Test volume data for 51 most commonly ordered laboratory tests in Calgary, Alberta, Canada.

Data presented in this article include the top 51 ordered laboratory tests in Calgary and surrounding area, Alberta, from January to December 2017. This data set was collected from Calgary Laboratory Service's Laboratory Information System, and included top 51 tests ordered from community (n = 11, 224, 330), inpatient (n = 2,340,594) and emergency (n = 1,670,062) settings. Test order mnemonic that were not true laboratory tests (eg: "extra PST tube", "extra tube", etc.) were excluded in the analysis. The top test ordered in all 3 test encounters was the complete blood count test (community encounter, n = 921, 873; inpatient setting, n = 357, 375; and emergency setting, n = 276, 954). This data article was submitted as a companion paper to the related research article, "Estimated costs of 51 commonly ordered laboratory tests in Canada" [1].

Pharmacological Management of Dementia with Lewy Bodies.

Dementia with Lewy bodies (DLB) is a complex disease that involves a variety of cognitive, behavioral and neurological symptoms, including progressive memory loss, visual hallucinations, parkinsonism, cognitive fluctuations and rapid eye movement sleep behavior disorder (RBD). These symptoms may appear in varying combinations and levels of severity in each patient who is seen in the clinic, making diagnosis and treatment a challenge. DLB is the third most common of all the neurodegenerative diseases behind both Alzheimer's disease and Parkinson's disease (PD). The median age of onset for DLB (76.3 years) is younger than that seen in PD dementia (81.4 years). New pathological studies have shown that most DLB patients have variable amounts of Alzheimer's changes in their brains, explaining the wide variability in this disease's clinical presentation and clinical course. This review discusses the three cholinesterase inhibitors that have been shown to be effective in managing the cognitive and behavioral symptoms of DLB: rivastigmine, galantamine and donepezil. Memantine is able to improve clinical global impression of change in those with mild to moderate DLB. Levodopa can treat the parkinsonism of some DLB patients, but the dose is often limited due to the fact that it can cause agitation or worsening of visual hallucinations. A recent phase 2 clinical trial showed the benefit of zonisamide when it is added as an adjunct to levodopa for treating DLB parkinsonism. While atypical antipsychotic drugs may not always be helpful as monotherapy in managing the agitation associated with DLB, low doses of valproic acid can be effective when added as an adjunct to drugs like quetiapine. Pimavanserin may prove to be a useful treatment for psychosis in DLB patients, but like other antipsychotic drugs that are used in dementia patients, there is a small increased risk of mortality. RBD, which is a common core clinical feature of DLB, can be managed with either melatonin or clonazepam. Two agents targeting alpha-synuclein (NPT200-11 and ambroxol) currently hold promise as disease-modifying therapies for DLB, but they are yet to be tested in clinical trials. An agent (E2027) that offers hope of neuroprotection by increasing central cyclic guanosine monophosphate (cGMP) levels is currently being examined in clinical trials in DLB patients.

Estimated costs of 51 commonly ordered laboratory tests in Canada.

INTRODUCTION: Test cost display has been shown to reduce inappropriate laboratory test ordering practices in the United States. Unfortunately, such a system is limited in the Canadian publically funded healthcare environment. Many Canadian physicians inaccurately estimate the cost of laboratory tests, which may contribute to mis-utilization. Here, we provide an estimated cost of over 50 commonly ordered laboratory tests in Canada as an educational tool for physicians. METHODS: Test volume data was collected from Calgary Laboratory Services' Laboratory Information System in order to determine which laboratory and diagnostic tests are most commonly ordered in Calgary and its surrounding area. Reference median cost (RMC) of fifty one commonly ordered test was calculated by determining the price list of all-inclusive indirect costs from six different clinical laboratories across Canada. RESULTS: Of the 51 laboratory tests included, the minimum RMC was $5 CAD (eg: albumin, calcium, urea), and the maximum RMC was $300 (surgical pathology report). CONCLUSIONS: A caveat to the provided list of test costs is that it is only an estimate and may differ from what each individual clinical laboratories charges to third parties or for research purposes. However, this list can serve as an educational tool and raise awareness for Canadian physicians on the relative costs of laboratory tests.

Sleep-Disordered Breathing and Cerebral Oxygenation During Sleep in Adults With Mild Cognitive Impairment.

The current study examined relationships between laterality in cerebral oxygenation (L-COX), sleep-disordered breathing (SDB), and daytime function in 16 adults with mild cognitive impairment (MCI). All participants underwent two nights of diagnostic polysomnography. Using dual-cerebral oximetry, L-COX was defined by differences ≥4% in right- versus left-sided percent cerebral oxyhemoglobin saturation. Eight patients had SDB. L-COX was found in five patients, but only on nights with SDB. Greater L-COX was associated more severe SDB: higher frequency of apneas + hypopneas per hour (r = 0.66, p < 0.01), desaturations per hour (r = 0.73, p < 0.01), and percent time with oxygen saturation <88% (r = 0.65, p < 0.01). Greater laterality, but not severity of SDB, was associated with poorer functional ability (Lawton Instrumental Activities of Daily Living Scale: r = -0.83, p = 0.02), lower cognitive function (Mini-Mental State Examination: r = -0.76, p = 0.03), and greater daytime sleepiness (Epworth Sleepiness Scale: r = 0.85, p < 0.001). L-COX associated with SDB suggests disruptions in cerebral autoregulation and need for aggressive treatment of SDB in individuals with MCI. [Res Gerontol Nurs. 2018; 11(6):282-292.].

Creating a comprehensive research strategy for cutaneous neurofibromas.

