete, Heraklion, Heraklion, Greece
| | - Alexandra Papaioannou
- Department of Anesthesiology, University Hospital of Crete, Heraklion, Heraklion, Greece
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio LM. International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:1065-1074. [PMID: 36799981 DOI: 10.1007/s00198-023-06688-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
UNLABELLED We identified a knowledge gap in the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. MAIN RESULTS This international consensus process established multidisciplinary biopsychosocial recommendations on pain, nutrition, safe movement, and exercise for individuals with acute and chronic vertebral fractures. SIGNIFICANCE These recommendations will guide clinical practice and inform interventions for future research. PURPOSE To establish international consensus on recommendations for the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. METHODS We adopted a five-step modified Delphi consensus process: (1) literature search and content analysis, (2) creation of the survey, (3) selection of the expert panel, (4) first round of the rating process, and (5) second round of the rating process. The first round included 49 statements and eight open-ended questions; the second round included 30 statements. Panelists were asked to rate their agreement with each of the statements using a 9-point scale, with the option to provide further comments. Consensus for each statement was determined by counting the number of panelists whose rating was outside the 3-point region containing the median. RESULTS We invited 76 people with degree in medicine, physiotherapy, kinesiology, and experience in the management of osteoporotic vertebral; 31 (41%) and 27 (36%) experts agreed to participate to the first and the second round, respectively. The mean percentage agreement after the first and second rounds was 76.6% ± 16.0% and 90.7% ± 6.5%, respectively. We established consensus on recommendations on pain, early satiety, weight loss, bracing, safe movement, and exercise for individuals with acute and chronic vertebral fractures. CONCLUSION Our international consensus provides multidisciplinary biopsychosocial recommendations to guide the management of osteoporotic vertebral fractures and inform interventions for future research.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada.
- International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - N Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
| | - S Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - L Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - J C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J Laprade
- Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada
| | - S N Morin
- Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada
| | - Z Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada
- Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada
| | - T H Wideman
- School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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28
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Hassanabadi N, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D, Morin SN. Variation in bone mineral density and fractures over 20 years among Canadians: a comparison of the Canadian Multicenter Osteoporosis Study and the Canadian Longitudinal Study on Aging. Osteoporos Int 2023; 34:357-367. [PMID: 36449036 PMCID: PMC9852141 DOI: 10.1007/s00198-022-06623-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
UNLABELLED International variations in osteoporosis and fracture rates have been reported, with temporal trends differing between populations. We observed higher BMD and lower fracture prevalence in a recently recruited cohort compared to that of a cohort recruited 20 years ago, even after adjusting for multiple covariates. PURPOSE We explored sex-specific differences in femoral neck bone mineral density (FN-BMD) and in prevalent major osteoporotic fractures (MOF) using two Canadian cohorts recruited 20 years apart. METHODS We included men and women aged 50-85 years from the Canadian Multicentre Osteoporosis Study (CaMos, N = 6,479; 1995-1997) and the Canadian Longitudinal Study on Aging (CLSA, N = 19,534; 2012-2015). We created regression models to compare FN-BMD and fracture risk between cohorts, adjusting for important covariates. Among participants with prevalent MOF, we compared anti-osteoporosis medication use. RESULTS Mean (SD) age in CaMos (65.4 years [8.6]) was higher than in CLSA (63.8 years [9.1]). CaMos participants had lower mean body mass index and higher prevalence of smoking (p < 0.001). Adjusted linear regression models (estimates [95%CI]) demonstrated lower FN-BMD in CaMos women (- 0.017 g/cm2 [- 0.021; - 0.014]) and men (- 0.006 g/cm2 [- 0.011; 0.000]), while adjusted odds ratios (95%CI) for prevalent MOF were higher in CaMos women (1.99 [1.71; 2.30]) and men (2.33 [1.82; 3.00]) compared to CLSA. In women with prevalent MOF, menopausal hormone therapy use was similar in both cohorts (43.3% vs 37.9%, p = 0.076), but supplements (32.0% vs 48.3%, p < 0.001) and bisphosphonate use (5.8% vs 17.3%, p < 0.001) were lower in CaMos. The proportion of men with MOF who received bisphosphonates was below 10% in both cohorts. CONCLUSION Higher BMD and lower fracture prevalence were noted in the more recently recruited CLSA cohort compared to CaMos, even after adjusting for multiple covariates. We noted an increase in bisphosphonate use in the recent cohort, but it remained very low in men.
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Affiliation(s)
- Nazila Hassanabadi
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - Claudie Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | | | - Angela M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - David Goltzman
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
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Hewston P, Bray SR, Kennedy CC, Ioannidis G, Bosch J, Marr S, Hanman A, Grenier A, Hladysh G, Papaioannou A. Does GERAS DANCE improve gait in older adults? Aging and Health Research 2023. [DOI: 10.1016/j.ahr.2023.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Leung T, Ayers S, Pluye P, Grad R, Sztramko R, Marr S, Papaioannou A, Clark S, Gerantonis P, Levinson AJ. Impact and Perceived Value of iGeriCare e-Learning Among Dementia Care Partners and Others: Pilot Evaluation Using the IAM4all Questionnaire. JMIR Aging 2022; 5:e40357. [PMID: 36150051 PMCID: PMC9816950 DOI: 10.2196/40357] [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: 07/12/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Care partners of people living with dementia may benefit from web-based education. We developed iGeriCare, an award-winning internet-based platform with 12 multimedia e-learning lessons about dementia. OBJECTIVE Our objective was to evaluate users' perceptions of impact. METHODS From March 17, 2021 to May 16, 2022, data were collected upon lesson completion. We used the content-validated Information Assessment Method for all (IAM4all) for patients and the public adapted for dementia care partners. The IAM4all questionnaire assesses outcomes of web-based consumer health information. Responses were collected using SurveyMonkey, and data were analyzed using IBM SPSS Statistics (version 28). RESULTS A total of 409 responses were collected, with 389 (95.1%) survey respondents completing the survey. Of 409 respondents, 179 (43.8%) identified as a family or friend care partner, 84 (20.5%) identified as an individual concerned they may have mild cognitive impairment or dementia, 380 (92.9%) identified the lesson as relevant or very relevant, and 403 (98.5%) understood the lesson well or very well. Over half of respondents felt they were motivated to learn more, they were taught something new, or they felt validated in what they do, while some felt reassured or felt that the lesson refreshed their memory. Of 409 respondents, 401 (98%) said they would use the information, in particular, to better understand something, discuss the information with someone else, do things differently, or do something. CONCLUSIONS Users identified iGeriCare as relevant and beneficial and said that they would use the information. To our knowledge, this is the first time the IAM4all questionnaire has been used to assess patient and caregiver feedback on internet-based dementia education resources. A randomized controlled trial to study feasibility and impact on caregiver knowledge, self-efficacy, and burden is in progress.
