Implementation of an Outpatient, Pharmacist-Directed Clinic for Chronic Obstructive Pulmonary Disease

Objective: To describe development and challenges of implementing a pharmacist-led chronic obstructive pulmonary disease (COPD) clinic in the primary care setting. Methods: Starting in October 2014, patients scoring 10-30 on the COPD Assessment Test (CAT) were assigned to the intervention or control group. Intervention patients met with a pharmacist, who provided medication and lifestyle counseling and therapy recommendations to the patients’ primary provider per protocol. Control patients were encouraged to make an appointment with their primary provider for standard care. Two months following the initial CAT administration, the survey was administered again to both study groups by phone. The primary outcome was a comparison of change in CAT scores from baseline between the groups. Secondary outcomes included an analysis of medications, smoking status, vaccination status, hospital stays, visit attendance, and self-evaluation of disease progression. Results: Of the 163 patients contacted, 29 were enrolled. Ninety-one percent of the patients screened with the CAT were eligible based on the CAT requirement with an average baseline CAT score of 18.75. The primary outcome, change in follow up CAT scores, were similar for intervention patients (n=18) versus control patients (n=11), +0.8 versus +0.7 respectively. Four of the intervention patients attended their clinic visit resulting in a 22% show rate. Conclusion: Although our study was underpowered to detect between group differences, the elevated baseline CAT scores support the need for therapy optimization in patients with COPD. Pharmacists are well qualified to meet this need by providing medication counseling, smoking cessation, and therapy management. Additional randomized controlled studies are needed to support improved outcomes for patients with COPD when pharmacists are part of the clinical patient care team

IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study

BACKGROUND: Factors of IT adoption have largely been discussed in the literature. However, existing frameworks (such as TAM or TTF) are failing to include one important aspect, the interaction between user and task. METHOD: Based on a literature study and a case study, we developed the FITT framework to help analyse the socio-organisational-technical factors that influence IT adoption in a health care setting. RESULTS: Our FITT framework ("Fit between Individuals, Task and Technology") is based on the idea that IT adoption in a clinical environment depends on the fit between the attributes of the individual users (e.g. computer anxiety, motivation), attributes of the technology (e.g. usability, functionality, performance), and attributes of the clinical tasks and processes (e.g. organisation, task complexity). We used this framework in the retrospective analysis of a three-year case study, describing the adoption of a nursing documentation system in various departments in a German University Hospital. We will show how the FITT framework helped analyzing the process of IT adoption during an IT implementation: we were able to describe every found IT adoption problem with regard to the three fit dimensions, and any intervention on the fit can be described with regard to the three objects of the FITT framework (individual, task, technology). We also derive facilitators and barriers to IT adoption of clinical information systems. CONCLUSION: This work should support a better understanding of the reasons for IT adoption failures and therefore enable better prepared and more successful IT introduction projects. We will discuss, however, that from a more epistemological point of view, it may be difficult or even impossible to analyse the complex and interacting factors that predict success or failure of IT projects in a socio-technical environment

Manganese Superoxide Dismutase: Guardian of the Powerhouse

The mitochondrion is vital for many metabolic pathways in the cell, contributing all or important constituent enzymes for diverse functions such as β-oxidation of fatty acids, the urea cycle, the citric acid cycle, and ATP synthesis. The mitochondrion is also a major site of reactive oxygen species (ROS) production in the cell. Aberrant production of mitochondrial ROS can have dramatic effects on cellular function, in part, due to oxidative modification of key metabolic proteins localized in the mitochondrion. The cell is equipped with myriad antioxidant enzyme systems to combat deleterious ROS production in mitochondria, with the mitochondrial antioxidant enzyme manganese superoxide dismutase (MnSOD) acting as the chief ROS scavenging enzyme in the cell. Factors that affect the expression and/or the activity of MnSOD, resulting in diminished antioxidant capacity of the cell, can have extraordinary consequences on the overall health of the cell by altering mitochondrial metabolic function, leading to the development and progression of numerous diseases. A better understanding of the mechanisms by which MnSOD protects cells from the harmful effects of overproduction of ROS, in particular, the effects of ROS on mitochondrial metabolic enzymes, may contribute to the development of novel treatments for various diseases in which ROS are an important component

Identification and Validation of Novel Cerebrospinal Fluid Biomarkers for Staging Early Alzheimer's Disease

