Serum vitamin D metabolite and acute-phase protein concentrations are frequently abnormal in a cohort of hospitalized dogs and cats.

OBJECTIVE: To determine whether serum 25-hydroxyvitamin D (25[OH]D) and 1,25-dihydroxyvitamin D (1,25[OH]2D) concentrations are associated with survival and negatively correlate with acute-phase protein (APP) concentrations in ill dogs and cats admitted to nursing care units. ANIMALS: Client-owned dogs (n = 79) and cats (16) admitted to 2 academic veterinary hospital nursing care units. METHODS: A prospective cohort study was conducted between August 12, 2019, and October 26, 2021. A diagnostic laboratory measured 25(OH)D, 1,25(OH)2D, and haptoglobin (HPT) in dogs and cats; C-reactive protein (CRP) in dogs; and serum amyloid A (SAA) in cats. Serum was collected within 12 hours of admission. Illness severity (acute patient physiologic and laboratory evaluation [APPLEfast]) scores and survival data were recorded. RESULTS: Serum 25(OH)D concentrations were in the deficient range for 22 of 79 dogs and 2 of 16 cats. There were no associations between serum analyte concentrations (25[OH]D, 1,25[OH]2D, and APP) or APPLEfast score and survival in dogs or cats. In dogs, HPT was negatively correlated with 25(OH)D (P = .002; r = -0.34) and 1,25(OH)2D (P = .012; r = -0.28), while CRP was positively correlated with HPT (P = .001; r = 0.32) and APPLEfast score (P = .014; r = 0.16). In cats, 1,25(OH)2D was negatively correlated with APPLEfast scores (P = .055; r = -0.49) and SAA was positively correlated with HPT (P = .002; r = 0.73). CLINICAL RELEVANCE: Serum 25(OH)D or 1,25(OH)2D was not associated with survival in our hospitalized patient population. Relationships between APP and serum vitamin D metabolites with APPLEfast scores in cats warrant further investigation as illness severity biomarkers.

Self-Reported Neuropsychiatric Post-COVID-19 Condition and CSF Markers of Neuroinflammation.

This case-control study assesses cerebrospinal fluid markers of neuroinflammation and blood-brain barrier disruption in individuals with post­COVID-19 condition who reported neuropsychiatric symptoms.

Fission Yeast Polarization: Modeling Cdc42 Oscillations, Symmetry Breaking, and Zones of Activation and Inhibition.

Cells polarize for growth, motion, or mating through regulation of membrane-bound small GTPases between active GTP-bound and inactive GDP-bound forms. Activators (GEFs, GTP exchange factors) and inhibitors (GAPs, GTPase activating proteins) provide positive and negative feedbacks. We show that a reaction-diffusion model on a curved surface accounts for key features of polarization of model organism fission yeast. The model implements Cdc42 membrane diffusion using measured values for diffusion coefficients and dissociation rates and assumes a limiting GEF pool (proteins Gef1 and Scd1), as in prior models for budding yeast. The model includes two types of GAPs, one representing tip-localized GAPs, such as Rga3; and one representing side-localized GAPs, such as Rga4 and Rga6, that we assume switch between fast and slow diffusing states. After adjustment of unknown rate constants, the model reproduces active Cdc42 zones at cell tips and the pattern of GEF and GAP localization at cell tips and sides. The model reproduces observed tip-to-tip oscillations with periods of the order of several minutes, as well as asymmetric to symmetric oscillations transitions (corresponding to NETO "new end take off"), assuming the limiting GEF amount increases with cell size.

Asymmetry of Brain Excitability: A New Biomarker that Predicts Objective and Subjective Symptoms in Multiple Sclerosis.