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Affiliation(s)
| | - Stephanie Ayers
- Division of e-Learning Innovation, McMaster University, Hamilton, ON, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Richard Sztramko
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon Marr
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Sandra Clark
- Division of e-Learning Innovation, McMaster University, Hamilton, ON, Canada
| | - Patricia Gerantonis
- Division of e-Learning Innovation, McMaster University, Hamilton, ON, Canada
| | - Anthony J Levinson
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Division of e-Learning Innovation, McMaster University, Hamilton, ON, Canada
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Morin SN, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D. Race/ethnic differences in the prevalence of osteoporosis, falls and fractures: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Osteoporos Int 2022; 33:2637-2648. [PMID: 36044061 DOI: 10.1007/s00198-022-06539-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
UNLABELLED Most of the published epidemiology on osteoporosis is derived from White populations; still many countries have increasing ethno-culturally diverse populations, leading to gaps in the development of population-specific effective fracture prevention strategies. We describe differences in prevalent fracture and bone mineral density patterns in Canadians of different racial/ethnic backgrounds. INTRODUCTION We described prevalent fracture and bone mineral density (BMD) patterns in Canadians by their racial/ethnic backgrounds. METHODS For this cross-sectional analysis, we used the Canadian Longitudinal Study on Aging baseline data (2011-2015) of 22,091 randomly selected participants of Black, East Asian, South or Southeast Asian (SSEA) and White race/ethnic backgrounds, aged 45-85 years with available information on the presence or absence of self-reported prevalent low trauma fractures and femoral neck BMD (FNBMD) measurement. Logistic and linear regression models examined associations of race/ethnic background with fracture and FNBMD, respectively. Covariates included sex, age, height, body mass index (BMI), grip strength and physical performance score. RESULTS We identified 11,166 women and 10,925 men. Self-reported race/ethnic backgrounds were: 139 Black, 205 East Asian, 269 SSEA and 21,478 White. White participants were older (mean 62.5 years) than the other groups (60.5 years) and had a higher BMI (28.0 kg/m2) than both Asian groups, but lower than the Black group. The population-weighted prevalence of falls was 10.0%, and that of low trauma fracture was 12.0% ranging from 3.3% (Black) to 12.3% (White), with Black and SSEA Canadians having lower adjusted odds ratios (aOR) of low trauma fractures than White Canadians (Black, aOR = 0.3 [95% confidence interval: 0.1-0.7]; SSEA, aOR = 0.5 [0.3-0.8]). The mean (SD) FNBMD varied between groups: Black, 0.907 g/cm2 (0.154); East Asian, 0.748 g/cm2 (0.119); SSEA, 0.769 g/cm2 (0.134); and White, 0.773 g/cm2 (0.128). Adjusted linear regressions suggested that Black and both Asian groups had higher FNBMD compared to White. CONCLUSION Our results support the importance of characterizing bone health predictors in Canadians of different race/ethnic backgrounds to tailor the development of population-specific fracture prevention strategies.
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Affiliation(s)
- Suzanne N Morin
- McGill University, Montreal, Quebec, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
| | - Claudie Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | | | | | - Elham Rahme
- McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | | | - David Goltzman
- McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
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Peppa V, Zoros E, Alexiou A, Bourmpos P, Papaioannou A, Pissakas G, Papagiannis P, Karaiskos P. DOSE VERIFICATION FOR CRANIOSPINAL IRRADIATION WITH VOLUMETRIC MODULATED ARC THERAPY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03094-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Fleet J, McIntyre A, Janzen S, Saikaley M, Qaqish M, Cianfarani R, Papaioannou A. Systematic Review Examining the Effect of Vitamin D Supplementation on Outcomes Post Stroke. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Wang E, Keller HH, Mourtzakis M, Rodrigues IB, Steinke A, Ashe MC, Thabane L, Brien S, Funnell L, Cheung A, Milligan J, Papaioannou A, Weston ZJ, Straus S, Giangregorio L. MoveStrong at Home: A feasibility study of a model for remote delivery of functional strength and balance training combined with nutrition education for older pre-frail and frail adults.
. Appl Physiol Nutr Metab 2022; 47:1172-1186. [DOI: 10.1139/apnm-2022-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Exercise and nutrition interventions are often recommended for frailty; however, effective strategies are required for real-world implementation. Our primary aim was to assess the feasibility and acceptability of telephone and virtual delivery of MoveStrong, an 8-week exercise and nutrition program with a 4-week follow-up for older pre-frail and frail adults. A priori criteria for success included: recruitment (≥25/12 weeks), retention at follow-up (≥80%), and adherence to exercise and nutrition sessions (≥70%). We recruited community-dwelling Ontario residents; ≥60 years, ≥1 chronic condition, ≥1 FRAIL scale score. Participants received mailed materials, a personalized exercise program, eleven remote one-on-one training sessions with an exercise physiologist and three online dietitian-led nutrition education sessions. We completed exploratory analyses of secondary outcomes including physical function and dietary protein intake. Semi-structured interviews supported program evaluation. In total, 30 participants were enrolled. 28 (93%) participants completed program and follow-up assessments. Adherence to exercise and nutrition sessions (CI) was 84% (77-91%) and 82% (70-93%) respectively. At program end and follow-up [mean change (CI)], significant improvements were measured in 30-second chair stand test [3.50 (1.12–5.86), 4.54 (1.94–7.13) chair stands] and dietary protein intake [12.9 (5.7–20.0), 9.2 (0.4–18.1) g]. Overall, participants were satisfied with program delivery. Trial registration number: NCT04663685.
