Deprescribing Antidepressants in Older People - Breaking Up Can Be Hard to Do.

Every drug review for older people should consider which medicines to continue, but equally important, which medicines can be discontinued. As we age, the balance between potential benefits and potential risks of medications often shifts towards more harm. For example, antidepressants are commonly prescribed in general, but in the older person, they carry specific potential harms.

Canadian practice guidelines for the treatment of children and adolescents with eating disorders.

Objectives: Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions.

Feasibility study of goal setting discussions between older adults and volunteers facilitated by an eHealth application: development of the Health TAPESTRY approach.

Background: In keeping with the changing needs of the Canadian population, primary care systems need to become more person-focused in providing quality care to older adults. As part of Health TAPESTRY, a complex intervention to strengthen primary care for older adults, a goal setting exercise was developed and tested in an initial feasibility study, intended to foster collaboration between patients and providers.

Methods: Participants-clinic clients-were recruited from the McMaster Family Health Team in Hamilton, Ontario.

Asthma.

Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions.

Genetic Myopathies Initially Diagnosed and Treated as Inflammatory Myopathy.

Objectives: Differentiating genetic myopathies from inflammatory myopathies can be challenging because of multiple overlapping clinical features. Examples are presented to highlight important clinical features that assist in the differentiation between the two.

Methods: Clinical features including age at onset, history, pattern of weakness, serum creatine kinase activity, electromyography findings, and muscle biopsies are reported in six patients initially thought to have an inflammatory myopathy in whom the final diagnosis was a genetic myopathy.

Routine Surveillance Versus Independent Assessment by an Outcome Adjudication Committee in Assessing Patients for Sternal Surgical Site Infections After Cardiac Surgery.

Based on a cohort of 966 patients, routine surveillance data were not sufficiently accurate for use in clinical trials investigating surgical site infections. Surveillance data can only be used if adequate 90-day follow-up is provided and if cases identified by surveillance are independently reviewed by a blinded outcome adjudication committee.

The impact of neighborhood composition on work-family conflict and distress.

Theories of work-family conflict (WFC) and health remain limited because they emphasize individual-level antecedents to the exclusion of broader contexts, such as residential neighborhoods. We address this issue by focusing on the impact of neighborhood social composition on WFC. Among couples with children we assess whether socially similar neighbors relative to oneself reduce perceptions and mental health consequences of WFC, and whether these associations differ by gender.

Exploring the school nutrition policy environment in Canada using the ANGELO framework.

Excess body weight has become a major public health issue. Given the link between poor nutrition, obesity, and chronic disease in youth, increasing attention is being paid to the school as an ideal setting for promoting nutritious eating practices. Informed by the ANGELO (Analysis Grid for Environments Linked to Obesity) framework, we employ a documentary analysis to investigate the context of school nutrition in Canada, particularly the relationship between regional- and upper-level policies.

Botulinum toxin type A in children and adolescents with severe cerebral palsy: a retrospective chart review.

This retrospective cohort study reviewed set goals and their outcomes of children and adolescents with severe cerebral palsy who received botulinum toxin A in 2008 and 2009. Sixty children (36 male, mean age 9 years) were included. They received on average 4 (range 1-7) treatments, with the dosage varying between 20 and 400 units per treatment (3-21 U/kg/body weight).

Are family physician visits and continuity of care associated with acute care use at end-of-life? A population-based cohort study of homecare cancer patients.

Background: Previous end-of-life cancer research has shown an association between increased family physician continuity of care and reduced use of acute care services; however, it did not focus on a homecare population or control for homecare nursing.

Aim: Among end-of-life homecare cancer patients, to investigate the association of family physician continuity with location of death and hospital and emergency department visits in the last 2 weeks of life while controlling for nursing hours.

Design: Retrospective population-based cohort study.

Cognitive function and self-care management in older patients with heart failure.

Aims: People with heart failure have difficulty with self-care management. We do not know if patients with heart failure have difficulty with self-care management due to underlying, mild cognitive impairment (MCI). The purpose of this study was to determine whether MCI, as identified on a simple screening tool, is significantly associated with self-care management in a sample of community dwelling older patients with heart failure.

Developing a theoretical framework for complex community-based interventions.

Applying existing theories to research, in the form of a theoretical framework, is necessary to advance knowledge from what is already known toward the next steps to be taken. This article proposes a guide on how to develop a theoretical framework for complex community-based interventions using the Cardiovascular Health Awareness Program as an example. Developing a theoretical framework starts with identifying the intervention's essential elements.