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التوصل للرعاية الصحية بطريقة \ستيب\
يصف هذا الكتاب الاستراتيجات والتكتيكات العملية التي استخدمتها منظمة بايلور للرعاية الصحية \"مبرص\" للتشغيل العملياتي لتوصيل الرعاية الصحية بطريقة (ستيب) أي بأمان وفي الوقت المناسب وبفاعلية وكفاءة وبعدالة بحيث يكون مركزها هو المريض والتزمت منظومة (مبرص) بتوصيل رعاية صحية بجودة مرتفعة منذ تأسست المنظمة في 1903 باعتبارها المصحة التذكارية المعمدانية\" في تكساس.
Book
The common inflammatory etiology of depression and cognitive impairment: a therapeutic target
Chronic inflammation has been shown to contribute to the development of a wide variety of disorders by means of a number of proposed mechanisms. Depression and cognitive impairment are two such disorders which may share a closely linked inflammatory etiology. The ability of inflammatory mediators to alter the activity of enzymes, from key metabolic pathways, may help explain the connection between these disorders. The chronic up-regulation of the kynurenine pathway results in an imbalance in critical neuroactive compounds involving the reduction of tryptophan and elevation of tryptophan metabolites. Such imbalances have established implications in both depression and cognitive impairment. This may implicate the immune system as a potential therapeutic target in the treatment of these disorders. The most common treatment modalities currently utilized, involve drug interventions which act on downstream targets. Such treatments help to reestablish protein balances, but fail to treat the inflammatory basis of the disorder. The use of anti-inflammatory interventions, such as regular exercise, may therefore, contribute to the effectiveness of current drug interventions in the treatment of both depression and cognitive impairment.
Journal Article
Orienteering combines vigorous-intensity exercise with navigation to improve human cognition and increase brain-derived neurotrophic factor
Exercise enhances aspects of human cognition, but its intensity may matter. Recent animal research suggests that vigorous exercise, which releases greater amounts of lactate, activates more brain-derived neurotrophic factor (BDNF) in the hippocampus and, thus, may be optimal for supporting cognitive function. The cognitive benefits of exercise may be further augmented when combined with cognitive training. The sport of orienteering simultaneously combines exercise with spatial navigation and, therefore, may result in greater cognitive benefits than exercising only, especially at vigorous intensities. The present study aimed to examine the effects of an acute bout of orienteering at different intensities on cognition and BDNF compared to exercising only. We hypothesized that vigorous-intensity orienteering would increase lactate and BDNF and improve cognition more than moderate-intensity orienteering or vigorous exercise alone. Sixty-three recreationally active, healthy young adults ( M age = 21.10±2.75 years) with no orienteering experience completed a 1.3 km intervention course by navigating and exercising at a vigorous (80–85% of heart rate reserve) or moderate (40–50% of heart rate reserve) intensity or exercising vigorously without navigation. Exercise intensity was monitored using peak lactate, heart rate and rating of perceived exertion. Serum BDNF was extracted immediately before and after the intervention. Memory was assessed using the Mnemonic Similarity Task (high-interference memory) and the Groton Maze Learning Test (spatial memory). Both exercising and orienteering at a vigorous intensity elicited greater peak lactate and increases in BDNF than moderate-intensity orienteering, and individuals with higher peak lactate also had greater increases in BDNF. High-interference memory improved after both vigorous-intensity interventions but did not improve after the moderate-intensity intervention. Spatial memory only increased after vigorous-intensity orienteering, suggesting that orienteering at a vigorous intensity may particularly benefit spatial cognition. Overall, the results demonstrate the benefits of vigorous exercise on human cognition and BDNF.
Journal Article
Targeting inflammation as a treatment modality for neuropathic pain in spinal cord injury: a randomized clinical trial
Background
The purpose of the present study was to examine the effectiveness of an anti-inflammatory intervention as a treatment for neuropathic pain following spinal cord injury (SCI).
Methods
This randomized, parallel-group, controlled clinical trial (NCT02099890) examined 20 participants with varying levels and severities of SCI, randomized (3:2) to either a 12-week anti-inflammatory diet, or control group. Outcome measures consisted of self-determined indices of pain as assessed using the neuropathic pain questionnaire (NPQ) and markers of inflammation as assessed by various pro- and anti-inflammatory cytokines, as well as the eicosanoids PGE2 and LTB4.
Results
A significant group × time interaction was found for sensory pain scores (
p
< 0.01). A Mann-Whitney test revealed that the change scores (3-month baseline) were significantly different between groups for IFN-y (
U
= 13.0,
p
= 0.01), IL-1β (
U
= 14.0,
p
= 0.01), and IL-2 (
U
= 12.0,
p
= 0.01). A Friedman test revealed the treatment group had a significant reduction in IFN-y (
x
2
= 8.67,
p
= 0.01), IL-1β (
x
2
= 17.78,
p
< 0.01), IL-6 (
x
2
= 6.17,
p
< 0.05), while the control group showed no significant change in any inflammatory mediator. A stepwise backward elimination multiple regression analysis showed that the change in sensory neuropathic pain was a function of the change in the proinflammatory cytokines IL-2 and IFN-y, as well as the eicosanoid PGE2 (
R
= 0.689,
R
2
= 0.474).
