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Puts M, Waked JAA, Strohschein F, Breunis H, Alqurini N, Berger A, Romanovsky L, Monette J, Mehta R, Li A, Wan-Chow-Wah D, Koneru R, Szumacher E, Mariano C, Hsu T, Brennenstuhl S, Amir E, Krzyzanowska MK, Jang R, Pitters E, Emmenegger U, Menjak IB, Bergman S, Lemonde M, Beland F, Alibhai SMH. Implementing geriatric assessment and management for older Canadians with cancer: Adherence to and satisfaction with the intervention, results of the 5C study. J Geriatr Oncol 2023; 14:101586. [PMID: 37459767 DOI: 10.1016/j.jgo.2023.101586] [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: 05/24/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Geriatric assessment and management (GAM) is recommended by professional organizations and recently several randomized controlled trials (RCTs) demonstrated benefits in multiple health outcomes. GAM typically leads to one or more recommendations for the older adult on how to optimize their health. However, little is known about how well recommendations are adhered to. Understanding these issues is vital to designing GAM trials and clinical programs. Therefore, the aim of this study was to examine the number of GAM recommendations made and adherence to and satisfaction with the intervention in a multicentre RCT of GAM for older adults with cancer. MATERIALS AND METHODS The 5C study was a two-group parallel RCT conducted in eight hospitals across Canada. Each centre kept a detailed recruitment and retention log. The intervention teams documented adherence to their recommendations. Medical records were also reviewed to assess which recommendations were adhered to. Twenty-three semi-structured interviews were conducted with 12 members of the intervention teams and 11 oncology team members to assess implementation of the study and the intervention. RESULTS Of the 350 participants who were enrolled, 173 were randomized to the intervention arm. Median number of recommendations was seven. Mean adherence to recommendations based on the GAM was 69%, but it varied by type of recommendation, ranging from 98% for laboratory tests to 28% for psychosocial/psychiatry oncology referrals. There was no difference in the number of recommendations or non-adherence to recommendations by sex, level of frailty, or functional status. Oncologists and intervention team members were satisfied with the study implementation and intervention delivery. DISCUSSION Adherence to recommendations was variable. Adherence to laboratory investigations and further imaging were generally high but much lower for recommendations regarding psychosocial support. Further collaborative work with older adults with cancer is needed to understand how to optimize the intervention to be consistent with patient goals, priorities, and values to ensure maximal impact on health outcomes.
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Affiliation(s)
- Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Jihad Abou Ali Waked
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Fay Strohschein
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Henriette Breunis
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Naser Alqurini
- Division of Geriatrics, Department of Medicine, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Arielle Berger
- Department of Geriatric Medicine, University Health Network, Ontario, Canada
| | - Lindy Romanovsky
- Department of Geriatric Medicine, University Health Network, Ontario, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Rajin Mehta
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anson Li
- Department of Geriatric Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Doreen Wan-Chow-Wah
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Rama Koneru
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Caroline Mariano
- Department of Medical Oncology, BC Cancer center, Vancouver, British Columbia, Canada
| | - Tina Hsu
- Division of Medical Oncology, the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medical Oncology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Raymond Jang
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Eric Pitters
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ines B Menjak
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simon Bergman
- Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Francois Beland
- Public Health School, University of Montreal, Montreal, Quebec, Canada
| | - Shabbir M H Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Mariano C, Brennenstuhl S, Alibhai S, Tejero I, Strohschein F, Monette J, Szumacher E, Hsu T, Puts M. Predictors and effects of toxicity experienced by older adults with cancer receiving systemic therapy in a randomized clinical trial of geriatric assessment. J Geriatr Oncol 2023; 14:101584. [PMID: 37429107 DOI: 10.1016/j.jgo.2023.101584] [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: 12/22/2022] [Revised: 03/06/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Older adults represent a large segment of the oncology population, however, they remain underrepresented in clinical research. Treatment of older adults is often extrapolated using data from younger and fitter patients, which may not be appropriate. Furthermore the implications of toxicity from treatment can be greater for this population. Predicting toxicity from treatment and its effect on quality of life and functional status for older adults therefore is important. MATERIALS AND METHODS We analyzed data from a clinical trial of geriatric assessment and management for Canadian elders with cancer (5C study). We assessed whether the baseline Cancer and Aging Research Group (CARG) toxicity score, G8 score, and Eastern Cooperative Oncology Group (ECOG) performance predicted grade 3-5 toxicity using logistic regression and pattern mixture models. We also assessed the impact of toxicity on quality of life and functional decline. Patients were followed for six months. RESULTS Three hundred sixteen patients were included. Mean age was 76 years old and 40% of patients were female. One hundred nineteen patients (38%) experienced at least one grade 3-5 toxicity. Neither the CARG toxicity score, G8, or ECOG were predictive of grade 3-5 toxicity. Patients who experienced grade 3-5 toxicity were more likely to have functional impairments over time (odds ratio 3.71, p = 0.03). However, they maintained their quality of life. DISCUSSION In this secondary analysis of a randomized controlled trial of geriatric assessment and management we did not find any predictors of grade 3-5 toxicity. Patients who did experience toxicity were more likely to report functional decline over time. Older adults who do experience treatment related toxicity may benefit from increased supports. CLINICAL TRIAL INFORMATION NCT0315467.
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Affiliation(s)
- Caroline Mariano
- Department of Medical Oncology, BC Cancer Center, Vancouver, British Columbia, Canada.
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir Alibhai
- Department of Geriatric Medicine, University Health Network, Toronto, Ontario, Canada
| | - Isabel Tejero
- Geriatrics Department, Hospital del Mar, Barcelona, Spain
| | - Fay Strohschein
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tina Hsu
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Puts M, Alqurini N, Strohschein F, Koneru R, Szumacher E, Mariano C, Monette J, Hsu T, Brennenstuhl S, McLean B, Wills A, Berger A, Amir E, Romanovsky L, Li A, Mehta R, Krzyzanowska M, Elser C, Jang R, Prica A, Wan-Chow-Wah D, Pitters E, Emmenegger U, Menjak IB, Bergman S, Lemonde M, Breunis H, Béland F, Alibhai SM. Impact of Geriatric Assessment and Management on Quality of Life, Unplanned Hospitalizations, Toxicity, and Survival for Older Adults With Cancer: The Randomized 5C Trial. J Clin Oncol 2023; 41:847-858. [PMID: 36473126 PMCID: PMC9902020 DOI: 10.1200/jco.22.01007] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE American Society of Clinical Oncology recommends that older adults with cancer being considered for chemotherapy receive geriatric assessment (GA) and management (GAM), but few randomized controlled trials have examined its impact on quality of life (QOL). PATIENTS AND METHODS The 5C study was a two-group parallel 1:1 single-blind multicenter randomized controlled trial of GAM for 6 months versus usual oncologic care. Eligible patients were age 70+ years, diagnosed with a solid tumor, lymphoma, or myeloma, referred for first-/second-line chemotherapy or immunotherapy or targeted therapy, and had an Eastern Cooperative Oncology Group performance status of 0-2. The primary outcome QOL was measured with the global health scale of the European Organisation for the Research and Treatment of Cancer QOL questionnaire and analyzed with a pattern mixture model using an intent-to-treat approach (at 6 and 12 months). Secondary outcomes included functional status, grade 3-5 treatment toxicity; health care use; satisfaction; cancer treatment plan modification; and overall survival. RESULTS From March 2018 to March 2020, 350 participants were enrolled. Mean age was 76 years and 40.3% were female. Fifty-four percent started treatment with palliative intent. Eighty-one (23.1%) patients died. GAM did not improve QOL (global QOL of 4.4 points [95% CI, 0.9 to 8.0] favoring the control arm). There was also no difference in survival, change in treatment plan, unplanned hospitalization/emergency department visits, and treatment toxicity between groups. CONCLUSION GAM did not improve QOL. Most intervention group participants received GA on or after treatment initiation per patient request. Considering recent completed trials, GA may have benefit if completed before treatment selection. The COVID-19 pandemic may have affected our QOL outcome and intervention delivery for some participants.
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Affiliation(s)
- Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada,Martine Puts, RN, PhD, FAAN, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Suite 130, Toronto, ON, Canada M5T 1P8; e-mail:
| | - Naser Alqurini
- Division of Geriatrics, Department of Medicine, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Fay Strohschein
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Rama Koneru
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Caroline Mariano
- Department of Medical Oncology, BC Cancer Center, Vancouver, British Columbia, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Tina Hsu
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Bianca McLean
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Arielle Berger
- Department of Geriatric Medicine, University Health Network, Toronto, Ontario, Canada
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Department of Medical Oncology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Lindy Romanovsky
- Department of Geriatric Medicine, University Health Network, Toronto, Ontario, Canada
| | - Anson Li
- Department of Geriatric Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Rajin Mehta
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Christine Elser
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Department of Medical Oncology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Raymond Jang
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anca Prica
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Doreen Wan-Chow-Wah
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Eric Pitters
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ines B. Menjak
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simon Bergman
- Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Henriette Breunis
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Francois Béland
- Public Health School, University of Montreal, Montreal, Quebec, Canada
| | - Shabbir M.H. Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Pitters E, Puts M, Alqurini N, Strohschein F, Koneru R, Szumacher E, Mariano C, Monette J, Hsu T, Brennenstuhl S, McLean B, Wills A, Berger A, Amir E, Romanovsky L, Li A, Mehta R, Krzyzanowska M, Elser C, Jang R, Prica A, Wan-Chow-Wah D, Emmenegger U, Menjak I, Bergman S, Lemonde M, Krahn M, Beland F, Breunis H, Alibhai S. The impact of the COVID-19 pandemic on quality of life, health care use and mortality in older adults in the 5C study of geriatric assessment and management: secondary analysis. J Geriatr Oncol 2022. [PMCID: PMC9595410 DOI: 10.1016/s1879-4068(22)00376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Puts M, Alqurini N, Strohschein F, Berger A, Romanovsky L, Monette J, Mehta R, Li A, Wan-Chow-Wah D, Hsu T, Brennenstuhl S, Koneru R, Szumacher E, Mariano C, McLean B, Wills A, Amir E, Krzyzanowska M, Elser C, Jang R, Prica A, Pitters E, Emmenegger U, Menjak I, Bergman S, Lemonde M, Breunis H, Beland F, Krahn M, Alibhai S. Recommendations and adherence to recommendations made based on a comprehensive geriatric assessment for Canadian older adults with cancer: Results of the 5C trial. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Puts M, Alqurini N, Strohschein F, Mariano C, Monette J, Wan-Chow-Wah D, Szumacher E, Koneru R, Mehta R, Li A, Hsu T, Brennenstuhl S, McLean B, Wills A, Amir E, Krzyzanowska M, Elser C, Pitters E, Breunis H, Berger A, Romanovsky L, Alibhai S. Comprehensive geriatric assessment and management for Canadian elders with Cancer: The 5C study. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wilchesky M, Ballard SA, Voyer P, McCusker J, Lungu O, Champoux N, Vu TTM, Cole MG, Monette J, Ciampi A, Belzile E, Carmichael PH, McConnell T. The PREvention Program for Alzheimer's RElated Delirium (PREPARED) cluster randomized trial: a study protocol. BMC Geriatr 2021; 21:645. [PMID: 34784897 PMCID: PMC8594158 DOI: 10.1186/s12877-021-02558-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Delirium is a significant cause of morbidity and mortality among older people admitted to both acute and long-term care facilities (LTCFs). Multicomponent interventions have been shown to reduce delirium incidence in the acute care setting (30-73%) by acting on modifiable risk factors. Little work, however, has focused on using this approach to reduce delirium incidence in LTCFs. METHODS The objective is to assess the effectiveness of the multicomponent PREPARED Trial intervention in reducing the following primary outcomes: incidence, severity, duration, and frequency of delirium episodes in cognitively impaired residents. This 4-year, parallel-design, cluster randomized study will involve nursing staff and residents in 45-50 LTCFs in Montreal, Canada. Participating public and private LTCFs (clusters) that provide 24-h nursing care will be assigned to either the PREPARED Trial intervention or the control (usual care) arm of the study using a covariate constrained randomization procedure. Approximately 400-600 LTC residents aged 65 and older with dementia and/or cognitive impairment will be enrolled in the study and followed for 18 weeks. Residents must be at risk of delirium, delirium-free at baseline and have resided at the facility for at least 2 weeks. Residents who are unable to communicate verbally, have a history of specific psychiatric conditions, or are receiving end-of-life care will be excluded. The PREPARED Trial intervention consists of four main components: a decision tree, an instruction manual, a training package, and a toolkit. Primary study outcomes will be assessed weekly. Functional autonomy and cognitive levels will be assessed at the beginning and end of follow-up, while information pertaining to modifiable delirium risk factors, medical consultations, and facility transfers will be collected retrospectively for the duration of the follow-up period. Primary outcomes will be reported at the level of intervention assignment. All researchers analyzing the data will be blinded to group allocation. DISCUSSION This large-scale intervention study will contribute significantly to the development of evidence-based clinical guidelines for delirium prevention in this frail elderly population, as it will be the first to evaluate the efficacy of a multicomponent delirium prevention program translated into LTC clinical practice on a large scale. TRIAL REGISTRATION NCT03718156 , ClinicalTrials.gov .
