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In JoVE (1)
Other Publications (33)
- Journal of Palliative Care
- CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne
- Medical Care
- Journal (Canadian Dental Association)
- Journal of Palliative Medicine
- Canadian Journal of Public Health. Revue Canadienne De Santé Publique
- Clinical and Investigative Medicine. Médecine Clinique Et Experimentale
- Brain Research
- BMC Family Practice
- BMC Palliative Care
- The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association
- The Journal of Pharmacology and Experimental Therapeutics
- Palliative Medicine
- Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
- Hormones and Behavior
- Journal of Medicinal Chemistry
- Bioorganic & Medicinal Chemistry Letters
- Bioorganic & Medicinal Chemistry Letters
- Medical Care
- Bioorganic & Medicinal Chemistry Letters
- Bioorganic & Medicinal Chemistry Letters
- Bioorganic & Medicinal Chemistry
- Journal of Medicinal Chemistry
- Bioorganic & Medicinal Chemistry Letters
- Healthcare Policy = Politiques De Santé
- Progress in Palliative Care
- Journal of Palliative Care
- Palliative Medicine
- Journal of Pain and Symptom Management
- Pharmacoepidemiology and Drug Safety
- Cancer Causes & Control : CCC
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Articles by Grace Johnston in JoVE
تحديد عدد الخلايا خلال زراعة الخلايا باستخدام خلية مكافحة الصولجان
Kathleen Ongena, Chandreyee Das, Janet L. Smith, Sónia Gil, Grace Johnston
Bioscience Division, Millipore Inc
لجنة مكافحة خلية الصولجان هو جهاز محمول باليد الآلية التي يمكن استخدامها لحساب عدد الخلايا ، ورصد حجم الخلية وقطر ، كما يمكن استخدامها للتحقق من صحة ونوعية السكان الخلوية من ثقافة إلى أخرى.
Other articles by Grace Johnston on PubMed
Journal of Palliative Care. 2002 | Pubmed ID: 12418364
Four dimensions for the provision of end-of-life care by clinicians were identified from a review and synthesis of the Canadian family physician and palliative care literatures. These dimensions are: clinician-patient continuity, timing and location of care, community-centred services, and multidisciplinary care. Indicators of each dimension are presented along with criteria for indicator selection. The analytic framework was refined during the linkage of population-based administrative databases to identify patterns of family physician service provision in the last months of life for persons dying from cancer in Nova Scotia, Canada. Data analysis was framed to inform palliative care policy and programs, as well as to enable comparison among geographic areas within and beyond Canada.
CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne. Feb, 2003 | Pubmed ID: 12566330
Although many patients with cancer would prefer to die at home, most die in hospital. We carried out a study to describe the yearly trends in the place of death between 1992 and 1997 and to determine predictors of out-of-hospital death for adults with cancer in Nova Scotia.
Medical Care. Aug, 2003 | Pubmed ID: 12886178
Despite cancer patients preferring to spend their last days out-of-hospital, many make difficult visits to the emergency department (ED). Family physician continuity of care has been shown in some clinical situations to reduce ED utilization.
Evolution of Interprofessional Learning: Dalhousie University's "From Family Violence to Health" Module
Journal (Canadian Dental Association). Nov, 2003 | Pubmed ID: 14611714
At Dalhousie University, interprofessional (IP) learning modules are used to help future health care professionals learn to work together in resolving complex problems. One module, "From Family Violence to Health," features the role of dental professionals. This paper describes the evolution of this module from the year 2000. By February 2003, 1,182 students from 15 health care professions had completed the module. Qualitative evaluation in years 1 and 2 of the program (2000 and 2001) revealed that, before participating in the IP module, many students were able to identify a role for themselves in the recognition of family violence and knew their responsibility to report incidents. However, after participating in the module, they had a greater understanding of the reporting of family violence, a more comprehensive and supportive perspective, increased recognition of how health care professionals could work together and improved awareness of the roles of other professions. In a quantitative evaluation in year 3 (2002), mean student ratings on a scale of 1 to 5 indicated that the IP module was relevant (4.2), increased their understanding of family violence (4.0), and had some impact in promoting IP learning (3.8). As health care delivery becomes more focused on care teams and system thinking, the provision of IP training is expected to increase. The Dalhousie University IP modules (available at http://www.dal.ca/~fhp/ipl/index.html) address health and social problems for which it is critical that health care and other professionals work together. Feedback from practitioners on the development of IP education is welcomed, particularly with regard to the IP module addressing family violence.