OBJECTIVES: Investigate whether asymmetrical corticospinal excitability exists in Multiple Sclerosis (MS) and its association with MS symptoms. METHODS: Bilateral resting and active motor thresholds (RMT, AMT) were gathered using transcranial magnetic stimulation among 82 MS patients. Corticospinal excitability (CSE) asymmetry was expressed as the ratio between weaker and stronger sides' RMT and AMT. Stronger and weaker side was determined by pinch and grip strength. We examined whether CSE asymmetry predicted symptoms. RESULTS: AMT asymmetry ratio revealed atypical CSE asymmetry whereby the hemisphere associated with the weaker hand was more excitable in early MS. After controlling for MS disease demographics, shifting of CSE asymmetry towards greater excitability in the stronger side significantly predicted more severe symptoms including Expanded Disease Severity Scale, nine-hole peg test, cognitive processing speed, walking speed, heat sensitivity, fatigue, and subjective impact of MS. CONCLUSION: CSE asymmetry significantly predicted the severity of MS-related physical and objective cognitive symptoms. The phenomenon may be related to neuroinflammation-mediated hyperexcitability. Shifting of asymmetry toward less excitability on the weaker side may suggest the onset of a more neurodegenerative phase of the disease. SIGNIFICANCE: Shifting of hemispheric excitability, detected using a CSE asymmetry ratio, may be a useful biomarker to track disease progression and understand the benefits of treatments.

Healthy Aging from the Perspectives of 683 Older People with Multiple Sclerosis.

Purpose. The aim of this study was to determine what factors most greatly contributed to healthy aging with multiple sclerosis (MS) from the perspective of a large sample of older people with MS. Design and Methods. Participants (n = 683; >55 years of age with symptoms >20 years) provided answers to an open-ended question regarding healthy aging and were categorized into three groups, 55-64 (young), 65-74 (middle), and 75 and over (oldest old). Sociodemographic actors were compared using ANOVA. Two independent raters used the framework method of analyzing qualitative data. Results. Participants averaged 64 years of age (±6.2) with MS symptoms for 32.9 years (±9.4). 531 participants were female (78%). The majority of participants lived in their own home (n = 657) with a spouse or partner (n = 483). Participants described seven themes: social connections, attitude and outlook on life, lifestyle choices and habits, health care system, spirituality and religion, independence, and finances. These themes had two shared characteristics, multidimensionality and interdependence. Implications. Learning from the experiences of older adults with MS can help young and middle aged people with MS plan to age in their own homes and communities. Our data suggests that older people with MS prioritize factors that are modifiable through targeted self-management strategies.

Caregivers' time utilization before and after the introduction of an electronic nursing documentation system in a residential aged care facility.

BACKGROUND: Despite increasing research on caregivers' interaction with technology, there has been no attempt to investigate how the introduction of an electronic system in a residential aged care facility (RACF) may affect caregivers' use of their time. OBJECTIVE: To assess how caregivers use their time before and after the introduction of an electronic documentation system in an RACF. METHODS: An observational work sampling study was undertaken with caregivers at two months before, and at 3, 6, 12 and 23 months after the implementation of an electronic documentation system. RESULTS: During the first 12 months after implementation, the proportion of time spent by personal carers on documentation increased, that on direct care reduced, and the proportion on communication remained unchanged. At 23 months, the proportion on documentation and direct care had returned to pre-implementation levels. The percentage of time spent on these activities by recreational activity officers remained unchanged at most measurement periods after implementation. Changes in proportions of time on other activities were not directly associated with the introduction of the electronic system. CONCLUSION: It may take over a year for some caregivers in an RACF to integrate the use of a newly introduced electronic documentation system into their daily work. Organisations implementing such systems should develop strategies that support and accelerate the caregivers' integration of the new documentation practice into their routine activities. The electronic documentation system may not however, replace the role of verbal communication between caregivers in aged care service.

Digital mammography: an update.

