1
|
Weidman DR, Lee SCES, Desmarais P, Stevens K, Klinger CA, Colquhoun H, Bender JL, Gupta A. Perspectives of Health Care Providers on Peer Support for Adolescents with Cancer in Pediatrics. J Adolesc Young Adult Oncol 2024. [PMID: 38526577 DOI: 10.1089/jayao.2023.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Health care providers (HCPs) play a key role in psychosocial care of adolescents with cancer (AWC) and present a unique perspective. This prospective study included a brief survey followed by an interview, seeking to understand HCPs' viewpoints on peer support needs of AWC. Participants were 10 multidisciplinary HCPs with 5-30 years of experience. Three key themes found were: observations made and relationships with AWC; challenges to providing support; and potential peer support interventions. HCPs want to provide peer support resources but lack adequate information. Next steps: interventions should include information dissemination to all HCPs caring for AWC.
Collapse
Affiliation(s)
- Danielle R Weidman
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Radiation Oncology, University Health Network, Toronto, Ontario, Canada
| | - Sandy Che-Eun Serena Lee
- Department of Radiation Oncology, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular and Medical Pharmacology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Philippe Desmarais
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, University of Montréal, Montréal, Québec, Canada
- Carrefour de l'innovation, Centre de Recherche due Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Katye Stevens
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Christopher A Klinger
- Translational Research Program, Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline L Bender
- ELLICSR Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Abha Gupta
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Radiation Oncology, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Couette M, Roy J, Doglioni DO, Bereznyakova O, Stapf C, Jacquin G, Fraïle V, Desmarais P, Desforges SM, Touma L, Nauche B, Bartolucci P, Kuo KHM, Forté S. Screening for cognitive impairment in adults with sickle cell disease: A systematic review and meta-analysis. Presse Med 2023; 52:104207. [PMID: 37979834 DOI: 10.1016/j.lpm.2023.104207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023] Open
Abstract
Neurovascular disease such as symptomatic stroke, silent brain infarcts and vascular cognitive impairment are common complications of sickle cell disease (SCD) that can have devastating consequences on quality of life, employment, and social functioning. Early recognition of neurovascular disease is a prerequisite for the timely optimization of medical care and to connect patients to adaptive resources. While cognitive impairment has been well described in children, currently available data are limited in adults. As a result, guidance on the optimal cognitive screening strategies in adults is scarce. We conducted a systematic review to identify the different screening tools that have been evaluated in SCD. A meta-analysis was performed to estimate the prevalence of suspected cognitive impairment in this population. In this qualitative synthesis, we present 8 studies that evaluated 6 different screening tools. Patient characteristics that impacted on cognitive screening performance included age, education level, and a prior history of stroke. We report a pooled prevalence of 38% [14-62%] of suspected cognitive impairment. We discuss the relative benefits and limitations of the different screening tools to help clinicians select an adapted approach tailored to their specific patients' needs. Further studies are needed to establish and validate cognitive screening strategies in patients with diverse cultural and educational backgrounds.
Collapse
Affiliation(s)
- Maryline Couette
- Sickle Cell Referral Centre-UMGGR, University of Paris Est Créteil, Henri Mondor APHP, 94010, Créteil, France; CARMAS (Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis), University of Paris Est Créteil, 94010, Créteil, France; IMRB, INSERM, University of Paris Est Créteil, 94010, Créteil, France
| | - Justine Roy
- Faculté de médecine, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Damien Oudin Doglioni
- Sickle Cell Referral Centre-UMGGR, University of Paris Est Créteil, Henri Mondor APHP, 94010, Créteil, France; Laboratoire Inter-Universitaire de Psychologie-Personnalité, Cognition, Changement Social (LIP/PC2S), Université Grenoble Alpes, 38058, Saint-Martin-d'Hères, France
| | - Olena Bereznyakova
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Christian Stapf
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Gregory Jacquin
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Valérie Fraïle
- Division of Psychology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada
| | - Philippe Desmarais
- Axe Neurosciences et Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, QC, H2X 0A9, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada; Division of Geriatrics, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada
| | - Sara-Maude Desforges
- Faculté de médecine, Université de Montréal, Montréal, QC, H3C 3J7, Canada; Department of Medecine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, H2X 0C1, Canada
| | - Lahoud Touma
- Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, H2X 0C1, Canada; Department of Neurosciences, Université de Montréal, Montréal, QC, H3C 3J7, Canada
| | - Bénédicte Nauche
- Library, Centre Hospitalier de l'Université de Montréal, Montréal, QC, H2X 3E4, Canada
| | - Pablo Bartolucci
- Sickle Cell Referral Centre-UMGGR, University of Paris Est Créteil, Henri Mondor APHP, 94010, Créteil, France; IMRB, INSERM, University of Paris Est Créteil, 94010, Créteil, France; INSERM-U955, Equipe 2, Laboratoire d'Excellence, GRex, Institut Mondor, 94000, Créteil, France
| | - Kevin H M Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada; Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, ON, M5G 2N2, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | - Stéphanie Forté
- Faculté de médecine, Université de Montréal, Montréal, QC, H3C 3J7, Canada; Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, H2X 3E4, Canada; Carrefour de l'innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, H2X 0A9, QC, Canada.
