The Top Articles of Dov Gandell MDCM, FRCPC October 31, 2014.
|
|
- Scarlett Horn
- 6 years ago
- Views:
Transcription
1 The Top Articles of 2014 Dov Gandell MDCM, FRCPC October 31, 2014.
2 Disclosure Statements Faculty: Dov Gandell Relationships with commercial interests: No commercial or industry disclosures
3 Final assessment: trick or treat? Treat a positive result that is valid and may influence practice Trick a negative result that does not terminate that area of investigation Empty wrapper a positive result with validity or safety concerns
4 Methods: article selection Canvassed division members, University of Toronto Geriatric Medicine Dr. Shabbir M.H. Alibhai and Dr. Rajin Mehta Scanned table of contents and read major journals Scanned and read journal review publications Reviewed articles presented at the Geriatric Medicine Journal Club
5 Methods: article selection Influence or understanding of daily practice Quality of the evidence Randomized controlled trial (RCT) Range of geriatric medicine syndromes Cognition (mild cognitive impairment, dementia, delirium) Frailty/mobility Medication appropriateness Lifestyle interventions
6 N Engl J Med 2013;368:
7 Randomized, single-blind, controlled trial Intervention Mediterranean diet supplemented with 1L per week extra virgin olive oil Mediterranean diet with 30 grams of nuts (walnuts, almonds, and hazelnuts) Control diet, low fat No total calorie restriction advised nor was physical activity promoted Median follow-up 4.8 years N = 7447 High-risk adult, primary prevention Primary Outcome Composite of myocardial infarct, stroke, and death from cardiovascular causes N Engl J Med 2013;368:
8 Inclusion years old Type II diabetes mellitus or 3 major cardiovascular risk factors Smoking, hypertension, elevated LDL, low HDL, obesity, or a family history of premature CAD Average participant 67 years old Spanish female Hypertension Hyperlipidemic BMI > 25 50% were diabetic N Engl J Med 2013;368:
9 Results Crude rate per 1000 patient/years 8.1 ( ) med diet plus EVOO versus 11.2 ( ), p = ( ) med diet plus nuts versus 11.2 ( ), p = 0.02 Adverse events Not reported TREAT Strengths It is reasonable to recommend the Mediterranean diet for primary prevention of cardiovascular disease in high risk seniors Randomized trial design for dietary intervention with a large sample size Length of follow-up Weaknesses/Discussion Change in control intervention midway through the trial More attrition in the control group Statistically significant result but small effect size Generalizability to the North American population unknown N Engl J Med 2013;368:
10 JAMA 2014;311(23):
11 Single-blind, randomized controlled trial Intervention Physical activity intervention 150 min/wk strength, flexibility, and balance training versus Health education program weekly workshops x 26 weeks, monthly thereafter Mean follow-up 2.7 years N = 1635 Pre-frail older adults Primary Outcome Major mobility disability loss of the ability to walk 400m in 15 minutes (without sitting or the help of another person or a walker) JAMA 2014;311(23):
12 Inclusion Sedentary less than 20min/week of physical activity Frail Short Physical Performance Battery (SPPB) < 9 Able to walk 400 m in less than 15 minutes Average participant 79 years old Caucasian female BMI 30 SPPB score of 7.3 Walking speed of 0.83 m/s JAMA 2014;311(23):
13 Results 30.1% intervention versus 35.5% control, HR 0.82 ( ), p=0.03 Major mobility disability or death 32.3% intervention versus 37.8% control, HR 0.82 ( ), p=0.02 Adverse events No difference Strengths TREAT 150 minutes of exercise weekly helps prevent mobility disability in older adults Large sample or pre-frail older adults with more than 2 years of follow-up 400 metre walk test correlated to gait speed which is associated with mortality Weaknesses/Discussion Functional outcomes were not reported Highly motivated, self-selected sample Intensive intervention and difficult outcome measure for most settings JAMA 2014;311(23):
14 N Engl J Med 2014;370:311-21
15 EXPEDITION 1 and EXPEDITION 2 Double-blind, placebo-controlled, randomized trials (Phase 3) Intervention Solanezumab 400mg IV Q4weeks versus placebo 18 months N = 1012, 1040 Mild to moderate Alzheimer s disease Primary Outcomes Cognition: Alzheimer s Disease Assessment Scale (ADAS-Cog 11) Range 0 70 with higher scores indicating greater impairment Function: Alzheimer s Disease Cooperative Study/Activities of Daily Living Scale (ADCS-ADL) Range 0 78 with lower scores indicating greater impairment N Engl J Med 2014;370:311-21
16 Inclusion/exclusion > 55 years old Mild to moderate Alzheimer s disease - Folstein Mini Mental Status Exam (FMMSE) 16 26/30 Absence of depression Geriatric Depression Scale (GDS) 6 Otherwise healthy Average participant 74 years old Caucasian, female 12 years education Folstein mini mental status exam score 21/30 Taking a cholinesterase inhibitor alone or in combination with memantine N Engl J Med 2014;370:311-21
17 Results Cognition: ADAS Cog (95% CI ; p = 0.24) Function: ADCS ADL -0.4 (95% CI ; p = 0.64) Adverse effects no significant differences Silver lining Biomarker results positive Pre-specified secondary analysis in mild disease revealed benefit More to come TRICK Despite the negative result from this trial, passive immunotherapy for mild Alzheimer s disease remains under investigation Solanezumab in mild AD, phase 3 December 2016 Crenezumab, two phase 2 trials (ABBY/BLAZE) data in abstract form presented July 2014 Gantenerumab July 2018 N Engl J Med 2014;370:311-21
18 JAMA 2014;311(1):33-44