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Affiliation(s)
- Ellen Wang
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
| | - Heather H. Keller
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
- Schlegel Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Marina Mourtzakis
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
| | | | - Alex Steinke
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
| | - Maureen C Ashe
- The University of British Columbia, Department of Family Practice, Vancouver, British Columbia, Canada
| | - Lehana Thabane
- McMaster University, Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada
- St Joseph’s Healthcare, Biostatistics Unit, Hamilton, Ontario, Canada
- University of Johannesburg, Faculty of Health Sciences, Johannesburg, South Africa
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Angela Cheung
- University Health Network, University of Toronto, Department of Medicine, Toronto, Ontario, Canada
| | - James Milligan
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- McMaster University, Department of Medicine, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- McMaster University, Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada
- McMaster University, Department of Medicine, Hamilton, Ontario, Canada
| | - Zachary J Weston
- Waterloo Wellington Local Health Integration Network, Waterloo, Ontario, Canada
- Wilfrid Laurier University, Faculty of Science, Waterloo, Ontario, Canada
| | - Sharon Straus
- University of Toronto, Department of Geriatric Medicine, Toronto, Ontario, Canada
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Lora Giangregorio
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
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Lee A, McArthur C, Ioannidis G, Adachi JD, Griffith LE, Thabane L, Giangregorio L, Morin SN, Leslie WD, Lee J, Papaioannou A. Association among cognition, frailty, and falls and self‐reported incident fractures: results from the Canadian Longitudinal Study on Aging (
CLSA
). JBMR Plus 2022; 6:e10679. [PMID: 36248272 PMCID: PMC9549720 DOI: 10.1002/jbm4.10679] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022] Open
Abstract
Cognition, frailty, and falls have been examined independently as potential correlates of fracture risk, but not simultaneously. Our objective was to explore the association between cognition, frailty, and falls and self‐reported incident fractures to determine if these factors show significant independent associations or interactions. We included participants who completed the Canadian Longitudinal Study on Aging (CLSA) 2012–2015 baseline comprehensive assessment, did not experience any self‐reported fractures in the year prior to cohort recruitment, and completed the follow‐up questionnaire at year 3 (n = 26,982). We compared all baseline cognitive measures available in the CLSA, the Rockwood Frailty Index (FI), and presence of self‐reported falls in the past 12 months in those with versus without self‐reported incident fractures in year 3 of follow‐up. We used multivariable logistic regression adjusted for covariates and examined two‐way interactions between cognition, frailty, and prior falls. CLSA specified analytic weights were applied. The mean ± standard error (SE) age of participants was 59.5 ± 0.1 years and 52.2% were female. A total of 715 participants (2.7%) self‐reported incident fractures at 3‐year follow‐up. Participants who experienced incident fractures had similar baseline cognition scores (mean ± SE; Rey Auditory Verbal Learning Test [RAVLT]: Immediate recall 6.1 ± 0.1 versus 5.9 ± 0.0; standardized difference [d] 0.124); higher FI scores (mean ± SE; FI 0.134 ± 0.005 versus 0.116 ± 0.001; d 0.193), and a greater percentage had fallen in the past 12 months (weighted n [%] 518 [7.2] versus 919 [3.5]; d 0.165). FI (each increment of 0.08) was associated with a significantly increased risk of self‐reported incident fractures in participants of all ages and those aged 65 years or older (adjusted odd ratio [OR] 1.24, 95% confidence limit [CL] 1.10–1.40; adjusted OR 1.44, 95% CL 1.11–1.52, respectively). The adjusted odds for self‐reported incident fractures in participants of all ages was also significantly associated with falls in the past 12 months prior to baseline (adjusted OR 1.83; 95% CL 1.13–2.97), but not in those aged 65 years or older. No interactions between cognition, frailty, and prior falls were found. However, considering the relatively young age of our cohort, it may be appropriate to make strong inferences in individuals older than 65 years of age. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Ahreum Lee
- GERAS Centre for Aging Research. Hamilton Ontario Canada
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Caitlin McArthur
- GERAS Centre for Aging Research. Hamilton Ontario Canada
- Dalhousie University, School of Physiotherapy Halifax Nova Scotia Canada
| | - George Ioannidis
- GERAS Centre for Aging Research. Hamilton Ontario Canada
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Jonathan D. Adachi
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Lauren E. Griffith
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
- McMaster University McMaster Institute for Research on Aging Hamilton Ontario Canada
| | - Lehana Thabane
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Lora Giangregorio
- University of Waterloo, Department of Kinesiology Waterloo Ontario Canada
- Schlegel‐UW Research Institute on Aging Waterloo Ontario Canada
| | - Suzanne N Morin
- McGill University, Department of Medicine, Montreal Quebec Canada
| | - William D. Leslie
- University of Manitoba, Department of Internal Medicine Winnipeg Manitoba Canada
| | - Justin Lee
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Alexandra Papaioannou
- GERAS Centre for Aging Research. Hamilton Ontario Canada
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
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36
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Chotiyarnwong P, McCloskey EV, Harvey NC, Lorentzon M, Prieto-Alhambra D, Abrahamsen B, Adachi JD, Borgström F, Bruyere O, Carey JJ, Clark P, Cooper C, Curtis EM, Dennison E, Diaz-Curiel M, Dimai HP, Grigorie D, Hiligsmann M, Khashayar P, Lewiecki EM, Lips P, Lorenc RS, Ortolani S, Papaioannou A, Silverman S, Sosa M, Szulc P, Ward KA, Yoshimura N, Kanis JA. Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group. Arch Osteoporos 2022; 17:87. [PMID: 35763133 PMCID: PMC9239944 DOI: 10.1007/s11657-022-01117-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. INTRODUCTION The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. METHODS The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. RESULTS AND CONCLUSION The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.