| |
Collapse
|
3
|
Nguyen QD, Forget MF, Zhang XS, Richer C, Podbielski R, Gaudreau P, Desmarais P. Systematic review of research barriers, facilitators, and stakeholders in long-term care and geriatric settings, and a conceptual mapping framework to build research capacity. BMC Geriatr 2023; 23:622. [PMID: 37794339 PMCID: PMC10552295 DOI: 10.1186/s12877-023-04318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Older adults are underrepresented in research. Heterogeneity of research processes in this population, specifically in long-term care (LTC) and geriatric acute care (GAC), is not well described and may impede the design, planning, and conduct of research. In this study, we identified, quantified, and mapped stakeholders, research stages, and transversal themes of research processes, to develop a mapping framework to improve research capacity by better characterizing this heterogeneity. METHODS Multicomponent mixed methods study. An environmental scan was used to initiate a preliminary framework. We conducted a systematic literature search on processes, barriers, and methods for clinical research in GAC and LTC to extract and update stakeholders, research stages, and themes. Importance and interactions of elements were synthesized via heatmaps by number of articles, mentions, and content intersections. RESULTS For our initial framework and environmental scan, we surveyed 24 stakeholders. Of 9277 records, 68 articles were included in our systematic review and allowed us to identify 12 stakeholders, 13 research stages, 17 transversal themes (either barriers, facilitators, general themes, or recommendations), and 1868 intersections. Differences in relative importance between LTC and GAC emerged for stakeholders (staff, managers vs. caregivers, ethics committees), and for research stages (funding, facility recruitment vs. ethics, individual recruitment). Crucial themes according to specific stakeholders were collaboration for the research team; communication, trust, and human resources for managers; heterogeneity for patients and residents. A heatmap framework synthesizing vital stakeholders and themes per research stage was generated. CONCLUSIONS We identified and quantified the interactions between stakeholders, stages, and themes to characterize heterogeneity in LTC and GAC research. Our framework may serve as a blueprint to co-construct and improve each stage of the research process.
Collapse
Affiliation(s)
- Quoc Dinh Nguyen
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada.
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada.
- Department of Medicine, Université de Montréal, Montreal, Canada.
| | - Marie-France Forget
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Xi Sophie Zhang
- Department of General Medicine, Centre intégré de santé et de services sociaux du Centre- Sud-de-l'île-de-Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Catherine Richer
- Department of General Medicine, Centre intégré de santé et de services sociaux du Centre- Sud-de-l'île-de-Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Renata Podbielski
- Direction of Teaching and the CHUM Académie, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Pierrette Gaudreau
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Philippe Desmarais
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| |
Collapse
|
4
|
Sammartino-Arbour A, Dufour A, Frenette V, Forget MF, Bruneau MA, Ducharme S, Camicioli R, Nguyen QD, Desmarais P. The Association Between Somatic Symptom Disorders and Neurocognitive Disorders: A Systematic Review. Am J Geriatr Psychiatry 2023; 31:33-43. [PMID: 35970734 DOI: 10.1016/j.jagp.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Onset of neuropsychiatric symptoms in older adults may represent prodromal manifestations of neurodegenerative disorders. The association between the onset of somatic symptom and related disorders (SSRD) and the subsequent development of neurodegenerative disorders remains unclear. A critical review of studies describing the association between SSRD and neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Frontotemporal dementia, and Lewy body dementia was performed. OBJECTIVE To critically review studies describing the association between SSRD and neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Frontotemporal dementia, and Lewy body dementia. METHODS A systematic review of Web of Science Core databases was carried out from inception of databases up to May 2021 to identify observational studies pertaining to both SSRD and neurodegenerative disorders. Data was extracted and compiled regarding subjects enrolled, age at onset of the SSRD and at onset of the neurodegenerative disorders, and specific SSRD manifestations and underlying neuropathologies reported. RESULTS Thirteen articles were included. Of the 123 identified subjects with SSRD at baseline, 34.1% developed a neurodegenerative disorder, with 80.9% of these being a Lewy body spectrum disorder. The interval between onset of SSRD manifestations and subsequent development of a neurodegenerative disorder was less than 3 years for half of the cases. Of the 1,494 subjects with a neurodegenerative disorder at baseline retrieved, SSRD manifestations were reported in 33.4% of Lewy body spectrum disorders cases. Onset of SSRD manifestations antedated or was concomitant to the diagnosis of the Lewy body spectrum disorder in 65.6% of cases. CONCLUSION While limited, current evidence suggests a possible association between late-onset SSRD and the subsequent development of neurodegenerative disorders, notably Lewy body spectrum disorders.
Collapse
Affiliation(s)
- Alexandra Sammartino-Arbour
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ariane Dufour
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Valérie Frenette
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Marie-France Forget
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Marie-Andrée Bruneau
- Department of Psychiatry (MAB), Université de Montréal, Montréal, Québec, Canada
| | - Simon Ducharme
- Department of Psychiatry (SD), Douglas Mental Health University Institute & Douglas Research Centre, McGill University, Montréal, Québec, Canada; McConnel Brain Imaging Centre (SD), Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute University of Alberta (RC), Edmonton, Alberta, Canada
| | - Quoc Dinh Nguyen
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Innovation Hub (QDN), Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Philippe Desmarais
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Department of Neurosciences (PD), Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| |
Collapse
|
5
|
Weidman DR, Lee SCES, Desmarais P, Stevens K, Klinger CA, Colquhoun H, Bender JL, Gupta A. Peer Support Perspectives of Parents of Adolescents with Cancer in Pediatrics. J Adolesc Young Adult Oncol 2022. [PMID: 36000974 DOI: 10.1089/jayao.2022.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Parents of adolescents with cancer (AWC) provide critical support throughout the cancer journey and could offer key insights into support needs. This prospective study aimed to obtain parent perspectives on peer support needs of AWC. Ten individual parents (9 mothers and 1 father) completed a survey and a semistructured interview. Four themes were identified: cancer journey challenges; emotions, reactions, and coping; personal support preferences; and AWC's support needs. Parents recognized that AWC require various support, but lacked insight into their specific peer support desires. Next step interventions should focus on peer support for AWC, while also incorporating peer support for parents.