Journal of Palliative Medicine. Dec, 2003 | Pubmed ID: 14733683
Continuity of primary care is known to be associated with both improved processes and outcomes of care. Despite continuity being a desired attribute of end-of-life care and despite the desire by most patients with cancer to die at home, there has been no health services research examining this relationship.
Canadian Journal of Public Health. Revue Canadienne De Santé Publique. Mar-Apr, 2004 | Pubmed ID: 15074897
Pap smear screening is effective in reducing the incidence of cervical cancer. However, some subgroups of women are less likely to be screened than others. Since Canadian provincial health databases do not contain data fields identifying ethnicity or language, analyses employing these variables are typically not available. This paper overcomes this problem by using community- rather than person-based measures. Associations with having had a recent Pap smear are reported by community income, language, ethnic group, and urban/rural status, as well as the woman's age.
Clinical and Investigative Medicine. Médecine Clinique Et Experimentale. Jun, 2004 | Pubmed ID: 15305806
To study the wait times for cancer patients from the time of diagnosis to consultation with a radiation oncologist (T1), from consultation to radiotherapy (T2) and from diagnosis to radiotherapy (T3) in the context of treatment practices and measurement issues.
Serotonin 2A Receptors Modulate Tail-skin Temperature in Two Rodent Models of Estrogen Deficiency-related Thermoregulatory Dysfunction
Brain Research. Dec, 2004 | Pubmed ID: 15527744
Menopause-associated thermoregulatory dysfunction, including hot flushes and night sweats, is effectively treated by hormonal therapies that include estrogens. Evidence suggests that estrogen regulates serotonin 2A (5-HT(2A)) receptor expression and that 5-HT(2A) receptors are involved in thermoregulation. Therefore, the role of 5-HT(2A) receptors in thermoregulation was assessed in two rat models of ovariectomy-induced thermoregulatory dysfunction. The first model is based on measurement of the tail-skin temperature (TST) increase following naloxone-induced withdrawal in morphine-dependent ovariectomized (OVX) rats (MD model), while the second model relies on telemetric assessment of diurnal TST changes in ovariectomized rats (telemetry model). Treatment with a 5-HT(2A/2C) receptor agonist, (-)-2,5-dimethoxy-4-iodoamphetamine hydrochloride (DOI), prevented the naloxone-induced TST increase in the MD model and restored normal active-phase TST in the telemetry model. The selective 5-HT(2A) receptor antagonist, MDL-100907, had no effect on the naloxone-induced flush when administered alone in the MD model, but it decreased DOI's ability to abate the flush. In the telemetry model, MDL-100907 attenuated the DOI-induced decrease in active-phase TST. Interestingly, MDL-100907 increased TST in both models when given alone, with the TST increase occurring prior to the naloxone-induced flush in the MD model. To evaluate the role of central nervous system (CNS) 5-HT(2A) receptors in TST regulation, DOI was administered in combination with a known peripheral 5-HT(2A/2C) receptor antagonist, xylamidine, in the MD model. Xylamidine had no effect on DOI's ability to abate the naloxone-induced flush. These results indicate that activation of central 5-HT(2A) receptors restores temperature regulation in two rodent models of ovariectomy-induced thermoregulatory dysfunction.
BMC Family Practice. Jan, 2005 | Pubmed ID: 15631626
During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992) to 30% (1998). These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP) visits to advanced cancer patients in Nova Scotia (NS) during the years of health care restructuring.
Home Visits by Family Physicians During the End-of-life: Does Patient Income or Residence Play a Role?
