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An interfaculty pain curriculum: lessons learned from six years experience.

https://arctichealth.org/en/permalink/ahliterature155295
Source
Pain. 2008 Nov 15;140(1):74-86
Publication Type
Article
Date
Nov-15-2008
Author
Judith Hunter
Judy Watt-Watson
Michael McGillion
Lalitha Raman-Wilms
Lynn Cockburn
Leila Lax
Jennifer Stinson
Andrea Cameron
Thuan Dao
Peter Pennefather
Martin Schreiber
Larry Librach
Tricia Kavanagh
Allan Gordon
Nora Cullen
David Mock
Michael Salter
Author Affiliation
Department of Physical Therapy, University of Toronto, Toronto, Ont., Canada. Judith.hunter@utoronto.ca
Source
Pain. 2008 Nov 15;140(1):74-86
Date
Nov-15-2008
Language
English
Publication Type
Article
Keywords
Curriculum - trends
Educational Measurement - methods
Faculty, Medical
Humans
Internship and Residency
Ontario
Pain - diagnosis
Pain Management
Professional Competence
Abstract
Minimal pain content has been documented in pre-licensure curricula and students lack important pain knowledge at graduation. To address this problem, we have implemented and evaluated a mandatory Interfaculty Pain Curriculum (IPC) yearly since 2002 for students (N=817 in 2007) from six Health Science Faculties/Departments. The 20-h pain curriculum continues to involve students from Dentistry, Medicine, Nursing, Pharmacy, Physical Therapy, and Occupational Therapy as part of their 2nd or 3rd year program. Evaluation methods based on Kirkpatrick's model now include evaluation of a Comprehensive Pain Management Plan along with the previously used Pain Knowledge and Beliefs Questionnaire (PKPQ) and Daily Content and Process Questionnaires (DCPQ). Important lessons have been learned and subsequent changes made in this iterative curriculum design based on extensive evaluation over the 6-year period. Modifications have included case development more relevant to the diverse student groups, learning contexts that are uni-, inter-, and multi-professional, and facilitator development in working with interprofessional student groups. PKBQ scores have improved in all years with a statistically significant average change on correct responses from 14% to 17%. The DCPQ responses have also indicated consistently that most students (85-95%) rated highly the patient panel, expert-lead clinically focused sessions, and small interprofessional groups. Relevancy and organization of the information presented have been generally rated highly from 80.3% to 91.2%. This curriculum continues to be a unique and valuable learning opportunity as we utilize lessons learned from extensive evaluation to move the pain agenda forward with pre-licensure health science students.
PubMed ID
18774226 View in PubMed
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Cannabis use amongst patients with inflammatory bowel disease.

https://arctichealth.org/en/permalink/ahliterature132644
Source
Eur J Gastroenterol Hepatol. 2011 Oct;23(10):891-6
Publication Type
Article
Date
Oct-2011
Author
Simon Lal
Neeraj Prasad
Manijeh Ryan
Sabrena Tangri
Mark S Silverberg
Allan Gordon
Hillary Steinhart
Author Affiliation
The IBD Clinic, Mount Sinai Hospital, Toronto, Ontario, Canada. simon.lal@srft.nhs.uk
Source
Eur J Gastroenterol Hepatol. 2011 Oct;23(10):891-6
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Adult
Cannabis - adverse effects
Colitis, Ulcerative - drug therapy - psychology
Complementary Therapies - utilization
Crohn Disease - drug therapy - psychology
Cross-Sectional Studies
Drug Utilization - statistics & numerical data
Female
Humans
Inflammatory Bowel Diseases - drug therapy - psychology
Male
Ontario
Phytotherapy - methods - utilization
Plant Extracts - therapeutic use
Quality of Life
Self Medication - statistics & numerical data
Abstract
Experimental evidence suggests the endogenous cannabinoid system may protect against colonic inflammation, leading to the possibility that activation of this system may have a therapeutic role in inflammatory bowel disease (IBD). Medicinal use of cannabis for chronic pain and other symptoms has been reported in a number of medical conditions. We aimed to evaluate cannabis use in patients with IBD.
One hundred patients with ulcerative colitis (UC) and 191 patients with Crohn's disease (CD) attending a tertiary-care outpatient clinic completed a questionnaire regarding current and previous cannabis use, socioeconomic factors, disease history and medication use, including complimentary alternative medicines. Quality of life was assessed using the short-inflammatory bowel disease questionnaire.