Collapse
Affiliation(s)
- Danielle R Weidman
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sandy Che-Eun Serena Lee
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Philippe Desmarais
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, University of Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche due Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Katye Stevens
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Christopher A Klinger
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline L Bender
- ELLICSR Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Dalla Lana School of Public Health and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Abha Gupta
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Guay-Gagnon M, Vat S, Forget MF, Tremblay-Gravel M, Ducharme S, Nguyen QD, Desmarais P. Sleep apnea and the risk of dementia: A systematic review and meta-analysis. J Sleep Res 2022; 31:e13589. [PMID: 35366021 DOI: 10.1111/jsr.13589] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/01/2022] [Accepted: 03/11/2022] [Indexed: 12/19/2022]
Abstract
Sleep apnea (SA) is potentially a modifiable risk factor for dementia. However, its associations to specific aetiologies of dementia remain uncertain. A systematic review and meta-analysis of cohort studies investigating the association between sleep apnea and specific aetiologies of dementia, including Alzheimer's disease (AD), Parkinson's disease (PD), Lewy body dementia (LBD), vascular dementia (VaD), and frontotemporal dementia (FTD) was performed. The use of biomarkers to support clinical diagnoses in eligible studies was collected. Eleven studies were included, comprising 1,333,424 patients. Patients with sleep apnea had an increased risk of developing any type of neurocognitive disorder (HR: 1.43 [95% CI 1.26-1.62]), Alzheimer's disease (HR: 1.28 [95% CI 1.16-1.41]), and Parkinson's disease (HR: 1.54 [95% CI 1.30-1.84]). No statistically significant association was found for vascular dementia. One study reported a two-fold increased risk for Lewy body dementia (HR: 2.06 [95% CI 1.45-2.91]). No studies investigated the risk for frontotemporal dementia and none of the studies reported results pertaining to biomarkers. Sleep apnea is associated with a significantly increased risk of dementia, particularly for Alzheimer's disease and Parkinson's disease, but not for vascular dementia. Future studies should look at the impact of sleep apnea on specific dementia biomarkers.
Collapse
Affiliation(s)
- Martin Guay-Gagnon
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Sopharat Vat
- Department of Medicine, Division of Pulmonary Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Cardiometabolic, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-France Forget
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | - Simon Ducharme
- Department of Psychiatry, Douglas Mental Health University Institute & Douglas Research Centre, McGill University, Montreal, Quebec, Canada.,McConnel Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Quoc Dinh Nguyen
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Desmarais
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Herrmann N, Ismail Z, Collins R, Desmarais P, Goodarzi Z, Henri‐Bhargava A, Iaboni A, Kirkham J, Massoud F, Moser A, Silvius J, Watt J, Seitz D. CCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementia. Alzheimers Dement (N Y) 2022; 8:e12099. [PMID: 35128025 PMCID: PMC8802736 DOI: 10.1002/trc2.12099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cognitive enhancers (ie, cholinesterase inhibitors and memantine) can provide symptomatic benefit for some individuals with dementia; however, there are circumstances in which the risks of continuing treatment may potentially outweigh benefits. The decision to deprescribe cognitive enhancers must consider each patient's preferences, treatment indications, current clinical status and symptoms, prognosis, and dementia type. METHODS The 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) established a subcommittee of experts to review current evidence on the deprescribing of cognitive enhancers. The questions answered by this group included: When should cognitive enhancers be deprescribed in persons with dementia and mild cognitive impairment? How should cognitive enhancers be deprescribed? And, what clinical factors should be considered when deprescribing cognitive enhancers? RESULTS Patient and care-partner preferences should be incorporated into all decisions to deprescribe cognitive enhancers. Cognitive enhancers should be discontinued in individuals without ongoing evidence of benefit or when the indication for cognitive enhancer use was inappropriate (eg, mild cognitive impairment). Deprescribing should occur gradually and cognitive enhancers should be reinitiated if patients' cognition or function deteriorates. Cognitive enhancers should be continued in individuals whose neuropsychiatric symptoms improve in response to treatment. Clinicians should not deprescribe cognitive enhancers in individuals with significant neuropsychiatric symptoms until symptoms have stabilized. CONCLUSION CCCDTD5 deprescribing recommendations provide evidence-informed recommendations related to cognitive enhancer deprescribing that will facilitate shared decision making among patients, care partners, and clinicians.