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Affiliation(s)
- P Chotiyarnwong
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - E V McCloskey
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Lorentzon
- University of Gothenburg, Gothenburg, Sweden
- Australian Catholic University, Melbourne, Australia
| | - D Prieto-Alhambra
- Oxford NIHR Biomedical Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- GREMPAL (Grup de Recerca en Malalties Prevalents de L'Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Gran Via de Les Corts Catalanes, 591 Atico, 08007, Barcelona, Spain
| | - B Abrahamsen
- Department of Clinical Research, Odense Patient Data Exploratory Network, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - J D Adachi
- Department of Medicine, Michael G DeGroote School of Medicine, St Joseph's Healthcare-McMaster University, Hamilton, ON, Canada
| | - F Borgström
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - O Bruyere
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - P Clark
- Clinical Epidemiology Unit of Hospital Infantil de México Federico Gómez-Faculty of Medicine, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Diaz-Curiel
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - D Grigorie
- Carol Davila University of Medicine, Bucharest, Romania
- Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - P Khashayar
- Center for Microsystems Technology, Imec and Ghent University, 9050, Ghent, Belgium
| | - E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - P Lips
- Department of Internal Medicine, Endocrine Section & Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R S Lorenc
- Multidisciplinary Osteoporosis Forum, SOMED, Warsaw, Poland
| | - S Ortolani
- IRCCS Istituto Auxologico, UO Endocrinologia E Malattie del Metabolismo, Milano, Italy
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- GERAS Centre for Aging Research, Hamilton, ON, Canada
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M Sosa
- Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Hospital University Insular, Las Palmas, Gran Canaria, Spain
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - K A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - J A Kanis
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK
- Australian Catholic University, Melbourne, Australia
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37
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Rodrigues IB, Wagler JB, Keller H, Thabane L, Weston ZJ, Straus SE, Papaioannou A, Mourtzakis M, Milligan J, Isaranuwatchai W, Loong D, Jain R, Funnell L, Cheung AM, Brien S, Ashe MC, Giangregorio LM. Encouraging older adults with pre-frailty and frailty to "MoveStrong": an analysis of secondary outcomes for a pilot randomized controlled trial. Health Promot Chronic Dis Prev Can 2022; 42:238-251. [PMID: 35766913 PMCID: PMC9388057 DOI: 10.24095/hpcdp.42.6.02] [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: 06/15/2023]
Abstract
BACKGROUND This 8-week pilot stepped-wedge randomized controlled trial evaluated the MoveStrong program for teaching adults who have frailty/pre-frailty about balance and functional strength training and sufficient protein intake to prevent falls and improve mobility. METHODS We recruited individuals aged 60 years and over, with a FRAIL scale score of 1 or higher and at least one chronic condition, who were not currently strength training. The program included 16 exercise physiologist-led hour-long group sessions and two dietitian-led hour-long nutrition sessions. We analyzed secondary outcomes-weight, gait speed, grip strength, physical capacity (fatigue levels), sit-to-stand functioning, dynamic balance, health-related quality of life (HRQoL), physical activity levels and protein intake-using a paired t test and a generalized estimating equation (GEE). RESULTS Of 44 participants (mean [SD] age 79 [9.82] years), 35 were pre-frail and 9 were frail. At follow-up, participants had significantly improved grip strength (1.63 kg, 95% CI: 0.62 to 2.63); sit-to-stand functioning (2 sit-to-stands, 95% CI: 1 to 3); and dynamic balance (1.68 s, 95% CI: 0.47 to 2.89). There were no significant improvements in gait speed, HRQoL index scores, self-rated health, physical activity levels (aerobic activity and strength training) or protein intake. GEE analysis revealed an interaction between exposure to MoveStrong and gait speed, sit-to-stand functioning, dynamic balance and HRQoL index scores. The total cost to administer the program and purchase equipment was CAD 14 700, equivalent to CAD 377 per participant. CONCLUSION Exploratory analyses suggest MoveStrong exercises may improve gait speed, sit-to-stand functioning, dynamic balance and HRQoL index scores in older individuals who are frail and pre-frail.
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Affiliation(s)
- Isabel B Rodrigues
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Justin B Wagler
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Zachary J Weston
- Waterloo Wellington Local Health Integration Network, Waterloo, Ontario, Canada
- Faculty of Science, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Sharon E Straus
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marina Mourtzakis
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jamie Milligan
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Desmond Loong
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ravi Jain
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Angela M Cheung
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Maureen C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
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38
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Okpara C, Edokwe C, Ioannidis G, Papaioannou A, Adachi JD, Thabane L. The reporting and handling of missing data in longitudinal studies of older adults is suboptimal: a methodological survey of geriatric journals. BMC Med Res Methodol 2022; 22:122. [PMID: 35473665 PMCID: PMC9040343 DOI: 10.1186/s12874-022-01605-w] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background Missing data are common in longitudinal studies, and more so, in studies of older adults, who are susceptible to health and functional decline that limit completion of assessments. We assessed the extent, current reporting, and handling of missing data in longitudinal studies of older adults. Methods Medline and Embase databases were searched from 2015 to 2019 for publications on longitudinal observational studies conducted among persons ≥55 years old. The search was restricted to 10 general geriatric journals published in English. Reporting and handling of missing data were assessed using questions developed from the recommended standards. Data were summarised descriptively as frequencies and proportions. Results A total of 165 studies were included in the review from 7032 identified records. In approximately half of the studies 97 (62.5%), there was either no comment on missing data or unclear descriptions. The percentage of missing data varied from 0.1 to 55%, with a 14% average among the studies that reported having missing data. Complete case analysis was the most common method for handling missing data with nearly 75% of the studies (n = 52) excluding individual observations due to missing data, at the initial phase of study inclusion or at the analysis stage. Of the 10 studies where multiple imputation was used, only 1 (10.0%) study followed the guideline for reporting the procedure fully using online supplementary documents. Conclusion The current reporting and handling of missing data in longitudinal observational studies of older adults are inadequate. Journal endorsement and implementation of guidelines may potentially improve the quality of missing data reporting. Further, authors should be encouraged to use online supplementary files to provide additional details on how missing data were addressed, to allow for more transparency and comprehensive appraisal of studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01605-w.
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Affiliation(s)
- Chinenye Okpara
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada.
| | | | - George Ioannidis
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada.,GERAS Centre, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada.,GERAS Centre, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonathan D Adachi
- GERAS Centre, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada.,GERAS Centre, Hamilton Health Sciences, Hamilton, ON, Canada.,Biostatistics Unit, Research Institute of St Joseph's Healthcare, Hamilton, ON, Canada.,Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Karageorgos V, Brofidi K, Stefanidou N, Papaioannou A, Daskalakis I, Sperelakis I, Balalis K. Femoral 3-in-1 Nerve Block for Total Knee Replacement, an Analgesic Approach Not to Be Neglected. Single Center Experience and Literature Review. Acta Med Acad 2022; 51:14-20. [PMID: 35695398 PMCID: PMC9982856 DOI: 10.5644/ama2006-124.365] [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: 01/30/2022] [Accepted: 04/20/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered. METHODS To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours. RESULTS Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine. CONCLUSION The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.
