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Karami V, Yaffe MJ, Gore G, Moon AJ, Abbasgholizadeh Rahimi S. Socially Assistive Robots for patients with Alzheimer's Disease: A scoping review. Arch Gerontol Geriatr 2024; 123:105409. [PMID: 38565072 DOI: 10.1016/j.archger.2024.105409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The most common form of dementia, Alzheimer's Disease (AD), is challenging for both those affected as well as for their care providers, and caregivers. Socially assistive robots (SARs) offer promising supportive care to assist in the complex management associated with AD. OBJECTIVES To conduct a scoping review of published articles that proposed, discussed, developed or tested SAR for interacting with AD patients. METHODS We performed a scoping review informed by the methodological framework of Arksey and O'Malley and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist for reporting the results. At the identification stage, an information specialist performed a comprehensive search of 8 electronic databases from the date of inception until January 2022 in eight bibliographic databases. The inclusion criteria were all populations who recive or provide care for AD, all interventions using SAR for AD and our outcomes of inteerst were any outcome related to AD patients or care providers or caregivers. All study types published in the English language were included. RESULTS After deduplication, 1251 articles were screened. Titles and abstracts screening resulted to 252 articles. Full-text review retained 125 included articles, with 72 focusing on daily life support, 46 on cognitive therapy, and 7 on cognitive assessment. CONCLUSION We conducted a comprehensive scoping review emphasizing on the interaction of SAR with AD patients, with a specific focus on daily life support, cognitive assessment, and cognitive therapy. We discussed our findings' pertinence relative to specific populations, interventions, and outcomes of human-SAR interaction on users and identified current knowledge gaps in SARs for AD patients.
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Affiliation(s)
- Vania Karami
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Mila - Quebec AI Institute, Montreal, Canada
| | - Mark J Yaffe
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada; St. Mary's Hospital Center, Montreal, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Canada
| | - AJung Moon
- Department of Electrical & Computer Engineering, Faculty of Engineering, McGill University, Montreal, Canada
| | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Mila - Quebec AI Institute, Montreal, Canada; Faculty of Dental Medicine and Oral Health Sciences.
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Yaffe MJ, McCusker J, Lambert SD, Haggerty J, Meguerditchian AN, Pineault M, Barnabé A, Belzile E, Minotti S, de Raad M. Self-care interventions to assist family physicians with mental health care of older patients during the COVID-19 pandemic: Feasibility, acceptability, and outcomes of a pilot randomized controlled trial. PLoS One 2024; 19:e0297937. [PMID: 38358971 PMCID: PMC10868770 DOI: 10.1371/journal.pone.0297937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has required family physicians to rapidly address increasing mental health problems with limited resources. Vulnerable home-based seniors with chronic physical conditions and commonly undermanaged symptoms of anxiety and depression were recruited in this pilot study to compare two brief self-care intervention strategies for the management of symptoms of depression and/or anxiety. METHODS We conducted a pilot RCT to compare two tele-health strategies to address mental health symptoms either with 1) validated CBT self-care tools plus up to three telephone calls from a trained lay coach vs. 2) the CBT self-guided tools alone. The interventions were abbreviated from those previously trialed by our team, to enable their completion in 2 months. Objectives were to assess the feasibility of delivering the interventions during a pandemic (recruitment and retention); and assess the comparative acceptability of the interventions across the two groups (satisfaction and tool use); and estimate preliminary comparative effectiveness of the interventions on severity of depression and anxiety symptoms. Because we were interested in whether the interventions were acceptable to a wide range of older adults, no mental health screening for eligibility was performed. RESULTS 90 eligible patients were randomized. 93% of study completers consulted the self-care tools and 84% of those in the coached arm received at least some coaching support. Satisfaction scores were high among participants in both groups. No difference in depression and anxiety outcomes between the coached and non-coached participants was observed, but coaching was found to have a significant effect on participants' use and perceived helpfulness of the tools. CONCLUSION Both interventions were feasible and acceptable to patients. Trained lay coaching increased patients' engagement with the tools. Self-care tools offer a low cost and acceptable remote activity that can be targeted to those with immediate needs. While effectiveness results were inconclusive, this may be due to the lack of eligibility screening for mental health symptoms, abbreviated toolkit, and fewer coaching sessions than those used in our previous effective interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0460937.
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Affiliation(s)
- Mark J. Yaffe
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- St. Mary’s Hospital Department of Family Medicine, Montreal, Quebec, Canada
- St. Mary’s Research Centre, Montreal, Quebec, Canada
| | - Jane McCusker
- St. Mary’s Research Centre, Montreal, Quebec, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Sylvie D. Lambert
- St. Mary’s Research Centre, Montreal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- St. Mary’s Research Centre, Montreal, Quebec, Canada
| | - Ari N. Meguerditchian
- St. Mary’s Research Centre, Montreal, Quebec, Canada
- Departments of Surgery and Oncology, McGill University, Montreal, Quebec, Canada
| | | | - Alexandra Barnabé
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Eric Belzile
- St. Mary’s Research Centre, Montreal, Quebec, Canada
| | - Simona Minotti
- St. Mary’s Research Centre, Montreal, Quebec, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Manon de Raad
- St. Mary’s Research Centre, Montreal, Quebec, Canada
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McCusker J, Lambert SD, Ciampi A, Jones JM, Li M, Yaffe MJ, Pelland ME, Belzile E, de Raad M. Trained lay coaches and self-care cognitive-behavioral tools improve depression outcomes. Patient Educ Couns 2022; 105:2747-2756. [PMID: 35397942 DOI: 10.1016/j.pec.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Identify the key effective components of a depression self-care intervention. METHODS Secondary analysis of data from 3 studies that demonstrated effectiveness of a similar depression self-care intervention (n = 275): 2 studies among patients with chronic physical conditions and 1 among cancer survivors. The studies used similar tools, and telephone-based lay coaching. Depression remission and reduction at 6 months were assessed with either PHQ-9 (chronic condition cohorts) or CES-D (cancer survivor cohort). Multiple logistic regression was used to analyze data when the interaction p-value with cohort was < 0.10. RESULTS The 3 coached cohorts achieved better depression outcomes than usual care. The combination of coaching and joint use of 2 tools based on cognitive-behavioral therapy (CBT) was associated with depression remission and reduction among chronic condition cohorts but not among cancer survivors. Neither the number nor the length of coach calls were associated with outcomes in pooled data. CONCLUSIONS Trained lay coaching and use of CBT-based self-care tools were associated with improved depression outcomes in patients with chronic conditions but not among cancer survivors. PRACTICE IMPLICATIONS Trained lay coaching and CBT tools are key components of depression self-care interventions. Further research is needed on the effective components in cancer survivors.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave, Montreal, Quebec H3A 1A2, Canada.
| | - Sylvie D Lambert
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada; Ingram School of Nursing, McGill University, 80 Sherbrooke St W, Suite1800, Montreal, Quebec H3A 2M7, Canada.
| | - Antonio Ciampi
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave, Montreal, Quebec H3A 1A2, Canada.
| | - Jennifer M Jones
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto M5G 2C1, Ontario, Canada.
| | - Madeline Li
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto M5G 2C1, Ontario, Canada.
| | - Mark J Yaffe
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada; Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, Quebec H3S 1Z1, Canada; Department of Family Medicine, St. Mary's Hospital Center, 3830 Lacombe Ave, Hayes Pavilion, Montreal H3T 1M5, Quebec, Canada.
| | - Marie-Eve Pelland
- Département de radio-oncologie, Centre hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada.
| | - Eric Belzile
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada.
| | - Manon de Raad
- St. Mary's Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada; Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada.
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Yaffe MJ. impact of virtual care on relationship centered care: Observations of a family physician. IJWPC 2022. [DOI: 10.26443/ijwpc.v9i1.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The COVID-19 pandemic propelled many physicians and their patients into an unfamiliar world of virtual care. This presentation is based on the perceptions of a family physician/ teacher/ researcher with 43 years of interest in, and promotion of, a strong doctor-patient relationship. It will describe a protocol that governed how tele-medicine and video-conferencing took place over nearly 18 months in his practice. It will then describe observed positive and negative impacts for the patients, their family members, the physician, and members of the family medicine health care team. Interpretation will be made about what such observations mean for the doctor-patient relationship.