A comparable proportion of UC and CD patients reported lifetime [48/95 (51%) UC vs. 91/189 (48%) CD] or current [11/95 (12%) UC vs. 30/189 (16%) CD] cannabis use. Of lifetime users, 14/43 (33%) UC and 40/80 (50%) CD patients have used it to relieve IBD-related symptoms, including abdominal pain, diarrhoea and reduced appetite. Patients were more likely to use cannabis for symptom relief if they had a history of abdominal surgery [29/48 (60%) vs. 24/74 (32%); P=0.002], chronic analgesic use [29/41 (71%) vs. 25/81 (31%); P
PubMed ID
21795981 View in PubMed
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Community-based adaptation research in the Canadian Arctic.

https://arctichealth.org/en/permalink/ahliterature276482
Source
Wiley Interdiscip Rev Clim Change. 2016 Mar-Apr;7(2):175-191
Publication Type
Article
Date
2016
Bussalleu,9 Jahir Diaz,9 Kaitlyn Finner,1 Allan Gordon,4 Catherine Huet,1 Knut Kitching,1 Marie-Pierre Lardeau,1 Graham McDowell,1 Ellen McDonald,3 Lesya Nakoneczny1 and Mya Sherman1 Edited by Maria Carmen Lemos, Domain Editor, and Mike Hulme, Editor-in-Chief Community-based adaptation (CBA) has
  1 document  
Author
James D Ford
Ellie Stephenson
Ashlee Cunsolo Willox
Victoria Edge
Khosrow Farahbakhsh
Christopher Furgal
Sherilee Harper
Susan Chatwood
Ian Mauro
Tristan Pearce
Stephanie Austin
Anna Bunce
Alejandra Bussalleu
Jahir Diaz
Kaitlyn Finner
Allan Gordon
Catherine Huet
Knut Kitching
Marie-Pierre Lardeau
Graham McDowell
Ellen McDonald
Lesya Nakoneczny
Mya Sherman
Source
Wiley Interdiscip Rev Clim Change. 2016 Mar-Apr;7(2):175-191
Date
2016
Language
English
Geographic Location
Canada
Publication Type
Article
File Size
191611
Keywords
Arctic Regions
Climate change
Adaptation
Communities
Traditional knowledge
Abstract
Community-based adaptation (CBA) has emerged over the last decade as an approach to empowering communities to plan for and cope with the impacts of climate change. While such approaches have been widely advocated, few have critically examined the tensions and challenges that CBA brings. Responding to this gap, this article critically examines the use of CBA approaches with Inuit communities in Canada. We suggest that CBA holds significant promise to make adaptation research more democratic and responsive to local needs, providing a basis for developing locally appropriate adaptations based on local/indigenous and Western knowledge. Yet, we argue that CBA is not a panacea, and its common portrayal as such obscures its limitations, nuances, and challenges. Indeed, if uncritically adopted, CBA can potentially lead to maladaptation, may be inappropriate in some instances, can legitimize outside intervention and control, and may further marginalize communities. We identify responsibilities for researchers engaging in CBA work to manage these challenges, emphasizing the centrality of how knowledge is generated, the need for project flexibility and openness to change, and the importance of ensuring partnerships between researchers and communities are transparent. Researchers also need to be realistic about what CBA can achieve, and should not assume that research has a positive role to play in community adaptation just because it utilizes participatory approaches. WIREs Clim Change 2016, 7:175-191. doi: 10.1002/wcc.376 For further resources related to this article, please visit the WIREs website.
PubMed ID
27668014 View in PubMed
Documents
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Cost-effectiveness of pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia: a Canadian perspective.

https://arctichealth.org/en/permalink/ahliterature165729
Source
Clin Ther. 2006 Nov;28(11):1922-34
Publication Type
Article
Date
Nov-2006
Author
Jean-Eric Tarride
Allan Gordon
Montserrat Vera-Llonch
Ellen Dukes
Catherine Rousseau
Author Affiliation
Program for Assessment of Technology in Health, St Joseph's Healthcare, Hamilton, Ontario, Canada.