BMC Palliative Care. Jan, 2005 | Pubmed ID: 15676069
BACKGROUND: With a growing trend for those with advanced cancer to die at home, there is a corresponding increase in need for primary medical care in that setting. Yet those with lower incomes and in rural regions are often challenged to have their health care needs met. This study examined the association between patient income and residence and the receipt of Family Physician (FP) home visits during the end-of-life among patients with cancer. METHODS: Data Sources/Study Setting. Secondary analysis of linked population-based data. Information pertaining to all patients who died due to lung, colorectal, breast or prostate cancer between 1992 and 1997 (N = 7,212) in the Canadian province of Nova Scotia (NS) was extracted from three administrative health databases and from Statistics Canada census records. Study Design. An ecological measure of income ('neighbourhood' median household income) was developed using census information. Multivariate logistic regression was then used to assess the association of income with the receipt of at least one home visit from a FP among all subjects and by region of residency during the end-of-life. Covariates in the initial multivariate model included patient demographics and alternative health services information such as total days spent as a hospital inpatient. Data Extraction Methods. Encrypted patient health card numbers were used to link all administrative health databases whereas the postal code was the link to Statistics Canada census information. RESULTS: Over 45% of all subjects received at least one home visit (n = 3265). Compared to those from low income areas, the log odds of receiving at least one home visit was significantly greater among subjects who reside in middle to high income neighbourhoods (for the highest income quintile, adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.15, 1.64; for upper-middle income, adjusted OR = 1.19, 95%CI = 1.02, 1.39; for middle income, adjusted OR = 1.33, 95%CI = 1.15, 1.54). This association was found to be primarily associated with residency outside of the largest metropolitan region of the province. CONCLUSION: The likelihood of receiving a FP home visit during the end-of-life is associated with neighbourhood income particularly among patients living outside of a major metropolitan region.
The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2005 | Pubmed ID: 16092297
Surveys indicate 50% to 80% of cancer patients would choose to die at home if possible, although far fewer actually do. In Nova Scotia (NS), cancer deaths occurring out-of-hospital increased from 19.8% in 1992 to 30.2% in 1997. The impact of rural residency on this trend has not been studied.
The Journal of Pharmacology and Experimental Therapeutics. Aug, 2006 | Pubmed ID: 16675639
The purpose of this study was to characterize a new chemical entity, desvenlafaxine succinate (DVS). DVS is a novel salt form of the isolated major active metabolite of venlafaxine. Competitive radioligand binding assays were performed using cells expressing either the human serotonin (5-HT) transporter (hSERT) or norepinephrine (NE) transporter (hNET) with K(i) values for DVS of 40.2 +/- 1.6 and 558.4 +/- 121.6 nM, respectively. DVS showed weak binding affinity (62% inhibition at 100 microM) at the human dopamine (DA) transporter. Inhibition of [3H]5-HT or [3H]NE uptake by DVS for the hSERT or hNET produced IC50 values of 47.3 +/- 19.4 and 531.3 +/- 113.0 nM, respectively. DVS (10 microM), examined at a large number of nontransporter targets, showed no significant activity. DVS (30 mg/kg orally) rapidly penetrated the male rat brain and hypothalamus. DVS (30 mg/kg orally) significantly increased extracellular NE levels compared with baseline in the male rat hypothalamus but had no effect on DA levels using microdialysis. To mimic chronic selective serotonin reuptake inhibitor treatment and to block the inhibitory 5-HT(1A) autoreceptors, a 5-HT(1A) antagonist, N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-N-2-pyridinylcyclo hexanecarboxamide maleate salt (WAY-100635) (0.3 mg/kg s.c.), was administered with DVS (30 mg/kg orally). 5-HT increased 78% compared with baseline with no additional increase in NE or DA levels. In conclusion, DVS is a new 5-HT and NE reuptake inhibitor in vitro and in vivo that demonstrates good brain-to-plasma ratios, suggesting utility in a variety of central nervous system-related disorders.