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Yaffe MJ. Content and analysis of a knowledge translation activity for an elder abuse detection tool: a descriptive study. BMC Geriatr 2021; 21:455. [PMID: 34362311 PMCID: PMC8349046 DOI: 10.1186/s12877-021-02402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/23/2021] [Indexed: 11/12/2022] Open
Abstract
Background Knowledge translation (KT) is challenging to carry out and assess. The content of a program developed to foster KT activities pertaining to the Elder Abuse Suspicion Index (EASI)©, a tool to help identify elder abuse, is described, along with reporting and analysis of some of its outcomes. Methods Enquiries about the use of the EASI were encouraged through completion of a structured questionnaire available on an EASI website. These were submitted by email and guided individualized responses. Descriptive data collated anonymously from the questionnaires described in aggregate corresponders’ occupations, countries of work, information needs about the tool, and intent of use. The processes that generated this data were evaluated as to whether they conformed to established elements of KT. Results One hundred thirty-eight queries were received over 6 years coming from enquirers with 12 different professional backgrounds, working in 25 countries. The information sought aimed to facilitate EASI use in clinical, quality improvement, public health, research, teaching, KT, and commercial ventures. Conclusions This activity, incorporating recognized elements of a KT undertaking, documents specific global interests in elder abuse detection. It suggests a model for researchers to gauge interest in their findings and to promote exchange around them. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02402-8.
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Affiliation(s)
- Mark J Yaffe
- Department of Family Medicine, McGill University, 5858 Cote -des-Neiges Road, Montreal, Quebec, H3S 1Z1, Canada. .,Family Medicine Centre, St. Mary's Hospital Center, Integrated University Centre for Health and Social Services of West Island of Montreal, 3830 Lacombe Avenue, Montreal, Quebec, H3T 1M5, Canada.
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McCusker J, Jones JM, Li M, Faria R, Yaffe MJ, Lambert SD, Ciampi A, Belzile E, de Raad M. CanDirect: Effectiveness of a Telephone-Supported Depression Self-Care Intervention for Cancer Survivors. J Clin Oncol 2021; 39:1150-1161. [PMID: 33555912 DOI: 10.1200/jco.20.01802] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Depression in post-treatment cancer survivors is common and can impair quality of life. CanDirect is a novel, telephone-delivered depression self-care intervention for cancer survivors. We conducted a randomized controlled superiority trial to compare CanDirect with usual care (UC) in this population. METHODS Participants completing cancer treatment within the past 10 years who had mild-moderate depressive symptoms with or without major depression were recruited from clinical and community settings in Quebec and Ontario. Permuted block random assignment allocated participants to CanDirect plus UC or to UC alone. Assessments of depression severity (Center for Epidemiological Studies-Depression scale [CES-D]; primary outcome) and secondary outcomes health-related quality of life (Short Form Survey-12 mental and physical component summaries), anxiety symptoms (Hospital Anxiety and Depression Scale), activation (Patient Activation Measure), depression diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV), and health services (self-report) were conducted at baseline, as well as 3 and 6 months (primary time point). Analyses of outcomes were adjusted for covariates using linear regression and missing data by inverse probability weighting. RESULTS Participants recruited between September 2016 and October 2018 were randomly assigned to CanDirect (n = 121) or UC (n = 124). Among 245 participants randomly assigned, 218 (89.0%) completed the primary outcome at 6 months. CanDirect participants reported less severe depressive symptoms on the CES-D than UC participants at 6 months, adjusted effect size (ES) 0.61 (95% CI, 0.33 to 0.88). CanDirect participants also had significantly greater quality of life, lower anxiety, more activation, and lower rates of depression diagnoses, compared with UC. Exploratory analysis suggested that sex was a modifier of the primary outcome (interaction term P value = .03); the intervention was less effective in men (ES, 0.12; 95% CI, -0.45 to 0.69). CONCLUSION The findings suggest that CanDirect is an effective method of managing mild-moderate depression symptoms in cancer survivors.
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Affiliation(s)
| | | | - Madeline Li
- Princess Margaret Cancer Centre, UHN, Toronto, ON, Canada
| | | | | | - Sylvie D Lambert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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Yaffe MJ. Breast cancer screening policy-good science should trump bad politics. ACTA ACUST UNITED AC 2020; 26:e714-e716. [PMID: 31896941 DOI: 10.3747/co.27.5661] [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: 11/15/2022]
Abstract
Dr. Steven Narod’s comments on breast cancer screening (Countercurrents: Is now the right time to pull the plug on mammography?) [...]
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Affiliation(s)
- M J Yaffe
- Sunnybrook Research Institute, Toronto, ON
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Yaffe MJ, Hovey RB, Rodriguez C. Use of patients' unsolicited correspondence to a family doctor to describe and understand valued components of a doctor-patient relationship: A Hermeneutics approach. BMC Fam Pract 2019; 20:136. [PMID: 31623577 PMCID: PMC6798372 DOI: 10.1186/s12875-019-1024-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
Abstract
Background Communication and behavior within doctor - patient encounters have been examined using varied techniques; however the nature of unsolicited writings from patients to their family doctors has rarely been reported. This paper therefore aimed to explore the content of, and motivation for, such correspondence. Methods One hundred and seven writings to one family physician about care provided during a four decade period were considered. Univariate analyses were used to identify features of patients or family members who wrote personalized notes to the doctor, when, and in what fashion. A hermeneutic approach helped look at the content of the notes, the specific words or sentiments used to describe encounters or care received, and possible motivations for writing. Iterative review of words or phrases generated themes which summarized appreciated physician or relational attributes, as well as motivations for writing. Results Notes were mostly handwritten, predominantly by women, and frequently coinciding with holidays and life span events. Appreciated doctor characteristics and behaviors were (1) quality care; and physician (2) competence; (3) physical presence; (4) positive personal traits; (5) provision of emotional support; and (6) spiritual impact. Motivations for writing were grouped as desire to (1) express appreciation for an established relationship; (2) acknowledge value / benefit experienced from continuity of care; (3) seek catharsis, emotional relief or closure; (4) reflect on termination of care; (5) validate care that incorporates both Hippocratic tradition and Asklepian healing; and (6) share personal reflection, experience, or impact. Conclusions Unsolicited writings provide personalized links from patients to physicians, expressing thoughts perhaps difficult to share face to face. They offer potential as teaching tools about the content of doctor-patient relationships; for example, the writers studied expressed appreciation for quality continuity care that was competent, considerate, and supportive of emotional and spiritual needs.
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Affiliation(s)
- Mark J Yaffe
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, suite 300, Montreal, Quebec, H3S 1Z1, Canada. .,St. Mary's Hospital Center, Family Medicine Centre, 3830 Lacombe Avenue, Montreal, Quebec, H3T1M5, Canada. .,Integrated University Centre for Health and Social Services of West Island of Montreal, Family Medicine Centre, 3830 Lacombe Avenue, Montreal, Quebec, H3T1M5, Canada.
| | - Richard B Hovey
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, 2001 McGill College, suite 500, Montreal, QC, H3A1G1, Canada
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, suite 300, Montreal, Quebec, H3S 1Z1, Canada
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McCusker J, Lambert SD, Haggerty J, Yaffe MJ, Belzile E, Ciampi A. Self-management support in primary care is associated with improvement in patient activation. Patient Educ Couns 2019; 102:571-577. [PMID: 30497799 DOI: 10.1016/j.pec.2018.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To examine: 1) whether patient characteristics predict perceived self-management support (usefulness of information and collaborative care planning) by primary care providers after six months, and 2) the association between perceived self-management support and patient activation at 6 months METHODS: We conducted a secondary analysis among 120 primary care patients aged 40 and over with a chronic physical condition and comorbid depressive symptoms who participated in a randomized controlled trial of a coaching intervention for depression self-management. Activation was measured at baseline (T0) and 6 months (T1). Self-management support was captured at T1 for physical and mood problems. RESULTS The sample of analysis was 120 patients who completed all relevant measures. At T1, the perceived usefulness of information for mood self-management was independently associated with activation. More severe depressive symptoms at T0 predicted lower perceived usefulness of chronic condition self-management information at T1. Lower T0 mental health-related quality of life predicted lower perceived usefulness of mood self-management information at T1. CONCLUSIONS Perceived informational support for mood self-management may contribute to increased activation. Patients with more severe mental health symptoms or impairment perceive that they receive less useful self-management information from their care team. PRACTICE IMPLICATIONS Care teams should determine whether patients with mood problems need greater self-management support.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pin. Avenue, H3A 1A2, Montreal, Quebec, Canada.
| | - Sylvie D Lambert
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Ingram School of Nursing, McGill University, McGill University, 680 Sherbrooke Street West, Suite 1800, H3A 2M7, Montreal, Quebec, Canada.
| | - Jeannie Haggerty
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd Floor, H3S 1Z1, Montreal, Quebec, Canada.
| | - Mark J Yaffe
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Family Medicine Centre, St. Mary's Hospital Center, 3830, H3T 1M5, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd Floor, H3S 1Z1, Montreal, Quebec, Canada.
| | - Eric Belzile
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada.
| | - Antonio Ciampi
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pin. Avenue, H3A 1A2, Montreal, Quebec, Canada.