Source
Clin Ther. 2006 Nov;28(11):1922-34
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Amines - economics - therapeutic use
Analgesics - economics - therapeutic use
Canada
Clinical Trials as Topic
Costs and Cost Analysis
Cross-Sectional Studies
Cyclohexanecarboxylic Acids - economics - therapeutic use
Data Collection
Diabetic Neuropathies - drug therapy - economics
Female
Humans
Male
Models, Theoretical
Neuralgia, Postherpetic - drug therapy - economics
Predictive value of tests
Time Factors
gamma-Aminobutyric Acid - analogs & derivatives - economics - therapeutic use
Abstract
Neuropathic pain (NeP) is a chronic condition that occurs frequently with diabetes and herpes zoster infection. In addition to potentially lasting many years, the relationship between chronic pain, anxiety/depression, and sleep, also referred to as the triad of pain, causes functional impairment in many areas of life.
The aim of this study was to examine the 12-week cost-effectiveness of 2 treatments of NeP, pregabalin versus gabapentin, in managing diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN) in a Canadian setting.
A stochastic simulation model evaluating NeP treatment was adapted to the Canadian setting. Using data from clinical trials of pregabalin (150-600 mg/d) and gabapentin (900-3600 mg/d), the model simulated 12-week treatment outcomes for patients with DPN or PHN. Resource utilization was identified through an Internet-based survey among 80 Canadian physicians. Utility values (as measured using the EuroQol EQ-5D) were obtained from 126 NeP patients participating in a cross-sectional study conducted at Canadian primary care sites. The economic analysis was expressed as incremental cost per quality-adjusted life year (QALY) gained and as incremental cost per day with no or mild pain. Model sensitivity to changes in key parameters was assessed.
Following 12-week treatment, compared with gabapentin, pregabalin was projected to result in 6 and 9 additional days with no or mild pain for patients with DPN and PHN, respectively. Pregabalin therapy was estimated to provide an additional 0.0047 QALY and 0.0086 QALY over gabapentin administration, for DPN and PHN, respectively. Mean (SE) direct costs per DPN patient were estimated as 837.53 Can dollars (37.31 dollars) (2004 dollars) with gabapentin and 818.49 dollars (36.50 dollars) with pregabalin, and per PHN patient as 720.61 dollars (33.70 dollars) with gabapentin and 667.07 dollars (25.33 dollars) with pregabalin. Model findings were sensitive to variation in the dose and corresponding cost of the comparator, but not in other parameters.
Based on the results of this analysis, in the treatment of NeP associated with DPN or PHN, pregabalin was a dominant or cost-effective treatment strategy compared with gabapentin.
PubMed ID
17213013 View in PubMed
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Experience of methadone therapy in 100 consecutive chronic pain patients in a multidisciplinary pain center.

https://arctichealth.org/en/permalink/ahliterature156626
Source
Pain Med. 2008 Oct;9(7):786-94
Publication Type
Article
Date
Oct-2008
Author
Philip Peng
Paul Tumber
Michael Stafford
Doug Gourlay
Patrick Wong
Marilyn Galonski
David Evans
Allan Gordon
Author Affiliation
Wasser Pain Management Center, Mount Sinai Hospital, Toronto, Ontario, Canada. Philip.peng@uhn.on.ca
Source
Pain Med. 2008 Oct;9(7):786-94
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Ambulatory Care - statistics & numerical data
Analgesics, Opioid - administration & dosage
Canada - epidemiology
Chronic Disease
Female
Humans
Male
Methadone - therapeutic use
Middle Aged
Pain - diagnosis - drug therapy - epidemiology
Pain Clinics
Pain Measurement - drug effects
Prevalence
Treatment Outcome
Abstract
The objective of the study was to describe the experience of methadone use in 100 consecutive chronic pain patients managed in a single multidisciplinary center.
A chart review of chronic pain patients on methadone therapy initiated at the Wasser Pain Management Center from January 2001 to June 2004. SETTING, PATIENTS, AND INTERVENTION: Outpatients receiving methadone for chronic pain management in a tertiary multidisciplinary pain center.
Effects on pain relief and function, conversion ratio from other opioids, side effects, and disposition were reviewed.