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Affiliation(s)
- Machelle Wilchesky
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada.
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada.
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Cote St. Catherine Road, Room E-0012, Montreal, QC, H3T 1E2, Canada.
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote St. Catherine Road, Montreal, QC, H3T 1E2, Canada.
| | - Stephanie A Ballard
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada
| | - Philippe Voyer
- Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 3645, Québec, QC, G1V 0A6, Canada
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050 chemin Sainte-Foy, L2-30, Quebec City, QC, G1S 4L8, Canada
| | - Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC, H3A 1A2, Canada
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Ovidiu Lungu
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada
- Functional Neuroimaging Unit, Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 Queen Mary Rd, Montreal, QC, H3W 1W5, Canada
- Department of Psychiatry, Université de Montréal, Pavillon Roger-Gaudry, Faculté de Medicine, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Nathalie Champoux
- Faculty of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - T T Minh Vu
- Centre de recherche du CHUM, 91000, rue Saint-Denis, Montréal, QC, H2X 0A9, Canada
| | - Martin G Cole
- Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, QC, H3A 1A, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Cote St. Catherine Road, Room E-0012, Montreal, QC, H3T 1E2, Canada
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC, H3A 1A2, Canada
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Eric Belzile
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050 chemin Sainte-Foy, L2-30, Quebec City, QC, G1S 4L8, Canada
| | - Ted McConnell
- Division of General Internal Medicine, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
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Tejera D, Rana M, Basik M, Boileau JF, Margolese R, Prakash I, Meguerditchian AN, Muanza T, Monette J, Wong SM. Population-based analysis of non-operative management and treatment patterns in older women with estrogen receptor-positive breast cancer. Breast Cancer Res Treat 2021; 190:491-501. [PMID: 34542772 DOI: 10.1007/s10549-021-06393-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the proportion of older women with ER + HER2- breast cancer receiving non-operative management versus surgery, and to evaluate the use of axillary staging and adjuvant radiation in this population. METHODS We queried the SEER database to identify all women aged 70 years or older with stage I-III ER + HER2- invasive breast cancer diagnosed between 2010 and 2016. We evaluated trends in non-operative management, breast surgery, axillary staging, and adjuvant radiation according to age at diagnosis. RESULTS We identified 57,351 older women with ER + HER2- disease. Overall, 3538 (6.2%) of the cohort underwent non-operative management, 38,452 (67.0%) underwent breast-conserving surgery (BCS), and 15,361 (26.8%) underwent mastectomy. The proportion of patients undergoing non-operative management increased from 2.8% among 70-74-year-old women to 30.1% in those ≥ 90 years old (p < 0.001). In 53,813 women who underwent surgery, 36,850 (68.5%) underwent sentinel lymph node biopsy, while 10,861 (20.2%) underwent axillary lymph node dissection. Subgroup analysis of 29,032 older women undergoing BCS for stage I ER + HER2- breast cancer revealed a 14.2% rate of omission of axillary staging, increasing from 5.3% in those 70-74 years to 67.6% in those ≥ 90 years old (p < 0.001). Receipt of adjuvant radiation occurred in 63.3% of older women following BCS and 18% post-mastectomy, with similar trends towards omission in older age groups. CONCLUSION Primary breast surgery remains the dominant management strategy for the majority of older women with ER + HER2- breast cancer. Omission of axillary staging and adjuvant radiation are used in a minority of eligible women undergoing breast conservation for early-stage disease.
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Affiliation(s)
- David Tejera
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
| | - Mariam Rana
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
| | - Mark Basik
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada.,Segal Cancer Centre, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, Montreal, QC, H3T1E2, Canada.,Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | | | - Richard Margolese
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada.,Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Ipshita Prakash
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada.,Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Ari N Meguerditchian
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada.,Department of Oncology, McGill University Medical School, Montreal, QC, Canada.,St-Mary's Research Centre, West Island University Health and Social Services Centre, Montreal, QC, Canada.,McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Thierry Muanza
- Department of Oncology, McGill University Medical School, Montreal, QC, Canada.,Department of Radiation Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Johanne Monette
- Department of Geriatric Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Stephanie M Wong
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada. .,Segal Cancer Centre, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, Montreal, QC, H3T1E2, Canada. .,Department of Oncology, McGill University Medical School, Montreal, QC, Canada.
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Silverstone-Simard I, Wu J, Nassim M, Friedman R, Segal M, Monette J, Rej S. Management of Agitation in Dementia and Effects on Inpatient Length of Stay. Can Geriatr J 2021; 24:111-117. [PMID: 34079604 PMCID: PMC8137459 DOI: 10.5770/cgj.24.483] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Agitation associated with dementia impacts delivery of medical care and is a major reason for institutionalization in dementia patients. This study examines the association of medication use and other clinical factors with patients' 'dischargeability' (i.e., amount of time until a patient is considered dischargeable from an inpatient unit). Methods This study was a retrospective chart review examining 200 patients with dementia and agitation, hospitalized at a Canadian acute care geriatric ward between November 2007 and November 2018. The main outcome measure was time until a patient was deemed dischargeable. Univariate linear regression analyses, followed by multiple linear regression analyses, were used. Results Risperidone and quetiapine were the most commonly prescribed medications, but were not associated with time until dischargeable. Olanzapine (40.9 vs. 16.2 days until dischargeable, β = 0.23, p = .001), regular benzodiazepine (32.7 vs. 16.5 days until dischargeable, β = 0.15, p = .027), and as-needed ('PRN') benzodiazepine use (31.7 vs. 15.9 days until dischargeable, β =0.19, p = .006) were independently associated with prolonging time until dischargeable. Conclusions Olanzapine, benzodiazepine, and PRN benzodiazepine use were associated with longer time until patients with dementia and agitation were considered ready for discharge. This raises the question as to whether the risks of these medications outweigh the benefits in a hospital setting.
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Affiliation(s)
- Isabelle Silverstone-Simard
- GeriPARTy Research Group, Dept. of Psychiatry, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, QC
| | - Joyce Wu
- GeriPARTy Research Group, Dept. of Psychiatry, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, QC
| | - Marouane Nassim
- GeriPARTy Research Group, Dept. of Psychiatry, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, QC
| | - Ruby Friedman
- Division of Geriatric Medicine, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, QC
| | - Marilyn Segal
- Division of Geriatric Medicine, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, QC
| | - Johanne Monette
- Division of Geriatric Medicine, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, QC
| | - Soham Rej
- GeriPARTy Research Group, Dept. of Psychiatry, Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, QC
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10
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Puts M, Alqurini N, Strohschein F, Monette J, Wan-Chow-Wah D, Koneru R, Szumacher E, Mehta R, Mariano CJ, Li A, Hsu T, Brennenstuhl S, Mclean B, Wills A, Amir E, Krzyzanowska MK, Elser C, Pitters E, Breunis H, Alibhai SM. Comprehensive geriatric assessment and management for Canadian elders with Cancer: The 5C study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12011 Background: Comprehensive Geriatric Assessment (CGA) is recommended by ASCO for older adults with cancer undergoing chemotherapy to identify issues that can interfere with treatment delivery and optimize functional status and quality of life. However, few randomized controlled trials have been completed so far. Our objective is to evaluate the effectiveness of CGA on improving quality of life for older adults receiving cancer treatment. Methods: Eligible patients were aged 70+, diagnosed with a solid tumour, lymphoma or myeloma, referred for first/second line chemotherapy, speaking English/French, and with an Eastern Collaborative Oncology Group Performance Status 0–2. The CGA was done by a nurse and geriatrician followed by monthly phone calls by the study nurse for 6 months. Patients were randomly assigned (1:1) to receive either the intervention (CGA plus follow-up by geriatric trained team in addition to usual oncology care) or usual care alone. All participants received a monthly healthy aging booklet for attention control. Randomization was stratified by center and treatment intent (curative/adjuvant versus palliative). Our primary outcome was health-related quality of life (HRQOL) assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health scale (items 29 and 30). Secondary outcomes include functional status (Instrumental Activities of Daily Living). Outcome data collection was completed monthly for the first 6 months, then at 9 and 12 months. For the primary outcome we used a pattern mixture model using an intent-to-treat approach (at 0, 3, and 6 months). The last data collection took place March 8 2021. Results: From May 2017 to March 2020, 351 participants from 8 hospitals across Canada were enrolled. All patients were seen on or after day 1 of treatment for the intervention per patient request. Patient characteristics at baseline were similar in both arms. The average age was 75.7 (SD = 4.8), 60.4% was male and 54.3% had treatment with palliative intent. Change in HRQOL scores did not differ by arm (p =.80). Neither group exceeded the MCID of 10 points. There was also no difference in IADL between the groups (p = 0.82). Conclusion: CGA was not effective in improving quality of life for older adults receiving cancer treatment in this study. CGA may need to be performed prior to treatment initiation to achieve benefits. Clinical trial information: NCT03154671.
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Affiliation(s)
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | | | - Johanne Monette
- McGill University, Jewish General Hospital, Montréal, QC, Canada
| | | | | | - Ewa Szumacher
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rajin Mehta
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Anson Li
- Royal Columbian Hospital, New Westminster, BC, Canada
| | - Tina Hsu
- Ottawa Hospital, Ottawa, ON, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Bianca Mclean
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, Toronto, ON, Canada
| | - Eitan Amir
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Christine Elser
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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11
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Wong SM, Boileau JF, Rana M, Muanza T, Margolese RG, Monette J, Bahoric B, Basik M. Breast cancer in women aged 80 years and older: Clinical characteristics and treatment patterns according to biologic subtype. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e12594] [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] Open
Abstract
e12594 Background: Older age is associated with poorer breast cancer-specific survival (BCSS) outcomes, despite a higher prevalence of biologically favorable disease. We sought to evaluate differences in the clinical characteristics and management of older women according to biologic subtype of breast cancer. Methods: The Surveillance, Epidemiology, and End Results (SEER) treatment database was queried to identify all women aged 80 years or older with a first diagnosis of invasive breast cancer between 2010 and 2016. Patients were subgrouped according to biologic subtype and clinical and treatment-related variables were compared. Multivariable logistic regression was then performed to determine factors independently associated with receipt of breast-conserving surgery (BCS) and adjuvant radiation. Results: Overall, 27,375 women with a median age of 84 (range, 80-108 years) met inclusion criteria. The majority of older women were diagnosed with HR+HER2- breast cancer (78.9%), followed by HER2+ (11.0%) and triple-negative breast cancer (TNBC) (10.0%). In women with stage I-III disease, non-operative management was employed in 13.4% of HR+HER2- patients, compared to 16.7% of HER2+ patients and 11.0% of TNBC (p < 0.001). In those undergoing surgery, BCS was most common in HR+HER2- patients (80.9%), compared to HER2+ (68.9%) and TNBC (67.8%; p < 0.001). Axillary surgery was performed in 74.0% of early stage patients with HR+HER2- disease, compared to patients with HER2+ (77.8%) and TNBC (79.3%; p < 0.001). In adjusted analyses controlling for stage and clinical variables, women aged 80 years or older with HER2+ breast cancer and TNBC had a lower likelihood of BCS (ORHER2+ 0.72, 95% CI 0.65-0.80; ORTNBC 0.72, 95% CI 0.65-0.81), and an increased likelihood of adjuvant radiation (ORHER2+ 1.14, 95% CI 1.02-1.27; ORTNBC 1.40, 95% CI 1.25-1.57). Conclusions: One fifth of women with breast cancer over age 80 are diagnosed with HER2+ and triple-negative subtypes, which are associated with more aggressive local therapy. Further studies are warranted to determine if higher rates of adjuvant radiation optimize local control in older HER2+ and TNBC patients at increased risk for early locoregional recurrences.