Ideally, disease modifying therapies for Alzheimer disease (AD) will be applied during the 'preclinical' stage (pathology present with cognition intact) before severe neuronal damage occurs, or upon recognizing very mild cognitive impairment. Developing and judiciously administering such therapies will require biomarker panels to identify early AD pathology, classify disease stage, monitor pathological progression, and predict cognitive decline. To discover such biomarkers, we measured AD-associated changes in the cerebrospinal fluid (CSF) proteome.CSF samples from individuals with mild AD (Clinical Dementia Rating [CDR] 1) (n = 24) and cognitively normal controls (CDR 0) (n = 24) were subjected to two-dimensional difference-in-gel electrophoresis. Within 119 differentially-abundant gel features, mass spectrometry (LC-MS/MS) identified 47 proteins. For validation, eleven proteins were re-evaluated by enzyme-linked immunosorbent assays (ELISA). Six of these assays (NrCAM, YKL-40, chromogranin A, carnosinase I, transthyretin, cystatin C) distinguished CDR 1 and CDR 0 groups and were subsequently applied (with tau, p-tau181 and Aβ42 ELISAs) to a larger independent cohort (n = 292) that included individuals with very mild dementia (CDR 0.5). Receiver-operating characteristic curve analyses using stepwise logistic regression yielded optimal biomarker combinations to distinguish CDR 0 from CDR>0 (tau, YKL-40, NrCAM) and CDR 1 from CDR<1 (tau, chromogranin A, carnosinase I) with areas under the curve of 0.90 (0.85-0.94 95% confidence interval [CI]) and 0.88 (0.81-0.94 CI), respectively.Four novel CSF biomarkers for AD (NrCAM, YKL-40, chromogranin A, carnosinase I) can improve the diagnostic accuracy of Aβ42 and tau. Together, these six markers describe six clinicopathological stages from cognitive normalcy to mild dementia, including stages defined by increased risk of cognitive decline. Such a panel might improve clinical trial efficiency by guiding subject enrollment and monitoring disease progression. Further studies will be required to validate this panel and evaluate its potential for distinguishing AD from other dementing conditions

The Centre of Excellence in Cancer Prevention Archive of Website Blog Posts (October 2013 to October 2018)

The Centre of Excellence in Cancer Prevention Blog was a web-based resource that was published online for five years (October 2013 through October 2018). The blog provided a regular source of accessible, evidence-based and current information on cancer prevention topics written by experts in the field. It was developed to be a useful and interesting resource for researchers, students, community organizations, policymakers, and members of the public interested in learning more about cancer prevention. Authors of blog posts include faculty from the University of British Columbia, Vancouver and Okanagan campuses, and the University of Victoria, students and staff at the Centre of Excellence in Cancer Prevention, BC Cancer, and community organizations (Canadian Cancer Society British Columbia Yukon, Canadian Cancer Society National, the BC Healthy Living Alliance, and the Canadian Men’s Health Foundation). Collectively, the blog topics comprise a tour de force of the field of cancer prevention, with special focus on activities carried out by the Centre of Excellence in Cancer Prevention and in Canada more widely during this time period. Blogs include attention to a wide array of cancer risk factors (energy balance, shiftwork, tobacco, sun exposure, nutrition, radioactivity, infections, alcohol, obesity, physical activity, and environmental exposures including climate change). A number of defined population groups with special concerns are highlighted, including Aboriginal Canadians, South Asian immigrants, gay men, men in general, Filipinos, and international variation. Issues that affect the population as a whole are also addressed, including economics, taxation, complementary and alternative medicine, and socioeconomic status. Specific intervention programs at the Centre of Excellence in Cancer Prevention are highlighted (e.g., the Breast Cancer Prevention and Risk Assessment Clinic, Cooking Class for Prostate Cancer Patients and Partners, Cancer Prevention 101, and the shiftworkers project), as well as other programs in BC and Canada (e.g., Food Explorers, It’s My Life). Please note that this is an archive and hyperlinks are no longer active.Health and Social Development, Faculty of (Okanagan)Medicine, Faculty ofNon UBCExperimental Medicine, Division ofNursing, School of (Okanagan)Physical Therapy, Department ofPopulation and Public Health (SPPH), School ofUnreviewedFacultyResearcherGraduateOthe