Clinical impact of double protease inhibitor boosting with Lopinavir/Ritonavir and Amprenavir as part of salvage antiretroviral therapy

Purpose: Double protease inhibitor (PI) boosting is being explored as a new strategy in salvage antiretroviral (ARV) therapy. However, if a negative drug interaction leads to decreased drug levels of either or both PIs, double PI boosting could lead to decreased virologic response. A negative drug interaction has been described between amprenavir (APV) and lopinavir/ritonavir (LPV/r). This observational cohort study assessed the virologic impact of the addition of APV to a salvage ARV regimen, which also contains LPV/r, compared to a regimen containing LPV/r alone. Method: Patients initiated on a salvage ARV regimen that included LPV/r obtained from the expanded access program in Toronto, Canada, were evaluated. APV (600-1,200 mg bid) was added at the discretion of the treating physician. Results: Using multivariate Cox proportional hazards models, we found that the addition of APV to a LPV/r-containing salvage regimen was not significantly associated with time to virologic suppression (< 50 copies/mL; adjusted hazard ratio [HR] = 0.75, p = .12) or with time to virologic rebound (adjusted HR = 1.46, p = .34). Those patients who received higher doses of APV had an increased chance of virologic suppression (p = .03). In a subset of 27 patients, the median LPV Ctrough was significantly lower in patients receiving APV (p = .04), and the median APV Ctrough was reduced compared to reported controls. Conclusion: Our data do not support an additional benefit in virologic reduction of double boosting with APV and LPV/r relative to LPV/r alone in salvage ARV therapy. Our study's limitations include its retrospective nature and the imbalance between the two groups potentially confounding the results. Although these factors were adjusted for in the multivariate analysis, a prospective randomized controlled trial is warranted to confirm our findings

GLADNET: Promise and Legacy

[Excerpt] The Global Applied Disability Research and Information Network on Employment and Training (GLADNET) was launched by the International Labour Organization (ILO) in 1995, in cooperation with over 50 social policy research centres, governmental and non- governmental organizations involved in disability-related employment programmes from over thirty countries around the world. Major organizations of persons with disabilities were also represented – the World Blind Union, the World Federation of the Deaf, Inclusion International (formerly the International League of Societies for Persons with Mental Handicap (ILSMH)) and Disabled Peoples International (DPI). GLADNET’s lifespan was little more than a generation (1995 – 2018). What’s of interest is that it survived beyond its first few years of existence. It could easily have died early on, given a significant change in nature of support from its initiating body. That it didn’t speaks to the aspirational nature and relevance of the vision prompting its formation. It’s in pursuit of that vision where GLADNET left its mark. This document focuses on its legacy, beginning with a brief review of context within which it was initiated

The Cost of Justice: Weighing the Costs of Fair and Effective Resolution to Legal Problems

There is a growing belief that our civil and family justice system2 is in crisis. Evidence is mounting that the public cannot afford to resolve their legal problems through the formal processes of our courts, and it is unclear whether they are accessing other civil justice system services to reach resolution or whether their legal problems remain unresolved. This is a vital concern not only for the individuals who are unable to pursue their claims, but also for the health, economic, and social well-being of all Canadians. There is increasing evidence that unresolved disputes have a significant negative impact on individuals, their families, businesses and society as a whole

Dispute Resolution, Access to Civil Justice and Legal Education

This article examines current dispute resolution teaching and research programs in the context of improving access to justice through recent civil justice reform initiatives. Animated by extensive domestic and international literature, online and survey-based research, the article explores the landscape of alternative dispute resolution education (primarily at law schools), comments on the need for continued thinking and reform and acts as a leading resource to assist in the ongoing, collaborative development of dispute resolution initiatives in legal education in Canada and abroad

Dispute Resolution, Access to Civil Justice and Legal Education

This article examines current dispute resolution teaching and research programs in the context of improving access to justice through recent civil justice reform initiatives. Animated by extensive domestic and international literature, online and survey-based research, the article explores the landscape of alternative dispute resolution education (primarily at law schools), comments on the need for continued thinking and reform and acts as a leading resource to assist in the ongoing, collaborative development of dispute resolution initiatives in legal education in Canada and abroad

User involvement in healthcare technology development and assessment: Structured literature review

