Effect of a multimethod quality improvement intervention on antipsychotic medication use among residents of long-term care.

Background: Antipsychotic medications are used to address neuropsychiatric symptoms associated with dementia. Evidence suggests that among older adults with dementia, their harms outweigh their benefits. A quality improvement initiative was conducted to address inappropriate antipsychotic medication use in long-term care (LTC) in the province of Alberta.

Achieving optimal technology use: A proposed model for health technology reassessment.

Background: Healthcare providers, managers and policy-makers in many jurisdictions are focused on a common goal: optimizing value and quality of care provided to their citizens within a resource envelope. Health technology reassessment is a structured, evidence-based assessment of the clinical, social, ethical and economic effects of a technology currently used in the healthcare system to inform optimal use of that technology in comparison with its alternatives. There are, however, few practical experiences with health technology reassessment and, as such, a nascent theoretical and methodological base.

La bioéthique, la réévaluation des technologies de la santé et la gestion.

La réévaluation des technologies de la santé (RTS), ce domaine émergent des services de santé et des recherches stratégiques, favorise la prise en charge optimale des technologies pendant toute leur vie utile. La RTS, qui est une évaluation structurée et fondée sur des données probantes des effets cliniques, économiques, sociaux et éthiques des technologies en place, permet de faire une utilisation optimale de ces technologies, d'en prévoir le retrait progressif et de mieux rentabiliser celles qui sont utilisées dans le milieu de la santé. Elle soulève des préoccupations éthiques chez les cliniciens qui prodiguent des soins directs aux patients, particulièrement lorsqu'elle vise un retrait progressif.

Bioethics, health technology reassessment, and management.

Health Technology Reassessment (HTR) is an emerging area of health services and policy research that supports optimal management of technologies throughout their lifecycle. As a structured, evidence-based assessment of the clinical, economic, social, and ethical impacts of existing technologies, HTR is a means of achieving optimal use, managed exit, and better value for money from technologies used in healthcare. This has been documented as raising ethical concerns among clinicians who are providing direct patient care, particularly when managed exit may be the goal.

Characteristics of frequent users of the emergency department in the general adult population: A systematic review of international healthcare systems.

Objectives: The objectives of this study were to synthesize and compare population characteristics associated with frequent emergency department (ED) use within and across healthcare systems.

Methods: A systematic review of literature published between 1950 and 2015 was conducted. Healthcare systems of included studies were categorized using the Rothgang-Wendt typology.

Reducing frequent visits to the emergency department: a systematic review of interventions.

Objective: The objective of this study was to establish the effectiveness of interventions to reduce frequent emergency department (ED) use among a general adult high ED-use population.

Methods: Systematic review of the literature from 1950-January 2015. Studies were included if they: had a control group (controlled trials or comparative cohort studies), were set in an ED or acute care facility, and examined the impact of an intervention to reduce frequent ED use in a general adult population.

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Adult and Youth Populations: A Systematic Literature Review and Meta-Analysis.

Background: Between 30% and 60% of individuals with major depressive disorder will have treatment-resistant depression (TRD): depression that does not subside with pharmaceutical treatment. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for TRD.

Objective: To establish the efficacy and optimal protocol for rTMS among adults and youth with TRD.

Effective use of the built environment to manage behavioural and psychological symptoms of dementia: a systematic review.

Objective: To determine the effectiveness of built environment interventions in managing behavioural and psychological symptoms of dementia (BPSD) among residents in long-term care settings.

Methods: Systematic review of literature published from 1995-2013. Studies were included if they: were randomized controlled trials, quasi-experimental trials, or comparative cohort studies; were in long-term or specialized dementia care; included residents with dementia and BPSD; and examined effectiveness of a built environment intervention on frequency and/or severity of BPSD.

Radiofrequency ablation for chronic low back pain: a systematic review of randomized controlled trials.

Background: Radiofrequency ablation (RFA), a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established.

Objective: To determine the efficacy of RFA for chronic low back pain associated with lumbar facet joints, sacroiliac joints, discogenic low back pain and the coccyx.

Demonstrating efficacy in preclinical studies of cellular therapies for spinal cord injury - how much is enough?

Cellular therapies represent a novel treatment approach for spinal cord injury (SCI), with many different cellular substrates showing promise in preclinical animal models of SCI. Considerable interest therefore exists to translate such cellular interventions into human clinical trials. Balanced against the urgency for clinical translation is the desire to establish the robustness of a cellular therapy's efficacy in preclinical studies, thereby optimizing its chances of succeeding in human trials.

Endogenous TrkB ligands suppress functional mechanosensory plasticity in the deafferented spinal cord.

Dorsal root injury (DRI) disrupts the flow of sensory information to the spinal cord. Although primary afferents do not regenerate to their original targets, spontaneous recovery can, by unknown mechanisms, occur after DRI. Here, we show that brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3), but not nerve growth factor or neurotrophin-4, are upregulated in the spinal gray matter after DRI.

Targeting myelin to optimize plasticity of spared spinal axons.

Functional re-innervation of target neurons following neurological damage such as spinal cord injury is an essential requirement of potential therapies. There are at least two avenues by which this can be achieved: (a) through the regeneration of injured axons and (b) through promoting plasticity of those spared by the initial insult. There are several reasons why the latter approach may be more feasible, not the least of which are the inhibitory character of the glial scar, the often long distances over which injured axons must regrow, and the fact that spared axons are often already in the vicinity of denervated targets.