Towards Using Administrative Databases to Measure Population-based Indicators of Quality of End-of-life Care: Testing the Methodology
Palliative Medicine. Dec, 2006 | Pubmed ID: 17148531
This study is concerned with methods to measure population-based indicators of quality end-of-life care. Using a retrospective cohort approach, we assessed the feasibility, validity and reliability of using administrative databases to measure quality indicators of end-of-life care in two Canadian provinces. The study sample consisted of all females who died of breast cancer between 1 January 1998 and 31 December 2002, in Nova Scotia or Ontario, Canada. From an initial list of 19 quality indicators selected from the literature, seven were determined to be fully measurable in both provinces. An additional seven indicators in one province and three in the other province were partially measurable. Tests comparing administrative and chart data show a high level of agreement with inter-rater reliability, confirming consistency in the chart abstraction process. Using administrative data is an efficient, population-based method to monitor quality of care which can compliment other methods, such as qualitative and purposefully collected clinical data.
Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer. Sep, 2007 | Pubmed ID: 17277924
With our population aging, an increasing proportion of cancer deaths will occur in nursing homes, yet little is known about their end-of-life care. This paper identifies associations between residing in a nursing home and end-of-life palliative cancer care, controlling for demographic factors.
Alleviation of Thermoregulatory Dysfunction with the New Serotonin and Norepinephrine Reuptake Inhibitor Desvenlafaxine Succinate in Ovariectomized Rodent Models
Endocrinology. Mar, 2007 | Pubmed ID: 17122073
Hot flushes and night sweats, referred to as vasomotor symptoms (VMS), are presumed to be a result of declining hormone levels and are the principal menopausal symptoms for which women seek medical treatment. To date, estrogens and/or some progestins are the most effective therapeutics for alleviating VMS; however, these therapies may not be appropriate for all women. Therefore, nonhormonal therapies are being evaluated. The present study investigated a new reuptake inhibitor, desvenlafaxine succinate (DVS), in animal models of temperature dysfunction. Both models used are based on measuring changes in tail-skin temperature (TST) in ovariectomized (OVX) rats. The first relies on naloxone-induced withdrawal in morphine-dependent (MD) OVX rats, resulting in an acute rise in TST. The second depends on an OVX-induced loss of TST decreases during the dark phase as measured by telemetry. An initial evaluation demonstrated abatement of the rise in TST with long-term administration of ethinyl estradiol or with a single oral dose of DVS (130 mg/kg) in the MD model. Further evaluation showed that orally administered DVS acutely and dose dependently (10-100 mg/kg) abated a naloxone-induced rise in TST of MD rats and alleviated OVX-induced temperature dysfunction in the telemetry model. Oral administration of DVS to OVX rats caused significant increases in serotonin and norepinephrine levels in the preoptic area of the hypothalamus, a key region of the brain involved in temperature regulation. These preclinical studies provide evidence that DVS directly impacts thermoregulatory dysfunction in OVX rats and may have utility in alleviating VMS associated with menopause.
Subchronic 17alpha-ethinyl Estradiol Differentially Affects Subtypes of Sleep and Wakefulness in Ovariectomized Rats
Hormones and Behavior. Jan, 2008 | Pubmed ID: 17976600
In ovariectomized (OVX) Sprague-Dawley rats, estradiol benzoate (EB) has been reported to decrease rapid eye movement (REM) and non-REM (NREM) sleep during the dark phase for up to 3 days. It is unknown, however, if estrogenic effects on sleep extend beyond 3 days or if other estrogens could induce the same changes. Furthermore, it is unclear whether the increased wakefulness in the dark phase was due to changes in active or quiet wakefulness. Therefore, we examined the effects of daily injections of 17alpha-ethinyl estradiol (EE) for 6 days on sleep and wakefulness in the OVX rat. After 3 days of baseline recording using a telemetric system, rats were administered sesame oil (sc) for 3 days followed by injection with EE (20 mug/rat/day, sc) for 6 days. After treatment, sleep was recorded during hormone withdrawal for an additional 5 days. A few sporadic but statistically significant increases in light phase sleep occurred during the last 3 days of EE treatment. Starting on day 2 of the study, EE caused statistically significant decreases in dark phase REM sleep that were maintained throughout the treatment period and persisted until the 3rd day of hormone withdrawal. During the dark phase, statistically significant decreases in NREM sleep and increases in active wakefulness started on the second day of treatment and abated by the end of treatment. This study demonstrated that EE had similar effects on sleep-wakefulness to EB and demonstrates the utility of telemetric polysomnographic recording of the female OVX rat as a model for understanding the estrogen-induced changes on sleep-wakefulness.