(1) Digital mammography can improve breast-image quality and storage through the digital capture of x-ray images. (2) Large comparative studies indicate that the overall accuracy of full-field digital mammography (FFDM) is similar to that of conventional filmscreen mammography (FSM). (3) Recent evidence suggests that FFDM is more accurate than FSM for diagnosing cancer in women younger than 50 years, those with dense breasts, and pre- or peri-menopausal women. (4) The costs of FFDM are higher than those for FSM. (5) The quality control of FFDM systems offers advantages compared to that of FSM, but it is more complex, and it is associated with a long learning curve.

Open magnetic resonance imaging (MRI) scanners.

(1) In most MRI scanners, the patient examination table fits inside a long cylindrical tube. Large patients cannot be accommodated, and some persons experience claustrophobic reactions. Open MRI systems, in which the patient is placed between two plates, overcome these disadvantages. (2) Open MRI scanners are widely used in health care. High-field closed MRI systems are preferred for many examinations. (3) Early versions of open MRI scanners had low magnetic field strength, gave poorer image quality than most closed systems, and required longer examination times. Newer open scanners include machines with higher magnetic field strengths and improved image quality. (4) Closed high magnetic field scanners with short magnets and wide bore tubes offer improved comfort to patients, and may be an alternative to open scanners. (5) There is interest in using open systems for intra-operative and image-guided interventions.

Radiofrequency ablation in the treatment of kidney cancer.

(1) The standard approach for the treatment of kidney (renal) cancer is radical or partial nephrectomy (removal of the kidney). (2) Radiofrequency ablation (RFA), a less invasive approach, is an option for the treatment of small tumours, and in cases where surgery is contraindicated. (3) Its safety and efficacy compare favourably with those of other approaches. (4) The persistence of residual tumour is a disadvantage of earlier versions of the technology. The use of more powerful radiofrequency (RF) generators may reduce such persistence, but definitive evidence is unavailable. (5) Experience with this application of the technology is limited. Longer follow-up of patients is required to provide an adequate comparison with nephrectomy.

Health technology assessment.

Health technology assessment (HTA) involves the systematic evaluation of healthcare technologies and the dissemination of assessment findings. Its main purpose is to provide objective information to support healthcare decisions and policy-making. This article provides a brief overview of HTA, covering availability of assessment reports, approaches used, relevance and reliability of assessments and the influence of HTA. HTA reports vary greatly in their scope and complexity, because of the range of questions considered and the needs of those who request advice on health technologies. A key to the reliability of an HTA report is its transparency. Explicit information should be provided on the question that is addressed, data used, approach to analysis, and any assumptions that are made. Effectiveness of HTA--the extent to which it influences decisions--will be highly dependent on how well assessment findings are disseminated.

Achievements and challenges on policies for allied health professionals who use telehealth in the Canadian Arctic.

We formulated policies and procedures for allied health professionals (AHPs) who provide services using telehealth in Nunavut, Canada's newest Arctic territory. These are a supplement to the clinical policies and procedures already established for Nunavut physicians and nurses. The services were in the areas of audiology, dietetics/nutrition, midwifery, occupational therapy, ophthalmic services, pharmacy, physiotherapy, psychology, respiratory therapy, social work and speech therapy. Documents specific to each of the services were developed, drawing on information from Government of Nunavut data, Nunavut healthcare providers and links made through the Internet. Topics included the scope and limitations of telehealth services, staff responsibilities, training and reporting, professional standards and cultural considerations. We also considered generic policies covering common issues such as jurisdiction, licensing and liability. The policies and procedures for AHPs will enhance and expand the successes already achieved with telehealth in Nunavut. The challenges are to balance the preferred approaches to service provision with the realities of health care and communications in an Arctic setting.

Technology and managed care: is telemedicine the right tool for rural communities?

Telemedicine offers a unique opportunity for the delivery of healthcare to rural communities. For this opportunity to be realized, telemedicine services need to be planned carefully with attention to acceptance by clients and providers, economic viability and effective administration. To be sustainable, services for rural populations must be supported by a well-defined and resourced infrastructure. Managed care, considered as an approach to the effective delivery of appropriate services, is indeed the right tool for rural communities. Cost savings will be an important issue for health care managers, but rural telemedicine services should be considered in a broader economic perspective, taking account of both costs and benefits from various perspectives, and considering long term outcomes.

