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Anton G, Alsalahi A, Yoon EJ, Turnbull J, Dragonette J, Richards B, Tong D, Soo TM. Fusion and patient-reported outcomes after navigated decortication and direct arthrodesis in minimally invasive sacroiliac joint fusion using cylindrical threaded implants: a case series and literature review. Neurosurg Focus 2023; 55:E2. [PMID: 37392775 DOI: 10.3171/2023.4.focus23145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Sacroiliac joint (SIJ) dysfunction is a significant cause of back pain. Despite recent advances in minimally invasive (MIS) SIJ fusion, the fusion rate remains controversial. This study sought to demonstrate that a navigated decortication and direct arthrodesis technique in MIS SIJ fusion would result in satisfactory fusion rates and patient-reported outcomes (PROs). METHODS The authors retrospectively reviewed consecutive patients who underwent MIS SIJ fusion from 2018 to 2021. SIJ fusion was performed using cylindrical threaded implants and SIJ decortication employing the O-arm surgical imaging system and StealthStation. The primary outcome was fusion, evaluated using CT at 6, 9, and 12 months postoperatively. Secondary outcomes included revision surgery, time to revision surgery, visual analog scale (VAS) score for back pain, and the Oswestry Disability Index (ODI), measured preoperatively and 6 and 12 months postoperatively. Patient demographics and perioperative data were also collected. PROs over time were analyzed using ANOVA followed by a post hoc analysis. RESULTS One hundred eighteen patients were included in this study. The mean (± SD) patient age was 58.56 ± 13.12 years, and most patients were female (68.6% vs 31.4% male). There were 19 smokers (16.1%) with an average BMI of 29.92 ± 6.73. One hundred twelve patients (94.9%) underwent successful fusion on CT. The ODI improved significantly from baseline to 6 months (Δ7.73, 95% CI 2.43-13.03, p = 0.002) and from baseline to 12 months (Δ7.54, 95% CI 1.65-13.43, p = 0.008). Similarly, VAS back pain scores improved significantly from baseline to 6 months (Δ2.31, 95% CI 1.07-3.56, p < 0.001) and from baseline to 12 months (Δ1.63, 95% CI 0.25-3.00, p = 0.015). CONCLUSIONS MIS SIJ fusion with navigated decortication and direct arthrodesis was associated with a high fusion rate and significant improvement in disability and pain scores. Further prospective studies examining this technique are warranted.
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Glegg S, McCrae K, Kolla G, Touesnard N, Turnbull J, Brothers TD, Brar R, Sutherland C, Le Foll B, Sereda A, Goyer MÈ, Rai N, Bernstein S, Fairbairn N. "COVID just kind of opened a can of whoop-ass": The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada. Int J Drug Policy 2022; 106:103742. [PMID: 35679695 PMCID: PMC9170132 DOI: 10.1016/j.drugpo.2022.103742] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In the context of the ongoing overdose crisis, a stark increase in toxic drug deaths from the unregulated street supply accompanied the onset of the COVID-19 pandemic. Injectable opioid agonist treatment (iOAT - hydromorphone or medical-grade heroin), tablet-based iOAT (TiOAT), and safer supply prescribing are emerging interventions used to address this crisis in Canada. Given rapid clinical guidance and policy change to enable their local adoption, our objectives were to describe the state of these interventions before the pandemic, and to document and explain changes in implementation during the early pandemic response (March-May 2020). METHODS Surveys and interviews with healthcare providers comprised this mixed methods national environmental scan of iOAT, TiOAT, and safer supply across Canada at two time points. Quantitative data were summarized using descriptive statistics; interview data were coded and analyzed thematically. RESULTS 103 sites in 6 Canadian provinces included 19 iOAT, 3 TiOAT and 21 safer supply sites on March 1, 2020; 60 new safer supply sites by May 1 represented a 285% increase. Most common substances were opioids, available at all sites; most common settings were addiction treatment programs and primary care clinics, and onsite pharmacies models. 79% of safer supply services were unfunded. Diversity in service delivery models demonstrated broad adaptability. Qualitative data reinforced the COVID-19 pandemic as the driving force behind scale-up. DISCUSSION Data confirmed the capacity for rapid scale-up of flexible, community-based safer supply prescribing during dual public health emergencies. Geographical, client demographic, and funding gaps highlight the need to target barriers to implementation, service delivery and sustainability.
