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Arsenault M, Long S, D'Souza V, Ilie A, Todd KJ. Telemedicine visits requiring follow-up in-person visits at an urban academic family medicine centre. Fam Pract 2024; 41:105-113. [PMID: 38382045 DOI: 10.1093/fampra/cmae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND With the onset of the COVID-19 pandemic, telemedicine was rapidly implemented in care settings globally. To understand what factors affect the successful completion of telemedicine visits in our urban, academic family medicine clinic setting, we analysed telemedicine visits carried out during the pandemic. METHODS We conducted a retrospective chart review of telemedicine visits from 2 clinical units within a family medicine centre. To investigate the association between incomplete visits and various factors (age, gender, presenting complaints, physician level of training [resident or staff] and patient-physician relational continuity), we performed a multivariable logistic regression on data from August 2020, February 2021, and May 2021. An incomplete visit is one that requires a follow-up in-person visit with a physician within 3 days. RESULTS Of the 2,138 telemedicine patient visits we investigated, 9.6% were incomplete. Patients presenting with lumps and bumps (OR: 3.84, 95% CI: 1.44, 10.5), as well as those seen by resident physicians (OR: 1.77, 95% CI: 1.22, 2.56) had increased odds of incomplete visits. Telemedicine visits at the family medicine clinic (Site A) with registered patients had lower odds of incomplete visits (OR: 0.24, 95% CI: 0.15, 0.39) than those at the community clinic (Site B), which provides urgent/episodic care with no associated relational continuity between patients and physicians. CONCLUSION In our urban clinical setting, only a small minority of telemedicine visits required an in-person follow-up visit. This information may be useful in guiding approaches to triaging patients to telemedicine or standard in-person care.
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Affiliation(s)
- Mylène Arsenault
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Stephanie Long
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Vinita D'Souza
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
| | - Alexandru Ilie
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Keith J Todd
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
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Soufi G, Voisard B, Latimer EA, Matai L, Moodie EEM, Laliberté V. Benefits of the PRISM Shelter-Based Program for Attainment of Stable Housing and Functional Outcomes by People Experiencing Homelessness and Mental Illness: A Quantitative Analysis. Can J Psychiatry 2023; 68:745-754. [PMID: 36938661 PMCID: PMC10517648 DOI: 10.1177/07067437231162494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE To explore the housing trajectory, personal recovery, functional level, and quality of life of clients at discharge and 1 year after completing Projet Réaffiliation Itinérance Santé Mentale (PRISM), a shelter-based mental health and rehabilitation program intended to provide individuals experiencing homelessness and severe mental illness with transition housing and to reconnect them with mental health and social services. METHOD Housing status, psychiatric follow-up trajectory, personal recovery (Canadian Personal Recovery Outcome Measure), functional level (Multnomah Community Ability Scale), and quality of life (Lehman Quality of Life Interview) were assessed at program entry, at program discharge and 1 year later. RESULTS Of the 50 clients who participated in the study from May 31, 2018, to December 31, 2019, 43 completed the program. Of these, 76.7% were discharged to housing modalities and 78% were engaged with psychiatric follow-up at the program's end. Housing stability, defined as residing at the same permanent address since discharge, was achieved for 62.5% of participants at 1-year follow-up. Functional level and quality of life scores improved significantly both at discharge and at 1-year follow-up from baseline. CONCLUSIONS Admission to PRISM helped clients secure long-term stable housing and appropriate psychiatric follow-up. Stable housing was maintained for most clients at 1-year follow-up, and they benefited from sustained functional and quality of life outcomes in long-term follow-up.