Successes and challenges in a field-based, multi-method study of home telehealth.

We are conducting a three-year study of telehealth in 11 home care offices that serve rural clients in Alberta. Three hundred and twenty palliative home care clients are being recruited to participate in a randomized controlled trial (RCT) to answer three questions about the use of video-phones and their effect on symptom management, quality of life and cost, as well as readiness to use the technology. Both successes and challenges have been identified in three main areas: technology, people/organizational issues and study design. Maintaining study integrity has been the key factor in decision making, as adjustments from the original proposal are made. It is already clear that field-based RCTs are feasible, but require commitment and flexibility on the part of researchers and community partners to work through the study implementation.

Policy implications associated with the socioeconomic and health system impact of telehealth: a case study from Canada.

This research was undertaken to inform future telehealth policy directions regarding the socioeconomic impact of telehealth. Fifty-seven sources were identified and analyzed through a comprehensive literature search of electronic databases, the Internet, journals, conference proceedings, as well as personal communication with consultants in the field. The review revealed a focus on certain socioeconomic indicators such as cost, access, and satisfaction. It also identified areas of opportunity for further research and policy analysis and development (e.g., social isolation, life stress, poverty), along with various barriers and challenges to the advancement of telehealth. These included confidentiality, reimbursement, and legal and ethical considerations. To become fully integrated into the health care system, telehealth must be viewed as more than an add-on service. This paper offers 19 general and 20 subject-specific telehealth recommendations, as well as seven policy strategies.

The socio-economic impact of telehealth: a systematic review.

We reviewed the socio-economic impact of telehealth, focusing on nine main areas: paediatrics, geriatrics, First Nations (i.e. indigenous peoples), home care, mental health, radiology, renal dialysis, rural/remote health services and rehabilitation. A systematic search led to the identification of 4646 citations or abstracts; from these, 306 sources were analysed. A central finding was that telehealth studies to date have not used socio-economic indicators consistently. However, specific telehealth applications have been shown to offer significant socio-economic benefit, to patients and families, health-care providers and the health-care system. The main benefits identified were: increased access to health services, cost-effectiveness, enhanced educational opportunities, improved health outcomes, better quality of care, better quality of life and enhanced social support. Although the review found a number of areas of socio-economic benefit, there is the continuing problem of limited generalizability.

Some successes and limitations with telehealth in Canada.

Canada has taken important steps towards establishing telehealth within its health-care system. However, in many areas telehealth in Canada has yet to progress beyond the stage of testing feasibility. A recent survey of eight Canadian telehealth programmes that are using videoconferencing indicated that there is little evidence of either clinical or economic benefits compared with conventional care. There are examples of sustainable, routine telehealth services in Canada. However, overall, the number of patients seen by telehealth is still very small in comparison with the number of face-to-face visits. 'People-related' factors seem dominant in determining the degree of success of telehealth applications.

Assessing telemedicine: a systematic review of the literature.