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Clarke GM, Holloway CMB, Zubovits JT, Nofech-Mozes S, Murray M, Liu K, Wang D, Kiss A, Yaffe MJ. Three-dimensional tumor visualization of invasive breast carcinomas using whole-mount serial section histopathology: implications for tumor size assessment. Breast Cancer Res Treat 2019; 174:669-677. [PMID: 30612274 DOI: 10.1007/s10549-018-05122-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/26/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Linear tumor size (T-size) estimated with conventional histology informs breast cancer management. Previously we demonstrated significant differences in margin and focality estimates using conventional histology versus digital whole-mount serial sections (WMSS). Using WMSS we can measure T-size or volume. Here, we compare WMSS T-size with volume, and with T-size measured conventionally. We also compare the ellipsoid model for calculating tumor volume to direct, WMSS measurement. METHODS Two pathologists contoured regions of invasive carcinoma and measured T-size from both WMSS and (simulated) conventional sections in 55 consecutive lumpectomy specimens. Volume was measured directly from the contours. Measurements were compared using the paired t-test or Spearman's rank-order correlation. A five-point 'border index' was devised and assigned to each case to parametrize tumor shape considering 'compactness' or cellularity. Tumor volumes calculated assuming ellipsoid geometry were compared with direct, WMSS measurements. RESULTS WMSS reported significantly larger T-size than conventional histology in the majority of cases [61.8%, 34/55; means = (2.34 cm; 1.99 cm), p < 0.001], with a 16.4% (9/55) rate of 'upstaging'. The majority of discordances were due to undersampling. T-size and volume were strongly correlated (r = 0.838, p < 0.001). Significantly lower volume was obtained with WMSS versus ellipsoid modeling [means = (1.18 cm3; 1.45 cm3), p < 0.001]. CONCLUSIONS Significantly larger T-size is measured with WMSS than conventionally, due primarily to undersampling in the latter. Volume and linear size are highly correlated. Diffuse tumors interspersed with normal or non-invasive elements may be sampled less extensively than more localized masses. The ellipsoid model overestimates tumor volume.
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Affiliation(s)
- G M Clarke
- Physical Sciences Platform, Sunnybrook Research Institute, Room C7-27c 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - C M B Holloway
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre, Room T2-015 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - J T Zubovits
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pathology, Scarborough and Rouge Hospital, 3030 Birchmount Road, Toronto, ON, M1W 3W3, Canada
| | - S Nofech-Mozes
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Room E423a 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - M Murray
- Physical Sciences Platform, Sunnybrook Research Institute, Room C7-48a 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - K Liu
- Physical Sciences Platform, Sunnybrook Research Institute, Room C7-27a 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - D Wang
- Physical Sciences Platform, Sunnybrook Research Institute, Room C7-27a 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - A Kiss
- Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Room G106 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - M J Yaffe
- Departments of Medical Biophysics and Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Physical Sciences Platform, Sunnybrook Research Institute, Room S6-57 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Affiliation(s)
- Mark J. Yaffe
- Department of Family Medicine; McGill University; Montreal Quebec Canada
- Department of Family Medicine; St. Mary's Hospital Center; Montreal Quebec Canada
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Ballard SA, Yaffe MJ, August L, Cetin-Sahin D, Wilchesky M. Adapting the Elder Abuse Suspicion Index© for Use in Long-Term Care: A Mixed-Methods Approach. J Appl Gerontol 2017; 38:1472-1491. [PMID: 29165023 DOI: 10.1177/0733464817732443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] Open
Abstract
Currently available elder abuse screening and identification tools have limitations for use in long-term care (LTC). This mixed-methods study sought to explore the appropriateness of using the Elder Abuse Suspicion Index© (a suspicion tool originally created for use with older adults in the ambulatory setting with Mini-Mental State Examination scores ≥ 24) with similarly cognitively functioning persons residing in LTC. Results were informed by a literature review, Internet-based consultations with elder abuse experts across Canada (n = 19), and data obtained from two purposively selected focus groups (n = 7 local elder abuse experts; n = 7 experienced front-line LTC clinicians). Analyses resulted in the development of a nine-question tool, the EASI-ltc, designed to raise suspicion of EA in cognitively intact older adults residing in LTC (with little or no cognitive impairment). Notable modifications to the original Elder Abuse Suspicion Index© (EASI) included three new questions to further address neglect and psychological abuse, and a context-specific preamble to orient responders.
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Affiliation(s)
- Stephanie A Ballard
- 1 McGill University, Montreal, Québec, Canada.,2 Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, Québec, Canada
| | - Mark J Yaffe
- 1 McGill University, Montreal, Québec, Canada.,3 St. Mary's Hospital Center, Montreal, Québec, Canada
| | - Linda August
- 4 Centre intégré universitaire de santé et de services sociaux Centre-Ouest-de-l'île-de-Montréal, Montreal, Québec, Canada
| | - Deniz Cetin-Sahin
- 2 Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, Québec, Canada
| | - Machelle Wilchesky
- 1 McGill University, Montreal, Québec, Canada.,2 Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, Québec, Canada.,5 Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
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Kurkurina E, Lange BCL, Lama SD, Burk-Leaver E, Yaffe MJ, Monin JK, Humphries D. Detection of elder abuse: Exploring the potential use of the Elder Abuse Suspicion Index© by law enforcement in the field. J Elder Abuse Negl 2017; 30:103-126. [DOI: 10.1080/08946566.2017.1382413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elina Kurkurina
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | - Sonam D. Lama
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Erin Burk-Leaver
- Robert N. Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, USA
| | - Mark J. Yaffe
- Departments of Family Medicine, St. Mary’s Hospital & McGill University, Montreal, Canada
| | - Joan K. Monin
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Debbie Humphries
- Department of Microbial Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Hong NJL, Clarke GM, Yaffe MJ, Holloway CMB. Cost-effectiveness analysis of whole-mount pathology processing for patients with early breast cancer undergoing breast conservation. ACTA ACUST UNITED AC 2016; 23:S23-31. [PMID: 26985143 DOI: 10.3747/co.23.2917] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obtaining accurate histopathologic detail for breast lumpectomy specimens is challenging because of sampling and loss of three-dimensional conformational features with conventional processing. The whole-mount (wm) technique is a novel method of serial pathologic sectioning designed to optimize cross-sectional visualization of resected specimens and determination of margin status. METHODS Using a Markov chain cohort simulation cost-effectiveness model, we compared conventional processing with wm technique for breast lumpectomies. Cost-effectiveness was evaluated from the perspective of the Canadian health care system and compared using incremental cost-effectiveness ratios (icers) for cost per quality-adjusted life-year (qaly) over a 10-year time horizon. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the model with willingness-to-pay (wtp) thresholds of $0-$100,000. Costs are reported in adjusted 2014 Canadian dollars, discounted at a rate of 3%. RESULTS Compared with conventional processing, wm processing is more costly ($19,989 vs. $18,427) but generates 0.03 more qalys over 10 years. The icer is $45,414, indicating that this additional amount is required for each additional qaly obtained. The model was robust to all variance in parameters, with the prevalence of positive margins accounting for most of the model's variability. CONCLUSIONS After a wtp threshold of $45,414, wm processing becomes cost-effective and ultimately generates fewer recurrences and marginally more qalys over time. Excellent baseline outcomes for the current treatment of breast cancer mean that incremental differences in survival are small. However, the overall benefit of the wm technique should be considered in the context of achieving improved accuracy and not just enhancements in clinical effectiveness.
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Affiliation(s)
- N J Look Hong
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON;; Department of Surgery, University of Toronto, Toronto, ON
| | - G M Clarke
- Sunnybrook Research Institute, Toronto, ON
| | - M J Yaffe
- Sunnybrook Research Institute, Toronto, ON
| | - C M B Holloway
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON;; Department of Surgery, University of Toronto, Toronto, ON
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Sahin D, Yaffe MJ, Sussman T, McCusker J. A mixed studies literature review of family physicians' participation in research. Fam Med 2014; 46:503-514. [PMID: 25058542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Family physicians' recruitment and adherence in research are challenging. This mixed studies literature review sought to identify the extent of family physicians' participation in primary health care research, as well as facilitators and inhibitors of their recruitment and subsequent protocol adherence in research projects. METHODS We searched Medline, Embase, PsycINFO, SCOPUS, Google Scholar, and BioMed Central Medical Research Methodology by using an explicit strategy. Sixty-two articles met predetermined selection criteria. Using a mixed method approach, we performed a content analysis of the results published in these articles to synthesize factors affecting family physicians' participation in research. RESULTS Recruitment rates varied between 2% and 81%. The most frequent types of participation requested were completion of questionnaires (48%) and recruitment of patients (37%). We found that family physicians' personal/professional factors mainly affected recruitment, practice/patient-related issues mainly affected adherence, and study protocol characteristics facilitated both recruitment and adherence of family physicians in research. CONCLUSIONS This review provides a synthesis of knowledge about factors mediating family physicians' roles in research. Our findings offer material for researchers to create checklists to help create and operationalize protocols that respect local clinical and research realities.