OBJECTIVE: Outside of procedural-based methods, there are currently no established medical treatments for cutaneous neurofibroma (cNF), which afflict up to 99% of patients with NF1. Further, adult patients often report cNF are the greatest burden of living with NF1. The Neurofibromatosis Therapeutic Acceleration Program (NTAP) launched a think tank to address core questions to facilitate development of effective therapeutics for cNF in people with NF1. METHODS: Experts (with and without explicit experience with NF1 or cNF) from multiple scientific and medical disciplines, representing the ranks of academia, industry, and government agencies, were invited to become a member of a team addressing a specific subset of questions pertinent to cNF. Teams met monthly to review published and unpublished materials, and created summaries about the material known and unknown that may influence therapeutic development for cNF. Teams prioritized questions and organized supporting data, which was presented to the entire body of experts by each team at a research summit. RESULTS: Four themes were identified as being relevant to creating a comprehensive research strategy for cNF: (1) establishing definitions of cNF, (2) determining the biology of cNF with respect to tumor initiation, progression, and maintenance, (3) outlining the factors that guide therapies development, and (4) defining core considerations for clinical trials design and optimization for cNF. CONCLUSION: Considerations and key questions for each of the thematic areas were identified and provided basis for a request for applications launched by NTAP focused on cNF and are described in the accompanying articles of this supplement.

Meta-analysis of Cigarette Smoking and Musculoskeletal Injuries in Military Training.

PURPOSE: Tobacco use is common among military personnel, as is musculoskeletal injury during training. In a review of the literature on musculoskeletal injuries, there was mixed evidence on the role of smoking as a risk factor. The purpose of this study is to review and analyze the literature on the impact of cigarette smoking on lower-extremity overuse injuries in military training. METHODS: We performed a literature search on articles published through October 2016. Search terms focused on lower-extremity overuse musculoskeletal injuries and cigarette smoking in military populations. We conducted a meta-analysis overall and by sex, including smoking intensity. RESULTS: We identified 129 potential studies and selected 18 based on quality. The overall rate ratio for smoking was 1.31, 1.31 for men, and 1.23 for women. Overall and for each sex, rate ratios were significantly greater than 1.0 for each intensity level of smoking. CONCLUSIONS: Smoking is a moderate risk factor for musculoskeletal injury and may account for a meaningful proportion of injuries among men and women due to the high prevalence of smoking and injury in this population. Although enlistees are not allowed to smoke during basic training, their risk of injury remains high, indicating that smokers may remain at increased risk for medium- to long-term duration.

Identification of Fall Prevention Strategies for the Military: A Review of the Literature.

UNLABELLED: In the U.S. Army, falls have historically been among the top five causes of hospitalization and a leading cause of nonbattle injuries in military operations overseas. OBJECTIVE: For safety and public health professionals, commanders, and supervisors looking to address this problem, a literature review was conducted to identify and summarize existing fall prevention strategies applicable to a working-age population. METHODS: A total of nine literature databases were searched for articles published from 1970 to 2011. Article titles and abstracts were screened to select original research with an injury or noninjury outcome. Intervention studies were reviewed in detail and quality scored by 3 public health scientists. RESULTS: The search identified over 2,200 articles. Of these, 525 met inclusion criteria and were reviewed in more detail, resulting in identification of 9 interventions. Nearly all of the identified interventions had been implemented in occupational environments. Study quality was rated and scores ranged from 4.5 to 8.0 (maximum 10 points). CONCLUSIONS: Few intervention studies were identified. Multifaceted programs showed the greatest promise for translation to military environments. Additional evaluation research is greatly needed to further efforts to address this leading military public health problem.

Managing migraine and other headache syndromes in those over 50.

Migraine in an older person may appear with sensory or motor phenomena ("late-life migraine accompaniments"), so that it may be confused with transient ischemic attack or stroke. An older patient may have cervicogenic headache in addition to migraine. Medication overuse headache is just as much of a problem in older patients as it is in younger ones. Abdominal migraine without headache can be seen in older adults as a migraine equivalent, just as it can occur in children. The most effective drugs for migraine prophylaxis in young people (divalproex, topiramate, metoprolol and propranolol) are similarly effective for those who are over the age of 50. Oral rescue drugs, including naproxen and hydroxyzine, are also useful in older adults. We need to remind older adults about the dangers of excessive use of caffeine in coffee, tea and energy drinks, since these substances can lead to daily HA and migraine equivalents.

Hope as a predictor of entering substance abuse treatment.

Identification of characteristics that predict entry into substance abuse treatment programs may facilitate efforts to make effective programs more attractive to people who could benefit from them. We examined dispositional hope as a predictor of entering a voluntary substance abuse treatment program for federal prison inmates. Controlling statistically for demographics, comorbid diagnoses, and drug-use history, increased hope was associated with lower probability of entering treatment. Discussion focused on the possibility that in the context of incarceration and substance abuse, high levels of hope may serve as a marker of excessive self-reliance and underestimation of the need for professional treatment.

The Hearing Aid Effect in African American and Caucasian Males as Perceived by Female Judges of the Same Race.

Prior studies have proven the existence of the "hearing aid effect" when photographs of Caucasian males and females wearing a body aid, a post-auricular aid (behind-the-ear), or no hearing aid were judged by lay persons and professionals. This study was performed to determine if African American and Caucasian males, judged by female members of their own race, were likely to be judged in a similar manner on the basis of appearance, personality, assertiveness, and achievement. Sixty female undergraduate education majors (30 African American; 30 Caucasian) used a semantic differential scale to rate slides of preteen African American and Caucasian males, with and without hearing aids. The results of this study showed that female African American and Caucasian judges rated males of their respective races differently. The hearing aid effect was predominant among the Caucasian judges across the dimensions of appearance, personality, assertiveness, and achievement. In contrast, the African American judges only exhibited a hearing aid effect on the appearance dimension.