The research on endothelial function in women and men at risk for cardiovascular disease (REWARD) study: methodology

Background Endothelial function has been shown to be a highly sensitive marker for the overall cardiovascular risk of an individual. Furthermore, there is evidence of important sex differences in endothelial function that may underlie the differential presentation of cardiovascular disease (CVD) in women relative to men. As such, measuring endothelial function may have sex-specific prognostic value for the prediction of CVD events, thus improving risk stratification for the overall prediction of CVD in both men and women. The primary objective of this study is to assess the clinical utility of the forearm hyperaemic reactivity (FHR) test (a proxy measure of endothelial function) for the prediction of CVD events in men vs. women using a novel, noninvasive nuclear medicine -based approach. It is hypothesised that: 1) endothelial dysfunction will be a significant predictor of 5-year CVD events independent of baseline stress test results, clinical, demographic, and psychological variables in both men and women; and 2) endothelial dysfunction will be a better predictor of 5-year CVD events in women compared to men. Methods/Design A total of 1972 patients (812 men and 1160 women) undergoing a dipyridamole stress testing were recruited. Medical history, CVD risk factors, health behaviours, psychological status, and gender identity were assessed via structured interview or self-report questionnaires at baseline. In addition, FHR was assessed, as well as levels of sex hormones via blood draw. Patients will be followed for 5 years to assess major CVD events (cardiac mortality, non-fatal MI, revascularization procedures, and cerebrovascular events). Discussion This is the first study to determine the extent and nature of any sex differences in the ability of endothelial function to predict CVD events. We believe the results of this study will provide data that will better inform the choice of diagnostic tests in men and women and bring the quality of risk stratification in women on par with that of men

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

La prise en charge du patient présentant une fibrillation auriculaire symptomatique à l’urgence

Selon l’étude de cohorte Framingham, l’incidence et la prévalence de la fibrillation auriculaire (FA) ont augmenté significativement au cours des dernières années. Avec la population vieillissante, il est primordial de s’intéresser à cette arythmie qui touche 10 à 15 % des personnes âgées de 80 ans et plus. Cette arythmie est par le fait même la plus fréquemment rencontrée dans les départements d’urgence et est responsable du tiers des admissions pour arythmie. En réponse aux études cliniques récentes, la Société canadienne de cardiologie (SCC) a mis à jour les lignes directrices quant à la prise en charge de la FA en 2018 et en 2020. Au moyen d’un cas clinique évolutif, cet article mettra en lumière l’évaluation clinique et la prise en charge de la FA symptomatique à l’urgence. De l’évaluation infirmière initiale au triage jusqu’à la prise en charge de la FA symptomatique, cet article vise à outiller les infirmiers et infirmières dans l’identification et la prise en charge de la clientèle affectée par cette arythmie en contexte d’urgence.Objectifs d’apprentissag

The research on endothelial function in women and men at risk for cardiovascular disease (REWARD) study: methodology

Abstract Background Endothelial function has been shown to be a highly sensitive marker for the overall cardiovascular risk of an individual. Furthermore, there is evidence of important sex differences in endothelial function that may underlie the differential presentation of cardiovascular disease (CVD) in women relative to men. As such, measuring endothelial function may have sex-specific prognostic value for the prediction of CVD events, thus improving risk stratification for the overall prediction of CVD in both men and women. The primary objective of this study is to assess the clinical utility of the forearm hyperaemic reactivity (FHR) test (a proxy measure of endothelial function) for the prediction of CVD events in men vs. women using a novel, noninvasive nuclear medicine -based approach. It is hypothesised that: 1) endothelial dysfunction will be a significant predictor of 5-year CVD events independent of baseline stress test results, clinical, demographic, and psychological variables in both men and women; and 2) endothelial dysfunction will be a better predictor of 5-year CVD events in women compared to men. Methods/Design A total of 1972 patients (812 men and 1160 women) undergoing a dipyridamole stress testing were recruited. Medical history, CVD risk factors, health behaviours, psychological status, and gender identity were assessed via structured interview or self-report questionnaires at baseline. In addition, FHR was assessed, as well as levels of sex hormones via blood draw. Patients will be followed for 5 years to assess major CVD events (cardiac mortality, non-fatal MI, revascularization procedures, and cerebrovascular events). Discussion This is the first study to determine the extent and nature of any sex differences in the ability of endothelial function to predict CVD events. We believe the results of this study will provide data that will better inform the choice of diagnostic tests in men and women and bring the quality of risk stratification in women on par with that of men.</p

Key Healthcare Providers’ Perspectives on the Implementation of Senior-Friendly Emergency Department Care in Quebec

Background: Senior-friendly emergency department (ED) care is emerging to address large numbers of older adults in healthcare and implementation is variable. Objectives: We aimed to explore key healthcare providers’ perspectives on factors affecting implementation of senior-friendly ED care during the first five years of the Senior-Friendly Hospital Initiative in the Province of Quebec, Canada. Methods: We conducted a descriptive qualitative study of four urban EDs. Key healthcare providers involved in care within the ED or after discharge to the community were purposefully selected. Semi-structured telephone interviews were conducted in participants’ preferred language, English or French. Recorded interviews were transcribed. A deductive-inductive thematic analysis was performed focusing on factors affecting implementation at the three following levels: provider-level (ED frontline staff, multidisciplinary, geriatric, and community providers), organizational-level (ED and hospital), and structural-level (health system and policies). Results: In total, 33 providers participated. The sample included 13 ED frontline nurses and physicians, 13 multidisciplinary and geriatric ED care providers, and 7 community partners from the local government health centres working closely with these EDs. Analysis of participants’ perceptions revealed one theme representing implementation at the provider level (attitude to senior-friendly care), six themes representing the organizational level (managerial support, staff training, protocols for care and tools, space and equipment, multidisciplinary support, hospital services support), and three themes representing the structural level (health information system, healthcare network, and staff and budget). Conclusion: Healthcare providers identified themes that can inform the development, effectiveness, and sustainability of other senior-friendly ED programs. Overall, successful implementation of senior-friendly ED care primarily depends on providers’ attitudes, but it requires a multidimensional approach and continuous support from organizations and healthcare systems