Collapse
Affiliation(s)
- Nathan Herrmann
- Department of PsychiatrySunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Cumming School of Medicine; Hotchkiss Brain Institute and O'Brien Institute of Public HealthUniversity of Calgary, Calgary, Alberta, Canada
| | - Rhonda Collins
- Department of Family MedicineMcMaster UniversityChief Medical Officer, Revera IncHamiltonOntarioCanada
| | - Philippe Desmarais
- Department of MedicineDivision of Geriatrics and Department of NeurosciencesCentre de Recherche du Centre Hospitalier de l'Université de MontréalMontréalQuébecCanada
| | - Zahra Goodarzi
- Division of Geriatrics, Department of Medicine, Cumming School of Medicine; Hotchkiss Brain Institute; O'Brien Institute of Public HealthUniversity of CalgaryCalgaryCanada
| | - Alexandre Henri‐Bhargava
- Division of Neurology, Faculty of MedicineUniversity of British Columbia; Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Andrea Iaboni
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Kite Research Institute, Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Julia Kirkham
- Department of PsychiatryCumming School of Medicine, University of Calgary
| | - Fadi Massoud
- Department of MedicineUniversity of SherbrookeSherbrookeQuebecCanada
| | - Andrea Moser
- Department of Family and Community MedicineUniversity of Toronto, Associate Medical Director, Jewish Home for the Aged, BaycrestTorontoOntarioCanada
| | - James Silvius
- Division of Geriatric Medicine, Department of Medicine, Cumming School of MedicineUniversity of Calgary, Calgary, Alberta, Canada
| | - Jennifer Watt
- Division of Geriatric MedicineDepartment of Medicine, University of TorontoTorontoOntarioCanada
| | - Dallas Seitz
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Cumming School of Medicine; Hotchkiss Brain Institute and O'Brien Institute of Public HealthUniversity of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
8
|
Guay‐Gagnon M, Desmarais P. The association between sleep apnea and neurodegenerative disorders: A systematic review and meta‐analysis with an emphasis on precision‐medicine. Alzheimers Dement 2021. [DOI: 10.1002/alz.057825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
9
|
Nguyen QD, Moodie EM, Desmarais P, Goulden R, Forget MF, Peters E, Saeed S, Keezer MR, Wolfson C. Appraising clinical applicability of studies: mapping and synthesis of current frameworks, and proposal of the FrACAS framework and VICORT checklist. BMC Med Res Methodol 2021; 21:248. [PMID: 34773994 PMCID: PMC8590785 DOI: 10.1186/s12874-021-01445-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Not all research findings are translated to clinical practice. Reasons for lack of applicability are varied, and multiple frameworks and criteria exist to appraise the general applicability of epidemiological and clinical research. In this two-part study, we identify, map, and synthesize frameworks and criteria; we develop a framework to assist clinicians to appraise applicability specifically from a clinical perspective. METHODS We conducted a literature search in PubMed and Embase to identify frameworks appraising applicability of study results. Conceptual thematic analysis was used to synthesize frameworks and criteria. We carried out a framework development process integrating contemporary debates in epidemiology, findings from the literature search and synthesis, iterative pilot-testing, and brainstorming and consensus discussions to propose a concise framework to appraise clinical applicability. RESULTS Of the 4622 references retrieved, we identified 26 unique frameworks featuring 21 criteria. Frameworks and criteria varied by scope and level of aggregation of the evidence appraised, target user, and specific area of applicability (internal validity, clinical applicability, external validity, and system applicability). Our proposed Framework Appraising the Clinical Applicability of Studies (FrACAS) classifies studies in three domains (research, practice informing, and practice changing) by examining six criteria sequentially: Validity, Indication-informativeness, Clinical relevance, Originality, Risk-benefit comprehensiveness, and Transposability (VICORT checklist). CONCLUSIONS Existing frameworks to applicability vary by scope, target user, and area of applicability. We introduce FrACAS to specifically assess applicability from a clinical perspective. Our framework can be used as a tool for the design, appraisal, and interpretation of epidemiological and clinical studies.
Collapse
Affiliation(s)
- Quoc Dinh Nguyen
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, 1000, Saint-Denis, Montreal, Quebec, H2X0C1, Canada.
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada.
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
| | - Erica M Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Philippe Desmarais
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, 1000, Saint-Denis, Montreal, Quebec, H2X0C1, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Robert Goulden
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Marie-France Forget
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, 1000, Saint-Denis, Montreal, Quebec, H2X0C1, Canada
| | - Eric Peters
- Department of Anesthesia, Centre hospitalier universitaire Sainte-Justine, Montreal, Canada
| | - Sahar Saeed
- Department of Infectious Disease, Washington University in St. Louis, St. Louis, USA
| | - Mark R Keezer
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Departments of Neurosciences & Social and Preventative Medicine, Université de Montréal, Montreal, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, Canada
| |
Collapse
|
10
|
Weidman DR, Desmarais P, Stevens K, Klinger CA, Colquhoun H, Bender JL, Gupta A. Peer Support Needs of Adolescents with Cancer in Pediatrics: A Canadian Mixed Methods Study. J Adolesc Young Adult Oncol 2021; 11:433-438. [PMID: 34591689 DOI: 10.1089/jayao.2021.0122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adolescents with cancer (AWC) in pediatrics may not have adequate opportunities for peer support. This mixed methods study aimed to characterize peer support needs of AWC during or shortly after treatment. Ten AWC with median age 16.5 (range 14-18) years completed a survey and semistructured interview. Three themes were apparent: cancer journey difficulties, current support system, and peer support perspectives. Participants felt incompletely understood by existing supports, lacked connection with other AWC, and craved experiential information. Peer support interventions should be flexible, facilitate various interactions, and include social media. The next step is to implement and evaluate an intervention.
Collapse
Affiliation(s)
- Danielle R Weidman
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Philippe Desmarais
- Centre Hospitalier de l'Université de Montréal, Department of Medicine, University of Montréal, Montréal, Canada
| | - Katye Stevens
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Christopher A Klinger
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Jacqueline L Bender
- ELLICSR Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Dalla Lana School of Public Health and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Abha Gupta
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| |
Collapse
|
11
|
Saeed U, Desmarais P, Masellis M. The APOE ε4 variant and hippocampal atrophy in Alzheimer's disease and Lewy body dementia: a systematic review of magnetic resonance imaging studies and therapeutic relevance. Expert Rev Neurother 2021; 21:851-870. [PMID: 34311631 DOI: 10.1080/14737175.2021.1956904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: The apolipoprotein E ɛ4-allele (APOE-ɛ4) increases the risk not only for Alzheimer's disease (AD) but also for Parkinson's disease dementia and dementia with Lewy bodies (collectively, Lewy body dementia [LBD]). Hippocampal volume is an important neuroimaging biomarker for AD and LBD, although its association with APOE-ɛ4 is inconsistently reported. We investigated the association of APOE-ε4 with hippocampal atrophy quantified using magnetic resonance imaging in AD and LBD.Areas covered: Databases were searched for volumetric and voxel-based morphometric studies published up until December 31st, 2020. Thirty-nine studies (25 cross-sectional, 14 longitudinal) were included. We observed that (1) APOE-ε4 was associated with greater rate of hippocampal atrophy in longitudinal studies in AD and in those who progressed from mild cognitive impairment to AD, (2) association of APOE-ε4 with hippocampal atrophy in cross-sectional studies was inconsistent, (3) APOE-ɛ4 may influence hippocampal atrophy in dementia with Lewy bodies, although longitudinal investigations are needed. We comprehensively discussed methodological aspects, APOE-based therapeutic approaches, and the association of APOE-ε4 with hippocampal sub-regions and cognitive performance.Expert opinion: The role of APOE-ɛ4 in modulating hippocampal phenotypes may be further clarified through more homogenous, well-powered, and pathology-proven, longitudinal investigations. Understanding the underlying mechanisms will facilitate the development of prevention strategies targeting APOE-ɛ4.