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Affiliation(s)
- Stephanie Glegg
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - Karen McCrae
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, Health and Wellness Building Room 273, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Natasha Touesnard
- Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, NS B3A 1X4, Canada
| | - Jeffrey Turnbull
- Ottawa Inner City Health, 5 Myrand Ave, Ottawa, ON K1N 5N7, Canada
| | - Thomas D Brothers
- Department of Medicine, Dalhousie University, Suite 442 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Rupinder Brar
- Vancouver Coastal Health Authority, 801-601 West Broadway, Vancouver, BC V5Z 4C2, Canada; Department of Family Medicine, The University of British Columbia, 3(rd) Floor, David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Christy Sutherland
- Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; PHS Community Services Society, 350 Columbia Street, Vancouver, BC V6A 4J1 Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Faculty of Medicine, Institute of Medical Science, Departments of Psychiatry, Family and Community Medicine, and Pharmacology and Toxicology, University of Toronto, 250 Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada
| | - Andrea Sereda
- Schulich School of Medicine, Western University, Clinical Skills Building, London, ON V6A 5C1, Canada
| | - Marie-Ève Goyer
- Department of Family Medicine, Université de Montréal, 2900 Edouard Montpetit Boulevard, QC H3T 1J4, Canada
| | - Nanky Rai
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 3157, Toronto, ON V5S 1A8, Canada
| | - Scott Bernstein
- Canadian Drug Policy Coalition, Simon Fraser University, 2400 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
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Eydt E, Glegg S, Sutherland C, Meador K, Trew M, Perreault M, Goyer MÈ, Le Foll B, Turnbull J, Fairbairn N. Service delivery models for injectable opioid agonist treatment in Canada: 2 sequential environmental scans. CMAJ Open 2021; 9:E115-E124. [PMID: 33622764 PMCID: PMC8034381 DOI: 10.9778/cmajo.20200021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) is an emerging evidence-based option in the continuum of care for opioid use disorder in parts of Canada. Our study objective was to identify and describe iOAT programs operating during the ongoing opioid overdose crisis. METHODS We conducted 2 sequential environmental scans. Programs were eligible to participate if they were in operation as of Sept. 1, 2018, and Mar. 1, 2019. Information was collected over 2-3 months for each scan (September-October 2018, March-May 2019). Programs that participated in the first scan and newly established programs were invited to participate in the second scan. The scans included questions about location, service delivery model, clinical and operational characteristics, numbers and demographic characteristics of clients, and program barriers and facilitators. Descriptive analysis was performed. RESULTS We identified 14 unique programs across the 2 scans. Eleven programs located in urban centres in British Columbia and Ontario participated in the first scan. At the time of the second scan, 2 of these programs were on hold and 2 of 3 newly established programs were in Alberta. The total capacity of all participating programs was 420 clients at most. Four service delivery models were identified; iOAT was most commonly integrated within existing health and social services. All programs offered hydromorphone, and 1 program also offered diacetylmorphine. In the first scan, 73% of clients (133/183) were male; the mean age of clients was 47 years. Limited capacity, pharmacy operations and lack of diacetylmorphine access were among the most frequently reported barriers. The most commonly reported facilitators included client-centred care, client relationships and access to other health and social support. INTERPRETATION Evidence indicates that iOAT can be successfully implemented using diverse service delivery models. Future work should facilitate scale-up of this evidence-based treatment where gaps persist in high-risk communities.
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Affiliation(s)
- Erin Eydt
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Stephanie Glegg
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Christy Sutherland
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Karine Meador
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Michael Trew
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Michel Perreault
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Marie-Ève Goyer
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Bernard Le Foll
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Jeffrey Turnbull
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
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Baral S, Bond A, Boozary A, Bruketa E, Elmi N, Freiheit D, Ghosh SM, Goyer ME, Orkin AM, Patel J, Richter T, Robertson A, Sutherland C, Svoboda T, Turnbull J, Wong A, Zhu A. Seeking shelter: homelessness and COVID-19. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Those experiencing homelessness in Canada are impacted inequitably by COVID-19 due to their increased exposure, vulnerability of environment and medical comorbidities, and their lack of access to preventive care and treatment in the context of the pandemic. In shelter environments one is unable to effectively physically distance, maintain hygiene, obtain a test, or isolate. As a result, unique strategies are required for this population to protect them and those who serve them. Recommendations are provided to reduce or prevent further negative consequences from the COVID-19 pandemic for people experiencing homelessness. These recommendations were informed by a systematic review of the literature, as well as a jurisdictional scan. Where evidence did not exist, expert consensus from key providers and those experiencing homelessness throughout Canada was included. These recommendations recognize the need for short-term interventions to mitigate the immediate risk to this community, including coordination of response, appropriate precautions and protective equipment, reducing congestion, cohorting, testing, case and contact management strategies, dealing with outbreaks, isolation centres, and immunization. Longer-term recommendations are also provided with a view to ending homelessness by addressing the root causes of homelessness and by the provision of adequate subsidized and supportive housing through a Housing First strategy. It is imperative that meaningful changes take place now in how we serve those experiencing homelessness and how we mitigate specific vulnerabilities. These recommendations call for intersectoral, collaborative engagement to work for solutions targeted towards protecting the most vulnerable within our community through both immediate actions and long-term planning to eliminate homelessness.