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Affiliation(s)
| | - Kalliopi Brofidi
- Department of ENT Surgery, University Hospital of Heraklion, Greece
| | - Nefeli Stefanidou
- Department of Anaesthesiology, University Hospital of Heraklion, Greece
| | | | - Ioannis Daskalakis
- Department of Orthopedic Surgery, University Hospital of Heraklion, Greece
| | - Ioannis Sperelakis
- Department of Orthopedic Surgery, University Hospital of Heraklion, Greece
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40
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Manji R, Ponzano M, Ashe MC, Wark JD, Kendler D, Papaioannou A, Cheung AM, Adachi JD, Thabane L, Scherer SC, Ziebart C, Gibbs JC, Giangregorio LM. Exploring the Association between Pain and Fracture Characteristics in Women with Osteoporotic Vertebral Fractures. Physiother Can 2022. [DOI: 10.3138/ptc-2020-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this study was to estimate the association between pain and the number, severity, and location of fractures in women with osteoporotic vertebral fractures. Method:We used an 11-point numeric pain rating scale to assess pain during movement in the preceding week and lateral spinal radiographs to confirm number, location, and severity of vertebral fractures. In model 1, we assessed the association between pain during movement and the number, severity, and location of fractures. We adjusted model 2 for pain medication use and age. Results: The mean age of participants was 76.4 (SD 6.9) years. We found no statistically significant associations between pain and fracture number (estimated β = 0.23, 95% CI: ‒0.27, 0.68), fracture severity (estimated β = ‒0.46, 95% CI: ‒1.38, 0.49), or fracture location at T4–T8 (estimated β = 0.06, 95% CI: ‒1.26, 1.34), T9–L1 (estimated β = 0.35, 95% CI: ‒1.17, 1.74), or L2–L4 (estimated β = 0.40, 95% CI: ‒1.01, 1.75). Age and pain medication use were not significantly associated with pain. Model 1 accounted for 4.7% and model 2 for 7.2% of the variance in self-reported pain. Conclusion: The number, location, and severity of fractures do not appear to be the primary explanation for pain in women with vertebral fractures. Clinicians must consider other factors contributing to pain.
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Affiliation(s)
- Rahim Manji
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Maureen C. Ashe
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - John D. Wark
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Bone & Mineral Medicine and Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Kendler
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Ontario, Canada
| | - Angela M. Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Samuel C. Scherer
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Christina Ziebart
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Jenna C. Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Lora M. Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Schlegel–UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
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Pinto D, Alshahrani M, Chapurlat R, Chevalley T, Dennison E, Camargos BM, Papaioannou A, Silverman S, Kaux JF, Lane NE, Morales Torres J, Paccou J, Rizzoli R, Bruyere O. The global approach to rehabilitation following an osteoporotic fragility fracture: A review of the rehabilitation working group of the International Osteoporosis Foundation (IOF) committee of scientific advisors. Osteoporos Int 2022; 33:527-540. [PMID: 35048200 DOI: 10.1007/s00198-021-06240-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/11/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To conduct a review of the current state of the evidence for rehabilitation strategies post-fragility fracture. METHODS Narrative review conducted by the Rehabilitation Working Group of the International Osteoporosis Foundation Committee of Scientific Advisors characterizing the range of rehabilitation modalities instrumental for the management of fragility fractures. RESULTS Multi-modal exercise post-fragility fracture to the spine and hip is strongly recommended to reduce pain, improve physical function, and improve quality of life. Outpatient physiotherapy post-hip fracture has a stronger evidence base than outpatient physiotherapy post-vertebral fracture. Appropriate nutritional care after fragility fracture provides a large range of improvement in morbidity and mortality. Education increases understanding of osteoporosis which in turn increases utilization of other rehabilitation services. Education may improve other health outcomes such as pain and increase a patient's ability for self-advocacy. CONCLUSION Rehabilitation interventions are inter-reliant, and research investigating the interaction of exercise, nutrition, and other multi-modal therapies may increase the relevance of rehabilitation research to clinical care.
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Affiliation(s)
- D Pinto
- Department of Physical Therapy, Marquette University, P.O. Box 1881, Wisconsin, 53201, Milwaukee, USA.
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, 4000, Liège, Belgium.
| | - M Alshahrani
- Department of Physical Therapy, Marquette University, P.O. Box 1881, Wisconsin, 53201, Milwaukee, USA
- Department of Medical Rehabilitation Science, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - T Chevalley
- Division of Bone Diseases, Department of Medicine, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - B M Camargos
- Densitometry Diagnostic Unit - Rede Materdei de Saúde, Belo Horizonte, Mina Gerais, Brazil
| | - A Papaioannou
- Department of Medicine, Division of Geriatrics, McMaster University, Hamilton, Canada
| | - S Silverman
- Cedars-Sinai Medical Center and University of California, Los Angeles, CA, USA
| | - J-F Kaux
- Department of Physical and Rehabilitation Medicine, University Hospital of Liège, University of Liège, Liège, Belgium
| | - N E Lane
- Department of Medicine and Rheumatology, Davis School of Medicine, University of California, Sacramento, CA, USA
| | - J Morales Torres
- University of Guanajuato at León, Osteoporosis Unit, Hospital Aranda de La Parra, León, Mexico
| | - J Paccou
- Département Universitaire de Rhumatologie, Centre Hospitalier Et Universitaire, Hôpital Roger Salengro, Lille, France
| | - R Rizzoli
- Division of Bone Diseases, Department of Medicine, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - O Bruyere
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, 4000, Liège, Belgium
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Papaioannou A, Centonze F, Metais A, Maurel M, Negroni L, Gonzalez-Quiroz M, Mahdizadeh SJ, Svensson G, Zare E, Blondel A, Koong AC, Hetz C, Pedeux R, Tremblay ML, Eriksson LA, Chevet E. Stress-induced tyrosine phosphorylation of RtcB modulates IRE1 activity and signaling outputs. Life Sci Alliance 2022; 5:5/5/e202201379. [PMID: 35193953 PMCID: PMC8899846 DOI: 10.26508/lsa.202201379] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/18/2022] Open
Abstract
ER stress is mediated by three sensors and the most evolutionary conserved IRE1α signals through its cytosolic kinase and endoribonuclease (RNase) activities. IRE1α RNase activity can either catalyze the initial step of XBP1 mRNA unconventional splicing or degrade a number of RNAs through regulated IRE1-dependent decay. Until now, the biochemical and biological outputs of IRE1α RNase activity have been well documented; however, the precise mechanisms controlling whether IRE1α signaling is adaptive or pro-death (terminal) remain unclear. We investigated those mechanisms and hypothesized that XBP1 mRNA splicing and regulated IRE1-dependent decay activity could be co-regulated by the IRE1α RNase regulatory network. We identified that RtcB, the tRNA ligase responsible for XBP1 mRNA splicing, is tyrosine-phosphorylated by c-Abl and dephosphorylated by PTP1B. Moreover, we show that the phosphorylation of RtcB at Y306 perturbs RtcB interaction with IRE1α, thereby attenuating XBP1 mRNA splicing. Our results demonstrate that the IRE1α RNase regulatory network is dynamically fine-tuned by tyrosine kinases and phosphatases upon various stresses and that the extent of RtcB tyrosine phosphorylation determines cell adaptive or death outputs.