Conclusions
Overall, the results of the study demonstrate the efficacy of targeting inflammation as a means of treating neuropathic pain in SCI, with a potential mechanism relating to the reduction in proinflammatory cytokines and PGE2.
Trial registration
ClinicalTrials.gov,
NCT02099890
Journal Article
A Multi-Ingredient Nutritional Supplement in Combination With Resistance Exercise and High-Intensity Interval Training Improves Cognitive Function and Increases N-3 Index in Healthy Older Men: A Randomized Controlled Trial
We aimed to evaluate the effect of multi-ingredient nutritional supplementation, with and without exercise training, on cognitive function in healthy older men. Forty-nine sedentary men [age: 73 ± 6 years (mean ± SD); body mass index: 28.5 ± 3.6 kg/m
] were randomized to consume a supplement (SUPP
= 25; 1500 mg
-3 polyunsaturated fatty acids, 30 g whey protein, 2.5 g creatine, 500 IU vitamin D, and 400 mg calcium) or control beverage (CON
= 24; 22 g maltodextrin) twice daily for 20 weeks consisting of Phase 1: SUPP/CON followed by Phase 2: 12-week resistance exercise training plus high-intensity interval training, while continuing to consume the study beverages (SUPP/CON + EX). At baseline, 6 weeks, and 19 weeks we assessed cognitive function [Montréal Cognitive Assessment (MOCA)], memory [word recall during the Rey Auditory Verbal Learning Test (RAVLT)], executive functions (working memory inhibition control), and nutrient bioavailability. We did not observe changes to any aspect of cognitive function after Phase 1; however, significant improvements in the following cognitive function outcomes were detected following Phase 2: MOCA scores increased (6 weeks: 23.5 ± 3.3 vs. 19 weeks: 24.4 ± 2.5,
= 0.013); number of words recalled during the RAVLT increased (6 weeks: 6.6 ± 3.6 vs. 19 weeks: 7.6 ± 3.8,
= 0.047); and reaction time improved (6 weeks: 567 ± 49 ms vs. 19 weeks: 551 ± 51 ms,
= 0.002). Although between-group differences in these outcomes were not significant, we observed within-group improvements in composite cognitive function scores over the course of the entire study only in the SUPP group (Δ = 0.58 ± 0.62,
= 0.004) but not in the CON group (Δ = 0.31 ± 0.61,
= 0.06). We observed a progressive increase in
-3 index, and a concomitant decrease in the ratio of arachidonic acid (ARA) to eicosapentaenoic acid (EPA) within erythrocyte plasma membranes, in the SUPP group only. At week 19,
-3 index (
= 0.49,
= 0.02) and the ARA:EPA ratio (
= -0.44,
= 0.03) were significantly correlated with composite cognitive function scores. Our results show that 12 weeks of RET + HIIT resulted in improved MOCA scores, word recall, and reaction time during an executive functions task; and suggest that a multi-ingredient supplement combined with this exercise training program may improve composite cognitive function scores in older men possibly via supplementation-mediated alterations to
-3 PUFA bioavailability.
: http://www.ClinicalTrials.gov, identifier NCT02281331.
Journal Article
A pilot living clinical practice guidelines approach was feasible and acceptable to guideline panel members
•Clinical Practice Guidelines are hard to keep up-to-date as new research is constantly being published.•To address this limitation, we piloted a “living” guidelines process using repeated searches covering small time periods.•The pilot focused on drug management of pain following spinal cord injury.•The “living” process identified 8 new papers and cost 97 person-hours, translating to $8738 USD.•“Living” research resources are especially critical following the COVID-19 pandemic.
Clinical practice guidelines (CPGs) help to translate best available evidence into clinical practice but can be challenging to keep current due to their resource intensive nature. A “living” process that is used to continually update CPGs may therefore be of value.
This pilot study assesses the development of a living CPG protocol based on the CanPainSCI CPG. Two “living CPG” update searches were performed; resource costs and acceptability were assessed by a research team across Australia and Canada
Two updates were completed over 3 years. Literature searches and data extraction were completed by trainees on 119 and 58 papers. Eight papers were included and reviewed by 14 expert panel members. Resource usage included a total 43 hours of screening by trainees at $2,356 (USD), 24 hours of expert panel review at $3,141 (USD) and 30 hours of project management at $3,241 (USD). Reviewers were generally satisfied with the process. All reviewers agreed that incorporating a living guidelines approach would be useful.
This paper outlines the process of maintaining a CPG through a living guideline process and provides resource costs and acceptability data which may aid stakeholders in the development of future CPGs.
Journal Article
Corrigendum: A Multi-Ingredient Nutritional Supplement in Combination With Resistance Exercise and High-Intensity Interval Training Improves Cognitive Function and Increases N-3 Index in Healthy Older Men: A Randomized Controlled Trial
[This corrects the article DOI: 10.3389/fnagi.2019.00107.].[This corrects the article DOI: 10.3389/fnagi.2019.00107.].