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Affiliation(s)
- Deniz Sahin
- Department of Family Medicine and St. Mary's Research Centre, McGill University, Montreal, Quebec
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Affiliation(s)
- David Barnard
- Miles J. Edwards Chair in Professionalism and Comfort Care at the Center for Ethics in Health Care and assistant vice provost for interprofessional education at Oregon Health and Science University in Portland
| | - Mark J Yaffe
- Professor of family medicine at McGill University and St. Mary's Hospital Center in Montreal, Quebec
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Weiss DR, Wolfson C, Yaffe MJ, Shrier I, Puts MTE. Physician counseling of older adults about physical activity: the importance of context. Am J Health Promot 2013; 27:71-4. [PMID: 23113775 DOI: 10.4278/ajhp.100804-qual-263] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Physicians are encouraged to discuss physical activity with their older adult patients. Studies of physician-initiated counseling have yielded inconsistent results, perhaps because older adults' perceptions and concerns about such counseling have not been addressed. The objective of the present work was therefore to explore such perceptions and their implications. DESIGN Qualitative study, using a grounded theory approach. Data were collected using both focus groups and semistructured interviews. SETTING Data were collected in several settings, including a fitness center and physicians' offices. SUBJECTS In a first sample, 56 adults aged 65 and older participated in one of six focus group sessions examining physical activity and exercise. Subsequently, 16 older adults participated in one of two focus groups comprising a second, validation sample. Individual semistructured interviews were conducted with a sample of five physicians. METHODS Data collection and analysis took place concurrently. Transcripts were analyzed using the constant comparative method. Recruitment, data collection, and analysis were informed by grounded theory. RESULTS Inactive older adults experiencing a health problem were more receptive than their healthy counterparts to receiving physical activity counseling from their physicians. Those who were receptive appeared to find such an intervention useful in leading to behavior change. CONCLUSION This study suggests that physicians' efforts in physical activity counseling may have the best impact when provided in the context of a health problem.
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Affiliation(s)
- Deborah R Weiss
- Institut national de la recherche scientifique, Institut Armand-Frappier, Laval, Quebec, Canada.
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Abstract
This study explored the feasibility of seniors aged 65 and over with MMSE ≥24 completing the EASI-sa, a self-administrable version of the Elder Abuse Suspicion Index (EASI). A convenience sample of 210 was stratified by age, sex, and language (English and French). All completed the EASI-sa within an estimated 5 minutes, 82.9% within 2 minutes. Completion time decreased with higher education, but was not affected by age, sex, language, or measured physical or mental health. No questions went unanswered; no words were poorly understood or discomforting. The EASI-sa completion was associated with a significantly increased understanding about elder abuse (p < 0.0001).
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Affiliation(s)
- Mark J Yaffe
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
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Yaffe MJ, Tazkarji B. Understanding elder abuse in family practice. Can Fam Physician 2012; 58:1336-e698. [PMID: 23242889 PMCID: PMC3520657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To discuss what constitutes elder abuse, why family physicians should be aware of it, what signs and symptoms might suggest mistreatment of older adults, how the Elder Abuse Suspicion Index might help in identification of abuse, and what options exist for responding to suspicions of abuse. SOURCES OF INFORMATION MEDLINE, PsycINFO, and Social Work Abstracts were searched for publications in English or French, from 1970 to 2011, using the terms elder abuse, elder neglect, elder mistreatment, seniors, older adults, violence, identification, detection tools, and signs and symptoms. Relevant publications were reviewed. MAIN MESSAGE Elder abuse is an important cause of morbidity and mortality in older adults. While family physicians are well placed to identify mistreatment of seniors, their actual rates of reporting abuse are lower than those in other professions. This might be improved by an understanding of the range of acts that constitute elder abuse and what signs and symptoms seen in the office might suggest abuse. Detection might be enhanced by use of a short validated tool, such as the Elder Abuse Suspicion Index. CONCLUSION Family physicians can play a larger role in identifying possible elder abuse. Once suspicion of abuse is raised, most communities have social service or law enforcement providers available to do additional assessments and interventions.
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Affiliation(s)
- Mark J Yaffe
- St Mary's Hospital, Family Medicine Centre, 3830 Lacombe Ave, Montreal, QC H3T 1M5.
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Passaperuma K, Warner E, Causer PA, Hill KA, Messner S, Wong JW, Jong RA, Wright FC, Yaffe MJ, Ramsay EA, Balasingham S, Verity L, Eisen A, Curpen B, Shumak R, Plewes DB, Narod SA. Long-term results of screening with magnetic resonance imaging in women with BRCA mutations. Br J Cancer 2012; 107:24-30. [PMID: 22588560 PMCID: PMC3389408 DOI: 10.1038/bjc.2012.204] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The addition of breast magnetic resonance imaging (MRI) to screening mammography for women with BRCA mutations significantly increases sensitivity, but there is little data on clinical outcomes. We report screening performance, cancer stage, distant recurrence rate, and breast cancer-specific mortality in our screening study. Methods: From 1997 to 2009, 496 women aged 25 to 65 years with a known BRCA1/2 mutation, of whom 380 had no previous cancer history, were enrolled in a prospective screening trial that included annual MRI and mammography. Results: In 1847 screening rounds, 57 cancers were identified (53 screen-detected, 1 interval, and 3 incidental at prophylactic mastectomy), of which 37 (65%) were invasive. Sensitivity of MRI vs mammography was 86% vs 19% over the entire study period (P<0.0001), but was 74% vs 35% from 1997 to 2002 (P=0.02) and 94% vs 9% from 2003 to 2009 (P<0.0001), respectively. The relative sensitivities of MRI and mammography did not differ by mutation, age, or invasive vs non-invasive disease. Of the incident cancers, 97% were Stage 0 or 1. Of 28 previously unaffected women diagnosed with invasive cancer, 1 BRCA1 mutation carrier died following relapse of a 3 cm, node-positive breast cancer diagnosed on her first screen at age 48 (annual breast cancer mortality rate=0.5%). Three patients died of other causes. None of the 24 survivors has had a distant recurrence at a median follow-up of 8.4 years since diagnosis. Conclusion: Magnetic resonance imaging surveillance of women with BRCA1/2 mutations will detect the majority of breast cancers at a very early stage. The absence of distant recurrences of incident cancers to date is encouraging. However, longer follow-up is needed to confirm the safety of breast surveillance.
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Affiliation(s)
- K Passaperuma
- Department of Medicine, Division of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
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23
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Abstract
OBJECTIVES The assessment of image quality is a crucial step in the development of a new imaging protocol. Having proposed and reported on a preliminary protocol for sialography using cone beam CT (CBCT), the purpose of this study was to further optimize this protocol by maximizing the image signal difference-to-noise ratio (SDNR) and to relate these new data to previously published dosimetric data for CBCT sialography. METHODS An imaging phantom was constructed using samples with different concentrations of iodine and a water-immersed mandible. The CB MercuRay (Hitachi Medical Systems, Tokyo, Japan) was used to image the phantom using different peak kilovoltage (kVp) and milliamperage (mA) settings. SDNR was then calculated using the raw images based on mean pixel values (MPV) measured in selected regions of interest (ROI). Finally, a figure of merit (FOM) was calculated to examine the trade-off between image SDNR and effective radiation dose. RESULTS The SDNR demonstrated an expected increase as the kVp increased from 60 to 120. Also, images made with the higher mA setting (15) had greater SDNR. The iodine concentration also influenced the image quality such that SDNR increased with increased amounts of iodine. The calculated FOM was greatest for the technique using 80 kVp, with equivalent results for 10 mA and 15 mA. CONCLUSION An optimized protocol for CBCT sialography using CB MercuRay entails a 6 inch field of view with 80 kVp and 10 mA.
