Aujourd’hui, on estime mondialement que près de 50 millions d’individus sont atteints de la maladie d’Alzheimer. Ce nombre doublera presque chaque 20 ans pour atteindre un nombre de près 75 millions ...de personnes en 2030 et 131,5 millions en 2050. De plus, la maladie d’Alzheimer a des conséquences sur toutes les dimensions de la personne humaine. La présente étude, qui découle d’une recherche de type « analyse documentaire », discute de ces conséquences sur quatre dimensions intrinsèques de la santé jugées les plus importantes, à savoir a) la dimension sociale, b) mentale, c) physique et et d) émotionnelle. L’état actuel de l’impact de la maladie d’Alzheimer sur ces dimensions, de même que les perspectives de stratégies d'intervention auprès des individus atteints de cette maladie, sont aussi abordés.
Heart failure continues to be one of the leading causes of morbidity and mortality worldwide. Myocardial infarction is the primary causative agent of chronic heart failure resulting in cardiomyocyte ...necrosis and the subsequent formation of fibrotic scar tissue. Current pharmacological and non-pharmacological therapies focus on managing symptoms of heart failure yet remain unable to reverse the underlying pathology. Heart transplantation usually cannot be relied on, as there is a major discrepancy between the availability of donors and recipients. As a result, heart failure carries a poor prognosis and high mortality rate. As the heart lacks significant endogenous regeneration potential, novel therapeutic approaches have incorporated the use of stem cells as a vehicle to treat heart failure as they possess the ability to self-renew and differentiate into multiple cell lineages and tissues. This review will discuss past, present, and future clinical trials, factors that influence stem cell therapy outcomes as well as ethical and safety considerations. Preclinical and clinical studies have shown a wide spectrum of outcomes when applying stem cells to improve cardiac function. This may reflect the infancy of clinical trials and the limited knowledge on the optimal cell type, dosing, route of administration, patient parameters and other important variables that contribute to successful stem cell therapy. Nonetheless, the field of stem cell therapeutics continues to advance at an unprecedented pace. We remain cautiously optimistic that stem cells will play a role in heart failure management in years to come.
Despite advancements in critical care and coronary revascularization, cardiogenic shock (CS) outcomes remain poor. Implementing a shock team and use of veno-arterial extracorporeal membrane ...oxygenation (VA-ECMO) have been associated with improved CS outcomes, but its feasibility in remote and rural areas remains unknown.
This retrospective study included patients with CS who required mechanical circulatory support (MCS) at Health Sciences North, Sudbury, Ontario. The analysis aimed to accomplish 2 objectives: first, to review the outcomes associated with use of Impella (Abiomed, Danvers, MA) and, second, to assess the feasibility of establishing a shock team to facilitate the local implementation of VA-ECMO. The primary endpoint was in-hospital mortality.
The outcomes of 15 patients with CS who received Impella between 2015 and 2021 were reviewed. Their average age was 65 years (standard deviation SD: 13), and 8 patients (53%) were female. CS was ischemic in 12 patients (80%). Transfemoral Impella CP (cardiac power) was the most frequently used (93%). Thirteen patients (87%) died during the index hospital stay post-Impella because of progressive circulatory failure. The shock team was established following consultations with several Canadian MCS centres, leading to the development of a protocol to guide use of MCS. There have been 4 cases in which percutaneous VA-ECMO using Cardiohelp (Getinge/Maquet, Wayne, NJ) has been used; 3 (75%) survived beyond the index hospitalization.
This analysis demonstrated the feasibility of implementing a shock team in remote Northern Ontario, enabling the use of VA-ECMO with success in a centre with a sizeable rural catchment area. This initiative helps address the gap in cardiac care outcomes between rural and urban areas in Ontario.
Early hospital ( < 48 hours) discharge following transcatheter aortic valve implantation (TAVI) is an increasingly adopted practice; however, data on the safety of such an approach among patients ...residing in North Ontario, including remote and medically underserved areas, are lacking.
This retrospective study included patients who underwent TAVI in Sudbury, Ontario. The safety of early discharge after implementation of the Vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway was assessed. The primary endpoint was 30-day mortality. Resource utilization before vs after 3M clinical pathway implementation was also compared.
A total of 291 patients who underwent TAVI between 2012 and 2021 were included in the study. One in-hospital death (0.6%) occurred after the 3M clinical pathway implementation, with no mortality observed beyond hospital discharge. Eleven patients (6.7%) required rehospitalization within 30 days. The need for mechanical ventilation and surgical vascular cut-down declined from 100% and 97%, respectively, at baseline, to 6% and 2%. The number of patients receiving TAVI on a given procedural day increased from 2 to 3 patients. The median post-TAVI hospital length of stay decreased from 5 days (2-6 days) to 1 day (1-3 days) after 3M clinical pathway implementation.
Following TAVI, early discharge of selected patients residing in Northern Ontario, including rural areas, using the Vancouver 3M clinical pathway was associated with favourable outcomes, short length of stay, and more-efficient resource utilization. These data can help improve healthcare efficiency and bridge variations in TAVI funding and accessibility in underserved locations.
