Case of Anthracycline-induced Cardiogenic Shock: A Call to Optimize Modifiable Cardiac Risk Factors Prior to Chemotherapy.

Anthracyclines, including doxorubicin, are an important class of chemotherapeutic agents. Their efficacy, however, is limited by cardiotoxicity. Risk factors for anthracycline-associated cardiotoxicity include dose, treatment-specific risk factors including adjunctive radiotherapy, patient-specific modifiable cardiac risk factors including hypertension, hyperlipidemia, diabetes mellitus, tobacco use and obesity, and patient-specific non-modifiable risk factors such as age. The reduction of treatment-specific factors is not always possible, but treatment and reduction of modifiable risk factors should always be an important aspect of the management plan and may reduce the risk of anthracycline-induced cardiotoxicity. We present the case of a 65-year-old male with multiple modifiable cardiovascular risk factors who developed cardiogenic shock shortly after the administration of combination therapy with anthracyclines for the treatment of Hodgkin's lymphoma.

Bridging the gap: the role of Physiatrists in caring for adults with cerebral palsy.

PURPOSE: Individuals with cerebral palsy (CP) experience a significant gap in care as they move from interdisciplinary pediatric programs to limited or non-existent care in the adult sector. A lack of knowledgeable adult care providers has repeatedly been identified as a challenge in transitioning those with CP from pediatric to adult care. The objective of this study was to determine the extent to which Physiatrists provide care to adults with CP and to identify barriers to their engagement with this population. METHOD: A survey was distributed to Physiatrists across Canada. Results were analyzed descriptively using SPSS software. RESULTS: Most Physiatrists provide care to very few adults with CP (10 or less), but over 80% feel that Physiatry is the most appropriate specialty to provide disability-related care to adults with CP following their pediatric discharge. Among the most frequently identified barriers to caring for this population were lack of accessible resources (i.e. social work, funded therapy, equipment) and lack of referrals. CONCLUSIONS: Physiatrists are willing and appropriate partners in transitioning patients with CP to adult care. Barriers to Physiatrists' engagement with this population appear to be amenable to change. IMPLICATIONS FOR REHABILITATION: A lack of knowledgeable and interested adult practitioners has repeatedly been identified as a challenge in transition planning for young adults with cerebral palsy (the vast majority of whom survive into adulthood). Physiatrists are ideally suited to manage adults with cerebral palsy, yet in this survey-based study, a majority of Canadian Physiatrists report caring for less than five adults with cerebral palsy on a regular basis. Barriers to further physiatric involvement in this population were reported to include lack of accessible resources and lack of referrals.

The next revolution in stroke care.

Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the burden of stroke have largely focused on prevention and acute care strategies. Despite considerable resources and attention, the focus on prevention and acute care has not been successful in changing the clinical trajectory for the majority of stroke patients. While efforts to prevent strokes will continue to have an impact, the total burden of stroke will increase due to the aging population and decreased mortality rates. There is strong evidence for the effectiveness of rehabilitation in better managing stroke and its related disabilities. The time has come to shift the attention in stroke care and research from prevention and cure to a greater focus and investment in the rehabilitation and quality of life of stroke survivors. The rebalancing of stroke care and research initiatives requires a reinvestment in rehabilitation and community reintegration of stroke survivors.

Happy and healthy only if occupied? Perceptions of health sciences students on occupation in later life.

BACKGROUND/AIM: In this study, we bring attention to the university education of health science students with respect to occupation in later life. Our goal was to provide descriptive data from narratives of a group of undergraduate students and initiate discussion about the place of occupation in the context of ageing to answer the following questions: (i) How young people perceive successful ageing in relation to occupation? and (ii) can spirituality-related activities be considered occupations in later life? METHODS: Based on a thematic selection, the quality of photographs and reflective narratives, 60 Photovoice assignments created by health sciences students were analysed using content analysis. RESULTS: The findings of this study indicate that students seem to neglect the benefits of 'being' through spiritual engagement, and instead emphasise the importance of 'doing', and perpetuate pervasive successful ageing discourses in Western societies. CONCLUSIONS: Occupational therapists have potential to take an active role in undergraduate health science education and to inform the development of holistic models that would include spirituality as an avenue to live late life to its fullest potential. Photovoice emerged as a powerful teaching method to increase awareness, empathy and compassion of young adults towards ageing.