Journal Article
Targeting inflammation to influence mood following spinal cord injury: a randomized clinical trial
Background
The purpose of the present study was to examine the efficacy of targeting inflammation as a means of improving mood following spinal cord injury (SCI) and explore the potential mechanisms of action.
Methods
The study was a randomized, parallel-group, controlled, clinical trial (NCT02099890) whereby 20 participants with varying levels and severities of SCI were randomized (3:2) to either the treatment group, consisting of a 12-week anti-inflammatory diet, or control group. Outcome measures were assessed at baseline, 1 and 3 months, and consisted of CES-D scores of depression, markers of inflammation as assessed by various pro- and anti-inflammatory cytokines and several amino acids related to depression.
Results
A significant group × time interaction was found for CES-D (Center for Epidemiologic studies Depression Scale) score (
p
= 0.01), the TRP/LNAA (tryptophan/large neutral amino acid) ratio (
p
= 0.04), the composite score of pro-inflammatory cytokines (
p
= 0.04), IL-1β (interleukin-1 beta) (
p
= 0.04), and IFN-γ (interferon gamma) (
p
= 0.03). Pearson’s
r
correlation showed significance between the ∆IL-1β and both the ∆CES-D score (
r
= 0.740,
p
< 0.01) and the ∆KYN/TRP (kynurenine/tryptophan) ratio (
r
= 0.536,
p
= 0.02). The ∆KYN/TRP ratio was also significantly correlated with the ∆CES-D score (
r
= 0.586,
p
= 0.01). Mediation analysis showed that the relationship between the ∆KYN/TRP ratio and the ∆CES-D score was mediated by the ∆IL-1β. Subgroup analysis showed that participants with high CES-D scores had significantly higher concentrations of IL-1β, and all correlations were maintained or strengthened within this subgroup.
Conclusions
Overall, the results demonstrated the effectiveness of targeting inflammation as a means of improving mood in SCI, with potential mechanisms relating to the reduction in IL-1β and improvements in levels of neuroactive compounds related to the kynurenine pathway. Due to the limited sample size, results should be interpreted with caution; however, they are worthy of further examination due to the potential impact of inflammation on depression.
Trial registration
ClinicalTrials.gov ID:
NCT02099890
.
Journal Article
Barriers and facilitators to adhering to an anti-inflammatory diet for individuals with spinal cord injuries
The purpose of this study was to explore the barriers and facilitators of an anti-inflammatory diet in people with spinal cord injury. Six participants (age range of 23–68 years, three women and three men) who had previously completed an anti-inflammatory diet study were interviewed. Facilitators identified were family support, autonomy over meal choice, peer support, health benefits gained, and implementation of adherence strategies. The main barriers discussed were lack of motivation after study period ended, social events, diet expenses, and lack of knowledge about the diet. Several health benefits including reductions in pain, edema, and improvements in cognition and mobility were reported.
Journal Article
Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial
ObjectiveThe study’s primary objective was to compare the effectiveness of intra-articular platelet-rich plasma injections versus corticosteroid injections for the treatment of cervical facetogenic pain. Secondary aims were to compare self-rated disability, pain self-efficacy, and the safety of the procedure between groups.MethodsA single-site randomized double-blind controlled trial with 40 participants assigned to receive either leucocyte-poor, low-concentrate platelet-rich plasma injections or corticosteroid injection without local anesthetic into the cervical facet joint under fluoroscopy. Outcomes were collected via telephone at 1, 3, and 6 months to determine treatment effectiveness.ResultsLow-concentrate platelet-rich plasma and corticosteroid injections had similar effects on cervical facetogenic pain intensity over a 6-month period post injection as demonstrated by a non-significant group-by-time interaction for Numeric Rating Scale scores (p>0.05). However, both groups showed a statistically significant decrease in cervical facetogenic pain intensity 1 month post treatment compared with baseline (p=0.02), while the platelet-rich plasma group also demonstrated a clinically significant decrease in pain intensity at the same time point. There was a significant interaction at 1 month post intervention for pain self-efficacy (p=0.04), with the platelet-rich plasma injection group showing a larger increase in pain self-efficacy compared with the corticosteroid injection group. No significant interaction was observed for self-rated disability; however, significant reductions were shown at 3 and 6 months post treatment compared with baseline in both groups (p<0.01). No significant differences between groups were reported for adverse events; however, those receiving platelet-rich plasma injection reported significantly less procedural pain (p=0.02).ConclusionBoth platelet-rich plasma and corticosteroid injections induced similar improvements in cervical facetogenic pain intensity (1 month post) and self-rated disability (3 and 6 months post). Pain self-efficacy demonstrated a significant interaction with platelet-rich plasma injection showing greater improvement 1 month post. Additionally, both treatments exhibited a similar low prevalence of adverse events; however, those receiving platelet-rich plasma injection reported less procedural pain.
Journal Article