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Affiliation(s)
- Stephanie M Wong
- McGill University, Jewish General Hospital Segal Cancer Centre, Montréal, QC, Canada
| | - Jean-Francois Boileau
- McGill University, Jewish General Hospital Segal Cancer Centre, Montréal, QC, Canada
| | - Mariam Rana
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
| | - Thierry Muanza
- McGill University, Jewish General Hospital, Montréal, QC, Canada
| | - Richard G. Margolese
- McGill University, Jewish General Hospital Segal Cancer Centre, Montréal, QC, Canada
| | - Johanne Monette
- McGill University, Jewish General Hospital, Montréal, QC, Canada
| | - Boris Bahoric
- McGill University, Jewish General Hospital, Montréal, QC, Canada
| | - Mark Basik
- McGill University, Jewish General Hospital Segal Cancer Centre, Montréal, QC, Canada
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12
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Puts M, Strohschein F, Mclean B, Alqurini N, Syed A, Amir E, Béland F, Berger A, Bergman S, Vanderbyl B, Breunis H, Elser C, Emmenegger U, Fung S, Hsu T, Jang R, Krahn M, Koneru R, Kozlowski N, Krzyzanowska M, Lemonde M, Li A, Mariano C, Mehta R, Monette J, Papadakos J, Pitters E, Prica A, Ray J, Romanofsky L, Szumacher E, Wan-Chow-Wah D, Langleben A, Alibhai S. CLINICAL AND COST-EFFECTIVENESS OF COMPREHENSIVE GERIATRIC ASSESSMENT AND MANAGEMENT FOR CANADIAN ELDERS WITH CANCER: THE 5C STUDY – INITIAL RECRUITMENT AND IMPLEMENTATION RESULTS. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Puts MTE, Hsu T, Mariano C, Monette J, Brennenstuhl S, Pitters E, Ray J, Wan-Chow-Wah D, Kozlowski N, Krzyzanowska M, Amir E, Elser C, Jang R, Prica A, Krahn M, Beland F, Bergman S, Koneru R, Lemonde M, Szumacher E, Zidulka J, Fung S, Li A, Emmenegger U, Mehta R, Flemming K, Breunis H, Alibhai SMH. Clinical and Cost-effectiveness of a Comprehensive geriatric assessment and management for Canadian elders with Cancer-the 5C study: a study protocol for a randomised controlled phase III trial. BMJ Open 2019; 9:e024485. [PMID: 31079079 PMCID: PMC6530407 DOI: 10.1136/bmjopen-2018-024485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 03/07/2019] [Accepted: 03/13/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Geriatric assessment and management is recommended for older adults with cancer referred for chemotherapy but no randomised controlled trial has been completed of this intervention in the oncology setting. TRIAL DESIGN A two-group parallel single blind multi-centre randomised trial with a companion trial-based economic evaluation from both payer and societal perspectives with process evaluation. PARTICIPANTS A total of 350 participants aged 70+, diagnosed with a solid tumour, lymphoma or myeloma, referred for first/second line chemotherapy, who speak English/French, have an Eastern Collaborative Oncology Group Performance Status 0-2 will be recruited. All participants will be followed for 12 months. INTERVENTION Geriatric assessment and management for 6 months. The control group will receive usual oncologic care. All participants will receive a monthly healthy ageing booklet for 6 months. OBJECTIVE To study the clinical and cost-effectiveness of geriatric assessment and management in optimising outcomes compared with usual oncology care. RANDOMISATION Participants will be allocated to one of the two arms in a 1:1 ratio. The randomisation will be stratified by centre and treatment intent (palliative vs other). OUTCOME Quality of life. SECONDARY OUTCOMES (1) Cost-effectiveness, (2) functional status, (3) number of geriatric issues successfully addressed, (4) grades3-5 treatment toxicity, (5) healthcare use, (6) satisfaction, (7) cancer treatment plan modification and (8) overall survival. PLANNED ANALYSIS For the primary outcome we will use a pattern mixture model using an intent-to-treat approach (at 3, 6 and12 months). We will conduct a cost-utility analysis alongside this clinical trial. For secondary outcomes 2-4, we will use a variety of methods. ETHICS AND DISSEMINATION Our study has been approved by all required REBs. We will disseminate our findings to stakeholders locally, nationally and internationally and by publishing the findings. TRIAL REGISTRATION NUMBER NCT03154671.
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Affiliation(s)
- Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tina Hsu
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Caroline Mariano
- Department of Medical Oncology, The Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, The Jewish General Hospital, Montreal, Quebec, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Eric Pitters
- Older adult representative, Oshawa, Ontario, Canada
| | - Jack Ray
- Older adult representative, Calgary, Alberta
| | - Doreen Wan-Chow-Wah
- Division of Geriatric Medicine, The Jewish General Hospital, Montreal, Quebec, Canada
| | - Natascha Kozlowski
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada
| | - Monika Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medical Oncology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Christine Elser
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medical Oncology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Raymond Jang
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anca Prica
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Francois Beland
- Public Health School, University of Montreal, Montreal, Quebec, Canada
| | - Simon Bergman
- Department of Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Rama Koneru
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Joan Zidulka
- Department of Oncology, St. Mary's Hospital, Montreal, Quebec, Canada
| | - Shek Fung
- Department of Oncology, St. Mary's Hospital, Montreal, Quebec, Canada
| | - Anson Li
- Department of Geriatric Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Urban Emmenegger
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajin Mehta
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kendra Flemming
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Henriette Breunis
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
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14
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Wilchesky M, Mueller G, Morin M, Marcotte M, Voyer P, Aubin M, Carmichael PH, Champoux N, Monette J, Giguère A, Durand P, Verreault R, Arcand M, Kröger E. The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study. BMC Geriatr 2018; 18:204. [PMID: 30180821 PMCID: PMC6123948 DOI: 10.1186/s12877-018-0895-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication regimens in nursing home (NH) residents with severe dementia should be frequently reviewed to avoid inappropriate medication, overtreatment and adverse drug events, within a comfort care approach. This study aimed at testing the feasibility of an interdisciplinary knowledge exchange (KE) intervention using a medication review guidance tool categorizing medications as either "generally", "sometimes" or "exceptionally" appropriate for NH residents with severe dementia. METHODS A quasi-experimental feasibility pilot study with 44 participating residents aged 65 years or over with severe dementia was carried out in three NH in Quebec City, Canada. The intervention comprised an information leaflet for residents' families, a 90-min KE session for NH general practitioners (GP), pharmacists and nurses focusing on the medication review guidance tool, a medication review by the pharmacists for participating residents with ensuing team discussion on medication changes, and a post-intervention KE session to obtain feedback from team staff. Medication regimens and levels of pain and of agitation of the participants were evaluated at baseline and at 4 months post-intervention. A questionnaire for team staff explored perceived barriers and facilitators. Statistical differences in measures comparing pre and post-intervention were assessed using paired t-tests and Cochran's-Q tests. RESULTS The KE sessions reached 34 NH team staff (5 GP, 4 pharmacists, 6 heads of care unit and 19 staff nurses). Forty-four residents participated in the study and were followed for a mean of 104 days. The total number of regular medications was 372 pre and 327 post-intervention. The mean number of regular medications per resident was 7.86 pre and 6.81 post-intervention. The odds ratios estimating the risks of using any regular medication or a "sometimes appropriate" medication post-intervention were 0.81 (95% CI: 0.71-0.92) and 0.83 (95% CI: 0.74-0.94), respectively. CONCLUSION A simple KE intervention using a medication review guidance tool categorizing medications as being either "generally", "sometimes" or "exceptionally" appropriate in severe dementia was well received and accompanied by an overall reduction in medication use by NH residents with severe dementia. Levels of agitation were unaffected and there was no clinically significant changes in levels of pain. Staff feedback provided opportunities to improve the intervention.
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Affiliation(s)
- Machelle Wilchesky
- Department of Family Medicine and Division of Geriatric Medicine, McGill University, 5858, Chemin de la Côte-des-Neiges, Montreal, Quebec, H3S 1Z1, Canada.,Donald Berman Maimonides Centre for Research in Aging, 5795 Caldwell Avenue, Montreal, Quebec, H4W 1W3, Canada
| | - Gerhard Mueller
- Department of Nursing Science and Gerontology, UMIT-The Health & Life Sciences University, Eduard-Wallnoefer-Zentrum 1, A-6060, Hall in Tyrol, Tyrol, Austria
| | - Michèle Morin
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Philippe Voyer
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Michèle Aubin
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Nathalie Champoux
- Faculté de médecine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Côte-Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada
| | - Anik Giguère
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Pierre Durand
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - René Verreault
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Marcel Arcand
- Centre de recherche sur le vieillissement, affilié à l'Université de Sherbrooke, 1036, rue Belvédère Sud, Sherbrooke, Quebec, J1H 4C4, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada. .,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada.
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15
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Puts MTE, Sattar S, Kulik M, MacDonald ME, McWatters K, Lee K, Brennenstuhl S, Jang R, Amir E, Krzyzanowska MK, Joshua AM, Monette J, Wan-Chow-Wah D, Alibhai SMH. A randomized phase II trial of geriatric assessment and management for older cancer patients. Support Care Cancer 2017; 26:109-117. [DOI: 10.1007/s00520-017-3820-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/03/2017] [Indexed: 01/15/2023]
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Cole MG, McCusker J, Wilchesky M, Voyer P, Monette J, Champoux N, Vu M, Ciampi A, Belzile E. Use of medications that antagonize mediators of inflammatory responses may reduce the risk of delirium in older adults: a nested case-control study. Int J Geriatr Psychiatry 2017; 32:208-213. [PMID: 27001903 DOI: 10.1002/gps.4468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this study is to explore whether the use of medications that antagonize mediators of inflammatory responses reduces the risk of delirium in older adults. METHODS A nested case-control study was conducted using data from a prospective study of delirium in older long-term care residents from 7 long-term care facilities in Montreal and Quebec City, Canada. The Confusion Assessment Method was used to diagnose incident delirium. The use of medications that antagonize mediators of inflammatory responses was determined by examining facility pharmacy databases and coding medications received daily by each resident. Risk sets were built using incidence density sampling: each risk set consisted of a case with incident delirium and all controls without incident delirium at the same date and facility. Conditional logistic regression was used to assess the association of exposure to inflammation antagonist medications with the incidence of delirium. RESULTS Of 254 residents, 95 developed incident delirium during 24 weeks (cases); each case was matched with up to 35 controls. Unadjusted and adjusted odds ratios (95% CI) of delirium for residents exposed to at least one inflammation antagonist medication were 0.53 (0.34, 0.81) and 0.60 (0.38, 0.92), respectively. Estimates of the risk of incident delirium associated with specific medications and medication classes were mostly protective but not statistically significant. CONCLUSION The use of medications that antagonize mediators of inflammatory responses may reduce the risk of delirium in older adults. Despite study limitations, the findings merit further investigation using larger patient samples, more precise measures of exposure and better control of potential confounding variables. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center and McGill University, Montreal, Quebec.,St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec
| | - Jane McCusker
- St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
| | - Machelle Wilchesky
- Division of Geriatric Medicine, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec.,Donald Berman Maimonides Geriatric Center, Montreal, Quebec
| | - Philippe Voyer
- Faculty of Nursing Sciences, Laval University, Montreal, Quebec
| | - Johanne Monette
- Division of Geriatric Medicine, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec.,Donald Berman Maimonides Geriatric Center, Montreal, Quebec
| | - Nathalie Champoux
- Institut Universitaire de Gériatrie de Montréal; Département de médecine familiale, Université de Montréal, Montreal, Quebec
| | - Minh Vu
- Division of Geriatric Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec.,Department of Medicine, Université de Montréal, Montreal, Quebec
| | - Antonio Ciampi
- St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
| | - Eric Belzile
- St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec
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Puts M, Sattar S, Macdonald ME, Kulik M, McWatters K, Lee K, Amir E, Jang RWJ, Krzyzanowska MK, Joshua AM, Monette J, Wan-Chow-Wah D, Alibhai SM. A feasibility trial of geriatric assessment and integrated care plan for older cancer patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Mary Ellen Macdonald
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Michael Kulik
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | | | - Eitan Amir
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Raymond Woo-Jun Jang
- Princess Margaret Cancer Centre, University Health Network, Division of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Monika K. Krzyzanowska
- Princess Margaret Cancer Centre, University Health Network, Division of Medical Oncology and Hematology, Toronto, ON, Canada
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Voyer P, Champoux N, Desrosiers J, Landreville P, McCusker J, Monette J, Savoie M, Carmichael PH, Richard H, Richard S. RADAR: A Measure of the Sixth Vital Sign? Clin Nurs Res 2015; 25:9-29. [PMID: 26337503 DOI: 10.1177/1054773815603346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to investigate the potential of RADAR (Recognizing Active Delirium As part of your Routine) as a measure of the sixth vital sign. This study was a secondary analysis of a study (N = 193) that took place in one acute care hospital and one long-term care facility. The primary outcome was a positive sixth vital sign, defined as the presence of both an altered level of consciousness and inattention. These indicators were assessed using the Confusion Assessment Method. RADAR identified 30 of the 43 participants as having a positive sixth vital sign and 58 of the 70 cases as not, yielding a sensitivity and specificity of 70% and 83%, respectively. Positive predictive value was 71%. RADAR's characteristics, including its brevity and acceptability by nursing staff, make this tool a good candidate as a measure of the sixth vital sign. Future studies should address the generalizability of RADAR among various populations and clinical settings.
