Theater of Witness: The Patient Experience of Dementia Shared through Testimonial Performance

Introduction: Dementia is a condition that modern medicine is ill-equipped to address, and to which art may have much to offer. This project combines reflective and creative processes in a theater collaboration between patients, caregivers, and healthcare students. The goal was to explore the ways in which theater can heal, and to better understand the patient experience of dementia. Methods: I worked with Teya Sepinuck on this project. We met with participants individually to conduct interviews about personal stories and held group workshops to explore our collective story. We worked with a percussionist and composer to explore accompanying music. We have been collaborating with participants to write scripts and develop choreography. We will perform the final piece in mid-September 2019. Results: This project has brought healing to its participants in different ways. As a group, we noticed unexpected connections between each other’s stories. Music became a powerful shared language, growing into a cornerstone of the project. Finally, every participant seemed to find catharsis in sharing their story, even if they were sharing of suffering, and vulnerability made way for love and healing. Discussion: Working on this piece has taught me lessons that I will carry on my path towards practicing medicine. Most notably, reflecting on my own story helped me notice connections between my life and the lives of other participants. This helped me empathize with people who were of different generations and cultures. I will remember the importance of knowing my own story and asking others about their stories

Non-tunneled versus tunneled dialysis catheters for acute kidney injury requiring renal replacement therapy: a prospective cohort study

Background: Acute kidney injury requiring renal replacement therapy (AKI-RRT) is associated with high morbidity, mortality and resource utilization. The type of vascular access placed for AKI-RRT is an important decision, for which there is a lack of evidence-based guidelines. Methods: We conducted a prospective cohort study over a 16-month period with 154 patients initiated on AKI-RRT via either a non-tunneled dialysis catheter (NTDC) or a tunneled dialysis catheter (TDC) at an academic hospital. We compared differences in renal replacement delivery and mechanical and infectious outcomes between NTDCs and TDCs. Results: Patients who received TDCs had significantly better RRT delivery, both with continuous venovenous hemofiltration (CVVH) and intermittent hemodialysis (IHD), compared to patients who received NTDCs; these findings were confirmed after multivariable adjustment for AKI-specific disease severity score, history of chronic kidney disease, renal consult team, and AKI cause. In CVVH and IHD, the median venous and arterial blood flow pressures were significantly higher with TDCs compared to NTDCs (p < 0.001). Additionally for CVVH, the median number of interruptions per catheter was higher with NTDCs compared to TDCs (Rate Ratio (RR) 2.7; p < 0.001), and for IHD, a higher median blood flow was seen with TDCs (p < 0.001). There were a significantly higher number of mechanical complications with NTDCs (RR 13.6 p = 0.001). No significant difference was observed between TDCs and NTDCs for positive blood cultures per catheter. Conclusions: Compared to NTDCs, TDCs for patients with AKI-RRT had improved RRT delivery and fewer mechanical complications. Initial TDC placement for AKI-RRT should be considered when not clinically contraindicated given the potential for improved RRT delivery and outcomes. Electronic supplementary material The online version of this article (10.1186/s12882-017-0760-x) contains supplementary material, which is available to authorized users

Additional file 1: Table S1. of Non-tunneled versus tunneled dialysis catheters for acute kidney injury requiring renal replacement therapy: a prospective cohort study

Characteristics of non-tunneled versus tunneled dialysis catheters used for AKI requiring renal replacement therapy. (DOCX 16 kb

Three-dimensional mapping of neurofibrillary tangle burden in the human medial temporal lobe

Tau protein neurofibrillary tangles are closely linked to neuronal/synaptic loss and cognitive decline in Alzheimer's disease and related dementias. Our knowledge of the pattern of neurofibrillary tangle progression in the human brain, critical to the development of imaging biomarkers and interpretation of in vivo imaging studies in Alzheimer's disease, is based on conventional two-dimensional histology studies that only sample the brain sparsely. To address this limitation, ex vivo MRI and dense serial histological imaging in 18 human medial temporal lobe specimens (age 75.3 ± 11.4 years, range 45 to 93) were used to construct three-dimensional quantitative maps of neurofibrillary tangle burden in the medial temporal lobe at individual and group levels. Group-level maps were obtained in the space of an in vivo brain template, and neurofibrillary tangles were measured in specific anatomical regions defined in this template. Three-dimensional maps of neurofibrillary tangle burden revealed significant variation along the anterior-posterior axis. While early neurofibrillary tangle pathology is thought to be confined to the transentorhinal region, we found similar levels of burden in this region and other medial temporal lobe subregions, including amygdala, temporopolar cortex, and subiculum/cornu ammonis 1 hippocampal subfields. Overall, the three-dimensional maps of neurofibrillary tangle burden presented here provide more complete information about the distribution of this neurodegenerative pathology in the region of the cortex where it first emerges in Alzheimer's disease, and may help inform the field about the patterns of pathology spread, as well as support development and validation of neuroimaging biomarkers