Cancer. May, 2008 | Pubmed ID: 18361447
Quality indicators (QIs) are tools designed to measure and improve quality of care. The objective of this study was to assess stakeholder acceptability of QIs of end-of-life (EOL) care that potentially were measurable from population-based administrative health databases.
Structure-activity Relationships of the Cycloalkanol Ethylamine Scaffold: Discovery of Selective Norepinephrine Reuptake Inhibitors
Journal of Medicinal Chemistry. Jul, 2008 | Pubmed ID: 18557608
Further exploration of the cycloalkanol ethylamine scaffold, of which venlafaxine ( 1) is a member, was undertaken to develop novel and selective norepinephrine reuptake inhibitors (NRIs) for evaluation in a variety of predictive animal models. These efforts led to the discovery of a piperazine-containing analogue, 17g (WY-46824), that exhibited potent norepinephrine reuptake inhibition, excellent selectivity over the serotonin transporter, but no selectivity over the dopamine transporter. Synthesis and testing of a series of cyclohexanol ethylpiperazines identified ( S)-(-)- 17i (WAY-256805), a potent norepinephrine reuptake inhibitor (IC 50 = 82 nM, K i = 50 nM) that exhibited excellent selectivity over both the serotonin and dopamine transporters and was efficacious in animal models of depression, pain, and thermoregulatory dysfunction.
Synthesis and Activity of 1-(3-amino-1-phenylpropyl)indolin-2-ones: a New Class of Selective Norepinephrine Reuptake Inhibitors
Bioorganic & Medicinal Chemistry Letters. Sep, 2008 | Pubmed ID: 18771916
Norepinephrine and serotonin play an important role in a wide variety of biological processes and are implicated in a number of neurological disorders. A novel class of 1-(3-amino-1-phenylpropyl)indolin-2-ones was designed and synthesized that displays potent norepinephrine reuptake inhibition while maintaining high selectivity (>100-fold) against the human serotonin and dopamine transporters.
Synthesis and Activity of Novel 1- or 3-(3-amino-1-phenyl Propyl)-1,3-dihydro-2H-benzimidazol-2-ones As Selective Norepinephrine Reuptake Inhibitors
Bioorganic & Medicinal Chemistry Letters. Dec, 2008 | Pubmed ID: 18951020
A series of novel 1- or 3-(3-amino-1-phenyl propyl)-1,3-dihydro-2H-benzimidazol-2-ones as selective norepinephrine reuptake inhibitors was discovered. Several compounds such as 15 and 20 showed good hNET potency. Compounds 15 and 20 also displayed excellent selectivity at hNET that appeared superior to those of reboxetine and atomoxetine (4 and 5).
Medical Care. Dec, 2008 | Pubmed ID: 19300309
Inequalities in access to palliative care programs (PCP) by age have been shown to exist in Canada and elsewhere. Few studies have been able to provide greater insight by simultaneously adjusting for multiple demographic, health service, and socio-cultural indicators.
3-(Arylamino)-3-phenylpropan-2-olamines As a New Series of Dual Norepinephrine and Serotonin Reuptake Inhibitors
Bioorganic & Medicinal Chemistry Letters. May, 2009 | Pubmed ID: 19329313
A series of 3-(arylamino)-3-phenylpropan-2-olamines was prepared and screened for their ability to inhibit monoamine reuptake. A number of analogues displayed significant dual norepinephrine and serotonin reuptake inhibition. Compounds in this class exhibited minimal affinity for the dopamine transporter.