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Affiliation(s)
- Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
| | - Andrew Bond
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Andrew Boozary
- Population Health and Social Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
- University of Toronto, Toronto, ON M5S 1A8, Canada
- Columbia University, New York, NY 10032, USA
| | - Eva Bruketa
- Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Nika Elmi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - S. Monty Ghosh
- Department of General Internal Medicine & Neurology, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Department of Medicine & Psychiatry, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marie Eve Goyer
- Family Medicine and Emergency Department, University of Montréal, Montréal, QC H3T 1J4, Canada
| | - Aaron M. Orkin
- Inner City Health Associates, Toronto, ON M5C 1K6, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Department of Emergency Medicine, St. Joseph’s Health Centre, Toronto, ON M6R 1B5, Canada
- Department of Emergency Medicine, Humber River Hospital, Toronto, ON M3M 0B2, Canada
| | - Jamie Patel
- Faculty of Community Services, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Tim Richter
- Canadian Alliance to End Homelessness, Calgary, AB T3H 0N8, Canada
| | - Angela Robertson
- Parkdale Queen West Community Health Centre, Toronto, ON M6K 1L2, Canada
| | - Christy Sutherland
- PHS Community Services Society, Vancouver, BC V6A 1M9, Canada
- Department of Family Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Tomislav Svoboda
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Jeffrey Turnbull
- University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Ottawa Inner City Health, Ottawa, ON K1N 5N7, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, SK S4T 0H8, Canada
| | - Alice Zhu
- University of Toronto, Toronto, ON M5S 1A8, Canada
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Tombal B, Freedland S, Armstrong A, Beer T, Stenzl A, Sternberg C, Hussain M, Ganguli A, Ramaswamy K, Bhadauria H, Ivanescu C, Turnbull J, Holmstrom S, Saad F. 665P Impact of enzalutamide on patient-reported fatigue in hormone-sensitive prostate cancer (HSPC) or castration-resistant prostate cancer (CRPC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Brereton PA, Robb P, Sargent CM, Crews HM, Wood R, Caputi A, Carrington J, Chetaneau B, Cohen S, Davies RW, Davis WS, Dix E, Ennion; RA, Furniss S, Gardner JW, Griffin J, Hampton I, Harrison N, Heide C, Hollywood F, Hopkins J, Liddle P, Meagher J, Osborne PY, Piatt T, Postlethwaite K, Procter J, Reynolds EB, Robinson J, Smith M, Sparkes S, Stangroom SG, Stevens R, Sutton P, Swain S, Turnbull J, Vidal JP, Waller JM, Zaiger K. Determination of Lead in Wine by Graphite Furnace Atomic Absorption Spectrophotometry: Interlaboratory Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.6.1287] [Citation(s) in RCA: 3] [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: 11/14/2022]
Abstract
Abstract
An interlaboratory study of a graphite furnace atomic absorption spectrophotometry (GFAAS) method for the determination of lead in wine was conducted. Seventeen laboratories from France, United States, and the United Kingdom, using a variety of GFAAS instruments, took part in the study. The method incorporated a novel matrix-matching procedure to minimize matrix effects between standards and samples. Six wine test materials were prepared and sent to participants as 12 blind duplicate or split level samples. There was good agreement between results obtained from participants and target values (24–279 μg/L) obtained with an inductively coupled plasma-mass spectrometry method. The precision of the GFAAS method was well within the range predicted by the Horwitz equation for the 6 test materials analyzed. Repeatability standard deviations ranged from 3 to 17%. Reproducibility standard deviations were in the range of 10 to 30%. The method is recommended for use for official purposes.
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Affiliation(s)
- Paul A Brereton
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Paul Robb
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Christine M Sargent
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Helen M Crews
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Roger Wood
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
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Turnbull J, Patel A, Athanassoglou V, Pandit JJ. Abandoning cricoid pressure - a reply. Anaesthesia 2018; 71:1489-1490. [PMID: 27870179 DOI: 10.1111/anae.13751] [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: 11/27/2022]
Affiliation(s)
- J Turnbull
- The Royal National Throat, Nose and Ear Hospital, London, UK
| | - A Patel
- The Royal National Throat, Nose and Ear Hospital, London, UK
| | | | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford, UK
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Thomas P, Turnbull J, Roberts J, Patel A, Brain A. Response to: 'Failed supraglottic airway': an algorithm for suboptimally placed supraglottic airway devices based on videolaryngoscopy. Br J Anaesth 2017; 119:1243. [PMID: 29156040 DOI: 10.1093/bja/aex409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Svystonyuk D, Turnbull J, Teng G, Belke D, Guzzardi D, Park D, Kang S, Fedak P. ACELLULAR EXTRACELLULAR MATRIX SCAFFOLD REPROGRAMS CARDIAC FIBROBLASTS AND PROMOTES ADAPTIVE CARDIAC REMODELING AND REPAIR. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kang S, Verma S, Teng G, Belke D, Svystonyuk D, Guzzardi D, Park D, Turnbull J, Malik G, Fedak P. DIRECT EFFECTS OF EMPAGLIFLOZIN ON EXTRACELLULAR MATRIX REMODELING IN HUMAN CARDIAC FIBROBLASTS: NOVEL TRANSLATIONAL CLUES TO EMPA-REG OUTCOME. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Guzzardi D, Teng G, Svystonyuk D, Kang S, Park D, Belke D, Turnbull J, Fedak P. FLUOROQUINOLONE INDUCES HUMAN AORTIC FIBROBLAST-MEDIATED EXTRACELLULAR MATRIX DYSREGULATION. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Garvin D, Worthington J, McGuire S, Burgetz S, Forster AJ, Patey A, Gerin-Lajoie C, Turnbull J, Roth V. Physician performance feedback in a Canadian academic center. Leadersh Health Serv (Bradf Engl) 2017; 30:457-474. [DOI: 10.1108/lhs-08-2016-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims at the implementation and early evaluation of a comprehensive, formative annual physician performance feedback process in a large academic health-care organization.
Design/methodology/approach
A mixed methods approach was used to introduce a formative feedback process to provide physicians with comprehensive feedback on performance and to support professional development. This initiative responded to organization-wide engagement surveys through which physicians identified effective performance feedback as a priority. In 2013, physicians primarily affiliated with the organization participated in a performance feedback process, and physician satisfaction and participant perceptions were explored through participant survey responses and physician leader focus groups. Training was required for physician leaders prior to conducting performance feedback discussions.
Findings
This process was completed by 98 per cent of eligible physicians, and 30 per cent completed an evaluation survey. While physicians endorsed the concept of a formative feedback process, process improvement opportunities were identified. Qualitative analysis revealed the following process improvement themes: simplify the tool, ensure leaders follow process, eliminate redundancies in data collection (through academic or licensing requirements) and provide objective quality metrics. Following physician leader training on performance feedback, 98 per cent of leaders who completed an evaluation questionnaire agreed or strongly agreed that the performance feedback process was useful and that training objectives were met.