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Affiliation(s)
- F M Jadu
- Faculty of Dentistry, the University of Toronto, Toronto, Canada
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Cigler T, Richardson H, Yaffe MJ, Fabian CJ, Johnston D, Ingle JN, Nassif E, Brunner RL, Wood ME, Pater JL, Hu H, Qi S, Tu D, Goss PE. A randomized, placebo-controlled trial (NCIC CTG MAP.2) examining the effects of exemestane on mammographic breast density, bone density, markers of bone metabolism and serum lipid levels in postmenopausal women. Breast Cancer Res Treat 2011; 126:453-61. [PMID: 21221773 DOI: 10.1007/s10549-010-1322-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 12/19/2010] [Indexed: 01/14/2023]
Abstract
We hypothesized that exemestane (EXE) would reduce mammographic breast density and have unique effects on biomarkers of bone and lipid metabolism. Healthy postmenopausal women were randomized to EXE (25 mg daily) or placebo (PLAC) for 12 months and followed for a total of 24 months. The primary endpoint was change in percent breast density (PD) between the baseline and 12-month mammograms and secondary endpoints were changes in serum lipid levels, bone biomarkers, and bone mineral density (BMD). Ninety-eight women were randomized (49 to EXE; 49 to PLAC) and 65 had PD data at baseline and 12 months. Among women treated with EXE, PD was not significantly changed from baseline at 6, 12, or 24 months and was not different from PLAC. EXE was associated with significant percentage increase from baseline in N-telopeptide at 12 months compared with PLAC. No differences in percent change from baseline in BMD (lumbar spine and femoral neck) were observed between EXE and PLAC at either 12 or 24 months. Patients on EXE had a significantly larger percent decrease in total cholesterol than in the PLAC arm at 6 months and in HDL cholesterol at 3, 6, and 12 months. No significant differences in percent change in LDL or triglycerides were noted at any time point between the two treatment arms. EXE administered for 1 year to healthy postmenopausal women did not result in significant changes in mammographic density. A reversible increase in the bone resorption marker N-telopeptide without significant change in bone specific alkaline phosphatase or BMD during the 12 months treatment period and 1 year later was noted. Changes in lipid parameters on this trial were modest and reversible.
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Affiliation(s)
- T Cigler
- Weill Cornell Medical College, New York, NY, USA
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Friedenreich CM, Woolcott CG, McTiernan A, Terry T, Brant R, Ballard-Barbash R, Irwin ML, Jones CA, Boyd NF, Yaffe MJ, Campbell KL, McNeely ML, Karvinen KH, Courneya KS. Adiposity changes after a 1-year aerobic exercise intervention among postmenopausal women: a randomized controlled trial. Int J Obes (Lond) 2010; 35:427-35. [PMID: 20820172 PMCID: PMC3061001 DOI: 10.1038/ijo.2010.147] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: We examined the effects of an aerobic exercise intervention on adiposity outcomes that may be involved in the association between physical activity and breast cancer risk. Design: This study was a two-centre, two-armed, randomized controlled trial. The 1-year-long exercise intervention included 45 min of moderate-to-vigorous aerobic exercise five times per week, with at least three of the sessions being facility based. The control group was asked not to change their activity and both groups were asked not to change their diet. Subjects: A total of 320 postmenopausal, sedentary, normal weight-to-obese women aged 50–74 years who were cancer-free, nondiabetic and nonhormone replacement therapy users were included in this study. Measurements: Anthropometric measurements of height, weight and waist and hip circumferences; dual energy X-ray absorptiometry measurements of total body fat; and computerized tomography measurements of abdominal adiposity were carried out. Results: Women in the exercise group exercised a mean of 3.6 days (s.d.=1.3) per week and 178.5 min (s.d.=76.1) per week. Changes in all measures of adiposity favored exercisers relative to controls (P<0.001). The mean difference between groups was: −1.8 kg for body weight; −2.0 kg for total body fat; −14.9 cm2 for intra-abdominal fat area; and −24.1 cm2 for subcutaneous abdominal fat area. A linear trend of greater body fat loss with increasing volume of exercise was also observed. Conclusion: A 1-year aerobic exercise program consistent with current public health guidelines resulted in reduced adiposity levels in previously sedentary postmenopausal women at higher risk of breast cancer.
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Affiliation(s)
- C M Friedenreich
- Department of Population Health Research, Alberta Health Services, Calgary, Alberta, Canada.
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Jadu F, Yaffe MJ, Lam EWN. A comparative study of the effective radiation doses from cone beam computed tomography and plain radiography for sialography. Dentomaxillofac Radiol 2010; 39:257-63. [PMID: 20587648 DOI: 10.1259/dmfr/62878962] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES As a first step in developing a protocol for multidimensional sialography using cone beam CT (CBCT), the objective of this study was to compare the effective radiation doses from sialography of the parotid and submandibular glands using plain radiography and CBCT. METHODS The effective doses were calculated from dose measurements made at 25 selected locations in the head and neck of a radiation analogue dosimeter (RANDO) phantom, using International Commission on Radiological Protection 2007 tissue weighting factors. RESULTS The effective dose (E) changed in relationship to changes in CBCT field of view (FOV), peak kilovoltage (kVp) and milliamperage (mA). Specifically, E decreased from a maximum of 932 microSv (30 cm FOV, 120 kVp, 15 mA) to 60 microSv (15 cm FOV, 80 kVp, 10 mA) for a parotid gland study and to 148 microSv (15 cm FOV, 80 kVp, 10 mA) for a submandibular study. The collective series of plain radiographs made during sialography of the parotid and submandibular glands yielded effective doses of 65 microSv and 156 microSv, respectively. The plain parotid gland series included one panoramic, two anterior-posterior skull and four lateral skull radiographs, whereas the submandibular gland series included one panoramic, one standard mandibular occlusal and four lateral skull radiographs. CONCLUSION The effective doses from CBCT examinations centred on the parotid and submandibular glands were similar to those calculated for plain radiograph sialography when a 15 cm FOV was chosen in combination with exposure conditions of 80 kVp and 10 mA.
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Affiliation(s)
- F Jadu
- Discipline of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, Ontario M5G 1G6, Canada
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Alonzo-Proulx O, Packard N, Boone JM, Al-Mayah A, Brock KK, Shen SZ, Yaffe MJ. Validation of a method for measuring the volumetric breast density from digital mammograms. Phys Med Biol 2010; 55:3027-44. [PMID: 20463377 PMCID: PMC3052857 DOI: 10.1088/0031-9155/55/11/003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to evaluate the performance of an algorithm used to measure the volumetric breast density (VBD) from digital mammograms. The algorithm is based on the calibration of the detector signal versus the thickness and composition of breast-equivalent phantoms. The baseline error in the density from the algorithm was found to be 1.25 +/- 2.3% VBD units (PVBD) when tested against a set of calibration phantoms, of thicknesses 3-8 cm, with compositions equivalent to fibroglandular content (breast density) between 0% and 100% and under x-ray beams between 26 kVp and 32 kVp with a Rh/Rh anode/filter. The algorithm was also tested against images from a dedicated breast computed tomography (CT) scanner acquired on 26 volunteers. The CT images were segmented into regions representing adipose, fibroglandular and skin tissues, and then deformed using a finite-element algorithm to simulate the effects of compression in mammography. The mean volume, VBD and thickness of the compressed breast for these deformed images were respectively 558 cm(3), 23.6% and 62 mm. The displaced CT images were then used to generate simulated digital mammograms, considering the effects of the polychromatic x-ray spectrum, the primary and scattered energy transmitted through the breast, the anti-scatter grid and the detector efficiency. The simulated mammograms were analyzed with the VBD algorithm and compared with the deformed CT volumes. With the Rh/Rh anode filter, the root mean square difference between the VBD from CT and from the algorithm was 2.6 PVBD, and a linear regression between the two gave a slope of 0.992 with an intercept of -1.4 PVBD and a correlation with R(2) = 0.963. The results with the Mo/Mo and Mo/Rh anode/filter were similar.
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Affiliation(s)
- O Alonzo-Proulx
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada.
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Abstract
PURPOSE For dosimetry and for work in optimization of x-ray imaging of the breast, it is commonly assumed that the breast is composed of 50% fibroglandular tissue and 50% fat. The purpose of this study was to assess whether this assumption was realistic. METHODS First, data obtained from an experimental breast CT scanner were used to validate an algorithm that measures breast density from digitized film mammograms. Density results obtained from a total of 2831 women, including 191 women receiving CT and from mammograms of 2640 women from three other groups, were then used to estimate breast compositions. RESULTS Mean compositions, expressed as percent fibroglandular tissue (including the skin), varied from 13.7% to 25.6% among the groups with an overall mean of 19.3%. The mean compressed breast thickness for the mammograms was 5.9 cm (sigma = 1.6 cm). 80% of the women in our study had volumetric breast density less than 27% and 95% were below 45%. CONCLUSIONS Based on the results obtained from the four groups of women in our study, the "50-50" breast is not a representative model of the breast composition.