19 Double-blind, placebo controlled, randomized trial Intervention Alpha-tocopherol 2000 IU daily Memantine titrated to 10 mg twice a day Alpha tocopherol and memantine, above doses Mean follow-up 2 years N = 613 Mild to moderate Alzheimer s disease Primary Outcome Function: Alzheimer s Disease Cooperative Study/Activities of Daily Living (ADCS ADL) scale Range 0 78 with lower scores indicating greater impairment JAMA 2014;311(1):33-44
20 Inclusion/exclusion Veterans with mild to moderate Alzheimer FMMSE 12 26/30 Taking a cholinesterase inhibitor Average participant 79 years old Caucasian man More than high school education FMMSE score 21/30 Cholinesterase inhibitor JAMA 2014;311(1):33-44
21 Results 3.15 units ADCS ADL inventory less decline alpha tocopherol versus placebo (95 CI , p = 0.03) Adverse effects No significant differences Strengths Duration of follow-up Outcome measures Weaknesses/Discussion Empty wrapper Vitamin E, given the sum of evidence in AD and in light of potential adverse effects, should not be routinely prescribed for Alzheimer s disease patients Most positive AD intervention trials reveal cognitive benefit, not function Unclear why memantine and vitamin E arm did not reveal benefit Safety risk platelet inhibition, cardiac outcomes, cancer risk JAMA 2014;311(1):33-44
22 CMAJ DOI: cmaj/140495
23 Multicentre, double-blind randomized controlled trial Intervention Melatonin 3mg HS for 5 consecutive days, starting within 24 hours after admission versus placebo N = 452 Patients scheduled for acute hip surgery Primary Outcome Incident delirium within 8 days of admission Delirium determined by DSM IV criteria CMAJ DOI: cmaj/140495
24 Inclusion 65 years old Emergent hip fracture surgery Exclusion Delirium on admission Already taking melatonin Average participant 84 years old Dutch female Admitted from home CMAJ DOI: cmaj/140495
25 Results Incident delirium 29.6% melatonin versus 25.5% placebo (95% CI ) No difference mortality, cognitive, functional outcomes at 3 months Delirium duration shorter in melatonin group Adverse effects not reported Strengths TOOTHBRUSH A large RCT did not demonstrate any benefit of melatonin in preventing post-operative Large sample size for a delirium study Sample representative of typical delirium hip fracture patients Long term follow-up data Weakness Apparent randomization failure more patients with previous delirium in melatonin group CMAJ DOI: cmaj/140495
26 N Engl J Med 2014;370:
27 Multicenter, randomized controlled trial Intervention 30-day event-triggered recorder versus 24 hour holter monitor N = 572 Cryptogenic ischemic stroke or TIA Primary outcome 30 seconds of atrial fibrillation within 90 days of randomization N Engl J Med 2014;370:
28 Inclusion 55 years old Cryptogenic ischemic stroke or TIA diagnosed by a stroke neurologist Event within 6 months of enrollment Minimum investigations: 24 hour ambulatory holter, ECG, echocardiogram, brain and neurovascular imaging Average participant 73 years old Caucasian male Ischemic stroke CHADS 2 score 3 75 days from event N Engl J Med 2014;370:
29 Results 16.1% intervention group versus 3.2% control group (95 CI ), p< % intervention group versus 11.1% control group had anticoagulation prescribed (95 CI ), p =0.01 Strengths TREAT Patients with ischemic cryptogenic stroke or TIA should receive prolonged cardiac monitoring to diagnose atrial fribrillation Highly representative patient sample Weaknesses/Discussion Point estimate of detected atrial fibrillation likely an underestimate large strokes excluded Intracranial imaging and transesophageal ultrasound not done as part of work-up N Engl J Med 2014;370:
30 JAMA Intern Med. 2014;174(6):
31 Cluster randomized controlled trial Eliminating Medications Through Patient Ownership of End Results (EMPOWER) Intervention 8 page booklet based on self-efficacy theory Self assessment on the risks of benzodiazepine use, presentation of the evidence for benzodiazepine-induced harms, knowledge statements to create cognitive dissonance about safety of benzodiazepine use, education about drug interactions, peer champion stories, suggestions for therapeutic substitutes for insomnia or anxiety, and step-wise tapering recommendations (visual 21 week tapering protocol Usual care N = 30 community pharmacies, 303 patients randomized Primary Outcome Complete cessation of benzodiazepine use in the 6 months following randomization JAMA Intern Med. 2014;174(6):
32 Inclusion/Exclusion criteria 65 years old Minimum of 5 active prescriptions One prescription for a benzodiazepine (short, intermediate, long) Benzodiazepine dispensed for at least 3 consecutive months before screening Dementia, psychiatric illness excluded Average participant 75 years old Female Benzodiazepine prescribed for either insomnia or anxiety Benzodiazepine use for a mean of 10 years Average daily dose was 1.3 mg of lorazepam JAMA Intern Med. 2014;174(6):
33 Results Complete cessation of benzodiazepine 27% intervention versus 5% controls, prevalence difference 23% (14 32%) Odds Ratio 8.3 ( ) NNT for complete cessation or a dose reduction was 3.7 Adverse effects Rebound insomnia or anxiety occurred in 42% but no differences in major adverse effects Strengths Direct to patient education approach TREAT Direct to patient education helps reduce inappropriate benzodiazepine use Data from older adults in benzodiazepine cessation trial Weaknesses No true control general medication education not provided to usual care Patients may have obtained benzodiazepine prescriptions from other pharmacies Follow-up relatively short JAMA Intern Med. 2014;174(6):
34 BMJ 2013;346:f2570
35 Cluster randomized controlled trial Long term follow-up of the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) Intervention Depression care manager working with the primary care physician to provide algorithm based care versus usual care N = 20 primary care practices, 1226 patients Primary Outcome Mortality risk Median follow-up of 98 months ( months) BMJ 2013;346:f2570