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Affiliation(s)
- Philippe Voyer
- Laval University, Quebec City, Canada Centre for Excellence in Aging-Research Unit, Quebec City, Canada
| | | | | | | | - Jane McCusker
- St Mary's Hospital, Montreal, Quebec, Canada McGill University, Montreal, Quebec, Canada
| | - Johanne Monette
- Jewish General Hospital, Montreal, Quebec, Canada Donald Berman Maimonides Geriatric Center, Montreal, Quebec, Canada
| | | | | | - Hélène Richard
- Centre for Excellence in Aging-Research Unit, Quebec City, Canada
| | - Sylvie Richard
- Centre for Excellence in Aging-Research Unit, Quebec City, Canada
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Lungu O, Bruneau MA, Ballard S, Voyer P, Landreville P, Verreault R, Gore B, Champoux N, Desrosiers J, Kröger E, Monette J, Peretti M, Wilchesky M. P4‐055: Changes in neuropsychiatric subsyndromes in long‐term care residents with dementia across the circadian cycle. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.1760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ovidiu Lungu
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
- Université de MontréalMontrealQCCanada
| | | | - Stephanie Ballard
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
| | | | | | - René Verreault
- Université LavalQuebec CityQCCanada
- Centre d'Excellence sur le Vieillissement du CHU de QuébecQuébecQCCanada
| | - Brian Gore
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
| | | | | | - Edeltraut Kröger
- Université LavalQuebec CityQCCanada
- Centre d'Excellence sur le Vieillissement du CHU de QuébecQuébecQCCanada
| | | | - Matteo Peretti
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
| | - Machelle Wilchesky
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
- McGill UniversityMontrealQCCanada
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Kröger E, Wilchesky M, Marcotte M, Voyer P, Morin M, Champoux N, Monette J, Aubin M, Durand PJ, Verreault R, Arcand M. Medication Use Among Nursing Home Residents With Severe Dementia: Identifying Categories of Appropriateness and Elements of a Successful Intervention. J Am Med Dir Assoc 2015; 16:629.e1-17. [DOI: 10.1016/j.jamda.2015.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 12/20/2022]
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21
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Puts M, Sattar S, McWatters K, Lee K, Amir E, Krzyzanowska MK, Joshua AM, Monette J, Wan-Chow-Wah D, Jang RWJ, Alibhai SM. A feasibility trial of geriatric assessment and integrated care plan for older cancer patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps9634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Eitan Amir
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Center, Toronto, ON, Canada
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22
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Puts MT, Tapscott B, Fitch M, Howell D, Monette J, Wan-Chow-Wah D, Krzyzanowska MK, Leighl NB, Springall E, Alibhai SM. A Systematic Review of Factors Influencing Older Adults’ Hypothetical Treatment Decisions. ACTA ACUST UNITED AC 2015. [DOI: 10.17925/ohr.2015.11.01.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose:Cancer affects mostly older adults and although research has shown that a significant proportion of seniors do not receive treatment, little is known about the reasons why. Therefore, we conducted a systematic review of reasons why older adults accept or decline cancer treatments.Design:Systematic review of studies reporting on hypothetical cancer treatment scenarios in older patients published between inception of 10 databases and February 2013.Results:Of 17,343 abstracts reviewed, a total of 12 studies were included (sample size 21 to 511). The willingness to be treated varied by the benefits of treatment (ranging from never to always accepting the treatment), the particular side effects of treatment, and previous treatments received/previous treatment experiences (those who were treated previously were more likely to accept the same treatment). Results showed conflicting findings with regard to the impact of age, education (those with lower/higher age/education wanting more benefits before accepting), and family situation (no effect/those who were single were less likely to accept).Conclusion:Willingness among older adults to be treated was most influenced by the extent of benefits and side effects as well as prior treatment experiences. However, little is known about treatment preferences of the oldest old, those with multimorbidity, and preferences for newer agents.
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Voyer P, McCusker J, Cole MG, Monette J, Champoux N, Ciampi A, Belzile E, Richard H. Behavioral and Psychological Symptoms of Dementia: How Long Does Every Behavior Last, and Are Particular Behaviors Associated With PRN Antipsychotic Agent Use? J Gerontol Nurs 2015; 41:22-37; quiz 38-9. [DOI: 10.3928/00989134-20141030-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/29/2014] [Indexed: 11/20/2022]
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McCusker J, Cole MG, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. Six-month outcomes of co-occurring delirium, depression, and dementia in long-term care. J Am Geriatr Soc 2014; 62:2296-302. [PMID: 25482152 DOI: 10.1111/jgs.13159] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the 6-month outcomes of co-occurring delirium (full syndrome and subsyndromal symptoms), depression, and dementia in a long-term care (LTC) population. DESIGN Observational, prospective cohort study with 6-month follow-up conducted from 2005 to 2009. SETTING Seven LTC facilities in the province of Quebec, Canada. PARTICIPANTS Newly admitted and long-term residents recruited consecutively from lists of residents aged 65 and older admitted for LTC, with stratification into groups with and without severe cognitive impairment. The study sample comprised 274 residents with complete data at baseline on delirium, dementia, and depression. MEASUREMENTS Outcomes were 6-month mortality, functional decline (10-point decline from baseline on 100-point Barthel scale), and cognitive decline (3-point decline on 30-point Mini-Mental State Examination). Predictors included delirium (full syndrome or subsyndromal symptoms, using the Confusion Assessment Method), depression (Cornell Scale for Depression in Dementia), and dementia (chart diagnosis). RESULTS The baseline prevalences of delirium, subsyndromal symptoms of delirium (SSD), depression, and dementia were 11%, 44%, 19%, and 66%, respectively. By 6 months, 10% of 274 had died, 19% of 233 had experienced functional decline, and 17% of 246 had experienced cognitive decline. An analysis using multivariable generalized linear models found the following significant interaction effects (P < .15): between depression and dementia for mortality, between delirium and depression for functional decline, and between SSD and dementia for cognitive decline. CONCLUSION Co-occurrence of delirium, SSD, depression, and dementia in LTC residents appears to affect some 6-month outcomes. Because of limited statistical power, it was not possible to draw conclusions about the effects of the co-occurrence of some syndromes on poorer outcomes.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, St Mary's Hospital Center, Montreal; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
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25
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Puts M, Tapscott B, Fitch M, Howell D, Monette J, Wan-Chow-Wah D, Krzyzanowska M, Leighl N, Springall E, Alibhai S. A systematic review of factors influencing older adults' decision to accept or decline cancer treatment in studies examining actual treatment decisions. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Yin H, Monette J, Wan-Chow-Wah D, Gotlieb W. Validation of g-8 screening tool for comprehensive geriatric assessment & post-operative delirium in gynecological cancer patients undergoing robotic surgery. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Kergoat H, Boisjoly H, Freeman EE, Monette J, Roy S, Kergoat MJ. The Perceived Needs and Availability of Eye Care Services for Older Adults in Long-term Care Facilities. Can Geriatr J 2014; 17:108-13. [PMID: 25232370 PMCID: PMC4164678 DOI: 10.5770/cgj.17.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The objective was to evaluate the eye care services offered to older residents living in long-term care facilities (LTCFs). Methods A questionnaire targeting residents aged ≥65 years was sent to all LTCFs in Quebec. Questions related to the institution’s characteristics, demographic data related to residents, oculovisual health of residents and barriers to eye care, eye care services offered within and outside the institution, and degree of satisfaction regarding the eye care services offered to residents. Results 196/428 (45.8%) LTCFs completed the questionnaire. Participating LTCFs had an average of 97.0 ± 5.1 residents with a mean age of 82.8 ± 3.0 yrs and 69% women. Eye care services were mostly offered outside the institution, on a “per request” basis. The main barriers to eye care were the perception that residents could not cooperate and the lack of eye care professionals. Most LTCFs were satisfied with the eye care services offered to residents. Conclusions The fact that the LTCFs were satisfied with the eye care services offered to their residents, although it was neither provided on a regular basis nor to all residents, suggests that eye care professionals should take a proactive educational role for improving services to older institutionalized adults.
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Affiliation(s)
- Hélène Kergoat
- School of Optometry, Université de Montréal, Montréal; ; Institut universitaire de gériatrie de Montréal, Montréal
| | - Hélène Boisjoly
- Faculty of Medicine, Université de Montréal, Montréal; ; Ophthalmology, Hôpital Maisonneuve-Rosemont, Montréal
| | - Ellen E Freeman
- Faculty of Medicine, Université de Montréal, Montréal; ; Ophthalmology, Hôpital Maisonneuve-Rosemont, Montréal
| | - Johanne Monette
- Jewish General Hospital, Montréal, McGill University, Montréal, QC ; McGill University, Montréal, QC
| | - Sylvie Roy
- Institut universitaire de gériatrie de Montréal, Montréal
| | - Marie-Jeanne Kergoat
- Institut universitaire de gériatrie de Montréal, Montréal; ; Faculty of Medicine, Université de Montréal, Montréal
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Voyer P, McCusker J, Cole MG, Monette J, Champoux N, Vu M, Ciampi A, Sanche S, Richard S, de Raad M. Feasibility and Acceptability of a Delirium Prevention Program for Cognitively Impaired Long Term Care Residents: A Participatory Approach. J Am Med Dir Assoc 2014; 15:77.e1-9. [DOI: 10.1016/j.jamda.2013.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
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29
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Puts MTE, Santos B, Hardt J, Monette J, Girre V, Atenafu EG, Springall E, Alibhai SMH. An update on a systematic review of the use of geriatric assessment for older adults in oncology. Ann Oncol 2013; 25:307-15. [PMID: 24256847 DOI: 10.1093/annonc/mdt386] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Our previous systematic review of geriatric assessment (GA) in oncology included a literature search up to November 2010. However, the quickly evolving field warranted an update. Aims of this review: (i) provide an overview of all GA instruments developed and/or in use in the oncology setting; (ii) evaluate effectiveness of GA in predicting/modifying outcomes (e.g. treatment decision impact, treatment toxicity, mortality, use of care). MATERIALS AND METHODS Systematic review of literature published between November 2010 and 10 August 2012. English, Dutch, French and German-language articles reporting cross-sectional or longitudinal, intervention or observational studies of GA instruments were included. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane Library. Two researchers independently reviewed abstracts, abstracted data and assessed the quality using standardized forms. A meta-analysis method of combining proportions was used for the outcome impact of GA on treatment modification with studies included in this update combined with those included in our previous systematic review on the use of GA. RESULTS Thirty-five manuscripts reporting 34 studies were identified. Quality of most studies was moderate to good. Eighteen studies were prospective, 11 cross-sectional and 5 retrospective. Three studies examined treatment decision-making impact and found decisions changed for fewer than half of assessed patients (weighted percent modification is 23.2% with 95% confidence interval (20.3% to 26.1%). Seven studies reported conflicting findings regarding predictive ability of GA for treatment toxicity/complications. Eleven studies examined GA predictions of mortality, and reported that instrumental activities of daily living, poor performance status and more numerous GA deficits were associated with increased mortality risk. Other outcomes could not be meta-analyzed. CONCLUSION Consistent with our previous review, several domains of GA are associated with adverse outcomes. However, further research examining effectiveness of GA on treatment decisions and oncologic outcomes is needed.
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Affiliation(s)
- M T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto
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30
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Tebo J, Strohschein F, Alfonso L, Wan-Chow-Wah D, Gaba F, Monette J, Belkhous N. Nurse navigation in the context of an interdisciplinary consultation service for older adults with cancer. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Wan-Chow-Wah D, Monette J, Gaba F, Alfonso L, Strohschein F, Tebo J, Chirigiu A, Puts M, Belkhous N. Functional disability and presence of frailty markers in older cancer patients referred to a geriatric oncology clinic. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Puts M, Wan-Chow-Wah D, Howell D, Fitch M, Krzyzanowska M, Leighl N, Monette J, Springall E, Alibhai S. A systematic review of factors influencing older adults' decision to accept or refuse cancer treatment. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Puts M, Monette J, Girre V, Sourial N, Wolfson C, Monette M, Batist G, Bergman H. The relationship of self-rated health with functional status, toxicity and mortality: Results of a prospective pilot study of older patients with newly-diagnosed cancer. J Geriatr Oncol 2013; 4:319-26. [DOI: 10.1016/j.jgo.2013.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/13/2013] [Accepted: 07/17/2013] [Indexed: 12/01/2022]
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Mandilaras V, Wan-Chow-Wah D, Monette J, Gaba F, Monette M, Alfonso L. The impact of cancer therapy on cognition in the elderly. Front Pharmacol 2013; 4:48. [PMID: 23626575 PMCID: PMC3630330 DOI: 10.3389/fphar.2013.00048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/28/2013] [Indexed: 12/20/2022] Open
Abstract
Cancer and cancer therapy-related cognitive impairment (formerly known as chemobrain or chemo-fog) are often described in the literature. In the past, studies have failed to prove the existence of cancer therapy-related cognitive dysfunction. However, more recently, prospective trials have shown that patients undergoing chemotherapy do display impairment in specific cognitive domains. Aging confers an increased risk of developing cancer, as well as cognitive impairment. The Geriatric Oncology clinic of the Segal Cancer Centre, Jewish General Hospital in Montreal was founded in 2006 to address the unique needs of older cancer patients. We will describe two cases of cancer therapy-related cognitive impairment from our Geriatric Oncology clinic. The first case is that of a 75 year old male diagnosed with stage III non-small cell lung carcinoma who complained of forgetfulness since starting carboplatin-paclitaxel. The second case is that of a 65 year old female diagnosed with stage I, estrogen-receptor-positive breast cancer who had undergone lumpectomy followed by adjuvant cyclophosphamide, methotrexate and fluorouracil chemotherapy, radiation therapy and was on exemestane when she was evaluated. We will also briefly review the literature of cancer therapy-related cognitive impairment.