Originality/value
This paper introduces a physician performance feedback model, leadership training approach and first-year implementation outcomes. The results of this study will be useful to health administrators and physician leaders interested in implementing physician performance feedback or improving physician engagement.
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Abstract
Learning disability nurses in the UK have received unprecedented attention over the past 5 years in response to anxieties about their role. The problem has been conceptualized as being the inability of nurses to articulate their contribution to meeting the needs of people with learning disabilities and a lack of evidence of their effectiveness. This paper proposes that, although nurses are valued for their contribution individually in services, they are working within devaluing systems which have created conceptual and strategic uncertainty about learning disabilities generally. In order to move forward, nurses need to understand the ways in which these systems exert their influence. It is proposed that if three broad aims for the profession are pursued this will help improve practice whilst simultaneously helping nurses feel more secure about their contribution in the field of learning disabilities.
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Ryan SJ, Marcar A, Stone P, Garikipati K, Kuisma R, Krouwel O, Turnbull J. Effects of aquatic physiotherapy on Health Related Quality of Life (HRQOL): perceptions of people with multiple sclerosis. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- J. Turnbull
- The Royal National Throat, Nose and Ear Hospital; London UK
| | - A. Patel
- The Royal National Throat, Nose and Ear Hospital; London UK
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Kobewka DM, van Walraven C, Turnbull J, Worthington J, Calder L, Forster A. Quality gaps identified through mortality review. BMJ Qual Saf 2016; 26:141-149. [PMID: 26856617 PMCID: PMC5284344 DOI: 10.1136/bmjqs-2015-004735] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/20/2015] [Accepted: 01/17/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospital mortality rate is a common measure of healthcare quality. Morbidity and mortality meetings are common but there are few reports of hospital-wide mortality-review processes to provide understanding of quality-of-care problems associated with patient deaths. OBJECTIVE To describe the implementation and results from an institution-wide mortality-review process. DESIGN A nurse and a physician independently reviewed every death that occurred at our multisite teaching institution over a 3-month period. Deaths judged by either reviewer to be unanticipated or to have any opportunity for improvement were reviewed by a multidisciplinary committee. We report characteristics of patients with unanticipated death or opportunity for improved care and summarise the opportunities for improved care. RESULTS Over a 3-month period, we reviewed all 427 deaths in our hospital in detail; 33 deaths (7.7%) were deemed unanticipated and 100 (23.4%) were deemed to be associated with an opportunity for improvement. We identified 97 opportunities to improve care. The most common gap in care was: 'goals of care not discussed or the discussion was inadequate' (n=25 (25.8%)) and 'delay or failure to achieve a timely diagnosis' (n=8 (8.3%)). Patients who had opportunities for improvement had longer length of stay and a lower baseline predicted risk of death in hospital. Nurse and physician reviewers spent approximately 142 h reviewing cases outside of committee meetings. CONCLUSIONS Our institution-wide mortality review found many quality gaps among decedents, in particular inadequate discussion of goals of care.
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Affiliation(s)
- Daniel M Kobewka
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Epidemiology and Community Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Carl van Walraven
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | | | - Lisa Calder
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan Forster
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Delannoy CMJ, Zadoks RN, Crumlish M, Rodgers D, Lainson FA, Ferguson HW, Turnbull J, Fontaine MC. Genomic comparison of virulent and non-virulent Streptococcus agalactiae in fish. J Fish Dis 2016; 39:13-29. [PMID: 25399660 DOI: 10.1111/jfd.12319] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 05/20/2014] [Revised: 09/05/2014] [Accepted: 09/06/2014] [Indexed: 06/04/2023]
Abstract
Streptococcus agalactiae infections in fish are predominantly caused by beta-haemolytic strains of clonal complex (CC) 7, notably its namesake sequence type (ST) 7, or by non-haemolytic strains of CC552, including the globally distributed ST260. In contrast, CC23, including its namesake ST23, has been associated with a wide homeothermic and poikilothermic host range, but never with fish. The aim of this study was to determine whether ST23 is virulent in fish and to identify genomic markers of fish adaptation of S. agalactiae. Intraperitoneal challenge of Nile tilapia, Oreochromis niloticus (Linnaeus), showed that ST260 is lethal at doses down to 10(2) cfu per fish, whereas ST23 does not cause disease at 10(7) cfu per fish. Comparison of the genome sequence of ST260 and ST23 with those of strains derived from fish, cattle and humans revealed the presence of genomic elements that are unique to subpopulations of S. agalactiae that have the ability to infect fish (CC7 and CC552). These loci occurred in clusters exhibiting typical signatures of mobile genetic elements. PCR-based screening of a collection of isolates from multiple host species confirmed the association of selected genes with fish-derived strains. Several fish-associated genes encode proteins that potentially provide fitness in the aquatic environment.