36 Inclusion Age 60 English speaking Mini mental status exam score > 17 Depression diagnosed with DSM IV criteria Average participant 71 years old Single female 13 years education MMSE score 28/30 Hamilton Depression Rating Score (HDRS) 21 major depression 5 not depressed BMJ 2013;346:f2570
37 Results Patients with major depression Usual care practices Mortality risk HIGHER HR 1.90 (95 CI ) than those without depression Intervention practices Mortality risk SIMILAR HR 1.09 (95 CI ) than those without depression. Intervention versus usual care practices Mortality risk LOWER Strengths HR 0.76 (95 CI ; p=0.05) than those without depression Length of the follow-up period TREAT Hard outcome evidence to support the need for better mental health care for older adults Weaknesses Small sample size most RCTs that demonstrate mortality benefit are much larger Suboptimal control Confidence interval includes 1 needs replication BMJ 2013;346:f2570
38 J Am Geriatr Soc 62: , 2014
39 Meta-analysis To evaluate the safety and efficacy of novel oral anticoagulants (NOACs) in elderly patients, defined as age RCTs (dabigatran 2, rivaroxaban 5, apixiban 3) N = TREAT Risk of major or clinically relevant bleeding NOACs vs conventional therapy Precise risk of adverse events with NOACs likely to come with post-marketing surveillance 6.4% vs 6.3%; OR 1.02 (95 CI ) Risk of major or clinically relevant bleeding NOAC vs warfarin 6.5% vs 7.1%; OR 0.76 (95 CI ) Risk of stroke and systemic embolism NOAC vs warfarin 3.3% vs 4.7%; OR 0.65, 95 CI NNT 71 J Am Geriatr Soc 62: , 2014
40 Ahmed et al. J Am Geriatr Soc 62: ,2014 Kahan et al. CMAJ 2014.DOI: /cmaj
41 Medicinal marijuana in older adults April 1 st, Health Canada approves Dried cannabis for purchase from a licensed distributor Physican s prescription required daily dose and monthly quantity Dried cannabis use in older adults 6.5% 61 to 76 years old 31 country survey, including Canada 37% 61 to 93 years old among 5500 prescription cannabis users in the Netherlands Ahmed et al. J Am Geriatr Soc 62: ,2014 CMAJ DOI: /cmaj
42 Medicinal marijuana in older adults The evidence N = 12, mean age 72.7 Severe Alzheimer s disease Dronabinol 2.5mg/d Anorexia and behavioural disturbance improved N = 2, 75- and 81- year old men Alzheimer s disease Dronabinol 2.5mg/d Reduced night time agitation J Clin Psychopharm 31(2); , 2011 Int J Geriat Pxychiatry 12; , 1997
43 Medicinal marijuana in older adults Risks Perceptual, motor, cognitive, functional, lung toxicity, driving Standard analgesics and synthetic oral cannabinoids trial first Clear indications neuropathic pain spasticity from multiple sclerosis Ahmed et al. J Am Geriatr Soc 62: ,2014 CMAJ DOI: /cmaj
44 TRICK 2014 brought no evidence to support the use of marijuana in older adults but prescriptions can now be written and patients may request them
45 Thank you
46 Identify the correct statement A) a large RCT has established the benefit of melatonin to reduce incident delirium in hip fracture patients B) multiple large RCTs of passive immunotherapy for Alzheimer s dementia reveal positive intermediate outcomes C) vitamin E should be prescribed for Alzheimer s disease patients D) the MoCA, applied properly, has high discriminative power to identify who will transition from MCI to overt dementia
47 Identify the correct statement A) a large RCT has established the benefit of melatonin to reduce incident delirium in hip fracture patients B) multiple large RCTs of passive immunotherapy for Alzheimer s dementia reveal positive intermediate outcomes C) vitamin E should be prescribed for Alzheimer s disease patients D) the MoCA, applied properly, has high discriminative power to identify who will transition from MCI to overt dementia
48 Which statement is false? A) The Mediterranean diet has been shown to prevent secondary but not primary cardiovascular outcomes B) 2.5 hours of exercise per week can prevent major mobility disability in older adults C) The literature demonstrates patients can successfully discontinue benzodiazepines without a physician initiating or leading the change D) Treating major depression with algorithm based care can improve survival
49 Which statement is false? A) The Mediterranean diet has been shown to prevent secondary but not primary cardiovascular outcomes B) 2.5 hours of exercise per week can prevent major mobility disability in older adults C) The literature demonstrates patients can successfully discontinue benzodiazepines without a physician initiating or leading the change D) Treating major depression with algorithm based care can improve survival
50 To improve my practice, I will A) start writing prescriptions for medicinal marijuana for all my patients B) investigate cryptogenic ischemic stroke or TIA with prolonged cardiac rhythm monitoring C) prescribe novel oral anticoagulants regardless of creatinine clearance D) forget to share or discuss the tricks and treats with my colleagues
51 To improve my practice, I will A) start writing prescriptions for medicinal marijuana for all my patients B) investigate cryptogenic ischemic stroke or TIA with prolonged cardiac rhythm monitoring C) prescribe novel oral anticoagulants regardless of creatinine clearance D) forget to share or discuss the tricks and treats with my colleagues
52 Other articles of interest Demographic Characteristics and Healthcare Use of Centenarians: A Population- Based Cohort Study J Am Geriatr Soc 62:86-93,2014 A controlled evaluation of comprehensive geriatric assessment in the emergency department: the Emergency Frailty Unit Age and Ageing 2014;43: Montreal Cognitive Assessment Memory Index Score (MoCA MIS) as a Predictor of Conversion from Mild Cognitive Impairment to Alzheimer s Disease J Am Geriatr Soc 62: ,2014 The impact of first- and second-eye cataract surgery on injurious falls that require hospitalisation: a whole population study Age and Ageing 2014;43: Life-span cognitive activity, neuropathologic burden, and cognitive aging. Neurology 2013;81:
Geriatrics and Cancer Care
Geriatrics and Cancer Care Roger Wong, BMSc, MD, FRCPC, FACP Postgraduate Dean of Medical Education Clinical Professor, Division of Geriatric Medicine UBC Faculty of Medicine Disclosure No competing interests
More informationDr Julia Hopyan Stroke Neurologist Sunnybrook Health Sciences Centre
Dr Julia Hopyan Stroke Neurologist Sunnybrook Health Sciences Centre Objectives To learn what s new in stroke care 2010-11 1) Acute stroke management Carotid artery stenting versus surgery for symptomatic
More informationHIP ATTACK Trial: Can we improve outcomes after a hip fracture with accelerated surgery? PJ Devereaux, MD, PhD
HIP ATTACK Trial: Can we improve outcomes after a hip fracture with accelerated surgery? PJ Devereaux, MD, PhD Disclosure Member of research group with policy of not accepting honorariums or other payments
More informationFINAL CDEC RECOMMENDATION
FINAL CDEC RECOMMENDATION APIXABAN (Eliquis Bristol-Myers Squibb Canada and Pfizer Canada Inc.) New Indication: Prevention of Stroke and Systemic Embolism in Patients with Atrial Fibrillation Recommendation:
More informationDefining Sub-Clinical Atrial Fibrillation and its management
Defining Sub-Clinical Atrial Fibrillation and its management Jeff Healey MD, MSc, FRCP, FHRS PHRI Chair in Cardiology Research Population Health Research Institute McMaster University, Canada Sub-Clinical
More informationInterprofessional Care for Elders through 48/5
Interprofessional Care for Elders through 48/5 Janet E. McElhaney, MD, FRCPC, FACP HSN Volunteer Association Chair in Geriatric Research Professor of Medicine, Northern Ontario School of Medicine Health
More informationTrial clinici nell anziano: efficacy or effectiveness?
LA SPERIMENTAZIONE FARMACOLOGICA CLINICA IN ETÀ GERIATRICA Trial clinici nell anziano: efficacy or effectiveness? Graziano Onder Fondazione Universitaria Policlinico A. Gemelli Università Cattolica del
More informationMODULE 1: Stroke Prevention in Atrial Fibrillation Benjamin Bell, MD, FRCPC
MODULE 1: Stroke Prevention in Atrial Fibrillation Benjamin Bell, MD, FRCPC Specialty: General Internal Medicine Lecturer, Department of Medicine University of Toronto Staff Physician, General Internal
More informationNew options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital
New options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital Disclosures: Honoraria, research support, and consulting f Sanofi, Boehringer-Ingleheim, Portola, BMS, Bayer,
More informationStudy period Total sample size (% women) 899 (37.7%) Warfarin Aspirin
Table S2 Sex- specific differences in oral anticoagulant prescription for stroke prevention in AF Total sample size (% women) Anticoagulant(s) studied Gage (2000) 1 Missouri, USA Discharged during 597
More informationKEEPING YOUR PATIENT OUT OF THE HOSPITAL BY PREVENTING A SECOND STROKE OR TIA December 8, 2017
KEEPING YOUR PATIENT OUT OF THE HOSPITAL BY PREVENTING A SECOND STROKE OR TIA December 8, 2017 1 Faculty Disclosure Faculty: Grant Stotts MD, FRCPC Assistant Professor, uottawa Brain and Mind Institute
More informationAF stroke prevention in the Canadian context
AF stroke prevention in the Canadian context 5 th Annual State of the Heart Toronto, May 31, 2014 Andrew C.T. Ha, MD, MSc, FRCPC Cardiac Electrophysiology Toronto General Hospital, University Health Network
More informationKnown as both a thief and murderer,
&A Dementia Drugs: When Should They Be Stopped? Ron Keren, MD, FRCPC As presented at the University of Toronto s Primary Care Conference, Toronto, Ontario (May 25) Known as both a thief and murderer, Alzheimer
More informationStroke Prevention in AF: How will it change in the next 5 years? Jeff Healey MD, MSc, FHRS Population Health Research Institute McMaster University
Stroke Prevention in AF: How will it change in the next 5 years? Jeff Healey MD, MSc, FHRS Population Health Research Institute McMaster University Disclosures Research Grants and speaking fees St. Jude
More informationMohammad Zubaid, MB, ChB, FRCPC, FACC
Management and one year outcome of atrial fibrillation in Middle Eastern cohort enrolled in the observational Gulf Survey of Atrial Fibrillation Events (Gulf SAFE) Mohammad Zubaid, MB, ChB, FRCPC, FACC
More informationIndications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute
Indications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute Disclosures Research Support/P.I. Employee Leo Pharma
More information:{ic0fp'16. Geriatric Medicine: Optimal Heart Health Amid Changing Guidelines. (and the Evidence for When to Stray) Kevin Overbeck, DO
:{ic0fp'16 ACOFP 53 rd Annual Convention & Scientific Seminars Geriatric Medicine: Optimal Heart Health Amid Changing Guidelines (and the Evidence for When to Stray) Kevin Overbeck, DO Optimal Heart Health
More informationBranko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center
Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center THE END! CHANGABLE Blood pressure Diabetes Mellitus Hyperlipidemia Atrial fibrillation Nicotine Drug abuse Life style NOT CHANGABLE
More informationDr. Meldon Kahan. Women s College Hospital. with PIA LAW
with PIA LAW and Toronto ABI Network Dr. Meldon Kahan Women s College Hospital Dr. Meldon Kahan is an Associate Professor in the Department of Family Medicine at University of Toronto, and Medical Director
More informationState of art in anticoagulation in non valvular Atrial Fibrillation: the additional value of Rivaroxaban real life data