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Affiliation(s)
- Victoria Mandilaras
- Division of Geriatric Medicine, Jewish General Hospital Montreal, QC, Canada ; Internal Medicine Residency Training Program, McGill University Montreal, QC, Canada
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35
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McCusker J, Cole MG, Voyer P, Vu M, Ciampi A, Monette J, Champoux N, Belzile E, Dyachenko A. Environmental factors predict the severity of delirium symptoms in long-term care residents with and without delirium. J Am Geriatr Soc 2013; 61:502-11. [PMID: 23581909 DOI: 10.1111/jgs.12164] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify potentially modifiable environmental factors (including number of medications) associated with changes over time in the severity of delirium symptoms and to explore the interactions between these factors and resident baseline vulnerability. DESIGN Prospective, observational cohort study. SETTING Seven long-term care (LTC) facilities. PARTICIPANTS Two hundred seventy-two LTC residents aged 65 and older with and without delirium. MEASUREMENTS Weekly assessments (for up to 6 months) of the severity of delirium symptoms using the Delirium Index (DI), environmental risk factors, and number of medications. Baseline vulnerability measures included a diagnosis of dementia and a delirium risk score. Associations between environmental factors, medications, and weekly changes in DI were analyzed using a general linear model with correlated errors. RESULTS Six potentially modifiable environmental factors predicted weekly changes in DI (absence of reading glasses, aids to orientation, family member, and glass of water and presence of bed rails and other restraints) as did the prescription of two or more new medications. Residents with dementia appeared to be more sensitive to the effects of these factors. CONCLUSION Six environmental factors and prescription of two or more new medications predicted changes in the severity of delirium symptoms. These risk factors are potentially modifiable through improved LTC clinical practices.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, St. Mary's Hospital, Montreal, Quebec, Canada.
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36
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Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. The course of subsyndromal delirium in older long-term care residents. Am J Geriatr Psychiatry 2013; 21:289-96. [PMID: 23395196 DOI: 10.1016/j.jagp.2012.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/16/2011] [Accepted: 10/20/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the course of incident subsyndromal delirium (SSD) in older long-term care (LTC) residents. A secondary objective was to explore the use of a more restrictive definition of SSD on the findings of the study. DESIGN Cohort study with repeated weekly assessments for up to 6 months. SETTING Seven LTC facilities in Montreal and Quebec City, Canada. PARTICIPANTS LTC residents aged 65 and more and free of delirium core symptoms at baseline. MEASURES The Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Index (DI), Hierarchic Dementia Scale, and Barthel Index were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. SSD1 required one or more CAM core symptoms; SSD2, a more restrictive definition, required two or more CAM core symptoms. RESULTS Sixty-eight residents had 129 incident episodes of SSD1: 32 had one episode and 36 had two or more episodes. Episodes lasted 7 - 133 days, mean 13.7 (SD: 14.8) days; mean number of symptoms per episode was 1.1 (SD: 0.4). Rates of recovery at 1, 2, and 4 weeks and 6 months were 45.7%, 61.2%, 64.6%, and 78.3%, respectively. Thirty-three residents had 49 episodes of SSD2: 21 had 1 episode and 12 had 2 or more episodes. Use of the more restrictive definition significantly increased time to recovery and reduced rate of recovery. CONCLUSION Episodes of SSD in older LTC residents appeared to last 7-133 days (mean: 13.7) and were often recurrent. Use of a more restrictive definition resulted in a more protracted course.
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Affiliation(s)
- Martin G Cole
- Department of Psychiatry, St Mary's Hospital, Montreal, Quebec, Canada.
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37
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Voyer P, McCusker J, Cole MG, Monette J, Champoux N, Ciampi A, Belzile E, Vu M, Richard S. Nursing Documentation in Long-Term Care Settings. Clin Nurs Res 2013; 23:442-61. [DOI: 10.1177/1054773813475809] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study on nursing documentation in long-term care facilities, a set of 9 delirium symptoms was used to evaluate the agreement between symptoms reported by nurses during monthly interviews and those documented in the nursing notes for the same 7-day observation period. Residents aged 65 and above ( N = 280) were assessed monthly over a 6-month period for the presence of delirium and its symptoms using the Confusion Assessment Method. The proportion of symptoms documented in the nursing notes ranged from 1.9% to 53.5%. A trend toward a lower proportion of documented symptoms for higher resident−nurse ratios was observed, although the difference was not statistically significant. Efforts should be made to improve the situation by revisiting the content of academic and clinical training given to nurses in addition to exploring innovative ways to make nursing documentation more efficient and less time-consuming within the current context of nurses’ work overload.
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Affiliation(s)
- Philippe Voyer
- Faculty of Nursing Sciences, Laval University, Quebec City, QC, Canada
- Centre for Excellence in Aging-Research Unit, Quebec City, QC, Canada
| | - Jane McCusker
- St. Mary’s Research Centre, Montreal, QC, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Martin G. Cole
- Department of Psychiatry, St Mary’s Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, Jewish General Hospital, Canada
- Donald Berman Maimonides Geriatric Center, Canada
| | - Nathalie Champoux
- Institut Universitaire de Gériatrie de Montréal, Département de Médecine Familiale, Université de Montréal, QC, Canada
| | - Antonio Ciampi
- St. Mary’s Research Centre, Montreal, QC, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Eric Belzile
- St. Mary’s Research Centre, Montreal, QC, Canada
| | - Minh Vu
- Division of Geriatric Medicine, Centre Hospitalier de l’Université de Montréal and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sylvie Richard
- Centre for Excellence in Aging-Research Unit, Quebec City, QC, Canada
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Williams JB, Alexander KP, Morin JF, Langlois Y, Noiseux N, Perrault LP, Smolderen K, Arnold SV, Eisenberg MJ, Pilote L, Monette J, Bergman H, Smith PK, Afilalo J. Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. Am J Cardiol 2013; 111:137-42. [PMID: 23245838 DOI: 10.1016/j.amjcard.2012.08.060] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 12/15/2022]
Abstract
The present study examined the association between patient-reported anxiety and postcardiac surgery mortality and major morbidity. Frailty Assessment Before Cardiac Surgery was a prospective multicenter cohort study of elderly patients undergoing cardiac surgery (coronary artery bypass surgery and/or valve repair or replacement) at 4 tertiary care hospitals from 2008 to 2009. The patients were evaluated a mean of 2 days preoperatively with the Hospital Anxiety and Depression Scale, a validated questionnaire assessing depression and anxiety in hospitalized patients. The primary predictor variable was a high level of anxiety, defined by a Hospital Anxiety and Depression Scale score of ≥ 11. The main outcome measure was all-cause mortality or major morbidity (e.g., stroke, renal failure, prolonged ventilation, deep sternal wound infection, or reoperation) occurring during the index hospitalization. Multivariable logistic regression analysis examined the association between high preoperative anxiety and all-cause mortality/major morbidity, adjusting for the Society of Thoracic Surgeons predicted risk, age, gender, and depression symptoms. A total of 148 patients (mean age 75.8 ± 4.4 years; 34% women) completed the Hospital Anxiety and Depression Scale. High levels of preoperative anxiety were present in 7% of patients. No differences were found in the type of surgery and Society of Thoracic Surgeons predicted risk across the preoperative levels of anxiety. After adjusting for potential confounders, high preoperative anxiety was remained independently predictive of postoperative mortality or major morbidity (odds ratio 5.1, 95% confidence interval 1.3 to 20.2; p = 0.02). In conclusion, although high levels of anxiety were present in few patients anticipating cardiac surgery, this conferred a strong and independent heightened risk of mortality or major morbidity.
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Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. The course of delirium in older long-term care residents. Int J Geriatr Psychiatry 2012; 27:1291-7. [PMID: 22517219 DOI: 10.1002/gps.3782] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/11/2012] [Accepted: 01/12/2012] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the course of delirium in older long-term care (LTC) residents. METHODS A prospective cohort study of 279 residents in seven LTC facilities in Montreal and Quebec City, Canada, was conducted. The Mini Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. Information on medical problems and medication was abstracted from resident charts. Data were analyzed using descriptive statistics, Cox proportional hazard regression, and logistic regression. RESULTS Of the 279 residents, 41 (14.7%) had 61 CAM-defined incident episodes of delirium: 28 (10%) had one episode and 13 (4.7%) had two or more episodes. Episode duration was 7-63 days, mean, 11.3 (SD, 10.1) days. The mean episode DI score was 11.5 (SD, 3.5). Rates of recovery at 1, 2, 4, and 24 weeks were 57.4%, 67.2% 77.1%, and 80.3%, respectively. Most episodes were preceded or followed by one or more CAM core symptoms of delirium, sometimes lasting many weeks. CONCLUSIONS Confusion Assessment Method-defined incident episodes of delirium in older LTC residents appear to last longer than episodes in acute care hospital patients, but rates of recovery at 4 and 24 weeks are similar. Notably, most episodes were preceded or followed by one or more CAM core symptoms of delirium. These findings have implications for clinical practice and research in LTC settings.
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Affiliation(s)
- Martin G Cole
- Department of Psychiatry, St Mary's Hospital Center and McGill University, Montreal, Quebec, Canada.
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Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Dyachenko A, Belzile E. Symptoms of Delirium Occurring Before and After Episodes of Delirium in Older Long-Term Care Residents. J Am Geriatr Soc 2012. [DOI: 10.1111/j.1532-5415.2012.04237.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Philippe Voyer
- Faculty of Nursing Sciences; Laval University; Laval; Quebec; Canada
| | | | - Nathalie Champoux
- Department of Family Medicine; Institut Universitaire de Gériatrie de Montréal; Université de Montréal; Montreal; Quebec; Canada
| | | | | | - Alina Dyachenko
- St. Mary's Research Center; St. Mary's Hospital Center; Montreal; Quebec; Canada
| | - Eric Belzile
- St. Mary's Research Center; St. Mary's Hospital Center; Montreal; Quebec; Canada
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McCusker J, Cole MG, Voyer P, Ciampi A, Monette J, Champoux N, Vu M, Belzile E. Development of a delirium risk screening tool for long-term care facilities. Int J Geriatr Psychiatry 2012; 27:999-1007. [PMID: 22367973 DOI: 10.1002/gps.2812] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/15/2011] [Accepted: 09/16/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study is to develop a delirium risk screening tool for use in long-term care (LTC) facilities. METHODS The sample comprised residents aged 65 years and over of seven LTC facilities in Montreal and Quebec City, Canada, admitted for LTC. Primary analyses were conducted among residents without delirium at baseline. Incident delirium was diagnosed using multiple data sources during the 6-month follow-up. Risk factors, all measured at or prior to baseline, included the following six groups: sociodemographic, medical, cognitive status, physical function, agitated behavior, and symptoms of depression. Variables were analyzed individually and by group using Cox regression models. Clinical judgment was used to select the most feasible among similarly performing factors. RESULTS The cohort comprised 206 residents without delirium at baseline; 69 cases of incident delirium were observed (rate 7.6 per 100 person weeks). The best-performing screening tool comprised five items, with an overall area under the curve of 0.82 (95% CI 0.76, 0.88). These items included brief measures of cognitive status, physical function, behavioral, and emotional problems. Using cut-points of 2 (or 3) over 5, the scale has a sensitivity of 90% (63%), specificity of 59% (85%), and positive predictive value of 52% (66%). CONCLUSIONS This brief screening tool allows nurses to identify LTC residents at increased risk for delirium. These residents can be targeted for closer monitoring and preventive interventions.
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Affiliation(s)
- Jane McCusker
- St Mary's Research Centre, St Mary's Hospital, Montreal, Quebec, Canada.