Structure-activity Relationships of the 1-amino-3-(1H-indol-1-yl)-3-phenylpropan-2-ol Series of Monoamine Reuptake Inhibitors
Bioorganic & Medicinal Chemistry Letters. Oct, 2009 | Pubmed ID: 19713106
The SAR of a series of 1-amino-3-(1H-indol-1-yl)-3-phenylpropan-2-ols as monoamine reuptake inhibitors, with a goal to improve both potency toward inhibiting the norepinephrine transporter and selectivity over the serotonin transporter, is reported. The effect of specific substitution on both the 3-phenyl group and the indole moiety were explored. This study led to the discovery of compound 20 which inhibited the norepinephrine transporter with an IC50 value of 4 nM while exhibiting 86-fold selectivity over the serotonin transporter.
Dual Acting Norepinephrine Reuptake Inhibitors and 5-HT(2A) Receptor Antagonists: Identification, Synthesis and Activity of Novel 4-aminoethyl-3-(phenylsulfonyl)-1H-indoles
Bioorganic & Medicinal Chemistry. Nov, 2009 | Pubmed ID: 19836247
The discovery of a series of 4-aminoethyl-3-(phenylsulfonyl)-1H-indoles, dual acting norepinephrine reuptake inhibitors (NRIs) and 5-HT(2A) receptor antagonists, is described. The synthesis and structure-activity relationship (SAR) of this novel series of compounds is also presented.
1-(Indolin-1-yl)-1-phenyl-3-propan-2-olamines As Potent and Selective Norepinephrine Reuptake Inhibitors
Journal of Medicinal Chemistry. Mar, 2010 | Pubmed ID: 20131864
Efforts to identify new selective and potent norepinephrine reuptake inhibitors (NRIs) for multiple indications by structural modification of the previous 3-(arylamino)-3-phenylpropan-2-olamine scaffold led to the discovery of a novel series of 1-(indolin-1-yl)-1-phenyl-3-propan-2-olamines (9). Investigation of the structure-activity relationships revealed that small alkyl substitution at the C3 position of the indoline ring enhanced selectivity for the norepinephrine transporter (NET) over the serotonin transporter (SERT). Several compounds bearing a 3,3-dimethyl group on the indoline ring, 9k, 9o,p, and 9s,t, exhibited potent inhibition of NET (IC(50) = 2.7-6.5 nM) and excellent selectivity over both serotonin and dopamine transporters. The best example from this series, 9p, a potent and highly selective NRI, displayed oral efficacy in a telemetric rat model of ovariectomized-induced thermoregulatory dysfunction, a mouse p-phenylquinone (PPQ) model of acute visceral pain, and a rat spinal nerve ligation (SNL) model of neuropathic pain.
Bioorganic & Medicinal Chemistry Letters. May, 2010 | Pubmed ID: 20378347
A series of heterocyclic cycloalkanol ethylamines have been prepared to expand our norepinephrine reuptake inhibitor (NRI) program. Synthesis of a variety of heterocycles identified (+)-S-21, a potent NRI efficacious in an animal model for thermoregulatory dysfunction.
Perspectives of an Interdisciplinaryg Research Team to Engage Practice: Lessons from a Knowledge Exchange Trainee Experience
Healthcare Policy = Politiques De Santé. May, 2010 | Pubmed ID: 21532769
End-of-life (EOL) care is an area of health services that will ultimately affect us all. To share the knowledge emerging from EOL research and to address inequities in the quality of EOL care in Nova Scotia, a knowledge exchange (KE) trainee was hired to translate research and surveillance into a Surveillance Report. The purpose of this paper is to reflect upon this initiative and share the research team's perspectives on their KE experiences. We describe four key competencies of the KE trainee selected, and discuss lessons learned from this KE trainee experience, to expand our understanding of KE.