State of art in anticoagulation in non valvular Atrial Fibrillation: the additional value of Rivaroxaban real life data Massimo Grimaldi Ospedale F. Miulli Acquaviva delle Fonti - Bari Disclosure Biosense
More informationProf. Fiorenzo Gaita
Adavances in Cardiac Arrhythmias and Great Innovations in Cardiology Turin 2014 Can rhythm control strategy reduce the risk of clinical and silent cerebral ischemia? Prof. Fiorenzo Gaita Director of the
More informationRational prescribing in the older adult. Assoc Prof Craig Whitehead
Rational prescribing in the older adult Assoc Prof Craig Whitehead Introduction Physioloical ageing and frailty Medication risks in older adults Drug Burden Anticholinergic and sedative drug burden Cascade
More informationUpdate in Outpatient Medicine ACP Scientific Session November 12, 2016
Update in Outpatient Medicine ACP Scientific Session November 12, 2016 Robert Gluckman MD, MACP Chief Medical Officer Providence Health Plans Disclosures Stock Holdings Abbott Labs Abbvie Bristol Myers
More informationExtrapolating from fit to frail. Is it possible? How to assess the efficacy of preventive strategies in older subjects
Extrapolating from fit to frail. Is it possible? How to assess the efficacy of preventive strategies in older subjects Antonio Cherubini IRCCS-INRCA, Italy CONFLICT OF INTEREST DISCLOSURE I have no potential
More informationCADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION
CADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION Edoxaban (Lixiana SERVIER Canada Inc.) Indication: Prevention of Stroke and Systemic Embolic Events in Patients With Nonvalvular Atrial Fibrillation
More informationIndividual Therapeutic Selection Of Anti-coagulants And Periprocedural. Miguel Valderrábano, MD
Individual Therapeutic Selection Of Anti-coagulants And Periprocedural Management Miguel Valderrábano, MD Outline Does the patient need anticoagulation? Review of clinical evidence for each anticoagulant
More informationUpdate in the Literature 2012
Update in the Literature 2012 Mel L. Anderson, MD, FACP Chief, Hospital Medicine Section Associate Chief, Medical Service Denver VA Medical Center Associate Professor of Medicine University of Colorado
More informationEpidemiology and Prevention of Stroke
Copyright Information Copyright protected material has been deleted from this presentation. References to the deleted material are provided for each slide. Epidemiology and Prevention of Stroke Larry B.
More informationTRANSIENT ISCHEMIC ATTACK (TIA)
TRANSIENT ISCHEMIC ATTACK (TIA) AND MINOR STROKE Dr. Leanne K. Casaubon, MD MSc FRCPC Associate Professor, University of Toronto Director, TIA and Minor Stroke (TAMS) Unit University Health Network - Toronto
More informationSESSION 3 11 AM 12:30 PM
SESSION 3 11 AM 12:30 PM for the Primary Prevention of Cardiovascular Disease: A Personalized Approach SPEAKER Samia Mora MD, MHS Presenter Disclosure Information The following relationships exist related
More informationNEUROPSYCHOMETRIC TESTS
NEUROPSYCHOMETRIC TESTS CAMCOG It is the Cognitive section of Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) The measure assesses orientation, language, memory, praxis, attention, abstract
More informationRETROSPECTIVE CLAIMS DATABASE STUDIES OF DIRECT ORAL ANTICOAGULANTS (DOACS) FOR STROKE PREVENTION IN NONVALVULAR ATRIAL FIBRILLATION
RETROSPECTIVE CLAIMS DATABASE STUDIES OF DIRECT ORAL ANTICOAGULANTS (DOACS) FOR STROKE PREVENTION IN NONVALVULAR ATRIAL FIBRILLATION Craig I. Coleman, PharmD Professor, University of Connecticut School
More informationAnticoagulation Beyond Coumadin
Anticoagulation Beyond Coumadin Saturday, September 21, 2013 Crystal Mountain Resort and Spa Pratik Bhattacharya MD, MPH Stroke Neurologist, Michigan Stroke Network; Assistant Professor of Neurology; Wayne
More informationMediterranean Diet: Miracle or Mirage. Edwin Cox, M.D.
Mediterranean Diet: Miracle or Mirage Edwin Cox, M.D. The Mediterranean Diet Unique Distinction The only major diet whose effectiveness has been demonstrated in controlled trials In subjects with a first
More informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationCardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003
Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,
More informationVarenicline and cardiovascular and neuropsychiatric events: Do Benefits outweigh risks?
Varenicline and cardiovascular and neuropsychiatric events: Do Benefits outweigh risks? Sonal Singh M.D., M.P.H, Johns Hopkins University Presented by: Sonal Singh, MD MPH September 19, 2012 1 CONFLICTS
More informationKEEPING YOUR PATIENT OUT OF THE HOSPITAL BY PREVENTING A SECOND STROKE
KEEPING YOUR PATIENT OUT OF THE HOSPITAL BY PREVENTING A SECOND STROKE Dr. Grant Stotts Staff Neurologist, Ottawa Hospital Director, Ottawa Stroke Program Medical Director, Champlain Regional Stroke Program
More informationStrategies To Maintain Independence In The Elderly
Strategies To Maintain Independence In The Elderly Laura Seriguchi, RN Guardian Medical Monitoring, Inc. And in the end, it s not the years in your life that count, it s the life in your years. ABRAHAM
More informationTroponin I elevation increases the risk of death and stroke in patients with atrial fibrillation a RE-LY substudy. Ziad Hijazi, MD
Troponin I elevation increases the risk of death and stroke in patients with atrial fibrillation a RE-LY substudy Ziad Hijazi, MD Uppsala Clinical Research Center (UCR) Uppsala University, Sweden Co-authors:
More informationTrends and Variation in Oral Anticoagulant Choice in Patients with Atrial Fibrillation,
Trends and Variation in Oral Anticoagulant Choice in Patients with Atrial Fibrillation, 2010-2017 Junya Zhu, PhD Department of Health Policy and Management January 23, 2018 Acknowledgments Co-Authors G.