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Affiliation(s)
- M J Yaffe
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada.
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Yaffe MJ. Detection and reporting of elder abuse. Fam Med 2010; 42:83. [PMID: 20135557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Yaffe MJ, Wolfson C, Lithwick M. Professions show different enquiry strategies for elder abuse detection: implications for training and interprofessional care. J Interprof Care 2010; 23:646-54. [PMID: 19842958 DOI: 10.3109/13561820902886279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In a project to develop and validate a tool to assist family physicians' identification of elder abuse, nine prospective questions underwent critique and ranking in focus groups comprised of 31 social workers, doctors, and nurses working with elder abuse. Differing attitudes to the questions were discernible amongst the three professions. The social workers' approach appeared based on need to advocate for clients. Nurses' viewpoints seemed influenced by utilitarian concerns for practicality and directness, desire to respect doctors' time constraints, and discomfort that some physicians' questioning might impose on nursing fields of interest. Physicians' concerns tended to be holistic, tempered by practicality and time management issues. However despite such differences expressed during lengthy group discussions, members of all three professions, when asked to independently rank the top five questions, favorably ranked the same five (though not necessarily in the same order). Since there are known barriers to successful elder abuse enquiry the differences and concerns seen in this study may represent another potential obstacle. Programs that address elder abuse might therefore consider sensitizing trainees to the potential predispositions within their own and their colleagues' professions. This proactive strategy might facilitate interprofessional approaches to elder abuse detection.
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Affiliation(s)
- Mark J Yaffe
- Departments of Family Medicine, McGill University & St. Mary's Hospital Centre, Montreal. Quebec, Canada.
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Yaffe MJ, Wolfson C, Lithwick M, Weiss D. Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI). J Elder Abuse Negl 2008; 20:276-300. [PMID: 18928055 DOI: 10.1080/08946560801973168] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.
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Affiliation(s)
- Mark J Yaffe
- Department of Family Medicine, St. Mary's Hospital Centre, 3830 Lacombe Avenue, Montreal, Quebec, Canada, H3T 1M5.
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Yaffe MJ, Wolfson C, Lithwick M, Weiss D. Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI). J Elder Abuse Negl 2008. [PMID: 18928055 DOI: 10.1080/08946560801973168.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.
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Affiliation(s)
- Mark J Yaffe
- Department of Family Medicine, St. Mary's Hospital Centre, 3830 Lacombe Avenue, Montreal, Quebec, Canada, H3T 1M5.
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Yaffe MJ, Jacobs BJ. Education about family caregiving: advocating family physician involvement. Can Fam Physician 2008; 54:1359-1365. [PMID: 18854449 PMCID: PMC2567280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Mark J Yaffe
- St Mary's Hospital Center, McGill University, 3830 Lacombe Ave, Montreal, QC H3T 1M5.
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Yaffe MJ. Three-dimensional mammography. Breast Cancer Res 2008. [PMCID: PMC3332581 DOI: 10.1186/bcr2009] [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: 12/03/2022] Open
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Yaffe MJ, Orzeck P, Barylak L. Family physicians' perspectives on care of dementia patients and family caregivers. Can Fam Physician 2008; 54:1008-1015. [PMID: 18625826 PMCID: PMC2464807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To identify factors that facilitate or impede family physicians in ambulatory care of patients with dementia and the family caregivers of such patients. DESIGN Explanatory qualitative analyses of focus group discussions. SETTING Large, medium, and small urban; suburban; and rural family practices from various regions of the province of Quebec. PARTICIPANTS Twenty-five family doctors whose practices had at least 75% ambulatory patients; of these patients, an estimated minimum of 20% were 65 years old or older and at least 2% suffered from dementia. METHOD Physicians were recruited by telephone to be paid participants in their regions in focus groups studying aspects of dementia care in ambulatory settings. Grounded theory and constant comparative methods were used to explore data from 3 French-speaking focus groups and 1 English-speaking focus group. MAIN FINDINGS Physicians were 72% male, had a mean of 21.3 years in practice, and spent about 87% of their professional time in office practice. An estimated 38.7% of their patients were 65 years old or older, and 5.6% of these patients had Alzheimer disease or related dementias. Physicians were comfortable caring for these patients and their family caregivers but thought much of this care should come from support services offered elsewhere. Physicians admitted they had little knowledge of these services and had little interest in acquiring information about them. Government-run, community-based health and social service centres were the "black boxes" to which they referred patients and their caregivers for any form of help. Inconsistencies in the services offered by these centres were noted. CONCLUSION; While family doctors are seeking a more seamless form of interdisciplinary dementia care, a large amount of that care comes from support services about which physicians are not well informed and are not interested in learning.
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Affiliation(s)
- Mark J Yaffe
- Department of Family Medicine, St Mary's Hospital Centre, 3830 Lacombe Ave, Montreal, QC H3T 1M5.
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Yaffe MJ. Contrast enhanced and dual energy mammography. Breast Cancer Res 2008. [PMCID: PMC3332583 DOI: 10.1186/bcr2011] [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: 11/10/2022] Open
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Mayo NE, Nadeau L, Ahmed S, White C, Grad R, Huang A, Yaffe MJ, Wood-Dauphinee S. Bridging the gap: the effectiveness of teaming a stroke coordinator with patient's personal physician on the outcome of stroke. Age Ageing 2008; 37:32-8. [PMID: 18006510 DOI: 10.1093/ageing/afm133] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES to test the hypothesis as to whether persons newly discharged into the community following an acute stroke and assigned a stroke case manager would experience, compared to usual post-hospital care, better health-related quality of life (HRQL), fewer emergency room visits and less non-elective hospitalisations. DESIGN a stratified, balanced, evaluator-blinded, randomised clinical trial. SETTING five university-affiliated acute-care hospitals in Montreal, Quebec, Canada. PARTICIPANTS persons (n = 190) returning home directly from the acute-care hospital following a first or recurrent stroke with a need for health care supervision post-discharge because of low function, co-morbidity, or isolation. INTERVENTION for 6 weeks following hospital discharge a nurse stroke care manager maintained contact with patients through home visits and telephone calls designed to coordinate care with the person's personal physician and link the stroke survivor into community-based stroke services. MEASUREMENTS the primary outcome was the Physical Component Summary (PCS) of the Short-Form (SF)-36 survey. A secondary outcome was utilisation of health services. Also measured was the impact of stroke on functioning. Measurements were made at hospital discharge (baseline), following the 6-week intervention and at 6-months post-stroke. RESULTS the average age of the participants was 70 years. Discharge was achieved on average 12 days post-stroke and most participants had had a stroke of moderate severity. There were no differences between groups on the primary outcome measure, health services utilisation, or any of the secondary outcome measures. CONCLUSION for this population, there was no evidence that this type of passive case management inferred any added benefit in terms of improvement in health-related quality of life or reduction in health services utilisation and stroke impact, than usual post-discharge management.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, McGill University Hospital Centre, Montreal, Quebec, Canada.
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Clarke GM, Eidt S, Sun L, Mawdsley G, Zubovits JT, Yaffe MJ. Whole-specimen histopathology: a method to produce whole-mount breast serial sections for 3-D digital histopathology imaging. Histopathology 2007; 50:232-42. [PMID: 17222252 DOI: 10.1111/j.1365-2559.2006.02561.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To develop a method for preparing diagnostic-quality, whole-mount serial sections of breast specimens while preserving 3-D conformation. This required supporting the fresh specimen prior to breadloafing and refining the conventional tissue processing method. The overall goal is to use digital images of whole-specimen histopathology to improve the estimation of extent of disease. METHODS AND RESULTS To maintain a 3-D conformation, the specimen is suspended in 3.5% agar at 55 degrees C. The block is sliced at 5-mm intervals. Sectioning is performed after extended fixation in 4% formaldehyde from paraformaldehyde in 0.1 m Millonig's buffer, followed by paraffin processing using a non-routine schedule and extended paraffin infiltration. Whole-mount serial breast sections are produced with features of equal or superior quality to that which can be achieved using conventional methods. The method is compatible with some immunohistochemical stains but requires further optimization for others. CONCLUSIONS The technique is currently suitable for research applications. With the reduction in processing time achievable with microwave-assisted processing, there is the potential for its use as a routine clinical method. This tool may improve the accuracy of margin estimates and identification of multifocality in breast cancer; further evaluation is necessary.