BACKGROUND: To clarify the current status of telemedicine, we carried out a systematic review of the literature. We identified controlled assessment studies of telemedicine that reported patient outcomes, administrative changes or economic assessments and assessed the quality of that literature. METHODS: We carried out a systematic electronic search for articles published from 1966 to early 2000 using the MEDLINE (1966-April 2000), HEALTHSTAR (1975-January 2000), EMBASE (1988-February 2000) and CINALH (1982-January 2000) databases. In addition, the HSTAT database (Health Services/Technology Assessment Text, US National Library of Medicine), the Database of Abstracts of Reviews of Effectiveness (DARE, NHS Centre for Reviews and Dissemination, United Kingdom), the NHS Economic Evaluation Database and the Cochrane Controlled Trials Register were searched. We consulted experts in the field and did a manual search of the reference lists of review articles. RESULTS: A total of 1124 studies were identified. Based on a review of the abstracts, 133 full-text articles were obtained for closer inspection. Of these, 50 were deemed to represent assessment studies fulfilling the inclusion criteria of the review. Thirty-four of the articles assessed at least some clinical outcomes; the remaining 16 were mainly economic analyses. Most of the available literature referred only to pilot projects and short-term outcomes, and most of the studies were of low quality. Relatively convincing evidence of effectiveness was found only for teleradiology, teleneurosurgery, telepsychiatry, transmission of echocardiographic images, and the use of electronic referrals enabling e-mail consultations and video conferencing between primary and secondary health care providers. Economic analyses suggested that teleradiology, especially transmission of CT images, can be cost-saving. INTERPRETATION: Evidence regarding the effectiveness or cost-effectiveness of telemedicine is still limited. Based on current scientific evidence, only a few telemedicine applications can be recommended for broader use.

Providing information on emerging health technologies to provincial decision makers: a pilot project.

A pilot project to provide advice on new and emerging medical technologies to decision makers in a provincial health care system was undertaken by a health technology assessment (HTA) program. Briefs were prepared on technologies which were not yet available in the province and which might have a significant impact on health care. These were sent to the ministry of health and regional health authorities and made available through the agency's website. Reaction to the briefs was sought from decision makers. Decision makers in the health ministry and health authorities found the briefs helpful, and wished to continue receiving them. They had made limited use of them for planning purposes, but the briefs provided useful input to further consideration of technologies in several cases. Within the HTA program, the briefs and the process that produced them were valuable in increasing awareness of new health technologies that might require assessment in future. This pilot project demonstrated the feasibility of providing timely advice on emerging health technologies within a provincial health system. However, while decision makers found the information provided to be useful, this had not yet been integrated with provincial health care planning. Necessary machinery within policy areas and communication with the HTA process appear to be in need of development.

Elements for assessment of telemedicine applications.

OBJECTIVES: As an initiative of the International Network of Agencies for Health Technology Assessment, an approach to assessment of telemedicine applications was prepared to assist decision makers who are considering introduction and use of this technology. METHODS: Review and commentary drawing on published assessment frameworks and reports of primary evaluations of telemedicine, with particular reference to experience in Finland and Canada. RESULTS: Elements of the approach included development of a business case (considering population and services, personnel and consumers, delivery arrangements, specifications and costs); subsequent evaluation of the telemedicine application; and follow-up (covering the domains of technical assessment, effectiveness, user assessment of the technology, costs of telemedicine, trials, economic evaluation methods, and sensitivity analysis). CONCLUSIONS: Decision makers should link introduction of new and often costly technology to appraisal of its feasibility, followed by evaluation of the application, including longer term consideration of its sustainability and impact on the healthcare system. As the effectiveness and efficiency of telemedicine applications will often be strongly influenced by local issues, results of assessments may not be generalizable.

Evaluation of a routine telepsychiatry service.

An assessment was undertaken of a routine telepsychiatry service in rural areas of a Canadian province as a follow-up to a pilot telepsychiatry project. Over two years, there were 546 consultations at the five participating general hospitals, although the level of use varied considerably between them. Health professionals expressed high satisfaction with the service. While there were equipment problems in 17% of all consultations in the second year, they did not seem to affect acceptance of the technique. A cost analysis comparing consultations provided by a visiting psychiatrist and telepsychiatry found a break-even point of 348 consultations a year. However, when use of the videoconferencing network for administrative meetings was considered, the break-even point was 224 consultations a year, substantially below the actual utilization of telepsychiatry. Telepsychiatry appeared to result in increased access to community mental health services, suggesting future increased demand for these. From the perspective of health authorities and health professionals, telepsychiatry proved to be a useful and sustainable addition to existing mental health services.