More informationCare of older people in surgery (COPS)
Care of older people in surgery (COPS) Who, what, and does it make a difference Professor Jacqueline Close Geriatrician - POWH Clinical Director Falls, Balance and Injury Research Centre Early Mobilisation
More informationShow Me the Outcomes!
Show Me the Outcomes! Real-World Safety Data on Oral Anticoagulants in Nonvalvular Atrial Fibrillation Gabby Anderson, PharmD PGY1 Pharmacy Resident anderson.gabrielle@mayo.edu Pharmacy Grand Rounds October
More informationIan McKeith MD, F Med Sci, Professor of Old Age Psychiatry, Newcastle University
Ian McKeith MD, F Med Sci, Professor of Old Age Psychiatry, Newcastle University Design of trials in DLB and PDD What has been learnt from previous trials in these indications and other dementias? Overview
More informationManagement of Anticoagulation during Device Implants; Coumadin to Novel Agents
Management of Anticoagulation during Device Implants; Coumadin to Novel Agents DR D Birnie Invited Faculty Core Curriculum Heart Rhythm Society May 8 th 2014 Disclosures Boehringer Ingleheim Research Support
More informationSUPPLEMENTAL MATERIALS
SUPPLEMENTAL MATERIALS Table S1: Variables included in the propensity-score matching Table S1.1: Components of the CHA 2DS 2Vasc score Table S2: Crude event rates in the compared AF patient cohorts Table
More informationDrug Class Review Newer Oral Anticoagulant Drugs
Drug Class Review Newer Oral Anticoagulant Drugs Final Original Report May 2016 The purpose of reports is to make available information regarding the comparative clinical effectiveness and harms of different
More informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationAnticoagulation Therapy in LTC
Anticoagulation Therapy in LTC By: Cynthia Leung, RPh, BScPhm, PharmD. Clinical Consultant Pharmacist MediSystem Pharmacy Jun 11, 2013 Agenda Stroke and Bleeding Risk Assessment Review of Oral Anticoagulation
More informationHEART INTERVENTIONS IN OLDER PATIENTS. FILTERING FOR FRAILTY.
HEART INTERVENTIONS IN OLDER PATIENTS. FILTERING FOR FRAILTY. December 8, 2017 Allen R. Huang, MDCM, FRCPC, FACP 1 Faculty Disclosure Faculty: Allen Huang MDCM, FRCPC, FACP Associate Professor, University
More informationDo Not Cite. Draft for Work Group Review.
Defect Free Acute Inpatient Ischemic Stroke Measure Bundle Measure Description Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke OR transient ischemic attack who were admitted
More informationLiping Liu Dpet. of Neurology and Stroke Center Beijing Tiantan Hospital Capital Medical University
Liping Liu Dpet. of Neurology and Stroke Center Beijing Tiantan Hospital Capital Medical University Disclosures Conflict of interest disclosures: No Disclosures Funding The CHANCE trial is funded by the
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised
Name: generic (trade) Dabigatran etexilate (Pradaxa ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised Direct thrombin inhibitor
More informationThe Geriatrician in the Trauma Service. Trauma Quality Improvement Program (TQIP) Annual Scientific Meeting and Training 2013
The Geriatrician in the Trauma Service Trauma Quality Improvement Program (TQIP) Annual Scientific Meeting and Training 2013 Challenges of the Geriatric Trauma Patient Challenges of the Geriatric Patient
More informationComorbidities in Multiple Myeloma
Comorbidities in Multiple Myeloma Michel Delforge, MD, PhD University Hospital Leuven Leuven, Belgium COMy, Bangkok 12 may 2014 Comy Meeting, Bangkok, 12 may 2014 Disclosures Advisory board: Janssen,
More informationAtrial Fibrillation Implementation challenges. Lesley Edgar Ross Maconachie
Atrial Fibrillation Implementation challenges Lesley Edgar Ross Maconachie Atrial Fibrillation Most common heart rhythm disturbance Rapid and irregular electrical signals Reduced efficiency of blood flow
More informationAsif Serajian DO FACC FSCAI
Anticoagulation and Antiplatelet update: A case based approach Asif Serajian DO FACC FSCAI No disclosures relevant to this talk Objectives 1. Discuss the indication for antiplatelet therapy for cardiac
More informationA Patient Unsuitable for VKA Treatment
Will Apixaban change practice in atrial fibrillation? A Patient Unsuitable for VKA Treatment Professor Yoseph Rozenman The E. Wolfson Medical Center Jerusalem June 2013 Disclosures I have the following
More informationCritical Review Form Therapy
Critical Review Form Therapy A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects, Lancet-Neurology 2007; 6: 953-960 Objectives: To evaluate the effect of
More informationMultifactorial risk assessments and evidence-based interventions to address falls in primary care. Objectives. Importance
Multifactorial risk assessments and evidence-based interventions to address falls in primary care Sarah Ross, DO, MS Assistant Professor Internal Medicine, Geriatrics Nicoleta Bugnariu, PT, PhD Associate
More informationWhat s new with DOACs? Defining place in therapy for edoxaban &
What s new with DOACs? Defining place in therapy for edoxaban & Use of DOACs in cardioversion Caitlin M. Gibson, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy University of North Texas
More informationUS FDA Approves Pradaxa (dabigatran etexilate) a breakthrough treatment for stroke risk reduction in non-valvular atrial fibrillation
Press Release For non-us Healthcare Media Boehringer Ingelheim GmbH Corporate Communications US FDA Approves Pradaxa (dabigatran etexilate) a breakthrough treatment for stroke risk reduction in non-valvular
More informationASPIRIN MISUSE AT HOME ACCORDING TO START AND STOPP IN FRAIL OLDER PERSONS
ASPIRIN MISUSE AT HOME ACCORDING TO START AND STOPP IN FRAIL OLDER PERSONS O. Dalleur 1,4, B. Boland 2,3, A. Spinewine 4-5 1 Pharmacy and 2 Geriatric Medicine, St-Luc university Hospital, 3 Institute of
More informationAnticoagulatie en de oudere patiënt: Terughoudenheid gerechtvaardigd of niet?