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Affiliation(s)
- C M J Delannoy
- Institute of Aquaculture, School of Natural Sciences, University of Stirling, Stirling, UK
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK
| | - R N Zadoks
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - M Crumlish
- Institute of Aquaculture, School of Natural Sciences, University of Stirling, Stirling, UK
| | - D Rodgers
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK
| | - F A Lainson
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK
| | - H W Ferguson
- School of Veterinary Medicine, St. George's University, St. George's, Grenada, West Indies
| | - J Turnbull
- Institute of Aquaculture, School of Natural Sciences, University of Stirling, Stirling, UK
| | - M C Fontaine
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK
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Hogg L, Madden-Scott S, Turnbull J, Osman L. P141 An evaluation of the acceptability of supervised ward-based exercise for patients admitted to hospital for acute exacerbation of COPD. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Thomas D Brothers
- Dalhousie University (Brothers, To, Van Zoost), Halifax, NS; The Ottawa Hospital (Turnbull), Ottawa Ont
| | - Matthew J To
- Dalhousie University (Brothers, To, Van Zoost), Halifax, NS; The Ottawa Hospital (Turnbull), Ottawa Ont
| | - Colin Van Zoost
- Dalhousie University (Brothers, To, Van Zoost), Halifax, NS; The Ottawa Hospital (Turnbull), Ottawa Ont
| | - Jeffrey Turnbull
- Dalhousie University (Brothers, To, Van Zoost), Halifax, NS; The Ottawa Hospital (Turnbull), Ottawa Ont
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Clavel V, Turnbull J, Morantz G. 114: A Curriculum in Pediatric Global Health: A New Competency-Based, Multi-Disciplinary Educational Program. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e75a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Hoffman K, Silvester L, Nott P, Goodfellow T, Richardson D, Wolstenholme S, Turnbull J, Jenks T, Brohi K. Evaluation of the value of rehabilitation prescriptions within four major trauma hospitals. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Turnbull J. EVOLVING PSYCHOSOCIAL APPROACHES TO ADDICTION TREATMENT. The Canadian Journal of Addiction 2014. [DOI: 10.1097/02024458-201412000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Teng G, Duff H, Belke D, Turnbull J, Meijndert C, Chen Y, O'Brien E, Fedak P. TETRANDRINE REVERSES HUMAN CARDIAC MYOFIBROBLAST ACTIVATION AND MYOCARDIAL FIBROSIS. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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25
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Baty R, Pisconti A, Turnbull J. P57 * STEM CELL PLASTICITY AND TUMORIGENISIS: REGULATORY ROLES OF HEPARAN SULPHATE IN THE CANCER STEM CELL NICHE. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou249.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- J Turnbull
- Royal National Throat, Nose and Ear Hospital, London, UK.
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McNeil R, Guirguis-Younger M, Dilley LB, Turnbull J, Hwang SW. Learning to account for the social determinants of health affecting homeless persons. Med Educ 2013; 47:485-494. [PMID: 23574061 DOI: 10.1111/medu.12132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
CONTEXT Intersecting social determinants of health constrain access to care and treatment adherence among homeless populations. Because clinicians seldom receive training in the social determinants of health, they may be unprepared to account for or address these factors when developing treatment strategies for homeless individuals. OBJECTIVES This study explored: (i) clinicians' preparedness to provide care responsive to the social determinants of health in homeless populations, and (ii) the steps taken by clinicians to overcome shortcomings in their clinical training in regard to the social determinants of health. METHODS Qualitative interviews were conducted with doctors (n = 6) and nurses (n = 18) in six Canadian cities. Participants had at least 2 years of experience in providing care to homeless populations. Interview transcripts were analysed using methods of constant comparison. RESULTS Participants highlighted how, when first providing care to this population, they were unprepared to account for or address social determinants shaping the health of homeless persons. However, participants recognised the necessity of addressing these factors to situate care within the social and structural contexts of homelessness. Participants' accounts illustrated that experiential learning was critical to increasing capacity to provide care responsive to the social determinants of health. Experiential learning was a continuous process that involved: (i) engaging with homeless persons in multiple settings and contexts to inform treatment strategies; (ii) evaluating the efficacy of treatment strategies through continued observation and critical reflection, and (iii) adjusting clinical practice to reflect observations and new knowledge. CONCLUSIONS This study underscores the need for greater emphasis on the social determinants of health in medical education in the context of homelessness. These insights may help to inform the development and design of service-learning initiatives that integrate understandings of the social determinants of health, and thus potentially improve the readiness of clinicians to address the complex factors that shape the health of homeless populations.
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Affiliation(s)
- Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
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Rutherford KMD, Donald RD, Arnott G, Rooke JA, Dixon L, Mehers JJM, Turnbull J, Lawrence AB. Farm animal welfare: assessing risks attributable to the prenatal environment. Anim Welf 2012. [DOI: 10.7120/09627286.21.3.419] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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McNeil R, Guirguis-Younger M, Dilley LB, Aubry TD, Turnbull J, Hwang SW. Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: a qualitative analysis. BMC Public Health 2012; 12:312. [PMID: 22545586 PMCID: PMC3355019 DOI: 10.1186/1471-2458-12-312] [Citation(s) in RCA: 28] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 04/30/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Homeless and marginally housed persons who use alcohol and/or illicit drugs often have end-of-life care needs that go unmet due to barriers that they face to accessing end-of-life care services. Many homeless and marginally housed persons who use these substances must therefore rely upon alternate sources of end-of-life care and support. This article explores the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons who use alcohol and/or illicit drugs. METHODS A qualitative case study design was used to explore end-of-life care services delivery to homeless and marginally housed persons in six Canadian cities. A key objective was to explore the role of harm reduction services. 54 health and social services professionals participated in semi-structured qualitative interviews. All participants reported that they provided care and support to this population at end-of-life. RESULTS Harm reduction services (e.g., syringe exchange programs, managed alcohol programs, etc.) were identified as a critical point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs. Where possible, harm reduction services facilitated referrals to end-of-life care services for this population. Harm reduction services also provided end-of-life care and support when members of this population were unable or unwilling to access end-of-life care services, thereby improving quality-of-life and increasing self-determination regarding place-of-death. CONCLUSIONS While partnerships between harm reduction programs and end-of-life care services are identified as one way to improve access, it is noted that more comprehensive harm reduction services might be needed in end-of-life care settings if they are to engage this underserved population.