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Puts MTE, Hardt J, Monette J, Girre V, Springall E, Alibhai SMH. Use of geriatric assessment for older adults in the oncology setting: a systematic review. J Natl Cancer Inst 2012; 104:1133-63. [PMID: 22851269 PMCID: PMC3413614 DOI: 10.1093/jnci/djs285] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [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: 12/11/2011] [Revised: 05/14/2012] [Accepted: 05/17/2012] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Geriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult's medical, psychological, social, and functional capacity. No systematic review of the use of geriatric assessment in oncology has been conducted. The goals of this systematic review were: 1) to provide an overview of all geriatric assessment instruments used in the oncology setting; 2) to examine the feasibility and psychometric properties of those instruments; and 3) to systematically evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes (including the impact on treatment decision making, toxicity of treatment, and mortality). METHODS We searched Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library for articles published in English, French, Dutch, or German between January 1, 1996, and November 16, 2010, reporting on cross-sectional, longitudinal, interventional, or observational studies that assessed the feasibility or effectiveness of geriatric assessment instruments. The quality of articles was evaluated using relevant quality assessment frameworks. RESULTS We identified 83 articles that reported on 73 studies. The quality of most studies was poor to moderate. Eleven studies examined psychometric properties or diagnostic accuracy of the geriatric assessment instruments used. The assessment generally took 10-45 min. Geriatric assessment was most often completed to describe a patient's health and functional status. Specific domains of geriatric assessment were associated with treatment toxicity in 6 of 9 studies and with mortality in 8 of 16 studies. Of the four studies that examined the impact of geriatric assessment on the cancer treatment decision, two found that geriatric assessment impacted 40%-50% of treatment decisions. CONCLUSION Geriatric assessment in the oncology setting is feasible, and some domains are associated with adverse outcomes. However, there is limited evidence that geriatric assessment impacted treatment decision making. Further research examining the effectiveness of geriatric assessment on treatment decisions and outcomes is needed.
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Affiliation(s)
- M T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
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Fayez R, AlMuntashery A, Bodie G, Almamar A, Gill R, Raîche I, Mueller C, AlMuntashery A, Fayez R, AlMuntashery A, Moustarah F, Khokhotva M, Anvari M, Kwong J, Elkassem S, Bonrath E, Zevin B, Sockalingam S, Smith C, Smith C, Whitlock K, Gill R, Suri M, Palter V, Wakeam E, Khan R, Martelli V, Malik A, Young P, Daigle C, McCreery G, Seth R, Paskar D, Sudarshan M, Richardson D, Haggar F, Davis V, Rivard J, Agzarian J, Racz J, Winocour J, Zilbert N, Decker C, Neumann K, Gosney J, Wissanji H, Chadi S, Alhabboubi M, Partridge E, Alhabboubi M, Olszewski M, Chan R, Nadler A, Hameed U, Brotherhood H, Menezes A, MacDonald B, Rakovich G, Hilsden R, Merani S, Davis P, Davis P, Cools-Lartigue J, Ojah J, Julien F, Carter D, Pitt D, Banks B, Rudovics A, Ravichandran P, Anantha R, Aad I, Kholdebarin R, Aird L, Wong S, Payne J, Hallet J, Farries L, Raiche I, Botkin C, Morency D, Berger-Richardson D, Isa A, Dupuis I, Schweigert M, Koubi S, Ernjakovic M, Grant K, Cools-Lartigue J, Carrott P, Stafford T, Malthaner R, Sudarshan M, Hanna W, Lee L, Markar S, Razzak R, Bharadwaj S, Ashrafi A, Ouellette D, Fergusson D, Forster A, Boushey R, Porter G, Johnson P, Gomes T, Chan B, Auer R, Moloo H, Mamdani M, Markar S, Al-Omran M, Al-Obaid O, Boushey R, Lim DR, Min BS, Baik SH, Gordon P, Kim NK, Lo A, Pinsk I, Bottoni D, Brown C, Raval M, Cheng H, Wong C, Johnston N, Farrokhyar F, Stephen W, Kelly S, Lindsay L, Forbes S, Knickle C, Bouchard A, Parry N, Leslie K, Ott M, Coughlin S, Gazala S, Gazala S, Donahoe L, Walker K, Li C, Alnasser S, Schweigert M, Schweigert M, Zhuruk A, Hanouf A, Vanounou T, Karanicolas P, Aubin JM, Yeung J, Dumitra S, Simoneau E, Vanounou T, Howe B, Hawel J, Jang JH, Bertens K, Rekman J, Wei A, Dumitra S, Koubi S, Ouellet JF, Wei A, Covelli A, Maniar R, Sun S, Davis V, Brackstone M, Boissonneault R, Kim S, Baliski C, Gazala S, Hameed U, Sudarshan M, Arnaout A, Wedman D, Nostedt M, Hebbard P, Shetty S, Dixon M, Wei A, Dixon M, Kazazian K, Lemke M, Wells B, Musselman R, Zih FSW, Menezes A, Nassif M, Leon-Carlyle M, Wei A, Krotneva S, Bradley N, Trabulsi N, Trabulsi N, Chin-Lenn L, Cheng H, Petrucci A, Sandhu L, Neville A, Lee L, Li C, Yang I, Prabhu KL, Melich G, Knowles S, Richardson D, Borowiec A, Hallet J, Boissonneault R, Kolozsvari N, Hallet J, Tuttle P, VanHouwelingen L, Haggar F, Boulanger-Gobeil C, Chan B, Chan B, Richardson D, Musselman R, Melich G, Phang P, Goldstein L, Wen C, Lebrun A, Chadi S, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Christou N, Court O, Bonrath E, Hagen J, Okrainec A, Sullivan P, Grantcharov T, Sharma A, Karmali S, Birch D, Majumdar S, Wang X, Tuepah R, Klarenbach S, Birch D, Karmali S, Sharma A, Padwal R, Smith C, Haggar F, Moloo H, Poulin E, Martel G, Yelle JD, Mamazza J, Jackson T, Penner T, Pitzul K, Urbach D, Okrainec A, Villeneuve S, Roy M, Fayez R, Demyttenaere S, Christou N, Court O, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, Fayez R, Demyttenaere S, Court O, Christou N, Biertho L, Hould FS, Lebel S, Lescelleur O, Marceau S, Marceau P, Biron S, Grantcharov T, Sharma A, Yusuf S, Okrainec A, Pitzul K, Urbach D, Jackson T, Lindsay D, Sullivan P, Smith L, Zevin B, Dedy N, Grantcharov T, Bonrath E, Aggarwal R, Grantcharov T, Cassin S, Crawford S, Pitzul K, Khan A, Hawa R, Jackson T, Okrainec A, Brar B, Mamazza J, Raîche I, Yelle JD, Haggar F, Moloo H, Brar B, Haggar F, Dent R, Mamazza J, Raîche I, Moloo H, Gill R, Ali T, Shi X, Birch D, Karmali S, Whitlock K, Shi X, Sarkhosh K, Birch D, Karmali S, Turner J, Nation P, Wizzard P, Brubaker P, Gisalet D, Wales P, Grantcharov T, Tien H, Spencer F, Brenneman F, Kowal J, Wiseman S, Fraser S, Vedel I, Deban M, Holcroft C, Monette M, Monette J, Bergman S, Bell C, Stukel T, Urbach D, Mueller T, Lucykx V, Lukowski C, Compston C, Churchill T, Khadaroo R, Grantcharov T, Vogt K, Dubois L, Gray D, Ananth A, Tai LH, Lam T, Falls T, Souza C, Bell J, Auer R, Crawford S, Parry N, Leslie K, Alhabboubi M, St-Louis E, Deckelbaum D, Razek T, Feldman L, Khwaja K, Porter G, Johnson P, Boushey R, Moloo H, Raiche I, Mamazza J, Schiller D, Eurich D, Sawyer M, Vergis A, Unger B, Hardy K, Andrew C, Gillman L, Park J, Prodger J, Kelly W, Kelly S, Prodger D, Ewara E, Martin J, Sarma S, Chu M, Schlachta C, Zaric G, Al-Ali K, Briggs K, George R, Murnaghan M, Leung A, Regehr G, Moulton CA, Mahmud S, Metcalfe J, McKay A, Park J, Hochman D, Burkle F, Redmond A, McQueen K, Desrosiers E, Gilbert A, Leslie K, Ott M, Sudarshan M, Jessula S, Alburakan A, Deckelbaum D, Razek T, Iqbal S, Khwaja K, Aikins C, Sudarshan M, Deckelbaum D, Iqbal S, Khwaja K, Razek T, Roberts N, Moulton CA, Murnaghan M, Cil T, Marshall J, Pederson K, Erichsen S, White J, Aarts MA, Okrainec A, Victor J, Pearsall E, McLeod R, Jackson T, Okrainec A, Penner T, Urbach D, Karimuddin A, Hall C, Bawan S, Malik S, Hayashi A, Gill R, McAlister C, Zhang N, DesRosiers E, Mills A, Crozier M, Lee L, Maxwell J, Partridge E, Chad S, Steigerwald S, Mapiour D, Roberts D, MacPherson C, Donahoe L, Mercer D, Hopman W, Latulippe JF, Knowles S, Moffat B, Parry N, Leslie K, Switzer N, Khadaroo R, Tul Y, Widder S, Molinari M, Levy A, Johnson P, Bailey J, Molinari M, Hayden J, Johnson P, Benlolo S, Marcus V, Ferri L, Finley R, Anderson D, Gagné JP, Chan S, Wong S, Li J, Michael A, Choi D, Liu E, Hoogenes J, Dath D, Aubin JM, Mew D, McConnell Y, Classen D, Kanthan S, Croome K, Kovacs M, Lazo-Langner A, Hernandez-Alejandro R, Vogt K, Crawford S, Parry N, Leslie K, Khoshgoo N, Iwasiow B, Keijzer R, Brown C, Isa D, Pace D, Widder S, Tul Y, Primrose M, Hudson D, Khadaroo R, Lauzier F, Mailloux O, Trottier V, ARchambault P, Zarychanski R, Turgeon A, Mailloux O, Hardy P, Muirhead R, Masters J, Haggar F, Poulin HME, Martel G, Mamazza J, Milbrandt C, Keijzer R, Sideris L, Grenier-Vallée P, Latulippe JF, Dubé P, Kurashima Y, Kaneva P, Feldman L, Fried G, Vassiliou M, Kwan AL, Fraser S, Solymosi N, Rauh N, Dubecz A, Renz M, Ofner D, Stein H, Borgaonkar M, Crystal P, Easson A, Escallon J, Reedijk M, Cil T, Leong W, McCready D, Clifton J, Mayo J, Finley R, Noreau-Nguyen M, Mulder D, Ferri L, Markar S, Hong J, Low D, Maslow A, Davignon K, Ng T, Tan L, Aruranian J, Kosa S, Ferri L, Murphy G, Allison F, Moshonov H, Darling G, Waddell T, De Perrot M, Cypel M, Yasufuku K, Keshavjee S, Paul N, Pierre A, Darling G, Pedneault C, Marcus V, Mulder D, Ferri L, Low D, Roa W, Löbenberg R, McEwan S, Bédard E, Louie B, Farivar A, McHugh S, Aye R, Tan-Tam C, De Vera M, Bond R, Ong S, Johal B, Schellenberg D, Po M, Nissar S, Lund C, Ahmadi S, Wakil N, Rakovich G, Beauchamps G, Preston S, Baker C, Low D, Campbell G, Malthaner R, Bethune D, Henteleff H, Johnston M, Buduhan G, Coughlin HE, Roth L, Bhandari M, Malthaner R, Johnson J, Kutsogiannis J, Bédard E, Rammohan K, Stewart K, Bédard E, Buduhan G, Gruchy J, Xu Z, Buduhan G, Ferri L, Mulder D, Ncuti A, Neville A, Kaneva P, Watson D, Vassiliou M, Carli F, Feldman L, Av R, Mayrand S, Franco E, Ferri L, Dubecz A, Renz M, Stadlhuber R, Ofner D, Stein H, Renz M, Dubecz A, Solymosi N, Thumfart L, Ofner D, Stein H, Croome K, Leeper R, Hernandez R, Livingstone S, Sapp J, Woodhall D, Alwayn I, Bergman S, Lam-McCulloch J, Balaa F, Jayaraman S, Quan D, Wei A, Guyatt G, Rekman J, Fairfull-Smith R, Mimeault R, Balaa F, Martel G, Boehnert M, Bazerbachi F, Knaak J, Selzner N, McGilvray I, Rotstein O, Adeyi O, Levy G, Keshavjee S, Grant D, Selzner M, Khalil JA, Jamal M, Chaudhury P, Zogopoulos G, Petrakos P, Tchervenkov J, Barkun J, Jamal M, Hassanain M, Chaudhury P, Wong S, Salman A, Tran T, Metrakos P, Groeschl R, Geller D, Marsh J, Gamblin T, Croome K, Croome K, Quan D, Hernandez R, Kim P, Greig PD, Gallinger S, Moulton CA, Wei A, Fischer S, Cleary S, Vogt K, Hernandez-Alejandro R, Gray D, Aubin J, Fairfull-Smith J, Mimeault R, Balaa F, Martel G, Devitt K, Ramjaun A, Gallingher S, Alabbad S, Constantinos D, Hassanein M, Barkun J, Metrakos P, Paraskevas S, Chaudhury P, Tchervenkov J, Borgaonkar M, Tanyingoh D, Dixon E, Kaplan G, Myers R, Howard T, Sutherland F, Zyromski N, Ball C, Coburn N, Moulton CA, Cleary S, Law C, Greig P, Steven G, Baxter N, Fitch M, Wright F, Hochman D, Wirtzfeld D, McKay A, Yaffe C, Yip B, Silverman R, Park J, McConnell Y, Temple W, Mack L, Schiller D, Bathe O, Sawyer M, Scott L, Vandenberg T, Perera F, Potvin K, Chambers A, Loungnarath R, DeBroux É, Lavertu S, Donath D, Ayoub JP, Tehfé M, Richard C, Cornacchi S, Heller B, Farrokhyar F, Babra M, Lovrics P, Liberto C, Ghosh S, McLean R, Schiller D, Jackson T, Okrainec A, Penner T, Urbach D, Dumitra S, Duplisea J, Wexler S, Seely J, Smylie J, Knight K, Robertson S, Watters J, Zhang T, Arneout A, Hochman D, Wirtzfeld D, McKay A, Yip B, Yaffe C, Silverman R, Park J, Baxter N, Yun L, Rakovitch E, Wright F, Warner E, McCready D, Hodgson N, Quan M, Natarajan B, Govindarajan V, Thomas P, Loggie B, Brar S, Mahar A, Law C, Coburn N, Devitt K, Wiebe M, Bathe O, McLeod R, Baxter N, Gagliardi A, Kennedy E, Urbach D, Brar S, Mahar A, Law C, Coburn N, Zih F, Rosario C, Dennis J, Gingras AC, Swallow C, Ko YJ, Rowsell C, Law C, Saskin R, Quan ML, Xie M, McLaughlin K, Marginean C, Moyana T, Moloo H, Boushey R, Auer R, Razik R, Haase E, Mathieson A, Smith A, Swallow C, Barnes A, Scheer A, Moloo H, Boushey R, Sabri E, Auer R, Reidel K, Trabulsi N, Meterissian S, Tamblyn R, Mayo N, Meguerditchian A, Brown J, Hamm J, Phang P, Raval M, Brown C, Devitt K, Wiebe M, Bathe O, McLeod R, Taylor B, Urbach D, Reidel K, Mayo N, Tamblyn R, Meguerditchian A, Hamm J, Wiseman S, Patakfalvi L, Nassif M, Turcotte R, Nichols A, Meguerditchian A, Riedel K, Winslade N, Grégoire JP, Meterissian S, Abrahamovicz M, Megueerditchian A, Pasieka J, McMillan C, Lipa J, Snell L, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Meterissian S, Tomlinson G, Kennedy E, Wei A, Baxter N, Urbach D, Liberman A, Charlebois P, Stein B, Ncuti A, Vassiliou M, Fried G, Feldman L, Capretti G, Power A, Liberman A, Charlebois P, Stein B, Kaneva P, Carli F, Fried G, Feldman L, Carli F, Charlebois P, Stein B, Liberman A, Kaneva P, Augustin B, Gamsa A, Kim DJ, Vassiliou M, Feldman L, Boushey R, Moloo H, Vu L, Chan S, Phang P, Gown A, Jones S, Wiseman S, Jeong DH, Hur H, Baik SH, Kim NK, Faria J, Min BS, Lumb K, Colquhoun P, Porter G, Johnson P, Baxter N, Schmocker S, Huang H, Victor J, Krzyzanowska MK, Brierley J, McLeod R, Kennedy E, Milot H, Desrosiers E, Lebrun A, Drolet S, Bouchard A, Grégoire