Anticoagulatie en de oudere patiënt: Terughoudenheid gerechtvaardigd of niet? 16/06/2018 apr. Julie Hias Satellite symposium supported by the Alliance BMS/Pfizer 432BE18PR03459/ 180570 (Date of Preparation:
More informationDeclaration of Conflict of Interest. No potential conflict of interest to disclose with regard to the topics of this presentations.
Declaration of Conflict of Interest No potential conflict of interest to disclose with regard to the topics of this presentations. Clinical implications of smoking relapse after acute ischemic stroke Furio
More informationObjectives. Case Ruby. 1- Warfarin. 1- Warfarin. Warfarin discontinuation 8/13/ DRUGS TO STOP GIVING HOSPICE PATIENTS
Objectives 10 DRUGS TO STOP GIVING HOSPICE PATIENTS Richard E. Allen MD, MPH Hospice Medical Director Family Medicine Residency Director Salt Lake City, Utah 2 Recognize 10 commonly prescribed medications
More informationNeuroPI Case Study: Anticoagulant Therapy
Case: An 82-year-old man presents to the hospital following a transient episode of left visual field changes. His symptoms lasted 20 minutes and resolved spontaneously. He has a normal neurological examination
More informationEthical questions about biomarkers of ageing the view of geriatrics
Ethical questions about biomarkers of ageing the view of geriatrics Biomarker of Ageing Halle 18.-20.09.2009 Manfred Gogol, M.D. Coppenbrügge Definition Biomarker of Ageing (BMA) are agents that allows
More informationSecondary Stroke Prevention
Secondary Stroke Prevention Acute stroke conference, Sunnybrook Estates January 20, 2011 Rick Swartz HBSc, MD, PhD, FRCPC Assistant Professor, Department of Medicine, Divisions of Neurology and Obstetrical
More informationSecondary Stroke Prevention: A Precautionary Tale
Secondary Stroke Prevention: A Precautionary Tale Kirsten George-Phillips, BSP Clinical Practice Leader, AHS Clinical Pharmacist, AHS Owen Stroke Prevention Clinic Learning Objectives! Examine literature
More informationSupplementary Online Content
Supplementary Online Content Wolters FJ, Li L, Gutnikov SA, Mehta Z, Rothwell PM. Medical attention seeking after transient ischemic attack and minor stroke in relation to the UK Face, Arm, Speech, Time
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Jasmine Menant NSW Falls Prevention Network Rural Forum 8 th March 2018 Acknowledgments: Prof Stephen Lord Recent falls risk factor studies Brain activation in older
More informationCan Catheter Ablation of AF Reduce the Risk of Stroke? CCCEP 2015 October 31, 2015
Can Catheter Ablation of AF Reduce the Risk of Stroke? CCCEP 2015 October 31, 2015 Atul Verma, MD FRCPC FHRS Director, Heart Rhythm Program Southlake Regional Health Centre Newmarket, Ontario, Canada Chair,
More informationB-Vitamins and the Ageing Brain
B-Vitamins and the Ageing Brain Helene McNulty PhD RD MRIA Director of the Northern Ireland Centre for Food, Nutrition and Health (NICHE) ulster.ac.uk Presentation Outline The Ageing Brain Evidence linking
More informationNovember 16-18, 2017 Hotel Monteleone New Orleans, LA. Provided by
November 16-18, 2017 Hotel Monteleone New Orleans, LA Provided by Treatment Targets in Alzheimer s Disease W. Vaughn McCall, MD, MS Professor and Case Distinguished University Chairman Department of Psychiatry
More informationUpdate in Geriatrics: Choosing Wisely Primum Non Nocere
Joseph G. Ouslander, M.D. Professor of Clinical Biomedical Science Senior Associate Dean for Geriatric Programs Chair, Department of Integrated Medical Science Charles E. Schmidt College of Medicine Professor
More informationDementia of the Alzheimer Type: the Drug Treatment Debate
Dementia of the Alzheimer Type: the Drug Treatment Debate I have no financial conflict of interest. Many years ago I was given a trip to San Fran and taught to use a slide set from the drug company. I
More informationAntipsychotic Medications
TRAIL: Team Review of EVIDENCE REVIEW & RECOMMENDATIONS FOR LTC Behavioural and psychological symptoms of dementia (BPSD) refer to the non-cognitive symptoms of disturbed perception, thought content, mood
More informationRecanalization Therapy & Secondary Prophylaxis in the Elderly
Recanalization Therapy & Secondary Prophylaxis in the Elderly 21 st Annual Meeting of the Swiss Stroke Society Lausanne,11.01.2018 PD Dr. G. M. De Marchis, MD MSc Neurology & Stroke Center University Hospital
More informationInformation about TIA
Information about TIA Transient Ischemic Attack (mini-stroke) Did I have a TIA? Did you have stroke-like symptoms such as slurred speech or weakness in one arm that seemed to go away after a few minutes
More informationDonepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer s disease (amended)
Issue date: November 2006 (amended September 2007) Review date: September 2009 Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer s disease (amended) Includes a
More informationNOAs for stroke prevention in Atrial Fibrillation: potential advantages in the elderly patients. Giancarlo Agnelli
NOAs for stroke prevention in Atrial Fibrillation: potential advantages in the elderly patients Giancarlo Agnelli Internal & Cardiovascular Medicine - Stroke Unit University of Perugia, Italy My talk today
More informationIS THERE STILL A PLACE FOR VITAMINE K ANTAGONISTS?
