In the blind cave-dwelling morph of A. mexicanus, the eye degenerates while other sensory systems, such as gustation, are expanded compared to their sighted (surface-dwelling) ancestor. This study compares the development of taste buds along the jaws of each morph. To determine whether cavefish have an altered onset or rate of taste bud development, we fluorescently labeled basal and receptor cells within taste buds over a developmental series. Our results show that taste bud number increases during development in both morphs. The rate of development is, however, accelerated in cavefish; a small difference in taste bud number exists at 5 dpf reaching threefold by 22 dpf. The expansion of taste buds in cavefish is, therefore, detectable after the onset of eye degeneration. This study provides important insights into the timing of taste bud expansion in cavefish as well as enhances our understanding of taste bud development in teleosts in general. Developmental Dynamics 238:3056-3064,
Introduction: Care by Design™ (CBD) (Canada), a model of coordinated team-based primary care, was implemented in long-term care facilities (LTCFs) in Halifax, Nova Scotia, Canada, to improve access to and continuity of primary care and to reduce high rates of transfers to emergency departments (EDs).Methods: This was an observational time series before and after the implementation of CBD (Canada). Participants are LTCF residents with 911 Emergency Health Services calls from 10 LTCFs, representing 1424 beds. Data were abstracted from LTCF charts and Emergency Health Services databases. The primary outcome was ambulance transports from LTCFs to EDs. Secondary outcomes included access (primary care physician notes in charts) and continuity (physician numbers and contacts).Results: After implementation of CBD (Canada), transports from LTCFs to EDs were reduced by 36%, from 68 to 44 per month (P ؍ .01). Relational and informational continuity of care improved with resident charts with >10 physician notes, increasing 38% before CBD to 55% after CBD (P ؍ .003), and the median number of chart notes increased from 7 to 10 (P ؍ .0026). Physicians contacted before 911 calls and onsite assessment increased from 38% to 54% (P ؍ .01) and 3.7% to 9.2% (P ؍ .03), respectively, before CBD to after CBD. Conclusion: A 34% reduction in overall transports from LTCFs to EDs is likely attributable to im-
BackgroundMost older adults living in long-term care facilities (LTCF) are frail and have complex care needs. Holistic understanding of residents’ health status is key to providing good care. Comprehensive Geriatric Assessment (CGA) is a valid assessment method which aims to embrace complexity. Here we aimed to study a CGA that has been modified for use in long-term care (the LTC-CGA) and to investigate its acceptability and usefulness to stakeholders and users.MethodsThis mixed methods study, conducted in 10 LTCFs in Halifax, Nova Scotia, reviewed 598 resident charts from pre- and post-implementation of the LTC-CGA. Qualitative methods explored stakeholder perspectives (physicians, nurses, paramedics, administrators, residents and families) though focus groups.ResultsThe LTC-CGA was present in 78% of LTCF charts in the post -implementation, period though it did not appear in acute care charts of transferred residents, despite the intention that it accompany residents between care sites. Some items had suboptimal completion rates (e.g., Advance Directives at 56.4%), though these were located in other sections of the LTCF chart (98.2%). Nevertheless, qualitative findings suggest the LTC-CGA describes a clinical baseline health status which enabled timely and informed clinical decision-making.ConclusionsThe LTC-CGA is a useful resource whose full capacity may not yet have been realized.
Polypharmacy was the norm of this sample of LTCF residents. Implementation of coordinated care through the CBD model was associated with a small decrease in polypharmacy but not overall use of PIMs. Further targeted efforts are required to substantially reduce both polypharmacy and PIMs in clinical practice.
Purpose: We compared practice of extended role practitioners and experienced therapists without extended practice training to determine differences in assessment and management of clients with inflammatory arthritis, in preparation for a randomized controlled trial. Methods: Retrospective review of randomly selected charts of extended-role trained occupational therapists or physiotherapists and from experienced therapists matched on therapist discipline, geographical location, and time of referral. Three trained reviewers used standardized forms to extract data independently. Results: We reviewed 58 charts of adult clients with inflammatory arthritis. Compared with experienced therapists, extended-role practitioners were more likely to receive referrals specifically for assessments (52% vs. 14%); to treat clients with undifferentiated arthritis (48% vs. 10%); to document comorbidities (90% vs. 66%); to advocate on behalf of the client with the client's family, physician, or specialist (52% vs. 21%); to recommend or provide exercise or physical activity (86% vs. 62%); to educate clients about pain management (41% vs. 28%), energy conservation (24% vs. 14%), and posture (21% vs. 7%); to recommend splints (41% vs. 31%); and to refer for or recommend radiologic or laboratory assessments (14% vs. 3%). Experienced therapists were more likely to provide education about joint protection (41% vs. 31%), community resources (31% vs. 7%), and assistive devices (45% vs. 21%). Conclusions: We identified possible differences in practice between extended-role practitioners and experienced therapists without training for extended practice. Capturing these details in future studies evaluating the efficacy of extended role practitioner interventions will be important.Key Words: arthritis; health manpower; education; professional; role; occupational therapy. RÉ SUMÉObjectif : Comparer la pratique des ergothé rapeutes et des physiothé rapeutes à responsabilité s é tendues à celle de thé rapeutes d'expé rience sans formation pour assumer des responsabilité s é tendues (les « thé rapeutes d'expé rience ») en vue d'é tablir les diffé rences dans l'é valuation et la gestion de clients aux prises avec de l'arthrite inflammatoire, en vue d'une é tude randomisé e contrô lé e. Mé thode : Examen ré trospectif de dossiers choisis au hasard provenant d'ergothé rapeutes et de physiothé rapeutes d'expé rience à responsabilité s é tendues et de dossiers de thé rapeutes d'expé rience, jumelé s en fonction de la discipline, de l'emplacement gé ographique et du moment où les patients ont é té dirigé s vers ces professionnels. Trois ré viseurs formé s à cet effet ont utilisé des formulaires normalisé s pour l'extraction indé pendante des donné es. 434From *The Arthritis Society, Toronto, Ont.; †Department
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