Collapse
Affiliation(s)
- Usman Saeed
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Philippe Desmarais
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Mario Masellis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Cognitive and Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Toronto, Canada
| |
Collapse
|
12
|
Forget MF, Del Degan S, Leblanc J, Tannous R, Desjardins M, Durand M, Vu TTM, Nguyen QD, Desmarais P. Delirium and Inflammation in Older Adults Hospitalized for COVID-19: A Cohort Study. Clin Interv Aging 2021; 16:1223-1230. [PMID: 34234422 PMCID: PMC8242147 DOI: 10.2147/cia.s315405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose The occurrence and predictors of delirium in older adults hospitalized for coronavirus disease 2019 (COVID-19) have not been well described. Highlighting the association with inflammatory markers may be useful for identifying delirium. This study aimed to determine the prevalence and incidence of delirium and explore its association with the C-reactive protein (CRP). Patients and Methods This cohort study of adults aged 65 and older with a COVID-19 diagnosis took place at an academic healthcare institution between April and May 2020. COVID-19 was diagnosed by positive nasopharyngeal swab. Serum levels of CRP were collected as a marker of systemic inflammation. The primary outcome was the prevalence and incidence of delirium. Delirium was diagnosed primarily during a patient's stay in hospital based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). To ensure that no delirium diagnosis was missed during hospital stay, clinical records were reviewed by clinicians with geriatric medicine training for retrospective diagnoses. Results A total of 127 patients aged 65 and older were hospitalized with a diagnosis of COVID-19. The median age was 82 years (IQR: 74–88), with 54 (43%) females. Overall, delirium was present in 62 (49%) patients: manifestations of delirium were present on the first day of hospitalization in 53 of these cases (86%), while 9 cases (14%) developed delirium during hospitalization. After controlling for age and sex, the mean CRP value over the first 3 days since arrival was associated with a higher risk of delirium (OR 1.35; 95% CI: 1.01–1.85) for every 50 mg/L increase. Conclusion In this cohort of older adults hospitalized for COVID-19, delirium was highly prevalent. An early increase in CRP levels should raise suspicion about the occurrence of delirium and could improve its diagnosis.
Collapse
Affiliation(s)
- Marie-France Forget
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sophie Del Degan
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Julie Leblanc
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Rita Tannous
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Michaël Desjardins
- Department of Medicine, Division of Infectious Disease, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Madeleine Durand
- Department of Medicine, Division of Internal Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Thien Tuong Minh Vu
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Quoc Dinh Nguyen
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Philippe Desmarais
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
13
|
Nguyen QD, Moodie EM, Forget MF, Desmarais P, Keezer MR, Wolfson C. Health Heterogeneity in Older Adults: Exploration in the Canadian Longitudinal Study on Aging. J Am Geriatr Soc 2021; 69:678-687. [PMID: 33155270 DOI: 10.1111/jgs.16919] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND A widely held dictum in aging research is that heterogeneity in health increases with age, but the basis for this claim has not been fully investigated. We examined heterogeneity at different ages across health characteristics to describe variation and trends; we investigated the comparative importance of between-age versus within-age heterogeneity. DESIGN This was a cohort study. SETTING Community-dwelling older adults. PARTICIPANTS A total of 30,097 adults aged 45 to 86 years, from the Canadian Longitudinal Study on Aging, were included. MEASUREMENTS Thirty-four health characteristics in eight domains (physical measures, vital signs, physiological measures, physical performance, function/disability, chronic conditions, frailty, laboratory values) were assessed cross-sectionally. We used regression models to examine heterogeneity in health characteristics (using absolute deviation) and domains (using effective variance) in relation to age. Comparison between between-age and within-age heterogeneity was quantified by estimating the age threshold at which the former exceeds the latter. RESULTS Of the 34 health characteristics, 17 showed increased heterogeneity, 8 decreased, and 9 no association with age. The associations between heterogeneity and age increased generally but were nonlinear for most domains and nonmonotonic for some. We observed peak heterogeneity at approximately 70 years. Between-age heterogeneity, compared with within-age heterogeneity, was most important for forced expiratory volume in 1 second and grip strength but varied across characteristics. CONCLUSION Overall health heterogeneity increases with age but does not uniformly increase across all variables and domains. Heterogeneity in aging reinforces the need for geriatric assessment and personalized care, depending on which health characteristics are assessed, their measurement properties, and their referent group. Our findings suggest further research to develop improved single-dimension and multidimensional instruments, as well as specific vital and laboratory reference ranges for older adults.