IS THERE STILL A PLACE FOR VITAMINE K ANTAGONISTS? J.Y. LE HEUZEY Georges Pompidou Hospital, René Descartes University, Paris H E G P Munich, August 27, 2012 Disclosure Consultant / Conferences / Advisory
More informationDual Antiplatelet Therapy Made Practical
Dual Antiplatelet Therapy Made Practical David Parra, Pharm.D., FCCP, BCPS Clinical Pharmacy Program Manager in Cardiology/Anticoagulation VISN 8 Pharmacy Benefits Management Clinical Associate Professor
More informationNeurocognitive Disorders Research to Emerging Therapies
Neurocognitive Disorders Research to Emerging Therapies Edward Huey, MD Assistant Professor of Psychiatry and Neurology The Taub Institute for Research on Alzheimer s Disease and the Aging Brain Columbia
More informationEvidence-Based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine in People with Dementia
Evidence-Based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine in People with Dementia ADI 2018, Chicago FACULTY OF MEDICINE Dr Emily Reeve NHMRC Cognitive Decline
More informationPrimary Care Atrial Fibrillation Update: Anticoagulation and Left Atrial Appendage Occlusion. Greg Francisco, MD, FACC
Primary Care Atrial Fibrillation Update: Anticoagulation and Left Atrial Appendage Occlusion Greg Francisco, MD, FACC DISCLOSURES None to declare Estimated 33.5million have AF worldwide (6-7million in
More informationIntegrating Geriatrics into Oncology Care
Integrating Geriatrics into Oncology Care William Dale, MD, PhD Chief, Geriatrics & Palliative Medicine Director, Specialized Oncology Care & Research in the Elderly (SOCARE) Clinic University of Chicago
More informationSession Objectives 11/27/2013
Workshop A3 and B3 This presenter has nothing to disclose Clinical and Cost Improvement for Population Health Scott Weingarten, MD Senior Vice President and Chief Clinical Transformation Officer Cedars-Sinai
More informationCitation for published version (APA): van Munster, B. C. (2009). Pathophysiological studies in delirium : a focus on genetics.
UvA-DARE (Digital Academic Repository) Pathophysiological studies in delirium : a focus on genetics van Munster, B.C. Link to publication Citation for published version (APA): van Munster, B. C. (2009).
More informationDelirium. Approach. Symptom Update Masterclass:
Symptom Update Masterclass: Delirium Jason Boland Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine Wolfson Centre for Palliative Care Research Hull York Medical School University
More informationCHAPTER 5 NEUROPSYCHOLOGICAL PROFILE OF ALZHEIMER S DISEASE
CHAPTER 5 NEUROPSYCHOLOGICAL PROFILE OF ALZHEIMER S DISEASE 5.1 GENERAL BACKGROUND Neuropsychological assessment plays a crucial role in the assessment of cognitive decline in older age. In India, there
More informationResident Assessment Best Practices M E G A N M. G R A E S E R, D N P, G N P - BC P H Y S I C I A N H O U S E C A L L S, L L C
Resident Assessment Best Practices M E G A N M. G R A E S E R, D N P, G N P - BC P H Y S I C I A N H O U S E C A L L S, L L C Who are you assessing? Elders that needing to make a transition in their care
More informationDavid Gardner, BSc Pharm, MSc CH&E, PharmD Professor, Department of Psychiatry & College of Pharmacy
David Gardner, BSc Pharm, MSc CH&E, PharmD Professor, Department of Psychiatry & College of Pharmacy It s no dream. Sleep well without sleeping pills. Outline Baby boomers & beyond: medication use Deprescribing
More informationUpdates in Stroke Management. Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy
Updates in Stroke Management Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy Disclosure I have no actual or potential conflict of interest
More informationAppendix L: Research recommendations
1 L.1 Dementia diagnosis (amyloid PET imaging) recommendation 1 Index Test Reference Test(s) Does amyloid PET imaging provide additional diagnostic value, and is it cost effective, for the diagnosis of
More informationIs Apixaban Effective for the Prevention of Stroke in Patients With Non-Valvular Atrial Fibrillation?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2014 Is Apixaban Effective for the Prevention
More informationStrokes, Falls, Forgetfulness and Frailty Managing the Very Elderly Hypertensive
Strokes, Falls, Forgetfulness and Frailty Managing the Very Elderly Hypertensive John Potter Professor Ageing and Stroke Medicine University of East Anglia Oh God who knowest us to be set midst great dangers,
More information-Guidelines for the discontinuation of oral antipsychotics in patients with BPSD within the primary care setting Summary- Quetiapine
-Guidelines for the discontinuation of oral antipsychotics in patients with BPSD within the primary care setting Summary- Quetiapine An independent report Time for action 1 by Professor Sube Banerjee looked
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (Review of TA 111) Appraisal
More information