Shabnam Asghari

Loss of PLA2G6 leads to elevated mitochondrial lipid peroxidation and mitochondrial dysfunction

Mutations in PLA2G6, which encodes ‘calcium-independent phospholipase A2 beta’, have been implicated in parkinsonian disorders. Kinghorn et al. show, in a Drosophila model and in human fibroblasts, that reduced PLA2G6 activity is associated with elevated mitochondrial lipid peroxidation and mitochondrial dysfunction. Treatment with deuterated polyunsaturated fatty acids reverses the deficits.

Prevalence and management of hypertension in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network

BACKGROUNDnMost epidemiologic reports on hypertension in Canada are based on data from surveys or on administrative data. We report on the prevalence and management of hypertension based on data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices.nnnMETHODSnWe included CPCSSN data as of Dec. 31, 2012, for patients 18 years and older who had at least 1xa0clinical encounter during the previous 2 years with one of the 444 family physicians and nurse-practitioners who participate in the CPCSSN. We calculated the prevalence of hypertension, the proportion of patients who achieved blood pressure targets, the number of encounters with primary care providers, comorbidities and pharmacologic management.nnnRESULTSnOf the 250xa0346 patients who met the eligibility criteria, 57xa0180 (22.8%) had a diagnosis of hypertension. Of the 44xa0981 patients for whom blood pressure data were available, 35xa0094 (78.0%) had achieved both targets for systolic (≤□140xa0mmxa0Hg) and diastolic (≤□90xa0mmxa0Hg) pressure. Compared with patients who did not have a hypertension diagnosis, those with hypertension were significantly more likely to have a comorbidity and visited their primary care provider more often. Among the patients with hypertension, 12.1% were not taking antihypertensive medications; nearly two-thirds (61.7%) had their condition controlled with 1 or 2 drugs.nnnINTERPRETATIONnThe prevalence of hypertension based on CPCSSN data was similar to estimates from the Canadian Health Measures Survey. Although achievement of blood pressure targets was high, patients with hypertension had more comorbidities and saw their primary care provider more often than those without hypertension.

Pharmacists and family physicians: improving interprofessional collaboration through joint understanding of our competencies.

Interprofessional collaboration (IPC) is an integral part of the practice of Medicine and Family Medicine. The World Health Organization (WHO) defines IPC as occurring when “multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care” (WHO, 2010). To provide effective, patient-centered care, family physicians must collaborate with other health and social care providers. This is especially true in Canada where there is an increasing level of chronic care and multimorbidity. Between 1998/99 and 2008/09 the prevalence of diagnosed diabetes among Canadians has increased by 70%. Over 36.5% of Canadian adults with diabetes report two or more other serious chronic conditions (hypertension, heart disease, chronic obstructive pulmonary disease, mood disorder, and/or arthritis) in addition to diabetes, and 12.5% report having three or more (Frank, 2005). The Collaborator role has therefore appropriately been included in the CanMEDS framework of competencies by the College of Physicians and Surgeons of Canada (Frank, 2005) and the College of Family Physicians of Canada (CFPC) (Tannenbaum et al., 2009). These frameworks are used in the design and accreditation of undergraduate and family medicine curricula as well as to improve patient care by ensuring that training programs in family medicine are responsive to societal needs (Tannenbaum et al., 2009).

Beta-blockers are associated with increased risk of first cardiovascular events in non-diabetic hypertensive elderly patients †

Although treatment should be considered for elderly patients with hypertension (HTN), the effectiveness of beta‐blockers (BBs) compared with other medications is less clear. This studys objective is to assess the relative effectiveness of BBs in elderly primary prevention patients with uncomplicated HTN.

Utility of computed tomography and derivation and validation of a score to identify an emergent outcome in 2,315 patients with suspected urinary tract stone.

