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Background: many heart failure disease management programs are primarily conducted in the male population. An approach incorporating disciplines such as physiotherapy, occupational therapy, social work, dietary and pharmacy in a standardized clinical pathway merits further investigation in older women with HF. Methods: in this randomized controlled trial, female patients in the intervention group received the multidisciplinary clinical pathway consisting of a series of 12 visits over a 6-week period in an outpatient clinic. Results: ninety-one community dwelling female patients aged 63 to 89 were randomized. Comparison of change between the two groups from baseline in the Minnesota Living with Heart Failure Questionnaire score did not show a difference (P<0.470). There was also no difference between the two groups in functional outcome as measured by change from baseline by the Physical Self-Maintenance Scale (P<0.321). The treatment group had significantly more hospitalizations, and cardiologist visits during the study period (P < 0.0001). Conclusion: It is feasible to conduct a randomized study in a frail community-based older female population and to test a complex multidisciplinary pathway. Future studies should provide insight into the optimal intensity and duration of heart failure management programs with optimal targeting.

assessing the nature of insomnia by using an effective assessment tool and providing patients with a non-pharmacological treatment should be the first intervention for insomnia. It is shown that non-pharmacological treatments for primary and secondary insomnia are feasible and effective alternatives to the use of benzodiazepines, and that family physicians should consider these when managing older patients with insomnia.

BackgroundThere are many reasons to develop telemedicine clinics for assessment and management of dementia. Time constraints, location, and poor weather conditions can all impact on the ability of patients and providers to attend rural clinics. The utility of telemedicine in the diagnosis of dementia and subsequent follow-up appears promising in the literature, as it provides a viable means of assessing cognition in patients in remote areas with limited access to medical specialists.Methods & ResultsThis study explored the feasibility of introducing a telemedicine memory disorder follow-up clinic in a rural community. The evaluation of 32 clinic sessions found high levels of satisfaction, with over 90% of physicians and patients indicating that they’d be willing to use video conferencing again. Physicians overwhelmingly felt the sessions provided enough information to assist in clinical decision-making (96%), and patients and CCAC Case Managers/Geriatric Assessors felt able to present the same information by video conferencing as in person (92% for both groups). The telemedicine clinic provided a number of favourable results such as: timely access to specialist care in the patient’s own community; fewer cancelled clinics; enhanced care transitions between the follow-up clinic and primary care with the support of a case manager/geriatric assessor; and enhanced follow-up for a complex patient population. In addition, the telemedicine initiative freed up spaces for “in-person” clinics. This allowed them to focus on new patient assessments.ConclusionsThe high satisfaction rates amongst all key stakeholders affirm that telemedicine is a viable option and worth continued efforts at shaping and developing, particularly in regions where local physician specialists are a scare resource.

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The authors describe the results of a survey they carried out in 2000 to determine the status of cultural sensitivity training in 16 Canadian medical schools using structured telephone interviews of associate and assistant deans or curriculum directors and curriculum coordinators. Their goal was to obtain a descriptive analysis of school-specific objectives, curriculum content, methods, and evaluation formats. The survey was prompted by the growing concern that in culturally diverse societies, medical education has failed to keep pace with the changing composition of the patient population. Only one of the eight schools that integrated cultural sensitivity within their objectives made explicit mention of the topic in its clerkship evaluation form. While seven of the 16 schools did not have any statement on cultural sensitivity in their curricular objectives, they integrated cultural sensitivity in their curricula using various educational methods, with PBL cases, lectures, and small-group discussions being the commonest formats. These educational methods were primarily offered to students in their first and second years. Student participation was required, but program lengths ranged from two to 40 hours. Additional findings for each school are presented. The authors conclude that while progress has been made, lack of adequate resources and a number of obstacles to inclusion of multicultural health content in curricula appear to remain ongoing problems. Further investment in faculty development and administrative staff support for a multicultural curriculum are needed, as is more research on effective curricular components.

Oxidative stress is one of the pathological mechanisms responsible for the beta- amyloid cascade associated with Alzheimer's disease (AD). Previous studies have demonstrated the role of carnosic acid (CA), an effective antioxidant, in combating oxidative stress. A progressive cognitive decline is one of the hallmarks of AD. Thus, we attempted to determine whether the administration of CA protects against memory deficit caused by beta-amyloid toxicity in rats. Beta-amyloid (1–40) was injected by stereotaxic surgery into the Ca1 region of the hippocampus of rats in the Amyloid beta (Aβ) groups. CA was delivered intraperitoneally, before and after surgery in animals in the CA groups. Passive avoidance learning and spontaneous alternation behavior were evaluated using the shuttle box and the Y-maze, respectively. The degenerating hippocampal neurons were detected by fluoro-jade b staining. We observed that beta-amyloid (1–40) can induce neurodegeneration in the Ca1 region of the hippocampus by using fluoro-jade b staining. Also, the behavioral tests revealed that CA may recover the passive avoidance learning and spontaneous alternation behavior scores in the Aβ + CA group, in comparison with the Aβ group. We found that CA may ameliorate the spatial and learning memory deficits induced by the toxicity of beta-amyloid in the rat hippocampus.

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