R, Vuong T, Loungnarath R, DeBroux E, Liberman A, Charlebois P, Stein B, Richard C, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou M, Fried G, Feldman L, Milot H, Drolet S, Bouchard A, Grégoire R, Powell R, Fowler A, Mathieson A, Martin K, Vogt K, Ott M, Pereira G, Einarsdottir K, Moloo H, Boushey R, Mamazza J, Bouchard A, Gagné J, Grégoire R, Thibault C, Bouchard P, Gomes T, Musselman R, Auer R, Moloo H, Mamdani M, Al-Omran M, Boushey R, AlObeed O, Armstrong J. Canadian Surgery Forum1 Is laparoscopic sleeve gastrectomy a reasonable stand-alone procedure for super morbidly obese patients?2 Postoperative monitoring requirements of patients with obstructive sleep apnea undergoing bariatric surgery3 Role of relaparoscopy in the diagnosis and treatment of bariatric complications in the early postoperative period4 Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding5 Prioritization and willingness to pay for bariatric surgery: the patient perspective6 Ventral hernia at the time of laparoscopic gastric bypass surgery: Should it be repaired?7 Linear stapled gastrojejunostomy with transverse handsewn enterotomy closure significantly reduces strictures for laparoscopic Roux-en-Y bypass8 Laparoscopic biliopancreatic diversion with duodenal switch as second stage for super super morbidly obese patients. Do all patients benefit?9 Sleeve gastrectomy in the super super morbidly obese (BMI > 60 kg/m2): a Canadian experience10 Laparoscopic gastric bypass for the treatment of refractory idiopathic gastroparesis: a report of 2 cases11 Duodeno-ileal switch as a primary bariatric and metabolic surgical option for the severely obese patient with comorbidities: review of a single-institution case series of duodeno-ileal intestinal bypass12 Management of large paraesophageal hernias in morbidly obese patients with laparoscopic sleeve gastrectomy: a case series13 Early results of the Ontario bariatric surgical program: using the bariatric registry14 Improving access to bariatric surgical care: Is universal health care the answer?15 Early and liberal postoperative exploration can reduce morbidity and mortality in patients undergoing bariatric surgery16 Withdrawn17 Identification and assessment of technical errors in laparoscopic Roux-en-Y gastric bypass18 A valid and reliable tool for assessment of surgical skill in laparoscopic Roux-en-Y gastric bypass19 Psychiatric predictors of presurgery drop-out following suitability assessment for bariatric surgery20 Predictors of outcomes following Roux-en-Y gastric bypass surgery at The Ottawa Hospital21 Prophylactic management of cholelithiasis in bariatric patients: Is routine cholecystectomy warranted?22 Early outcomes of Roux-en-Y gastric bypass in a publicly funded obesity program23 Similar incidence of gastrojejunal anastomotic stricture formation with hand-sewn and 21 mm circular stapler techniques during Roux-en-Y gastric bypass24 (CAGS Basic Science Award) Exogenous glucagon-like peptide-1 improves clinical, morphological and histological outcomes of intestinal adaptation in a distal-intestinal resection piglet model of short bowel syndrome25 (CAGS Clinical Research Award) Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial26 Negative-pressure wound therapy (iVAC) on closed, high-risk incisions following abdominal wall reconstruction27 The impact of seed granting on research in the University of British Columbia Department of Surgery28 Quality of surgical care is inadequate for elderly patients29 Recurrence of inguinal hernia in general and hernia specialty hospitals in Ontario, Canada30 Oncostatin M receptor deficiency results in increased mortality in an intestinal ischemia reperfusion model in mice31 Laparoscopic repair of large paraesophageal hernias with anterior gastropexy: a multicentre trial32 Response to preoperative medical therapy predicts success of laparoscopic splenectomy for immune thrombocytopenic purpura33 Perioperative sepsis, but not hemorrhagic shock, promotes the development of cancer metastases in a murine model34 Measuring the impact of implementing an acute care surgery service on the management of acute biliary disease35 Patient flow and efficiency in an acute care surgery service36 The relationship between treatment factors and postoperative complications after radical surgery for rectal cancer37 Risk of ventral hernia after laparoscopic colon surgery38 Urinary metabolomics as a tool for early detection of Barrett’s and esophageal cancer39 Construct validity of individual and summary performance metrics associated with a computer-based laparo-scopic simulator40 Impact of a city-wide health system reorganization on emergency department visits in hospitals in surrounding communities41 Transcatheter aortic valve implantation for the nonoperative management of aortic stenosis: a cost-effectiveness analysis42 Breast cancer: racial differences in age of onset. A potential confounder in Canadian screening recommendations43 Risk taking in surgery: in and out of the comfort zone44 A tumour board in the office: Track those cancer patients!45 Increased patient BMI is not associated with advanced colon cancer stage or grade on presentation: a retrospective chart review46 Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies. Report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict47 Learning the CanMEDS role of professional: a pilot project of supervised discussion groups addressing the hidden curriculum48 Assessing the changing scope of training in Canadian general surgery programs: expected versus actual experience49 Predicting need for surgical management for massive gastrointestinal hemorrhage50 International health care experience: using CanMEDS to evaluate learning outcomes following a surgical mission in Mampong, Ghana51 The open abdomen: risk factors for mortality and rates of closure52 How surgeons think: an exploration of mental practice in surgical preparation53 The surgery wiki: a novel method for delivery of under-graduate surgical education54 Understanding surgical residents’ postoperative practices before implementing an enhanced recovery after surgery (ERAS) guideline at the University of Toronto55 From laparoscopic transabdominal to posterior retroperitoneal adrenalectomy: a paradigm shift in operative approach56 A retrospective audit of outcomes in patients over the age of 80 undergoing acute care abdominal surgery57 Canadian general surgery residents’ perspectives on work-hour regulations58 Timing of surgical intervention and its outcomes in acute appendicitis59 Preparing surgical trainees to deal with adverse events. An outline of learning issues60 Acute care surgical service: surgeon agreement at the time of handover61 Predicting discharge of elderly patients to prehospitalization residence following emergency general surgery62 Morbidity and mortality after emergency abdominal surgery in octo- and nonagenarians63 The impact of acute abdominal illness and urgent admission to hospital on the living situation of elderly patients64 A comparison of laparoscopic versus open subtotal gastrectomy for antral gastric adenocarcinoma: a North American perspective65 Minimally invasive excision of ectopic mediastinal parathyroid adenomas66 Perioperative outcomes of laparoscopic hernia repair in a tertiary care centre: a single institution’s experience67 Evaluation of a student-run, practical and didactic curriculum for preclerkship medical students68 Joseph Lister: Father of Modern Surgery69 Comparisons of melanoma sentinel lymph node biopsy prediction nomograms in a cohort of Canadian patients70 Local experience with myocutaneous flaps after extensive pelvic surgery71 The treatment of noncirrhotic splanchnic vein thrombosis: Is anticoagulation enough?72 Implementation of an acute care surgery service does not affect wait-times for elective cancer surgeries: an institutional experience73 Use of human collagen mesh for closure of a large abdominal wall defect, after colon cancer surgery, a case report74 The role of miR-200b in pulmonary hypoplasia associated with congenital diaphragmatic hernia75 Systematic review and meta-analysis of electrocautery versus scalpel for incising epidermis and dermis76 Accuracy of sentinel lymph node biopsy for early breast cancer in the community setting in St. John’s, New-foundland: results of a retrospective review77 Acute surgical outcomes in the 80 plus population78 The liberal use of platelets transfusions in the acute phase of trauma resuscitation: a systematic review79 Implementation of an acute care surgical on call program in a Canadian community hospital80 Short-term outcomes following paraesophageal hernia repair in the elderly patient81 First experience with single incision surgery: feasibility in the pediatric population and cost evaluation82 The impact of the establishment of an acute care surgery unit on the outcomes of appendectomies and cholecystectomies83 Description and preliminary evaluation of a low-cost simulator for training and evaluation of flexible endoscopic skills84 Tumour lysis syndrome in metastatic colon cancer: a case report85 Acute care surgery service model implementation study at a single institution86 Colonic disasters approached by emergent subtotal and total colectomy: lessons learned from 120 consecutive cases87 Acellular collagen matrix stent to protect bowel anastomoses88 Lessons we learned from preoperative MRI-guided wire localization of breast lesions: the University Health Network (UHN) experience89 Interim cost comparison for the use of platinum micro-coils in the operative localization of small peripheral lung nodules90 Routine barium esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer91 Iron deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair92 A randomized comparison of different ventilation strategies during thoracotomy and lung resection93 The Canadian Lung Volume Reduction Surgery study: an 8-year follow-up94 A comparison of minimally invasive versus open Ivor-Lewis esophagectomy95 A new paradigm in the follow-up after curative resection for lung cancer: minimal-dose CT scan allows for early detection of asymptomatic cancer activity96 Predictors of lymph node metastasis in early esophageal adenocarcinoma: Is endoscopic resection worth the risk?97 How well can thoracic surgery residents operate? Comparing resident and program director opinions98 The impact of extremes of age on short- and long-term outcomes following surgical resection of esophageal malignancy99 Epidermal growth factor receptor targeted gold nanoparticles for the enhanced radiation treatment of non–small cell lung cancer100 Laparoscopic Heller myotomy results in excellent outcomes in all subtypes of achalasia as defined by the Chicago classification101 Neoadjuvant chemoradiation versus surgery in managing esophageal cancer102 Quality of life postesophagectomy for cancer!103 The implementation, evolution and translocation of standardized clinical pathways can improve perioperative outcomes following surgical treatment of esophageal cancer104 A tissue-mimicking phantom for applications in thoracic surgical simulation105 Sublobar resection compared with lobectomy for early stage non–small cell lung cancer: a single institution study106 Not all reviews are equal: the quality of systematic reviews and meta-analyses in thoracic surgery107 Do postoperative complications affect health-related quality of life after video-assisted thoracoscopic lobectomy for patients with lung cancer? A cohort study108 Thoracoscopic plication for palliation of dyspnea secondary to unilateral diaphragmatic paralysis: A worthwhile venture?109 Thoracic surgery experience in Canadian general surgery residency programs110 Perioperative morbidity and pathologic response rates following neoadjuvant chemotherapy and chemoradiation for locally advanced esophageal carcinoma111 An enhanced recovery pathway reduces length of stay after esophagectomy112 Predictors of dysplastic and neoplastic progression of Barrett’s esophagus113 Recurrent esophageal cancer complicated by tracheoesophageal fistula: management by means of palliative airway stenting114 Pancreaticopleural fistula-induced empyema thoracis: principles and results of surgical management115 Prognostic factors of early postoperative mortality following right extended hepatectomy116 Optimizing steatotic livers for transplantation using a cell-penetrating peptide CPP-fused heme oxygenase117 Video outlining the technical steps for a robot-assisted laparoscopic pancreaticoduodenectomy118 Establishment of a collaborative group to conduct innovative clinical trials in Canada119 Hepatic resection for metastatic malignant melanoma: a systematic review and meta-analysis120 Acellular normothermic ex vivo liver perfusion for donor liver preservation121 Pancreatic cancer and predictors of survival: comparing the CA 19–9/bilirubin ratio with the McGill Brisbane Scoring System122 Staged liver resections for bilobar hepatic colorectal metastases: a single centre experience123 Economic model of observation versus immediate resection of hepatic adenomas124 Resection of colorectal liver metastasis