Collapse
Affiliation(s)
- Quoc Dinh Nguyen
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Innovation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Erica M Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Marie-France Forget
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Philippe Desmarais
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Innovation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Mark R Keezer
- Innovation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Department of Neurosciences & Social and Preventative Medicine, Université de Montréal, Montreal, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada.,Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, Canada
| |
Collapse
|
14
|
Bruneau MA, Desmarais P, Pokrzywko K. Post-traumatic stress disorder mistaken for behavioural and psychological symptoms of dementia: case series and recommendations of care. Psychogeriatrics 2020; 20:754-759. [PMID: 32239593 DOI: 10.1111/psyg.12549] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
Abstract
In late life, traumas may act cumulatively to exacerbate vulnerability to post-traumatic stress disorder (PTSD). PTSD is also a risk factor for cognitive decline. Major neurocognitive disorder (MND) can be associated with worsening of already controlled PTSD symptoms, late-life resurgence or de novo emergence. Misidentifying PTSD symptoms in MND can have negative consequences for the patient and families. We review the literature pertaining to PTSD and dementia and describe five cases referred for consultation in geriatric psychiatry initially for behavioural and psychological symptoms of dementia (BPSD), which were eventually diagnosed and treated as PTSD in MND subjects. We propose that certain PTSD symptoms in patients with MND are misinterpreted as BPSD and therefore, not properly addressed. For example, flashbacks could be interpreted as hallucinations, hypervigilance as paranoia, nightmares as sleep disturbances, and hyperreactivity as agitation/aggression. We suggest that better identification of PTSD symptoms in MND is needed. We propose specific recommendations for care, namely: clarifying diagnosis by distinguishing PTSD symptoms coexisting with different types of dementia from a specific dementia symptom (BPSD), gathering a detailed history of the trauma in order to personalise non-pharmacological interventions, adapting psychotherapeutic strategies to patients with dementia, using selective serotonin reuptake inhibitors as first-line treatment and avoiding antipsychotics and benzodiazepines. Proper identification of PTSD symptoms in patients with MND is essential and allows a more tailored and efficient treatment, with decrease in inappropriate use of physical and chemical restraints.
Collapse
Affiliation(s)
- Marie-Andrée Bruneau
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.,Department of Psychiatry and Addictology, University of Montréal, Québec, Canada
| | - Philippe Desmarais
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Klara Pokrzywko
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.,Department of Psychiatry and Addictology, University of Montréal, Québec, Canada
| |
Collapse
|
15
|
Piredda R, Desmarais P, Masellis M, Gasca‐Salas C. Cognitive and psychiatric symptoms in genetically determined Parkinson’s disease: a systematic review. Eur J Neurol 2019; 27:229-234. [DOI: 10.1111/ene.14115] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Affiliation(s)
- R. Piredda
- CINAC‐HM Puerta del Sur CEU‐San Pablo University Móstoles, Madrid Spain
- Department of Neurology IRCCS Istituto Clinico Humanitas Rozzano Milano Italy
| | - P. Desmarais
- Cognitive and Movement Disorders Clinic Sunnybrook Health Sciences Centre Toronto Canada
- L.C. Campbell Cognitive Neurology Research Unit Sunnybrook Health Sciences Centre Toronto Canada
- Hurvitz Brain Sciences Program Sunnybrook Research Institute University of Toronto Toronto Canada
- Division of Neurology Department of Medicine University of Toronto Toronto Canada
| | - M. Masellis
- Cognitive and Movement Disorders Clinic Sunnybrook Health Sciences Centre Toronto Canada
- L.C. Campbell Cognitive Neurology Research Unit Sunnybrook Health Sciences Centre Toronto Canada
- Hurvitz Brain Sciences Program Sunnybrook Research Institute University of Toronto Toronto Canada
- Division of Neurology Department of Medicine University of Toronto Toronto Canada
- Institute of Medical Science University of Toronto Toronto Canada
| | - C. Gasca‐Salas
- CINAC‐HM Puerta del Sur CEU‐San Pablo University Móstoles, Madrid Spain
- CIBERNED Institute Carlos III Madrid Spain
| |
Collapse
|
16
|
Nguyen QD, Peters E, Wassef A, Desmarais P, Rémillard-Labrosse D, Tremblay-Gravel M. Evolution of Age and Female Representation in the Most-Cited Randomized Controlled Trials of Cardiology of the Last 20 Years. Circ Cardiovasc Qual Outcomes 2019; 11:e004713. [PMID: 29853466 DOI: 10.1161/circoutcomes.118.004713] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/08/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Older adults and women have historically been underrepresented in randomized controlled trials of cardiology. Recent temporal evolution and factors influencing representation are incompletely investigated. We aimed to contrast age and female representation in the most influential randomized controlled trials in cardiology of the last 20 years to population prevalence and to assess the study factors affecting representation. METHODS AND RESULTS Using Web of Science, we selected the 25 most-cited cardiology articles each year between 1996 and 2015, and extracted mean age, percentage of women, funding source, sample size, disease condition, intervention type, and exclusion criteria. The outcomes were the evolution of the mean age and the percentage of women over time. Protocol design elements and year of publication were assessed as predictors of outcomes in multivariable regressions. A total of 500 studies were analyzed, where the mean age was 62.6±7.4 years and the median percentage of women was 28.6% (22.2-40.5). Compared with population prevalence derived from National Health and Nutrition Examination Survey 2015-2016, gaps in representation were apparent and more pronounced for coronary artery disease (-5.0 years; -27.2% women) and heart failure (-6.0 years; -25.4% women). The mean age (0.15 year per year; 95% confidence interval, 0.04-0.26) and percentage of women (+0.29% per year; 95% confidence interval, 0.07-0.50), slightly but significantly increased over time. Private funding, small sample size, and exclusions pertaining to maximal age, atrial fibrillation, and diabetes mellitus were associated with a decreased mean age in multivariable linear regressions. Age and life expectancy exclusions were associated with lower female percentage. CONCLUSIONS Although age and female representation increased over time, the modest trends are unlikely to resolve the persistently wide gaps with actual populational prevalence, especially for coronary artery disease and HF. Representation is modulated by the cardiovascular condition studied and some modifiable protocol elements.