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Affiliation(s)
- G M Clarke
- Imaging Research, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
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Sewitch MJ, Yaffe MJ, McCusker J, Ciampi A. Helping family doctors detect vulnerable caregivers after an emergency department visit for an elderly relative: results of a longitudinal study. BMC Fam Pract 2006; 7:46. [PMID: 16854239 PMCID: PMC1559627 DOI: 10.1186/1471-2296-7-46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 07/19/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Family doctors have been ascribed a role in monitoring patients and their informal caregivers. Little is known about the factors that might alert physicians to changing circumstances or needs of the caregivers. The study objective was to examine changes in family caregivers' quality of life following an emergency department (ED) visit by an older community-dwelling relative that might cue doctors to subsequent caregiver distress. METHODS A longitudinal study with follow-up at 1- and 4-months was conducted in the EDs of 4 hospitals in Montreal, Canada. Caregivers reported on demographics and quality of life (SF-36). Patients reported on demographics and functional disability. Multiple linear regression for repeated measures was used to evaluate changes in caregiver quality of life and factors related to these changes. RESULTS 159 caregivers (60.5 yrs +/- 15.8%; 73.0% female), including 68 (42.8%) spouses, 60 (37.7%) adult children, and 31 (19.5%) other relatives participated. Following an initial ED visit by older relatives, caregiver general health and physical functioning declined over time, while mental health status improved. Compared to the other relative caregiver group, spouses were at increased risk for decline in general health, mental health, and physical functioning at 1 month, while adult children were at increased risk for decline in physical health at 1 month. CONCLUSION Spouses were most at risk for decline in quality of life. Primary care physicians who become aware of an ED visit by an elderly person may be alerted to possible subsequent deterioration in family caregivers, especially spouses.
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Affiliation(s)
- Maida J Sewitch
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, and Department of Medicine, McGill University, Montreal, Canada
| | - Mark J Yaffe
- Department of Family Medicine, St. Mary's Hospital, and Department of Family Medicine, McGill University, Montreal, Canada
| | - Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Montreal, Canada
| | - Antonio Ciampi
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Yaffe MJ, Primeau F, McCusker J, Cole MG, Belzile E, Dendukuri N, Elie M, Laplante J. Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients/family: a descriptive study. BMC Fam Pract 2005; 6:15. [PMID: 15840163 PMCID: PMC1090569 DOI: 10.1186/1471-2296-6-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 04/19/2005] [Indexed: 11/10/2022]
Abstract
BACKGROUND Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. METHODS An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared. RESULTS 101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined. CONCLUSION Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.
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Affiliation(s)
- Mark J Yaffe
- Departments of Family Medicine, McGill University and St. Mary's Hospital Centre, 3830 Lacombe Avenue, Montreal, Qc, H3T 1M5, Canada
| | - Francois Primeau
- Department of Psychiatry, Laval University, Quebec City, Qc, Canada
| | - Jane McCusker
- Departments of Epidemiology and Biostatistics, McGill University and St. Mary's Hospital Centre, Montreal, Qc, Canada
| | - Martin G Cole
- Department of Psychiatry, McGill University and St. Mary's Hospital Centre. Montreal, Qc, Canada
| | - Eric Belzile
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital Centre, Montreal, Qc, Canada
| | - Nandini Dendukuri
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Michel Elie
- Department of Psychiatry, McGill University and St. Mary's Hospital Centre, Montreal, Qc, Canada
| | - Johanne Laplante
- Johanne Laplante, Departments of Nursing and Psychiatry, St. Mary's Hospital Centre, Montreal, Quebec, Canada
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Yaffe MJ, Gupta G, Still S, Boillat M, Russillo B, Schiff B, Sproule D. Morbidity and mortality audits: "How to"for family practice. Can Fam Physician 2005; 51:234-9. [PMID: 15751567 PMCID: PMC1472972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PROBLEM BEING ADDRESSED While professions hold their members responsible for self-regulation, many physicians have insufficient information about outcome measures in their practices to judge performance and are inexperienced in performing audits to gather the information they need to judge performance. OBJECTIVE OF PROGRAM To develop a structure and process to support family doctors with little experience in doing quality improvement studies to conduct morbidity and mortality (M&M) audits. PROGRAM DESCRIPTION A family medicine teaching group provides members on a rotating basis to an M&M review committee. The committee meets eight times a year and has done four audits, the most comprehensive on the topic of preventable hospital admissions. Both implicit and explicit criteria were incorporated into decision making. Strengths and limitations of the audit process and practice changes that resulted from the audit are discussed. CONCLUSION Morbidity and mortality audits can vary in rigour. To promote physicians' interest in and commitment to audits, factors considered should reflect the goals, needs, skills, and time available of the physicians involved. Practical learning often results from simple projects.
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Affiliation(s)
- Mark J Yaffe
- Department of Family Medicine, St Mary's Hospital, Montreal, Quebec.
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Abstract
OBJECTIVES To examine the relationship between depression among medically ill, frail elders and family caregivers' hours of care, health status, and quality of life. DESIGN AND METHODS A cross-sectional study of 193 family caregivers of seniors treated in the emergency department (ED) was conducted. Measures included patient depression (Geriatric Depression Scale-15), and caregivers' hours of care, mental health and physical functioning (SF-36), and quality of life (EQ-5D). RESULTS Mean caregiver age was 60.0 +/- 16.1 years and 70.5% were female. More caregivers of depressed seniors provided more care in the previous month (37.3% vs 22.4%, p = 0.03), had poor mental health (63.5% vs 47.0%, p = 0.03), and poor perceived quality of life (63.5% vs 50.4%, p = 0.04) compared to caregivers of non-depressed seniors. Multiple logistic regression analyses indicated that patient depression was associated with poor caregiver quality of life (OR = 3.15, 95% CI 1.48, 6.73), and poor mental health in spousal and adult child caregivers (OR = 2.72, 95% CI = 0.88, 8.39, and OR = 3.29, 95% CI = 1.10, 9.86, respectively). CONCLUSIONS Psychosocial support may be needed for caregivers of depressed seniors.
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Affiliation(s)
- Maida J Sewitch
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, and Department of Medicine, McGill University, Montreal, Canada.
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Abstract
The important role of family caregivers in maintaining their disabled and elderly members in the community is becoming increasingly recognized. Caregiver research, for the most part, has explored burden and emotional distress as outcomes of the caregiving experience. Although there is a growing consensus among health-care researchers concerning the importance of quality of life (QoL) as an outcome, there is little research examining QoL of family caregivers. The purpose of this paper, therefore, was to construct a conceptual framework from which to study the QoL of family caregivers of stroke survivors. Findings from a review of studies addressing the QoL of these caregivers guided the development of the model. The components of the model include the caregiving situation, characteristics of the caregiver, and environmental factors, and their proposed relationships with QoL. This model provides a framework for investigating how the caregiving experience impacts on the caregiver's QoL.
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Affiliation(s)
- Carole L White
- Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada.
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Yaffe MJ, Klvana J. Physician perspectives on the elderly patient-family caregiver-physician encounter. Isr Med Assoc J 2002; 4:785-9. [PMID: 12389341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Eldercare often necessitates the presence of a family caregiver at the senior's visit to a doctor's office. Studies indicate that some caregivers are not satisfied with these encounters or with their outcomes. An understanding of the dynamics of these complex interactions is required. OBJECTIVES To explore family physicians' attitudes to interfacing with family caregivers of the elderly, to identify factors within the family doctor-elderly patient-caregiver encounters in the office setting that might be problematic for physicians, to ascertain factors that might contribute to doctors' behaviors and concerns, and to propose possible solutions for optimizing the outcomes of these visits. METHOD A questionnaire for self-administration was mailed to 200 family physicians in Montreal, Canada who are affiliated with two community secondary care and one tertiary care hospital and involved in geriatric office practice. The survey focused on family physician attitudes, concerns and observations on the interactions among themselves, elderly patients and their family caregivers during office visits. RESULTS A total of 142 completed questionnaires were returned with a 71% response rate. Most family doctors felt that it was their responsibility to respond to caregiver concerns (90.6%) and that they were generally meeting their needs (94.2%). In contrast, 81% found this activity stressful and that as few as three such encounters per day were sufficient to generate stress. Causes of stress included: a) concern regarding misdiagnosis, b) different agendas or conflicting responses of patient and caregiver to doctors' suggestions, and c) reluctance of the elderly or the caregiver to use community resources. A common physician strategy was reliance on acquired professional experience to solving problems of the elderly or of their caregivers. CONCLUSIONS Despite the stress involved, physicians are interested in assisting caregivers in the management of the elderly. Many doctors lack adequate knowledge about or confidence in community resources. Clinicians may require enhanced skills in conflict resolution necessary to achieve optimal outcomes.