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Affiliation(s)
- Alexandra Papaioannou
- INSERM U1242, University of Rennes, Rennes, France.,Centre Eugène Marquis, Rennes, France
| | - Federica Centonze
- INSERM U1242, University of Rennes, Rennes, France.,Centre Eugène Marquis, Rennes, France
| | - Alice Metais
- INSERM U1242, University of Rennes, Rennes, France.,Centre Eugène Marquis, Rennes, France
| | - Marion Maurel
- INSERM U1242, University of Rennes, Rennes, France.,Centre Eugène Marquis, Rennes, France
| | - Luc Negroni
- Centre National de la Recherche Scientifique, UMR7104, Illkirch, France.,Institut National de la Santé et de la Recherche Médicale, U1258, Illkirch, France.,Université de Strasbourg, Illkirch, France
| | - Matías Gonzalez-Quiroz
- INSERM U1242, University of Rennes, Rennes, France.,Biomedical Neuroscience Institute, Faculty of Medicine, University of Chile, Santiago, Chile.,Center for Geroscience, Brain Health and Metabolism (GERO), Santiago, Chile.,Program of Cellular and Molecular Biology, Institute of Biomedical Sciences, University of Chile, Santiago, Chile
| | | | - Gabriella Svensson
- Department of Chemistry and Molecular Biology, University of Gothenburg, Göteborg, Sweden
| | - Ensieh Zare
- Department of Chemistry and Molecular Biology, University of Gothenburg, Göteborg, Sweden
| | - Alice Blondel
- INSERM U1242, University of Rennes, Rennes, France.,Centre Eugène Marquis, Rennes, France
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudio Hetz
- Biomedical Neuroscience Institute, Faculty of Medicine, University of Chile, Santiago, Chile.,Center for Geroscience, Brain Health and Metabolism (GERO), Santiago, Chile.,Program of Cellular and Molecular Biology, Institute of Biomedical Sciences, University of Chile, Santiago, Chile
| | - Rémy Pedeux
- INSERM U1242, University of Rennes, Rennes, France.,Centre Eugène Marquis, Rennes, France
| | - Michel L Tremblay
- Goodman Cancer Research Centre, McGill University, Montreal, Canada.,Department of Biochemistry, McGill University, Montreal, Canada
| | - Leif A Eriksson
- Department of Chemistry and Molecular Biology, University of Gothenburg, Göteborg, Sweden
| | - Eric Chevet
- INSERM U1242, University of Rennes, Rennes, France .,Centre Eugène Marquis, Rennes, France
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McArthur C, Lee A, Alrob HA, Adachi JD, Giangregorio L, Griffith LE, Morin S, Thabane L, Ioannidis G, Lee J, Leslie WD, Papaioannou A. An update of the prevalence of osteoporosis, fracture risk factors, and medication use among community-dwelling older adults: results from the Canadian Longitudinal Study on Aging (CLSA). Arch Osteoporos 2022; 17:31. [PMID: 35122160 PMCID: PMC8816745 DOI: 10.1007/s11657-022-01073-1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023]
Abstract
The prevalence of self-reported and DXA-confirmed osteoporosis was 7.8% (males 2.2%; females 12.7%), and 3.6% (males 1.2%; females 5.9%), respectively. We found that most community-dwelling older adults at high fracture risk are not taking osteoporosis medication, particularly males. There is a major opportunity for improved primary fracture prevention in the community. PURPOSE To provide an up-to-date prevalence estimate of osteoporosis, fracture risk factors, fracture risk, and the proportion of older Canadians at high fracture risk who are not taking an osteoporosis medication. METHODS We included Canadian Longitudinal Study on Aging (CLSA) participants: a community-dwelling cohort aged 45 to 85 years who completed the baseline (2015) comprehensive interview and had dual-energy X-ray absorptiometry (DXA) scans (N = 30,097). We describe the age- and sex-stratified prevalence of (1) self-reported osteoporosis; (2) DXA-confirmed osteoporosis; (3) fracture risk factors and people who are at high risk (FRAX® major osteoporotic fracture probability ≥ 20%); and (4) people who are at high fracture risk not taking osteoporosis medications. Sampling weights, as defined by the CLSA, were applied. RESULTS The mean age of participants was 70.0 (SD 10.3). Overall, 7.8% had self-reported osteoporosis (males 2.2%; females 12.7%) while 3.6% had DXA-confirmed osteoporosis (males 1.2%; females 5.9%), and 2.8% were at high fracture risk (males 0.3%; females 5.1%). Of people who had osteoporosis and were at high risk, 77.3% were not taking an osteoporosis medication (males 92.3%; females 76.8%). CONCLUSIONS Our study provides an up-to-date prevalence estimate of osteoporosis for community-dwelling older Canadians. We found that most community-dwelling older adults at high fracture risk are not taking an osteoporosis medication, particularly males. There is a major opportunity for improved primary fracture prevention in the community.
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Affiliation(s)
- Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Forrest Building, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada. .,GERAS Centre for Aging Research, Hamilton, Ontario, Canada.