Collapse
Affiliation(s)
- Quoc Dinh Nguyen
- Division of Geriatrics, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Canada (Q.D.N., P.D.).
| | | | | | - Philippe Desmarais
- Division of Geriatrics, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Canada (Q.D.N., P.D.)
| | - Delphine Rémillard-Labrosse
- Faculty of Medicine, Université de Montréal, Canada. Department of Family Medicine, Hôpital Cité-de-la-Santé, Laval, Canada (D.R.-L.)
| | | |
Collapse
|
17
|
Abstract
"With a rapidly aging world population, it is critical for physicians of every specialty to adapt the ways they provide medical and perioperative care to patients. Older adults represent the largest population of health care users, and they have very different needs and preferences compared with their younger counterparts. In this article, the authors discuss some of the current gaps in geriatric anesthesia and perioperative care, as they elaborate on what can be expected in the near future at different levels of the health care system: the patient, the environment, and the anesthesia specialty."
Collapse
Affiliation(s)
- Philippe Desmarais
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room A455, Toronto, Ontario M4N 3M5, Canada; L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG19, Toronto, Ontario M4N 3M5, Canada
| | - Fahad Alam
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, Ontario M4N 3M5, Canada
| | - Stephen Choi
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, Ontario M4N 3M5, Canada
| | - Sinziana Avramescu
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, Ontario M4N 3M5, Canada; Department of Anesthesia, Humber River Hospital, 1235 Wilson Avenue, Toronto, Ontario M3M 0B2, Canada.
| |
Collapse
|
18
|
Desmarais P, Rohrer JD, Nguyen QD, Herrmann N, Stuss DT, Lang AE, Boxer AL, Dickerson BC, Rosen H, van Swieten JC, Meeter LH, Borroni B, Tartaglia MC, Feldman HH, Black SE, Masellis M. Therapeutic trial design for frontotemporal dementia and related disorders. J Neurol Neurosurg Psychiatry 2019; 90:412-423. [PMID: 30361298 DOI: 10.1136/jnnp-2018-318603] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 12/13/2022]
Abstract
The frontotemporal dementia (FTD) spectrum is a heterogeneous group of neurodegenerative syndromes with overlapping clinical, molecular and pathological features, all of which challenge the design of clinical trials in these conditions. To date, no pharmacological interventions have been proven effective in significantly modifying the course of these disorders. This study critically reviews the construct and methodology of previously published randomised controlled trials (RCTs) in FTD spectrum disorders in order to identify limitations and potential reasons for negative results. Moreover, recommendations based on the identified gaps are elaborated in order to guide future clinical trial design. A systematic literature review was carried out and presented in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. A total of 23 RCTs in cohorts with diagnoses of behavioural and language variants of FTD, corticobasal syndrome and progressive supranuclear palsy syndrome were identified out of the 943 citations retrieved and were included in the qualitative review. Most studies identified were early-phase clinical trials that were small in size, short in duration and frequently underpowered. Diagnoses of populations enrolled in clinical trials were based on clinical presentation and rarely included precision-medicine tools, such as genetic and molecular testing. Uniformity and standardisation of research outcomes in the FTD spectrum are essential. Several elements should be carefully considered and planned in future clinical trials. We anticipate that precision-medicine approaches will be crucial to adequately address heterogeneity in the FTD spectrum research.
Collapse
Affiliation(s)
- Philippe Desmarais
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Quoc Dinh Nguyen
- Division of Geriatric Medicine, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Donald T Stuss
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Howie Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | | | - Lieke H Meeter
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Carmela Tartaglia
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Howard H Feldman
- Department of Neurosciences, University of California, San Diego, California, USA.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mario Masellis
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .,LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Nguyen Q, Peters E, Wassef A, Desmarais P, Remillard-Labrosse D, Tremblay-Gravel M. THE EVOLUTION OF AGE AND WOMEN REPRESENTATION IN THE MOST CITED RANDOMIZED TRIALS OF CARDIOLOGY OF THE LAST 20 YEARS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - P Desmarais
- Centre Hospitalier de l’Université de Montréal
| | | | | |
Collapse
|
20
|
Desmarais P, Miville C, Milán-Tomás Á, Nguyen QD, Ojeda-López C, Masellis M, Black SE, Andrade DM, Herrmann N. Age representation in antiepileptic drug trials: A systematic review and meta-analysis. Epilepsy Res 2018; 142:9-15. [DOI: 10.1016/j.eplepsyres.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/19/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
|
21
|
Pion CM, Nehme J, Filion J, Desmarais P, Masson H, Bruneau M, Soucy J. [IC‐P‐073]: CEREBRAL 18F‐FLUORODEOXYGLUCOSE‐POSITRON EMISSION TOMOGRAPHY IN PROLONGED DELIRIUM. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jessica Nehme
- University of Montreal Hospital CentreMontrealQCCanada
| | - Josée Filion
- University of Montreal Hospital CentreMontrealQCCanada
| | - Philippe Desmarais
- University of MontrealMontrealQCCanada
- University of TorontoTorontoONCanada
| | - Hélène Masson
- University of Montreal Hospital CentreMontrealQCCanada
| | - Marie‐Andrée Bruneau
- University of MontrealMontrealQCCanada
- Institut Universitaire de Gériatrie de MontréalMontréalQCCanada
| | - Jean‐Paul Soucy
- University of Montreal Hospital CentreMontrealQCCanada
- PERFORM Centre ‐ Concordia UniversityMontréalQCCanada
- Montreal Neurological InstituteMontrealQCCanada
| |
Collapse
|
22
|
Desmarais P, Laskine M, Caporuscio C. Primary pulmonary artery angiosarcoma mimicking pulmonary embolism in a 66-year-old man with dyspnea. CMAJ 2016; 188:E509-E512. [PMID: 27527482 DOI: 10.1503/cmaj.151417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Philippe Desmarais
- Geriatric Service (Desmarais) and Internal Medicine Service (Laskine, Caporuscio), Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Que.