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Affiliation(s)
- Mark J Yaffe
- Department of Family Medicine, St. Mary's Hospital, McGill University Faculty of Medicine, Montreal, Canada.
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Ford NL, Yaffe MJ. Comparison of image quality indicators among mammography facilities in Ontario. Can Assoc Radiol J 2001; 52:369-72. [PMID: 11780545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To compare the technical aspects of image quality of mammography machines in facilities across Ontario. METHODS Eight mammographic physics consultants took measurements and calculated accreditation phantom scores, mean glandular dose, entrance exposure, average optical density, half value layer and the limiting resolution of the imaging chain for 100 mammography machines across Ontario. RESULTS Of the 100 machines, 39 were affiliated with the Ontario Breast Screening Program (OBSP), and the remaining 61 were applying to become OBSP affiliates. All of the OBSP facilities and 32 of the applicants were accredited with the Mammography Accreditation Program (MAP) of the Canadian Association of Radiologists (CAR). All OBSP facilities had passing phantom scores, and 84% of the applicants with CAR accreditation and 79% of those without had passing phantom scores. The mean glandular dose was 1.5 (range 1.0-1.9, standard deviation [SD] 0.22) mGy for OBSP facilities, 1.3 (0.8-1.8, SD 0.29) mGy for CAR accredited and 1.4 (0.9-1.9, SD 0.24) mGy for nonaccredited applicants. Mean entrance exposures were 798 (540-1280, SD 135) mR, 717 (430-980, SD 153) mR and 770 (520-930, SD 116) mR for the OBSP, accredited and nonaccredited facilities respectively. There were no appreciable differences in the mean optical densities (approx. 1.62 OD), mean half-value layers (approx. 0.34 mm Al) or mean resolutions measured with the large focal spot (nominal size of 0.3 mm) either parallel (approx. 16 line pairs/mm) or perpendicular (approx. 14 line pairs/mm) to the cathode-anode axis of the x-ray tube, among the 3 types of facilities. CONCLUSION Image quality is increased and variability is decreased in facilities participating in a province-wide screening program.
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Affiliation(s)
- N L Ford
- Sunnybrook and Women's College Health Sciences Centre, Room S657, 2075 Bayview Ave., Toronto, ON M4N 3M5
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Haus AG, Yaffe MJ, Feig SA, Hendrick RE, Butler PA, Wilcox PA, Bansal S. Relationship between phantom failure rates and radiation dose in mammography accreditation. Med Phys 2001; 28:2297-301. [PMID: 11764036 DOI: 10.1118/1.1408283] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The American College of Radiology Mammography Accreditation Program (ACR MAP) reviews both clinical mammograms and a phantom image to assess clinical and technical quality from each mammography unit. The phantom contains details representing fibers (speculations), speck groups (microcalcifications), and masses. The depiction of these structures by the mammographic system is scored by medical physicists. The phantom image is taken using the facility's exposure technique for a 4.2-cm thick breast of average composition. The mean glandular dose (MGD) is determined from a set of thermoluminescent dosimeters placed on top of the chest wall edge of the phantom. Phantom scores and MGD data collected from 1993 to 1999 based on 31 535 unit evaluations are presented in this paper. The relationship between the failure rate for phantom image quality and MGD has been analyzed. While over all doses the phantom failure rate was 11%, for doses of 0.26 to 0.50 mGy the failure rate was 43%. The phantom failure rate fell continuously to about 6% for MGDs in the range of 1.51-2.0 mGy. With further increases in dose, failure rates began to rise. Factors that may account for these results are presented and discussed.
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Affiliation(s)
- A G Haus
- Sunnybrook & Womens College Health Sciences Center, Toronto, Canada.
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Yaffe MJ, Russillo B, Hyland C, Kovacs L, McAlister E. Better care and better teaching. New model of postpartum care for early discharge programs. Can Fam Physician 2001; 47:2027-33. [PMID: 11723597 PMCID: PMC2018431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
PROBLEM BEING ADDRESSED Rapid postpartum discharge has reduced opportunities to detect early newborn or parenting problems and to teach neonatal assessment and maternal postpartum care to medical trainees. OBJECTIVE OF PROGRAM Development of a program to not only ensure adequate care of mothers and newborns after early hospital discharge, but also to teach outpatient assessment skills to family medicine residents. MAIN COMPONENTS OF PROGRAM In an urban, secondary care, university-affiliated teaching hospital predominantly training family medicine residents, an interdisciplinary committee created and supervised a neonatal and maternal postpartum assessment program. Newborn infants and their mothers are seen by a family physician, a family medicine resident, and a nurse within 48 hours of discharge, after which care is assumed in the community by the child's primary care physician. An assessment protocol developed by the interdisciplinary group promotes standardized mother and child care and a structured learning experience for trainees. CONCLUSION Rapid follow up of early discharged infants and their mothers can be facilitated by a program of standardized assessment by a roster of pooled, interacting family physicians and nurses. When this assessment occurs in a teaching milieu, a comprehensive learning experience can be combined with defined objectives that emphasize and encourage newborn and maternal assessment for ambulatory patients.
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Warner E, Plewes DB, Shumak RS, Catzavelos GC, Di Prospero LS, Yaffe MJ, Goel V, Ramsay E, Chart PL, Cole DE, Taylor GA, Cutrara M, Samuels TH, Murphy JP, Murphy JM, Narod SA. Comparison of breast magnetic resonance imaging, mammography, and ultrasound for surveillance of women at high risk for hereditary breast cancer. J Clin Oncol 2001; 19:3524-31. [PMID: 11481359 DOI: 10.1200/jco.2001.19.15.3524] [Citation(s) in RCA: 314] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Recommended surveillance for BRCA1 and BRCA2 mutation carriers includes regular mammography and clinical breast examination, although the effectiveness of these screening techniques in mutation carriers has not been established. The purpose of the present study was to compare breast magnetic resonance imaging (MRI) with ultrasound, mammography, and physical examination in women at high risk for hereditary breast cancer. PATIENTS AND METHODS A total of 196 women, aged 26 to 59 years, with proven BRCA1 or BRCA2 mutations or strong family histories of breast or ovarian cancer underwent mammography, ultrasound, MRI, and clinical breast examination on a single day. A biopsy was performed when any of the four investigations was judged to be suspicious for malignancy. RESULTS Six invasive breast cancers and one noninvasive breast cancer were detected among the 196 high-risk women. Five of the invasive cancers occurred in mutation carriers, and the sixth occurred in a woman with a previous history of breast cancer. The prevalence of invasive or noninvasive breast cancer in the 96 mutation carriers was 6.2%. All six invasive cancers were detected by MRI, all were 1.0 cm or less in diameter, and all were node-negative. In contrast, only three invasive cancers were detected by ultrasound, two by mammography, and two by physical examination. The addition of MRI to the more commonly available triad of mammography, ultrasound, and breast examination identified two additional invasive breast cancers that would otherwise have been missed. CONCLUSION Breast MRI may be superior to mammography and ultrasound for the screening of women at high risk for hereditary breast cancer.
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Affiliation(s)
- E Warner
- Division of Medical Oncology, Department of Medical Biophysics, and Centre for Research in Women's Health, Toronto, Ontario, Canada.
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Boyd NF, Martin LJ, Stone J, Greenberg C, Minkin S, Yaffe MJ. Mammographic densities as a marker of human breast cancer risk and their use in chemoprevention. Curr Oncol Rep 2001; 3:314-21. [PMID: 11389815 DOI: 10.1007/s11912-001-0083-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Differences in the parenchymal pattern of the breast on mammography reflect differences in the amounts of stromal, epithelial, and fat tissue present in the breast. Stroma and epithelium are radiologically dense, whereas fat is lucent. Extensive areas of mammographically dense breast tissue are strongly associated with an increased risk of breast cancer. A variety of interventions, including gonadotropin-releasing hormone inhibitor, tamoxifen, stopping hormone replacement therapy (HRT), and adopting a low-fat, high-carbohydrate diet, all influence the tissue composition of the breast and reduce mammographic densities. Of the interventions examined to date, only tamoxifen has been shown to reduce the incidence of breast cancer, at least in the short term. Conversely, HRT, which increases density, also increases risk of breast cancer. These results suggest that mammographic density may be a short-term marker of the effect on the breast of potential preventive interventions for breast cancer.
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Affiliation(s)
- N F Boyd
- Division of Epidemiology and Statistics, Ontario Cancer Institute, Room 10-415, 610 University Avenue, Toronto, ON, Canada M5G 2M9
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