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Affiliation(s)
- Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - Laura B Dilley
- Faculty of Education, Simon Fraser University, Surrey, BC, Canada
| | - Tim D Aubry
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey Turnbull
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Inner City Health, Ottawa, ON, Canada
| | - Stephen W Hwang
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
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Turnbull J, Adams O. The healthcare quality agenda in Canada. Healthc Pap 2012; 11:24-9; discussion 79-83. [PMID: 21952023 DOI: 10.12927/hcpap.2011.22555] [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: 10/26/2022]
Abstract
Sullivan et al. have captured several important themes. One of the reasons that healthcare has been slow to adopt a culture of quality has been that it has taken a long time to recognize that quality is a continuous journey along several dimensions. Following advances in the early 1990s on appropriateness and effectiveness, there has been a decade-long preoccupation with accessibility that still remains an issue. Patient-centredness is one of the most recent dimensions to receive attention, and the overall goal of quality - improved patient outcomes - needs considerable work. Measurement and reporting are fundamental to quality improvement, but the provincial and territorial governments have not lived up to their Health Accord commitments to regular reporting on common indicators. At least six provinces have established health quality councils, but it remains to be seen if this bottom-up approach will lead to a common reporting framework that will support benchmarking. Canada would likely benefit from a pan-Canadian approach to innovation in healthcare quality.
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Turnbull J. It is time to transform our health care system. J Cutan Med Surg 2011; 15:241-4. [PMID: 21962180 DOI: 10.2310/7750.2011.00001x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Turnbull J. Le temps est venu de transformer notre système de santé. J Cutan Med Surg 2011. [DOI: 10.2310/7750.2011.00001f] [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: 11/18/2022]
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Harirchian MH, Shandiz EE, Turnbull J, Minassian BA, Shahsiah R. Lafora disease: a case report, pathologic and genetic study. INDIAN J PATHOL MICR 2011; 54:374-5. [PMID: 21623095 DOI: 10.4103/0377-4929.81645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 19-year-old male patient presented with progressive myoclonic seizures and speech disorder. The patient had photosensitivity, a few episodes of sudden transient blindness, and infrequent complex visual auras, dysarthria and mild ataxia, frequent myoclonic jerks prominently in the legs and severe dementia. Microscopic examination of the axillary skin biopsy revealed periodic acid-Schiff positive inclusion bodies in abluminal side of the apocrine sweat gland acini. Molecular screening showed a homozygous R241X mutation in EPM2A. Genotyping helps in the correct diagnosis of the Lafora disease (LD), which may be difficult to diagnose based on the available histopathological testing only. Our study is an effort to determine the distribution of mutations in LD patients in our region.
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Affiliation(s)
- M H Harirchian
- Iranian Center of Neurological Research, Tehran University of Medical Science, Tehran, Iran
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Turnbull J, Girard JM, Pencea N, Zhao X, Graham TE, Wang P, Ackerley CA, Minassian BA. Lafora bodies in skeletal muscle are fiber type specific. Neurology 2011; 76:1674-6. [PMID: 21451149 DOI: 10.1212/wnl.0b013e318219faf6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Turnbull
- Genetics & Genome Biology, Hospital for Sick Children, Toronto, Canada
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Turnbull J, Calestani M, Pope C, Halford S, Prichard J. 017 Case study of a computer decision support system for emergency care: the impact on the ambulance control room. Arch Emerg Med 2011. [DOI: 10.1136/emj.2010.108605.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hitomi T, Koubeissi M, Kaffashi F, Turnbull J, Lüders H. P16-11 Visual processing in the inferior temporal cortex. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)60818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Del-Pozo J, Turnbull J, Ferguson H, Crumlish M. A comparative molecular study of the presence of "Candidatus arthromitus" in the digestive system of rainbow trout, Oncorhynchus mykiss (Walbaum), healthy and affected with rainbow trout gastroenteritis. J Fish Dis 2010; 33:241-250. [PMID: 19912454 DOI: 10.1111/j.1365-2761.2009.01117.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Observations were made using histopathological techniques in conjunction with a nested polymerase chain reaction (PCR) protocol for the specific detection of "Candidatus arthromitus" on DNA extracted from wax-embedded tissues and fresh digestive contents of rainbow trout. Samples positive for "Candidatus arthromitus" DNA included fish with rainbow trout gastroenteritis (RTGE), clinically normal cohabiting fish, and apparently healthy controls from RTGE positive and RTGE negative sites. The results obtained from the PCR were confirmed by nucleotide sequencing. "Candidatus arthromitus" DNA was found in distal intestine as well as in sections of pyloric caeca, suggesting that both these locations are appropriate for molecular detection of "Candidatus arthromitus" DNA in trout. Furthermore, rainbow trout fry distal intestinal samples from two different hatcheries where RTGE had not been reported were also positive. Differences in "Candidatus arthromitus" DNA detection between paraffin wax-embedded and fresh digestive content samples from the same fish suggested that it may be predominantly epithelium-associated in healthy trout. Parallel histopathological observations indicated that pyloric caeca are the preferred site for visualizing segmented filamentous bacteria (SFB) in trout with RTGE. The results of this study showed that the presence of SFB was not invariably associated with clinical disease and that more information is required to understand the role of these organisms.