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Affiliation(s)
- Ghassen Soufi
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Brigitte Voisard
- Department of Psychology, Université du Québec à Montréal (UQAM), Montreal, Quebec, Canada
| | - Eric A. Latimer
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Psychosocial Division, Douglas Hospital Research Centre, Verdun, Quebec, Canada
| | - Lavina Matai
- Department of Epidemiology, Biostatistics and Occupational Health, and Department of Equity, Ethics and Policy, McGill University, Montreal, Quebec, Canada
| | - Erica E. M. Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Vincent Laliberté
- Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Djerroud L, Leclair G, Sullivan T, Dagenais-Beaulé V. Visual compatibility and particle counter evaluations of syringes of intramuscular psychotropic coadministered solutions. Eur J Hosp Pharm 2023; 30:e97-e100. [PMID: 36002244 PMCID: PMC10086701 DOI: 10.1136/ejhpharm-2022-003378] [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: 05/11/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients in the acute phase of agitation can require the administration of multiple drugs by intramuscular injection in order to temporarily stabilise their condition. Administration of multiple psychotropic medications in a single syringe can be beneficial to both the patient and healthcare professionals. However, there are very little data in the literature regarding psychotropic drug compatibility in syringes for acute agitation. OBJECTIVE The aim of this study was to assess the visual compatibility of various combinations of 12 intramuscular psychotropic medications in syringes, and to validate compatibility with the use of a particle counter. The medications evaluated were benztropine mesylate, diazepam, dimenhydrinate, diphenhydramine hydrochloride, haloperidol lactate, hydroxyzine, lorazepam, loxapine, methotrimeprazine, midazolam, olanzapine and zuclopenthixol acetate. METHODS Compounded solutions of medication combinations underwent visual inspection initially and after 0.25, 0.5, 1, 2 and 4 hours using a white background and a black background. In order to validate the compatibility results, the presence of particulate matter was determined by light obscuration. RESULTS This study identified 35 combinations that were visually compatible and 35 that were visually incompatible. We chose eight highly clinically relevant combinations to test using the requirements of the United States Pharmacopoeia (USP) chapter 788 (Particulate Matter in Injections). Of those eight, six were physically compatible, including the triple combinations of lorazepam and haloperidol with either benztropine or diphenhydramine. CONCLUSION These physical compatibility results will give healthcare professionals an idea of the possible compatible combinations of psychotropic drugs in syringes, and thus complete some of the missing data in the literature.
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Affiliation(s)
- Lydia Djerroud
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
- Pharmacy, Jewish General Hospital, Montreal, Québec, Canada
| | - Gregoire Leclair
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
- Groupe de Recherche Universitaire sur le Médicament, Université de Montréal, Montreal, Québec, Canada
| | | | - Vincent Dagenais-Beaulé
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
- Pharmacy, Jewish General Hospital, Montreal, Québec, Canada
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
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Fontaine J, Chin E, Provencher JF, Rainone A, Wazzan D, Roy C, Rej S, Lordkipanidze M, Dagenais-Beaulé V. Assessing cardiometabolic parameter monitoring in inpatients taking a second-generation antipsychotic: The CAMI-SGA study - a cross-sectional study. BMJ Open 2022; 12:e055454. [PMID: 35414553 PMCID: PMC9006820 DOI: 10.1136/bmjopen-2021-055454] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study aims to determine the proportion of initial cardiometabolic assessment and its predicting factors in adults with schizophrenia, bipolar disorder or other related diagnoses for whom a second-generation antipsychotic was prescribed in the hospital setting. DESIGN Cross-sectional study. SETTING The psychiatry unit of a Canadian tertiary care teaching hospital in Montreal, Canada. PARTICIPANTS 402 patients with aforementioned disorders who initiated, restarted or switched to one of the following antipsychotics: clozapine, olanzapine, risperidone, paliperidone or quetiapine, between 2013 and 2016. PRIMARY OUTCOME MEASURES We assessed the proportion of cardiometabolic parameters monitored. SECONDARY OUTCOME MEASURES We identified predictors that influence the monitoring of cardiometabolic parameters and we assessed the proportion of adequate interventions following the screening of uncontrolled blood pressure and fasting glucose or glycated haemoglobin (HbA1c) results. RESULTS Only 37.3% of patients received monitoring for at least three cardiometabolic parameters. Blood pressure was assessed in 99.8% of patients; lipid profile in 24.4%; fasting glucose or HbA1c in 33.3% and weight or body mass index in 97.8% of patients while waist circumference was assessed in 4.5% of patients. For patients with abnormal blood pressure and glycaemic values, 42.3% and 41.2% subsequent interventions were done, respectively. The study highlighted the psychiatric diagnosis (substance induced disorder OR 0.06 95% CI 0.00 to 0.44), the presence of a court-ordered treatment (OR 0.79 95% CI 0.35 to 1.79) and the treating psychiatrist (up to OR 34.0 95% CI 16.2 to 140.7) as predictors of cardiometabolic monitoring. CONCLUSIONS This study reports suboptimal baseline cardiometabolic monitoring of patients taking an antipsychotic in a Canadian hospital. Optimising collaboration within a multidisciplinary team may increase cardiometabolic monitoring.