| | - Ahreum Lee
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Hajar Abu Alrob
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan D Adachi
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.,Schlegel-UW Research Institute On Aging, Waterloo, Ontario, Canada
| | - Lauren E Griffith
- Health Research Methodology, McMaster University, Hamilton, Ontario, Canada.,McMaster Institute for Research On Aging, Hamilton, Ontario, Canada
| | - Suzanne Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lehana Thabane
- Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - George Ioannidis
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Justin Lee
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - William D Leslie
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexandra Papaioannou
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
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Papaioannou A, Papavassiliou-Alexiou I, Moutiaga S. Career resilience and self-efficacy of Greek primary school leaders in times of socioeconomic crisis. IJEM 2022. [DOI: 10.1108/ijem-01-2021-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper investigates the levels of career resilience and self-efficacy of the principals of primary school units, identifies the relationship between them and determines the effect of the demographic elements of the sample on their career resilience and self-efficacy.Design/methodology/approachThe convenient sample of this study was 165 principals from public schools across the prefecture of Central Macedonia. A total of 422 questionnaires were mailed to all principals of kindergarten and elementary schools, accompanied by a personal letter to inform them about the procedure and the purpose of the survey. A pilot survey took place to check the adequacy of and get feedback on the questionnaire. The questionnaire used in the study consisted of three parts: The Career Resilience Scale (CRS) by Kodama (2015), the Principal Self-Efficacy Scale (PSES) by Tschannen-Moran and Gareis (2004) and demographic questions.FindingsThe results of the survey showed that principals have high levels of career resilience and very high levels of self-efficacy. There are four factors that form the levels of career resilience: (a) problem-solving skills (b) social skills (c) interest in innovation and (d) optimism for the future. Demographic factors play a role in shaping career resilience as they affect two of the four factors. There are two factors that shape levels of self-efficacy: (a) self-efficiency in administration and (b) self-efficiency in moral leadership. Demographic factors play a role in shaping the factor of self-efficacy that refers to administration. Finally, there was a high positive correlation and a causal relationship between career resilience and self-efficacy.Research limitations/implicationsThe convenient sample used in the present study is a limiting factor, as it may not be representative of Greek primary school principals. Also, research is based on self-evaluation questionnaires, which may show a lack of objectivity, as the answers may reflect the personal worldviews of leaders and particular needs of educational institutions (Sarid, 2021). This fact may not allow us to generalize the results.Practical implicationsThe present study showed that resilience and self-efficacy have a causal relationship and that one enhances another, making their relation pivotal for a successful educational leadership. Regarding the professional development of school leaders, educational leadership training programs could be designed and offered by the Greek Ministry of Education (Dexter et al., 2020). Coaching programs and practices that help principals develop social skills, coping mechanisms, emotional capacities and confidence in one's knowledge should be widely introduced. Governments have to take the necessary initiative to ensure that, particularly in adverse contexts, education stimulate and nurture resilience and self-efficacy among citizens, by promoting appropriate lifelong learning programs and by ensuring the continuous training of employees (Renko et al., 2020).Social implicationsCareer resilience and self-efficacy ensures economic prosperity in times of crisis, globalization and rapid technology development and may be the best way to create strong and successful leaders. Coaching programs and practices that help principals develop social skills, coping mechanisms, emotional capacities and confidence in one's knowledge should be widely introduced. The results of the present research could prove helpful in developing strategic plans, building networks between organizations to improve communication and flow of information, through employee exchange programs.Originality/valueThis research, which combined career resilience and self-efficacy, took place for the first time in Greece. The CRS by Kodama (2015) was also used for the first time in Greek population.
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Hewston P, Kennedy C, Ioannidis G, Merom D, Hladysh G, Marr S, Lee J, Sztramko R, Trainor L, Grenier A, Woolhouse MH, Patterson C, Papaioannou A. Development of GERAS DANcing for Cognition and Exercise (DANCE): a feasibility study. Pilot Feasibility Stud 2022; 8:9. [PMID: 35045863 PMCID: PMC8767754 DOI: 10.1186/s40814-021-00956-3] [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: 05/07/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dance is a mind-body activity of purposeful rhythmic movement to music. There is growing interest in using dance as a form of cognitive and physical rehabilitation. This manuscript describes the development of GERAS DANcing for Cognition and Exercise (DANCE) and evaluates its feasibility in older adults with cognitive and mobility impairments. METHODS The progressive dance curricula were delivered for 15 weeks (1-h class; twice weekly). Participants were eligible if they were community-dwelling older adults aged 60+ with early cognitive or mobility impairment able to follow three-step commands and move independently. Feasibility outcomes included recruitment/retention, adherence, participant satisfaction, safety, and adverse events. RESULTS Twenty-five older adults (mean (standard deviation [SD]) age = 77.55 (6.10) years, range 68-90 years) with early cognitive (Montreal Cognitive Assessment score (SD) = 21.77 (4.05)) and mobility (92% were pre-frail/frail as indicated on the Fried Frailty Phenotype) impairments were recruited from a geriatric out-patient clinic or within the community. A total of 20/25 (80%) participants completed the study. Average class attendance was 72%, and self-reported homework adherence "most-days / every day" was 89%. A stepwise progression in the dance curricula was observed with increases in motor complexity and balance demands, and 95% of participants rated the program as a "just-right" challenge. Ninety percent of participants rated GERAS DANCE as excellent, and 100% would recommend the program to a friend or family member. Over 50% of participants connected outside of class time for a self-initiated coffee club. Adverse events of falls and fractures were reported for 2 participants, which occurred at home unrelated to the dance intervention during the study period. Pre-determined thresholds for feasibility were met for all outcomes. DISCUSSION GERAS DANCE is a feasible and enjoyable program for older adults with early cognitive or mobility impairments. GERAS DANCE curriculum grading (duration; sequence; instructions) and motor complexity increases in agility, balance, and coordination appear appropriately tailored for this population. Future work will explore the feasibility of GERAS DANCE in new settings (i.e., virtually online, community centers, or retirement homes) and the mind-body-social benefits of dance.
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Affiliation(s)
- Patricia Hewston
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada. .,Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Courtney Kennedy
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - George Ioannidis
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dafna Merom
- School of Science and Health , University of Western Sydney, Penrith, Australia
| | | | - Sharon Marr
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Justin Lee
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Sztramko
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Laurel Trainor
- Department of Psychology, Neuroscience, & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Amanda Grenier
- Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Christopher Patterson
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alexandra Papaioannou
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research and Methods, McMaster University, Hamilton, ON, Canada
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46
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Duque G, Iuliano S, Close JC.T, Fatima M, Ganda K, Bird S, Kirk B, Levidiotis M, Said CM, Papaioannou A, Inderjeeth CA. Prevention of Osteoporotic Fractures in Residential Aged Care: Updated Consensus Recommendations. J Am Med Dir Assoc 2022; 23:756-763. [DOI: 10.1016/j.jamda.2021.12.041] [Citation(s) in RCA: 1] [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] [Received: 10/12/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 02/07/2023]
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47
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Hewston P, Kennedy C, Ioannidis G, Merom D, Marr S, Hladysh G, Papaioannou A. Effects of GERAS DANCE on cognitive function in older adults with and without cognitive impairment. Alzheimers Dement 2021. [DOI: 10.1002/alz.055812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Dafna Merom
- University of Western Sydney Campbelltown Australia
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Sztramko R, Levinson AJ, Wurster AE, Jezrawi R, Sivapathasundaram B, Papaioannou A, Cowan D, St Onge J, Marr S, Patterson C, Woo T, Mosca L, Lokker C. Online Educational Tools for Caregivers of People with Dementia: A Scoping Literature Review. Can Geriatr J 2021; 24:351-366. [PMID: 34912490 PMCID: PMC8629496 DOI: 10.5770/cgj.24.506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Informal caregivers of people with dementia provide the majority of health-based care to people with dementia. Providing this care requires knowledge and access to resources, which caregivers often do not receive. We set out to evaluate the effect of online educational tools on informal caregiver self-efficacy, quality of life, burden/stress, depression, and anxiety, and to identify effective processes for online educational tool development. METHODS We conducted a scoping review of articles on online educational interventions for informal caregivers of people with dementia searching CINAHL, MEDLINE, EMBASE, and PubMed from 1990 to March 2018, with an updated search conducted in 2020. The identified articles were screened and the data were charted. RESULTS 33 articles that reported on 24 interventions were included. There is some evidence that online interventions improve caregiver-related outcomes such as self-efficacy, depression, dementia knowledge, and quality of life; and decrease caregiver burden. Common findings across the studies included the need for tailored, stage-specific information applicable to the caregiver's situation and the use of psychosocial techniques to develop the knowledge components of the interventions. CONCLUSION We demonstrate the importance of having caregivers and health-care professionals involved at all stages of tool conceptualization and development. Online tools should be evaluated with robust trials that focus on how increased knowledge and development approaches affect caregiver-related outcomes.