| | - Mikhael Laskine
- Geriatric Service (Desmarais) and Internal Medicine Service (Laskine, Caporuscio), Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Que
| | - Christine Caporuscio
- Geriatric Service (Desmarais) and Internal Medicine Service (Laskine, Caporuscio), Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Que
| |
Collapse
|
23
|
Desmarais P, Massoud F, Filion J, Nguyen QD, Bajsarowicz P. Quetiapine for Psychosis in Parkinson Disease and Neurodegenerative Parkinsonian Disorders: A Systematic Review. J Geriatr Psychiatry Neurol 2016; 29:227-36. [PMID: 27056066 DOI: 10.1177/0891988716640378] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/16/2016] [Indexed: 11/17/2022]
Abstract
We performed a systematic review of randomized controlled trials to assess the high-level evidence regarding the role of quetiapine in the treatment of psychosis in patients with neurodegenerative parkinsonian disorders. Studies were included in the qualitative review if they (1) enrolled participants with diagnosis of Parkinson disease, Lewy body dementia, or any other neurodegenerative parkinsonian disorders; (2) assessed the efficacy of quetiapine; and (3) evaluated psychotic and motor outcomes using validated tools. Of the 341 manuscripts identified, 7 studies fulfilled our inclusion criteria. The studies' risk of bias was considered low. A total of 241 participants enrolled in these trials. Heterogeneity was high due to inclusion criteria, user definitions, assessment tools, and study design. Although not causing any motor deterioration, quetiapine failed to significantly reduce psychotic symptoms compared to placebo when objectively assessed on the Brief Psychotic Rating Scale, the most frequently reported scale in these studies. High loss to follow-up and dropout rates as well as significant improvement in psychotic symptoms in the placebo groups may have affected measurements of possible positive medication effects.
Collapse
Affiliation(s)
- Philippe Desmarais
- Division of Geriatric Medicine, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Fadi Massoud
- Division of Geriatric Medicine, Department of Medicine, Centre Hospitalier Charles LeMoyne, Longueuil, Québec, Canada
| | - Josée Filion
- Division of Geriatric Medicine, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Quoc Dinh Nguyen
- Division of Geriatric Medicine, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Paulina Bajsarowicz
- Geriatric Psychiatry Service, Department of Psychiatry, Douglas Mental Health University Institute, Verdun, Québec, Canada
| |
Collapse
|
24
|
McIvor A, Kayser J, Assaad JM, Brosky G, Demarest P, Desmarais P, Hampson C, Khara M, Pathammavong R, Weinberg R. Best practices for smoking cessation interventions in primary care. Can Respir J 2009; 16:129-34. [PMID: 19707607 PMCID: PMC2734439 DOI: 10.1155/2009/412385] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Canada, smoking is the leading preventable cause of premature death. Family physicians and nurse practitioners are uniquely positioned to initiate smoking cessation. Because smoking is a chronic addiction, repeated, opportunity-based interventions are most effective in addressing physical dependence and modifying deeply ingrained patterns of beliefs and behaviour. However, only a small minority of family physicians provide thorough smoking cessation counselling and less than one-half offer adjunct support to patients. OBJECTIVE To identify the key steps family physicians and nurse practitioners can take to strengthen effective smoking cessation interventions for their patients. METHODS A multidisciplinary panel of health care practitioners involved with smoking cessation from across Canada was convened to discuss best practices derived from international guidelines, including those from the United States, Europe, and Australia, and other relevant literature. The panellists subsequently refined their findings in the form of the present article. RESULTS The present paper outlines best practices for brief and effective counselling for, and treatment of, tobacco addiction. By adopting a simple series of questions, taking 30 s to 3 min to complete, health care professionals can initiate smoking cessation interventions. Integrating these strategies into daily practice provides opportunities to significantly improve the quality and duration of patients' lives. CONCLUSION Tobacco addiction is the most important preventable cause of morbidity and mortality in Canada. Family physicians, nurse practitioners and other front-line health care professionals are well positioned to influence and assist their patients in quitting, thereby reducing the burden on both personal health and the public health care system.
Collapse
Affiliation(s)
- Andrew McIvor
- Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Ontario.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Potter PC, Carte G, Davis G, Desmarais P, Friedman R, Gill M, Gravet C, Green R, Groenewald M, Hockman M, Jeena P, Jooma O, Joyce G, Manjra A, Ossip M, Seedat R, Vidjak D, Wolff L. Clinical management of allergic rhinitis - the Allergy Society of South Africa Consensus update. S Afr Med J 2006; 96:1269-72. [PMID: 17252158] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
MESH Headings
- Humans
- Incidence
- Rhinitis, Allergic, Perennial/classification
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/classification
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/therapy
- Societies, Medical
- South Africa/epidemiology
- Treatment Outcome
Collapse
Affiliation(s)
- P C Potter
- Allergy Diagnostic and Clinical Research Unit, UCT Lung Institute, University of Cape Town.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|