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Affiliation(s)
- Jennifer Fontaine
- Department of Pharmacy, Jewish General Hospital, Montreal, Quebec, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
| | - Evelyn Chin
- Department of Pharmacy, Jewish General Hospital, Montreal, Quebec, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
| | - Jean-François Provencher
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
- Department of Pharmacy, Verdun Hospital, Jewish General Hospital, Montreal, Quebec, Canada
| | - Anthony Rainone
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
- Department of Pharmacy, McGill University Health Centre, Jewish General Hospital, Montreal, Quebec, Canada
| | - Dana Wazzan
- Department of Pharmacy, Jewish General Hospital, Montreal, Quebec, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
| | - Carmella Roy
- Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
- Psychiatry, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Soham Rej
- Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Marie Lordkipanidze
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
- Pharmacy & Research Institute, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Vincent Dagenais-Beaulé
- Department of Pharmacy, Jewish General Hospital, Montreal, Quebec, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
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Ghilarov D, Inaba-Inoue S, Stepien P, Qu F, Michalczyk E, Pakosz Z, Nomura N, Ogasawara S, Walker GC, Rebuffat S, Iwata S, Heddle JG, Beis K. Molecular mechanism of SbmA, a promiscuous transporter exploited by antimicrobial peptides. Sci Adv 2021; 7:eabj5363. [PMID: 34516884 PMCID: PMC8442886 DOI: 10.1126/sciadv.abj5363] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/16/2021] [Indexed: 05/12/2023]
Abstract
Antibiotic metabolites and antimicrobial peptides mediate competition between bacterial species. Many of them hijack inner and outer membrane proteins to enter cells. Sensitivity of enteric bacteria to multiple peptide antibiotics is controlled by the single inner membrane protein SbmA. To establish the molecular mechanism of peptide transport by SbmA and related BacA, we determined their cryo–electron microscopy structures at 3.2 and 6 Å local resolution, respectively. The structures show a previously unknown fold, defining a new class of secondary transporters named SbmA-like peptide transporters. The core domain includes conserved glutamates, which provide a pathway for proton translocation, powering transport. The structures show an outward-open conformation with a large cavity that can accommodate diverse substrates. We propose a molecular mechanism for antibacterial peptide uptake paving the way for creation of narrow-targeted therapeutics.
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Affiliation(s)
- Dmitry Ghilarov
- Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Satomi Inaba-Inoue
- Department of Life Sciences, Imperial College London, Exhibition Road, South Kensington, London SW7 2AZ, UK
- Rutherford Appleton Laboratory, Research Complex at Harwell, Didcot, Oxfordshire OX11 0FA, UK
- Diffraction and Scattering Division, Japan Synchrotron Radiation Research Institute, SPring-8, 1-1-1, Kouto, Sayo, Hyogo 679-5198, Japan
| | - Piotr Stepien
- Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Feng Qu
- Department of Life Sciences, Imperial College London, Exhibition Road, South Kensington, London SW7 2AZ, UK
- Rutherford Appleton Laboratory, Research Complex at Harwell, Didcot, Oxfordshire OX11 0FA, UK
| | | | - Zuzanna Pakosz
- Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
- Postgraduate School of Molecular Medicine, Warsaw, Poland
| | - Norimichi Nomura
- Department of Cell Biology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Satoshi Ogasawara
- Department of Cell Biology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Graham Charles Walker
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sylvie Rebuffat
- Molecules of Communication and Adaptation of Microorganisms Laboratory (MCAM, UMR 7245 CNRS-MNHN), Muséum National d’Histoire Naturelle, Sorbonne Universités, Centre National de la Recherche Scientifique, CP 54, 57 rue Cuvier, Paris 75005, France
| | - So Iwata
- Department of Cell Biology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
- RIKEN SPring-8 Center, 1-1-1 Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5148, Japan
- Research Acceleration Program, Membrane Protein Crystallography Project, Japan Science and Technology Agency, Kyoto, Japan
| | | | - Konstantinos Beis
- Department of Life Sciences, Imperial College London, Exhibition Road, South Kensington, London SW7 2AZ, UK
- Rutherford Appleton Laboratory, Research Complex at Harwell, Didcot, Oxfordshire OX11 0FA, UK
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