OBJECTIVEnBecause a majority of urinary tract stones (UTSs) pass spontaneously and clinically significant alternative pathology is rare, we hypothesize that many computed tomographic (CT) scans to diagnose them are likely unnecessary. We sought to measure the impact of renal CT scans on resource use and to justify a prospective study to derive a score that predicts an emergent diagnosis in patients with suspected UTS by doing so in our retrospective series.nnnMETHODSnWe conducted a retrospective study of ED patients who had noncontrast CT of the abdomen for suspected UTS. A split-sample was used to derive and validate a score to predict the presence of an emergent diagnosis on CT.nnnRESULTSnOf the 2,315 patients (50.8% female, mean age 45 years), 49 (2.1%) had an emergent outcome observed on CT. An additional 12 (0.5%) patients had an urgent outcome and 239 (10.6%) had a urologic procedure within 8 weeks of the CT. Serum white blood cell count, highest temperature, urine red blood cell count, and the presence of abdominal pain were significant predictors of the primary outcome. A score derived using these predictors had a potential range of -2 (0.26% predicted risk, 0.5% actual risk of the outcome) to 6 (52% predicted risk). The score was moderately discriminatory with c-statistics of 0.752 (derivation) and 0.668 (validation) and accurate with Hosmer-Lemeshow statistics of 10.553 (p u200a=u200a 0.228, derivation) and 9.70 (p u200a=u200a 0.286, validation).nnnCONCLUSIONSnA sensible, relevant score derived and validated on all patients presenting with symptoms suggestive of renal colic could be useful in reducing abdominal CT scan ordering.

Adaptation of POCT for pharmacies to reduce risk and optimize access to care in HIV, the APPROACH study protocol: examining acceptability and feasibility

BackgroundApproximately 1 in 5 Canadians with HIV are unaware of their status. In many provinces and especially rural communities, barriers to HIV testing include lack of access, privacy concerns, and stigma. The availability of HIV point-of-care testing (POCT) is limited across Canada. Pharmacists are well positioned to address barriers by offering rapid HIV POCT and facilitating linkage to care.MethodsWe will use a type-2 hybrid implementation-effectiveness design to assess a pilot HIV POCT model in one urban and one rural pharmacy in each of two Canadian provinces over 6xa0months. In this feasibility trial the research aims include developing and assisting pharmacies in implementing the model, evaluating processes/determinants of program implementation, evaluating the model’s effects on client outcomes, preferences, and testing satisfaction. Using a community-based research approach, the research team will engage community stakeholders in each province including individuals with lived experience to inform the development of the pharmacy-based HIV testing model and support the research team throughout the study. A multipronged promotion campaign will be used to promote the study and facilitate recruitment. The pharmacy-based testing model will include pre/post-test counseling and linkage to care plans in addition to pharmacist-administered HIV POCT. Pharmacists will complete a comprehensive training program prior to implementing the testing model. Client demographics and satisfaction will be assessed by surveys and interviews. Pharmacists will document time required for testing and participate in a post-study focus group to discuss barriers/enablers. Implementation will be assessed qualitatively and quantitatively. The process of developing and implementing the model will be described using qualitative data and a logic model. Acceptability and barriers/enablers will be examined qualitatively based on survey responses. A preliminary costing assessment will consider the client, pharmacy, and government perspectives.DiscussionThe results of this pilot will inform modifications to the HIV POCT model to optimize effectiveness and increase scalability. The study has national importance, providing valuable information on improving access to HIV testing. Future applications of this research may expand the role of pharmacists in offering POCT for other sexually transmitted/bloodborne infections as tests become available in Canada.Trial registrationClinicaltrials.gov, NCT03210701

Patient satisfaction with chronic HIV care provided through an innovative pharmacist/nurse-managed clinic and a multidisciplinary clinic

Background: Pharmacist/nurse-led clinics are an established model for many chronic diseases but not yet for HIV. At our centre, patients with HIV are seen by a multidisciplinary team (physician, nurse, pharmacist, social worker) at least yearly. Some attend an HIV-specialist pharmacist/nurse clinic (or “nonphysician clinic,” NPC) for alternate biannual visits. Our objective was to assess patient satisfaction with care received through both clinics. Methods: The Patient Satisfaction Survey for HIV Ambulatory Care (assesses satisfaction with access to care, clinic visits and quality of care) was administered by telephone to adults who attended either clinic between January and July 2014. Descriptive statistics described patient characteristics and satisfaction scores. Fisher’s exact test compared satisfaction scores between the NPC and multidisciplinary clinic (MDC). Multivariate logistic regression examined associations between overall satisfaction with care and clinic type and patient characteristics (e.g., age, disease duration). Results: Respondents were very satisfied with the overall quality of HIV care in both the NPC and MDC (89% vs 93%, respectively, p = 0.6). Patients from both clinics expressed satisfaction with access to care, treatment plan input, their provider’s knowledge of the newest developments in HIV care and explanation of medication side effects, with no significant differences noted. Significantly more MDC patients reported being asked about housing/finances, alcohol/drug use and whether they needed help disclosing their status. Patient characteristics were not significantly associated with satisfaction with overall quality of care. Conclusion: Patients are satisfied with both clinics, supporting NPC as an innovative model for chronic HIV care. Comparison of outcomes between clinics is needed to ensure high-quality care.