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Affiliation(s)
- J Del-Pozo
- Department of veterinary pathology, Easter Bush Veterinary Centre, Roslin, Midlothian, UK.
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40
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Affiliation(s)
- Jeffrey Turnbull
- Ottawa Inner City Health Inc. and the University of Ottawa, Ottawa, Ont.
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Andrade DM, Turnbull J, Minassian BA. Lafora disease, seizures and sugars. Acta Myol 2007; 26:83-6. [PMID: 17915579 PMCID: PMC2949329] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Lafora disease (LD) is the most severe form of Progressive Myoclonus Epilepsy with teenage onset. It has an autosomal recessive mode of inheritance and is almost universally fatal by the second or third decade of life. To date, there is no prevention or cure. In the last decade, with the identification of the genes responsible for this disease, much knowledge has been gained with the potential for the future development of effective treatment. This review will briefly address clinical issues and will focus on the molecular aspects of the disease.
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Affiliation(s)
- D M Andrade
- Division of Neurology, Krembil Neuroscience Centre, University of Toronto, Toronto Western Hospital, Toronto, Canada
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Lohi H, Turnbull J, Zhao XC, Pullenayegum S, Ianzano L, Yahyaoui M, Mikati MA, Quinn NP, Franceschetti S, Zara F, Minassian BA. Genetic diagnosis in Lafora disease. Neurology 2007; 68:996-1001. [PMID: 17389303 DOI: 10.1212/01.wnl.0000258561.02248.2f] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 11/15/2022] Open
Abstract
Lafora disease (LD) can be diagnosed by skin biopsy, but this approach has both false negatives and false positives. Biopsies of other organs can also be diagnostic but are more invasive. Genetic diagnosis is also possible but can be inconclusive, for example, in patients with only one heterozygous EPM2A mutation and patients with apparently homozygous EPM2B mutations where one parent is not a carrier of the mutation. We sought to identify occult mutations and clarify the genotypes and confirm the diagnosis of LD in patients with apparent nonrecessive disease inheritance. We used single nucleotide polymorphism, quantitative PCR, and fluorescent in situ hybridization analyses. We identified large EPM2A and EPM2B deletions undetectable by PCR in the heterozygous state and describe simple methods for their routine detection. We report a coding sequence change in several patients and describe why the pathogenic role of this change remains unclear. We confirm that adult-onset LD is due to EPM2B mutations. Finally, we report major intrafamilial heterogeneity in age at onset in LD.
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Affiliation(s)
- H Lohi
- Program in Genetics and Genomic Biology and Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
AIT-082 is a purine derivative with neuroprotective and neurotrophic activity that is desirable in a candidate therapy for Amyotrophic Lateral Sclerosis. Consequently, we investigated the effect of AIT-082 in a transgenic mouse model of ALS. AIT-082 (0, 1, 3, 10, 30, 60, 100 mg/kg) was given to TgN(SOD1-G93A)1Gur transgenic mice from age 30 days until death. The age at onset of clinical signs of disease and the age at death were recorded for each animal. Disease progression was measured by the weekly average distance run in a running wheel. Analysis was made by the Kaplan Meier method with log rank statistics, log rank for trend and Cox regression. Neuropathological study of the brain, spinal cord, muscles and other organs was undertaken at death. In a second experiment we studied the effect of AIT-082 (30 mg/kg) at the onset of disease and during survival of transgenic G93A SOD1 mice, beginning dosing at different ages (20, 30, 40, 60, 80 days). Disease onset was mildly earlier (i.e. worse) at 1 and 10 mg/kg AIT-082 and mildly delayed at 30 mg/kg. This improvement did not reach the usual statistical significance. There was no difference in the age at death for any treatment dose. There was no difference in the neuropathology of treated and untreated G93A mice. However, there was an early improvement in the running wheel function at all tested doses. Using Cox regression, after adjustment for sex, the mice in the running wheels had slightly delayed onset of disease without change in survival and, after adjustment for exercise, the female mice had slightly improved survival. Consequently, AIT-082 would not be an attractive candidate for ALS clinical trials as monotherapy and justification for its use in combination therapy would require additional laboratory support. There was dissociation between the endpoints of disease progression (as judged by running wheel performance) and disease onset and survival. AIT-082 improved early running wheel performance yet led to accelerated late decline and had no impact on survival. It is possible that the drug facilitates early sprouting that leads to accelerated late decline.
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Affiliation(s)
- F Jiang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Muckle W, Turnbull J. Abriter les sans-abri. CMAJ 2006. [DOI: 10.1503/cmaj.061394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
BACKGROUND The homeless have high rates of mortality, but live in environments not conducive to terminal care. Traditional palliative care hospitals may be reluctant to accept such patients, due to behavior or lifestyle concerns. The Ottawa Inner City Health Project (OICHP) is a pilot study to improve health care delivery to homeless adults. This is a retrospective analysis of a cohort of terminally ill homeless individuals and the effectiveness of shelter-based palliative care. As proof of principle, a cost comparison was performed. METHODS 28 consecutive homeless terminally ill patients were admitted and died at a shelter-based palliative care hospice. Demographics, diagnoses at admission and course were recorded. Burden of illness was assessed by medical and psychiatric diagnoses, addictions, Karnofsky scale and symptom management. An expert panel was convened to identify alternate care locations. Using standard costing scales, direct versus alternate care costs were compared. RESULTS 28 patients had a mean age 49 years; average length of stay 120 days. DIAGNOSES: liver disease 43%, HIV/AIDS 25%, malignancy 25% and other 8%. Addiction to drugs or alcohol and mental illness in 82% of patients. Karnofsky performance score mean 40 +/- 16.8. Pain management with continuous opiates in 71%. The majority reunited with family. Compared to alternate care locations, the hospice projected 1.39 million dollars savings for the patients described. CONCLUSION The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions. Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings.