Purpose – Medical device users are one of the principal stakeholders of medical device technologies. User involvement in medical device technology development and assessment is central to meet their needs. Design/methodology/approach – A structured review of literature, published from 1980 to 2005 in peer-reviewed journals, was carried out from social science perspective to investigate the practice of user involvement in the development and assessment of medical device technologies. This was followed by qualitative thematic analysis. Findings – It is found that users of medical devices include clinicians, patients, carers and others. Different kinds of medical devices are developed and assessed by user involvement. The user involvement occurs at different stages of the medical device technology lifecycle and the degree of user involvement is in the order of design stage > testing and trials stage > deployment stage > concept stage. Methods most commonly used for capturing users’ perspectives are usability tests, interviews and questionnaire surveys. Research limitations/implications – We did not review the relevant literature published in engineering, medical and nursing fields, which might have been useful. Practical implications – Consideration of the users’ characteristics and the context of medical device use is critical for developing and assessing medical device technologies from users’ perspectives. Originality/value – This study shows that users of medical device technologies are not homogeneous but heterogeneous, in several aspects, and their needs, skills and working environments vary. This is important consideration for incorporating users’ perspectives in medical device technologies. Paper type: Literature review

Understanding the Roles of Physiotherapists Within Ontario Primary Health Care Teams: A Mixed Methods Inquiry

A mixed methods program of research was undertaken in order to better understand the roles of physiotherapists within Ontario primary health care (PHC) teams. A profile of Ontario PHC teams (Family Health Teams and Community Health Centres) was generated to determine the complement of providers and provision of health programming within each PHC team. This first study provided an important contextual backdrop as well as a means to purposefully sample participants for the two following studies. The second study used qualitative descriptive method to explore the perceptions of family physicians and nurse practitioners related to the inclusion of physiotherapists (PTs) within Ontario PHC teams. The final study used grounded theory method to generate an explanatory scheme to explicate how PTs currently working within Ontario PHC team enact practice. Overall, Family Health Teams (FHTs) and Community Health Centres (CHCs) were characterized by diverse teams and both models offered health programming. Physiotherapists were integrated into these teams to a limited degree however, particularly within FHTs. Perceptions of family physicians and nurse practitioners unanimously described the benefit of including PTs within PHC teams, particularly in the areas of musculoskeletal health and chronic disease management. Finally, PTs within PHC teams were found to enact five inter-related roles: manager, evaluator, collaborator, educator and advocate. The enactment of these roles were found to be impacted by three contexts: interprofessional team, community and population served, and organizational structure and funding. Overall, the findings support the inclusion of PTs within Ontario PHC teams. In addition to describing the areas of practice and specific roles relative to PTs contribution within Ontario PHC teams, this inquiry also explained how PTs enacted these roles. Further, this program of research articulated how the three above noted contexts impact how PTs practice in order to fulfill Ontario’s PHC mandate

An integrated knowledge translation experience: Use of the Network of Pediatric Audiologists of Canada to facilitate the development of The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP v1.0).

The goals of this project were: (1) to determine the important factors that influence implementation of evidence-based practice by Canadian audiologists; and (2) to utilize the knowledge-to-action process (Graham et al., 2006) during the development of a guideline for outcome measures to evaluate the auditory development and performance of young children who wear hearing aids, to facilitate clinical uptake and identify barriers to implementation (Bagatto, Moodie & Scollie, 2010; Bagatto et al., 2011; Bagatto, Moodie, Seewald, Bartlett, & Scollie, 2011; Moodie, Bagatto et al., 2011; Moodie, Kothari et al., 2011). Two projects (Chapters 3 and 4) included the participation of The Network of Pediatric Audiologists of Canada. The outcome measures guideline to evaluate the auditory development and performance of young children who wear hearing aids is called The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP). This body of work includes a chapter on knowledge translation and how it can be used to promote the clinical implementation of evidence in audiology (Chapter 3). It also includes three studies: (1) an examination of factors influencing the use of evidence by Canadian audiologists [Chapter 2]; (2) an initial evaluation by the Network of Pediatric Audiologists of Canada of the individual components considered for inclusion in the UWO PedAMP [Chapter 4]; and (3) a final evaluation by the Network audiologists of the released version of the UWO PedAMP and associated training materials [Chapter 5]. Results of the first study indicated that Canadian audiologists rate themselves as competent in finding, evaluating and using research evidence to change practice. Their greatest barriers to evidence-based practice are related to time. By partnering with Canadian audiologists and using the knowledge-to-action framework to guide us (Chapter 4), we were successful in developing the UWO PedAMP guideline into what they rated as being a high-quality, systematic, hearing aid outcome evaluation tool that improves the quality and effectiveness of audiological care received by young children with hearing loss. The results presented in Chapter 5 indicated that the UWO PedAMP is appropriate for clinical implementation, and is recommended by these Canadian audiologists as preferred audiology practice