in the elderly125 Acceptable long-term survival in patients undergoing liver resection for metastases from noncolorectal, non-neuroendocrine, nonsarcoma malignancies126 Patient and clinicopathological features and prognosis of CK19+ hepatocellular carcinomas: a case–control study127 The management of blunt hepatic trauma in the age of angioembolization: a single centre experience128 Liver resections for noncolorectal and non-neuroendocrine metastases: an evaluation of oncologic outcomes129 Developing an evidence-based clinical pathway for patients undergoing pancreaticoduodenectomy130 Hepatitis C infection and hepatocellular carcinoma in liver transplant: a 20 year experience131 The effect of medication on the risk of post-ERCP pancreatitis132 Temporal trends in the use of diagnostic imaging for patients with hepato-pancreato-biliary (HPB) conditions: How much ionizing radiation are we really using?196 A phase II study of aggressive metastasectomy for intra-and extrahepatic metastases from colorectal cancer133 Why do women choose mastectomy for breast cancer treatment? A conceptual framework for understanding surgical decision-making in early-stage breast cancer134 Synoptic operative reporting: documentation of quality of care data for rectal cancer surgery135 Learning curve analysis for cytoreductive surgery: a useful application of the cumulative sum (CUSUM) method136 Pancreatic cancer is strongly associated with a unique urinary metabolomic signature137 Concurrent neoadjuvant chemo/radiation in locally advanced breast cancer138 Impact of positron emission tomography on clinical staging of newly diagnosed rectal cancer: a specialized single centre retrospective study139 An evaluation of intraoperative Faxitron microradiography versus conventional specimen radiography for the excision of nonpalpable breast lesions140 Comparison of breast cancer treatment wait-times in the Southern Interior of British Columbia in 2006 and 2010141 Factors affecting lymph nodes harvest in colorectal carcinoma142 Laparoscopic adrenalectomy for metastases143 You have a message! Social networking as a motivator for fundamentals of laparoscopic surgery (FLS) training144 The evaluation and validation of a rapid diagnostic and support clinic for women assessment for breast cancer145 Oncoplastic breast surgery: oncologic benefits and limitations146 A qualitative study on rectal cancer patients’ preferences for location of surgical care147 The effect of surgery on local recurrence in young women with breast cancer148 Elevated IL-6 and IL-8 levels in tumour microenvironment is not associated with increased serum levels in humans with Pseudomyxoma peritonei and peritoneal mesothelioma149 Conversion from laparoscopic to open approach during gastrectomy: a population-based analysis150 A scoping review of surgical process improvement tools (SPITs) in cancer surgery151 Splenectomy during gastric cancer surgery: a population-based study152 Defining the polo-like kinase 4 (Plk4) interactome in cancer cell protrusions153 Neoadjuvant imatinib mesylate for locally advanced gastrointestinal stromal tumours154 Implementing results from ACOSOG Z0011: Practice-changing or practice-affirming?155 Should lymph node retrieval be a surgical quality indicator in colon cancer?156 Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer157 Clinical research in surgical oncology: an analysis of clinicaltrials.gov158 Radiation therapy after breast conserving surgery: When are we missing the mark?159 The accuracy of endorectal ultrasound in staging rectal lesions in patients undergoing transanal endoscopic microsurgery160 Quality improvement in gastrointestinal cancer surgery: expert panel recommendations for priority research areas161 Factors influencing the quality of local management of ductal carcinoma in situ: a cohort study162 Papillary thyroid microcarcinoma: Does size matter?163 Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: systematic review of clinical efficacy and quality assessment of reported trials164 Adherence to antiestrogen therapy in seniors with breast cancer: How well are we doing?165 Parathyroid carcinoma: Challenging the surgical dogma?166 A qualitative assessment of the journey to delayed breast reconstruction195 The role of yoga therapy in breast cancer patients167 Outcomes reported in comparative studies of surgical interventions168 Enhanced recovery pathways decrease length of stay following colorectal surgery, but how quickly do patients actually recover?169 The impact of complications on bed utilization after elective colorectal resection170 Impact of trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study171 Complex fistula-in-ano: Should the plug be abandoned in favour of the LIFT or BioLIFT?172 Prognostic utility of cyclooxygenase-2 expression by colon and rectal cancer173 Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is complex and time-consuming: analysis of learning curves for a novice minimally invasive surgeon174 Intraoperative quality assessment following double stapled circular colorectal anastomosis175 Improving patient outcomes through quality assessment of rectal cancer care176 Are physicians willing to accept a decrease in treatment effectiveness for improved functional outcomes for low rectal cancer?177 Turnbull-Cutait delayed coloanal anastomosis for the treatment of distal rectal cancer: a prospective cohort study178 Preoperative high-dose rate brachytherapy in preparation for sphincter preservation surgery for patients with advanced cancer of the lower rectum179 Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection180 The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review181 Is a vertical rectus abdominus flap (VRAM) necessary? An analysis of perineal wound complications182 Fistula plug versus endorectal anal advancement flap for the treatment of high transsphincteric cryptoglandular anal fistulas: a systematic review and meta-analysis183 Maternal and neonatal outcomes following colorectal cancer surgery184 Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option185 Trends in colon cancer in Ontario: 2002–2009186 Validation of electronically derived short-term outcomes in colorectal surgery187 A population-based assessment of transanal and endoscopic resection for adenocarcinoma of the rectum188 Laparoscopic colorectal surgery in the emergency setting: trends in the province of Ontario from 2002 to 2009189 Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with case series of internal hernia through pelvic mesh which was placed in attempt to prevent perineal hernia190 Effect of rectal cancer treatments on quality of life191 The use of antibacterial sutures as an adjunctive preventative strategy for surgical site infection in Canada: an economic analysis192 Impact of socioeconomic status on colorectal cancer screening and stage at presentation: preliminary results of a population-based study from an urban Canadian centre193 Initial perioperative results of the first transanal endoscopic microsurgery (TEM) program in the province of Quebec194 Use of negative pressure wound therapy decreases perineal wound infections following abdominal perineal resection. Can J Surg 2012; 55:S63-S135. [DOI: 10.1503/cjs.016712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Monette J, Alessa W, McCusker J, Cole M, Voyer P, Champoux N, Ciampi A, Sourial N, Monette M, Belzile E. Association of resident and room characteristics with antipsychotic use in long-term care facilities (LTCF). Arch Gerontol Geriatr 2012; 55:66-9. [DOI: 10.1016/j.archger.2011.06.011] [Citation(s) in RCA: 6] [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: 01/31/2011] [Revised: 06/10/2011] [Accepted: 06/10/2011] [Indexed: 10/17/2022]
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Keith D, Butler J, Bemer B, Mogle J, Monette J, Hair J, Heinecke J, Sliwinski M, Hagen T. P02.97. Lipoic acid supplementation induces a transient stress response and improves episodic memory and cholesterol efflux in humans. BMC Complement Altern Med 2012. [PMCID: PMC3373675 DOI: 10.1186/1472-6882-12-s1-p153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Monette J, Monette M, Sourial N, Vandal AC, Wolfson C, Champoux N, Fletcher J, Savoie ML. Effect of an Interdisciplinary Educational Program on Antipsychotic Prescribing Among Residents With Dementia in Two Long-Term Care Centers. J Appl Gerontol 2012; 32:833-54. [DOI: 10.1177/0733464812440042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The effect of an educational program on antipsychotic prescribing was assessed in two Canadian long-term care centers (LTCC). In each center (Center A residents, n = 258 and Center B residents, n = 191, with dementia at program inception), the rate of change in the odds of using antipsychotics in residents was estimated using mixed-effects logistic regression during a 6-month program period and a 4-month postprogram period, with baseline proportions of use estimated during the 6 months prior to the program. Preprogram proportions of antipsychotic use were 41.6% and 46.2%, respectively. Antipsychotic use decreased during the program in both centers: (odds ratio with 95% CI: 0.943 per week [0.921, 0.965] and 0.969 per week [0.944, 0.994], respectively). During the postprogram period, antipsychotic use increased in Center A (1.039 per week [1.007, 1.072]) but decreased progressively in Center B. The study results suggest the need to implement an ongoing educational program in LTCC.
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Affiliation(s)
| | | | | | - Alain C. Vandal
- Faculty of Health and Environmental Sciences, Auckland, New Zealand
| | - Christina Wolfson
- Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Allan Memorial Institute, Montreal, Canada
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McCusker J, Cole MG, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. Prevalence and incidence of delirium in long-term care. Int J Geriatr Psychiatry 2011; 26:1152-61. [PMID: 21274904 DOI: 10.1002/gps.2654] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 09/27/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVES (1) To describe the prevalence and 6-month incidence of delirium in long-term care facility (LTCF) residents age 65 and over; (2) To describe differences in these measures by resident baseline characteristics. METHODS A multisite, prospective observational study was conducted in seven LTCFs in the province of Quebec, Canada. Residents of age 65 and over were recruited into two cohorts: Cohort A with a Mini-Mental State Examination (MMSE) score of 10 or more and Cohort B with an MMSE score of less than 10. Baseline resident measurements were obtained from research resident assessments, nurse interviews, and chart review. Weekly resident assessments for up to 24 weeks included the Confusion Assessment Method (CAM). RESULTS Two hundred seventy-nine residents were recruited and completed baseline delirium assessments: 204 in Cohort A and 75 in Cohort B. The prevalence of delirium at baseline was 3.4% in Cohort A and 33.3% in Cohort B. The incidence of delirium among those without delirium at baseline (per 100 person-weeks of follow-up) was 1.6 in Cohort A and 6.9 in Cohort B. In multivariate analyses, a diagnosis of dementia, moderate to severe cognitive impairment, and depressive symptoms at baseline were associated with a greater prevalence and incidence of delirium. CONCLUSION Delirium is an important clinical problem in LTCF residents, particularly among those with moderate to severe cognitive impairment at baseline.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, Quebec, Canada.
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Puts M, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H. A pilot study on frailty, health and functioning in older newly-diagnosed cancer patients, what have we learned? J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2011.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. Subsyndromal Delirium in Older Long-Term Care Residents: Incidence, Risk Factors, and Outcomes. J Am Geriatr Soc 2011; 59:1829-36. [DOI: 10.1111/j.1532-5415.2011.03595.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Philippe Voyer
- Faculty of Nursing Sciences; Laval University; Quebec City; Canada
| | - Johanne Monette
- Division of Geriatric Medicine; Jewish General Hospital and Maimonides Geriatric Center
| | - Nathalie Champoux
- Département de Médecine Familiale; Institut Universitaire de Gériatrie de Montréal
| | | | - Minh Vu
- Division of Geriatric Medicine; Centre Hospitalier de l'Université de Montréal and Department of Medicine; Université de Montréal; Montreal; Canada
| | - Eric Belzile
- St. Mary's Research Centre; St. Mary's Hospital; Montreal; Canada
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Afilalo J, Eisenberg MJ, Bergman H, Monette J, Morin JF, Langlois Y, Noiseux N, Perrault LP, Alexander KP. Reply. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.01.064] [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: 10/17/2022]
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