Il est de plus en plus admis d’accorder un congé rapide de l’hôpital (< 48 heures) après une implantation valvulaire aortique par cathéter (IVAC); toutefois, on ne dispose pas de données sur l’innocuité de cette pratique pour les patients du nord de l’Ontario, y compris ceux qui résident en régions éloignées moins bien desservies par les services médicaux.
Cette étude rétrospective a porté sur des patients ayant subi une IVAC à Sudbury (Ontario). L’innocuité d’un congé rapide après l’implantation selon le parcours de soins Vancouver 3M (multidisciplinaire, multimodal, mais minimaliste) a été évaluée. Le principal paramètre d’évaluation était la mortalité à 30 jours. Une comparaison de l’utilisation des ressources avant et après la mise en œuvre du parcours de soins 3M a également été effectuée.
Au total, 291 patients ayant subi une IVAC entre 2012 et 2021 ont été inclus dans l’étude. Un décès à l’hôpital (0,6 %) est survenu après la mise en œuvre du parcours de soins 3M, et aucune mortalité n’a été relevée après le congé de l’hôpital. Onze patients (6,7 %) ont dû être réhospitalisés dans les 30 jours suivants. Le recours à la ventilation mécanique et à la dénudation vasculaire a chuté, passant de 100 % et 97 % au départ, respectivement, à 6 % et 2 %. Le nombre de patients par jour d’intervention subissant une IVAC est passé de deux à trois patients. À la suite de la mise en œuvre du parcours de soins 3M, la durée médiane du séjour à l’hôpital après une IVAC est passée de cinq jours (deux à six jours) à un jour (un à trois jours).
Après une IVAC, le congé rapide de patients sélectionnés habitant dans le nord de l’Ontario, y compris ceux habitant en région rurale, selon le parcours de soins Vancouver 3M a été associé à des résultats de santé favorables, à une durée courte d’hospitalisation et à une utilisation plus efficace des ressources. Ces données peuvent contribuer à améliorer l’efficacité des soins de santé et à combler des écarts liés aux variations du financement et de l’accessibilité des IVAC dans les régions moins bien desservies.
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Background: With the COVID-19 pandemic declared in March 2020 by the World Health Organization (WHO), many undergraduate education programs were disrupted, and some quickly transitioned to online ...learning. Medical students were left without crucial clinical experiences. A learner-driven telemedicine curriculum was implemented to provide learners with clinical experiences, knowledge, and skills in teleurology via the Ontario Telemedicine Network (OTN) between February and May 2021. Methods: Six volunteer Northern Ontario School of Medicine (NOSM) learners enrolled for 12 weeks. A needs assessment was completed. Learning contracts were used in the design and evaluation. Five modules were developed. Informed consent for students to participate in confidential care was received from patients. Expected activities included 2 patient encounters per month, a summary of experiences, and a "learner-faculty feedback loop." Small-group discussions were held. OTN was the platform of care for videoconferencing. Curriculum feedback and faculty and learner evaluations were completed via online surveys. Results: Of 6 enrollees, 5 completed the curriculum. Patient encounters varied from consultation, postoperative care, counselling, and education. Students gained a better understanding of how telemedicine may be utilized. All participants set learning goals, reflected on these, had successful patient encounters, and learned about office tele-urology. The participant satisfaction rate was 100%. One learner withdrew owing to excess workload. Limitations included small numbers, a solo urologist, time factor, use of only the OTN hub, and lack of formal structure. Conclusion: A learner-driven telemedicine curriculum provided medical students an opportunity to learn about telemedicine with a focus on office tele-urology. Learners gained useful telemedicine competencies. A telemedicine curriculum for undergraduate medical students is recommended.
Despite advancements in critical care and coronary revascularization, cardiogenic shock (CS) outcomes remain poor. Implementing a shock team and VA-ECMO utilization have been associated with improved ...CS outcomes, but their feasibility in remote and rural areas remains unknown.
This retrospective study included patients with CS who required mechanical circulatory support (MCS) at Health Sciences North, Sudbury, Ontario. The analysis aimed to accomplish two objectives: firstly, to review the outcomes associated with Impella® usage, and secondly, to assess the feasibility of establishing a shock team to facilitate the local implementation of VA-ECMO. The primary endpoint was in-hospital mortality.
The outcomes of 15 CS patients who received Impella® between 2015-2021 were reviewed. Their average age was 65 years (SD,13), and 8 patients (53%) were female. CS was ischemic in 12 patients (80%). Transfemoral Impella® CP (cardiac power) was the most frequently used (93%). Thirteen patients (87%) died during the index hospital stay post-Impella® due to progressive circulatory failure. The shock team was established following consultations with several Canadian MCS centres, leading to the development of a protocol to guide MCS utilization. There have been four cases where percutaneous VA-ECMO using Cardiohelpâ has been utilized; three (75%) survived beyond the index hospitalization.
This analysis demonstrated the feasibility of implementing a shock team in remote Northern-Ontario, enabling the use of VA-ECMO with success in a centre with a sizeable rural catchment area. This initiative helps address the gap in cardiac care outcomes between rural and urban areas in Ontario.
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