Charts of 100 methadone patients (age 45 +/- 11 years old; M/F: 3/7; duration of pain 129 +/- 110 months) managed by five physicians and one nurse were reviewed. The main reason for the initiation of methadone therapy was opioid rotation (72%). The average oral morphine equivalent dose was 77 mg/day before methadone therapy, and the methadone dose after initial stabilization was 42 mg with no consistent conversion ratio observed. The mean duration of methadone therapy was 11 months. Most of the patients (91%) were taking concomitant adjuvant analgesics or psychotropic agents, mostly antidepressants and anticonvulsants. The average Numeric Verbal Rating Score before and after methadone treatment was 7.2 +/- 1.7 and 5.2 +/- 2.5 (P
PubMed ID
18564997 View in PubMed
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The index herd with PMWS in Sweden: presence of serum amyloid A, circovirus 2 viral load and antibody levels in healthy and PMWS-affected pigs.

https://arctichealth.org/en/permalink/ahliterature89516
Source
Acta Vet Scand. 2009;51:13
Publication Type
Article
Date
2009
Author
Wallgren Per
Brunborg Inger Marit
Blomqvist Gunilla
Bergström Gunnar
Wikström Frida
Allan Gordon
Fossum Caroline
Jonassen Christine Monceyron
Author Affiliation
National Veterinary Institute, SVA, 751 89 Uppsala, Sweden. Per.Wallgren@sva.se
Source
Acta Vet Scand. 2009;51:13
Date
2009
Language
English
Publication Type
Article
Keywords
Animals
Antibodies, Viral - blood
Circoviridae Infections - epidemiology - immunology - veterinary - virology
Circovirus - immunology
DNA, Viral - blood
Disease Outbreaks - veterinary
Male
Porcine Postweaning Multisystemic Wasting Syndrome - blood - epidemiology - immunology - virology
Serum Amyloid A Protein - metabolism
Sweden - epidemiology
Swine
Abstract
BACKGROUND: Postweaning Multisystemic Wasting Syndrome (PMWS) is an emerging disease in pigs of multifactorial origin, but associated to porcine circovirus type 2 (PCV2) infection. PMWS was first diagnosed in Sweden at a progeny test station that received pigs aged five weeks from 19 different nucleus herds on the day after weaning. The objective of this study was to examine, for the first time in an index outbreak of PMWS, the relationship between PCV2 virus, antibodies to PCV2 and serum amyloid a (SAA) in sequentially collected serum samples from pigs with and without signs of PMWS. METHODS: Forty pigs of the last batch that entered the station at a mean age of 37.5 days were monitored for signs of PMWS during the first 55 days after arrival. Serum was collected on six occasions and analysed for presence of PCV2 DNA and antibodies to PCV2, as well as for levels of SAA. RESULTS: Four of the pigs (10%) were concluded to have developed PMWS, with necropsy confirmation in three of them. These pigs displayed low levels of maternal antibodies to PCV2, more than 107 PCV2 viral DNA copies per ml serum and failed to mount a serological response to the virus. Starting between day 23 and 34 after arrival, an increase in PCV2 viral load was seen in all pigs, but PCV2 did not induce any SAA-response. Pigs that remained healthy seroconverted to PCV2 as the viral load was increased, regardless of initially having low or high levels of PCV2-antibodies. CONCLUSION: In this index case of PMWS in Sweden, pigs affected by PMWS were not able to mount a relevant serum antibody response which contributed to the disease progression. The maximal PCV2 virus load was significantly higher and was also detected at an earlier stage in PMWS-affected pigs than in healthy pigs. However, a viral load above 107 PCV2 DNA copies per ml serum was also recorded in 18 out of 34 pigs without any clinical signs of PMWS, suggesting that these pigs were able to initiate a protective immune response to PCV2.
PubMed ID
19327135 View in PubMed
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Phylogenetic analysis of porcine circovirus type 2 (PCV2) pre- and post-epizootic postweaning multisystemic wasting syndrome (PMWS).