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Affiliation(s)
- Richard Sztramko
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Anthony J. Levinson
- Division of e-Learning Innovation, Faculty of Health Sciences, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Andrea E. Wurster
- GERAS Centre, St. Peter’s Hospital, Hamilton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - Rita Jezrawi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | | | - Alexandra Papaioannou
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - David Cowan
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Joye St Onge
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Sharon Marr
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Christopher Patterson
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Tricia Woo
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Lori Mosca
- Division of e-Learning Innovation, Faculty of Health Sciences, McMaster University, Hamilton
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
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Ghazalbash S, Zargoush M, Mowbray F, Papaioannou A. Examining the predictability and prognostication of multimorbidity among older Delayed-Discharge Patients: A Machine learning analytics. Int J Med Inform 2021; 156:104597. [PMID: 34619571 DOI: 10.1016/j.ijmedinf.2021.104597] [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: 04/02/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient complexity among older delayed-discharge patients complicates discharge planning, resulting in a higher rate of adverse outcomes, such as readmission and mortality. Early prediction of multimorbidity, as a common indicator of patient complexity, can support proactive discharge planning by prioritizing complex patients and reducing healthcare inefficiencies. OBJECTIVE We set out to accomplish the following two objectives: 1) to examine the predictability of three common multimorbidity indices, including Charlson-Deyo Comorbidity Index (CDCI), the Elixhauser Comorbidity Index (ECI), and the Functional Comorbidity Index (FCI) using machine learning (ML), and 2) to assess the prognostic power of these indices in predicting 30-day readmission and mortality. MATERIALS AND METHODS We used data including 163,983 observations of patients aged 65 and older who experienced discharge delay in Ontario, Canada, during 2004 - 2017. First, we utilized various classification ML algorithms, including classification and regression trees, random forests, bagging trees, extreme gradient boosting, and logistic regression, to predict the multimorbidity status based on CDCI, ECI, and FCI. Second, we used adjusted multinomial logistic regression to assess the association between multimorbidity indices and the patient-important outcomes, including 30-day mortality and readmission. RESULTS For all ML algorithms and regardless of the predictive performance criteria, better predictions were established for the CDCI compared with the ECI and FCI. Remarkably, the most predictable multimorbidity index (i.e., CDCI with Area Under the Receiver Operating Characteristic Curve = 0.80, 95% CI = 0.79 - 0.81) also offered the highest prognostications regarding adverse events (RRRmortality = 3.44, 95% CI = 3.21 - 3.68 and RRRreadmission = 1.36, 95% CI = 1.31 - 1.40). CONCLUSIONS Our findings highlight the feasibility and utility of predicting multimorbidity status using ML algorithms, resulting in the early detection of patients at risk of mortality and readmission. This can support proactive triage and decision-making about staffing and resource allocation, with the goal of optimizing patient outcomes and facilitating an upstream and informed discharge process through prioritizing complex patients for discharge and providing patient-centered care.
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Affiliation(s)
- Somayeh Ghazalbash
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Manaf Zargoush
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada.
| | - Fabrice Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Big Data and Geriatric Models of Care (BDG) Cluster, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada
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Rodrigues IB, Wang E, Keller H, Thabane L, Ashe MC, Brien S, Cheung AM, Funnell L, Jain R, Loong D, Isaranuwatchai W, Milligan J, Mourtzakis M, Papaioannou A, Straus S, Weston ZJ, Giangregorio LM. The MoveStrong program for promoting balance and functional strength training and adequate protein intake in pre-frail older adults: A pilot randomized controlled trial. PLoS One 2021; 16:e0257742. [PMID: 34559837 PMCID: PMC8462677 DOI: 10.1371/journal.pone.0257742] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/03/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Balance and functional strength training can improve muscle strength and physical functioning outcomes and decrease the risk of falls in older adults. To maximize the benefits of strength training, adequate protein intake is also important. However, the number of older individuals that consume enough protein or routinely engage in strength training remains low at less than 5% and even lower for activities that challenge balance. Our primary aim was to assess the feasibility of implementing a model (MoveStrong) of service delivery to teach older adults about balance and functional strength training and methods to increase protein intake. METHODS This study was a closed cohort stepped wedge randomized controlled trial. We recruited individuals ≥60 years considered pre-frail or frail with at least one chronic condition who were not currently engaging in regular strength training from Northern (rural) and Southern (urban) Ontario sites in Canada. The primary outcome was feasibility of implementation, defined by recruitment, retention, and adherence, and safety (defined by monitoring adverse events). We also reported participants' and providers' experience with MoveStrong, adaptations to the model based on participant's and provider's experience, and program fidelity. RESULTS We recruited 44 participants to the study and the average adherence rate was 72% with a retention of 71%. The program had a high-fidelity score. One person experienced a fall-related injury during exercise, while two other participants reported pain during certain activities. Five individuals experienced injuries or health problems that were not related to the program. Suggestions for future trials include modifying some exercises, exploring volunteer assistance, increasing the diversity of participants enrolled, and considering a different study design. CONCLUSIONS Our pilot trial demonstrates the feasibility of recruitment and adherence for a larger multisite RCT of balance and functional strength training with attention to protein intake in pre-frail and frail older adults.
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Affiliation(s)
- Isabel B. Rodrigues
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
| | - Ellen Wang
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
| | - Heather Keller
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Maureen C. Ashe
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, ON, Canada
| | - Angela M. Cheung
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, ON, Canada
| | - Ravi Jain
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, ON, Canada
| | - Desmond Loong
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, Toronto, ON, Canada
| | - Jamie Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Marina Mourtzakis
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon Straus
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Zachary J. Weston
- Waterloo Wellington Local Health Integration Network, Waterloo, ON, Canada
- Faculty of Science, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Lora M. Giangregorio
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
- * E-mail:
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