SUMMARYPurpose: Evidence from the pediatric population exists for the efficacy of ketogenic diets in reducing seizure frequency in patients with intractable epilepsy. Recent evidence suggests that a Modified Atkins Diet may be a beneficial form of cotherapy for adult patients with pharmacoresistant epilepsy. Methods: A prospective, open-label study was performed of adults >18 years of age with pharmacoresistant epilepsy. Carbohydrates were restricted to 20 g/day. Fluids and calories from protein and fat were allowed ad libitum. Key Findings: Eighteen patients, ages 18-55 years, were initially enrolled. Using an intent-to-treat analysis, 12% had a >50% seizure reduction after 3 months; 28% after 6 months, and 21% after 12 months. Response at 3 months predicted response at 12 months in 79% of patients. The mean decrease in weight was 10.9 kg and the mean decrease in body mass index (BMI) was 3.8, p = 0.01. Fourteen of 18 patients (78%) completed 12 months of this diet. Patients experienced a decrease in triglycerides from (mean) 1.22 to 0.9 mM (p = 0.02). Significance: The Modified Atkins Diet demonstrates modest efficacy as cotherapy for some adults with pharmacoresistant epilepsy and may be also helpful for weight loss. Financial and logistical barriers were significant factors for those who declined enrollment and for those who discontinued the study.
The proportion of patients meeting clinical practice guidelines compares favorably to similar studies. In some cases, patients' clinical conditions or unit HOB angle protocol explained not meeting guidelines. However, there were cases where reasons for not meeting guidelines were unknown.
Technology Evaluation in the Elderly Network (TVN) was funded in July 2012 under the Canadian Networks of Centres of Excellence (NCE) program, to develop, rigorously evaluate, and ethically disseminate information about the use of technologies for the care of seriously ill elderly patients and their families. TVN's vision is to position Canada as a global leader in providing the highest quality of care for its aging population. The focus is on the frail elderly with multiple chronic conditions, across all settings of care. As part of the NCE's mandate and TVN's strategic priorities and mission, we have developed a unique Interdisciplinary Training Program designed to promote and facilitate interdisciplinary learning by providing experiential and entrepreneurial opportunities. The goal is to develop Highly Qualified Personnel (HQP) with disciplinary, interdisciplinary, and transdisciplinary skills, experiences, and attitudes necessary to provide creative solutions to the complex and multi-faceted issues confronting the seriously ill, frail elderly. The TVN Interdisciplinary Training Program is based on an experiential learning approach that crosses health sciences, law, social sciences, and ethical aspects of working with the frail elderly. The program provides trainees with unique educational experiences that deepen appreciation for holistic care, increase exposure to interdisciplinary research through knowledge creation and translation projects, and advance intellectual and professional development.The goals for the TVN Interdisciplinary Training Program align with the NCE training mandate, which is to: 1) create a collaborative, multidisciplinary training program to develop HQP, 2) improve trainee's viability for future employment, and 3) provide support to trainees to facilitate their success. The training program was launched in Summer 2013. We currently have over 120 HQP in approximately 23 different disciplines-including law, ethics, public policy, social work, engineering, and other disciplineswith an interest in improving care for the frail elderly participating in our training program. These individuals may be undergraduates, graduates, postdoctoral fellows, or working professionals. The program emphasizes the acquisition and application of knowledge and skills across all of its components. HQPs work in teams of four to identify and develop an online collaborative project. Online collaborative projects facilitate interprofessional collaboration through multi-sectoral and multi-disciplinary learning by enabling interactions. They also participate in at least one, and up to two, external placements in a sector and/or discipline in which they have not been previously engaged, with reports or projects required at completion. Under the direction of their supervisors and mentors, students complete at least two academic products involving knowledge mobilization efforts. Mentorship is another component of the training program whereby HQPs meet with interdisciplinary mentors, patients and their families and supp...
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