https://arctichealth.org/en/permalink/ahliterature93441
Source
Virus Genes. 2008 Jun;36(3):509-20
Publication Type
Article
Date
Jun-2008
Author
Timmusk Sirje
Wallgren Per
Brunborg Inger Marit
Wikström Frida Hasslung
Allan Gordon
Meehan Brian
McMenamy Michael
McNeilly Francis
Fuxler Lisbeth
Belák Katinka
Põdersoo Diivi
Saar Tiiu
Berg Mikael
Fossum Caroline
Author Affiliation
Department of Biomedical Sciences and Veterinary Public Health, Section of Immunology, Biomedical Centre, Swedish University of Agricultural Sciences (SLU), P.O. Box 588, 751 23 Uppsala, Sweden. Sirje.Timmusk@bvf.slu.se
Source
Virus Genes. 2008 Jun;36(3):509-20
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Amino Acid Sequence
Animals
Circoviridae Infections - pathology - veterinary - virology
Europe
Female
Genotype
Male
Molecular Sequence Data
Open Reading Frames
Parvovirus, Porcine - classification - genetics - isolation & purification
Phylogeny
Porcine Postweaning Multisystemic Wasting Syndrome - pathology - virology
Sequence Alignment
Sequence Analysis
Swine
Viral Proteins - chemistry - genetics
Abstract
The porcine circovirus type 2 (PCV2) genome encodes three major open reading frames (ORFs) encoding the replicase proteins (ORF1), the viral capsid protein (ORF2), and a protein with suggested apoptotic activity (ORF3). Previous phylogenetic analyses of complete genome sequences of PCV2 from GenBank have demonstrated 95-100% intra-group nucleotide sequence identity. However, although these isolates were readily grouped into clusters and clades, there was no correlation between the occurrence of specific PCV2 genotypes and the geographic origin or health status of the pig. In the present study, a unique dataset from a field study spanning the years pre and post the recognition of postweaning multisystemic wasting syndrome (PMWS) in Sweden was utilized. Using this dataset it was possible to discriminate three Swedish genogroups (SG1-3) of PCV2, of which SG1 was recovered from a pig on a healthy farm ten years before the first diagnosis of PMWS in Sweden. The SG1 PCV2/ORF2 gene sequence has been demonstrated to exhibit a high genetic stability over time and has subsequently only been demonstrated in samples from pigs on nondiseased farms. In contrast, SG2 was almost exclusively found on farms that had only recently broken down with PMWS whereas the SG3 genogroup predominated in pigs from PMWS-affected farms. These results further support the results obtained from earlier in vitro and in vivo experimental models and suggest the association of specific PCV2 genogroups with diseased and nondiseased pigs in the field.
PubMed ID
18343985 View in PubMed
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Understanding the information and service needs of young adults with chronic pain: perspectives of young adults and their providers.

https://arctichealth.org/en/permalink/ahliterature117173
Source
Clin J Pain. 2013 Jul;29(7):600-12
Publication Type
Article
Date
Jul-2013
Author
Jennifer Stinson
Meghan White
Lisa Isaac
Fiona Campbell
Stephen Brown
Danielle Ruskin
Allan Gordon
Marilyn Galonski
Leah Pink
Norman Buckley
James L Henry
Chitra Lalloo
Allia Karim
Author Affiliation
Department of Anesthesia and Pain, The Hospital for Sick Children, Toronto, Canada. jennifer.stinson@sickkids.ca
Source
Clin J Pain. 2013 Jul;29(7):600-12
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Attitude to Health
Chronic Pain - diagnosis - epidemiology - therapy
Female
Health Literacy - utilization
Health Personnel - statistics & numerical data
Humans
Male
Needs Assessment - statistics & numerical data
Ontario - epidemiology
Patient Education as Topic - statistics & numerical data
Young Adult
Abstract
To qualitatively explore the information and service needs of young adults (YAs) with chronic pain to inform the development of a web-based chronic pain self-management program.
A convenience sample of YAs (n=17; aged 18 to 29 y) with chronic pain was recruited from 2 adult tertiary care multidisciplinary chronic pain clinics in Ontario. Interdisciplinary health care professionals who had worked in chronic pain for at least 1 year were also recruited from these sites. Five audiotaped focus groups were conducted, 3 for YAs and 2 for health care professionals. Transcribed data were organized into categories that reflected emerging themes.
Findings uncovered 4 major themes: (1) pain impact, (2) pain management strategies, (3) barriers to care, and (4) service delivery recommendations. Subthemes were found under each major theme. Pain had an impact on social and emotional realms and role functioning, physical functioning, and future vocational and life goals. Pain management strategies were comprised of psychological, physical, and pharmacological approaches and development of support systems. Barriers to care were revealed at the patient, health care system, and societal levels. Finally, service delivery recommendations were divided into 2 subthemes pertaining to improved services and Internet-based programs.
Participants unanimously felt that a web-based program would be an acceptable means to help improve access to services and meet the need for more information about chronic pain, strategies to manage pain symptoms, and social support to address the unique developmental needs of YAs.
PubMed ID
23328333 View in PubMed
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