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Affiliation(s)
- Tiina Podymow
- University of Ottawa, Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.
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Salisbury C, Burgess A, Lattimer V, Heaney D, Walker J, Turnbull J, Smith H. Developing a standard short questionnaire for the assessment of patient satisfaction with out-of-hours primary care. Fam Pract 2005; 22:560-9. [PMID: 15964865 DOI: 10.1093/fampra/cmi050] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Governmental reviews of out-of-hours services in England and Scotland have recommended that a standard questionnaire should be used to assess patient satisfaction. This is important because of the rapid introduction of new forms of care. OBJECTIVE To produce a brief, reliable and valid measure of patient satisfaction for use by a wide variety of providers of out-of-hours primary care. METHODS The Short Questionnaire for Out-of-Hours care was designed and compared with a longer questionnaire which had been validated and used in earlier research. Questionnaires were sent to 1906 people contacting an out-of-hours GP co-operative. Three versions of the short questionnaire were used with different formats. Analysis compared the response rates, measurement properties, concurrent and construct validity of the short and long questionnaires, and of different versions of the short questionnaire. RESULTS AND CONCLUSIONS There was no significant difference in the overall response rates obtained from the short or long questionnaires (45.7% versus 41.9%; P = 0.17). The effective response rate of questionnaires from which all satisfaction scales could be calculated was higher for the short questionnaire (43.0% versus 36.4%; P = 0.01). There were no significant differences in response rates or distribution of responses between different versions of the short questionnaire. There was moderate agreement between items on the short questionnaire and corresponding scales on the long questionnaire. Scores using the short questionnaire showed anticipated relationships with the age and sex of patients and with characteristics of how the service was delivered. The SQOC is valid and reliable for routine service use.
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Affiliation(s)
- C Salisbury
- Academic Unit of Primary Health Care, University of Bristol, UK.
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Hughen K, Lehman S, Southon J, Overpeck J, Marchal O, Herring C, Turnbull J. 14C Activity and Global Carbon Cycle Changes over the Past 50,000 Years. Science 2004; 303:202-7. [PMID: 14716006 DOI: 10.1126/science.1090300] [Citation(s) in RCA: 396] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A series of 14C measurements in Ocean Drilling Program cores from the tropical Cariaco Basin, which have been correlated to the annual-layer counted chronology for the Greenland Ice Sheet Project 2 (GISP2) ice core, provides a high-resolution calibration of the radiocarbon time scale back to 50,000 years before the present. Independent radiometric dating of events correlated to GISP2 suggests that the calibration is accurate. Reconstructed 14C activities varied substantially during the last glacial period, including sharp peaks synchronous with the Laschamp and Mono Lake geomagnetic field intensity minimal and cosmogenic nuclide peaks in ice cores and marine sediments. Simulations with a geochemical box model suggest that much of the variability can be explained by geomagnetically modulated changes in 14C production rate together with plausible changes in deep-ocean ventilation and the global carbon cycle during glaciation.
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Affiliation(s)
- K Hughen
- Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution (WHOI), Woods Hole, MA 02543, USA.
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Tarnopolsky MA, Bourgeois JM, Snow R, Keys S, Roy BD, Kwiecien JM, Turnbull J. Histological assessment of intermediate- and long-term creatine monohydrate supplementation in mice and rats. Am J Physiol Regul Integr Comp Physiol 2003; 285:R762-9. [PMID: 12959920 DOI: 10.1152/ajpregu.00270.2003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Creatine monohydrate (CrM) supplementation appears to be relatively safe based on data from short-term and intermediate-term human studies and results from several therapeutic trials. The purpose of the current study was to characterize pathological changes after intermediate-term and long-term CrM supplementation in mice [healthy control and SOD1 (G93A) transgenic] and rats (prednisolone and nonprednisolone treated). Histological assessment (18-20 organs/tissues) was performed on G93A mice after 159 days, and in Sprague-Dawley rats after 365 days, of CrM supplementation (2% wt/wt) compared with control feed. Liver histology was also evaluated in CD-1 mice after 300 days of low-dose CrM supplementation (0.025 and 0.05 g x kg-1x day-1) and in Sprague-Dawley rats after 52 days of CrM supplementation (2% wt/wt) with and without prednisolone. Areas of hepatitis were observed in the livers of the CrM-supplemented G93A mice (P < 0.05), with no significant inflammatory lesions in any of the other 18-20 tissues/organs that were evaluated. The CD-1 mice also showed significant hepatic inflammatory lesions (P < 0.05), yet there was no negative effect of CrM on liver histology in the Sprague-Dawley rats after intermediate-term or long-term supplementation nor was inflammation seen in any other tissues/organs (P = not significant). Dietary CrM supplementation can induce inflammatory changes in the liver of mice, but not rats. The observed inflammatory changes in the murine liver must be considered in the evaluation of hepatic metabolism in CrM-supplemented mice. Species differences must be considered in the evaluation of toxicological and physiological studies.
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Affiliation(s)
- M A Tarnopolsky
- Department of Pediatrics and Medicine, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.
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