Progress in Palliative Care. Jan, 2011 | Pubmed ID: 21731193
Persons with limited life expectancy (LLE) - less than 1 year - are significant consumers of health care, are at increased risk of polypharmacy and adverse drug events, and have dynamic health statuses. Therefore, medication use among this population must be appropriate and regularly evaluated. The objective of this review is to assess the current state of knowledge and clinical practice presented in the literature regarding preventive medication use among persons with LLE. We searched Medline, Embase, and CINAHL using Medical Subject Headings. Broad searches were first conducted using the terms 'terminal care or therapy' or 'advanced disease' and 'polypharmacy' or 'inappropriate medication' or 'preventive medicine', followed by more specific searches using the terms 'statins' or 'anti-hypertensives' or 'bisphosphonates' or 'laxatives' and 'terminal care'. Frameworks to assess appropriate versus inappropriate medications for persons with LLE, and the prevalence of potentially inappropriate medication use among this population, are presented. A considerable proportion of individuals with a known terminal condition continue to take chronic disease preventive medications until death despite questionable benefit. The addition of palliative preventive medications is advised. There is an indication that as death approaches the shift from a curative to palliative goal of care translates into a shift in medication use. This literature review is a first step towards improving medication use and decreasing polypharmacy in persons at the end of life. There is a need to develop consensus criteria to assess appropriate versus inappropriate medication use, specifically for individuals at the end of life.
Identifying Population Groups with Low Palliative Care Program Enrolment Using Classification and Regression Tree Analysis
Journal of Palliative Care. 2011 | Pubmed ID: 21805944
Classification and regression tree (CART) analysis was used to identify subpopulations with lower palliative care program (PCP) enrolment rates. CART analysis uses recursive partitioning to group predictors. The PCP enrolment rate was 72 percent for the 6,892 adults who died of cancer from 2000 and 2005 in two counties in Nova Scotia, Canada. The lowest PCP enrolment rates were for nursing home residents over 82 years (27 percent), a group residing more than 43 kilometres from the PCP (31 percent), and another group living less than two weeks after their cancer diagnosis (37 percent). The highest rate (86 percent) was for the 2,118 persons who received palliative radiation. Findings from multiple logistic regression (MLR) were provided for comparison. CART findings identified low PCP enrolment subpopulations that were defined by interactions among demographic, social, medical, and health system predictors.
Variation in the Use of Palliative Radiotherapy at End of Life: Examining Demographic, Clinical, Health Service, and Geographic Factors in a Population-based Study
Palliative Medicine. Mar, 2011 | Pubmed ID: 20937613
Palliative radiotherapy (PRT) can improve quality of life for people dying of cancer. Variation in the delivery of PRT by factors unrelated to need may indicate that not all patients who may benefit from PRT receive it. In this study, 13,494 adults who died of cancer between 2000 and 2005 in Nova Scotia, Canada, were linked to radiotherapy records. Multivariate logistic regression was used to examine the relationships among demographic, clinical, service, and geographic variables, and PRT consultation and treatment. Among the decedents, 4188 (31.0%) received PRT consultation and 3032 (22.3%) treatment. PRT declined with increased travel time and community deprivation. Females, older persons, and nursing home residents also had lower PRT rates. Variations were observed by cancer site and previous oncology care. Variations in PRT use should be discussed with referring physicians, and improved means of access to PRT considered. Benchmarks for optimal rates of PRT are needed.
Journal of Pain and Symptom Management. Apr, 2011 | Pubmed ID: 21276697
Palliative care researchers face challenges recruiting and retaining study subjects.
The Effect of an Educational Intervention on Meperidine Use in Nova Scotia, Canada: a Time Series Analysis
Pharmacoepidemiology and Drug Safety. Feb, 2012 | Pubmed ID: 22081471
To evaluate the impact of a prescriber focused individual educational and audit-feedback intervention undertaken by the Nova Scotia Prescription Monitoring Program (NSPMP) in March/April 2007 to reduce meperidine use.
Impact of Comorbidity and Healthcare Utilization on Colorectal Cancer Stage at Diagnosis: Literature Review
Cancer Causes & Control : CCC. Feb, 2012 | Pubmed ID: 22101505
Individuals diagnosed with cancer close to death have low access to enrollment in palliative care programs. The purpose of this literature review was to assess the usefulness of pre-diagnostic comorbidity and healthcare utilization as indicators of late-stage colorectal cancer (CRC) diagnosis, to help with early identification of individuals who may benefit from palliative care.